17 Oct 2019
Source: PM-JAY website
- It is the apex body responsible for implementing India’s flagship public health insurance/assurance scheme ‘Ayushman Bharat Pradhan Mantri Jan Arogya Yojana’.
- National Health Authority is the successor of National Health Agency, which was functioning as a registered society since 23rd May, 2018.
- Pursuant to Cabinet decision for full functional autonomy, National Health Agency was reconstituted as the National Health Authority on 2nd January 2019, under Ga
- NHA is governed by a Governing Board chaired by the Union Minister for Health and Family Welfare.
- Chief Executive Officer (CEO), an officer in the rank of Secretary to the Government of India manages its affairs.
Functions of NHA
- Formulation of various operational guidelines related to PM-JAY, model documents and contracts to ensure standardization and interoperability
- Determine the central ceiling for premium (or maximum central contribution for trusts) per family per year to be provided to the States/UTs and review it from time to time, based on the field evidence and actuarial analysis
- Develop, and enforce compliance with, standards for treatment protocols, quality protocols, minimum documentation protocols, data sharing protocols, data privacy and security protocols, fraud prevention and control including penal provisions etc.
- Develop mechanisms for strategic purchasing of health care services through PM-JAY, so as to get best return on Government’s investment.
- Set up systems and processes for convergence of PM-JAY with other health insurance/assurance schemes. This will include schemes being implemented by both State and Central Governments.
- National Health Authority will also develop a pathway to converge PM-JAY with schemes targeting both formal and informal sector workers
- Build a state of the art health information technology ecosystem with requisite foundational components on which PM-JAY and other health systems can be hosted/linked(with consultation of MeitY)
- Explore options including ways to link PM-JAY with the larger health care system, especially primary care, in consultation with the Ministry of Health and Family Welfare, GoI
- Work closely with Insurance Regulatory and Development Authority on development and implementation of Health Insurance Regulations targeting insurance companies, Third Party Administrators, hospitals and other stakeholders
- Effective implementation of PM-JAY across the country and its regular monitoring including taking course corrections actions, as and when required
- Coordination with various State Governments on a regular basis for implementation of PM-JAY
- Capacity building of State Health Agencies and other stakeholders continuously
- Carrying out awareness activities for informing beneficiaries and other stakeholders about the scheme
- Prevention, detection and control of frauds and abuse
- Grievance redressal for all the stakeholders at various levels
- Set up an efficient monitoring system for the scheme
- Stimulate cross learning, sharing of best practices amongst States and documentation of these practices
- Ensure interoperability, standardization, and convergence amongst schemes of Central Ministries
- Conduct and facilitate policy relevant research and evaluation studies including knowledge sharing and information dissemination at national and international level
- Develop strategic partnerships and collaboration with Central and State Governments, other public and private institutions including not-for-profit institutions, banks, insurance companies, academic institutions including universities, missions, think tanks, and other national and international bodies of repute in areas relevant to the objectives of PM-JAY
- Generate evidence for the policy makers from schemes’ data and other research/evaluations so as to facilitate evidence-based decision making and policy formulation by the Government.
- Act as apex body for State Health Agencies that have been set up to implement PM-JAY
- Take any decision related to the implementation of the scheme, recruitment rules and hiring of staff, disbursement of grant-in-aid to the States, and issue relevant directions from time to time, as required