The Mukhya Mantri State Health Care Scheme (MMSHCS) provides health insurance coverage to populations in Himachal Pradesh not covered under other schemes. It covers 9 categories including senior citizens, widows, anganwadi workers, disabled people, and contractual/daily wage government employees. Benefits include annual coverage of Rs. 30,000 per family for hospitalization and Rs. 1,75,000 for certain major procedures. The scheme is funded entirely by the state government and utilizes existing RSBY software and smart cards to reduce costs.
The document discusses the Accredited Social Health Activist (ASHA) program in India. It provides details about:
1) ASHAs are community health workers selected by villages to serve as a liaison between the community and the public health system.
2) They promote health awareness, community participation, and act as agents of change on health practices.
3) ASHAs undergo initial and continuing training, and are supported by structures at state, district, block and PHC levels to monitor performance and ensure timely payments.
RSBY is India's health insurance scheme that provides coverage for hospitalization costs to low-income informal sector workers. Over 120 million people are enrolled, with over 5 million hospitalization cases covered to date. While progress has been made in expanding coverage and improving access to care, challenges remain in strengthening implementation systems, ensuring quality of care, preventing fraud, and using the program to build universal healthcare coverage. Next steps include piloting outpatient benefits, expanding coverage to other vulnerable groups, and leveraging the smart card platform to deliver other social services to the poor.
Mr Anil Swarup Dir General, Ministry of Labour & Development, Govt of India presented on the biggest health insurance scheme (RSBY) run by the government at a seminar hosted by CIRM in Chennai, India
Rajbhra Medicare Pvt Ltd proposes outsourcing the operations of community health centers and district hospitals in remote areas of Himachal Pradesh on a revenue sharing basis. They have experience successfully managing rural hospitals in other states. They will take over management, recruit staff, upgrade facilities to meet IPHS standards, implement IT systems and provide services 24/7 to transform rural healthcare delivery. In return, the government would provide capital grants and an operating grant structured as a fixed amount plus a share of any revenue generated, with the shares adjusted over time to incentivize increased revenues that cover costs. Strict monitoring will ensure targets are met.
Rashtriya Swasthya Bima Yojana – Performance Trends and Policy RecommendationsCIRM
India is characterized by modest health indicators, a paucity of medical financing schemes that have reached scale, high per capita out-of-pocket health expenditure, and very low public health spending on low-income citizens. The lack of financing options especially when the population is facing a double burden of disease (frequent communicable and catastrophic lifestyle diseases) leads to poor health outcomes and to poverty traps. Hence, optimal public health financing is important for improving national health outcomes and reducing vulnerability.
The Rashtriya Swasthya Bima Yojana (RSBY) is an Indian government-run health insurance scheme that provides health insurance coverage to below poverty line (BPL) families. It covers over 34 million BPL families. The scheme aims to address issues with previous government health insurance schemes by learning from their successes and failures. Key features include providing portability across India, using biometric smart cards for cashless access to public and private hospitals, and incentivizing various stakeholders like insurers, hospitals, and intermediaries. However, there remains a large gap between the number of registered beneficiaries and actual hospitalizations, and there are also issues with awareness, coordination, and implementation.
The document provides details about the Medicare and Medicaid EHR Incentive Program for eligible professionals. It covers who is eligible to participate, including specific provider types for each program. It discusses the incentive payment amounts for both programs over multiple years. It also outlines the meaningful use requirements including objectives and clinical quality measures that must be met to receive incentive payments.
The document discusses the Accredited Social Health Activist (ASHA) program in India. It provides details about:
1) ASHAs are community health workers selected by villages to serve as a liaison between the community and the public health system.
2) They promote health awareness, community participation, and act as agents of change on health practices.
3) ASHAs undergo initial and continuing training, and are supported by structures at state, district, block and PHC levels to monitor performance and ensure timely payments.
RSBY is India's health insurance scheme that provides coverage for hospitalization costs to low-income informal sector workers. Over 120 million people are enrolled, with over 5 million hospitalization cases covered to date. While progress has been made in expanding coverage and improving access to care, challenges remain in strengthening implementation systems, ensuring quality of care, preventing fraud, and using the program to build universal healthcare coverage. Next steps include piloting outpatient benefits, expanding coverage to other vulnerable groups, and leveraging the smart card platform to deliver other social services to the poor.
