To be eligible for empanelment under the Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) in India, hospitals must meet specific criteria set by the National Health Authority (NHA) and State Health Agencies (SHAs). These ensure quality healthcare services for beneficiaries. Below are the minimum eligibility requirements for hospital empanelment:
- Registration and
Licensing:
- The hospital
must be registered with the appropriate state or central authority (e.g., under
the Clinical Establishments Act or equivalent state legislation).
- Valid licenses
for medical services, diagnostics, and other facilities must be in place (e.g.,
pharmacy, radiology, pathology).
- Operational
Status:
- The hospital
must be operational and providing healthcare services at the time of
application.
- Minimum Bed
Capacity:
- For general
hospitals, a minimum of 10 inpatient beds is typically required.
- Specialty or
super-specialty hospitals may have specific bed requirements based on services
offered.
- Relaxations may
apply in aspirational districts or underserved areas, where bed requirements
may be lower.
- Infrastructure:
- Adequate
physical infrastructure, including clean and functional wards, operation
theaters (if applicable), intensive care units (ICUs), and emergency services.
- Availability of
essential utilities like electricity, water, and sanitation.
- Compliance with
Standards:
- Adherence to
minimum standards for infrastructure, staffing, and equipment as outlined in
the PMJAY guidelines.
- Compliance with
fire safety, biomedical waste management, and infection control norms.
2. Staffing
Requirements
- Qualified Medical
Personnel:
- At least one
full-time qualified doctor (MBBS or equivalent) must be available.
- Specialists
(MD/MS or equivalent) are required for specific treatments or specialties
offered.
- Support Staff:
- Adequate
nursing staff (registered nurses or ANMs) and paramedical staff (e.g., lab
technicians, pharmacists).
- Staff must be
registered with relevant councils (e.g., Medical Council of India, Nursing
Council).
- Nodal Officer:
- A designated
nodal officer to coordinate with the PMJAY scheme for administrative and
operational purposes.
3. Service
Capabilities
- Minimum Services:
- The hospital
must provide secondary or tertiary care services covered under PMJAY (e.g.,
general medicine, surgery, orthopedics, cardiology, etc.).
- Diagnostic
services like X-ray, ultrasound, or laboratory tests must be available either
in-house or through tie-ups.
- Specialty-Specific
Requirements:
- For specialty
services (e.g., oncology, cardiology), the hospital must have appropriate
equipment, infrastructure, and specialists.
- Super-specialty
hospitals need advanced facilities like cath labs, CT/MRI scanners, or dialysis
units, depending on the specialty.
4. Quality
Certifications (Optional but Preferred)
- Hospitals with
NABH (National Accreditation Board for Hospitals) or NABL (National
Accreditation Board for Testing and Calibration Laboratories) accreditation may
qualify for fast-track empanelment.
- Non-accredited
hospitals must still meet PMJAY’s quality standards and undergo verification.
5. Public vs. Private
Hospitals
- Public Hospitals:
- All public
hospitals at the level of Community Health Centres (CHCs) and above are deemed
empanelled in states implementing PMJAY.
- No separate
application is required, but they must meet operational standards.
- Private Hospitals:
- Private
hospitals must apply through the Hospital Empanelment Module (HEM) portal and
undergo verification by the SHA.
- Approval is
granted based on adherence to PMJAY criteria.
- ESIC Hospitals:
- Employee State
Insurance Corporation (ESIC) hospitals may be empanelled based on bed occupancy
ratios and mutual agreements with PMJAY.
6. Empanelment
Process
- Application:
- Hospitals
register on the HEM portal (https://hospitals.pmjay.gov.in) and submit details
about infrastructure, services, and staff.
- Verification:
- Desktop and
physical verification by District Empanelment Committees (DECs) within 15
working days.
- DECs assess
compliance with PMJAY standards.
- Approval:
- SHAs approve or
reject applications based on DEC recommendations.
- Approved
hospitals sign a Memorandum of Understanding (MoU) with the SHA.
- Training:
- Hospitals
receive training on PMJAY systems, billing, and claim processes.
7. Additional
Requirements
- IT Infrastructure:
- Hospitals must
have internet connectivity and systems to process cashless transactions and
claims under PMJAY.
- Familiarity
with the Transaction Management System (TMS) is required.
- Fraud Prevention:
- Hospitals must
agree to audits and investigations to prevent fraud or abuse of the scheme.
- Non-compliance
may lead to suspension or de-empanelment.
- Geographical
Equity:
- SHAs prioritize
empanelment in underserved areas to ensure equitable access.
8. Relaxations and
Fast-Track Options
- Aspirational
Districts:
- Lower bed or
staffing requirements may apply in designated aspirational districts to improve
access.
- Accredited
Hospitals:
- NABH-accredited
hospitals or those empanelled under state schemes may qualify for fast-track
empanelment.
- National Health
Care Providers (NHCPs):
- Institutions
like AIIMS or those run by the Ministry of Health and Family Welfare are
automatically empanelled.
9. Key Notes
- The empanelment
process is rigorous to ensure quality care, with over 30,000 hospitals (50%
private) empanelled as of recent estimates.
- Hospitals must
maintain records and submit claims accurately to avoid penalties.
- The list of
empanelled hospitals is available on the official PMJAY website
(https://pmjay.gov.in) or through state-specific portals.
For detailed guidelines, hospitals can refer to the NHA’s Hospital Empanelment Guidelines available on the PMJAY website or contact their respective SHA.
[](https://www.pib.gov.in/Pressreleaseshare.aspx?PRID=1575551)[](https://lazymonkey.in/blog/guidelines-on-hospital-empanelment-de-empanelment/)
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