TWENTIETH CONGRESS OF THE 
REPUBLIC OF THE PHILIPPINES 
First Regular Session
25 JULIO P4:18
SENATE 
S. No. *^04
iTC',
Introduced by Sen. Panfilo M. Lacson
AN ACT
INSTITUTING THE MEDICAL ASSISTANCE TO INDIGENT AND FINANCIALLY 
INCAPACITATED PATIENTS (MAIFIP) UNDER THE FRAMEWORK OF THE 
UNIVERSAL HEALTH CARE FOR ALL FILIPINOS, AMENDING FOR THE 
PURPOSE REPUBLIC ACT NO. 11223, OTHERWISE KNOWN AS THE 
"UNIVERSAL HEALTH CARE ACT"
EXPLANATORY NOTE
The Constitution and laws of the land articulate and uphold the people's right 
to health and healthcare. The mandate that health services must be provided to "all 
the people at affordable cost", as stipulated in the Constitution, underscores the 
principles of inclusiveness and universality of the people's right to health.
This is also one of the fundamental rights of the poor, as recognized and 
protected under many laws that mandate priority for the vulnerable and marginalized 
groups.
Hence, the government has rolled out various social protection programs that 
ensure equity and accessibility of health services. The Medical Assistance to Indigent 
and Financially Incapacitated Patients (MAIFIP) Program of the Department of Health 
(DOH) serves as one of the banner social safety nets providing medical assistance to 
indigent and financially incapacitated patients.
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Along with other medical assistance programs implemented across various 
government agencies, the MAIFIP must complement Republic Act No. 11223, known 
as the "Universal Health Care (UHC) Act," to ensure that the objectives of all medical 
assistance initiatives are achieved efficiently. This will also help eliminate overlaps and 
redundancies while maximizing overall program effectiveness and health outcomes.
The Social Protection Plan 2023-2028 likewise made mention of the need to 
assess the existing medical assistance programs for possible duplication.
With the passage of UHC, every Filipino citizen is automatically enrolled in the 
National Health Insurance Program. This enhances access to individual healthcare 
through secured financing of PhilHealth and enables the DOH to implement more 
effective population-based public health programs.
By consolidating MAIFIP within the framework of the UHC, we can effectively 
address the issue of payment delays for medical services rendered by DOH-licensed 
and/or accredited health facilities because of political interference. The proposed 
legislation also aims to eliminate the politicization of the program, thus curbing the 
culture of mendicancy and political patronage.
This was evidenced by recent news wherein private hospitals refused to honor 
guarantee letters issued by government officials to indigent patients under the MAIFIP 
program, citing unresolved outstanding payables accruing over several months.
Guarantee letters, issued by governors, senators, congressmen, and other 
government officials, serve to facilitate the payment of hospital bills for indigent 
patients. However, some private healthcare facilities expressed concerns that their 
services might not be compensated under MAIFIP due to guarantee letters endorsed 
by political candidates who subsequently lost the recent midterm elections.


These issues grossly undermine the delivery of public services and cast the 
medical program in a negative light.
Hence, this bill seeks to consolidate and harmonize MAIFIP with the Universal 
Healthcare Act under the unified program to be known as the Universal Medical 
Assistance Program (UMAP). UMAP shall be accessible to all patients, regardless of 
indigency status, who are financially incapacitated and unable to meet the necessary 
expenditures for the medical treatment of their catastrophic or life- and limb- 
threatening illnesses.
UMAP will be in accordance with the full implementation of the No Balance 
Billing (NBB) and No Co-Payment policies. It shall serve as a supplementary but 
guaranteed source of financing to benefit qualified patients who, after having 
exhausted PhilHealth benefits and other subsidies, still have to incur out-of-pocket 
payments.
The bill also penalizes political exploitation and manipulation of the program in 
any shape or form. To ensure its proper implementation, monitoring, and evaluation, 
a medical assistance database shall be in place to allow for verification, claims tracking, 
and program evaluation.
A coherent and unified health system under Universal Healthcare must be 
established to effectively address the needs of indigent and marginalized families. 
Individuals, regardless of economic status, who suffer from catastrophic illnesses and 
similar medical conditions and its corresponding substantial financial burdens, should 
meaningfully benefit from the government's comprehensive safety net and enjoy 
affordable and accessible health services - free from political interventions that 
shamelessly exploit government programs to curry public favor.
This bill aims to achieve these objectives and ensure the convergence and 
complementarity of medical assistance programs in pursuit of every Filipino's right to 
health.


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It is for this purpose that the approval of this bill is earnestly sought.