Mr Anil Swarup Dir General, Ministry of Labour & Development, Govt of India presented on the biggest health insurance scheme (RSBY) run by the government at a seminar hosted by CIRM in Chennai, India
Rajbhra Medicare Pvt Ltd proposes outsourcing the operations of community health centers and district hospitals in remote areas of Himachal Pradesh on a revenue sharing basis. They have experience successfully managing rural hospitals in other states. They will take over management, recruit staff, upgrade facilities to meet IPHS standards, implement IT systems and provide services 24/7 to transform rural healthcare delivery. In return, the government would provide capital grants and an operating grant structured as a fixed amount plus a share of any revenue generated, with the shares adjusted over time to incentivize increased revenues that cover costs. Strict monitoring will ensure targets are met.
Rashtriya Swasthya Bima Yojana – Performance Trends and Policy RecommendationsCIRM
India is characterized by modest health indicators, a paucity of medical financing schemes that have reached scale, high per capita out-of-pocket health expenditure, and very low public health spending on low-income citizens. The lack of financing options especially when the population is facing a double burden of disease (frequent communicable and catastrophic lifestyle diseases) leads to poor health outcomes and to poverty traps. Hence, optimal public health financing is important for improving national health outcomes and reducing vulnerability.
The Rashtriya Swasthya Bima Yojana (RSBY) is an Indian government-run health insurance scheme that provides health insurance coverage to below poverty line (BPL) families. It covers over 34 million BPL families. The scheme aims to address issues with previous government health insurance schemes by learning from their successes and failures. Key features include providing portability across India, using biometric smart cards for cashless access to public and private hospitals, and incentivizing various stakeholders like insurers, hospitals, and intermediaries. However, there remains a large gap between the number of registered beneficiaries and actual hospitalizations, and there are also issues with awareness, coordination, and implementation.
The document provides details about the Medicare and Medicaid EHR Incentive Program for eligible professionals. It covers who is eligible to participate, including specific provider types for each program. It discusses the incentive payment amounts for both programs over multiple years. It also outlines the meaningful use requirements including objectives and clinical quality measures that must be met to receive incentive payments.
The document discusses healthcare financing in different countries and contexts. In high income countries, most healthcare is financed through government and private insurance pools. In low and middle income countries, healthcare is often paid for through private out-of-pocket spending. Globally, high income countries spend more on healthcare and have lower disease burdens compared to low and middle income countries.
The study assessed awareness and utilization of the Rashtriya Swasthya Bima Yojana (RSBY) and Comprehensive Health Insurance Scheme (CHIS) in wards 14 and 15 of Ettumanoor Panchayat, Kerala. It found that 72.4% of respondents were enrolled in RSBY/CHIS, while awareness and socioeconomic status were associated with enrollment. Only 22.85% of enrolled families utilized the schemes. The study recommends increasing awareness programs, insurance amounts, covered hospitals and facilities to improve utilization.
Meaningful Use and Electronic Health Records: What You Need to KnowQualifacts
The document discusses meaningful use and electronic health records (EHRs). It explains that meaningful use aims to improve health outcomes, quality, and costs through certified EHR use. It outlines the Medicare and Medicaid EHR incentive programs and payment amounts eligible professionals can receive for meeting meaningful use criteria over multiple years. The document also discusses patient volume requirements, exclusions, calculations, and how groups can qualify. It provides an overview of stage 1 meaningful use measures and certification levels for EHRs.
2015 City & County of San Francisco New Employee Orientation: Health Benefitssfhss
The document provides an overview of health benefits for a new employee. It summarizes the contact information for the Health Service System (HSS), which administers benefits. It describes the benefits enrollment process, eligible dependents, medical and dental plan options, flexible spending accounts, and other benefits like vision, life insurance, and the employee assistance program.
HRSA requirements for a compliant sliding fee scaleCompliatric
The Health Center Compliance Manual outlines the requirements of both the program legislation and implementing regulations. The most recent updates to the Manual from HRSA provided some needed clarification in a number of areas, including the Sliding Fee Discount Program that is central to the Health Center Program. This webinar will outline the Sliding Fee requirements and provide examples and best practices for Community Health Centers to consider.
The document summarizes the Maxicare Healthcare Program which provides health insurance through different membership plans. The key details are:
1. Maxicare offers individual, family, group and corporate membership plans with varying coverage and fees depending on the plan.
2. Membership benefits include coverage for outpatient and inpatient medical care, annual checkups according to the plan, and emergency care at affiliated hospitals.
3. The plans provide coverage for hospital rooms and boards, medical procedures, medicines, and doctor fees, with maximum annual benefit limits depending on the plan.
