REPRES,

S3 i>
E-Filed 7
RECEIVED
Republic of the Philippines {|= DATE _July 7, 2022
House of Representatives
Quezon City
NINETEENTH CONGRESS
First Regular Session

House BillNo. _1614___

Introduced by Representative Albert Raymond S. Garcia

Ina country registering the highest Coronavirus Disease 2019 (COVID-19) infection

in Southeast Asia"! nothing could probably be more revolting than to uncover that the
officials tasked with the administration and management of the National Health Insurance
Program and the National Health insurance Fund are themselves allegedly robbing the
coffers they were sworn to protect. In a pandemic that has caused thousands of deaths in
our country, bleeding billions of pesos away from state resources intended for this purpose

is a brazen violation of the Filipinos’ right to health and right to life {21

Allegations of corruption in the state-run Philippine Health Insurance Corporation
(PhilHealth) is not new. It dates back several years and has taken many forms: diverted
premium payments of up to P114 million in 2012, sham cataract removals worth P2 billion
in 2014, fraudulent dialysis claims, “upcasing” of mild respiratory infections to pneumonia,
maintenance in the membership rosters of some 50,000 “supercentenarians” aged from 100

to 121,93) and procurement of overpriced and obsolete information technology

equipment. /41 The allegations recently turned to their worst when the pandemic that is
devastating our country’s people and economy appeared to open more opportunities for
corruption with the reported purchase of overpriced COVID-19 test kits, and the
implementation of an interim reimbursement mechanism that expedited COVID-19 related
advances to hospitals in regions with low infections rates, while hospitals in high infection

areas, including government facilities, still await reimbursement.[5]

While the reported acts of corruption still remain to be established beyond
reasonable doubt, the persistent allegations of abuse against the agency's resources
suggest a systemic flaw that begs to be addressed. At the heart of the problem is the
persistent resistance of the Agency to upgrade its information technology backbone. It is of
critical importance that reforms and modemization of the National Health Insurance
Program begins with a state-of-the-art information system that provides real-time
information on claims, expenditures, and health conditions of the country.


PhilHealth is the principal implementer of the Universal Health Care Act. With limited
resources to finance the implementation of the universal coverage of all Filipinos, it is
imperative that its funds are prudently utilized and safeguarded against loss or wastage.

This bill seeks to institute reforms in the administration of the National Health
Insurance Program to strengthen institutional checks by separating the financing and
purchasing functions of the Program and delegating the relevant responsibilities to two (2)
distinct corporate entities working independently but in coordinated fashion towards a
common objective of efficiently administering the country’s health insurance program.

The financing function embracing membership eligibility, premium, collection,
formulation of rules and standards for program benefits, reimbursement of medical claims,
investment of program and reserve funds, and actuarial studies shall be retained by
PhilHealth. On the other hand, the purchasing function involving, mainly, the analysis of the
trends and impacts of financing on population health outcomes through review and approval
of benefit claims, and assessment of promotive, preventive, curative and rehabilitative
services shall be assumed by the Health Insurance Review and Assessment Corporation,
a juridical entity created under the proposed measure. Modernization and upgrading of
information technology systems will be under the HIRAC.

In bifurcating the aforementioned functions, and in strengthening the ability to
analyze trends, shape policy directions toward prevention and improvements in population
health outcomes, regulate medical benefits and review of medical claims, the measure
hopes to enhance controls, plug perceived weaknesses in the system and eliminate the
‘opportunity for corruption. More importantly, this measure seeks to ensure that health
inequity from structural and systemic biases against the poor that have evolved through the
years, are continuously addressed. The proposed reform in the system likewise provides
an occasion to inject fresh blood of highly qualified, competent, young, idealistic, and
service-driven personnel that shall form the core of the new corporation's workforce.

—

Support for this bill is earnestly requested from our colleagues.

REP. Al
id Dis
11] ptos/ww.aseanbriefing.com/news/coronavirus-asia-asean-live-updates-by-country/; last
accessed on 9 September 2020.

accessed on 9 September 2020.

8] Id.; see also https: .somp.com/week-asia/economics/article/309786 1/philippines-
coronavirus-crisis-led-massive-philhealth; last accessed on 9 September 2020.
(4)

Id.

6 Id.



Republic of the Philippines
House of Representatives
Quezon City
NINETEENTH CONGRESS
First Regular Session

House Bill No. 1614

Introduced by Representative Albert Raymond S. Garcia

AN ACT
INSTITUTING REFORMS IN THE NATIONAL HEALTH INSURANCE
PROGRAM, AMENDING FOR THE PURPOSE CERTAIN LAWS AND FOR
OTHER PURPOSES

Be it enacted by the Senate and House of Representatives of the Philippines
in Congress assembled:

SECTION 1. Short Title. — This Act shall be known as the “National Health
Insurance Reform Act.”

SEC. 2. Declaration of Policy — It is the policy of the State to provide all
Filipinos access to a comprehensive set of quality and cost-effective, promotive,
preventive, curative, rehabilitative and palliative health services without causing
financial hardship, and prioritizes the needs of the populations who cannot afford
such services. Towards this end, the State shall institute reforms in the
administration of the National Health Insurance Program by restructuring the
financing and purchasing functions to strengthen institutional checks and balances
and ensure that all Filipinos are guaranteed equitable access to quality and
affordable health care goods and services and protected against financial risk

SEC. 3. Scope. - This Act shall provide for the restructuring of the National
Health insurance Program by placing the administration and management of the
same under different government entities separately performing the management of
program funds and formulation of rules and standards for program benefits, and the
analysis of trends and impacts of financing on population health outcomes, review,
and approval of benefit claims, assessment of promotive, preventive, curative and
rehabilitative services, and defining the roles and responsibilities of the government
entities vested with the powers and functions relative thereto.


mean:

(a)

(b)

(c)

(1)
(2)

(3)

(4)

(6)

(9)

SEC. 4. Definition of Terms. — As used in this Act, the following terms shall

Beneficiary refers to any person entitled to health care benefits under the
National Health Insurance Program;

Case-based payment refers to a payment method that reimburses to
hospitals a predetermined fixed rate for each treated case or disease;

Entitlement refers to any singular or package of health services provided to
Filipinos for the purpose of improving health; (d) Dependent refers to:

the legitimate spouse who is not a member;

the unmarried and unemployed legitimate, legitimated, illegitimate,
acknowledged children as appearing in the birth certificate; legally
adopted or stepchildren below twenty-one (21) years of age;

children who are twenty-one (21) years old and above but suffering
from congenital disability, either physical or mental, or any disability
acquired that renders them totally dependent on the member for
support;

the parents who are sixty (60) years old or above whose monthly
income is below an amount to be determined by the Commission in
accordance with the guiding principles set forth in Republic Act No.
7875, otherwise known as the “National Health Insurance Act of 1995”,
as amended;

parents with permanent disability that render them totally dependent
on the member for subsistence.

