The Madras High Court disposed of a Petition filed seeking direction to the respondents to form a committee to conduct comprehensive costing analysis for revising/enhancing the tariff for all procedures under the Tamil Nadu Chief Minister’s Comprehensive Health Insurance Scheme (TNCMCHIS) to the Hospitals accredited with NABH for the benefit of the peoples of Delta Districts (Tanjore, Pudukottai, Nagapattinam).
A status report is filed by the second respondent. It is stated that pending petition, dated 08.01.2022 has been issued to continue to implement the Chief Minister’s Comprehensive Health Insurance Scheme for a period of five years, with effect from 11.01.2022 to 10.01.2027 through a Insurance Company at a premium of Rs.849/- per annum for around 1.47 crore families. The National Pradhan Manthri Jan Arogya Yojana (ABPMJAY), Government of India Insurance Scheme, was integrated with Chief Minister’s Comprehensive Health Insurance Scheme with effect from 23.09.2018. Thus, the sum insured per family is fixed as Rs.5 lakh per annum with 1991 procedures and 86.50 families from Socio Economic Case Census (SECC) data base 2011.
It is further stated that the ceiling limit for enrolling a beneficiary under the Scheme has been increased to Rs.1.20 lakh from 2022 onwards to get health coverage up to Rs.5 lakh per year per family. Three third party administrators have been selected to implement the Scheme in 38 districts on rotation basis. A tripartite Memorandum of Agreement was entered into between the Insurer, hospitals and third party administrators to render cashless health services to the beneficiaries at fixed package rates . According to the State Government Pleader, various Committees are constituted under CMCHIS to review the smooth functioning of the Scheme.
According to the State Government Pleader, the present tender agreement for the implementation of CMCHIS is for 5 years from 11.01.2022 to 10.01.2027. Any revision/increase in the package cost can be done only after the end of the present contract period. The High Level Committee headed by Secretary, Health Department, State Empowered Committee headed by Chief Secretary to Government and the Core Committee are constituted to deal with several issues arising out of CMCHIS. Therefore, there is no further need for constituting another Committee.
As per the status report, the package rates of CMCHIS is based on the current cost prevailing in the market, expenses incurred in the previous scheme and the feedback received from the hospitals in consultation with experts of the empaneled health care providers, Deans and HODs of medical colleges. Since the infrastructure available in EHCPS in other States are different from Tamil Nadu, arriving at uniformity is difficult in comparison to the above reports. Further, while fixing the package rates, due consideration is given for inflation, tax variations, minimum wages, etc. and thus, the package rates are arrived at in a scientific manner.
In view of the above the , the Division Bench of Acting Chief Justice D. Krishnakumar and Justice PB Balaji disposed of the Petition.