- The Tamil Nadu government issued an order to implement a new health insurance scheme to provide healthcare assistance to government employees, public sector organizations, and their families.
- Under the scheme, employees and their families can receive up to Rs. 4 lakh (approximately $5,300 USD) for medical treatments over a four-year period.
- The government selected United India Insurance Company Limited to administer the scheme. Employees will pay Rs. 150 (approximately $2 USD) per month in premiums for coverage.
This document outlines the scope of work for analyzing compliance of the Rashtriya Swasthya Bima Yojana (RSBY) health insurance scheme in Chhattisgarh. It seeks proposals from agencies to [1] support monitoring of RSBY activities including enrollment, hospital empanelment, hospitalization, claims, awareness and grievances; [2] conduct communication audits; [3] perform audits of RSBY processes, hospital documentation, transactions, and random concurrent/regular audits of claims; and [4] conduct random user experience surveys. The selected agency will work closely with the state government and other RSBY stakeholders to monitor and improve the implementation of the public health insurance program.
RSBY is a health insurance scheme in India that provides cashless insurance coverage of Rs. 30,000 per year for hospitalization to below poverty line families. It was launched in 2008 to provide health insurance to families not covered by other government schemes. The scheme uses smart cards and is funded jointly by the central and state governments. It aims to empower beneficiaries and provide a business model for various stakeholders like insurers, hospitals, and intermediaries. However, there are some shortcomings like unnecessary treatment, lack of primary care coverage, and not accounting for state-specific health needs.
National health service corp presentation to mo rhit may 27 2010learfield
The document summarizes the National Health Service Corps (NHSC), which provides clinicians to work in underserved areas. The NHSC offers scholarship and loan repayment programs to recruit primary care providers to work in Health Professional Shortage Areas (HPSAs). Sites must be located in and provide services to HPSAs to be eligible. The document outlines NHSC programs and funding provided by the American Recovery and Reinvestment Act to recruit additional clinicians and expand access to care.
The document discusses National Health Accounts (NHA) in Bangladesh. It provides definitions of NHA according to WHO as a systematic monitoring of health resource flows. It summarizes the Bangladesh NHA (BNHA) framework which incorporates financing agents and providers. Key results from BNHA show total health expenditure increasing from 1997 to 2007 with households contributing through out-of-pocket payments mostly for medicines. While GDP spending on health increased slightly over time, public spending remained around 1% of GDP.
The document provides information about open enrollment for employee benefits at a company. It summarizes the various benefit plans including medical coverage through JP Farley, dental through Anthem, vision through VSP, and life and disability insurance through Aetna. Details are provided on plan costs, coverage amounts, and requirements for dependent eligibility. The presentation instructs employees to complete enrollment by November 21st online or waive coverage, and to watch for new ID cards in the mail. Contact information is provided for benefits questions.
Usual, customary and reasonable (UCR) fees are rates set by insurance companies to determine reimbursement amounts for medical procedures. UCR fees are influenced by geographic location and population size, with fees generally higher in more populated areas with higher costs of living. However, there is no standard or regulation for how insurance companies set UCR fees. Surveys of fees charged by doctors are conducted but data may be outdated by the time it is received and applied. As a result, UCR fees can vary widely between insurance companies and often do not adequately cover actual physician fees.
1. Behavioral health providers can participate in the Connecticut Medicaid EHR Incentive Program by having their rendering providers reassign incentive dollars back to the agency.
2. To participate, providers must have an individual Connecticut Medical Assistance Program provider ID and attest that they have adopted, implemented, or upgraded to a certified EHR system.
3. Eligible provider types include physicians, nurse practitioners, certified nurse-midwives, dentists, and physician assistants working in federally qualified health centers. Providers must also meet patient volume requirements related to Medicaid patients.
Power Point Region 4 EN Recruitment Teleconferenceabbap86
Region wide Ticket to Work Recruitment Teleconference co-presented by Region 4 Senior Account Manager Donna De Julius and Region 4 Account Manager Andrew Baptista
Ayushman Bharat Yojana (ABPM-JAY) provides a health insurance coverage of Rs. 500,000 per family per year for secondary and tertiary care hospitalization to over 10.74 crore poor and vulnerable families. It aims to fulfill the demand for universal healthcare. Key features include paperless and cashless access to healthcare, portability of services across the country, and flexibility for states to implement through insurance, trusts, or mixed models. Implementation is supported through technology modules for beneficiary identification, hospital empanelment, and claims management. Pradhan Mantri Arogya Mitras are trained healthcare facilitators who help beneficiaries navigate the scheme and access services.
