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RECEIVED 2

DATE September 2, 201

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Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

EIGHTEENTH CONGRESS
Third Regular Session

HOUSE BILL No. 10135

Introduced by HON. LUIS RAYMUND “LRAY” F. VILLAFUERTE, JR.

AN ACT
ENHANCING THE PATIENT'S RIGHT TO MEDICAL EXPENSE TRANSPARENCY
AND PREVENTING UNEXPECTED MEDICAL BILLS, AND FOR OTHER
PURPOSES

This bill seeks to prevent unexpected medical bills and inflated out-of-pocket
expenses by: (1) informing patients about actual prices, (2) requiring health care
providers, health insurance issuers and self-insured group health plans to provide
information about expected out-of-pocket costs, (3) increasing access to data to
make healthcare information more transparent and useful to patients, (4) expanding
the ability of consumers to choose healthcare plans, and (5) removing public barriers
to price transparency in the healthcare sector.

Among the medical expenses, out-of-pocket expenditures remain to be the major
source of financing for medical care. According to the 2012 Family Income and
Expenditure Survey, the out-of-pocket health expenditures increased by 150% from
2000 to 2012.

This proposed measure seeks to prevent medical expenses that can easily be
inflated without price transparency.

In view of this, early passage of this bill is sought.

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LUIS RAY! ID “LI F. VILLAFUERTE, JR.


Republic of the Philippines:
HOUSE OF REPRESENTATIVES
Queson City

EIGHTEENTH CONGRESS
Third Regular Session

HOUSE BILL No.10135

Introduced by HON. LUIS RAYMUND “LRAY” F. VILLAFUERTE, JR.

AN ACT
ENHANCING THE PATIENT'S RIGHT TO MEDICAL EXPENSE TRANSPARENCY
AND PREVENTING UNEXPECTED MEDICAL BILLS, AND FOR OTHER
PURPOSES

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

Section 1. Short Title. - This Act shall be known as the "Medical Bill Transparency
Act’.

Section 2. Objective. — This Act shall aim to enhance the ability of patients to choose
the healthcare that is best for them, by allowing them to make fully informed decisions
about their healthcare, and the price and quality of a good or service in advance. It
shall also be the objective of this Act to help prevent ‘surprise billing’ or patients
receiving unexpected bills at inflated prices.

Section 3. Policy. ~ It shall be the policy of the State to ensure that patients are
engaged with their healthcare decisions and have the information requisite for
choosing the healthcare they want and need. The government shall aim to eliminate
unnecessary barriers to price and quality transparency; to increase the availability of
meaningful price and quality information for patients; to enhance patients’ control over
their own healthcare resources, including health insurance coverage; and to protect
patients from surprise medical bills.

Section 4. Informing Patients about Actual Prices. ~ Within sixty (60) days of the date
of this Act, the Secretary of Health shall craft regulations consistent with applicable
law, to require hospitals to publicly post standard charge information, including
charges and information based on negotiated rates and for common or shoppable
items and services, in an  easy-to-understand, consumer-friendly, and
machine-readable format using consensus-based data standards that will
meaningfully inform patients’ decision making and allow patients to compare prices
across hospitals.


The regulation should require the posting of standard charge information for services,
supplies, or fees billed by the hospital or provided by employees of the hospital. The
regulation should also require hospitals to regularly update the posted information
and establish a monitoring mechanism for the Secretary to ensure compliance with
the posting requirement, as needed.

The regulation should also require the detailed itemization of actual medical bills.

Section 5. Transparency in Health Insurance Coverage. - Within ninety (90) days of
the date of this Act, the Secretaries of Health and Finance shall jointly issue
regulations requiring healthcare providers, health insurance issuers, and self-insured
group health plans to provide or facilitate access to information about expected
out-of-pocket costs for items or services to patients before they receive care.

The Secretaries of Health and Finance shall, prior to the issuance of the regulation,
issue an advance notice of proposed rulemaking, consistent with applicable law,
soliciting comment on the proposal.

Section 6. Barriers to Health Transparency. — Within one hundred and eighty (180)
days from the date of effectivity of this Act, the Secretary of Health, in consultation
with the Department of Trade and Industry, Department of Finance, the Philippine
Competition Commission, and other relevant agencies shall issue a report describing
the manners in which government rules and practice, or the private sector, are
impeding healthcare price and quality transparency for patients, and providing
recommendations for eliminating these impediments in a way that promotes
competition.

Section 7. Increasing Access to Data to Make Healthcare Information More
Transparent and Useful to Patients. — Within one-hundred and eighty (180) days of
the date of effectivity of this Act, the Secretary of Health, in consultation with relevant
agencies, shall increase access to claims data from taxpayer-funded healthcare
Programs, including those of the Philippine Health Insurance Corporation, for
researchers, innovators, providers, and entrepreneurs, in a manner that is consistent
with applicable law and that ensures patient privacy and security.

Access to this data shall be provided in a manner that will facilitate the development
Of tools that empower patients to be better informed as they make decisions related to
healthcare goods and services. Access to this data shalll also be provided in a manner
that will enable researchers and entrepreneurs to locate inefficiencies and
opportunities for improvement, such as patterns of performance of medical
procedures that are outside the recommended standards of care.

As part of this process, the Secretary of Health shall make a list of priority data sets
that, if de-identified, could advance the policies set forth by this Act, and shall report
to the President and to Congress on proposed plans for future release of these
priority datasets and on any barriers to their release.

Section 8. Empowering Patients by Enhancing Control over Their Healthcare
Resources. — Within one-hundred and twenty (120) days of the date of this Act,, the
Secretary of Finance, to the extent consistent with law, shall issue guidance to


expand the ability of patients to select health insurance plans that cover low-cost
preventive care and/or medical care that helps maintain health status for individuals
with chronic conditions.

Section 9. Addressing Surprise Medical Billing. - Within one-hundred and twenty (120)
days of the date of this Act, the Secretary of Health shall submit a report to the
President and to Congress on measures that can be taken to address surprise
medical billing.

Section 10. Non-Impairment Clause. — Nothing in this Act shall be construed to impair
or otherwise affect the authority granted by law to an executive department or agency,
or the head thereof; or the functions of the Secretaries of Finance and Budget and
Management relating to budgetary, administrative, or legislative proposals.

Furthermore, this Act shall be implemented consistent with applicable laws and
subject to the availability of appropriations.

Section 11. Separability Clause. — If any part or provision of this Act is held invalid or
unconstitutional, the remaining parts or provisions not affected shall remain in full
force and effect.

Section 12. Repealing Clause. — All laws, decrees, orders, rules and regulations
inconsistent with the provisions of this Act are hereby repealed or modified
accordingly.

Section 13. Effectivity. - This Act shall take effect fifteen (15) days after its publication
in the Official Gazette or in any newspaper of general circulation.

Approved,