Direct contributors refer to those who have the capacity to pay premiums, are
gainfully employed and are bound by employer-employee relationship, or are
self-earning professional practitioners, migrant workers, including their
qualified dependents, and lifetime members.

Fee-for-service refers to a fee predetermined by the Commission for each
service delivered by a health care provider based on the bill. The payment
system shall be based on a pre-negotiated schedule promulgated by the
Commission;

Global budget refers to an approach in the purchase of medical services by
which health care provider negotiations concerning the costs of providing a
specific package of medical benefits is based solely on a predetermined and
fixed budget


(h)

(1)

(2)

(3)

1)

)

(m)

(n)

Health benefit package refers to a set of individual-based entitlements
covered by the NHIP which includes primary care; medicines, diagnostics
and laboratory; and preventive, curative, and rehabilitative services; (i) Health
care provider refers to any of the following:

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;

A health care professional, who may be a doctor of medicine, nurse,
midwife, or other allied professional or practitioner duly licensed to
practice in the Philippines;

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;

Pharmacies or drug outlets, laboratories and diagnostic clinics.

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 issue of a health intervention or health
technology;

Indirect contributors refer to all others not included as direct contributors, as
well as their qualified dependents, whose premium shall be subsidized by the
national government including those who are subsidized as a result of special
laws;

Member refers to a person whose premiums have been regularly paid to the
National Health Insurance Program either as a direct or indirect contributor,

Migrant workers refer to documented or undocumented Filipinos who are
engaged in remunerated activity in another country of which they are not
citizens;

National Health Insurance Program refers to the compulsory health insurance
program of the government established under Republic Act No. 7875, as
amended, which shall provide universal health insurance coverage and
ensure affordable, acceptable, available and accessible health care services
for all Filipinos;


(0)

(p)

(a)

®

(u)

Philippine National Drug Formulary refers to the essential drugs list of the
Philippines prepared by the National Drug Committee of the Department of
Health in consultation with experts and specialists from organized
professional medical societies, medical academe and the pharmaceutical
industry, and updated every year;

Portability refers to the feature that enables a member to avail of program
benefits in an area outside the jurisdiction of his local health insurance office;

Professional practitioners include doctors, lawyers, certified public
accountants, and other practitioners required to pass government licensure
examinations in order to practice their professions;

Public health services refer to services that strengthen preventive and
promotive health care through improving conditions in partnership with the
community at large. These include control of communicable and non-
communicable diseases, health promotion, public information and education,
water and sanitation, environmental protection, and health-related data
collection, surveillance, and outcome monitoring;

Quality assurance refers to a formal set of activities to review and ensure the
quality of services provided. It includes quality assessment and corrective
actions to remedy any deficiencies identified in the quality of direct patient,
administrative, and support services;

Self-earning individuals refer to those who render services or sell goods as a
means of livelihood outside of an employer-employee relationship, or as a
career, but do not belong to the informal sector. These include businessmen,
entrepreneurs, actors,

Utilization review refers to a formal review of a patient utilization or of the
appropriateness of health care services, on a prospective, concurrent or
retrospective basis;

CHAPTER II
THE NATIONAL HEALTH INSURANCE PROGRAM

SEC. 5. Administration and Management. — The National Health Insurance

Program (NHIP) shall be administered and managed by the Philippine Health
Insurance Corporation (PhilHealth) and the Health Insurance Review and
Assessment Corporation (HIRAC) created under Section 28 of this Act. Except as
otherwise provided in this Act, the administration and management of the NHIP,
including membership coverage and entitlement to benefits shall continue to be
governed by the provisions of Republic Act No. 7875, as amended by Republic Act
No. 9241, Republic Act No. 10606, and Republic Act No. 11223, otherwise known
as the “Universal Health Care Act.”


SEC. 6. Roles and Responsibilities of PhilHealth and HIRAC. - The
provision of any existing law to the contrary notwithstanding, the responsibility of
PhilHealth in the implementation of the NHIP shall embrace the program coverage,
membership eligibility, premium collection, formulation of rules and standards for
program benefits, claims reimbursement, management of program funds, actuarial
studies, and other related responsibilities specified in this Act.

The HIRAC shall assume the responsibility of conducting analysis of trends
and impacts of health financing on population health outcomes, review and approval
of benefit claims, assessment of promotive, preventive, curative and rehabilitative
services, and such other related functions defined in this Act.

CHAPTER III
THE PHILIPPINE HEALTH INSURANCE CORPORATION

SEC. 7. Powers and Functions of PhilHealth. - The Philippine Health
Insurance Corporation created under Republic Act No. 7875, as amended, shall
exercise the following powers and functions:

(a) Formulate and promulgate policies on benefit packages under the Program
and for the sound administration of the National Health Insurance Fund;

(b) Set standards, rules, and regulations necessary to ensure the provision of
health benefits, quality of care, appropriate utilization of services, member
satisfaction, fund viability, and overall accomplishment of the Program
objectives;

(©) _ Formulate and implement guidelines on contributions and payments;

(@) Pay the claims for reimbursement of health care providers duly reviewed and
approved by HIRAC;

(e) _ Receive and manage grants, donations, and other forms of assistance;
(f) — Sue and be sued in court;

(g) Acquire property, real and personal, which may be necessary or expedient
for the attainment of the purposes of this Act;

(h) Collect, deposit, invest, administer, and disburse the National Health
Insurance Fund in accordance with the provisions of this Act;

(0) Keep records of its operations and the investments of the National Health
Insurance Fund;

(i) Establish and maintain an electronic database of all its members and ensure
its security to facilitate efficient and effective services;


(k)
()

(m)

(n)

(0)
()

(a)

(0)

Invest in the acceleration of PhilHealth's information technology systems;

Establish an office, or where it is not feasible, designate a focal person in
every Consular Office in all countries where there are Filipino citizens. The
office or the focal person shall, among others, process, review and pay the
claims of overseas Filipino workers (OFWs);

Visit, enter and inspect facilities of employers during office hours, unless
there is reason to believe that inspection has to be done beyond office hours,
and where applicable, secure copies of their financial, and other records and
data pertinent to the premium contributions, and that of their employees;