RSBY was launched in early 2008 and was initially designed to target only the Below Poverty Line (BPL) households, but has been expanded to cover other defined categories of unorganized
This document proposes a medical and life insurance scheme for informal sector workers, especially rag pickers, to provide them social security and welfare protections. It notes that over 92% of India's workforce is employed informally without job or social security benefits. The proposed scheme would provide low-cost insurance covering occupational diseases through a biometric-enabled smart card distributed by post offices. Hospitals would be empaneled for cashless treatment access. Key stakeholders like municipal corporations, insurance companies, and healthcare providers are identified along with their roles. Implementation would require initial funding and establishing state nodal agencies to facilitate monitoring and address issues.
Tracking implementation and (un)intended consequences of peripheral health fa...resyst
The document discusses the Health Sector Services Fund (HSSF) in Kenya, which provides direct financing to peripheral health facilities to improve quality of care and sustainability. It outlines the implementation of HSSF, including challenges around delays in funding, inadequate funding levels, and complex reporting requirements. The document also examines knowledge gaps and next steps for HSSF as Kenya's health system undergoes devolution and the introduction of new financing mechanisms.
The document provides information about Vermont's Medicaid Electronic Health Record Incentive Program (EHRIP) for eligible professionals. It discusses eligibility requirements, including patient volume thresholds and definitions. It outlines the steps to register at CMS and attest through Vermont's MAPIR system. Eligible professionals can qualify for incentive payments by adopting, implementing, or upgrading to certified EHR technology. The document also reviews options to reassign incentive payments and important program resources.
The document discusses healthcare financing in different countries and contexts. In high income countries, most healthcare is financed through government and private insurance pools. In low and middle income countries, healthcare is often paid for through private out-of-pocket spending. Globally, high income countries spend more on healthcare and have lower disease burdens compared to low and middle income countries.
The study assessed awareness and utilization of the Rashtriya Swasthya Bima Yojana (RSBY) and Comprehensive Health Insurance Scheme (CHIS) in wards 14 and 15 of Ettumanoor Panchayat, Kerala. It found that 72.4% of respondents were enrolled in RSBY/CHIS, while awareness and socioeconomic status were associated with enrollment. Only 22.85% of enrolled families utilized the schemes. The study recommends increasing awareness programs, insurance amounts, covered hospitals and facilities to improve utilization.
Meaningful Use and Electronic Health Records: What You Need to KnowQualifacts
The document discusses meaningful use and electronic health records (EHRs). It explains that meaningful use aims to improve health outcomes, quality, and costs through certified EHR use. It outlines the Medicare and Medicaid EHR incentive programs and payment amounts eligible professionals can receive for meeting meaningful use criteria over multiple years. The document also discusses patient volume requirements, exclusions, calculations, and how groups can qualify. It provides an overview of stage 1 meaningful use measures and certification levels for EHRs.
2015 City & County of San Francisco New Employee Orientation: Health Benefitssfhss
The document provides an overview of health benefits for a new employee. It summarizes the contact information for the Health Service System (HSS), which administers benefits. It describes the benefits enrollment process, eligible dependents, medical and dental plan options, flexible spending accounts, and other benefits like vision, life insurance, and the employee assistance program.
HRSA requirements for a compliant sliding fee scaleCompliatric
The Health Center Compliance Manual outlines the requirements of both the program legislation and implementing regulations. The most recent updates to the Manual from HRSA provided some needed clarification in a number of areas, including the Sliding Fee Discount Program that is central to the Health Center Program. This webinar will outline the Sliding Fee requirements and provide examples and best practices for Community Health Centers to consider.
The document summarizes the Maxicare Healthcare Program which provides health insurance through different membership plans. The key details are:
1. Maxicare offers individual, family, group and corporate membership plans with varying coverage and fees depending on the plan.
2. Membership benefits include coverage for outpatient and inpatient medical care, annual checkups according to the plan, and emergency care at affiliated hospitals.
3. The plans provide coverage for hospital rooms and boards, medical procedures, medicines, and doctor fees, with maximum annual benefit limits depending on the plan.
- The Tamil Nadu government issued an order to implement a new health insurance scheme to provide healthcare assistance to government employees, public sector organizations, and their families.
