Ayushman Bharat PM-JAY is a flagship scheme of Government of India was launched on 23rd September 2018 by the Hon’ble Prime Minister Shri Narendra Modi on pan India basis to achieve the vision of Universal Health Coverage (UHC). Ayushman Bharat PM-JAY, aims at providing health benefit cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalization on cashless family floater basis. There is no cap on the family size under the scheme. PM-JAY has been rolled out for the bottom 40% of poor and vulnerable population. The households included are based on the deprivation and occupational criteria of Socio-Economic Caste Census 2011 (SECC 2011) for rural and urban areas respectively. PM-JAY is completely funded by the Government, and cost of implementation is shared between Central and State Governments.

Outline of KASP

Govt of Kerala decided to converge all the Government sponsored health care schemes namely RSBY, Comprehensive Health Insurance Scheme-CHIS, Senior Citizen Health Insurance Scheme-SCHIS and Karunya Benevolent Fund-KBF along with Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY) and formulated Karunya Arogya Suraksha Padhathi (KASP). From 1st July 2020, the scheme was implemented directly by Government of Kerala under trust mode (through the newly constituted State Health Agency (SHA). The claims of Public and Private Empaneled Health care Providers (EHCPs) is serviced by a TPA/ISA.

Quality Initiatives under AB – PMJAY

As part of encouraging Hospitals to improve the quality of services, AB-PMJAY is already providing the following incentives to EHCPs Sl. No. Criteria Incentive over and above the package rates 1. Entry Level NABH Accreditation 10% 2. Full NABH Accreditation 15%

AB PMJAY has also developed its own quality standards.

AB-PMJAY Quality Certification programme is a joint initiative by National Health Authority (NHA) and Quality Council of India (QCI) with a vision to strengthen the healthcare ecosystem and benchmark the empanelled hospitals on the quality parameters.

The certification programme is a three-tier system as below:

1. Gold Quality Certification

2. Silver Quality Certification

3. Bronze Quality Certification

Kerala is the first state to have this workshop conducted in association with NHA, GIZ and QCI. A state level workshop was organised on 31 Oct 2022. This workshop was intended to orient the State Health Agency (SHA) and District Project Coordinators (DPC) regarding the process and challenges faced in Quality accreditations.

Following the state workshop, 3 Zonal Workshops (one each in Thiruvananthapuram, Ernakulam and Kozhikode) was held between 1-4 Nov 2022, where in selected EHCPs participated.