PAHfrt0^46!. LACSON
hator


TWENTIETH CONGRESS OF THE 
REPUBLIC OF THE PHILIPPINES 
First Regular Session
SENATE
s. No. 404
25 JULIO P4J9
lu.c,:
Introduced by Sen. Panfilo M. Lacson
AN ACT
INSTITUTING THE MEDICAL ASSISTANCE TO INDIGENT AND FINANCIALLY 
INCAPACITATED PATIENTS (MAIFIP) UNDER THE FRAMEWORK OF THE 
UNIVERSAL HEALTH CARE FOR ALL FILIPINOS, AMENDING FOR THE 
PURPOSE REPUBLIC ACT NO. 11223, OTHERWISE KNOWN AS THE 
"UNIVERSAL HEALTH CARE ACT"
Be it enacted by the Senate and House of Representatives of the Philippines in 
Congress assembled:
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Section. 1. Short Title. -This Act shall be known as the "Universal Medical
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Assistance Act of 2025."
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Sec. 2. Insert a new paragraph (e) on Section 2 of Republic Act No. 11223,
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which shall read as follows:
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(E) A COMPREHENSIVE AND INCLUSIVE GOVERNMENT
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MEDICAL ASSISTANCE PROGRAM THAT PROMOTE
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EFFICIENCY, TRANSPARENCY, EQUITY, AND RESPONSIBLE
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USE OF HEALTHCARE RESOURCES.
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Sec. 3. Sec. 3 of Republic Act No. 11223 is hereby amended to read as follows: 
SEC. 3. General Objectives. — This Act seeks to:
(a) Progressively realize universal health care in the country 
through a systemic approach and clear delineation of roles of key 
agencies and stakeholders towards better performance in the 
health system; [and]


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(b) Ensure that all Filipinos are guaranteed equitable access to 
quality and affordable health care goods and services, and 
protected against financial riskH; AND
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(C) ESTABLISH AN ACCESSIBLE MEDICAL ASSISTANCE 
PROGRAM THAT ADDRESSES THE DIVERSE HEALTH NEEDS 
OF ALL FILIPINOS.
Sec. 4. Sec. 4 of Republic Act No. 11223 is hereby amended to read as follows:
SEC. 4. Definition of Terms. - As used in this Act:
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(a) Abuse of authority refers to an act of a person performing a 
duty or function that goes beyond what is authorized by this Act 
and Republic Act No. 7875, otherwise known as the "National 
Health Insurance Act of 1995", as amended, or their implementing 
rules and regulations (IRR), and is inimical to the public;
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(b) Amenities refer to features of the health service that provide 
comfort or convenience, such as private accommodation, air 
conditioning, telephone, television, and choice of meals, among 
others;
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(c) Basic or ward accommodation refers to the provision of regular 
meal, bed in shared room, fan ventilation, and shared toilet and 
bath;
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(D) CASE RATE REFERS TO THE FIXED RATE OR AMOUNT 
THAT THE PHILHEALTH WILL REIMBURSE FOR A SPECIFIC 
ILLNESS/CASE AS DEFINED BY PERTINENT PHILHEALTH 
CIRCULARS;


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(E) CATASTROPHIC DISEASE REFERS TO A CLINICALLY 
SEVERE ILLNESS OR MEDICAL CONDITION REQUIRING 
PROLONGED, INTENSIVE, OR RECURRENT 
HOSPITALIZATION, TREATMENT, RECOVERY, AND 
REHABILITATION. IT IS USUALLY CHARACTERIZED BY 
HIGH-COST MEDICAL INTERVENTIONS AND SIGNIFICANT 
OUT-OF-POCKET EXPENDITURES, CAUSING FINANCIAL 
HARDSHIP OR IMPOVERISHMENT, PARTICULARLY FOR 
LOW-INCOME OR VULNERABLE POPULATIONS. THESE 
INCLUDE, BUT ARE NOT LIMITED TO, CANCER, 
PSYCHIATRIC CONDITIONS, HEART ATTACK, OR STROKE.
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(F) CATASTROPHIC HEALTH EXPENDITURE REFERS TO 
OUT-OF-POCKET HEALTH SPENDING THAT EXCEEDS A 
CERTAIN THRESHOLD OP A HOUSEHOLD'S INCOME OR 
TOTAL EXPENDITURE, SUCH THAT IT RESULTS IN 
FINANCIAL DISTRESS, THE DISRUPTION OF ESSENTIAL 
NON-HEALTH CONSUMPTION, OR MAY LEAD TO 
IMPOVERISHMENT. IT REFLECTS THE HOUSEHOLD'S 
INABILITY TO ABSORB HEALTH COSTS WITHOUT 
SACRIFICING BASIC NEEDS, AND SERVES AS AN 
INDICATOR OF INADEQUATE FINANCIAL RISK 
PROTECTION IN THE HEALTH SYSTEM.
