National Health Authority

The National Health Authority or the NHA is the apex body responsible for implementing India’s flagship public health insurance/assurance scheme ‘Ayushman Bharat Pradhan Mantri Jan Arogya Yojana’ (AB-PMJAY). NHA has been set-up to implement the PM-JAY at the national level. In the States, SHAs or State Health Agencies in the form of a society/trust have been set up with full operational autonomy over the implementation of this scheme including extending the coverage to non SECC beneficiaries.

History

National Health Authority is the successor of National Health Agency, which was functioning as a registered society since 23 May 2018. Pursuant to Cabinet decision for full functional autonomy, National Health Agency was reconstituted as the National Health Authority on 2 January 2019, under Gazette Notification Registered No. DL –(N) 04/0007/2003-18.[1][2] On 2 January 2019 the organization renamed itself to become the "National Health Agency".[1][2] The reason for the rename was the Union Council of Ministers wish for the organization to be autonomous.[1][2]

Governing Board

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 Chairperson and 11 members.

Functions of NHA
  • Formulation of various operational guidelines related to PM-JAY, model documents and contracts to ensure standardisation 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, standardisation, 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.

References
  1. India Today Web Desk (3 January 2019). "Cabinet to replace National Health Agency with National Health Authority". India Today.
  2. Sharma, Neetu Chandra (2 January 2019). "Cabinet approved restructuring of National Health Agency as "National Health Authority"". Livemint.
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