GUJARAT NATIONAL LAW UNIVERSITY

GANDHINAGAR

SEMESTER II (2013-2018)

ASSIGNMENT ON

MUKHYAMANTRI
AMRUTUM (MA) YOJANA

Submitted to: Submitted by:

 Ms. Rachna Raval Kareena Kala

MUKHYAMANTRI AMRUTUM (MA) YOJANA

INTODUCTION:
Healthcare services are one of the most fundamental requirements of a society, but they remain
largely beyond the reach of the masses due to sheer affordability factors. A large number of
households are pushed into poverty as a result of high costs of household spending on health
care. The Below Poverty Line (BPL) population is especially vulnerable to the catastrophic
health risks. To address this key vulnerability faced by the BPL population in the Gujarat, the
State Government has launched a medical care scheme called Mukhyamantri Amrutum (MA)
Yojana. It is a tertiary health coverage scheme for BPL families .

OBJECTIVES:

 The scheme is proposed to take major initiative to provide financial assistance to BPL families to
combat deadly disease which often debilitate the entire family. Other major initiative are holistic
approach on nutritional front ,strengthening drug delivery system as well as Rural and Urban
health systems and cancer screening for women in remote locations.

 The objective of the scheme is to improve access of BPL families to quality medical and surgical
care for the treatment of identified diseases involving hospitalization, surgeries and therapies
through an empanelled network of health care providers.

BENEFITS:

All predefined medical procedures and other services as a part of the disease/treatment packages
would be provided on a complete cashless basis. The two recent sectors that are introduced in the
hospitals are Medical Oncology and Surgical Oncology under which the patient are given the
Chemo and Radiotherapy .The surgeries covered are of :
1.Cardiovascular
2.Neurosurgeries
3.Burns
4.PolyTrauma
5.Cancer
6.Renal
7. Neo-natal (newborn) diseases
 'MA' provides quality medical and surgical care for the catastrophic illnesses involving
hospitalization, surgeries and therapies through an empanelled network of hospitals to the BPL
families.

APPLICATIONS :

 The scheme benefits Below Poverty Line (BPL) Families of all 26 districts of Gujarat namely
Banaskantha, Sabarkantha, Dang, Narmada, Tapi, Bharuch, Dahod, Kutch, Jamnagar, Patan, Anand,
Vadodra, Valsad, Surat, Navsari, Ahmedabad, Gandhinagar, Mehsana, Kheda, Panchmahal,
Surendranagar, Rajkot, Amreli, Bhavnagar, Junagadh, and Porbandar. According to a recent
enumeration made by the Rural and Urban Development Department, there are approximately 39
lakh BPL families in the said twenty six districts of the State.

 According to the guidelines of the scheme a BPL family consists of the head of the family,
spouse, and up to three dependents. The dependents will include such members as listed as part
of the family in the beneficiary database provided by the Rural and Urban Development
Department, Gandhinagar.

 The scheme meets expenses of hospitalization and surgical procedures of the beneficiary
members up to Rs.2.0 lakh per family of five members per year. The benefit on family will be on
floater basis i.e. the total reimbursement of Rs.2 lakh can be availed individually or collectively
by members of the family. Further, the scheme also includes a provision for transport allowance
that will amount to Rs.300 per visit subjected to an annual ceiling of Rs.3000. The transport
allowance is also part of the total coverage of Rs 2,00,000/- per family.

 All predefined medical procedures are part of the disease/treatment packages. An enrolled BPL
beneficiary may go to any of Network Hospital with a QR Coded Plastic Card and come out
without making any payment to the Hospital for the procedures covered under MA.

 Services will be rendered by both identified private/public/trust hospitals.

 QR coded (Quick Response Code) Plastic cards will be issued to the eligible families under the
scheme. The transactions for the treatment of inpatients shall be cashless.
 To implement the scheme State Government has established a “State Nodal Cell (SNC)” at the
State, which will administer the Mukhyamantri Amrutum (MA) Yojana.

 For the claim processing, deployment of Arogya Mitras, District Coordinators, IEC activities,
empanelment of hospitals etc. An Implementation Support Agency (ISA) has been selected and
very soon, through a Mega Health Camp the scheme will be launched.
In case of new medical coverage card, the coverage shall commence operation from the day on
which the MA Card is issued .The beneficiary need not to have pay anything to get the medical
coverage.

PROCEDURE FOR AVAILING TREATMENT IN THE NETWORK HOSPITALS BY

THE BENEFICIARIES:

Step 1: The Beneficiaries approach the nearby Sub District Hospital/District Hospital/Medical
College & Hospital/Network Hospital. Arogya Mitras would facilitate the Beneficiary. If the
Beneficiary visits any other Government hospital other than the Network Hospital, the doctors
will give him/her a referral card to the Network Hospital after preliminary diagnosis. The
Beneficiary may also attend the Health Camps being conducted by the Network Hospitals and
can get the referral card based on the diagnosis.