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[(#] (G) Co-insurance refers to a percentage of a medical charge 
that is paid by the insured, with the rest paid by the health 
insurance plan;
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(H) COMPASSIONATE DRUG USE REFERS TO THE USE OF 
DRUGS OR MEDICINES NOT INCLUDED IN THE PHILIPPINE 
NATIONAL FORMULARY BY PATIENTS WITH SERIOUS OR


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LIFE-THREATENING CONDITIONS WHEN NO OTHER 
TREATMENTS ARE AVAILABLE.
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[(e)] (I) Co-payment refers to a flat fee or predetermined rate paid 
at point of service;
[(^] 0) Direct contributors refer to those who have the capacity to 
pay premiums, are gainfully employed and are bound by an 
employer-employee relationship, or are self-earning, professional 
practitioners, migrant workers, including their qualified dependents, 
and lifetime members;
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(K) DOUBLE CHARGING REFERS TO CHARGING OF FUNDS 
TO PARTICULAR HEALTH SERVICES PROVIDED TO 
PATIENTS WHICH HAVE ALREADY BEEN PAID AND 
SHOULDERED BY ANOTHER ENTITY/AGENCY.
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[(§)] (L) Emergency refers to a condition or state of a 
patient wherein based on the objective findings of a prudent 
medical officer on duty, there is immediate danger and where 
delay in initial support and treatment may cause loss of life 
or permanent disability to the patient, or in the case of a pregnant 
woman, permanent injury or loss of her unborn child, or a non- 
institutional delivery;
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[(h)] (M) Entitlement refers to any singular or package of health 
services provided to Filipinos for the purpose of improving health;
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[(i)] (N) Essentia! health benefit package refers to a set of 
individual-based entitlements covered by the National Health 
Insurance Program (NHIP) which includes primary care; medicines.


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diagnostics and laboratory; and preventive, curative, and 
rehabilitative services;
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(O) FINANCIALLY INCAPACITATED PATIENTS ARE 
PATIENTS WHO ARE NOT CLASSIFIED AS INDIGENTS BUT 
WHO DEMONSTRATE INABILITY TO PAY OR SPEND FOR 
NECESSARY EXPENDITURES FOR THEIR RESPECTIVE 
MEDICAL TREATMENT SUCH AS, BUT NOT LIMITED TO, 
CATASTROPHIC ILLNESS OR ILLNESSES WHICH ARE LIFE 
OR LIMB-THREATENING AND REQUIRE PROLONGED 
HOSPITALIZATION, ILLNESSES THAT REQUIRE EXTREMELY 
EXPENSIVE TREATMENTS, OR OTHER SPECIAL BUT 
ESSENTIAL CARE THAT WOULD DEPLETE ONE'S FINANCIAL 
RESOURCES, AS ASSESSED AND CERTIFIED BY THE 
MEDICAL SOCIAL WORKER
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[0] (P) Fraudulent act refers to any act of misrepresentation or 
deception resulting in undue benefit or advantage on the part of 
the doer or any means that deviate from normal procedure and is 
undertaken for personal gain, resulting thereafter to damage and 
prejudice which may be capable of pecuniary estimation;
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[(k)] (Q) Health care provider refers to any of the following:
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(1) A health facility, which may be public or private, devoted 
primarily to the provision of services for health promotion, 
prevention, diagnosis, treatment, rehabilitation and palliation of 
individuals suffering from illness, disease, injury, disability, or 
deformity, or in need of obstetrical or other medical and nursing 
care;


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(2) A health care professional, who may be a doctor of medicine, 
nurse, midwife, dentist, or other allied professional or practitioner 
duly licensed to practice in the Philippines;
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(3) A community-based health care organization, which is an 
association of members of the community organized for the purpose 
of improving the health status of that community; or
(4) Pharmacies or drug outlets, laboratories and diagnostic clinics.
