Consider the following statements regarding Fraud detection and anti-abuse mechanisms using AI and data analytics:
1. The 'Hospital Grading System' launched in 2020 links the release of central government funds directly to the hospital's performance in fraud prevention audits conducted by the Comptroller and Auditor General.
2. The PM-JAY portal integrates with the Goods and Services Tax Network (GSTN) to cross-verify hospital expenditure patterns, a feature introduced in the 2021 amendment to the scheme's operational guidelines.
3. The National Health Authority utilizes the Anti-Fraud AI (AFA) system, which leverages machine learning algorithms to identify suspicious patterns in hospital billing data across the PM-JAY network.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 3 is correct. Statement 1 is incorrect. Statement 2 is incorrect.
Statement 3 is correct as the National Health Authority (NHA) employs the Anti-Fraud AI (AFA) system to detect anomalies and fraudulent billing patterns through predictive analytics. Statement 1 is incorrect because hospital grading is based on quality and patient satisfaction metrics, not linked to CAG-conducted fraud audits for fund release. Statement 2 is incorrect as there is no such provision in the PM-JAY operational guidelines to integrate with the GSTN for cross-verifying hospital expenditure patterns.
Consider the following statements regarding Incentive structures for high-performing states and hospitals:
1. States achieving a high percentage of e-KYC completion for beneficiaries receive additional administrative budget allocations as part of the performance-linked funding mechanism.
2. The National Health Authority introduced the 'Kayakalp' awards to incentivize public hospitals for maintaining high standards of hygiene and sanitation under the PM-JAY framework.
3. The 2018 PM-JAY operational guidelines established a direct tax rebate for private hospitals that achieve a 90% occupancy rate for Ayushman Bharat patients throughout the fiscal year.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is correct. Statement 2 is correct. Statement 3 is incorrect.
Statement 1 is correct as the National Health Authority (NHA) uses performance-based incentives, including administrative budget allocations, to encourage high e-KYC completion rates for better beneficiary identification. Statement 2 is correct because the 'Kayakalp' initiative, launched in 2015 and integrated into PM-JAY quality frameworks, rewards public health facilities for excellence in hygiene, sanitation, and infection control. Statement 3 is incorrect because there is no provision for direct tax rebates for private hospitals based on occupancy rates under the PM-JAY operational guidelines; instead, hospitals are reimbursed through a pre-defined package rate system.
Consider the following statements regarding Fraud detection and anti-abuse mechanisms using AI and data analytics:
1. The National Health Authority launched the 'Arogya-Mitra' mobile application in 2022, which allows patients to upload surgical photos to verify the completion of procedures as part of the scheme's biometric authentication layer.
2. Under the 2019 data sharing protocol, the NHA provides the Central Bureau of Investigation with automated access to the Ayushman Bharat database for the purpose of initiating criminal proceedings against non-compliant healthcare providers.
3. The 'Health Benefit Package 2.0' includes a provision for the automatic suspension of hospital empanelment when the claim rejection rate exceeds 15% during a single financial quarter.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is incorrect. Statement 2 is incorrect. Statement 3 is incorrect.
All three statements are incorrect: the 'Arogya-Mitra' app is for healthcare facilitators to manage patient services, not for patient-led surgical photo verification; the NHA maintains strict data privacy protocols and does not provide the CBI with automated, direct access to the database; and there is no policy mandating automatic hospital de-empanelment based on a 15% claim rejection rate, as fraud detection relies on a multi-layered risk-scoring mechanism rather than a fixed percentage threshold.
Consider the following statements regarding Inter-state portability of benefits and cross-border claim settlement:
1. The Central Claims Processing System, launched in 2020, handles the settlement of inter-state portability claims by deducting the treatment costs from the annual budgetary allocation of the beneficiary's home state.
2. The Inter-State Portability portal allows empaneled hospitals to submit claims directly to the National Health Authority for services rendered to beneficiaries registered under different state-specific schemes.
3. Under the provisions of the 2021 portability expansion, patients are permitted to access secondary care services in any state, provided they obtain a digital referral code from the District Medical Officer of their home district.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 2 is correct. Statement 1 is incorrect. Statement 3 is incorrect.
Statement 2 is correct as the National Health Authority (NHA) facilitates seamless portability, allowing hospitals to claim reimbursement directly through the IT platform for patients treated outside their home state. Statement 1 is incorrect because claims are settled via a 'portability ledger' mechanism between states rather than by deducting from the central budgetary allocation. Statement 3 is incorrect because PM-JAY is designed to be 'cashless and paperless' across the country, and there is no requirement for a digital referral code from a District Medical Officer to access secondary care in another state.
Consider the following statements regarding IT infrastructure and the role of the Transaction Management System (TMS):
1. Under the PM-JAY governance framework, the Transaction Management System processes claims based on the Health Benefit Packages (HBP) 2.0, which were finalized in 2020 to include mandatory coverage for outpatient diagnostic services.
2. The Transaction Management System operates as a cloud-based interface that allows state governments to independently modify the reimbursement rates for surgical procedures without prior approval from the National Health Authority.
3. The IT architecture of the Ayushman Bharat mission relies on the Transaction Management System to authenticate medical practitioners through the Medical Council of India database before authorizing surgical procedures in tertiary care centers.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is incorrect. Statement 2 is incorrect. Statement 3 is incorrect.
Statement 1 is incorrect because HBP 2.0 focused on rationalizing rates for secondary and tertiary care, not outpatient diagnostic services. Statement 2 is incorrect as the National Health Authority (NHA) maintains centralized control over reimbursement rates to ensure uniformity, and states cannot unilaterally modify them without NHA approval. Statement 3 is incorrect because the TMS authenticates beneficiaries via Aadhaar/e-KYC and empanelled hospitals, not individual medical practitioners through the Medical Council of India database.
Consider the following statements regarding Standard Treatment Guidelines (STGs) and their impact on clinical governance:
1. The PM-JAY operational guidelines refer to the use of the electronic health record system, which provides for the automatic transfer of patient data to the Insurance Regulatory and Development Authority for periodic clinical review.
2. The clinical governance structure of PM-JAY encompasses the State Health Agencies, which hold the authority to modify the Standard Treatment Guidelines to reflect the specific demographic disease burden identified in the 2011 Census.
3. The secondary care packages under PM-JAY include provisions for tertiary interventions, and the 2021 amendment to the guidelines allows hospitals to bypass the referral system for patients residing in aspirational districts.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is incorrect. Statement 2 is incorrect. Statement 3 is incorrect.
All three statements are incorrect because PM-JAY data is managed through the Transaction Management System (TMS) under the National Health Authority, not the IRDAI; State Health Agencies do not have the authority to unilaterally modify national STGs, which are standardized to ensure uniform quality of care; and the PM-JAY guidelines maintain a strict referral protocol for tertiary care, with no provision in the 2021 amendments allowing hospitals to bypass these requirements based on residence in aspirational districts.
Consider the following statements regarding Inter-state portability of benefits and cross-border claim settlement:
1. Claim settlement for cross-border treatments is managed through the Transaction Management System (TMS) portal, which facilitates the automated transfer of funds between the National Health Authority and State Health Agencies.
2. The portability mechanism operates under the 2019 guidelines, which permit beneficiaries to claim travel allowances for cross-border medical visits if the distance between the home state and the treatment facility exceeds 500 kilometers.
3. The Ayushman Bharat PM-JAY framework enables beneficiaries to access cashless healthcare services at any empaneled hospital across India through the inter-state portability feature.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is correct. Statement 3 is correct. Statement 2 is incorrect.
Statement 1 is correct as the Transaction Management System (TMS) acts as the central digital backbone for processing claims and facilitating fund settlements between the National Health Authority (NHA) and State Health Agencies (SHAs). Statement 3 is correct because PM-JAY is designed as a pan-India scheme, ensuring that any eligible beneficiary can access cashless treatment at any of the thousands of empaneled hospitals across the country regardless of their state of residence. Statement 2 is incorrect because, while PM-JAY provides portability for medical treatment, there is no provision under the scheme's guidelines that grants beneficiaries travel allowances for cross-border medical visits.
Consider the following statements regarding Public-Private Partnership (PPP) models in service delivery:
1. The National Health Authority (NHA) functions as the apex body for the implementation of PM-JAY, overseeing the empanelment of both public and private hospitals under the scheme.
2. Under the 2018 guidelines, the National Health Agency replaced the Rashtriya Swasthya Bima Yojana, and the funding ratio for all participating states was fixed at a uniform 90:10 split between the Union and the states.
3. The Pradhan Mantri Jan Arogya Yojana utilizes a trust-based model in 20 states, while the remaining 16 states operate under a fully centralized insurance-based model managed by the Insurance Regulatory and Development Authority.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is correct. Statement 2 is incorrect. Statement 3 is incorrect.
