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The Government of India has developed specific guidelines for the empanelment of hospitals under the Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) which mandates a physical verification of hospital at the time of empanelment. As per empanelment guidelines, public hospitals with inpatient services are deemed empanelled.
National Health Authority (NHA) has launched an improved version of the Hospital Engagement Module (HEM 2.0) which mandates physical verification for private hospitals, including the submission of original photographs, latitude-longitude details of the hospital along with the physical verifier which ensures that the visit has taken place. Further, HEM 2.0 has also introduced a feature that allows for periodic reviews to ensure that hospital information remains accurate.
As per the terms and conditions of empanelment, hospitals are mandated to provide the services to eligible beneficiaries under AB-PMJAY. In case services under the scheme are not provided by the empanelled hospital, beneficiaries can lodge grievances. Under AB-PMJAY, a three-tier grievance redressal system at District, State and National level has been created to resolve the issues faced by beneficiaries in utilizing healthcare services. At each level, there is a dedicated nodal officer and Grievance Redressal Committees to address the grievances.
Beneficiaries can also file their grievance using different mediums including web-based portal Centralized Grievance Redressal Management System (CGRMS), Central & State call centers (14,555), email, letter to SHAs etc. Based on the nature of grievance, necessary action, including providing support to the beneficiaries in availing treatment under the scheme, for resolution of grievances is taken.
Further, in appropriate cases, provisions for taking stringent action (such as de-empanelment, levying penalty on errant hospitals, suspension, issuance of warning letter, lodging of FIRs) are available to the State Health Authorities against fraudulent entities.
The Union Minister of State for Health and Family Welfare, Shri Prataprao Jadhav stated this in a written reply in the Rajya Sabha yesterday.