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§0] (R) Health care provider network refers to a group of primary 
to tertiary care providers, whether public or private, offering people- 
centered and comprehensive care in an integrated and coordinated 
manner with the primary care provider acting as the navigator and 
coordinator of health care within the network;
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[fm)] (S) Health Maintenance Organization (HMO) refers to an 
entity that provides, offers, or covers designated health services for 
its plan holders or members for a fixed prepaid premium;
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[(f^] (T) Health Technology Assessment (HTA) refers to the 
systematic evaluation of properties, effects, or impact of health- 
related technologies, devices, medicines, vaccines, procedures and 
all other health-related systems developed to solve a health 
problem and improve quality of lives and health outcomes, utilizing 
a multidisciplinary process to evaluate the social, economic, 
organizational, and ethical issues of a health intervention or health 
technology;
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[(e^] (U) Indirect contributors refer to all others not included as 
direct contributors, as well as their qualified dependents, whose


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premium shall be subsidized by the national government Including 
those who are subsidized as a resuit of special laws;
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[(p)] (V) Individual-based health services refer to services which 
can be accessed within a health facility or remotely that can be 
definitively traced back to one (1) recipient, has limited effect at a 
population level and does not alter the underlying JAcause of illness 
such as ambulatory and inpatient care, medicines, laboratory tests 
and procedures, among others;
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(W) MEDICAL ASSISTANCE BENEFICIARY REFERS TO AN 
INDIVIDUAL WHO IS EITHER INDIGENT OR FINANCIALLY 
INCAPACITATED, AND WHO HAS BEEN ASSESSED AND 
CERTIFIED BY A LICENSED MEDICAL SOCIAL WORKER TO 
HAVE LIMITED OR NO MEANS TO AFFORD NECESSARY 
MEDICAL CARE. THIS INCLUDES PATIENTS WITH 
CATASTROPHIC ILLNESSES OR ANY LIFE- OR LIMB- 
THREATENING CONDITION REQUIRING PROLONGED 
HOSPITALIZATION, HIGH-COST THERAPIES OR 
TREATMENTS, OR OTHER ESSENTIAL BUT FINANCIALLY 
BURDENSOME INTERVENTIONS, THE COST OF WHICH 
WOULD SIGNIFICANTLY DEPLETE THE PATIENTS OR 
FAMILY'S FINANCIAL RESOURCES.
(X) MEDICAL ASSISTANCE TO INDIGENT AND FINANCIALLY 
INCAPACITATED PATIENTS (MAIFIP) PROGRAM REFERS TO 
THE EXISTING DOH MEDICAL ASSISTANCE PROGRAM FOR 
INDIGENT AND FINANCIALLY INCAPACITATED PATIENTS 
FUNDED THROUGH THE GENERAL APPROPRIATIONS ACT;
(Y) NO BALANCE BILLING (NBB) REFERS TO THE POLICY, 
WHICH PROVIDES THAT NO OTHER FEES OR EXPENSES 
SHALL BE CHARGED OR BE PAID FOR BY THE INDIGENT 
PATIENTS ABOVE AND BEYOND THE PACKAGED RATES


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PROVIDED BY PHILHEALTH DURING THEIR CONFINEMENT 
PERIOD.
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E(^] (Z) Population-based health services refer to interventions 
such as health promotion, disease surveillance, and vector control, 
which have population groups as recipients;
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[(f)] (AA) Primary care refers to initial-contact, accessible, 
continuous, comprehensive and coordinated care that is accessible 
at the time of need including a range of services for all presenting 
conditions, and the ability to coordinate referrals to other health 
care providers in the health care delivery system, when necessary;
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[(s)] (BB) Primary care provider refers to a health care worker, 
with defined competencies, who has received certification in 
primary care as determined by the Department of Health (DOH) or 
any health institution that is licensed and certified by the DOH;
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[(t)] (CC) Private health insurance refers to coverage of a defined 
set of health services financed through private payments in the form 
of a premium to the insurer; and
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[(tf)] (DD) Unethical act refers to any action, scheme or ploy 
against the NHIP, such as overtoiling, upcasing, "harboring ghost 
patients or recruitment practice, or any act contrary to the Code of 
Ethics of the responsible person's profession or practice, or other 
similar, analogous acts that put or tend to put in disrepute the 
integrity and effective implementation of the NHIP.
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Sec. 5. Sec. 6 of Republic Act No. 11223 is hereby amended to read as follows: 
SEC. 6. Service Coverage. - (a) Every Filipino shall be granted 
immediate eligibility and access to preventive, promotive, curative.