Statement 1 is correct as the National Health Authority (NHA) is the apex body responsible for the overall implementation, policy formulation, and empanelment of hospitals under PM-JAY. Statement 2 is incorrect because the funding ratio is 90:10 only for North Eastern and Himalayan states, while it is 60:40 for other states and 100% for Union Territories without legislature. Statement 3 is incorrect because PM-JAY allows states to choose between Trust, Insurance, or a Hybrid model, and there is no mandate for a centralized insurance-based model managed by IRDAI across 16 states.
Consider the following statements regarding Standard Treatment Guidelines (STGs) and their impact on clinical governance:
1. The National Quality Assurance Standards for public health facilities provide a mechanism for the state governments to adjust the PM-JAY treatment pricing based on the local cost of living index established in 2020.
2. The PM-JAY IT platform utilizes the National Health Stack architecture to enable the automatic rejection of insurance claims that deviate from the 2016 National Medical Council clinical practice guidelines.
3. The PM-JAY clinical governance framework incorporates over 1,600 health benefit packages, each mapped to specific treatment protocols to ensure consistency in patient care outcomes.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 3 is correct. Statement 1 is incorrect. Statement 2 is incorrect.
Statement 3 is correct because PM-JAY utilizes a robust clinical governance framework with over 1,600 health benefit packages mapped to specific treatment protocols to standardize care and curb over-treatment. Statement 1 is incorrect as PM-JAY pricing is determined by the National Health Authority based on market studies and clinical costs, not by a state-level adjustment mechanism linked to a 2020 cost of living index. Statement 2 is incorrect because while the IT platform uses the National Health Stack for fraud detection and claims processing, it does not automatically reject claims based on 2016 guidelines, as clinical protocols are dynamic and governed by the NHA's evolving Health Benefit Package (HBP) master data.
Consider the following statements regarding Role of State Health Agencies (SHAs) in decentralized implementation:
1. The SHA is authorized to modify the eligibility criteria for beneficiaries defined under the Socio-Economic Caste Census 2011 to include additional low-income groups identified by the state's 2018 survey.
2. The National Health Authority provides a fixed annual budget to the SHA, which the agency utilizes to procure medical equipment for public hospitals participating in the PM-JAY network.
3. The State Health Agency operates under the direct supervision of the Union Ministry of Finance, which allocates the 60:40 funding ratio for the implementation of the PM-JAY scheme.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is incorrect. Statement 2 is incorrect. Statement 3 is incorrect.
Statement 1 is incorrect because while states can expand coverage, they cannot modify the core SECC 2011 eligibility criteria defined by the Centre. Statement 2 is incorrect as the NHA provides funds for premium payments or claims management, not for procuring medical equipment for public hospitals, which remains a state-level infrastructure responsibility. Statement 3 is incorrect because the SHA operates under the State Government and the National Health Authority (NHA), not the Union Ministry of Finance, which is not the nodal agency for scheme implementation.
Consider the following statements regarding Incentive structures for high-performing states and hospitals:
1. The NHA utilizes the 'Health Benefit Package 2022' framework to adjust reimbursement rates for hospitals located in aspirational districts, aiming to bridge regional healthcare disparities.
2. Under the PM-JAY incentive structure, hospitals performing surgeries in the 'High-Volume, Low-Cost' category receive a 10% bonus on the standard package rate for exceeding defined annual targets.
3. Since the inception of the scheme in 2018, the NHA has implemented a 'Star Rating' system for empanelled hospitals, which correlates with the visibility of these facilities on the official beneficiary portal.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is correct. Statement 2 is correct. Statement 3 is correct.
Statement 1 is correct as the National Health Authority (NHA) introduced add-on payments for hospitals in aspirational districts under the HBP 2022 to incentivize service delivery in underserved regions. Statement 2 is correct because the PM-JAY framework provides performance-linked incentives, including bonuses for hospitals achieving high-volume surgical targets to improve efficiency. Statement 3 is correct as the NHA launched the 'Hospital Performance Monitoring' dashboard and star-rating system, which publicly displays hospital quality metrics to empower beneficiaries and drive competitive performance among empanelled facilities.
Consider the following statements regarding Role of Pradhan Mantri Arogya Mitras (PMAMs) in beneficiary facilitation:
1. The role of the PMAM includes generating the e-card for eligible beneficiaries and providing information regarding the coverage limits of 5 lakh rupees per family per year.
2. The PMAMs are trained under the National Health Authority (NHA) framework to assist patients in navigating the hospital admission process for secondary and tertiary care.
3. As of the 2023 guidelines, PMAMs are responsible for verifying the identity of beneficiaries using Aadhaar-based e-KYC or other government-approved documents at the point of care.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is correct. Statement 2 is correct. Statement 3 is correct.
All three statements are correct: PMAMs act as the primary interface at empanelled hospitals, facilitating e-card generation and educating beneficiaries on the ₹5 lakh annual family coverage. They are trained under the NHA's Skill Development framework to streamline hospital admissions for secondary and tertiary care. Furthermore, PMAMs are mandated to ensure secure beneficiary identification through Aadhaar-based e-KYC or other NHA-approved documents to prevent fraud and ensure service delivery to eligible individuals.
Consider the following statements regarding Public-Private Partnership (PPP) models in service delivery:
1. The Hospital Empanelment and Quality Standards (HEQS) committee, established in 2019, oversees the accreditation of private hospitals and grants automatic eligibility to all facilities holding a valid NABH entry-level certificate.
2. The Health Benefit Packages (HBP) under PM-JAY were revised in 2022 to include 1,949 medical procedures, providing standardized rates for services delivered through private healthcare providers.
3. As of the 2023-24 fiscal year, the Ayushman Bharat PM-JAY framework allows for the portability of benefits, enabling beneficiaries to access secondary and tertiary care services across any empanelled hospital in India.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 2 is correct. Statement 3 is correct. Statement 1 is incorrect.
Statement 1 is incorrect because while NABH accreditation is encouraged, there is no 'automatic eligibility' for empanelment; hospitals must still undergo a rigorous verification process by the State Health Agency (SHA) to meet specific infrastructure and service standards. Statement 2 is correct as the HBP 2022 was indeed expanded to include 1,949 procedures to ensure cost-effective and standardized pricing for private providers. Statement 3 is correct because PM-JAY is designed as a pan-India scheme, ensuring that beneficiaries can access cashless secondary and tertiary care at any empanelled public or private hospital across the country, regardless of their state of residence.
Consider the following statements regarding Fraud detection and anti-abuse mechanisms using AI and data analytics:
1. The Transaction Management System (TMS) under Ayushman Bharat generates real-time alerts for 'high-frequency' procedures, allowing state health agencies to conduct targeted audits of claims exceeding the 95th percentile of regional cost variations.
2. As of the 2023-24 fiscal period, the PM-JAY framework incorporates the 'Fraud and Abuse Control Guidelines' which provide a standardized mechanism for state-level de-empanelment of hospitals based on automated risk scores.
3. The NHA implemented the 'National Anti-Fraud Unit' (NAFU) in 2018 to coordinate with State Anti-Fraud Units (SAFUs) for the centralized monitoring of claim processing through data analytics dashboards.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is correct. Statement 2 is correct. Statement 3 is correct.
All three statements are correct: the Transaction Management System (TMS) utilizes real-time analytics to flag outliers and high-frequency procedures for targeted audits to prevent billing irregularities. The 'Fraud and Abuse Control Guidelines' establish a robust, standardized framework that empowers State Health Agencies (SHAs) to initiate de-empanelment processes based on objective, AI-driven risk scoring. Furthermore, the National Anti-Fraud Unit (NAFU) was established by the National Health Authority (NHA) at the scheme's inception in 2018 to act as the apex body for coordinating with State Anti-Fraud Units (SAFUs) through centralized data monitoring.
Consider the following statements regarding IT infrastructure and the role of the Transaction Management System (TMS):
1. The National Health Authority (NHA) integrated the Transaction Management System with the National Health Claims Exchange (NHCX) in 2022 to standardize the digital exchange of health claims data between providers and payers.
2. The Transaction Management System (TMS) under PM-JAY serves as the primary digital interface for hospital empanelment and real-time claim processing across the National Health Authority's IT ecosystem.
3. As of the 2023-24 financial year, the PM-JAY IT infrastructure utilizes the Hospital Transaction Management System (HTMS) to facilitate the verification of beneficiary eligibility through the Ayushman App.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is correct. Statement 2 is correct. Statement 3 is correct.
All three statements are correct. The NHA integrated the TMS with the NHCX in 2022 to enable interoperability and standardized claim processing across the health ecosystem. The TMS functions as the core digital backbone for PM-JAY, managing end-to-end hospital empanelment and real-time claims, while the Hospital Transaction Management System (HTMS) is specifically utilized within the Ayushman App to verify beneficiary eligibility and facilitate seamless service delivery as of the 2023-24 fiscal period.
