Himachal Pradesh High Court Directs State to Release Pending Hospital Payments Under Health Schemes
The Himachal Pradesh High Court has issued a significant ruling, declaring that the state government's failure to release approved payments to empanelled hospitals under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) and the Himcare Scheme is unjustifiable. This decision came during a hearing on a petition filed by hospitals facing financial strain due to non-payment of claims.
Court Orders Swift Action on Approved Bills
A bench headed by Justice Jyotsna Rewal Dua took up the petition and directed the state government to clear pending payments of duly approved bills to M/s Maatri Medicity and Orthocare Hospital in Una district within one month. The court emphasized the urgency of the matter, noting that the hospital had submitted claims in strict accordance with prescribed guidelines, which were verified and approved by authorities.
Additionally, the court issued notices to both the state and central governments, seeking their responses within three weeks. This move underscores the court's intent to address systemic issues in the disbursal of funds under these critical health schemes.
Financial Strain on Empanelled Hospitals
The court observed that the petitioner hospital is legally obligated to provide cashless treatment to eligible beneficiaries as an empanelled healthcare provider under both Ayushman Bharat and Himcare. Despite the approved claims being reflected on the official portal of the Himachal Pradesh Swasthya Bima Yojna Society, payments were not released, causing severe financial disruption.
The petitioner argued that the delay in disbursing funds has severely impacted cash flow and created operational hardships, threatening the hospital's ability to continue offering essential services. The court acknowledged these challenges, holding that a case for interim relief was clearly made out based on the documents presented.
Integration of Ayushman Bharat and Himcare Schemes
The petition highlighted that through a notification dated December 29, 2018, the state government extended cashless treatment coverage to families not previously covered, modeling it on the Ayushman Bharat PM-JAY under the Mukhya Mantri Himachal Health Care Scheme (Himcare). This integration means hospitals empanelled under Ayushman Bharat are automatically empanelled under Himcare, with package rates adopted from the central scheme.
Under the Himcare Scheme, empanelled hospitals provide cashless treatment coverage of up to Rs 5 lakh per family per year, following guidelines issued for Ayushman Bharat PM-JAY. This alignment aims to enhance healthcare access but has been hampered by payment delays, as evidenced in this case.
Court's Emphasis on Timely Disbursal
In its ruling, the court directed state government authorities to release the approved payments by the next date of hearing, stressing that withholding sanctioned claims cannot be justified. This directive aims to alleviate the financial burden on hospitals and ensure uninterrupted healthcare services for beneficiaries.
The court's intervention highlights the need for efficient administrative processes to support the implementation of national and state health schemes, safeguarding both provider sustainability and patient welfare.
