Citing that cataract surgeries and sterilisation procedures are covered under existing national programmes, an expert panel has suggested removing these from the list of services under the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana. The panel headed by Niti Aayog member Vinod K Paul has also recommended constituting a separate committee to ensure there is no overlapping of services provided under the AB-PMJAY and creating a mechanism to check duplication.
A final decision over removing cataract surgeries and sterilisation procedures -- vasectomy and tubectomy -- is yet to be taken. "According to the panel, procedures or ailments which are already covered in existing national programmes, should be removed from the list of packages offered under the insurance (scheme) to check duplication or any kind of fraud.
"During a review, we suspected double dipping as we found that same names figured on the lists of patients treated under national programmes and those applying to avail treatment under the AB-PMJAY (Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana)," a government official said. Cataract operations, which figured in the list of claims under the insurance scheme, are already funded under the centrally-sponsored National Programme for Control of Blindness and Visual Impairment, while vasectomy and tubectomy are covered under Family Planning programmes.
The National Health Authority, the apex body implementing the AB-PMJAY, has also revised prices of 1,392 medical packages reimbursed under the scheme to make them more "rational in terms of terminology, administration and prices", a source said. Besides, cancer care has also been upgraded and reimbursement would be based on the drug regime and not on the type of cancer.
The revised prices of packages is likely to be announced on September 23, when the AB-PMJAY completes a year, according to sources. Free-of-cost treatment under the government's flagship AB-PMJAY has helped more than 39 lakh people save Rs 12,000 crore since its launch in September 23 last year.
Currently, more than 18,000 hospitals have been empanelled under the PM-JAY or are in the process . Several events are being planned across the country to commemorate the first anniversary of its launch and September 23 will be celebrated as 'Ayushman Bharat Diwas' to generate awareness about the scheme. PTI PLB
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