Consider the following statements regarding The 'Trust' vs 'Insurance' model of implementation:
1. Under the trust model, the Union Ministry of Health and Family Welfare provides 100% of the funding for claim settlements, while the state government handles the digital platform infrastructure.
2. The 2018 PM-JAY framework established the National Health Agency as a statutory body under the Ministry of Finance to oversee the actuarial assessment of state-level insurance premiums.
3. The National Health Authority allows states to choose between an insurance model, a trust model, or a hybrid model for the implementation of PM-JAY.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 3 is correct. Statement 1 is incorrect. Statement 2 is incorrect.
Statement 3 is correct because the National Health Authority (NHA) provides states the flexibility to implement PM-JAY through an insurance company, a dedicated state health agency (Trust model), or a hybrid approach. Statement 1 is incorrect because funding is shared between the Centre and States (typically 60:40), and the Trust model involves the State Health Agency managing claims directly rather than the Union Ministry handling 100% of settlements. Statement 2 is incorrect because the National Health Authority is an attached office under the Ministry of Health and Family Welfare, not a statutory body under the Ministry of Finance, and it oversees policy implementation rather than actuarial assessments of premiums.
Consider the following statements regarding Monitoring of out-of-pocket expenditure (OOPE) reduction metrics:
1. The National Health Authority utilizes the Transaction Management System to track real-time reduction in out-of-pocket expenditure for secondary and tertiary care hospitalizations.
2. The 75th round of the National Sample Survey Office data serves as the baseline for calculating the pre-implementation levels of catastrophic health expenditure in India.
3. The 2018 PM-JAY operational guidelines include the provision for direct cash transfers to patients for outpatient diagnostic services, and this mechanism accounts for the 15 percent reduction in reported out-of-pocket expenditure.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is correct. Statement 2 is correct. Statement 3 is incorrect.
Statement 1 is correct as the National Health Authority uses the Transaction Management System (TMS) to monitor real-time hospitalizations and claims, which helps estimate the reduction in out-of-pocket expenditure (OOPE). Statement 2 is correct because the 75th round of the NSSO (2017-18) provides the official baseline for measuring catastrophic health expenditure prior to the launch of PM-JAY. Statement 3 is incorrect because PM-JAY is primarily a cashless, paperless scheme for secondary and tertiary inpatient care and does not include direct cash transfers for outpatient diagnostic services.
Consider the following statements regarding Role of the Health Benefit Package (HBP) revision committee:
1. The HBP revision committee encompasses the oversight of the Pradhan Mantri Jan Arogya Yojana's IT infrastructure, and it facilitates the direct transfer of funds to beneficiaries through the Direct Benefit Transfer (DBT) portal.
2. The HBP revision committee refers to the guidelines established by the Medical Council of India (MCI) to fix the professional fees of surgeons, and it provides for the automatic indexing of package rates based on the annual Consumer Price Index.
3. As of the 2022 revision, the Health Benefit Package (HBP) 2.2 framework introduced over 1,600 distinct medical and surgical procedures to ensure comprehensive secondary and tertiary care coverage.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 3 is correct. Statement 1 is incorrect. Statement 2 is incorrect.
Statement 3 is correct because the HBP 2.2 framework significantly expanded the scope of PM-JAY to include over 1,600 procedures to enhance secondary and tertiary care access. Statement 1 is incorrect because the HBP committee focuses exclusively on clinical procedures and pricing, whereas IT infrastructure and DBT management are handled by the National Health Authority's (NHA) IT division. Statement 2 is incorrect because the committee does not follow MCI guidelines for professional fees, nor is there a mechanism for automatic indexing of rates based on the Consumer Price Index; instead, rates are periodically reviewed and adjusted by the NHA based on evidence-based costing and stakeholder consultations.
Consider the following statements regarding National Health Authority (NHA) organizational structure and mandate:
1. The Governing Board of the National Health Authority is chaired by the Union Minister for Health and Family Welfare and includes the CEO of NITI Aayog as a member.
2. Under the Ayushman Bharat scheme, the National Health Authority provides for the portability of health services, allowing beneficiaries to access treatment at any empanelled hospital across India.
3. The National Health Authority was established on 2 January 2019 by replacing the erstwhile National Health Agency to implement the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is correct. Statement 2 is correct. Statement 3 is correct.
The Governing Board of the NHA is indeed chaired by the Union Minister for Health and Family Welfare and includes the CEO of NITI Aayog as a member, ensuring high-level policy coordination. The NHA facilitates seamless portability of health services, enabling beneficiaries to access cashless treatment at any of the thousands of empanelled hospitals across India, regardless of their state of residence. Furthermore, the NHA was formally established as an attached office to the Ministry of Health and Family Welfare on 2 January 2019, succeeding the National Health Agency to provide a robust institutional framework for the implementation of the PM-JAY scheme.
Consider the following statements regarding Role of the Health Benefit Package (HBP) revision committee:
1. The HBP revision committee is associated with the selection process of third-party administrators (TPAs), and it manages the digital interface for the processing of claims submitted by public sector hospitals.
2. The HBP framework includes provisions for the inclusion of traditional AYUSH treatments, and the committee holds the authority to approve the accreditation of wellness centers under the Ayushman Bharat Health and Wellness Centre scheme.
3. The Health Benefit Package (HBP) revision committee, chaired by the Member (Health) of NITI Aayog, is responsible for periodic adjustments to the rates and coverage of medical procedures under PM-JAY.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 3 is correct. Statement 1 is incorrect. Statement 2 is incorrect.
Statement 3 is correct because the HBP revision committee, chaired by the Member (Health) of NITI Aayog, is tasked with the scientific review and periodic rationalization of medical procedure rates to ensure they remain viable for hospitals. Statement 1 is incorrect as the selection of TPAs and the management of the IT platform (TMS) are handled by the National Health Authority (NHA), not the HBP committee. Statement 2 is incorrect because, while AYUSH treatments are covered under PM-JAY, the accreditation of Health and Wellness Centres is managed by the Ministry of Health and Family Welfare under the Ayushman Bharat-HWCs vertical, independent of the HBP revision committee's mandate.
Consider the following statements regarding Monitoring of out-of-pocket expenditure (OOPE) reduction metrics:
1. Data from the National Health Accounts estimates for 2019-20 indicate that the share of out-of-pocket expenditure in total health expenditure declined to 47.1 percent.
2. The National Health Authority introduced the 'Ayushman Mitra' initiative to assist beneficiaries at empanelled hospitals in navigating the cashless transaction process.
3. The PM-JAY portability feature allows beneficiaries to access empanelled hospital services across state lines, ensuring financial protection regardless of the place of residence.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is correct. Statement 2 is correct. Statement 3 is correct.
All three statements are correct: The National Health Accounts (NHA) 2019-20 report confirms that OOPE as a share of Total Health Expenditure (THE) fell to 47.1%, down from 62.6% in 2014-15. The 'Ayushman Mitra' initiative was specifically launched by the National Health Authority to act as a frontline facilitator for patients at empanelled hospitals, while the PM-JAY portability feature provides nationwide coverage, allowing beneficiaries to avail of cashless treatment at any empanelled hospital across India regardless of their home state.
Consider the following statements regarding Audit mechanisms and performance monitoring of empanelled hospitals:
1. The Hospital Empanelment and Quality Standards committee oversees the accreditation status of facilities under the National Accreditation Board for Hospitals and Healthcare Providers.
2. The Transaction Management System generates automated alerts for suspicious claims, which are then processed by the National Anti-Fraud Unit established in 2018.
3. The PM-JAY operational framework incorporates the 2015 Clinical Establishments Act to define the legal liability of the Union Ministry of Health regarding individual medical malpractice claims.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is correct. Statement 2 is correct. Statement 3 is incorrect.
Statement 1 is correct as the Hospital Empanelment and Quality Standards (HEQS) committee ensures hospitals meet the required quality benchmarks, often linked to NABH accreditation. Statement 2 is correct because the National Anti-Fraud Unit (NAFU) was established in 2018 to monitor the Transaction Management System (TMS) and utilize data analytics to detect fraudulent claims. Statement 3 is incorrect because the PM-JAY operational framework does not make the Union Ministry of Health legally liable for individual medical malpractice; malpractice remains the responsibility of the empanelled hospital and the respective State Health Agencies.
Consider the following statements regarding Data privacy and security protocols under the Ayushman Bharat health stack:
1. The Ayushman Bharat Digital Mission (ABDM) incorporates the 2019 Personal Data Protection Bill as its primary legal foundation, and the NHA acts as the central adjudicating authority for all cross-border health data disputes.
2. The National Health Authority (NHA) functions as the apex body responsible for the implementation of Ayushman Bharat PM-JAY and oversees the Ayushman Bharat Digital Mission (ABDM) framework.