Impose interest and/or surcharges of not exceeding three per cent (3%) per
month, for employers and not exceeding one and one-half per cent (1.5%)
for self-earning, professional practitioners, and migrant workers.
Notwithstanding the provisions of any law to the contrary, the PhilHealth may
also compromise, waive or release, in whole or in part, such interest or
surcharges imposed regardless of the amount involved under such valid
terms and conditions as it may prescribe;

Accredit independent pharmacies and retail drug outlets;

Monitor compliance by the regulatory agencies with the requirements of this
Act and to carry out necessary actions to enforce compliance;

Fix the reasonable compensation, allowances and other benefits of all
positions, including its President and Chief Executive Officer (CEO), based
on a comprehensive job analysis and audit of actual duties and
responsibilities, subject to the approval of the President of the Philippines.
The compensation plan shall be comparable with government social security
institutions and shall be subject to periodic review by the Board no more than
‘once every four (4) years without prejudice to merit reviews or increases
based on productivity and efficiency;

Establish the organizational structure and staffing pattern of PhilHealth's
central and regional offices to cover as many provinces, cities and legislative
districts, including foreign countries, whenever and wherever it may be
expedient, necessary and feasible and to inspect or cause to be inspected
periodically such offices, subject to the approval of the Board;

Maintain a Provident Fund which consists of contributions made by both
PhilHealth and its officials and employees and earnings thereon, for the
payment of benefits to such officials and employees or their dependents or
heirs under such terms and conditions as may be prescribed by the Board,
subject to the approval of the President of the Philippines;


(u)

(v)

Adopt or approve the annual and supplemental budget of receipts and
expenditures including, salaries, allowances and early retirement of
PhilHealth personnel and to authorize such capital and operating
expenditures and disbursements as may be necessary and proper for the
effective management and operation of PhilHealth: Provided, That this shall
be subject to the budgetary limitations stated under Section 21 of this Act:
Provided, further, That the submission of the corporate budget to the
Department of Budget and Management (DBM) shall be for information
purposes only;

Submit to the President of the Philippines and to both Houses of Congress
its Annual Report which shall contain the status of the National Health
Insurance Fund, its total disbursements, reserves, any request for additional
appropriations, and other data pertinent to the administration, management,
and financing of the fund and publish a synopsis of such report in PhilHealth’s
website and in two (2) newspapers of general circulation; and

Perform such other acts as it may deem appropriate for the attainment of the
objectives of PhilHealth and for the proper enforcement of the provisions of
this Act.

SEC. 8. Quasi-Judicial Powers. — To carry out its tasks more effectively,

PhilHealth shall be vested with the following powers:

(a)

(b)

Subject to the respondent's right to due process, to conduct investigations for
the determination of a question, controversy, complaint, or unresolved
grievance brought to its attention, and render decisions, orders, or resolutions
thereon. It shall proceed to hear and determine the case even in the absence
of any party who has been properly served with notice to appear. It shall
conduct its proceedings or any part thereof in public or in executive session;
adjourn its hearings to any time and place; refer technical matters or accounts
to an expert and to accept his reports as evidence; direct parties to be joined
in or excluded from the proceedings; and give all such directions as it may
deem necessary or expedient in the determination of the dispute before it;

To summon the parties to a controversy, issue subpoenas requiring the
attendance and testimony of witnesses or the production of documents and
other materials necessary to a just determination of the case under
investigation;

Subject to the respondent's right to due process, to suspend temporarily,
revoke permanently, or restore the accreditation of a health care provider or
the right to benefits of a member and/or impose fines. The decision shall
immediately be executory, even pending appeal, when the public interest so
requires and as may be provided for in the implementing rules and


regulations. Suspension of accreditation shall not exceed six (6) months.
Suspension of the rights of members shall not exceed six (6) months.

The revocation of a health care provider's accreditation shall operate to
disqualify him from obtaining another accreditation in his own name, under a
different name, or through another person, whether natural or juridical.

The PhilHealth shall not be bound by the technical rules of evidence.

SEC. 9. PhilHealth Board of Directors. — The PhilHealth Board of Directors,
hereinafter referred to as the Board, shall have a maximum of thirteen (13)
members, consisting of the following:

(a) The Secretary of Health as ex officio non-voting Chairperson;
(b) The Secretary of Finance;

(c) The Secretary of Social Welfare and Development;

(d) The Secretary of Budget and Management;

(e) The Secretary of Labor and Employment;

(f) Three (3) expert panel members with expertise in public health,
management, finance, or health economics; and

(g) _ Five (5) sectoral panel members, representing the direct contributors, indirect
contributors, employers group, health care providers to be endorsed by their
national associations of health care institutions and health care professionals,
and a representative of the elected local chief executives to be endorsed by
the League of Provinces of the Philippines, League of Cities of the Philippines
and League of Municipalities of the Philippines.

At least one (1) of the expert panel members and at least two (2) of the
sectoral panel members shall be women.

The expert and sectoral panel members must: (i) be Filipino citizens; (ii) be
of good moral character; (iii) be of recognized probity and independence and must
have distinguished themselves professionally in public, civic or academic service;
(iv) be in the active practice of their professions for at least seven (7) years; and (v)
not be appointed within one (1) year after losing in the immediately preceding
elections, whether regular or special. They shall be appointed by the President of
the Philippines and shall serve a term of office in accordance with Republic Act No.
10149.

All appointive members of the Board must undergo training in health care
financing and health systems, costing, health services, and HTA prior to the start of
their term. Noncompliance shall be a ground for termination of membership.


The incumbent appointive members of the PhilHealth Board shall continue to
serve as such upon the effectivity of this Act unless sooner replaced for just and
valid cause. Subsequent appointments to the Board shall be governed by the
nomination and selection process promulgated by the Governance Commission for
Government-Owned or Controlled Corporations (GCG) in accordance with the
provisions of Republic Act No. 10149.

SEC. 10. Meetings and Quorum. - The Board shall hold regular meetings
at least once a month. Special meetings may be convened at the call of the
Chairperson or by a majority of the members of the Board. The presence of a
majority of all the members shall constitute a quorum. In the absence of the
Chairperson and the Vice Chairperson, a temporary presiding officer shall be
designated by the majority of the quorum.

SEC. 11. Allowances and Per Diems. - The members of the Board shall
receive a per diem for every meeting attended and such other allowances as may
be allowed by the regulations issued by the GCG and other pertinent budgetary
laws, rules and regulations on compensation, honoraria and allowances.

SEC. 12. President and Chief Executive Officer (CEQ). - Upon the
recommendation of the Board, the President of the Philippines shall appoint the
President and CEO of PhilHealth from the Board's non-ex officio members:
Provided, That the Board shall not recommend a President and CEO of PhilHealth
unless the member is a Filipino citizen and must have at least seven (7) years of
experience in the field of public health, management, finance, and health economics
or a combination of any of these expertise.

