Republic of the Philippines

Bouse of Representatives
Queson City, Metro Manila

Twentieth Congress
First Regular Session

HOUSE BILL NO. 2

Introduced by Representatives Ferdinand Martin G. Romualdez,
Andrew Julian K. Romualdez and Jude A. Acidre

EXPLANATORY NOTE

This bill seeks to strengthen the Philippine healthcare system to better
achieve efficiency and equity and improve public health emergency
preparedness, amending for the purpose Republic Act (RA) No. 11223, otherwise
known as the “Universal Health Care Act.”

Section 15, Article II of the 1987 Constitution provides that “she State shall
protect and promote the right to health of the people and instill health
consciousness among them." Section 11, Article XIII of the same also states that
“the State shall adopt an integrated and comprehensive approach to health
development which shall endeavor to make essential goods, health, and other
social services available to all the people at affordable cost.”

Pursuant to the aforementioned constitutional mandate, the “Universal
Health Care Act” was enacted in 2018. The primary objective of the law is to
gradually ensure fair access to quality and affordable healthcare goods and
services for all Filipinos while providing financial risk protection through a
systematic process and defined roles of various government entities.

While significant progress has been made through the implementation of
the law, there are still many hurdles to ensuring healthcare objectives are properly
achieved. Thus, despite the noble intent of the law, many Filipinos still face


significant challenges when attempting to access quality healthcare.

High cost of treatment, health inequities, insufficient healthcare facilities,
fragmented health financing systems, inadequate staffing, and weak health
information systems still prove as barriers to strengthening local and national
health systems. Even with increased public funding for health and advancements
in health outcomes and coverage indicators over the preceding decade, disparities
among wealth brackets and between urban and rural regions remain, limiting the
ability of the measures provided under RA 11223 to provide universal and
equitable healthcare access to all.

For this reason, amendments to RA 11223 must be introduced to truly
attain its objectives. Hence, this bill

Among the bill’s primary provisions is to change the premium contribution
structure for direct and indirect contributors to the Philippine Health Insurance
Corporation (PhilHealth). Under this proposed measure, the premium
contribution rates will be based on actuarial studies and assessments considering
the projected healthcare utilization. The adjusted premium rates shall be subject
to the approval of Congress.

In addition, migrant workers, whether on land or at sea, may no longer have
to pay premiums. Their employers will pay 50% of their dues, with the national
government covering the remainder.

Aside from that, the bill provides that the Department of Health and
PhilHealth shall include a mechanism for lowering premium contribution rates
This bill likewise states that any unused portion of premium subsidies for indirect
contributors must be allocated exclusively for an increase in benefits or a decrease
in forthcoming premium subsidies.

To ensure proper utilization of PhilHealth funds, administrative expenses
were limited to 7.5% of the total reimbursements of the total cost of health
services paid by PhilHealth in the immediately preceding year.

If the measure is enacted, local government units shall have the authority
to establish or maintain Special Health Funds to enhance localized healthcare
services.

Another equally important provision is the proposed establishment of the
Universal Health Care Coordinating Council, a national governance body that
will oversee the accelerated implementation of the Universal Health Care Act and
serve as a policy and operational collaboration hub among relevant agencies and

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organizations.

Considering the proposed reforms in the country’s major healthcare
policies, this bill will address the gaps, uncertainties, challenges, and flaws in
achieving its intended results. Once passed, this measure will certainly maximize
the potential of the Universal Health Care law to become the instrument for
universal and equitable healthcare access for every Filipino.

During the Nineteenth Congress, several bills were filed proposing
amendments to the Universal Health Care Act, including similar bills that were
principally authored by Representatives Joey Sarte Salceda, Anthony Rolando
“Tony” Golez Jr., and Albert S. Garcia that proposed broader reforms to the
National Health Insurance System under the Universal Health Care framework.

In view of the foregoing, the immediate approval of this bill is earnestly

sought.
ng hh G. ROMUALDEZ

JUDE 4 ACIDRE ANDREW JULIAN K. ROMUALDEZ


Republic of the Philippines

House of Representatives
Quezon City, filetra Manila

Twentieth Congress
First Regular Session

HOUSE BILL NO. 2

Introduced by Representatives Ferdinand Martin G. Romualdez,
Andrew Julian K. Romualdez and Jude A. Acidre

AN ACT
STRENGTHENING THE PHILIPPINE HEALTHCARE SYSTEM TO
ACHIEVE EFFICIENCY AND EQUITY, AND TO IMPROVE PUBLIC
HEALTH EMERGENCY PREPAREDNESS, 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:

SECTION 1. Section 4 of Republic Act No. 11223, otherwise known as the
“Universal Health Care Act”, is hereby amended to read as follows:

“SEC. 4, Definition of Terms. — As used in this Act:
(a) Abuse of authority — xxx;
(b) Amenities — xxx;
(c) Basic or ward accommodation — xxx;
(d) BENEFIT-RISK ASSESSMENT OR EVALUATION REFERS TO A

METHOD OF EVALUATING THE USEFULNESS OF A DRUG
FOR A SPECIFIC INDICATION, TAKING INTO ACCOUNT


THE BENEFITS AND RISKS ASSOCIATED WITH THAT
DRUG UNDER NORMAL CONDITIONS OF USE;

(€) Co-insurance ~ xxx;

(8) Co-payment - xxx;
(G) DEPENDENTS OF A MEMBER REFER TO:

(1) THE LEGITIMATE SPOUSE WHO IS NOT A MEMBER;