- Under the scheme, employees and their families can receive up to Rs. 4 lakh (approximately $5,300 USD) for medical treatments over a four-year period.
- The government selected United India Insurance Company Limited to administer the scheme. Employees will pay Rs. 150 (approximately $2 USD) per month in premiums for coverage.
This document outlines the scope of work for analyzing compliance of the Rashtriya Swasthya Bima Yojana (RSBY) health insurance scheme in Chhattisgarh. It seeks proposals from agencies to [1] support monitoring of RSBY activities including enrollment, hospital empanelment, hospitalization, claims, awareness and grievances; [2] conduct communication audits; [3] perform audits of RSBY processes, hospital documentation, transactions, and random concurrent/regular audits of claims; and [4] conduct random user experience surveys. The selected agency will work closely with the state government and other RSBY stakeholders to monitor and improve the implementation of the public health insurance program.
RSBY is a health insurance scheme in India that provides cashless insurance coverage of Rs. 30,000 per year for hospitalization to below poverty line families. It was launched in 2008 to provide health insurance to families not covered by other government schemes. The scheme uses smart cards and is funded jointly by the central and state governments. It aims to empower beneficiaries and provide a business model for various stakeholders like insurers, hospitals, and intermediaries. However, there are some shortcomings like unnecessary treatment, lack of primary care coverage, and not accounting for state-specific health needs.
National health service corp presentation to mo rhit may 27 2010learfield
The document summarizes the National Health Service Corps (NHSC), which provides clinicians to work in underserved areas. The NHSC offers scholarship and loan repayment programs to recruit primary care providers to work in Health Professional Shortage Areas (HPSAs). Sites must be located in and provide services to HPSAs to be eligible. The document outlines NHSC programs and funding provided by the American Recovery and Reinvestment Act to recruit additional clinicians and expand access to care.
The document discusses National Health Accounts (NHA) in Bangladesh. It provides definitions of NHA according to WHO as a systematic monitoring of health resource flows. It summarizes the Bangladesh NHA (BNHA) framework which incorporates financing agents and providers. Key results from BNHA show total health expenditure increasing from 1997 to 2007 with households contributing through out-of-pocket payments mostly for medicines. While GDP spending on health increased slightly over time, public spending remained around 1% of GDP.
The document provides information about open enrollment for employee benefits at a company. It summarizes the various benefit plans including medical coverage through JP Farley, dental through Anthem, vision through VSP, and life and disability insurance through Aetna. Details are provided on plan costs, coverage amounts, and requirements for dependent eligibility. The presentation instructs employees to complete enrollment by November 21st online or waive coverage, and to watch for new ID cards in the mail. Contact information is provided for benefits questions.
Usual, customary and reasonable (UCR) fees are rates set by insurance companies to determine reimbursement amounts for medical procedures. UCR fees are influenced by geographic location and population size, with fees generally higher in more populated areas with higher costs of living. However, there is no standard or regulation for how insurance companies set UCR fees. Surveys of fees charged by doctors are conducted but data may be outdated by the time it is received and applied. As a result, UCR fees can vary widely between insurance companies and often do not adequately cover actual physician fees.
1. Behavioral health providers can participate in the Connecticut Medicaid EHR Incentive Program by having their rendering providers reassign incentive dollars back to the agency.
2. To participate, providers must have an individual Connecticut Medical Assistance Program provider ID and attest that they have adopted, implemented, or upgraded to a certified EHR system.
3. Eligible provider types include physicians, nurse practitioners, certified nurse-midwives, dentists, and physician assistants working in federally qualified health centers. Providers must also meet patient volume requirements related to Medicaid patients.
Power Point Region 4 EN Recruitment Teleconferenceabbap86
Region wide Ticket to Work Recruitment Teleconference co-presented by Region 4 Senior Account Manager Donna De Julius and Region 4 Account Manager Andrew Baptista
Ayushman Bharat Yojana (ABPM-JAY) provides a health insurance coverage of Rs. 500,000 per family per year for secondary and tertiary care hospitalization to over 10.74 crore poor and vulnerable families. It aims to fulfill the demand for universal healthcare. Key features include paperless and cashless access to healthcare, portability of services across the country, and flexibility for states to implement through insurance, trusts, or mixed models. Implementation is supported through technology modules for beneficiary identification, hospital empanelment, and claims management. Pradhan Mantri Arogya Mitras are trained healthcare facilitators who help beneficiaries navigate the scheme and access services.