The President and CEO shall have a tenure of one (1) year in accordance
with the provisions of Republic Act No. 10149. He shall also be the Vice Chairperson
of the Board.

SEC. 13. PhilHealth Personnel as Public Health Workers. — All PhilHealth
personnel shall be classified as public health workers in accordance with the
pertinent provisions under Republic Act No. 7305, otherwise known as the Magna
Carta of Public Health Workers.

SEC. 14. PhilHealth Actuary. — The PhilHealth shall maintain an Office of
the Actuary within the corporation to conduct the necessary actuarial studies and
present recommendations on insurance premiums, investments and other related
matters.

CHAPTER IV
LOCAL HEALTH INSURANCE OFFICE

SEC. 15. Establishment. — The PhilHealth shall establish a Local Health
Insurance Office, hereinafter referred to as the Office, in every province or chartered


city, or wherever it is deemed practicable to bring its services closer to members of
the Program. However, one Office may serve the needs of more than one province
or city when the merged operations will result in lower administrative cost and
greater cross-subsidy between rich and poor localities.

Provinces and cities where prospective members are organized shall receive

priority in the establishment of local health insurance offices.

SEC 16. Functions. — Each Office shall have the following powers and

functions:

(a)

(b)
(c)

(4)
(e)

()

(9)

(h)
(i)

1)

(k)

To consult and coordinate, as needed, with the local government units within
its jurisdiction in the implementation of the Program;

To register members of the Program from all areas within its jurisdiction;

To collect and receive premiums and other payment contributions to the
Program;

To maintain and update the membership eligibility list at community levels;

To recommend to the Board a uniform package of personal health service
benefits which is at least equal to the minimum package of such benefits
prescribed by the Board as applying to the nation;

To grant or deny accreditation to health care providers in their area of
jurisdiction, subject to the rules and regulations to be issued by the Board;

To establish referral systems and network arrangements with other Offices
as may be necessary in accordance with the guidelines prescribed by the
Board;

To serve as the first level for appeals and grievance cases;

To establish mechanisms by which private and public sector health facilities
and human resources may be shared in the interest of optimizing the use of
health resources;

To support the management information system requirements of
PhilHealth;

To tap community-based volunteer health workers and barangay officials, if
necessary, for premium collection and similar activities, and to grant such
workers incentives according to the guidelines set by the PhilHealth and in
accordance with applicable laws. However, the incentives for the barangay
officials shall accrue to the barangay and not to the said officials.


() To participate in information and education activities that are consistent with
the government's comprehensive and coordinated approach to health
development with emphasis on scaling up health promotion and preventive
care; and

(m) To prepare an annual report according to guidelines promulgated by the
Board and to submit the same to the PhilHealth central office.

CHAPTER V
HEALTH CARE PROVIDERS

SEC. 17. Authority to Grant Accreditation. - The PhilHealth shall have the
authority to grant accreditation to health care providers based on the set of rules,
standards and minimum criteria prescribed by the Board. The accreditation confers
the privilege to participate in the Program.

SEC. 18. Accreditation Eligibility. — All health care providers, as
enumerated in Section 4(i) hereof and operating for at least three (3) years may
apply for accreditation: Provided, That a health care provider which has not operated
for at least three (3) years may likewise apply and qualify for accreditation if it
complies with all the other accreditation requirements of and further meets any of
the following conditions:

(a) Its managing health care professional has had a working experience in
another accredited health care institution for at least three (3) years;

(b) _Itoperates as a tertiary facility or its equivalent;

(c) It operates in a local government unit where the accredited health care
provider cannot adequately or fully service its population; and

(d) Other conditions as may be determined by PhilHealth.

A health care provider found guilty of any violation of this Act shall not be
eligible to apply for the renewal of accreditation.

SEC. 19. Provider Payment Mechanisms. — The following mechanisms for
public and private providers shall be allowed in the Program:

(a) Fee-for-service payments — payments made by PhilHealth for professional
fees or hospital charges, or both, based on arrangements with health care
providers. This fee shall be based on a schedule to be established by the
Board which shall be reviewed periodically but not less than every three (3)
years;

(b) | Case-based payment;
(c) Global budget; and


(d) Such other provider payment mechanism that may be determined and
adopted by PhilHealth.

Subject to the approval of the Board, PhilHealth may adopt other payment
mechanism that are most beneficial to the members and PhilHealth.

Each PhilHealth local office shall recommend the appropriate payment
mechanism within its jurisdiction for approval by PhilHealth. Special consideration
shall be given to payment for services rendered by public and private health care
providers serving remote or medically underserved areas.

CHAPTER VI
THE NATIONAL HEALTH INSURANCE FUND AND RESERVE FUND

SEC. 20. Administration and Management of the National Health
Insurance Fund and Reserve Fund. — The National Health Insurance Fund and
the Reserve Fund, hereinafter referred to as “Funds”, shall be administered and
managed by PhilHealth in accordance with the provisions of Republic Act No. 7875,
as amended, and by the provisions of this Act.

SEC. 21. Financial Management. — The use, disposition, investment,
disbursement, administration and management of the Funds including any subsidy,
grant, or donation received for program operations shall be governed by resolution
of the PhilHealth Board, subject to the following limitations:

(a) _ All funds under the management and control of PhilHeaith shall be subject to
all rules and regulations applicable to public funds; and

(b) The cost of administering the Program shall not be more than seven and one-
half per cent (7.5%) of the actual total premium collected from direct and
indirect contributory members during the immediately preceding year, to be
divided equally between PhilHealth and HIRAC. The PhilHealth shall remit
the share of HIRAC within ten (10) days following the end of every quarter.

CHAPTER VII
FINANCING

SEC. 22. Premium Contributions. — For direct contributors, premium rates
shall be in accordance with the following schedule, and monthly floor and ceiling:

Year Premium Rate Floor Ceiling

2019 2.75% P10,000.00 P50,000.00



2020 3.00% P10,000.00 P60,000.00
2021 3.50% P10,000.00 P70,000.00
2022 4.00% P10,000.00 P80,000.00
2023 4.50% P10,000.00 P90,000.00
2024 5.00% P10,000.00 P100,000.00
2025 5.00% P10,000.00 P100,000.00

For indirect contributors, premium subsidy shall be gradually adjusted and
included annually in the General Appropriations Act (GAA): Provided, That the funds
shall be released to PhilHealth: Provided, further, That the Department of Finance
(DOF), in coordination with PhilHealth, may request Congress to appropriate
supplemental funding to meet targeted milestones of the Universal Health Care Act:
Provided, finally, That for every increase in the rate of contribution of direct
contributors and premium subsidy of indirect contributors, PhilHealth shall, upon the
recommendation of the Health Technology Assessment Committee created under
Republic Act No. 11223, provide for a corresponding increase in benefits.

