Srinagar, Mar 14: The State Health Agency, Jammu and Kashmir on Friday finalised its decision to reserve four surgical procedures exclusively for public hospitals under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY), thereby excluding them from private healthcare facilities.
The new policy, which will come into effect from March 15, 2025, has come in pursuance to the decisions taken in the 8th & 9th Governing Council meeting of the State Health Agency.
“It has been decided to implement significant changes in the Health Benefit Packages (HBP) 2.2 across all empanelled public and private hospitals in the UT of J&K. These changes shall come into effect from March 15, 2025,” the SHA, J&K said in an order issued today.
The certain procedures that have been exclusively reserved for public hospitals include Appendectomy, Cholecystectomy, Hemorrhoidectomy and Fissure in Ano barring private hospitals from offering them under ‘Golden Card,’ the insurance coverage mechanism of the Ayushman Bharat Pradhan Mantri Mantri Jan Arogya Yojana (AB-PMJAY).
The order said the 10 per cent additional package price that were previously applied to private hospitals under HBP 2.2 shall no longer be applicable and all packages for private hospitals will be standardised as per the base rates under HBP 2.2.
Under the revised package rates for different hospital categories, it said for Sub-District Hospitals (SDH)/Community Health Centres (CHCs) the package rates shall be set at 65 percent of the HBP 2.2 rates.
Similarly, for District Hospitals, Government Medical Colleges (GMCs), and Private Hospitals, the package rates shall remain at 100 percent of HBP 2.2 rates.
As per order, all hospital administrators are mandated to comply with these changes and ensure their effective execution from 15th March 2025 and also take necessary steps for the immediate implementation of these changes and ensure seamless transition.
There was no immediate reaction from the private hospitals on the government move. Earlier, private hospitals in J&K empanelled under the AB-PMJAY scheme had expressed concern over the government’s move to exclude the four surgical procedures.
On March 03, the High Court of Jammu and Kashmir and Ladakh directed Health and Medical Education Department to consider allowing four surgical procedures in private hospitals, which were initially proposed to be reserved for public hospitals under PMJAY.
Earlier, various empaneled private hospitals, diagnostic centers, and dialysis centers sought directions from High Court for the respondents for the extension of National Health Packages mentioned in the Office Memorandum dated April 6, 2022, under the AB-PMJAY Health Benefit Package Master 2022 in J&K.
The petitioners had requested an amendment to the “Request for Proposal” for selecting an insurance company for implementing Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and Ayushman Bharat PMJAY-SEHAT in the Union Territory.