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rehabilitative, and palliative care for medical, dental, mental and 
emergency health services, delivered either as population-based or 
individual-based health services: Provided, That the goods and 
services to be included shall be determined through a fair and 
transparent HTA process;
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(b) Within two (2) years from the effectivity of this Act, PhilHealth 
shall implement a comprehensive outpatient benefit, including 
outpatient drug benefit and emergency medical services in 
accordance with the recommendations of the Health Technology 
Assessment Council (HTAC) created under Section 34 hereof;
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(c) The DOH and the local government units (LGUs) shall endeavor 
to provide a health care delivery system that will afford every Filipino 
a primary care provider that would act as the navigator, coordinator, 
and initial and continuing point of contact in the health care delivery 
system: Provided, That except in emergency or serious cases and 
when proximity is a concern, access to higher levels of care shall 
be coordinated by the primary care provider; [aed]
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(d) Every Filipino shall register with a public or private primary care 
provider of choice. The DOH shall promulgate the guidelines on the 
licensing of primary care providers and the registration of every 
Filipino to a primary care provider^]; AND
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(E) THE DOH SHALL PROVIDE DIRECT, ACCESSIBLE, AND 
EQUITABLE MEDICAL ASSISTANCE TO INDIGENTS OR 
FINANCIALLY INCAPACITATED PATIENTS THROUGH THE 
MEDICAL ASSISTANCE TO INDIGENT AND FINANCIALLY 
INCAPACITATED PATIENTS (MAIFIP) PROGRAM IN 
ACCORDANCE WITH THE FULL IMPLEMENTATION OF THE NO 
BALANCE BILLING (NBB) AND NO CO-PAYMENT POLICIES


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UNDER THIS ACT; PROVIDED, THAT SUCH MEDICAL 
ASSISTANCE SHALL COVERALL NECESSARY EXPENDITURES, 
AS CERTIFIED BY MEDICAL PRACTITIONERS, THAT ARE NOT 
SUFFICIENTLY COVERED BY PHILHEALTH, LOCAL 
GOVERNMENT UNIT (LGU) HEALTH PROGRAMS, OR OTHER 
SUBSIDY FUNDS, TO ENSURE THAT MEDICAL ASSISTANCE 
BENEFICIARIES DO NOT INCUR OUT-OF-POCKET EXPENSES.
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Sec. 6. Insert a new paragraph on Sec. 7 of Republic Act No. 11223, to read as
follows:
(C) THE NATIONAL GOVERNMENT SHALL FINANCE THE 
UNIVERSAL MEDICAL ASSISTANCE PROGRAM FOR 
IN DIGENTS OR FINANCIALLY INCAPACITATED PATIENTS.
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Sec. 7. Insert a new Chapter V, with new sections, on Republic Act No. 11223,
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to read as follows;
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CHAPTER V
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UNIVERSAL MEDICAL ASSISTANCE PROGRAM (UMAP)
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SEC. 19. COVERAGE. - ALL FILIPINOS, WHETHER IN­
PATIENTS OR OUT-PATIENTS, WHO ARE QUALIFIED AS 
MEDICAL ASSISTANCE BENEFICIARIES, SHALL BE 
ENTITLED TO RECEIVE MEDICAL ASSISTANCE FROM THE 
DOH TO COVER CLINICALLY INDICATED NEEDS AS 
PRESCRIBED BY A HEALTH CARE PROVIDER LICENSED BY 
THE DOH AND/OR ACCREDITED BY THE PHILHEALTH. THE 
EXISTING MEDICAL ASSISTANCE TO INDIGENT AND 
FINANCIALLY INCAPACITATED PATIENTS (MAIFIP) SHALL 
BE SUBSUMED UNDER THIS PROGRAM AND SHALL BE 
FULLY HARMONIZED WITH THE PROVISIONS HEREOF AND 
ITS CORRESPONDING IMPLEMENTING RULES AND 
REGULATIONS.
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SEC. 20. SERVICES COVERED. - THE MEDICAL ASSISTANCE
SHALL COVER MEDICINES, SERVICES, OTHER MEDICAL
PRODUCTS AS PRESCRIBED BY A DOH-LICENSED AND/OR
PHILHEALTH ACCREDITED PHYSICIAN OR HEALTH
PROFESSIONAL, SUCH AS, BUT NOT LIMITED TO THE
FOLLOWING:
(A) DRUGS AND MEDICINES AS APPROVED BY THE FOOD 
AND DRUG ADMINISTRATION (PDA);
(B) LABORATORY, IMAGING, RADIOLOGICAL, AND OTHER
DIAGNOSTIC 
PROCEDURES 
INCLUDING
CORRESPONDING ASSESSMENT/ READERS FEES;
(C) BLOOD, BLOOD PRODUCTS AND BLOOD SCREENING 
SERVICES;
(D) CLINICALLY INDICATED MEDICAL-SURGICAL CASES, 
HIGH-RISK OBSTETRICS-GYNECOLOGICAL CASES, 
DENTAL PROCEDURES REQUIRING IMPLANTS, 
MEDICAL DEVICES AND SUPPLIES, AND OTHER 
MEDICALLY NECESSARY INTERVENTIONS;
(E) PRESCRIBED POST-HOSPITALIZATION SERVICES, 
INCLUDING REHABILITATION SERVICES, AFTERCARE 
PROGRAMS, AND APPROPRIATE MENTAL AND 
PSYCHOSOCIAL SUPPORT;
(F) ALL HOSPITAL BILLS OR CHARGES INCURRED DURING 
CONFINEMENT OR TREATMENT; AND
(G) PROFESSIONAL FEES, PROVIDED THAT SUCH FEES 
SHALL NOT EXCEED FIFTY PERCENT (50%) OF THE 
TOTAL APPROVED AMOUNT OF MEDICAL ASSISTANCE.