CHAPTER VIII
GRIEVANCE AND APPEAL

SEC. 23. Grievance System. - A system of grievance is hereby established,
wherein members, dependents, or health care providers of the Program who believe
they have been aggrieved by any decision of the implementers of the Program, may
seek redress of the grievance in accordance with the provisions of this Chapter.

SEC. 24. Grounds for Grievances. - The following acts shall constitute valid
grounds for grievance action:

(a) any violation of the rights of patients;

(b) willful neglect of duties of Program implementers that results in the loss or
non-enjoyment of benefits by members or their dependents;

(©) __ unjustifiable delay in actions on claims;

(4) _ delay in the processing of claims that extends beyond the period provided for
in this Act; and

(e) any other act or neglect that tends to undermine or defeat the purposes of
this Act.


SEC. 25. Grievance and Appeal Procedures. — A member, his dependent,
or a health care provider may file a complaint for grievance based on any of the
above grounds, in accordance with the following procedures;

(a) | Acomplaint for grievance must be filed with the PhilHealth which shall refer
such complaint to the Grievance and Appeal Review Committee. The Grievance
and Appeal Review Committee shall rule on the complaint through a notice of
resolution within forty-five (45) calendar days from receipt thereof.

(b) Appeals from Office decisions must be filed with the Board within thirty (30)
calendar days from receipt of notice of resolution.

(c) The Offices shall have no jurisdiction over any issue involving the suspension
or revocation of accreditation, or the imposition of fines.

(d) All decisions of the Board as to entitlement to benefits of members or to
payments of health care providers shall be considered final and executory.

SEC. 26. Grievance and Appeal Review Committee. - The Board shall
create a Grievance and Appeal Review Committee, composed of five (5) members,
hereinafter referred to as the Committee, which, subject to the procedures
enumerated above, shall receive and decide on complaints from members and
health care providers relative to this Act and its implementing rules and regulations.

The Committee shall have as one of its members a representative of any of
the accredited health care providers as endorsed by the DOH.

SEC. 27. Hearing Procedures of the Committee. — Upon the filing of the
complaint, the Grievance and Appeal Review Committee, from a consideration of
the allegations thereof, may dismiss the case outright due to lack of verification,
failure to state a cause of action, or any other valid ground for dismissal of the
complaint; or require the respondent to file a verified answer within five (5) days from
service of summons.

Should the defendant fail to answer the complaint within the reglementary
five-day period herein provided, the Committee, motu propio or upon motion of the
complainant, shall render judgment as may be warranted by the facts alleged in the
complaint and limited to what is prayed for therein.

After an answer is filed and the issues are joined, the Committee shall require
the parties to submit, within ten (10) days from receipt of the order, the affidavits of
witnesses and other evidence on the factual issues defined therein, together with a
brief statement of their positions setting forth the law and the facts relied upon by
them. In the event the Committee finds, upon consideration of the pleadings, the
affidavits and other evidence, and position statements submitted by the parties, that
a judgment may be rendered thereon without need of a formal hearing, it may


proceed to render judgment not later than ten (10) days from the submission of the
position statements of the parties.

In cases where the Committee deems it necessary to hold a hearing to clarify
specific factual matters before rendering judgment, it shall set the case for hearing
for the purpose. At such hearing, witnesses whose affidavits were previously
submitted may be asked clarificatory questions by the proponent and by the
Committee and may be cross-examined by the adverse party. The order setting the
case for hearing shall specify the witnesses who will be called to testify, and the
matters on which their examination will deal. The hearing shall be terminated within
fifteen (15) days, and the case decided upon by the Committee within fifteen (15)
days from such termination.

The decision of the Committee shall become final and executory fifteen (15)
days after notice thereof: Provided, That the decision may be appealed to the Board
by filing the appellant's memorandum of appeal within fifteen (15) days from receipt
of the copy of the judgment appealed from. The appellee shall be given fifteen (15)
days from notice to file the appellee’s memorandum after which the Board shall
decide the appeal within thirty (30) days from the submittal of the said pleadings.

The decision of the Board shall become final and executory fifteen (15) days
after notice thereof: Provided, That the decision may be subject to judicial review by
the Supreme Court on purely questions of law in accordance with the Rules of Court.

The Committee and the Board, in the exercise of their quasi-judicial functions,
as specified in Section 8 of this Act, can administer oaths, certify to official acts and
issue subpoena to compel the attendance and testimony of witnesses, and
subpoena duces tecum ad testificandum to enjoin the production of books, papers
and other records and to testify therein on any question arising out of this Act. Any
case of contumacy shall be dealt with in accordance with the provisions of the
Revised Administrative Code and the Rules of Court. The Committee or the Board,
as the case may be, shall prescribe the necessary administrative sanctions such as
fines, warnings, suspension or revocation of the right to participate in the Program,
when warranted.

In all its proceedings, the Committee and the Board shall not be bound by the
technical rules of evidence: Provided, That the Rules of Court shall apply with
suppletory effect.

CHAPTER IX,

THE HEALTH INSURANCE REVIEW AND ASSESSMENT
CORPORATION

SEC. 28. Creation of the Health Insurance Review and Assessment
Corporation. - There is hereby created a Health Insurance Review and
Assessment Corporation, which shall assume the authority and responsibility of


PhilHealth on the analysis of trends and impacts of health financing on population
health outcomes, review and approval of benefit claims, and assessment of
promotive, preventive, curative and rehabilitative services.

The HIRAC shall be a tax-exempt government corporation attached to the
Department of Health for policy coordination and guidance.

SEC. 29. Exemption from Taxes and Duties. — The HIRAC shall be exempt
from the payment of taxes on all income or investment earnings.

Any donation, contribution, bequest, subsidy or financial aid which may be
made to HIRAC shall constitute as allowable deduction from the income of the donor
for income tax purposes and shall be exempt from donor's tax, subject to such
conditions as provided in the National Internal Revenue Code, as amended.

SEC. 30. Powers and Functions. — The HIRAC shall exercise the following
powers and functions:

(a) Establish the roadmap for implementation of universal health care (UHC)
through strategic purchasing of services addressing leading causes of
morbidity and mortality in the country;

(b) Develop and maintain an information technology system to establish realtime
monitoring of claims by health care providers, availment of benefits, quality
of care and services, and overall accomplishment of Program objectives;

(c) Build capacity of LGUs to implement UHC through the Social Health
Insurance Academy that will be expanded to link up with the Local
Government Development Academy and other relevant institutions involved
with Local Government development.