3. The Health Information Exchange and Consent Manager (HIE-CM) framework follows the guidelines established by the 2018 DISHA Act, which provides for the creation of a National Electronic Health Authority to oversee data encryption standards.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 2 is correct. Statement 1 is incorrect. Statement 3 is incorrect.
Statement 2 is correct because the National Health Authority (NHA) is the apex body mandated to implement PM-JAY and the ABDM framework. Statement 1 is incorrect because the 2019 Personal Data Protection Bill was withdrawn, and the ABDM operates under the Digital Personal Data Protection Act, 2023, with the Data Protection Board of India, not the NHA, serving as the adjudicating authority. Statement 3 is incorrect because the DISHA (Digital Information Security in Healthcare Act) was a draft proposal that was never enacted into law, and the HIE-CM framework relies on the ABDM Health Information Standards rather than a non-existent 2018 Act.
Consider the following statements regarding Inter-state portability of benefits and cross-border claim settlement:
1. The National Health Authority introduced the 'One Nation, One Card' initiative to streamline the verification process for migrant beneficiaries seeking medical services outside their registered state of residence.
2. As of the 2023-24 financial year, the PM-JAY ecosystem has recorded over 1.5 million inter-state portability transactions since the inception of the scheme in 2018.
3. Under the portability guidelines, the reimbursement rates for a procedure are determined by the health benefit package rates of the state where the hospital is located, rather than the beneficiary's home state.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is correct. Statement 2 is correct. Statement 3 is correct.
Statement 1 is correct as the 'One Nation, One Card' initiative enables beneficiaries to access cashless services across any empanelled hospital in India, regardless of their state of registration. Statement 2 is correct, with NHA data confirming that inter-state portability has facilitated over 1.5 million hospital admissions for migrant populations since the scheme's 2018 launch. Statement 3 is correct because the scheme follows a 'destination-based' payment model, where the hospital is reimbursed according to the rates defined by the state where the medical procedure is performed, ensuring administrative consistency.
Consider the following statements regarding Role of State Health Agencies (SHAs) in decentralized implementation:
1. The State Health Agency (SHA) is registered as a society under the Societies Registration Act, 1860, to oversee the implementation of PM-JAY at the state level.
2. The SHA is empowered to empanel healthcare providers, including both public and private hospitals, based on the minimum quality standards prescribed by the National Health Authority.
3. Under the decentralized framework, the SHA maintains a dedicated IT infrastructure that interfaces with the national Transaction Management System to facilitate real-time claim processing.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is correct. Statement 2 is correct. Statement 3 is correct.
The State Health Agency (SHA) is established as a registered society or trust by state governments to ensure administrative autonomy in implementing PM-JAY, as mandated by the National Health Authority (NHA) guidelines. SHAs are empowered to empanel hospitals based on NHA's quality benchmarks and manage the decentralized IT infrastructure, which seamlessly integrates with the national Transaction Management System (TMS) to enable real-time monitoring and transparent claim settlements. All three statements are factually correct as they align with the operational framework defined under the Ayushman Bharat PM-JAY mission document.
Consider the following statements regarding Empanelment criteria and de-empanelment protocols for healthcare providers:
1. Under the PM-JAY guidelines, hospitals are categorized into primary, secondary, and tertiary levels, with specific requirements for Intensive Care Unit (ICU) beds and specialized diagnostic equipment for tertiary empanelment.
2. The PM-JAY framework allows for the automatic empanelment of hospitals accredited by the National Accreditation Board for Hospitals (NABH), which was established under the Quality Council of India in 2005.
3. The National Health Authority (NHA) maintains the empanelment process through the Hospital Empanelment Module (HEM) portal, which serves as the centralized digital interface for healthcare providers.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is correct. Statement 3 is correct. Statement 2 is incorrect.
Statement 1 is correct as PM-JAY mandates specific infrastructure, such as ICU beds and diagnostic facilities, for hospitals to qualify for secondary and tertiary care empanelment. Statement 3 is correct because the Hospital Empanelment Module (HEM) portal is the official centralized digital platform managed by the National Health Authority (NHA) for the onboarding and management of healthcare providers. Statement 2 is incorrect because while NABH accreditation is a preferred qualification that may fast-track the process, it does not grant 'automatic' empanelment; all hospitals must still undergo the mandatory verification and compliance checks stipulated by the NHA.
Consider the following statements regarding Integration of PM-JAY with the Ayushman Bharat Digital Mission (ABDM):
1. Under the PM-JAY and ABDM convergence framework, the Electronic Health Record (EHR) system allows for the seamless transfer of patient medical history across empanelled hospitals.
2. The NHA launched the 'Scan and Share' QR code initiative at PM-JAY empanelled hospitals to reduce patient registration time through the ABDM digital infrastructure.
3. The 2018 PM-JAY guidelines encompass the use of the Ayushman Bharat Health Account (ABHA) for the real-time monitoring of pharmaceutical supply chains within state-run district hospitals.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is correct. Statement 2 is correct. Statement 3 is incorrect.
Statement 1 is correct as the convergence enables interoperability of Electronic Health Records (EHR) through the ABDM ecosystem, facilitating secure data exchange between empanelled hospitals. Statement 2 is correct because the 'Scan and Share' QR code initiative, launched by the National Health Authority (NHA), leverages ABHA IDs to instantly populate patient registration data, significantly reducing waiting times. Statement 3 is incorrect because the ABHA is designed for individual health record management and patient identification, not for the real-time monitoring of pharmaceutical supply chains, which is managed by separate digital platforms like the Integrated Health Information Platform (IHIP) or state-specific logistics systems.
Consider the following statements regarding Grievance redressal mechanisms and the role of the National Anti-Fraud Unit (NAFU):
1. State Health Agencies are empowered to initiate de-empanelment proceedings against hospitals, provided the investigation is completed within a fixed 30-day window following the initial fraud report.
2. The National Anti-Fraud Unit utilizes the Transaction Management System to track hospital claims, which was formally integrated into the Insurance Regulatory and Development Authority of India database in 2020.
3. The Central Grievance Redressal Management System (CGRMS) serves as the primary portal for beneficiary complaints and operates under the direct administrative supervision of the Ministry of Finance.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is incorrect. Statement 2 is incorrect. Statement 3 is incorrect.
Statement 1 is incorrect because while State Health Agencies (SHAs) manage de-empanelment, there is no statutory 30-day fixed window for investigations under PM-JAY guidelines. Statement 2 is incorrect as the Transaction Management System (TMS) is an internal NHA platform and is not integrated with the IRDAI database. Statement 3 is incorrect because the CGRMS is under the administrative supervision of the National Health Authority (NHA), not the Ministry of Finance.
Consider the following statements regarding Monitoring of out-of-pocket expenditure (OOPE) reduction metrics:
1. State Health Agencies are tasked with conducting periodic audits of hospital discharge summaries to verify the non-collection of informal payments from patients.
2. Under the Ayushman Bharat PM-JAY framework, the Health Benefit Packages 2.2 include specific cost-capping mechanisms designed to mitigate financial burden on beneficiaries.
3. The PM-JAY dashboard reports that over 6.2 crore hospital admissions have been authorized since the inception of the scheme in September 2018.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is correct. Statement 2 is correct. Statement 3 is correct.
All three statements are correct: State Health Agencies (SHAs) are mandated to audit discharge summaries to ensure a cashless experience and prevent informal payments, while Health Benefit Packages (HBP) 2.2 introduced refined cost-capping and rationalized rates to minimize out-of-pocket expenditure. Furthermore, the National Health Authority's official PM-JAY dashboard confirms that cumulative authorized hospital admissions have surpassed the 6.2 crore milestone since the scheme's launch on September 23, 2018.
Consider the following statements regarding Inter-ministerial convergence with schemes like PM-POSHAN and Mission Indradhanush:
1. Under the convergence guidelines issued in 2018, the National Health Authority provides direct budgetary support to the Ministry of Education for the procurement of iron-folic acid tablets distributed via the PM-POSHAN network.
2. The PM-JAY portal provides a centralized database for the PM-POSHAN scheme, allowing for the automatic transfer of midday meal funds to the bank accounts of beneficiaries identified through the Socio-Economic Caste Census 2011.
3. Mission Indradhanush incorporates the Ayushman Bharat digital health ID as a prerequisite for vaccine administration, ensuring that every child receives a unique health record generated at the time of birth registration.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is incorrect. Statement 2 is incorrect. Statement 3 is incorrect.
All three statements are incorrect because there is no provision under PM-JAY for direct budgetary support to the Ministry of Education for iron-folic acid procurement, nor does the PM-JAY portal manage PM-POSHAN fund transfers or beneficiary databases. Furthermore, while Mission Indradhanush utilizes digital platforms like U-WIN for tracking, the Ayushman Bharat Health Account (ABHA) is not a mandatory prerequisite for vaccine administration, and birth registration is not linked to the automatic generation of such health IDs.