(2) THE TWENTY-THREE (23) YEARS OF AGE AND BELOW
WHO ARE UNMARRIED AND UNEMPLOYED, LEGITIMATE,
LEGITIMATED, ILLEGITIMATE, ACKNOWLEDGED
CHILDREN AS APPEARING IN THE BIRTH CERTIFICATE,
LEGALLY ADOPTED, OR STEPCHILDREN, OR CHILDREN
OF SOLO AND FOSTER PARENTS;

(64 (H) Direct contributors — xxx;

[9H Emergency = xxx;

£4 (J) Entitlement — xxx;

{@} (K) EQUITY REFERS TO THE FAIR AND JUST
OPPORTUNITY TO BE AS HEALTHY AS POSSIBLE. IT
ALSO REFERS TO REDUCING AND ULTIMATELY
ELIMINATING DISPARITIES IN HEALTH AND IN THE

DETERMINANTS OF HEALTH THAT ADVERSELY AFFECT
EXCLUDED OR MARGINALIZED GROUPS,

{49} (L) Essential health benefit package refers to a set of individual-
based entitlements covered by the National Health Insurance Program
(NHIP) which includes primary care; medicines, diagnostics and
laboratory; and preventive, curative, fand} rehabilitative services; AND
DENTAL SERVICES;

£654 (M) Fraudulent act — xxx;

{6} (N) Health care provider - xxx;

£(9)} (O) Health care provider network — xxx;

{£0}} (P) Health Maintenance Organization (HMO) ~ xxx;


£9) (Q) Health Technology Assessment (HTA) refers to the systematic
evaluation of properties, effects, or impact of healtht-related] technologies

-} utilizing a multidisciplinary process to evaluate [the]
ITS CLINICAL, social, economic, [organizational] LEGAL, [end]
ethical, AND COMPATIBILITY TO HEALTH SYSTEM issues [ofa
health_intervention—orhealthtechnolegy] TO INFORM POLICY-
DECISION MAKING, ESPECIALLY ON HOW TO BEST
ALLOCATE LIMITED FUNDS TO HEALTH INTERVENTIONS
AND TECHNOLOGIES;

£a}} (R) Indirect contributors ~ xxx;
(S) Individual-based health services ~ xxx;

{4} (T) MIGRANT WORKERS AND OVERSEAS FILIPINOS IN
DISTRESS REFER TO OVERSEAS FILIPINOS WHO HAVE
MEDICAL, PSYCHO-SOCIAL, OR LEGAL PROBLEMS
REQUIRING TREATMENT, HOSPITALIZATION,
COUNSELING, LEGAL REPRESENTATION, OR ANY OTHER
KIND OF INTERVENTION BY THE AUTHORITIES IN THE
COUNTRY WHERE THEY ARE FOUND;

£69}} (U) Population-based health services — xxx;
[69] (V) Primary care — xxx;
{9 (W) Primary care provider — xxx;

(X) 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; fand}

(Y) REAL-WORLD EVIDENCE REFERS TO CLINICAL
EVIDENCE ON A MEDICAL PRODUCT’S SAFETY AND
EFFICACY THAT IS GENERATED USING SEVERAL SOURCES
OF DATA, INCLUDING ELECTRONIC HEALTH RECORDS,
REGISTRIES, CLAIMS/BILLING DATA, AND PATIENT-
GENERATED DATA INCLUDING THOSE FROM MOBILE
HEALTH APPLICATIONS AND WEARABLE DEVICES; AND


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{69} (Z) Unethical act. ~ xxx.”

SEC. 2. Section 9 of Republic Act No. 11223 is hereby amended to read as

follows:

“SEC. 9. Entitlement to Benefits. - Every member shall be granted
immediate eligibility for health benefit package under the Program:
Provided, That PhilHealth Identification Card shall not be required in the
availment of any health service: Provided, further, That no co-payment
shall be charged for services rendered in basic or ward accommodation:
Provided, furthermore, That co-payments and co-insurance for amenities
in public hospitals shall be regulated by the DOH and PhilHealth:
Provided, finally, That the current PhilHealth package for members shall
not be reduced.

PhilHealth shall provide additional Program benefits for direct
contributors, where applicable: Provided, That failure to pay premiums
shall not prevent the enjoyment of any Program benefits: Provided,
further, That employers and self-employed direct contributors shall be
required to pay all missed contributions with an interest, compounded
monthly, of at least three percent (3%) for employers, and not exceeding
one and one-half percent (1.5%) SIMPLE INTEREST MONTHLY for
self-earning, professional practitioners, and migrant workers.”

SEC. 3. Section 10 of Republic Act No. 11223 is hereby amended to read as

follows

“SEC. 10. Premium Contributions. — For direct contributors,
premium rates shall be in accordance with the following schedule, and
monthly income floor and ceiling:

Year_| Premium Rate | Income Floor Income Ceiling
2019 2.75% P10,000.00 50,000.00
2020 3.00% 10,000.00 60,000.00
2021 3.50% P10,000.00 70,000.00
2022 4.00% P10,000.00 P80,000.00
2023 4.50% P 10,000.00 90,000.00
2024 5.00% P10,000.00 P100,000.00
2025 5.00% P10,000.00 P100,000.00

