Republic of the Philippines [2
HOUSE OF REPRESENTATIVES IS )
Quezon City = DATE August 4, 2025
‘TWENTIETH CONGRESS e TIME —S:10pm_
First Regular Session \4

BY _Tweety
S

Wo we’

HOUSE BILL NO. 2989

Introduced by Representative ANTOLIN “LENLEN™ A. ORETA III

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”

EXPLANATORY NOTE

Article II, Section 15 of the 1987 Constitution declares that “The State shall protect and
promote the right to health of the people and instill health consciousness among them.” Article
XIII, Section 2 further provides 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,

This constitutional mandate laid the foundation for the enactment of Republic Act No. 11223,
or the Universal Health Care (UHC) Act, which ensures that every Filipino has equitable
access to comprehensive health care services.

However, the COVID-19 pandemic, a public health emergency, exposed serious institutional,
fiscal, and operational gaps that hinder the full implementation of the law. These include
inefficiencies in the delivery of benefits, limitations in coordination between national agencies
and local governments, outdated contribution schemes, and the need for clearer financial
protection for vulnerable sectors such as migrant workers and overseas Filipinos in distress

This bill proposes amendments to the Universal Health Care Act to address these challenges
and further strengthen the country’s healthcare system by improving efficiency and equity,
and by building resilience moving forward through the lessons leamed during the pandemic.
‘Among others, this bill adjusts the premium contribution scheme for direct and indirect
contributors to be based on actuarially adjusted rates, subject to the approval of Congress. It
protects migrant workers from unfair financial burdens and strengthens the role of local
governments in managing health resources. It also provides a mechanism for lowering
premium contribution rates and ensures that no portion of PhilHealth’s reserve fund shall
accrue to the general fund of the national goverment or its instrumentalities.

‘This bill was approved by the House of Representatives in the 19% Congress and was duly
transmitted to the Senate. This is refiled in the 20" Congress under the same considerations for

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which it was previously approved. The present proponent seeks to continue this important
reform and acknowledges the efforts of his predecessors.

In view of the foregoing, the immediate passage of this bill is earnestly sought.

ANTOLIN f ENLEN” A. ORETA II

Lone District, Malabon City

Page 2 of 16


Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

TWENTIETH CONGRESS
First Regular Session

HOUSE BILL NO. 2989

Introduced by Representative Antolin A. Oreta II

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;

(©) Basic or ward accommodation - xxx;

(4) Co-insurance - xxx:

(€) Co-payment - xxx;

(F) 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.

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[(} (G) Direct contributors - xxx;

[HH) Emergency - xxx;

£49} (1) Entitlement - xxx;

{43} (J) 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 SERVICE!

£G)} (K) Fraudulent act - xxx;

£48} (L) Health care provider - xxx;
44) (M) Health care provider network - xxx;
4m} (N) Health Maintenance Organization (HMO) - xxx;

£49} (O) Health Technology Assessment (HTA) refers to the systematic evaluation of
properties, effects, or impact of healthf-releted] technologies f-deviees,-medieines;
‘vaccines; provedures-and-all other health-related systems-developed-to-solve-a-health
problem—and—improve—quality—of lives—and—health—outeomese utilizing a
multidisciplinary process to evaluate [the] ITS CLINICAL, social, economic,
[organizational] LEGAL, [and] ethical, AND COMPATIBILITY TO HEALTH

SYSTEM issues [of-e-health-intervention-orhealth-technology] TO INFORM
POLICY-DECISION MAKING, ESPECIALLY ON HOW TO BEST
ALLOCATE LIMITED FUNDS TO HEALTH INTERVENTIONS AND
TECHNOLOGIES;

te} (P) Indirect contributors - xxx;

fp} (Q) Individual-based health services ~ xxx;

(R) 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;

{4a} (S) Population-based health services - xxx;

£9} (1) Primary care - xxx;

[63] (U) Primary care provider = xxx;

{9} (V) 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; fad}

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1
2 (W) REAL-WORLD EVIDENCE REFERS TO CLINICAL EVIDENCE ON A
3 MEDICAL PRODUCT'S SAFETY AND EFFICACY THAT IS GENERATED
4 USING SEVERAL SOURCES OF DATA, INCLUDING ELECTRONIC
5 HEALTH RECORDS, REGISTRIES, CLAIMS/BILLING DATA, AND
6 PATIENT-GENERATED DATA INCLUDING THOSE FROM MOBILE
7 HEALTH APPLICATIONS AND WEARABLE DEVICES; AND
8
9 68} (X) Unethical act — xxx.*
10
MW SEC. 2. Section 9 of Republic Act No. 11223 is hereby amended to read as follows:
12
13 “SEC. 9. Entitlement to Benefits. - Every member shall be granted immediate
14 eligibility for health benefit package under the Program: Provided, That PhilHealth
15 Identification Card shall not be required in the availment of any health servi
16 Provided, further, That no co-payment shall be charged for services rendered in basi
17 or ward accommodation: Provided, furthermore, That co-payments and co-insurance
18 for amenities in public hospitals shall be regulated by the DOH and PhilHealth:
19 Provided, finally, That the current PhilHealth package for members shall not be
20 reduced.
21
22 PhilHealth shall provide additional Program benefits for direct contributors, where
R applicable: Provided, That failure to pay premiums shall not provent the enjoyment
24 of any Program benefits: Provided, further, That employers and self-employed direct
25 contributors shall be required to pay all missed contributions with an interest,
26 compounded monthly, of at least three percent (3%) for employers, and not
27 exceeding one and one-half percent (1.5%) SIMPLE INTEREST MONTHLY for
28 self-earning, professional practitioners, and migrant workers.”
29
30 SEC. 3. Section 10 of Republic Act No. 11223 is hereby amended to read as follows:
31
32 “SEC. 10. Premium Contributions. ~ For direct contributors, premium rates
33 shall be in accordance with the following schedule, and monthly income floor and
34 ceiling:
35
36 _ T
Year Premium Rate | Income Floor Income Ceiling
2019 | 275% 10,000.00 | P50,00000 |
10,000.00 60,000.00
10,000.00 70,000.00
— P10,000.00 80,000.00
10,000.00 90,000.00
10,000.00 100,000.00
10,000.00 P100,000.00
37
38 PREMIUM CONTRIBUTIONS FOR DIRECT AND INDIRECT
39 CONTRIBUTORS SHALL BE DERIVED FROM ACTUARIALLY-
40 ADJUSTED RATES, CONSIDERING BUT NOT LIMITED TO THE