Step 2: The Arogya Mitras engaged by the Implementation Support Agency examine the referral
card and the Bar Coded Plastic Card and facilitate the Beneficiary to undergo preliminary
diagnosis and basic tests.

Step 3: The Network Hospital, based on the diagnosis, admits the patient and sends
preauthorization request to the Implementation Support Agency.

Step 4: Doctors/Specialists of the Implementation Support Agency examine the preauthorization

request and approve preauthorization within 24 hours on receiving the preauthorization request
from the Network Hospitals, if all the conditions are satisfied.

Step 5: The Network Hospital extends cashless treatment and surgery to the Beneficiary subject
to the limits prescribed under the Scheme

ADDITIONAL BENEFITS TO BE PROVIDED BY HEALTH SERVICES PROVIDERS

 In addition to the benefits mentioned above, both Public and Private Health Services Providers
should provide free Registration and free OPD consultation to the MA enrolled Beneficiaries.

ELIGIBLE HEALTH SERVICES PROVIDERS:

Empanelment of Public/Grant in Aid hospitals:

All Government/Grant in Aid hospitals as decided by the State Government shall be empanelled.

Criteria for Empanelment of Private Providers:

The empanelment criteria of the Health Services Providers is defined and listed in Part II of this RFP
Document, under the head of Eligibility Criteria. The Implementation Support Agency (ISA) shall
sign Service Agreements with the entities owning all the Hospitals to be empanelled under the
Scheme. The empanelled Hospitals shall extend medical aid to the Beneficiaries as per the Scheme

INNOVATIONS OF PROGRAMME/PROJECT/INITIATIVE:

 Empowering the beneficiary-MA yojana provides the participating BPL beneficiary with
freedom of choice between public and private hospitals and makes him/her a potential client
worth attracting on account of significant revenues that hospitals stand to earn through the
scheme.

 Information (IT) intensive: Biometric Technology, Web based platform for all transactions,
Quick Responses (QR) Card Technology, PKI enabled transactions at hospitals.

 Portability- The key feature of MA is that a beneficiary who has been enrolled in a particular
Taluka (Block) will be able to use his/her MA Card in any MA empanelled hospital across
Gujarat. This scheme is truly unique and beneficial to poor families that migrate from one place
to another. Add-on card also be given to migrant workers to carry a share of the coverage with
them separately.

 Safe and Foolproof- The use of biometric and PKI enabled transactions makes this scheme safe
and foolproof. The card delivery system ensures that the card reaches the correct beneficiary and
there remains accountability in terms of issuance of the MA Card and its usages. The use of
biometric ensures that only the beneficiary can use the MA Card.

 Cashless and Paperless Transaction- A beneficiary of MA gets cashless benefit in any of the
empanelled hospitals. He/She only needs to carry his/her MA Card and provide verification
through his/her finger print. For empanelled hospitals it is a paperless scheme as they do not
need to send all the papers related to treatment to the ISA. They send online claims to the ISA.
 ACHIEVEMENTS OF THE PROGRAMME/PROJECT/INITIATIVE:

 On first day of launching MA yojana two beneficiaries benefited for claim of Rs.1 lakh in private
and government hospitals. Also 15.1 lakh beneficiaries identified for MA yojana and 7.5 lakhs
MA Card printed and distributed till 17/9/12.

 MA card becomes single key for cashless transactions for availing Medical treatment.

 Large number of BPL families covered (approx 39 lakh families).

 Hospitals with top notches facilities and equipments are empanelled to provide medical treatment
which provides wide choices of Hospitals.

 Taluka Kiosks (226 locations ) are set up at every Taluka level for enrollment and help of
beneficiary for MA Yojana. Also, Kiosks are set up at 50 city civic (CVC’s) across Gujarat
Mobile kiosk (100 Mobile Kiosk) to cover remote areas and enrollment at doorsteps of
beneficiaries.

CHALLENGES FACED WHILE IMPLEMENTING THE

PROJECT/PROGRAMME/INITIATIVE AND HOW THEY WERE OVERCOME:

 Getting Buy-in of the Stakeholders –First major challenge was to get the buy-in of not only
people within the State Government but also of Implementation Support Agency (third Party
Auditors) and Card Technology industry. Intensive meetings were organized with all the
stakeholders to explain the scheme design and to get them on board.

 Supply of Necessary Hardware and Software- As huge database is involved and all transaction
are online, special care has been taken to access the requirements of necessary hardware and
software. It needed supply of QR card related to equipments in large numbers. The buy-in of the
industry helped in their responding to the demand.