RSBY was launched in early 2008 and was initially designed to target only the Below Poverty Line (BPL) households, but has been expanded to cover other defined categories of unorganized
This document proposes a medical and life insurance scheme for informal sector workers, especially rag pickers, to provide them social security and welfare protections. It notes that over 92% of India's workforce is employed informally without job or social security benefits. The proposed scheme would provide low-cost insurance covering occupational diseases through a biometric-enabled smart card distributed by post offices. Hospitals would be empaneled for cashless treatment access. Key stakeholders like municipal corporations, insurance companies, and healthcare providers are identified along with their roles. Implementation would require initial funding and establishing state nodal agencies to facilitate monitoring and address issues.
Tracking implementation and (un)intended consequences of peripheral health fa...resyst
The document discusses the Health Sector Services Fund (HSSF) in Kenya, which provides direct financing to peripheral health facilities to improve quality of care and sustainability. It outlines the implementation of HSSF, including challenges around delays in funding, inadequate funding levels, and complex reporting requirements. The document also examines knowledge gaps and next steps for HSSF as Kenya's health system undergoes devolution and the introduction of new financing mechanisms.
The document provides information about Vermont's Medicaid Electronic Health Record Incentive Program (EHRIP) for eligible professionals. It discusses eligibility requirements, including patient volume thresholds and definitions. It outlines the steps to register at CMS and attest through Vermont's MAPIR system. Eligible professionals can qualify for incentive payments by adopting, implementing, or upgrading to certified EHR technology. The document also reviews options to reassign incentive payments and important program resources.
This document discusses the path toward achieving meaningful use of electronic health records (EHRs) according to government regulations. It outlines key dates for EHR incentive programs, including publication of final rules in 2010 and incentive payments beginning for eligible professionals in 2011 and hospitals in 2010. It also summarizes the eligibility criteria, reporting periods, payment amounts and schedules for Medicare and Medicaid EHR incentive programs for both professionals and hospitals.
National Maternal and children health programLalitaDubile
This document summarizes maternal health initiatives and statistics in India. It notes that India's maternal mortality ratio has declined significantly from 556 per 100,000 live births in 2000 to 130 in 2015, and neonatal mortality has also dropped. However, more progress is still needed to meet national targets. Key programs discussed include Janani Shishu Suraksha Karyakram, which provides free care for deliveries and complications; LaQshya, which improves quality of labor rooms; and various trainings to strengthen health workforce skills. Anemia and institutional delivery rates vary significantly between states. Moving forward, priorities include delayed cord clamping, revised ANC guidelines, improved referral protocols, and a focus on respectful maternity care.
presentation is all about ppp in one hand and ppp in health on the other. ppp is not only remain as collaboration for the use of government mobey by the private party but now has legal and administrative aspects as well. however, to make ppp as vibrant and result oriented, mutual trust has to biult between both the parties that would be supplemented by some successful cases of ppp specially in health sector.
The Nagar Panchayat Hospital provides healthcare services to residents of Vallabh Vidyanagar, Gujarat. It is overseen by the local civic administration and a health committee. The hospital aims to provide medical support, immunization, and prevent disease prevention. However, it faces challenges with sustainability, centralized decision making, and lack of formal systems. A revamped system is proposed, establishing a board to oversee the hospital, recruiting more staff, and allocating surpluses to growth, infrastructure, and community programs to make the hospital more self-sufficient.
Arogya karnataka a universal health coverage schemeDrSridevi NH
govt of karnataka is the first to launch a UHC scheme followed by a call from WHO. this ppt is on comparision of various programmes which were present before with that of a new programme
The presentation aim to explain Pradhan Mantri Jan-Arogya Yojana (Ayushman Bharat) to everyone. In terms of how what where, so that public can get benefit of it.
A critical assessment of health care purchasing in Tanzania: a comparison of ...resyst
This presentation was given at the International Health Economics Association (iHEA) World Congress in Milan, in July 2015. It includes results and policy implications from the RESYST Purchasing Study conducted Tanzania.
HEALTH SYSTEMS MANAGEMENT II UNIT THREE.pptxWILLIAMSADU1
This document provides an overview of managing finances in health systems. It discusses various sources of funds for health services including user fees, community health funds, and donor support. It also outlines proper accounting procedures for maintaining financial records such as ledgers, cash books, and receipts. The objectives of the course are to familiarize participants with accounting procedures, financial documentation, and budgeting and reporting processes.