(d) Develop strategic communication campaigns to inform members and the
general public about the health insurance program, where they can access
information and how to verify claims and benefits on-line.

(e) Support the use of technology in the delivery of health care services
especially in far flung areas such as, but not limited to, telemedicine,
electronic health record, and the establishment of a comprehensive health

database;

(f) Implement the guidelines on benefits, portability of benefits, cost containment
and quality assurance; and health care provider arrangements, methods, and
referral systems;

(9) _ Establish local branch offices;

(h) Sue and be sued in court;


0)

1)

(k)

()

(m)

(n)

(0)

(p)

(a)

10)

Acquire property, real and personal, which may be necessary or expedient
for the attainment of the purposes of this Act;

Negotiate and enter into contracts with health care institutions, professionals,
and other persons, juridical or natural, regarding the pricing, payment
mechanisms, design and implementation of administrative and operating
systems and procedures, financing, and delivery of health services in behalf
of members;

Authorize local branch offices to negotiate and enter into contracts in the
name and on behalf of HIRAC with any accredit government or private sector
health provider organization, including but not limited to health maintenance
organizations, cooperatives and medical foundations, for the provision of at
least the minimum package of personal health services prescribed by
PhilHealth.

Review, process, approve, and endorse for payment by PhilHealth the claims
for reimbursement of health care providers;

‘Supervise the provision of health benefits and visit, enter and inspect facilities
of health care providers during office hours, unless there is reason to believe
that inspection has to be done beyond office hours, and where applicable,
secure copies of their medical, financial, and other records and data pertinent
to the claims, accreditation, and that of their patients who are members of the
Program;

Establish and maintain an electronic data base of all members, invest in
information technology systems, and ensure its security to facilitate the
delivery of efficient and effective services;

Conduct information campaign on the principles of the NHIP to the public and
to accredited health care providers. The campaign shall include the current
benefit packages provided by the HIRAC, the mechanisms to avail of the
current benefit packages, and the list of accredited and disaccredited health
care providers;

Conduct pre-audit and post-audit on the quality of services rendered by
health care providers;

Establish an office, or where it is not feasible, designate a focal person in
every Philippine Consular Office in all countries where there are Filipino
citizens. The office or the focal person shall, among others process and
review claims of the overseas Filipino workers;

Charge fees, as necessary, for claims review and processing performed by
its central and local branch offices;


(s)

0)

(u)

(v)

(w)

(x)

Fix the reasonable compensation, allowances and other benefits of all
positions, including its President and Chief Executive Officer (CEO), based
on a comprehensive job analysis and audit of actual duties and
responsibilities, subject to the approval of the President of the Philippines.
The compensation plan shall be comparable with government social security
institutions and shall be subject to periodic review by the Board no more than
once every four (4) years without prejudice to merit reviews or increases
based on productivity and efficiency;

Establish the organizational structure and staffing pattern of HIRAC’s central
and regional offices to cover as many provinces, cities and legislative
districts, including foreign countries, whenever and wherever it may be
expedient, necessary and feasible and to inspect or cause to be inspected
periodically such offices, subject to the approval of the Board;

Maintain a Provident Fund which consists of contributions made by both
HIRAC and its officials and employees and earnings thereon, for the payment
of benefits to such officials and employees or their dependents or heirs under
such terms and conditions as may be prescribed by the Board, subject to the
approval of the President of the Philippines;

‘Adopt or approve the annual and supplemental budget of receipts and
expenditures including, salaries, allowances and early retirement of HIRAC
personnel and to authorize such capital and operating expenditures and
disbursements as may be necessary and proper for the effective
management and operation of HIRAC: Provided, That this shall be subject to
the budgetary limitations stated under Section 21 of this Act: Provided,
further, That the submission of the corporate budget to the DBM shall be for
information purposes only;

Submit to the President of the Philippines and to both Houses of Congress
its Annual Report which shall contain significant highlights of the
implementation of the Program, such as total purchases, average costing to
beneficiaries, and other pertinent data, and publish a synopsis of such report
in its website and in two (2) newspapers of general circulation;

Perform such other acts as the HIRAC may deem appropriate for the
attainment of its objectives and for the proper enforcement of the provisions
of this Act.

SEC. 31. Board of Directors. — The HIRAC Board of Directors, hereinafter

referred to as the Board, shall be composed of the following:

(a)
(b)

The Secretary of Health as ex officio non-voting Chairperson;

The Secretary of Budget and Management;


(c) The Secretary of Finance;

(d) The Commissioner of the Insurance Commission;

(e) Two (2) expert panel members with expertise in public health, finance, or
health economics;

0) Three (3) sectoral panel members, representing the direct contributors,

indirect contributors, and health care providers to be endorsed by their
national association of health care institutions and health care
professionals.

At least one (1) of the expert panel members and at least one (1) of the
sectoral panel members shall be women.

The expert and sectoral panel members must: (i) be Filipino citizens; (ii) be
of good moral character; (iii) be of recognized probity and independence and must
have distinguished themselves professionally in public, civic or academic service;
(iv) be in the active practice of their professions for at least seven (7) years; (v) not
be holding appointment of similar capacity in another government agency or
instrumentality; and (vi) not be appointed within one (1) year after losing in the
immediately preceding elections, whether regular or special. They shall be
appointed by the President of the Philippines and shall serve a term of office in
accordance with Republic Act No. 10149.

All appointive members of the Board must undergo training in health care
financing, health systems, costing health services and HTA prior to the start of their
term. Noncompliance shall be a ground for termination of membership.

Within thirty (30) days following the effectivity of this Act, the GCG shall, in
accordance with the provisions of Republic Act No. 10149, promulgate the
nomination and selection process for appointive members in the Board with a clear
set of qualifications, credentials, and recommendation from the concerned sectors.

SEC. 32. Meetings and Quorum. - The Board shall hold regular meetings
at least once a month. Special meetings may be convened at the call of the
Chairperson or by a majority of the members of the Board. The presence of a
majority of all the members shall constitute a quorum. In the absence of the
Chairperson and Vice Chairperson, a temporary presiding officer shall be
designated by the majority of the quorum.

SEC. 33. Allowances and Per Diems. - The members of the Board shall
receive a per diem for every meeting attended and such other allowances as may
be allowed by the regulations issued by the GCG and other pertinent budgetary
laws, rules and regulations on compensation, honoraria and allowances.