PREMIUM CONTRIBUTIONS FOR DIRECT AND
INDIRECT CONTRIBUTORS SHALL BE DERIVED FROM

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ACTUARIALLY-ADJUSTED RATES, CONSIDERING BUT
NOT LIMITED TO THE PROJECTED HEALTHCARE
UTILIZATION, COST TRENDS, AND DEMOGRAPHIC AND
ECONOMIC FACTORS. FOR THIS PURPOSE, AN ANNUAL
ACTUARIAL REPORT SHALL BE CONDUCTED BY
PHILHEALTH AND SUBMITTED TO CONGRESS:
PROVIDED, THAT A NON-GOVERNMENT, IMPARTIAL,
AND CREDIBLE INDEPENDENT BODY TO BE
DETERMINED BY THE UNIVERSAL HEALTH CARE
COORDINATING COUNCIL (UHC-CC), ESTABLISHED
UNDER SECTION 10 OF THIS ACT SHALL REVIEW THE
ANNUAL ACTUARIAL REPORT PRIOR TO ITS SUBMISSION
TO CONGRESS TO ENSURE TRANSPARENCY AND
ACCURACY IN THE FINDINGS.

THE ACTUARIALLY-ADJUSTED PREMIUM RATES, AS
DETERMINED BY THE ANNUAL ACTUARIAL REVIEW,
SHALL BE SUBJECT TO THE APPROVAL OF CONGRESS, AS
AN INTEGRAL’ PART OF THE BUDGET PROCESS:
PROVIDED, THAT THE PREMIUM RATE SHALL BE SET AT
THREE AND ONE-HALF PERCENT (3.5%), AND THE
PREMIUM FLOOR AND PREMIUM CEILING SHALL
REMAIN THE SAME UNTIL THE ACTUARIAL REVIEW HAS
BEEN SUBMITTED AND APPROVED BY CONGRESS,
PRIMARILY FOR BENEFITS EXPANSION AND SOCIAL
SOLIDARITY CONSIDERATIONS: PROVIDED, FURTHER,
THAT UPON LEGISLATIVE APPROVAL, ADJUSTMENTS TO
PREMIUM RATES SHALL BE IMPLEMENTED AT THE
COMMENCEMENT OF THE FOLLOWING FISCAL YEAR.

FOR MIGRANT WORKERS, PREMIUM
CONTRIBUTIONS SHALL BE BASED ON THE INCOME
FLOOR: PROVIDED, THAT FIFTY PERCENT (50%) OF THE
PREMIUM CONTRIBUTION OF MIGRANT WORKERS
SHALL BE SHOULDERED BY THE ' NATIONAL
GOVERNMENT: PROVIDED, FURTHER, THAT EMPLOYERS
OF SEAFARERS, THROUGH THE LOCAL MANNING
AGENCIES, SHALL CONTINUE TO SHOULDER FIFTY
PERCENT (50%) OF THE PREMIUM CONTRIBUTION OF
THE SEAFARERS: PROVIDED, FURTHERMORE, THAT
EMPLOYERS OF LAND-BASED MIGRANT WORKERS
SHALL


SHOULDER FIFTY PERCENT (50%) OF THE PREMIUM
CONTRIBUTION OF SAID MIGRANT WORKERS: PROVIDED,
FURTHERMORE, THAT UNPAID PREMIUM
CONTRIBUTIONS OF MIGRANT WORKERS AND
OVERSEAS FILIPINOS IN DISTRESS UNDER REPUBLIC
ACT NO. 8042, OTHERWISE KNOWN AS THE ‘MIGRANT
WORKERS AND OVERSEAS FILIPINOS ACT OF 1995’, AS
AMENDED BY REPUBLIC ACT NO. 10022, SHALL NOT BE
COLLECTED UPON THEIR ARRIVAL IN THE COUNTRY:
PROVIDED, FINALLY, THAT FAILURE TO PAY
PHILHEALTH CONTRIBUTIONS SHALL NOT BE A
GROUND FOR THE NON-ISSUANCE OF AN OVERSEAS
EMPLOYMENT CERTIFICATE OF A MIGRANT WORKER.

FILIPINOS WITH DUAL CITIZENSHIP (FDC), OR THOSE
WHO HAVE RETAINED AND RE-ACQUIRED FILIPINO
CITIZENSHIP BY VIRTUE OF REPUBLIC ACT NO. 9225, OR
THE ‘CITIZENSHIP RETENTION AND RE-ACQUISITION
ACT OF 2003’, MAY ENJOY THE BENEFITS PROVIDED BY
THE STATE HEALTH INSURER: PROVIDED, THAT
FAILURE TO PAY PREMIUMS SHALL NOT PREVENT THE
FDC AND THEIR LEGAL DEPENDENTS FROM ENJOYING
ANY PROGRAM BENEFIT.

i For indirect contributors, premium subsidy shall be
gradually adjusted and included annually in the General Appropriations
Act (GAA): Provided, [fu#ther,] That the funds shall be released to
PhilHealth: Provided, further{mere:},That the DOH, in coordination
with PhilHealth, may request Congress to appropriate supplemental
funding to meet targeted milestones of this Act: Provided, [finaly]
FURTHERMORE, That for every increase in the rate of contribution
of direct contributors and premium subsidy of indirect contributors,
PhilHealth shall provide for a corresponding increase in benefits:
PROVIDED, FINALLY, THAT ANY UNUSED PORTION OF
THE PREMIUM SUBSIDY OF INDIRECT CONTRIBUTORS
SHALL BE USED EXCLUSIVELY FOR AN INCREASE IN
BENEFITS OR DECREASE IN FORTHCOMING PREMIUM
SUBSIDIES, THE PROVISIONS OF EXISTING LAWS TO THE
CONTRARY NOTWITHSTANDING.”

