National Health Authority 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 Gazette Notification Registered No. DL –(N) 04/0007/2003-18.
NHA has been set-up to implement the PM-JAY at the national level. An attached office of the Ministry of health and Family Welfare with full functional autonomy, 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. The CEO is the Ex-Office Member Secretary to the Governing Board. To implement the scheme in the State, State Health Agencies (SHAs) in the form of a society/trust have been set up by the States. SHAs have full operational autonomy over implementation of the scheme in the State including extending the coverage to non SECC beneficiaries.
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. Create conducive conditions for strategic purchasing by preparing list of packages and their rates and updating those from time to time using a transparent, predictable and evidences-based process. Set up effective and efficient mechanisms to pay to the health care providers
- 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; Information Technology standards will be developed in consultation with Ministry of Electronic and Information Technology (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 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 and
- Any other activities as assigned by the Government of India from time to time
The NHA is governed by a Governing Board chaired by the Union Minister for Health and Family Welfare, Government of India; and is headed by a full-time Chief Executive Officer (CEO) supported by Deputy CEO and Executive Directors. The CEO of the NHA functions as the Member Secretary of the Governing Board.
The Governing Board comprises of Chairman and 11 members.List of the Members of the Governing Board:
- Chairman: Union Minister for Health and Family Welfare, Govt. of India
- Member:Chief Executive Officer, NITI Aayog, Govt. of India (Ex Officio)
- Member: Secretary (Expenditure), Ministry of Finance, Govt. of India (Ex Officio)
- Member:Secretary (Health and Family Welfare), Ministry of Health and Family Welfare, Govt. of India (ex-officio)
- Member 4 and 5: two domain experts from the fields such as Administrative, Insurance, Public and Private Health care providers, Economics, Public Health, Management etc.
- Member (6-10): Five principal secretaries (Health) of the state government (one representing each of the five zones of the country viz; North, east, South, west and North east) on a rotational basis, and
- Member: Chief Executive Officer (CEO) of National Health Authority (Ex Officio)
- The Governing Board is the supreme decision-making authority of NHA and responsible for all matters related to PM-JAY and the Authority
- The Governing Board shall frame rules, regulations, guidelines and procedures for the selection, recruitment of the staff, personnel rules for the Authority
- All the major regulations issued in the name of Authority requires the approval of the Governing Board and shall follow a public consultation route in the interest of transparency
- The Governing Board may delegate the powers to CEO of NHA as deemed appropriate
- The Governing Board may form sub-committee for areas as deemed appropriate for smooth functioning of PM-JAY
- The Governing Board shall atleast meet once a quarter to decide issues, protocols made by CEO of Authority
- The Governing Board shall periodically review the performance of NHA on such parameters as may be considered expedient by the board including expenditure of budgets allocated
- To effectively carry out tasks allotted, NHA through the Governing Board is responsible for the following
- Frame, amend and repeal policies and administrative and financial procedures related to hiring/retention/utilization/mobilization of resources, outsourcing of various tasks, budgetary support and release of funds including guidelines for bank accounts (escrow/other type of bank account as the case may be) for the management and administration of the Authority and for the conduct of the activities of the authority
- Acquire, hire or take on lease, construct property, movable or immovable, and provide their maintenance as may be necessary to carry out the objects of the Authority
- Initiate and enter into contracts and other such instruments by whatever names called to achieve the stated objects of Authority
- Receive budgetary support from the government of India. In addition, generate funds for the Authority if possible
- Develop strategic partnerships and collaborations 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, and undertake any other role as required to reach its objectives effectively
Chief Executive Officer
A full time Chief Executive Officer (CEO), in the rank of Secretary to the Government of India, is appointed by Central Government at NHA. The CEO is the Ex-Officio Member Secretary to the Governing Board and has complete operational control over the NHA for implementation of PM-JAY. However, for all policy matters, the CEO reports to the Governing Board and work under their guidance. He exercises all administrative powers within the Authority and over its staff, delegated to him by the Governing Board. The CEO also exercises the financial power of a Secretary to the Government of India as envisaged under GFR and Financial Rules & regulations of Government of India.Powers and functions of the CEO :
- The day-to-day adminstration of the Authority. For this purpose, he shall report to the Chairman of the Governing Board,
- Implementing the work programmes and decisions adopted by the Authority,
- Drawing up of proposal for the Governing Board’s decisions and work programmes,
- the preparation of the statement of the revenue and expenditure and the execution of the budget of the authority,
- performing such other functions, or exercising such other powers, as may be specified by regulations,
- ensure compliance to rules, procedure, regulations related to selection and recruitment of the staff for the Authority, as laid by the Governing Board; and
- any other activities as assigned by the Government of India from time to time.
Dr. Indu Bhushan serves as the CEO of Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB - PMJAY) and the National Health Authority (NHA), Government of India.
Dr. Bhushan is an ex-Indian Administrative Service (IAS) officer of the Indian Civil Services, 1983 Rajasthan cadre. He holds a Doctorate in Health Economics and a Master of Health Sciences from the Johns Hopkins University, USA. He is an alumnus of the prestigious Indian Institute of Technology-Banaras Hindu University (IIT BHU) and IIT Delhi where he completed his B. Tech and Post-Graduate Diploma, respectively. He is also a Chartered Financial Analyst (CFA).