The document provides guidelines for financial management and accounting at sub-centres under the National Health Mission in India. It outlines funds received for activities like Janani Suraksha Yojana (cash assistance for mothers during pregnancy and childbirth) and annual maintenance grants. It describes proper maintenance of accounts, documents, and internal controls like cash books, bank reconciliation, and budgeting. It also covers the scope and process of annual audits to ensure accuracy and compliance in use of public health funds.
Meaningful Use Survivor: 4 Steps to a Successful AuditQualifacts
This document provides an overview and guidance on preparing for audits of the CMS EHR Incentive Programs. It discusses that CMS and state Medicaid agencies will audit providers who attest to receive EHR incentive payments. It outlines the audit process, including triggers for an audit, who may be audited, and the steps of receiving an audit letter, providing documentation, and receiving a determination. It emphasizes the importance of creating an audit trail and retaining all documentation used for attestation for six years. Finally, it provides some tips and examples of documentation that could be requested during an audit.
1) The document proposes a solution called MobiHeal, which are mobile health units that function as ambulances and mobile clinics, to address problems in India's rural healthcare system like lack of emergency services and limited access to primary healthcare facilities.
2) Each MobiHeal would serve around 12 villages covering an area of 42 square kilometers, providing both emergency ambulance services and serving as a mobile clinic that visits each village on a rotating schedule.
3) In addition to emergency services and primary healthcare, MobiHeal units would offer services like immunizations, pre- and post-natal care, family planning programs, and help control epidemics. The model is proposed to be funded through government budgets as well
1. Mukhya Mantri State
Health Care Scheme
(MMSHCS)
HP Swasthya Bima Yojna Society
Dept. Health & FW
Shimla, Himachal Pradesh
2. Brief About the Scheme
• The Govt. of Himachal Pradesh has decided to provide health
insurance coverage to population which is not covered under RSBY.
• Hence the new scheme “MMSHCS” is formulated in 2015.
• First State to launch health coverage for unique categories.
• Software and hardware used that of RSBY to cut the cost.
• The size of the family would be 5 only.
• 100% State funded.
3. Benefits of the Scheme
• Rs. 30,000/- per year on family floater basis
• Hospitalization (Indoor & Daycare).
• In 174 Hospitals.
• More than 1400 procedures defined under RSBY
• 100 Rs. Transportation cost to be reimbursed by hospital (cap: 1000 per
year).
• Maternity benefit & new born care is covered.
• Completely cashless
• Pre & Post hospitalization expenses (1 day prior & 5 day post hospitalization)
• Day Care procedures also covered (listed)
• Package rates are defined as that of RSBY only.
4. Benefits of the Scheme cont….
• Rs. 1, 75,000/- per year on family floater basis
• 3 Hospitals viz. IGMC, RPGMC Tanda, PGI Chandigarh are empanelled.
• More than 320 procedures are covered, including cancer
• Packages are defined by the State Govt.
• 15 days prior and 60 days post hospitalization expenses are covered.
• Rs. 1000/- transporation cost at the time of discharge (cap: Max. 3000/year)
5. Categories Covered
There are 9 Categories covered under the Scheme
• Senior Citizens (Above 80 Years of Age)
• Ekal Naris
• Anganwari Workers
• Anganwari Helpers
• Mid-day Meal Workers
• Persons with more than 70% disability
• Contractual Employees (Govt., Auto. Bodies, Societies, Boards, corp.)
• Part time Workers (Govt., Auto. Bodies, Societies, Boards, corp.)
• Daily Wage Workers (Govt., Auto. Bodies, Societies, Boards, corp.)
Note: The beneficiaries who are not enrolled under RSBY & any other
medical reimbursement Scheme are eligible
6. Definitons of Categories
Note: The beneficiaries who are not enrolled under RSBY & any other medical
reimbursement Scheme are eligible
• Senior Citizens: > 80 years, Dependents are above 80 years only.
• Ekal Naris: Widows, Divorced, Abandoned, with missing husband and Un-married
women. (Certified from Panchyat/Block or membership in Ekal nari Shakti
Sangatan)
• Anganwari Workers: All. (Dept. Verification must)
• Anganwari Helpers: All. (Dept. Verification must)
• Mid-day Meal Workers: All. (Dept. Verification must)
• Persons with more than 70% disability: Medical Certificate is must.