SEC. 4. Section 11 of Republic Act No. 11223 is hereby amended to read as

follows


“SEC. 11. Program Reserve Funds. — PhilHealth shall set aside a
portion of its accumulated revenues AS MENTIONED IN SECTION 37
OF THIS ACT AND ANY OTHER INCOME FROM ANY SOURCE
not needed to meet the cost of the current year’s expenditures as reserve
funds: Provided, That the total amount of reserves shall not exceed a ceiling
equivalent to the amount actuarially estimated for two (2) years’ projected
Program expenditures: Provided, further, That whenever actual reserves
exceed the required ceiling at the end of the fiscal year, the excess of the
PhilHealth reserve fund shall be used to increase the Program’s benefits and
to decrease the [emeunt—ef—members—eentributiens] PREMIUM
CONTRIBUTION RATES OF MEMBERS: PROVIDED, FINALLY,
THAT THE DOH AND PHILHEALTH SHALL INCLUDE A
MECHANISM FOR LOWERING PREMIUM CONTRIBUTION IN
THE IMPLEMENTING RULES AND REGULATIONS OF THIS
ACT.

XXX
(a) xxx
(b) xxx
(c) xxx
(d) xxx
(©) xxx

(f) In bonds, securities, promissory notes, or other evidences of
indebtedness of accredited and financially sound [medical]
GOVERNMENT FINANCIAL institutions exclusively to finance the
construction, improvement and maintenance of hospitals and other medical
facilities, INCLUDING PURCHASE AND MAINTENANCE OF
CLINICAL EQUIPMENT AND DEVICES: Provided, That such
securities and instruments shall be guaranteed by the Republic of the
Philippines or the issuing [medical] GOVERNMENT FINANCIAL
institution and the issued securities are both rated triple ‘A’ by authorized
accredited domestic rating agencies: Provided, further, That said
investments shall not exceed ten percent (10%) of the total reserve fund;
and


(g) In debt instruments and other securities traded in the secondary
markets with the same intrinsic quality as those enumerated in paragraphs
(a) to (e) hereof, subject to the approval of the PhilHealth Board.

As part of its investments operations, PhilHealth may hire institutions
with valid trust licenses as its external local fund managers to manage the
reserve fund, as it may deem appropriate, through public bidding. The fund
manager shall submit an annual report on investment performance to
PhilHealth.

XXX

The PhilHealth shall manage the supplemental benefits fund to the
minimum required to ensure that the supplemental benefit payments are
secure,

NOTWITHSTANDING ANY LAW TO THE CONTRARY, NO
PORTION OF THE RESERVE FUND OR ANY FUND OR INCOME
OF PHILHEALTH, INCLUDING THE PROVIDENT FUND UNDER
SECTION 16 (C) AND THE SPECIAL HEALTH FUND UNDER
SECTION 20 OF THIS ACT, SHALL ACCRUE TO THE GENERAL
FUND OF THE NATIONAL GOVERNMENT OR TO ANY OF ITS
AGENCIES OR INSTRUMENTALITIES, INCLUDING
GOVERNMENT-OWNED OR-CONTROLLED CORPORATIONS.”

SEC. 5. Section 12 of Republic Act No. 11223 is hereby amended to read as

follows:

“SEC. 12. Administrative Expense. — [Ne-more-than-sever-end-onehalt



THE CORPORATION IS AUTHORIZED TO CHARGE THE
COSTS OF ADMINISTERING THE PROGRAM. SUCH COSTS
MAY INCLUDE ADMINISTRATION, MONITORING,
MARKETING AND PROMOTION, RESEARCH AND
DEVELOPMENT, AUDIT AND EVALUATION,
INFORMATION SERVICES, AND OTHER NECESSARY
ACTIVITIES FOR THE EFFECTIVE MANAGEMENT OF THE
PROGRAM. THE TOTAL ANNUAL COSTS FOR THESE
SHALL NOT EXCEED SEVEN AND ONE-HALF PERCENT
(7.5%) OF THE TOTAL REIMBURSEMENTS OR TOTAL
COST OF HEALTH SERVICES PAID BY THE CORPORATION
IN THE IMMEDIATELY PRECEDING YEAR.”

SEC. 6. Section 13 of Republic Act No. 11223 is hereby amended to read as

follows:

“SEC.13. PhilHealth Board of Directors. —

(a) xxx

(b) The Secretary of Health shall be an ex-officio [nenvoting] VOTIN
Chairperson of the Board.

(©) xxx.”

SEC. 7. A new section is hereby added to Republic Act No. 11223,

immediately after Section 16 thereof, to read as follows:

“SEC. 16-A. - COMPETITION AND INNOVATION IN THE
PHILHEALTH BENEFIT DELIVERY SYSTEM. - THE
PHILHEALTH BENEFIT DELIVERY SYSTEM SHALL BE OPEN
TO COMPETITION AND INNOVATION, WHERE
MANAGEMENT MAY ALLOW ALTERNATIVE SUPPLY
ARRANGEMENTS SUCH AS PUBLIC, PRIVATE, OR
CONSORTIA OF PUBLIC AND PRIVATE ENTITIES TO
COMPETITIVELY BID FOR THE PROVISION OF
PHILHEALTH BENEFITS TO SELECT MEMBERSHIP GROUPS:
PROVIDED, THAT THE SELECTION OF MEMBERSHIP
GROUPS MUST RESULT IN COST-EFFECTIVE BENEFIT
SPENDING: PROVIDED, FURTHER, THAT THE
ADMINISTRATIVE COSTS OF SUCH THIRD-PARTY
PROVIDERS ARE INCLUDED IN THE OVERALL CAP
LEGISLATED FOR THE PROGRAM: PROVIDED, FINALLY,

