Aarogyasri Health Care Trust
A.Background:
Aarogyasri Scheme is a unique Government-sponsored Community Health Insurance Scheme being implemented by the Government of Telangana. The scheme is the flagship of all health initiatives of the State Government with a mission to provide quality healthcare to the BPL population. The aim of the Government is to achieve “Health for All. The scheme is a unique PPP model in the field of Health Insurance, tailor-made to the health needs of poor patients and providing end-to-end cashless medical services for identified diseases through a network of service providers from the Government and private sector.
In order to facilitate the effective implementation of the scheme, the State Government set up the Aarogyasri Health Care Trust, under the chairmanship of the Honorable Chief Minister. The Trust is administered by a Chief Executive Officer.
The scheme is designed in such a way that the benefit in primary care is addressed through free screening and outpatient consultation both in the network hospitals as part of scheme implementation. The out-patient services in-network hospitals are supplementing the government health care system in preventive and primary care.
The entire process from diagnosing, treatment, follow- up and claim payment is made transparent through online web-based processing to prevent any misuse and fraud. The scheme is complimentary to facilities available in government hospitals and put together fully meets the medical requirements of the BPL population including prevention and primary care. All the Primary Health Centers (PHCs) which are the first contact point, Area/District Hospitals and Network Hospitals, are provided with Help Desks manned by AAROGYA MITHRAs to facilitate the illiterate patients.
B.Objective:
To provide Free quality hospital care and equity of access to BPL families to protect against Catastrophic health expenditures through Strengthened public institutions and by the purchase of quality private medical services from an identified network of health care providers through a self-funded reimbursement mechanism (serviced by Trust) to assist BPL families for their catastrophic health needs.
C.Important stakeholders in the scheme are:
i)The beneficiaries
The beneficiaries of the scheme are the members of Below Poverty Line (BPL) families as enumerated and photographed in White Ration Card.
ii)Network Hospitals – Service Providers
A health care provider shall be a hospital or nursing home in the state both from the public and private sector established for indoor medical care and treatment of disease and injuries and should be registered under Telangana Private Allopathic Medical Establishments (Registration & Regulation) Act and Pre-Conception and Pre-Natal Diagnostic Techniques Act (Wherever Applicable).
iii)District Administration- Mobilization
District-level monitoring committees are set up with the district collector as the chairman of the committee. This committee not only reviews the implementation of the scheme through regular review meetings with the field staff.
iv)Software Company – Technology Solutions
A dedicated real-time online workflow system was designed by the Trust in order to bring dynamism and decentralization of work like Online processing of the cases starting from registration of case at a first referral center, health camps, etc., registration at network hospital, pre-authorization, treatment and other services at the hospital, discharge and post-treatment follow-up, claim settlement, payment gateway, accounting system, TDS deductions, e-office solutions etc. The maintenance of the workflow is done round the clock.
D.Population coverage:
5.71 lakh Below Poverty Line (BPL) families are eligible beneficiaries
E.CMCO Referral Centres:
Patients who are natives of the state of Telangana and not having a White Ration Card, suffering from identified diseases are eligible to obtain the CMCO referral card. The CMCO center will generate the referral card with the digital photograph which will enable the patient to avail cashless treatment under the Aarogyasri scheme.
F.Financial coverage:
The scheme shall provide coverage for the services to the beneficiaries up to Rs.1.50 lakh per family per annum on a floater basis and 0.50 lakh through the buffer, thus total coverage is for Rs.2.0 lakhs. There shall be no co-payment under this scheme.
The following are the categories under which High-end procedures beyond the financial coverage of 2.00 Lakh are included in the Aarogyasri Scheme.
- Cochlear Implantation Surgery.
- Medical Oncology
- Organ Transplantation Surgeries
- Maintenance Haemodialysis
- Thalassemia
G.Benefit Coverage:
The scheme shall provide coverage for the following “Listed Therapies” for identified diseases in Secondary and Tertiary care as listed on the website: www.aarogyasri.telangana.gov.in
- 949 Secondary and Tertiary Care procedures.
- 126 Follow-up packages.
- 9 Organ Transplantation packages with Lifelong 28 Immunosuppressive Follow-up packages for Organ Transplantation.
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- Package includes the following services:
- End-to-end cashless service offered through an NWH from the time of reporting of a patient till ten days post-discharge medication, including complications if any up to thirty (30) days post-discharge, for those patients who undergo a “listed therapy(ies);
- Free evaluation of patients for listed therapies who may not undergo treatment for “listed therapies
- Pre-existing diseases
All the pre-existing cases of the above-mentioned diseases are covered under the scheme. - Follow-up Services
One-year Follow-up package for 126 listed Secondary and Tertiary Care procedures. Follow-up services are provided through fixed packages to the patients who require long-term follow-up therapy including consultation, investigations, drugs in order to get optimum benefit from the procedure and avoid complications.
ACHIEVEMENTS SINCE THE FORMATION OF TELANGANA STATE.
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- Inclusion of 9 Organ Transplantation Surgeries under the Aarogyasri scheme.
- Cadaver Liver Transplantation Surgery
- Live Liver Transplantation Surgery
- Cadaver Heart Transplantation Surgery
- Cadaver Renal Transplantation Surgery
- Live Renal Transplantation Surgery
- Cadaver Lung Transplantation Surgery
- Allogeneic Stem Cell Transplantation Treatment
- Autologous Stem Cell Transplantation Treatment
- Cadaver Heart and Lung Transplantation Surgery Package
- Implementation of Lifelong immunosuppressive therapy for Post Organ Transplantation Surgeries under the Aarogyasri scheme.
- Beyond 2.00 Lakhs Annual Financial Coverage amount, under the following specialties, Aarogyasri beneficiaries are allowed to avail cashless treatment for High-end therapies.
- Cochlear Implantation Surgeries
- Medical Oncology
- Organ Transplantation Surgeries
- Maintenance Hemodialysis treatment
- Thalassemia
- Establishment of 2 Dialysis Centre in Government Hospitals in Nizamabad District under Public-Private Partnership (PPP) to follow HUB AND SPOKE model for managing Dialysis units established in peripheral institutions in providing dialysis treatment to the patients under Aarogyasri Scheme.
- Bus Pass facility to Dialysis patients undergoing treatment under Aarogyasri Scheme.
- Consideration of Age limit beyond 3yrs up to 5yrs of age for Cochlear Implantation Surgery under exceptional conditions on case to case basis under Aarogyasri Scheme.
- Inclusion of Varicose Veins procedure in the listed therapies under the Aarogyasri Scheme and the issue of guidelines.
- Adoption of stent prices from NPPA as per the Gazette of India orders for PTCA with bare metal and drug-eluting stents under the Aarogyasri scheme.
- Aarogyasri Health Care Trust GPS-based mobile app.
- Extending 136 procedures reserved for Govt. Hospitals under the Scheme were opened for Private Medical College Hospitals.
- Inclusion of 9 Organ Transplantation Surgeries under the Aarogyasri scheme.