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SUBJECT TO THE GUIDELINES OF THE FOOD AND DRUG 
ADMINISTRATION (FDA), THE COST OF DRUGS AND 
MEDICINES AUTHORIZED FOR COMPASSIONATE USE FOR
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TERMINALLY OR SERIOUSLY ILL PATIENTS SHALL 
LIKEWISE BE COVERED UNDERTHIS MEDICAL ASSISTANCE 
PROGRAM.
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SEC. 21. COORDINATED CARE. - THE UTILIZATION OF 
UMAP AND ITS APPROPRIATIONS SHALL PRIMARILY 
COVER QUALIFIED UMAP BENEFICIARIES SEEKING CARE 
IN GOVERNMENT HEALTH FACILITIES. IN CASE OF NON­
AVAILABILITY OF CLINICALLY INDICATED DRUGS AND 
MEDICINES, PROCEDURES, OR SERVICES, OR LACK OF 
AVAILABLE BEDS, A GOVERNMENT HEALTH FACILITY MAY 
REFER A MEDICAL ASSISTANCE BENEFICIARYTO ANOTHER 
GOVERNMENT HEALTH FACILITY OR PHILHEALTH 
ACCREDITED PRIVATE HEALTHCARE PROVIDER; 
PROVIDED, THAT SUCH REFERRAL SHALL GIVE PRIORITY 
AND PREFERENCE TO A GOVERNMENT HEALTH FACILITY.
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PRIVATE HEALTH FACILITIES MAY PROVIDE THE 
CLINICALLY INDICATED NEEDS OF THE QUALIFIED 
BENEFICIARIES ONLY UNDER COMPELLING 
CIRCUMSTANCES, SUCH AS WHEN SERVICES ARE 
UNAVAILABLE, INACCESSIBLE, OR INADEQUATE IN 
GOVERNMENT FACILITIES. IN SUCH CASES, 
REIMBURSEMENT OR PAYMENT TO THE ACCREDITED 
PRIVATE HEALTHCARE PROVIDER SHALL BE PROCESSED 
WITHIN SIXTY (60) CALENDAR DAYS FROM THE RECEIPT 
OF THE BILLING STATEMENT AND SUPPORTING 
DOCUMENTS, IN ACCORDANCE WITH DOH FINANCIAL AND 
ADMINISTRATIVE GUIDELINES.
SEC. 22. EQUITABLE FINANCING. - MEDICAL ASSISTANCE 
FOR THE SERVICES ENUMERATED UNDER SECTION 20 OF 
THIS ACT SHALL BE GRANTED ONLY UPON VERIFICATION
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THAT SUCH SERVICES ARE NOT SUFFICIENTLY COVERED 
BY THE APPLICABLE PHILHEALTH CASE RATE, EXISTING 
HEALTH SERVICE SUBSIDIES OF THE LGU, OR OTHER 
GOVERNMENT MEDICAL ASSISTANCE FUNDS, INCLUDING 
BUT NOT LIMITED TO THE CANCER ASSISTANCE FUND AND 
THE PHILIPPINE CHARITY SWEEPSTAKES OFFICE (PCSO) 
PROGRAMS. DOUBLE CHARGING OF CLAIMS ACROSS 
FUNDING SOURCES SHALL BE STRICTLY PROHIBITED. THE 
DOH, PHILHEALTH AND ACCREDITED PUBLIC AND 
PRIVATE HEALTH FACILITIES SHALL STRICTLY ADHERE TO 
THE NO BALANCE BILLING AND NO CO-PAYMENT 
POLICIES.
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TAKING INTO CONSIDERATION THE PREVAILING HEALTH 
BENEFIT SCHEDULES, COSTS OF MEDICAL SERVICES AND 
MEDICINES, LGU-FUNDED HEALTH SERVICES, AND OTHER 
RELEVANT GOVERNMENT MEDICAL ASSISTANCE 
PROGRAMS, THE DOH SHALL SUBMIT TO CONGRESS AN 
ANNUAL UMAP FINANCING STRATEGY.