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34
35
36
37
38
39
40
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THAT THE FOLLOWING SHALL BE KEY CONSIDERATIONS
IN THE COMPETITIVE SELECTION OF BIDDERS:

() MAXIMUM COVERAGE FOR A GIVEN PESO VALUE OF
PREMIUM;

(I) THE PROVIDER HAS A SUFFICIENT NETWORK OF
OWN FACILITIES AND PARTNERS THAT CAN SUPPORT
PORTABILITY OF BENEFITS; AND

(Il) CONCESSION PERIOD TO ALLOW PROVIDERS TO
RECOVER INVESTMENTS.”

SEC. 8. Section 20 of Republic Act No. 11223 is hereby amended to read as
follows:

“SEC. 20. Special Health Fund. - The province-wide or city-wide health
system shall pool and manage, through a special health fund, all resources
intended for health services to finance population-based and individual-based
health services, health system operating costs, capital investments, and
remuneration of [additienel} health workers and incentives for all health
workers: PROVIDED, THAT COMPONENT CITIES AND
MUNICIPALITIES MAY ESTABLISH AND/OR MAINTAIN THEIR
OWN SPECIAL HEALTH FUNDS FOR THE SAME PURPOSE AS
PROVIDED FOR IN THIS ACT: Provided, FURTHER, That the DOH,
in consultation with the UHC-CC, DBM, and the LGUs, shall develop
guidelines for the use of the Special Health Fund.”

SEC. 9. Section 21 of Republic Act No. 11223 is hereby amended to read as
follows:

“SEC. 21. Income Derived from PhilHealth Payments. ~ All income derived
from PhilHealth payments shall accrue to the Special Health Fund OF THE
PROVINCE-WIDE OR CITY-WIDE HEALTH SYSTEMS AS
ESTABLISHED OR MAINTAINED ABOVE: PROVIDED, THAT
SUCH INCOME SHALL BE APPORTIONED BETWEEN AND
AMONG THE VARIOUS SPECIAL HEALTH FUNDS ACCORDING
TO A FORMULA TO BE DETERMINED BY THE UHC
COORDINATING COUNCIL: PROVIDED, FURTHER, THAT ALL
SPECIAL HEALTH FUNDS ARE to be allocated by the LGUs
exclusively for the improvement of the LGU health system: Provided,
FURTHERMORE, That PhilHealth payments shall be credited to the annual
regular income (ARI) of the LGU THAT OWNS THE HEALTH CARE

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INSTITUTION FOR WHICH IT IS DUE: PROVIDED, FINALLY,
THAT HEALTH FACILITIES OPERATING AS LOCAL
ECONOMIC ENTERPRISES (LEE) SHALL BE ALLOWED TO
RETAIN THEIR INCOME DERIVED FROM PHILHEALTH AND
THAT LGUS MAY CONTINUE TO SUBSIDIZE LEE.”

SEC. 10. A new Section 30-A shall be inserted before Section 30 of Republic

Act No. 11223, which shall in turn be renumbered to Section 30-B. The new
Section 30-A shall read as follows:

“SEC. 30-A. THE UNIVERSAL HEALTH CARE COORDINATING
COUNCIL (UHC-CC). - THE UNIVERSAL HEALTH CARE
COORDINATING COUNCIL IS HEREBY CREATED AS A
NATIONAL GOVERNANCE BODY, WHICH SHALL
INTENSIFY THE GOVERNMENT’S EFFORTS IN PURSUING
THE DEVELOPMENT OF POLICIES, AS WELL AS
UNDERTAKING PROGRAMS AND PROJECTS RELATING TO
THE UHC. AS A NATIONAL GOVERNANCE BODY, IT
SHALL EXPEDITE THE

IMPLEMENTATION OF REPUBLIC ACT NO. 11223 OR THE
UHC ACT AT THE NATIONAL AND SUBNATIONAL LEVELS
AND PROVIDE A VENUE FOR POLICY DISCOURSE AND
OPERATIONAL COLLABORATION AMONG RELEVANT
AGENCIES AND ORGANIZATIONS. IT SHALL BE COMPOSED
OF:

(a) THE SECRETARY OF HEALTH AS COUNCIL CHAIR;
(b)THE SECRETARY OF THE INTERIOR AND LOCAL

GOVERNMENT AS COUNCIL CO-CHAIR; AND

(c) COUNCIL MEMBERS COMPRISED OF HEAD OFFICIALS OR

THEIR DESIGNATED ALTERNATES FROM THE FOLLOWING
AGENCIES AND ORGANIZATIONS:

(i), COMMISSION ON HIGHER EDUCATION (CHED);

(ii) DEPARTMENT OF BUDGET AND MANAGEMENT (DBM);
(ii) DEPARTMENT OF EDUCATION (DEPED);
(iv) DEPARTMENT OF FINANCE (DOF);

(v) DEPARTMENT OF INFORMATION AND
COMMUNICATIONS TECHNOLOGY (DICT);

(vi) DEPARTMENT OF LABOR AND EMPLOYMENT (DOLE);


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(vii) DEPARTMENT OF SOCIAL WELFARE AND
DEVELOPMENT (DSWD);