• Contractual Employees: On contract basis. (Dept. Verification must)
• Part time Workers: All (Dept. Verification is must)
• Daily Wage Workers: All (Dept. Verification must)
7. Total No. of Families
2, 00, 000 approximately across
Himachal Pradesh
Ref: Statistical outline- HP
10. Stake Holders Involved
HP Swasthy Bima Yojna society, Dept. of Health &
FW- State Nodal Agency (SNA)
Rural Technologies Solutions Pvt. Ltd., New Delhi-
Support Agency
District Administration
All other Concerned departments
11. Difference B/w RSBY and MMSHCS
MMSHCS RSBY
Smart Card is valid for 5 years.
Smart Card is valid for 1 year (subject to
renewal of policy).
Smart Card has to be renewed after 3
years.
New Smart Card is issued every year.
No insurance company is involved
Scheme is contracted out to Insurance
Company (PPP model)
Claim amount will be reimbursed by
HPSBYS (claims are processed by RTS)
Claims are settled by the insurance
company
On the spot data Capturing
Pre-enrollment data of beneficiaries is
collected
Permanent Enrollment Centre at district
level
No Permanent enrollment Centre
Smart Card is valid only within Himachal
Pradesh
Smart Card is valid across India
(Hospitals empanelled under RSBY)
12. MMSHCS RSBY
Completely State funded Centre:State (90:10)
Rs. 30 is collected only one time (at the
time of registration)
Rs. 30 is collected during each and every
enrollment
Beneficiary Category is identified by the State
Government
Categories are identified by Government of
India
Difference B/w RSBY and MMSHCS
14. Enrollment Software
• The Existing RSBY Software will be used. Same key
management system viz. DKMA and FKO cards
• On-the-spot data capturing & enrollment software will be used.
• Modified version of RSBY kiosk will be integrated.
Transaction Management Software (Hospitals)
• The Hospitals can process the claims using same RSBY TMS
(Transaction Management Software)
• The Claims uploaded by the hospitals will be received on SNA
server
17. Documents (Beneficiaries) at
time of Enrollment
• Photo identity card
I. Aadhar card (1st preference) or
II. Voters Id card or
III. Pan card
IV. Ration card
• Enrollment & Declaration form - can be
downloaded online/ copies also available at
enrollment centre. (www.nrhmhp.gov.in)
• Department Verification: Other than senior
citizens rest of the categories must submit the
certificate ex: contractual employees- certificate from
the respective institution. (Mentioned at the bottom of
Enrollment form)
18.
19.
20.
21. What beneficiary will receive
after enrollment?
• A Smart Card
• Smart card Cover
• A 3-fold leaflet containing information
22. Role of State Nodal Agency
• Overall designing & Implementation of the Scheme
• Monitoring & Evaluation
• Reimbursing of the claim amount to hospitals
• Grievance redressal
• Coordinating with district administration
• Conducting IEC activities
23. Role of Support Agency
Rural Technology Solutions Pvt. Ltd. will be
conducting below functions
• Planning & Conducting enrollment process
• Conducting IEC activities
• Installing software (TMS) in hospitals
• Data processing of claims and submitting to SNA for
reimbursement
24. Role of District Administration
Provide support to “Agency” in implementing the
scheme
Ensuring participation of FKOs in enrollment process
Help in organizing the District/Block workshops
Help in linking with various departments involved in the scheme
Provide space for PEC & District kiosk at a Government location
Organize Periodic review meetings
25. Role of FKO (Field Key
Officer)
Who is FKO?
Field key officer is a government employee who is
nominated by district/block administration.
• Identifying the beneficiary eligibility (cross verifying the
documents)
• Ensuring proper enrollment of the beneficiary family
• Authorizing enrollment team to print and issue the smart
card
26. Role of Hospitals
Providing “Cashless” treatment to beneficiaries.
Providing Rs. 100/- to beneficiary at the time of discharge
(Transportation cost)- limited to 1000/year.
Maintaining records and reports separately from that of
RSBY
Uploading the claims within 24 hours of discharge of
patient
Periodic checking of bank account for reimbursement
27. IEC Activities
Hoardings
Advertisement in new papers
Advertisement in Local TVs and FM radios
Bulk SMS
Department Notifications
Direct post
Pamphlets at the time of enrollment
29. FAQ- Frequently Asked
Questions
• Are outsourced employees also covered?
No. As of now they are not covered.
• Incase of identified beneficiaries’ wife/dependents are
covered under other medical reimbursement scheme, are
they eligible?
No. If the dependents are covered under other schemes,
they are not eligible
• What happens if contractual employee becomes regular?
Concerned dept. will send letter to SNA, and his card will
be hot listed.