SHA issues clarification on SEHAT scheme

Srinagar, Nov 19: In response to the concerns raised about the AB-PMJAY SEHAT scheme in Greater Kashmir story ‘SEHAT Unhealthy on Tuesday, the J&K State Health Agency (SHA) issued a clarification to present a “complete picture” while acknowledging delays in payment to empanelled hospitals and promising a December 2024 deadline to clear payment backlogs.

The SHA statement issued here said that the report presented an “incomplete picture”, overlooking “key improvements and efforts initiated since October 2024”.

According to SHA, “Over 54,000 cases have been processed across both private and public hospitals since October.”

The number validates the Greater Kashmir story figure of ‘around 1000 cases processed daily’, a number that adds up to nearly 50,000 cases since October.

The statement acknowledged the delays in payments and clarified that some delays stemmed from ‘Empanelled Health Care Providers (EHCPs) not adhering to the guidelines set by the National Health Authority’.

The SHA officials said that many cases had been submitted “with incomplete or missing mandatory documents, leading to bottlenecks and wasted time at various stages of the processing workflow”.

The SHA reiterated the need for accurate and complete documentation from all EHCPs to avoid unnecessary delays.

Greater Kashmir had quoted hospitals contending that “cases of dialysis centres and nursing homes are being rejected without justifications and without prior intimation”.

Addressing another concern raised in the report, the SHA affirmed that they were strictly following the directions of the Jammu and Kashmir High Court, ensuring that no claims were unfairly rejected or reduced.

The statement assured the EHCPs that “sufficient funds are available, and every valid claim will be settled without undue delay”.

The SHA communicated the government’s intent to resolve the ongoing crisis and to clear all pending payments by the end of December 2024.

Greater Kashmir, in its report, had included the directions of Chief Secretary Atal Dulloo issued earlier this month.

“On November 5, Chief Secretary Atal Dulloo had impressed upon the Health and Medical Education Department to expedite the payments, and clear all dues by the end of this year,” the Greater Kashmir reported.

The agency also highlighted the challenges posed by IFFCO Tokio Insurance Company Ltd’s failure to meet contractual obligations but underscored that the SEHAT scheme remains a crucial safety net for the residents of J&K, easing the financial burden of healthcare expenses.

“The SHA appeals to all valued stakeholders, including private hospitals, to collaborate with the SHA in addressing these issues,” the SHA statement said.

AB-PMJAY SEHAT scheme, launched in 2020 is a government health insurance initiative, the first of its kind in J&K provides free health coverage of up to Rs 5 lakh per family annually for hospitalisation.

It aims to make quality healthcare accessible to all residents of J&K, especially the economically vulnerable.