(viii) NATIONAL ECONOMIC AND DEVELOPMENT
AUTHORITY (NEDA);
(ix) PHILIPPINE STATISTICS AUTHORITY (PSA);
(x) PHILIPPINE INSTITUTE FOR DEVELOPMENT STUDIES
(PIDs);
(xi) PHILIPPINE HEALTH INSURANCE CORPORATION
(PHILHEALTH);
PROFESSIONAL REGULATION COMMISSION (PRC);
TECHNICAL EDUCATION AND SKILLS DEVELOPMENT
AUTHORITY (TESDA);
(xiv) UNION OF LOCAL AUTHORITIES OF THE PHILIPPINES
(ULAP); AND
(xv) UNIVERSITY OF THE PHILIPPINES MANILA - NATIONAL
INSTITUTES OF HEALTH (UPM-NIH);

THE OFFICE OF THE PRESIDENT SHALL PROVIDE FURTHER
DIRECTION TO ITS ESTABLISHMENT AND FUNCTION BY
ISSUANCE OF AN EXECUTIVE ORDER.

THE SECRETARIAT OF THE UHC-CC SHALL BE DESIGNATED
BY THE SECRETARY OF HEALTH FROM THE EXISTING

PERSONNEL OF THE DOH. IT MAY BE COMPLEMENTED BY
ADDITIONAL STAFF FROM PHILHEALTH.

THE ADMINISTRATIVE EXPENSES NECESSARY FOR THE
FUNCTIONS OF THE UHC-CC SHALL BE DRAWN FROM THE
PHILHEALTH CORPORATE OPERATING BUDGET.”

SEC. 11. Section 32 of Republic Act No. 11223 is hereby amended to read
as follows:

“SEC. 32. Monitoring [and], Evaluation, AND ACCOUNTABILITY.

(a) xxx

(b) xxx

12


(C) IN ADDITION TO AUDITS BY THE COMMISSION ON
AUDIT (COA) AS MANDATED BY LAW AND RELEVANT
REGULATIONS, PHILHEALTH SHALL BE SUBJECT TO
EXTERNAL AUDIT AT LEAST ONCE EVERY FISCAL YEAR
BY AN ACCREDITED PRIVATE-SECTOR AUDITING FIRM TO
BE IDENTIFIED BY THE UHC-CC; AND

(D) THE PHILHEALTH PRESIDENT AND CEO SHALL
SUBMIT TO THE PHILHEALTH BOARD, THE PRESIDENT OF
THE REPUBLIC OF THE PHILIPPINES, AND CONGRESS, A
REPORT ON THE MEASURES TAKEN BY THE
CORPORATION TO ADDRESS ISSUES RAISED IN AUDIT
REPORTS BY THE COA AND IN THE THIRD-PARTY AUDIT.”

SEC. 12. Section 34 of Republic Act No. 11223 is hereby amended to read
as follows:

"SEC. 34. Health Technology Assessment (HTA). ~(a) The HTA process
shall be institutionalized as a fair'and transparent priority setting mechanism
that shall be recommendatory to the DOH and PhilHealth for [the
development of policies and programs, regulation, and the determination of
a range of entitlements such as drugs, medicines, pharmaceutical products,
and other devices, procedures and services} THE FINANCING OF A
SPECIFIC HEALTH TECHNOLOGY USED AS A HUMAN
INTERVENTION AS PART OF BENEFITS OR PROGRAM
IMPLEMENTATION as provided for under this Act: Provided, That
investments on any health technology or development of any benefit package
by the DOH and PhilHealth shall be [based on the positive] INFORMED
BY THE recommendations of the HTA: Provided, further, That despite
having undergone the HTA process, all health technology, intervention or
benefit package shall still be subjected to periodic review: Provided,
furthermore, That a health technology assessment may be conducted as new
evidence emerges which may have substantial impact on the initial coverage
decision by the DOH or PhilHealth: Provided, finally, That the HTA process
shall adhere to the principles of ethical soundness, inclusiveness and
preferential regard for the underserved, evidence-based and scientific
defensibility, transparency and accountability, efficiency, enforceability and
availability of remedies, and due process.

(b) The following criteria must be observed in the conduct of HTA:

a) Responsiveness to DISEASE Magnitude, AND Severity [,
and-dquity], — The health interventions must address the top medical

2B


conditions that place the heaviest burden on the population, including
dimensions of magnitude or the number of people affected by a health
problem, and severity or health loss by an individual as a result of disease,
such as death, handicap, disability or pain, and conditions of the poorest
and most vulnerable population;

(2) Safety and Effectiveness. ~ Each intervention must have undergone
[Phese-4 APPROPRIATE clinical trial. [;
meta-analysis-must-be-readily-available The interventions must also not
pose any harm to the users and health care providers IN CASES WHERE
THE INTERVENTION MAY CAUSE HARM SUCH AS
RADIATION DOSES, THE INTERVENTION MUST INCLUDE
PRECAUTIONS OR MEASURES TO MINIMIZE THE RISK TO
THE USER AND HEALTH CARE PROVIDERS.