 Improving the enrollment and hospitalization- Issuance of QR Coded “ MA cards ˮ in the village
is one of the most challenging aspects of MA Cards are issued the awareness in the beneficiaries
about the usage of MA card at empanelled hospitals. Sensitization activities by all the
stakeholders helped improve the awareness in the beneficiaries.
 Lack of capacities at different levels- Building the capacities at each level to implement a
complex scheme like Mukhyamantri Amrutum (MA) was another challenge. Capacities were not
lacking only in the government but also among hospitals, ISA (Third Party Auditors), Manpower
Provision Agency as well as IT services vendor.

 Monitoring and Control- As there is large number beneficiaries and stakeholders involved in the
scheme , the transactions of money happens in large amount , monitoring and making the process
transparent using various validation and de-duplication technology are its challenges.

MAJOR POINTS ON HOW THE PROJECT/PROGRAMME/INITIATIVE CAN BE

REPLICATED OR ADAPTED BY OTHERS:

 Application platform is consistent for different instances and hence same platform can be used
for multiple clients.

 Standardized processes enabled through popular technology for easy replication.

 Technology is effective leveraged to reduce human intervention and hence addresses depleting
workforce issues in government.

 It is easy to use technology which can be easily integrated with legacy systems if any.

 Smooth data transfer, data collection to expedite the processes.

METHODS TO ELABORATE ON THE SCALABILITY OF THE PROGRAMME /

PROJECT/INITIATIVE:

 MA Yojana has been established high-Tech IT infrastructure which provides platform for other
health related schemes for BPL or other beneficiaries in future.

 Higher volume can be catered to by implementing the solution outside Gujarat.

 With increase in number of processes a wider ambit of stakeholders can be addressed.

 MA Card can become single card for availing other health related schemes by BPL families by
integrating other scheme provided by government of Gujarat.

EMPANELMENT PROCEDURE AND DISCIPLINARY PROCEEDINGS:

i. Empanelment:

The District Advisory and Grievance Redressal Committee (DAGRC) will ensure that the
Network Hospitals are having adequate infrastructure, man power, equipment etc., as per the
standards listed for empanelment of Hospital under the Scheme.

ii. Disciplinary actions and De-listing:

On recommendation by the District Advisory and Grievance Redressal Committee (DAGRC),

the SNC/ISA shall take various disciplinary actions against any Network Hospital including de-
listing from the empanelment if it is found that guidelines of the Scheme are not followed by it
and services offered are not satisfactory as per laid down standards. The Hospital may also be
delisted or de-empanelled if the infrastructure in the Hospital is found below the standards laid
down by State Nodal Cell any time during the empanelment period.

ADDITIONAL RESPONSIBILITIES OF THE HEALTH SERVICES PROVIDERS

In addition to providing cashless treatment, the Health Services Providers shall:

a. Display clearly their status of being an empanelled provider of Health Services under the
Mukhyamantri Amrutum (MA) Yojana, in the prescribed format given by State Nodal Cell, at
their main gate.
b. Maintain a functional help desk for giving necessary assistance to the MA Beneficiaries. At
least two persons in the Hospital shall be nominated by the Hospital, who will be trained in
different aspects of MA Yojana by the ISA.
c. Display a poster near the reception/admission desks along with the other materials supplied by
the ISA for the ease of Beneficiaries, Government and ISA. The template of empanelled status
and poster for reception area will be provided by the State Nodal Cell.
d. Send Hospitalisation data of MA patients electronically on a daily basis to the designated
server.

SPECIAL FUNCTIONARIES TO BE PROVIDED BY THE NETWORK HOSPITALS:

The Network Hospitals shall Provide the services of a dedicated Medical Officer to work as,
Hospital Arogya Mitra‟ for the Scheme and he will be responsible to the State Nodal Cell and
the ISA for doing various activities under the Scheme including Health Camps, Follow-up of
referred patients from camps, diagnosis, out-patient details, e-preauthorization, surgeries,
feedback on the patient‟s condition and services offered by the Hospital during Hospital stay of
the patients, discharges, deaths if any, follow-up free consultation of the patients and distribution
of medicines after discharge etc. At the Hospital level, the Hospital Arogya Mitra will coordinate
with Arogya Mitra and the Beneficiary. The role of Hospital Arogya Mitra (HAM) is attached as
Annexure-11.
HEALTH CAMP GUIDELINES

HEALTH CAMP REGISTRATION CUM PRESCRIPTION CARD

Date: ……………………………
Place of Health Camp: …………………………………………………………
Patient Name:………………………………………………Age:………Sex:………,
Full Name of Head of the Family:………………………………………………….
Relation with Head of the Family:………………….............
Address:……………..………………………………………………………………………………
……………………………………………………………………………
Tel No (if any):………………..
Clinical Notes:………………………………………………………………………………

Provisional Diagnosis:………………………………………………………………………
Treatment Advised:…………………………………………………………………………

Details of Medicines Prescribed:…………………………………………………

……………………………………………………………………………………………
………………………………………………………………………………………………

Name & Signature of the Treating

Doctor