Dr. Bhushan is a bureaucrat-turned-economist with a career spanning 35 years across a multitude of sectors. He served for nine years in the IAS prior to leaving government service. Thereafter, he worked as Senior Economist with the World Bank Group prior to moving to ADB. Until his appointment as CEO, AB - PMJAY, he served as Director General, East Asia Department of the Asian Development Bank (ADB). He has held multiple positions within ADB including Director General, Strategy and Policy Department and led ADB’s engagement with the People's Republic of China (PRC), Hong Kong, Republic of Korea, Mongolia, and Taiwan including management of $12.6 billion portfolio comprising of 113 projects. Dr. Bhushan administered and provided oversight to sectors like energy, environment, natural resources and agriculture, transport, public management, financial sector and regional cooperation, urban and social development. He also supervised ADB’s resident missions in the People’s Republic of China and Mongolia.
Dr. Bhushan lives in an empty nest in New Delhi, with his wife, Anjana, an ex-IAS officer, and works with the World Health Organisation (WHO). He has two daughters, Devika and Ambika, who are both medical doctors and live in the USA. He likes to play bridge and catch the latest movies and theatrical shows on the weekend.
Deputy Chief Executive Officer
Deputy Chief Executive Officer (Dy. CEO) in the rank of Joint Secretary has been appointed by Government of India to assist the CEO, NHA in managing the affairs of the organisation. Dy. CEO is the second highest official in the organisational hierarchy of NHA.Deputy CEO's Profile
Dr Praveen Gedam, an IAS officer of 2002 batch, Maharashtra cadre, has joined the NHA as Deputy CEO for Ayushman Bharat. Before joining NHA, he was serving as the private secretary to Hon’ble Minister of Railways. Prior to this, he was the Transport Commissioner of Maharashtra state and also served as the Commissioner for Nashik Municipal Corporation. He was handpicked at the 11th hour to lead the preparations to the Nashik Kumbhmela in 2015. He and his team set an unprecedented zero-causality-zero-epidemic-zero-missing-person record while successfully managing the mega-event.
Before that he has served in various positions with the Government of Maharashtra viz. Collector & District Magistrate in two districts i.e. Solapur and Osmanabad; Director of Groundwater Surveys and Development
Agency, Pune; CEO of Zilla Parishad Latur; Commissioner, Municipal Corporation, Jalgaon; Assistant Collector & Sub Divisional Officer, Dapoli. He is a medical doctor by education & National Talent Scholar. He has an experience of 10 years in implementation of various program and schemes related to public health.
State Health Agencies
SHA is a nodal agency responsible for implementation of PM-JAY in the state headed by CEO. SHA can hire additional staff or engaged Implementation Support (ISA) to perform required tasks for implementation of the scheme. CEO, SHA is appointed by the State government and is ex-officio member secretary of the Governing Council of the SHA. Along with day to day operations of implementation of PM-JAY in the state, SHA is also responsible for data sharing, verification and validation of family members, IEC, monitoring of the scheme etc.Roles and responsibilities of SHA
- Policy related issues of State Health Assurance/ Insurance scheme and its linkage to PM-JAY
- Alliance of State scheme with PM-JAY
- Selection of Insurance Company through tendering process (if implementing PM-JAY through Insurance Companies)
- Selection of Implementation Support Agencies (in Trust/ society mode) if needed
- Awareness generation and demand creation
- Aadhaar seeding and issuing print out of E-card to validated beneficiaries
- Empanelment of network hospitals which meet the criteria
- Monitoring of services provided by health care providers
- Fraud and abuse control
- Punitive actions against the providers for fraud and corrupt practices
- Monitoring of pre-authorizations which are already approved by Insurer/ISA
- Administration of hospital claims which are already approved by Insurer/ ISA
- Package price revisions or adaptation of PM-JAY list
- Adapting PM-JAY treatment protocols for listed therapies to State needs
- Adapting operational guidelines in consultation with NHA, where necessary
- Forming grievance redressal committees and overseeing the grievance redressal function
- Capacity development planning and undertaking capacity development initiatives
- Development of proposals for policy changes –e.g. incentive systems for public providers and implementation thereof
- Management of funds through the Escrow account set up for purposes of premium release to Insurance Company under PM-JAY
- Data management
- Evaluation through independent agencies
- Setting up District level offices and hiring of staff for District
- Oversee District level offices
- Preparation of periodic reports based on scheme data and implementation status
- Implementing incentive systems for ASHA workers & public providers in line with national guidance
District Implementation Unit
In addition to the State level entity, a District Implementation Unit (DIU) is also established to support the implementation in every district included under the scheme. This team will be in addition to the team deployed by the insurance company/ ISA. The DIU will be chaired by the Deputy Commissioner/ District Magistrate/ Collector of the district. This Unit is to coordinate with the implementing agency (ISA/insurer) and the network hospitals to ensure effective implementation and also send review reports periodically. The DIU has to work closely and coordinate with the District Chief Medical officer and his/her team.