ALL DRUGS MUST HAVE UNDERGONE
PHARMACOVIGILANCE STUDIES SUCH AS BUT NOT
LIMITED TO PHASE IV CLINICAL TRIAL OR REAL-WORLD
EVIDENCE, AND THERE MUST BE A_BENEFIT-RISK
ASSESSMENT: PROVIDED, THAT FOR THE FOLLOWING
HEALTH TECHNOLOGIES WHERE PHASE IV CLINICAL
TRIALS MAY NOT BE CONSISTENTLY AVAILABLE, REAL-
WORLD EVIDENCE, INCLUDING ALL RELEVANT AND
DEPENDABLE SOURCES OF EVIDENCE SHALL BE
CONSIDERED:

(i) | TRADITIONAL MEDICINE;

(ii) PREVENTIVE AND PROMOTIVE HEALTH;

(iii) MEDICAL AND SURGICAL PROCEDURES;

(iv) CLINICAL EQUIPMENT AND DEVICES; AND

(v) DIGITAL AND OTHER HEALTH TECHNOLOGIES.

PROVIDED, THAT IN CASE OF A PANDEMIC OR UPON THE
DECLARATION OF A STATE OF PUBLIC HEALTH
EMERGENCY, THE REQUIREMENT FOR POST MARKETING.
SURVEILLANCE STUDIES FOR DRUGS AND VACCINES MAY
BE DISPENSED WITH: PROVIDED, FURTHER, THAT SUCH
DRUGS OR VACCINES RECEIVE EMERGENCY USE
AUTHORIZATION (EUA) FROM THE FOOD AND DRUG
ADMINISTRATION WHILE THE RESULTS OF RANDOMIZED

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TRIALS, WHETHER PRELIMINARY OR FINAL RESULTS, ARE
NOT AVAILABLE.

Xxx

(6) ETHICAL, LEGAL, SOCIAL, AND HEALTH SYSTEMS
IMPLICATIONS. - THE HTAC MUST BE GIVEN THE
FLEXIBILITY TO MODIFY ITS EVALUATION FRAMEWORK
DURING PUBLIC HEALTH EMERGENCIES WHEREIN THERE
ARE LIMITATIONS IN TERMS OF TYPES OF EVIDENCE AND
URGENCY IN PRODUCING RECOMMENDATIONS.

EACH INTERVENTION MAY BE ASSESSED FOR THE
FOLLOWING:

(i) | ETHICAL CONSIDERATIONS — SITUATIONS WHERE THE
USE OR ABSENCE OF THE TECHNOLOGY MAY RUN
COUNTER TO THE PRINCIPLE OF JUSTICE, EQUITY OR
FAIRNESS OF HEALTHCARE SUCH AS RISKS OF THE
TECHNOLOGY WITH RESPECT TO BASIC HUMAN
RIGHTS;

(ii) LEGAL CONSIDERATIONS - LOCAL AND
INTERNATIONAL LAWS CONCERNING REGULATION OF
PARTICULAR HEALTH TECHNOLOGIES SUCH AS
PATENT, MARKET ENTRY, OFF-LABEL USE, DATA
PROTECTION, PRODUCT LIABILITY, PATIENT RIGHTS,
DISEASE-SPECIFIC LAWS AND POLICIES; IMPACT OF
DECISIONS TO OTHER EXISTING POLICIES;

(iii) SOCIAL IMPLICATIONS - CONSIDERATION OF PATIENT
EXPERIENCE, PREFERENCES AND VALUES SUCH AS
MORAL, RELIGIOUS AND CULTURAL; ACCOUNTING OF
HEALTH DISPARITIES BASED ON ETHNICITY, AGE,
GENDER IDENTITY, SEXUAL ORIENTATION,
SOCIOECONOMIC STATUS, OR GEOGRAPHICAL
LOCATION; AND

(iv) HEALTH SYSTEM IMPLICATIONS - EFFECTS ON THE
CURRENT HEALTH SYSTEM AND SERVICE DELIVERY;
CHANGE IN CLINICAL PRACTICE GUIDELINES AND
IMPACT TO THE VARIATION IN PRACTICE;
INFRASTRUCTURE AND HUMAN RESOURCE NEEDS;

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HEALTH SYSTEM ISSUES THAT MAY IMPACT ACCESS TO
THE TECHNOLOGY.

XXX,

(c) The HTAC, to be composed of health experts, shall be [ereated
within-the- DOH} CONSTITUTED WITHIN THE DOST and
supported by a Secretariat and a Technical Unit for Policy, Planning
and Evaluation with evidence generation and validation capacity IN
ITS TRANSITION INTO AN INDEPENDENT AGENCY
ATTACHED TO THE DOST UPON ESTABLISHMENT AND
EFFECTIVE OPERATION UNDER THE DOH. The HTAC
shall: (1) facilitate provision of financing and/or coverage
recommendations on health technologies to be financed by DOH and
PhilHealth; (2) oversee and coordinate the HTA process with DOH
and PhilHealth; and (3) review and assess existing DOH and
PhilHealth benefit packages. [Within—five—(S}—years—after the

BOSH}

(d) The HTAC shall conduct the HTA in accordance with the
principles, criteria, and procedures of this Act and ensure that its
process is transparent, conducted with reasonable promptness, and
the result of its deliberations is made public. The HTAC shall consist
of a core committee and subcommittees.

The core committee, which shall elect from among themselves its
Chairperson, shall be composed of nine (9) voting members, namely:
a public health epidemiologist; a health economist; an ethicist; a
citizen’s representative; a sociologist or anthropologist; a clinical
trial or research methods expert; a clinical epidemiologist or
evidence-based medicine expert; a medico-legal expert; and a public
health expert.