SEC. 34. President and Chief Executive Officer (CEO). — Upon the
recommendation of the Board, the President of the Philippines shall appoint the
President and CEO of HIRAC from the Board's non-ex officio members: Provided,
That the Board shall not recommend a President and CEO unless the member is a
Filipino citizen and must have at least seven (7) years of experience in the field of
public health, management, finance, and health economics or a combination of any
of the aforementioned expertise.

The President and CEO shall have a tenure of one (1) year in accordance
with the provisions of Republic Act No. 10149. He shall also be the Vice Chairperson
of the Board.

SEC. 35. HIRAC Personnel as Public Health Workers. — All HIRAC
personnel shall be classified as public health workers in accordance with the
pertinent provisions under Republic Act No. 7305, otherwise known as the Magna
Carta of Public Health Workers.

SEC. 36. Health Policy Research. - The HIRAC shall establish, among
others, a Health Policy Research Department, which shall perform the following
duties and functions:

(a) Develop a broad conceptual framework for implementation of the UHC
Program through a to ensure improvement in population outcomes through
strategic procurement of promotive, preventive, curative and rehabilitative
services that address concerns of public health magnitude;

(b) Conduct researches and studies to analyze trends and demonstrate the
impact of health financing policies on population health outcomes - toward
the development of policies to ensure the adequacy and responsiveness of
the Program to evolving needs of various population subsets, as well as new
problems;

(c) Review, evaluate, and assess the Program's impact on equity, access as well
as on the quality and cost of health care in the country;

(4) Review fees, charges, compensation rates, medical practice standards,
health outcomes and satisfaction of members, benefits, and other matters
pertinent to the operation of the Program;

(e) Submit for consideration of program of quality assurance, utilization review,
and technology assessment;

(f) Submit recommendations on policy and operational issues that will help
HIRAC meet the objectives of this Act; and

(2) Conduct client-satisfaction surveys and research in order to assess
outcomes of service rendered by health care providers.


CHAPTER X
REVIEW OF BENEFIT CLAIMS

SEC. 37. Free Choice of Health Facility, Medical or Dental Practitioner.
— Beneficiaries requiring treatment or confinement shall be free to choose from
accredited health care providers. Such choice shall, however, be subject to the
appropriateness of treatment in the facility chosen or by the desired provider.

SEC. 38. Reimbursement and Period to File Claims. — All claims for
reimbursement or payment for services rendered shall be filed immediately after the
discharge of the patient from the health care provider.

The period to file the claim may be extended for such reasonable causes as
may be determined by the HIRAC.

SEC. 39. Quality Assurance. - Under the guidelines approved by the
HIRAC, health care providers shall take part in programs of quality assurance,
utilization review, and technology assessment that have the following objectives:

(a) To ensure that the quality of personal health services delivered, measured in
terms of inputs, process, and outcomes, are of reasonable quality in the
context of the Philippines over time;

(b)  Toensure that the health care standards are uniform within local jurisdictions
and eventually throughout the nation; and

(c) To see to it that the acquisition and use of scarce and expensive medical
technologies and equipment are consistent with actual needs and standards
of medical practice, and that:

(1) the performance of medical procedures and the administration of
drugs are appropriate, necessary and unquestionably consistent with
accepted standards of medical practice and ethics. Drugs for which
payments will be made shall be those included in the Philippine
National Drug Formulary, unless explicit exception is granted by
PhilHealth.

(2) the performance of medical procedures and the administration of
drugs are appropriate, consistent with accepted standards of medical
practice and ethics, and respectful of the local culture.

SEC. 40. Safeguards Against Over and Under Utilization. — \tis incumbent
upon the HIRAC to set up a monitoring mechanism to be operationalized through a
contract with health care providers to ensure that there are safeguards against:

(a) over-utilization of services;


(b) unnecessary diagnostic and therapeutic procedures and intervention;

(c) irrational medication and prescriptions;
(a) under-utilization of services; and
(e) inappropriate referral practices.

The HIRAC may deny or reduce the payment for claims when such claims
are attended by false or incorrect information and when the claimants fail without
justifiable cause to comply with the pertinent rules and regulations issued pursuant
to this Act.

CHAPTER XI
PENAL PROVISIONS

SEC. 41. Penalties. — Any violation of the provisions of this Act, after due
notice and hearing, shall suffer the corresponding penalties as herein provided:

(a) Ahealth care provider contracted for the provision of individual-based health
services who commits an unethical act, abuses the authority vested upon the health
care provider, or performs a fraudulent act shall be punished by a fine of Two
hundred thousand pesos (P200,000.00) for each count or suspension of contract up
to three (3) months or the remaining period of its contract or accreditation whichever
is shorter or both, at the discretion of PhilHealth, taking into consideration the gravity
of the offense.

The same shall also constitute a criminal violation punishable by
imprisonment of six (6) months and one (1) day up to six (6) years, upon the
discretion of the court, without prejudice to criminal liability defined under the
Revised Penal Code.

If the health care provider is a juridical person, its officers or employees or
other representatives found to be directly responsible, who acted negligently or with
intent, or have directly or indirectly caused the commission of the violation, shall be
liable. Recidivists may no longer be contracted as participants of the Program.

(b) | Amemberwho commits any violation of this Act or knowingly and deliberately
cooperates or agree, whether explicitly or implicitly, to the commission of the
violation by a contracted health care provider or employer as defined in this section,
including the filing of a fraudulent claim for benefits or entitlement under this Act,
shall be punished by a fine of Fifty thousand pesos (P50,000.00) for each count or
suspension from availment of the benefits of the Program for not less than three (3)
months but not more than six (6) months, or both, at the discretion of PhilHealth.

(c)__ Anemployer who:


(2)

Deliberately or through inexcusable negligence, fails or refuses to register
employees regardless of their employment status, accurately and timely
deduct contributions from the employee's compensation or to accurately and
timely remit or submit the report of the same to PhilHealth shall be punished
with a fine of Fifty thousand pesos (P50,000.00) for every violation per
affected employee, or imprisonment of not less than six (6) months but not
more than one (1) year, or both such fine and imprisonment, at the discretion
of the court.

Any employer or any officer authorized to collect contribution under this Act,
after collecting or deducting the monthly contributions from the employee's
compensation, fails or refuses for whatever reason to accurately and timely
remit the contributions to PhilHealth within thirty (30) days from due date shall
be presumed prima facie, to have misappropriated the same and is obligated
to hold the same in trust for and in behalf of the employee and PhilHealth,
and is immediately obligated to return or remit the amount.

If the employer is a juridical person, its officers and employees or other r

epresentatives found to be responsible, whether they acted
negligently or with intent, or have directly or indirectly caused the commission
on of the violation, shall be liable.