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THE NATIONAL GOVERNMENT SHALL DIRECTLY 
APPROPRIATE TO ALL PUBLIC HOSPITALS, INCLUDING 
SPECIALTY HOSPITALS AND HOSPITALS OPERATED BY 
STATE UNIVERSITIES AND COLLEGES (SUCS), THEIR 
ANNUAL APPROPRIATIONS FOR MEDICAL ASSISTANCE 
UNDER THE UMAP. AS PROVIDED UNDER THE REPORTING 
AND RECORDING REQUIREMENTS OF MAIFIP IN 
PREVIOUS YEARS, THE MONTHLY FUND UTILIZATION 
REPORTS, NUMBER OF INDIGENT AND FINANCIALLY 
INCAPACITATED PATIENTS ASSISTED, AND THE STATUS 
OF THE IMPLEMENTATION OF THE UMAP OF EACH 
GOVERNMENT HEALTH FACILITY OF DOH, INCLUDING
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SPECIALTY HOSPITALS AND SUCS, SHALL BE USED IN THE 
DELIBERATION AND FINAL DETERMINATION OF THEIR 
RESPECTIVE BUDGETS.
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SUCH FUNDS SHALL BE EXCLUSIVELY APPLIED TO COVER 
THE COST OF SERVICES ENUMERATED UNDER SECTION 20 
OF THIS ACT THAT ARE NOT FULLY PAID OR REIMBURSED 
THROUGH EXISTING PHILHEALTH CASE RATES, LGU 
HEALTH SERVICE SUBSIDIES, OR OTHER MEDICAL 
ASSISTANCE PROGRAMS. IN NO CASE SHALL UMAP FUNDS 
BE CONVERTED INTO CASH OR RECEIVED DIRECTLY BY 
PATIENTS OR THEIR RELATIVES OR REPRESENTATIVES.
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PROVIDED, THAT PRIVATE HEALTH FACILITIES 
ATTENDING TO PATIENTS QUALIFIED UNDER THE UMAP 
SHALL BE ENTITLED TO REIMBURSEMENT OF INCURRED 
EXPENSES, CHARGEABLE AGAINST THE APPROPRIATIONS 
OF THE DEPARTMENT OF HEALTH (DOH) UNDER THIS ACT, 
AND SUBJECT TO THE RULES AND PROCEDURES AS MAY BE 
PRESCRIBED IN THE IMPLEMENTING GUIDELINES TO BE 
ISSUED BY THE DOH.
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29
THE UNIVERSAL MEDICAL ASSISTANCE PROGRAM SHALL 
FUNCTION AS A SUPPLEMENTARY BUT GUARANTEED 
SOURCE OF FINANCING TO ENSURE THAT NO QUALIFIED 
BENEFICIARY IS DENIED ACCESS TO CLINICALLY 
NECESSARY SERVICES OR REQUIRED TO PAY OUT-OF- 
POCKET. IT SHALL BE UTILIZED ONLY AFTER THE 
EXHAUSTION OR INSUFFICIENCY OF PHILHEALTH 
BENEFITS, LGU HEALTH SUBSIDIES, AND OTHER 
AVAILABLE GOVERNMENT MEDICAL ASSISTANCE 
PROGRAMS. IN NO CASE SHALL THE PATIENT OR THEIR
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1
2
FAMILY BE REQUIRED TO PAY THE BALANCE OF ANY 
COVERED SERVICE.
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6
PHILHEALTH SHALL ENSURE THE MAXIMIZATION OF ITS 
SUPPORT VALUE AND BENEFIT COVERAGE, AND IN NO 
CASE SHALL UMAP SERVE AS THE PRIMARY SOURCE OF 
FINANCING FOR MEDICALLY INDICATED SERVICES.
7
8 
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10
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SEC. 23. MEDICAL ASSISTANCE DATABASE. - ALL 
BENEFICIARIES OF MEDICAL ASSISTANCE SHALL BE 
REQUIRED TO SUBMIT THEIR PHILSYS CARD NUMBER 
(PCN) WHICH SHALL BE INTEGRATED INTO THE DOH 
CENTRAL BENEFICIARY DATABASE. THE DOH SHALL 
INSTITUTIONALIZE AND MAINTAIN A SECURE, 
INTEROPERABLE, AND CENTRALIZED DIGITAL REGISTRY 
OF BENEFICIARIES TO SUPPORT ELIGIBILITY 
VERIFICATION, CLAIMS TRACKING, AND PROGRAM 
EVALUATION.