The subcommittees to be constituted shall include, among others:
Drugs, Vaccines, Clinical Equipment and Devices, Medical and
Surgical Procedure, Preventive and Promotive Health Services, and
Traditional Medicine, AND DIGITAL AND OTHER HEALTH
TECHNOLOGIES. Each subcommittee shall have a minimum of

[one-4)-and-meximum-of] three (3) [pen-veting] members [foreach
subeommittee].

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The HTAC may call upon technical resource persons from the
DOH, PhilHealth, Food and Drug Administration (FDA), patient
groups, fand-eliniea- medicine] HTA-RELA TED experts fastegular
resouree-persens]; and representatives from the private sector and
health care providers [as-by-invitation] resource persons. THESE
RESOURCE PERSONS EXCEPT GOVERNMENT
REPRESENTATIVES SHALL RECEIVE AN HONORARIUM
IN ACCORDANCE WITH EXISTING BUDGETARY LAWS,
RULES AND REGULATIONS.

(e) The HTAC’s core committee and subcommittee members
shall be appointed by the Secretary of [Health] SCIENCE AND
TECHNOLOGY FOLLOWING ITS TRANSITION FROM
DOH INTO AN ATTACHED AGENCY UNDER DOST for a
term of [three-3}] FOUR (4) years except for the medico-legal
expert, ethicist, and the sociologist or anthropologist who shall serve
for a term of [feu#-4)] FIVE (5) years: Provided, That no member
shall serve for more than three (3) consecutive terms: Provided,
further, That the members of the HTAC AND ANY INVITED
RESOURCE PERSONS EXCEPT GOVERNMENT
REPRESENTATIVES shall receive an honorarium in accordance
with existing [peeies] BUDGETARY LAWS, RULES AND
REGULATIONS.: Provided, furthermore, That the DOH shall
promulgate the nomination process for all HTAC members with a
clear set of qualifications, credentials and recommendations from the

sectors concemned|: Provided. finally, That the Secretary ofthe DOST
attached agency under DOS.”

SEC. 13. Section 36 of Republic Act No. 11223 is hereby amended to read
as follows:

“SEC. 36. Health Information System. - All health service providers and
insurers shall each maintain a health information system consisting of
enterprise resource planning, human resource information, electronic health
records, and an electronic prescription log consistent with DOH standards,
which shall be electronically uploaded on a regular basis through
interoperable systems: Provided, That the health information system shall
be developed and funded by the DOH and PhilHealth: Provided, further,
That patient privacy and confidentiality shall at all times be upheld, in
accordance with the Data Privacy Act of 2012.

7


30

PHILHEALTH SHALL MAINTAIN AN ELECTRONIC
NATIONAL HEALTH RECORDS SYSTEM WHERE PATIENT
DATA, INCLUDING ALL REQUESTED, ACTUALLY GRANTED,
AND PAID CLAIMS AND BENEFITS SHALL BE STORED, AND
MAY BE OBTAINED UPON REQUEST BY THE PATIENT. THE
DICT SHALL PROVIDE SUPPORT IN DESIGNING A SECURE
DATABASE WITH MECHANISMS FOR DETECTING PROBABLE
FRAUD: PROVIDED, THAT THE DATABASE SHALL ABIDE BY
THE ‘ONE-PATIENT, ONE-RECORD’ PRINCIPLE.”

SEC. 14. Section 38 of Republic Act No. 11223 is hereby amended to read

as follows:

to

“SEC. 38. Penal Provisions. —
XXX

(F)ANY LGU OFFICIAL WHO MISAPPROPRIATES,
DIVERTS, OR USES FUNDS ALLOCATED UNDER THIS ACT
FOR NON-HEALTH RELATED EXPENDITURES, OR PERMITS
SUCH MISUSE KNOWINGLY, SHALL BE SUBJECT TO THE
FOLLOWING PENALTIES:

(1)A FINE OF NOT LESS THAN ONE HUNDRED THOUSAND
PESOS (P 100,000.00) AND NOT MORE THAN FIVE HUNDRED
THOUSAND PESOS (P500,000.00) PER VIOLATION;

(2) IMPRISONMENT FOR A TERM OF NOT LESS THAN ONE
(1) YEAR AND NOT MORE THAN SIX (6) YEARS; AND

(3)DISQUALIFICATION FROM HOLDING ANY PUBLIC
OFFICE FOR A PERIOD OF NOT LESS THAN FIVE (5) YEARS.”

SEC. 15. Non-diminution of Benefits. — Nothing in this Act shall be construed

eliminate or diminish any benefits or entitlements already granted to members of
PhilHealth.

“SEC. 16. IMPLEMENTING RULES AND REGULATIONS. - THE

DOH AND THE PHILHEALTH, IN CONSULTATION WITH THE
UHC-CC, SHALL PROMULGATE THE NECESSARY RULES AND
REGULATIONS FOR THE EFFECTIVE IMPLEMENTATION OF THIS

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ACT NO LATER THAN ONE HUNDRED EIGHTY (180) DAYS UPON
THE EFFECTIVITY OF THIS ACT.”

SEC. 17. Separability Clause. — If any provision of this Act is declared
invalid or unconstitutional, the remainder thereof not otherwise affected shall
remain in full force and effect.

SEC. 18, Repealing Clause. — All laws, presidential decrees, executive orders,
letters of instruction, proclamations, and administrative regulations that are
inconsistent with the provisions of this Act are hereby repealed, amended, or
modified accordingly.

SEC. 19. Effectivity. — This Act shall take effect fifteen (15) days after its
publication in the Official Gazette or in a newspaper of general circulation.

Approved,

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