Consider the following statements regarding Public-Private Partnership (PPP) models in service delivery:
1. The 2020 amendment to the PM-JAY operational guidelines introduced a mandatory cap on the number of private hospitals per district, limiting the total empanelment to 50 facilities to ensure equitable distribution.
2. The Ayushman Bharat Digital Mission, launched in 2021, provides for the automatic empanelment of private diagnostic centers into the PM-JAY network once they achieve a Level 3 certification from the Quality Council of India.
3. The PM-JAY portability mechanism is linked to the Aadhaar-enabled payment system, which allows private hospitals to receive direct reimbursement from the Ministry of Finance within 15 days of claim submission.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is incorrect. Statement 2 is incorrect. Statement 3 is incorrect.
All three statements are incorrect because PM-JAY does not impose a mandatory cap of 50 private hospitals per district, as empanelment is demand-driven and based on fulfilling criteria set by the State Health Agencies. The Ayushman Bharat Digital Mission (ABDM) focuses on creating a digital health ecosystem and does not grant automatic empanelment to diagnostic centers based on Quality Council of India certification. Furthermore, the PM-JAY portability mechanism facilitates cross-state treatment for beneficiaries, but reimbursements are processed through the National Health Authority (NHA) or State Health Agencies (SHA) rather than the Ministry of Finance, and they are not linked to an Aadhaar-enabled payment system for hospital settlements.
Consider the following statements regarding Financial architecture: Funding ratios between Centre and States:
1. Under the PM-JAY framework, the premium for the insurance cover is calculated based on the tender process conducted by the respective State Health Agencies.
2. The National Health Authority serves as the apex body responsible for the implementation of PM-JAY and manages the financial disbursements to states.
3. The 90:10 funding ratio for Himalayan states was introduced in the 2018 budget speech, mirroring the cost-sharing mechanism established for the Pradhan Mantri Fasal Bima Yojana.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is correct. Statement 2 is correct. Statement 3 is incorrect.
Statement 1 is correct as State Health Agencies (SHAs) are empowered to conduct tenders to determine premiums based on local market conditions. Statement 2 is correct because the National Health Authority (NHA) is the apex body tasked with the overall strategy, implementation, and management of the PM-JAY fund flow. Statement 3 is incorrect because, while the 90:10 funding ratio for North-Eastern and Himalayan states is accurate, it follows the standard pattern for Centrally Sponsored Schemes rather than the Pradhan Mantri Fasal Bima Yojana, which has a different financial structure.
Consider the following statements regarding Grievance redressal mechanisms and the role of the National Anti-Fraud Unit (NAFU):
1. Grievance officers at the district level are responsible for resolving complaints within 15 days, a timeline established by the 2018 PM-JAY implementation framework under the Ministry of Health and Family Welfare.
2. The Anti-Fraud Guidelines allow for the imposition of financial penalties on empanelled hospitals, with the collected funds transferred directly to the Consolidated Fund of India for scheme sustainability.
3. The National Anti-Fraud Unit (NAFU) functions under the National Health Authority to oversee the implementation of the Anti-Fraud Guidelines issued in 2019 for the Ayushman Bharat PM-JAY scheme.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 3 is correct. Statement 1 is incorrect. Statement 2 is incorrect.
Statement 3 is correct as the National Anti-Fraud Unit (NAFU) was established under the National Health Authority to enforce the 2019 Anti-Fraud Guidelines. Statement 1 is incorrect because the PM-JAY framework mandates grievance resolution within 30 days, not 15. Statement 2 is incorrect because financial penalties collected from hospitals are deposited into the State Health Agency (SHA) escrow account or the dedicated scheme fund, not the Consolidated Fund of India.
Consider the following statements regarding The 'Trust' vs 'Insurance' model of implementation:
1. Under the trust model, the State Health Agency directly manages the claim settlement process and maintains a revolving fund to reimburse empanelled hospitals.
2. As of 2023, a significant number of states, including Gujarat and Kerala, have transitioned from the insurance model to the trust model to reduce administrative overheads.
3. In the insurance model, the state government pays a fixed premium per family to an insurance company, which then assumes the financial risk for hospital claims.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is correct. Statement 2 is correct. Statement 3 is correct.
Under the Trust model, the State Health Agency (SHA) acts as the insurer, managing claims directly through a revolving fund to eliminate profit margins and administrative costs associated with private insurers. Statement 2 is correct as states like Gujarat and Kerala shifted to the Trust model to gain greater control over fund utilization and reduce the high premium costs charged by insurance companies. Statement 3 accurately describes the Insurance model, where the state transfers financial risk to an insurance company in exchange for a fixed annual premium per family, making all three statements factually correct.
Consider the following statements regarding Empanelment criteria and de-empanelment protocols for healthcare providers:
1. The State Health Agency (SHA) possesses the authority to initiate de-empanelment based on the findings of the District Grievance Redressal Committee, which operates under the chairmanship of the District Magistrate.
2. The de-empanelment of a healthcare provider involves a mandatory 30-day suspension period, during which the hospital remains eligible for reimbursement of claims submitted prior to the date of the initial audit.
3. The empanelment criteria for private hospitals include the presence of a 24-hour pharmacy and a dedicated blood bank, both of which are regulated under the Drugs and Cosmetics Act of 1940.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is incorrect. Statement 2 is incorrect. Statement 3 is incorrect.
Statement 1 is incorrect because the District Grievance Redressal Committee (DGRC) only recommends action, while the final authority for de-empanelment rests with the State Health Agency (SHA) based on specific evidence, not solely on DGRC findings. Statement 2 is incorrect as there is no mandatory 30-day suspension period; de-empanelment is an immediate process following established due process and show-cause notices, and claims are scrutinized based on the date of fraud or violation rather than the audit date. Statement 3 is incorrect because, while hospitals must have access to pharmacy and blood bank services, the PM-JAY guidelines allow for tie-ups with external licensed vendors rather than mandating that these facilities be physically present within the hospital premises.
Consider the following statements regarding Integration of PM-JAY with the Ayushman Bharat Digital Mission (ABDM):
1. The integration of PM-JAY with the Health Claims Exchange (HCX) allows for the automated processing of health insurance claims using standardized digital protocols.
2. The ABDM framework includes the Health Facility Registry (HFR), which provides for the direct transfer of annual premium subsidies from the central government to the bank accounts of private hospital administrators.
3. The Ayushman Bharat Digital Mission (ABDM) sandbox environment provides a testing platform for private health tech companies to develop interoperable solutions for PM-JAY claim settlements.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is correct. Statement 3 is correct. Statement 2 is incorrect.
Statement 1 is correct as the Health Claims Exchange (HCX) facilitates interoperability, enabling automated, paperless claim processing between providers and payers. Statement 3 is correct because the ABDM sandbox serves as a controlled testing environment for innovators to build and validate digital health solutions that integrate with the PM-JAY ecosystem. Statement 2 is incorrect because the Health Facility Registry (HFR) is a repository of verified health facilities and does not handle the direct transfer of premium subsidies; subsidies under PM-JAY are managed through the National Health Authority's (NHA) IT platform and state-level implementation agencies, not via the HFR.
Consider the following statements regarding Role of Pradhan Mantri Arogya Mitras (PMAMs) in beneficiary facilitation:
1. The PMAM portal facilitates the direct transfer of insurance claim amounts to the beneficiary's bank account once the hospital discharge summary is uploaded by the medical staff.
2. PMAMs operate under the direct administrative control of the Ministry of Finance, which allocates the operational budget for their certification and training programs.
3. Pradhan Mantri Arogya Mitras (PMAMs) are stationed at empanelled hospitals to facilitate beneficiary identification and verification through the Beneficiary Identification System (BIS).
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 3 is correct. Statement 1 is incorrect. Statement 2 is incorrect.
Statement 3 is correct because PMAMs act as the primary interface at empanelled hospitals, responsible for verifying beneficiaries via the Beneficiary Identification System (BIS) and guiding them through the admission process. Statement 1 is incorrect because PM-JAY is a cashless and paperless scheme where claims are settled directly between the insurer/trust and the hospital, not via direct transfer to the beneficiary. Statement 2 is incorrect because PMAMs operate under the administrative control of the National Health Authority (NHA) and State Health Agencies (SHAs) under the Ministry of Health and Family Welfare, not the Ministry of Finance.
Consider the following statements regarding Integration of PM-JAY with the Ayushman Bharat Digital Mission (ABDM):
1. As of 2024, the National Health Authority (NHA) has enabled the linking of PM-JAY beneficiary records with the Unified Health Interface (UHI) to streamline hospital empanelment processes.
2. The National Health Authority integrated the PM-JAY database with the Co-WIN platform in 2021, which allows for the automatic conversion of vaccination certificates into lifetime health insurance coverage.