Deducts, directly or indirectly, from the compensation of the covered
employees or otherwise recover from them the employer's own contribution
on behalf of such employees shall be punished with a fine of Five thousand
pesos (P5,000.00) multiplied by the total number of affected employees or
imprisonment of not less than six (6) months but not more than one (1) year,
or both such fine and imprisonment, at the discretion of the court.

If the unlawful deduction is committed by an association, partnership,
corporation or any other institution, its managing directors or partners or
president or general manager, or other persons responsible for the
commission of the act shall be liable for the penalties provided for in this Act.

(d) Any director, officer or employee of PhilHealth or HIRAC who:

(1)

Without prior authority or contrary to the provisions of this Act or its IRR,
wrongfully receives or keep funds or property payable or deliverable to
PhilHealth or HIRAC, and who appropriates and applies such fund or
property for personal use, or shall willingly or negligently consents either
expressly or implicitly to the misappropriation of funds or property without
objection to the same and promptly reporting the matter to proper authority,
shall be liable for misappropriation of funds under this Act and shall be
punished with a fine equivalent to triple the amount misappropriated per
count and suspension for three (3) months without pay.


(2) Commits an unethical act, abuse of authority, or performs a fraudulent act
shall be punished by a fine of Two hundred thousand pesos (P200,000.00)
or suspension for three (3) months without pay, or both, at the discretion of
PhilHealth or HIRAC, as the case may be, taking into consideration the
gravity of the offense. The same shall also constitute a criminal violation
punishable by imprisonment for six (6) months and one (1) day up to six (6)
years, upon discretion of the court without prejudice to the criminal liability
defined under the Revised Penal Code.

Other violations of the provisions of this Act or of the rules and regulations
promulgated by PhilHealth or HIRAC shall be punished with a fine of not less than
Five thousand pesos (P5,000.00) but not more than Twenty thousand pesos
(P20,000.00).

All other violations involving the funds of PhilHealth shall be governed by the
applicable provisions of the Revised Penal Code or other laws, taking into
consideration the rules on collection, remittances, and investment of funds as may
be promulgated by PhilHealth.

The PhilHealth may enumerate circumstances that will mitigate or aggravate
the liability of the offender or erring health care provider, member or employer.

Despite the cessation of operation by a health care provider or termination of
practice of an independent health care professional while the complaint is being
heard, the proceeding shall continue until the resolution of the case.

CHAPTER XiIl
GENERAL PROVISIONS

SEC. 42. Appropriations. - The amount necessary for the organization and
continued operation of the HIRAC shall be taken from:

(a) initial appropriation of Two Billion Pesos (P 2,000,000,000.00) from the funds
of PhilHealth, Five Hundred Million Pesos (Php500,000,000.00) of which
shall be allocated for the operations of HIRAC and One Billion Five Hundred
Million Pesos (Php1,500,000,000.00) for the establishment and continuous
upgrading of the information technology for health financing.

(b) _ share from the 7.5% cost for administering the Program as provided for in
Section 21(b) of this Act;

(c) Fees charged for the review and processing of claims of health care
providers, the amount of which shall be retained and form part of the
corporate funds available for inclusion in the corporate operating budget.

The HIRAC may request Congress to appropriate supplemental funding
should the abovementioned funds become insufficient to meet operational costs.


SEC. 43. Transfer of Functions and Responsibilities. — Within thirty (30)
days after the effectivity of this Act, PhilHealth shall commence the turnover of
functions and responsibilities transferred to HIRAC. The turnover shall be carried
out without any disruption in the delivery of services and benefits under the Program
and shall be completed within a period not exceeding six (6) months.

SEC. 44. Separation Benefits of Officials and Employees Affected. —
PhilHealth officials and employees that may be displaced or separated from the
service as a result of the restructuring of the Program pursuant to this Act shall be
entitled to either a separation pay and other benefits in accordance with existing
laws, rules and regulations or be entitled to avail of the privileges provided under a
separation plan which shall be one and one-half month salary for every year of
service in the government: Provided, That those who avail of the privilege but are
subsequently employed in the new corporation or in any government agency or
instrumentality, shall start their government service anew.

Separated personnel as a result of the restructuring, if qualified, shall be
given preference in the hiring of manpower requirements of the HIRAC.

With respect to employees who are not rehired, the government, through the
Department of Labor and Employment, shall endeavor to implement re-training, job
counselling, and job placement programs.

CHAPTER Xill
MISCELLANEOUS PROVISIONS

SEC. 45. Oversight Provision. - The Joint Congressional Oversight
Committee on Universal Health Care created under Section 39 of Republic Act No.
11223 shall conduct a regular review of the implementation of this Act. For this
purpose, PhilHealth and HIRAC shall separately furnish the Joint Congressional
Oversight Committee, within ten (10) days following the end of every quarter, a
report on the significant accomplishments, innovations, changes, and challenges in
implementing the Program, among others.

The National Economic and Development Authority, in coordination with the
Philippine Statistics Authority, National Institutes of Health, and other academic
institutions shall undertake studies to validate and evaluate the accomplishments of
this Act. These validation studies and annual reports, on the performance of
PhilHealth and HIRAC shall be submitted to the Joint Congressional Oversight
Committee.

SEC. 46. Implementing Rules and Regulations (IRR). — The DOH,
PhilHealth and HIRAC, in consultation and coordination with appropriate national
government agencies, civil society organizations, nongovernment organizations,
private sector representatives, and other stakeholders, shall promulgate the


necessary rules and regulations for the effective implementation of this Act, within
one hundred twenty (120) days from its effectivity

SEC. 47. Separability Clause. - If any part of this Act is held invalid or
unconstitutional, the remaining parts or provisions not affected shall remain in full
force and effect.

SEC. 48. Repealing Clause. — The pertinent provisions of the following laws
are hereby amended accordingly:

(a) Sections 16, 17, 20, 21, 22, 23, 31, 32, 34, 35, 37, 38, 39, 41, 42 and 43 of
Republic Act No. 7875, otherwise known as the “National Health Insurance

Program", as amended by Republic Act No. 9241 and Republic Act No.
10606; and

(b) Sections 10, 12, 13, 14 and 38 of Republic Act No. 11223, otherwise known
as the “Universal Health Care Act.”

All other laws, decrees, executive orders and rules and regulations contrary
to or inconsistent with the provisions of this Act are hereby repealed or amended
accordingly.

SEC. 49. Effectivity. - This Act shall take effect fifteen (15) days after it
publication in the Official Gazette or in any newspaper of general circulation.

Approved