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SUBJECT TO THE PROVISIONS OF REPUBLIC ACT NO. 
10173, OR THE "DATA PRIVACY ACT OF 2012," AND IN 
ACCORDANCE WITH APPLICABLE GOVERNMENT DATA- 
SHARING GUIDELINES, THE DOH SHALL ESTABLISH A 
MECHANISM FOR REAL-TIME, PRIVACY-COMPLIANT DATA 
SHARING WITH PHILHEALTH, ACCREDITED HEALTH 
FACILITIES, AND OTHER GOVERNMENT AGENCIES OR 
INSTITUTIONS PROVIDING MEDICAL ASSISTANCE. SUCH 
SHARING SHALL BE LIMITED TO THE EXTENT NECESSARY 
TO FACILITATE SERVICE DELIVERY, PREVENT 
DUPLICATION OF BENEFITS, AND SUPPORT EVIDENCE- 
BASED HEALTH FINANCING.
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1 
Sec. 8. All succeeding chapters and sections of Republic Act No. 11223 are
2 
renumbered accordingiy.
3 
Sec. 9. Insert a new section on Republic Act No. 11223, to read as follows:
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5
6
7
8 
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10
SEC. 43. PROHIBITION AGAINST POLITICAL 
EXPLOITATION AND MANIPULATION. - NO PUBLIC 
OFFICIAL OR GOVERNMENT EMPLOYEE SHALL INTERFERE 
WITH, INFLUENCE, OR REPRESENT THEMSELVES, 
WHETHER DIRECTLY OR INDIRECTLY, AS HAVING 
CONTROL OR INFLUENCE OVER ANY ASPECT OF THE 
IMPLEMENTATION OF THIS PROGRAM.
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LIKEWISE, NO PUBLIC OFFICIAL OR EMPLOYEE SHALL 
ENDORSE, RECOMMEND, OR INTERVENE IN THE 
INCLUSION OR EXCLUSION OF ANY INDIVIDUAL AS A 
BENEFICIARY OF THE PROGRAM. ONLY DULY AUTHORIZED 
PERSONNEL OF THE DOH OR DESIGNATED HEALTH 
FACILITY STAFF MAY PARTICIPATE IN THE 
ADMINISTRATION AND IMPLEMENTATION OF THE 
PROGRAM.
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21 
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23
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25
ALL ASSISTANCE PROVIDED UNDER THIS ACT SHALL BE 
EXPLICITLY IDENTIFIED AS FUNDED BY PUBLIC 
RESOURCES COMING FROM TAXPAYERS' MONEY. NO 
PUBLIC OFFICIAL SHALL CLAIM, IMPLY, OR REPRESENT 
THAT SUCH FUNDS WERE PERSONALLY DONATED OR 
ALLOCATED THROUGH HIS OR HER INDIVIDUAL 
INITIATIVE OR DISCRETION.
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ANY PERSON FOUND TO HAVE VIOLATED THIS PROVISION 
SHALL BE PENALIZED WITH PERPETUAL ABSOLUTE 
DISQUALIFICATION FROM HOLDING PUBLIC OFFICE,
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WITHOUT PREJUDICE TO THE FILING OF OTHER 
CRIMINAL, CIVIL, OR ADMINISTRATIVE CHARGES UNDER 
EXISTING LAWS.
4 
Sec. 10. All succeeding sections of Republic Act No. 11223 are renumbered
5 
accordingly.
6 
Sec. 11. Appropriations. -The amount necessary to carry out the provisions of
7 
this Act shall be sourced from Annual appropriations of the DOH included in
8 
the General Appropriations Act.
9 
Sec. 12. Implementing Rules and Regulations. - Within three (3) months from
10 
the effectivity of this Act, the Secretary of the DOH shall, in coordination with
11 
appropriate government departments and agencies with the participation of the iocal
12 
government units, promulgate the necessary rules and regulations to carry out the
13 
provisions of this Act.
14 
Sec. 13. Separability Qause. - Should any provision of this Act be found
15 
unconstitutional by a court of law, such provision shall be severed from the remainder
16 
of this Act, and such action shall not affect the enforceability of the remaining
17 
provisions of this Act.
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Sec. 14. Repealing Qause. - All laws, decrees, letters of instruction, resolutions,
19 
orders or parts thereof which are inconsistent with the provisions of this Act are hereby
20 
repealed, modified or amended accordingly.
21 
Sec. 15. Effectivity Qause. -This Act shall take effect fifteen (15) days following
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its publication in the Official Gazette or in two (2) newspapers of general circulation
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in the Philippines.
24 
Approved,
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