3. The Ayushman Bharat Digital Mission (ABDM) facilitates the creation of ABHA IDs, which serve as the foundational digital identity for beneficiaries under the PM-JAY scheme.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is correct. Statement 3 is correct. Statement 2 is incorrect.
Statement 1 is correct as the NHA has integrated PM-JAY with the Unified Health Interface (UHI) to enhance digital discovery and service delivery, while Statement 3 is correct because the ABHA (Ayushman Bharat Health Account) ID acts as a unique digital identifier that links a beneficiary's health records across the PM-JAY ecosystem. Statement 2 is incorrect because while the PM-JAY database was used for priority vaccination during the pandemic, Co-WIN vaccination certificates do not automatically convert into lifetime health insurance coverage, as PM-JAY remains a means-tested scheme for identified vulnerable families.
Consider the following statements regarding National Health Authority (NHA) organizational structure and mandate:
1. The Governing Board of the National Health Authority includes the Secretary of the Ministry of Finance as the ex-officio Chairperson, overseeing the financial disbursement of the 5 lakh rupee insurance cover.
2. The National Health Authority operates under the Ministry of Finance to oversee the budgetary allocation of the PM-JAY fund, which received an initial corpus of 5,000 crore rupees in 2018.
3. The National Health Authority was constituted through an Act of Parliament in 2018, which provides for the creation of State Health Agencies to manage the IT infrastructure of the scheme.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is incorrect. Statement 2 is incorrect. Statement 3 is incorrect.
The National Health Authority (NHA) is an attached office of the Ministry of Health and Family Welfare, not the Ministry of Finance, and it is chaired by the Union Minister of Health and Family Welfare, not the Finance Secretary. Furthermore, the NHA was established as a society under the Societies Registration Act, 1860, rather than through an Act of Parliament, and State Health Agencies are responsible for the implementation of the scheme at the state level rather than solely managing IT infrastructure.
Consider the following statements regarding Financial architecture: Funding ratios between Centre and States:
1. The Union Territory of Delhi receives 90 percent funding from the Centre for PM-JAY, reflecting its status as a special category region under the NITI Aayog framework.
2. The 60:40 funding pattern for PM-JAY follows the recommendations of the 14th Finance Commission, which also governs the implementation of the National Health Mission.
3. States with a legislative assembly, including NCT of Delhi and Puducherry, receive a 75:25 funding split from the Centre to support the expansion of secondary care services.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is incorrect. Statement 2 is incorrect. Statement 3 is incorrect.
The funding pattern for PM-JAY is strictly defined as 60:40 for all States and UTs with legislatures, 90:10 for the 8 North Eastern States and 3 Himalayan States (J&K, Himachal Pradesh, and Uttarakhand), and 100% central funding for UTs without legislatures. Statement 1 is incorrect because Delhi follows the 60:40 ratio, not 90:10. Statement 2 is incorrect because the 60:40 ratio for PM-JAY is a specific cabinet-approved design for this scheme and is not derived from the 14th Finance Commission's general devolution formula. Statement 3 is incorrect as the funding split for States and UTs with a legislative assembly is fixed at 60:40, not 75:25.
Consider the following statements regarding Audit mechanisms and performance monitoring of empanelled hospitals:
1. Empanelled hospitals are subject to periodic physical audits conducted by the State Health Agencies as per the operational guidelines of the PM-JAY scheme.
2. The National Health Authority established the Quality Council of India in 2018 to perform direct, real-time clinical audits of all surgical procedures conducted in private empanelled hospitals.
3. The National Health Authority utilizes the Anti-Fraud Guidelines issued in 2019 to standardize the monitoring of empanelled healthcare providers.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is correct. Statement 3 is correct. Statement 2 is incorrect.
Statement 1 is correct as State Health Agencies (SHAs) are mandated to conduct periodic physical audits to ensure compliance with PM-JAY operational guidelines, and Statement 3 is correct because the NHA issued comprehensive Anti-Fraud Guidelines in 2019 to provide a standardized framework for monitoring and fraud control across all empanelled providers. Statement 2 is incorrect because while the NHA collaborates with the Quality Council of India (QCI) for hospital empanelment and quality certification (NABH/NQAS), it does not task QCI with performing direct, real-time clinical audits of all surgical procedures, which remains a function of the internal audit and fraud control units of the NHA and SHAs.
Consider the following statements regarding Inter-ministerial convergence with schemes like PM-POSHAN and Mission Indradhanush:
1. Mission Indradhanush is associated with the Ayushman Bharat PM-JAY insurance cover, providing a cashless benefit of five lakh rupees per family for complications arising from adverse events following immunization.
2. Mission Indradhanush utilizes the health infrastructure established under the Ayushman Bharat Health and Wellness Centres to track immunization coverage for pregnant women and children under two years of age.
3. The Ayushman Bharat PM-JAY scheme facilitates the screening of children under the Rashtriya Bal Swasthya Karyakram, which operates in coordination with the PM-POSHAN framework to address nutritional deficiencies.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 2 is correct. Statement 3 is correct. Statement 1 is incorrect.
Statement 1 is incorrect because Mission Indradhanush is a vaccination drive focused on full immunization coverage and is not linked to the PM-JAY insurance cover for adverse events. Statement 2 is correct as the Ayushman Bharat Health and Wellness Centres (AB-HWCs) serve as the primary delivery points for immunization services under Mission Indradhanush, ensuring tracking of pregnant women and children. Statement 3 is correct because the Rashtriya Bal Swasthya Karyakram (RBSK) is integrated with PM-JAY for tertiary care and works alongside the PM-POSHAN scheme to identify and manage nutritional deficiencies and health issues in school-going children.
Consider the following statements regarding Audit mechanisms and performance monitoring of empanelled hospitals:
1. The performance of empanelled hospitals is evaluated through the 'Hospital Performance Index', which tracks parameters such as claim settlement ratios and patient feedback scores.
2. State Health Agencies maintain the authority to impose financial penalties on hospitals found violating the 'Standard Treatment Guidelines' notified under the scheme.
3. Financial audits of empanelled hospitals include a mandatory review of the 'Health Benefit Packages' pricing structure to ensure adherence to the 2022 revised rates.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is correct. Statement 2 is correct. Statement 3 is correct.
Statement 1 is correct as the National Health Authority utilizes the Hospital Performance Index to evaluate empanelled hospitals based on metrics like claim processing efficiency, quality of care, and patient satisfaction. Statement 2 is correct because State Health Agencies (SHAs) are empowered under the PM-JAY guidelines to levy financial penalties or initiate de-empanelment proceedings against hospitals that deviate from the mandated Standard Treatment Guidelines. Statement 3 is correct as the NHA conducts periodic financial audits to ensure hospitals strictly adhere to the revised Health Benefit Packages (HBP 2022) pricing, preventing overcharging and ensuring financial transparency within the scheme.
Consider the following statements regarding Empanelment criteria and de-empanelment protocols for healthcare providers:
1. The National Health Authority provides for a financial penalty system during de-empanelment, where the hospital forfeits the entire performance bank guarantee deposited at the time of initial registration.
2. The de-empanelment protocol includes a provision for a show-cause notice period of 15 days, allowing the hospital to submit a formal response before the State Health Agency initiates the removal process.
3. The criteria for empanelment in rural areas include a relaxation of the requirement for specialized medical staff, provided the facility maintains a minimum of 50 beds as per the 2018 operational guidelines.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 2 is correct. Statement 1 is incorrect. Statement 3 is incorrect.
Statement 2 is correct because the PM-JAY guidelines mandate a 15-day show-cause notice period for hospitals to respond to allegations before the State Health Agency can initiate de-empanelment. Statement 1 is incorrect as the penalty for de-empanelment is not a blanket forfeiture of the entire performance bank guarantee, but rather determined based on the severity of the violation and specific contractual terms. Statement 3 is incorrect because the 2018 operational guidelines require a minimum of 10 beds for empanelment in rural areas, not 50, and there is no provision allowing a total waiver of specialized medical staff requirements.
Consider the following statements regarding Grievance redressal mechanisms and the role of the National Anti-Fraud Unit (NAFU):
1. State Anti-Fraud Units (SAFUs) coordinate with local law enforcement agencies to conduct field audits, and their operational expenditure is shared between the Centre and States in a 90:10 ratio.
2. The National Health Authority introduced the 'Fraud and Abuse Control' module in 2021, which provides for automated claim rejection if a hospital fails to submit biometric verification within 48 hours of discharge.
3. Beneficiaries can escalate unresolved grievances to the National Health Authority's appellate committee, which holds quarterly review meetings chaired by the Union Health Secretary.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is incorrect. Statement 2 is incorrect. Statement 3 is incorrect.
Statement 1 is incorrect because while SAFUs conduct audits, the operational expenditure for PM-JAY implementation, including anti-fraud activities, follows a 60:40 funding ratio for most states, not 90:10. Statement 2 is incorrect as there is no provision for automated claim rejection based on a 48-hour biometric window; while biometric authentication is encouraged, claim processing relies on the Transaction Management System (TMS) and clinical validation. Statement 3 is incorrect because grievances are handled through the Central Grievance Redressal Management System (CGRMS), and the appellate committee is not chaired by the Union Health Secretary, nor does it operate under a mandated quarterly review meeting structure.
Consider the following statements regarding Data privacy and security protocols under the Ayushman Bharat health stack:
1. The National Health Authority released the 'Health Data Management Policy' in 2022 to provide a framework for the protection of personal data within the Ayushman Bharat Digital Mission.
2. The ABDM Sandbox environment serves as a testing ground where private sector health-tech companies can integrate their applications with the health stack while adhering to security protocols.
3. Consent Managers within the Ayushman Bharat health stack operate as digital entities that enable patients to grant, manage, and revoke access to their health records through a standardized interface.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is correct. Statement 2 is correct. Statement 3 is correct.
All three statements are correct: The National Health Authority (NHA) notified the Health Data Management Policy in 2022 to establish a robust data protection framework under the Ayushman Bharat Digital Mission (ABDM). The ABDM Sandbox functions as a controlled environment for health-tech innovators to test their solutions against ABDM APIs while ensuring compliance with security and privacy standards. Furthermore, Consent Managers are integral components of the ABDM architecture that empower patients with granular control over their health data through a standardized, interoperable interface.
Consider the following statements regarding Legal framework and legislative backing of the NHA:
1. The National Health Authority was reconstituted as a statutory body under the Health Insurance Regulatory Authority Act, 2018, to streamline the implementation of the PM-JAY scheme.
2. The Ayushman Bharat PM-JAY is governed by the provisions of the Disaster Management Act, 2005, which allows the National Health Authority to coordinate emergency health responses across state boundaries.
3. The Governing Board of the National Health Authority includes the Finance Secretary as a permanent member and follows the budgetary protocols defined in the Fiscal Responsibility and Budget Management Act, 2003.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is incorrect. Statement 2 is incorrect. Statement 3 is incorrect.
The National Health Authority (NHA) is not a statutory body but was established as an attached office of the Ministry of Health and Family Welfare through a Cabinet notification, not the Health Insurance Regulatory Authority Act. PM-JAY is implemented under the National Health Mission framework rather than the Disaster Management Act, 2005, which is reserved for disaster-specific responses. Furthermore, the NHA Governing Board is chaired by the Union Minister for Health and Family Welfare, and its budgetary operations are governed by standard government financial rules rather than the FRBM Act, 2003.
Consider the following statements regarding National Health Authority (NHA) organizational structure and mandate:
1. The National Health Authority oversees the Pradhan Mantri Suraksha Bima Yojana, which provides a 2 lakh rupee accidental death cover to citizens aged between 18 and 70 years.
2. The National Health Authority is responsible for the implementation of the Ayushman Bharat Digital Mission, which aims to create a digital health ecosystem for the country.
3. The National Health Authority functions as an attached office to the Department of Health and Family Welfare, operating with full functional autonomy in its day-to-day operations.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 2 is correct. Statement 3 is correct. Statement 1 is incorrect.
Statement 1 is incorrect because the Pradhan Mantri Suraksha Bima Yojana is administered by the Department of Financial Services under the Ministry of Finance, not the NHA. Statement 2 is correct as the NHA is the apex body mandated to implement the Ayushman Bharat Digital Mission (ABDM) to create a robust digital health infrastructure. Statement 3 is correct because the NHA was established as an attached office to the Ministry of Health and Family Welfare, enjoying full functional autonomy to implement the PM-JAY and related digital health initiatives.
Consider the following statements regarding Role of Pradhan Mantri Arogya Mitras (PMAMs) in beneficiary facilitation:
1. PMAMs act as the primary interface between the hospital help desk and the State Health Agency (SHA) to ensure timely pre-authorization requests for surgical procedures.
2. The National Health Authority introduced the PMAM certification module in 2018, which allows these facilitators to independently approve surgical procedures without hospital medical officer review.
3. Under the PM-JAY implementation guidelines, PMAMs are responsible for the clinical diagnosis of patients and the subsequent selection of the appropriate health benefit package codes.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is correct. Statement 2 is incorrect. Statement 3 is incorrect.
Statement 1 is correct as PMAMs serve as the frontline facilitators at hospitals, managing the help desk and coordinating with the State Health Agency to ensure seamless pre-authorization for treatments. Statement 2 is incorrect because while PMAMs undergo certification, they have no authority to approve surgical procedures, which remains the exclusive domain of medical professionals. Statement 3 is incorrect because PMAMs are non-clinical administrative staff; the clinical diagnosis and selection of health benefit packages must be performed by qualified doctors or medical officers, not the facilitators.
Consider the following statements regarding Incentive structures for high-performing states and hospitals:
1. The Ayushman Bharat Digital Mission framework allows for the automatic conversion of state-level health insurance premiums into capital grants for hospitals that maintain a 5-star rating for three consecutive years.
2. The NHA's 'Quality Incentive Fund' provides for a 15% increase in base reimbursement rates for all hospitals accredited by the Quality Council of India since the 2020 policy update.
3. The 2023 revised guidelines for PM-JAY include a provision for 'Performance-Linked Payments' to hospitals based on patient satisfaction scores collected through the Ayushman App.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 3 is correct. Statement 1 is incorrect. Statement 2 is incorrect.
Statement 3 is correct as the 2023 revised PM-JAY guidelines introduced performance-linked incentives, including patient satisfaction scores via the Ayushman App to drive quality care. Statement 1 is incorrect because there is no provision for converting insurance premiums into capital grants for 5-star rated hospitals under the Ayushman Bharat Digital Mission. Statement 2 is incorrect because while the NHA promotes quality, it does not provide a blanket 15% increase in reimbursement rates for QCI-accredited hospitals; instead, it utilizes specific 'quality-based incentives' tied to NABH accreditation levels.
Consider the following statements regarding Inter-ministerial convergence with schemes like PM-POSHAN and Mission Indradhanush:
1. The Rashtriya Bal Swasthya Karyakram encompasses the PM-POSHAN initiative, functioning as a sub-component of the Ayushman Bharat scheme to provide tertiary surgical care for children identified during school health screenings.
2. The 2020 convergence roadmap between the Ministry of Health and the Ministry of Women and Child Development designates PM-JAY empanelled hospitals as the primary centers for the distribution of supplementary nutrition under the Anganwadi services.
3. The Ayushman Bharat PM-JAY framework includes provisions for the management of the PM-POSHAN kitchen facilities, assigning the National Health Authority the responsibility for food safety audits in schools across aspirational districts.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is incorrect. Statement 2 is incorrect. Statement 3 is incorrect.
All three statements are incorrect because they misrepresent the mandates of these schemes: Rashtriya Bal Swasthya Karyakram (RBSK) is a separate health screening program under the National Health Mission, not a sub-component of PM-JAY; PM-JAY empanelled hospitals are strictly for tertiary care and are not involved in the distribution of supplementary nutrition under Anganwadi services; and the National Health Authority (NHA) manages health insurance claims, whereas food safety audits and PM-POSHAN kitchen oversight fall under the Ministry of Education and FSSAI.
Consider the following statements regarding Legal framework and legislative backing of the NHA:
1. The National Health Authority operates under the National Medical Commission Act, 2019, which provides the regulatory oversight for its digital health mission and financial disbursements.
2. The National Health Authority was established as an attached office to the Ministry of Health and Family Welfare through a gazette notification dated 2 January 2019.
3. The Governing Board of the National Health Authority is chaired by the Union Minister for Health and Family Welfare and includes the CEO as its Member Secretary.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 2 is correct. Statement 3 is correct. Statement 1 is incorrect.
Statement 1 is incorrect because the National Health Authority (NHA) is not governed by the National Medical Commission Act, 2019; instead, it was established as an attached office to the Ministry of Health and Family Welfare via a gazette notification on 2 January 2019 to implement the Ayushman Bharat PM-JAY. Statement 2 is correct as it accurately reflects the official notification date and the administrative status of the NHA. Statement 3 is correct because the Governing Board is chaired by the Union Minister for Health and Family Welfare, with the CEO of the NHA serving as the Member Secretary, ensuring high-level policy oversight.
Consider the following statements regarding Legal framework and legislative backing of the NHA:
1. Rule 10 of the Government of India (Allocation of Business) Rules, 1961, provides the administrative basis for the National Health Authority to oversee digital health infrastructure.
2. The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana operates under the legal framework of the Societies Registration Act, 1860, as a registered society.
3. The National Health Authority functions as the successor to the National Health Agency, which was initially constituted on 11 May 2018 to implement the scheme.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is correct. Statement 2 is correct. Statement 3 is correct.
Statement 1 is correct as the NHA was notified under the Allocation of Business Rules, 1961, to oversee the implementation of PM-JAY and the Ayushman Bharat Digital Mission. Statement 2 is correct because the NHA was registered as an autonomous body under the Societies Registration Act, 1860, to provide functional autonomy in scheme management. Statement 3 is correct as the National Health Agency was reconstituted as the National Health Authority on 2 January 2019, succeeding the original body established on 11 May 2018 to implement the scheme.
Consider the following statements regarding The 'Trust' vs 'Insurance' model of implementation:
1. State Health Agencies operating under the insurance model are permitted to retain surplus premium funds after the contract period, provided these funds are reinvested in primary healthcare centers.
2. The PM-JAY guidelines specify that in the trust model, the financial liability for claims exceeding the allocated budget rests with the state government's health department.
3. The insurance model for PM-JAY was introduced in the 2019 Union Budget, which replaced the previous trust-based pilot projects initiated by the Rashtriya Swasthya Bima Yojana.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 2 is correct. Statement 1 is incorrect. Statement 3 is incorrect.
Statement 2 is correct because, under the Trust model, the State Health Agency (SHA) manages the fund directly, making the state government responsible for any financial liabilities or deficits. Statement 1 is incorrect because insurance companies are not permitted to retain surplus premiums; any excess must be refunded to the SHA, and the model does not mandate reinvestment in primary healthcare centers. Statement 3 is incorrect because the PM-JAY was launched in 2018 with a hybrid implementation framework allowing states to choose between Trust, Insurance, or a combination, rather than being introduced in the 2019 budget as a replacement for RSBY.
Consider the following statements regarding IT infrastructure and the role of the Transaction Management System (TMS):
1. The Transaction Management System was launched in 2018 under the aegis of the Ministry of Health and Family Welfare to replace the legacy Rashtriya Swasthya Bima Yojana portal for direct cash transfers to beneficiaries.
2. The IT infrastructure of PM-JAY incorporates the Beneficiary Identification System (BIS) for card generation, while the TMS functions as a decentralized ledger for tracking state-level budgetary allocations to empanelled private hospitals.
3. The National Health Authority introduced the Transaction Management System in 2019 to provide a unified platform for pharmaceutical procurement and the distribution of generic medicines to district-level hospitals.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is incorrect. Statement 2 is incorrect. Statement 3 is incorrect.
All three statements are incorrect because the Transaction Management System (TMS) is a core component of the PM-JAY IT ecosystem designed specifically for the end-to-end processing of hospital claims and pre-authorization requests, not for cash transfers, budgetary ledger tracking, or pharmaceutical procurement. The Beneficiary Identification System (BIS) is used to verify and issue e-cards to eligible beneficiaries, while the TMS facilitates the seamless submission, verification, and settlement of claims between empanelled hospitals and the National Health Authority (NHA). Consequently, none of the statements accurately describe the functional scope or the governance framework of the TMS within the Ayushman Bharat mission.
Consider the following statements regarding Role of the Health Benefit Package (HBP) revision committee:
1. The HBP revision committee coordinates with the Insurance Regulatory and Development Authority of India (IRDAI) to determine the premium rates for private insurers participating in the PM-JAY implementation model.
2. The HBP revision committee operates under the administrative jurisdiction of the Ministry of Finance, and its primary function involves the direct allocation of budgetary grants to state-level empanelled hospitals.
3. The National Health Authority (NHA) established the HBP review panel in 2018 to oversee the procurement of diagnostic equipment, and the panel functions by setting the floor prices for pharmaceutical supplies.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is incorrect. Statement 2 is incorrect. Statement 3 is incorrect.
All three statements are incorrect because the HBP revision committee, constituted by the National Health Authority (NHA), is exclusively tasked with periodically reviewing and rationalizing the rates and scope of medical procedures under PM-JAY, not with insurance premium regulation or hospital budgetary allocations. The committee functions under the Ministry of Health and Family Welfare (MoHFW) rather than the Ministry of Finance, and it does not handle the procurement of diagnostic equipment or the setting of floor prices for pharmaceuticals, which are market-driven or state-procured. Consequently, the committee's role is strictly limited to clinical service pricing and package optimization to ensure quality healthcare access.
Consider the following statements regarding Financial architecture: Funding ratios between Centre and States:
1. The funding ratio for the Ayushman Bharat PM-JAY is shared between the Centre and the States in a 60:40 ratio for most Indian states.
2. For the North Eastern states and the three Himalayan states of Himachal Pradesh, Uttarakhand, and Jammu and Kashmir, the Centre contributes 90 percent of the funding.
3. In Union Territories without a legislature, the Central Government provides 100 percent of the financial resources for the scheme.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is correct. Statement 2 is correct. Statement 3 is correct.
The funding pattern for Ayushman Bharat PM-JAY follows the standard formula for Centrally Sponsored Schemes, where the Centre and States share costs in a 60:40 ratio for most states, while a 90:10 ratio applies to the eight North Eastern states and three Himalayan states (Himachal Pradesh, Uttarakhand, and Jammu & Kashmir). Furthermore, the scheme is fully funded (100%) by the Central Government in Union Territories without a legislature, ensuring uniform implementation across these regions. As all three statements accurately reflect these established fiscal arrangements, they are all correct.
Consider the following statements regarding Data privacy and security protocols under the Ayushman Bharat health stack:
1. Under the ABDM data privacy policy, the Health Information Provider (HIP) retains the responsibility for verifying the identity of the data requester before sharing any personal health records.
2. The Ayushman Bharat Health Account (ABHA) number utilizes a 14-digit unique identification system to facilitate the secure exchange of health records across the digital ecosystem.
3. The Data Privacy Policy of the ABDM incorporates the principle of 'Data Minimization', ensuring that health information systems collect only the information necessary for the specific health service requested.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 1 is correct. Statement 2 is correct. Statement 3 is correct.
All three statements are correct: Statement 1 is accurate as the ABDM framework mandates that the Health Information Provider (HIP) must authenticate the requester to ensure consent-based data sharing; Statement 2 is correct because the ABHA number is indeed a 14-digit unique identifier designed to interlink health records securely; Statement 3 is correct as the ABDM policy strictly adheres to the 'Data Minimization' principle, limiting data collection to what is essential for the specific healthcare service requested.
Consider the following statements regarding Role of State Health Agencies (SHAs) in decentralized implementation:
1. The SHA serves as the primary appellate authority for judicial review, allowing hospitals to challenge the de-empanelment decisions of the National Health Authority in the state high court.
2. The SHA is responsible for the constitution of the District Implementation Unit (DIU) to monitor the grievance redressal mechanism and service delivery at the grassroots level.
3. The Governing Council of the SHA is typically chaired by the State's Principal Secretary of Health, ensuring administrative coordination between the state government and the National Health Authority.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 2 is correct. Statement 3 is correct. Statement 1 is incorrect.
Statement 1 is incorrect because the SHA acts as an appellate authority for internal grievance redressal, but it cannot facilitate judicial review in High Courts, as the scheme's guidelines do not bypass the constitutional jurisdiction of courts. Statement 2 is correct as the SHA is mandated to establish District Implementation Units (DIUs) to ensure effective field-level monitoring and grievance management under the PM-JAY framework. Statement 3 is correct because the Governing Council of the SHA is chaired by the State's Principal Secretary (Health) to maintain seamless administrative alignment and operational synergy between state-level execution and the National Health Authority.
Consider the following statements regarding Standard Treatment Guidelines (STGs) and their impact on clinical governance:
1. The Ministry of Health and Family Welfare introduced the Health Technology Assessment Board in 2017, which functions as the primary body responsible for auditing individual physician prescriptions under the PM-JAY scheme.
2. The National Health Authority released the first comprehensive set of Standard Treatment Guidelines for the Ayushman Bharat PM-JAY in 2018 to standardize clinical practices across empanelled hospitals.
3. The 2019 clinical audit report noted that the integration of the Hospital Empanelment and Quality Standards portal allows for real-time tracking of patient recovery rates against the 2015 WHO benchmark indicators.
How many of the statements given above are correct?
- Only one
- Only two
- All three
- None
Explanation: Statement 2 is correct. Statement 1 is incorrect. Statement 3 is incorrect.
Statement 2 is correct as the National Health Authority (NHA) introduced STGs to ensure uniform quality and cost-effectiveness in PM-JAY empanelled hospitals. Statement 1 is incorrect because the Health Technology Assessment in India (HTAIn) body evaluates the cost-effectiveness of health interventions for policy-making rather than auditing individual physician prescriptions. Statement 3 is incorrect because there is no 2019 clinical audit report that links real-time patient recovery tracking to 2015 WHO benchmarks within the Hospital Empanelment and Quality Standards (HEQS) portal.