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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
AN INDEPENDENT BODY 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

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AND THEIR LEGAL DEPENDENTS FROM ENJOYING ANY PROGRAM
BENEFIT.

{ProvidedsFhet} For indirect contributors, premium subsidy shall be gradually
adjusted and included annually in the General Appropriations Act (GAA):
Provided, [frther.] That the funds shall be released to PhilHealth: Provided,
further{moresf,That the DOH, in coordination with PhilHealth, may request
Congress to appropriate supplemental funding to meet targeted milestones of this
Act: Provided, [finally] 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
‘THE INCREASE IN BENEFITS.”

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 [amount of members”eontributions] PREMIUM CONTRIBUTION RATES OF
MEMBERS: PROVIDED, FINALLY, THAT THE DOH AND PHILHEALTH
SHALL INCLUDE A MECHANISM FOR LOWERING PREMIUM
CONTRIBUTION RATES IN THE IMPLEMENTING RULES AND
REGULATIONS OF THIS ACT.

Xxx

(a) xxx

(b) xxx

(©) xxx

(d) xxx

(©) xxx

(f) In bonds, securities, promissory notes, or other evidences of indebtedness of
accredited and financially sound medical 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 institution and the issued

securities are both rated triple 'A' by authorized accredited domestic rating agencies:

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eIAVawKe

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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 (c) hereof, subject to the
approval of the PhilHealth Board.

the-National-Government-orte-any_of ts_agencies-or insirumentalities,ineluding
government-owned or controlled corporations}

As part of its investments operations, PhilHealth may hire institutions with valid trust
licenses as its extemal 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 =, Remar tan coven and-one-elfpoeen

the aetual total premium collected trom-direet and indirect

tnombers—duing_the-imeediately preceding voor shell be aloud for tre
ands fi e :

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. ~

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(a) xxx

(b) The Secretary of Health shall be an ex-officio [nenveting] VOTING Chairperson
of the Board,

(0) 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, THAT THE
FOLLOWING SHALL BE KEY CONSIDERATIONS IN THE COMPETITIVE
SELECTION OF BIDDERS:

PESO VALUE OF

() MAXIMUM COVERAGE FOR A GIVE
PREMIUM;

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

(Ill) 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 [additionel} 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 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:

Page 9 of 16


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“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 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-CCQ). - 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);

DEPARTMENT OF BUDGET AND MANAGEMENT (DBM);

DEPARTMENT OF EDUCATION (DEPED);

(iv) DEPARTMENT OF FINANCE (DOF);

(vy) DEPARTMENT OF INFORMATION AND COMMUNICATIONS

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

Page 10 of 16


(vii) DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT

(DSWD);

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.”

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

(©) IN ADDITION TO AUDITS BY THE COMMISSION ON AUDIT (COA)
AS MANDATED BY LAW AND RELEVANT REGULATIONS,
PHILHEALTH SHALL BE SUBJECT TO EXTERNAL AUDIT BY AN
ACCREDITED PRIVATE-SECTOR AUDITING FIRM, AT LEAST ONCE
EVERY FISCAL YEAR; 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 USED FOR
HUMAN INTERVENTIONS as provided for under this Act: Provided, That investments
on any health technology or development of any benefit package by the DOH and

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PhilHealth shall be based on the positive 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 ot 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:

(1) Responsiveness 10 DISEASE Magnitude, AND Severity [, and-Equity]. The
health interventions must address the top medical 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 [Phase }¥4
APPROPRIATE clinical trial. [-and-systematic- review-and-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 AND VACCINES MUST HAVE UNDERGONE PHASE IV
CLINICAL TRIAL, AND THERE MUST BE AN EVIDENCE SYNTHESIS:
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;

(
(iv) CLINICAL EQUIPMENT AND DEVICES; AND

) MEDICAL AND SURGICAL PROCEDURES;

(vy) 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 PHASE IV TRIALS FOR DRUGS AND VACCINES
MAY BE DISPENSED WITH, IF NOT AVAILABLE, OR MAY BE ASSESSED
USING REAL WORLD EVIDENCE.

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Seormiaauvaeone

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@

(ii)

(iv)

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:

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;

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

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,

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;
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

Page 13 of 16


(4) 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 ethi zens 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-)-and-maximam-of] three (3) [non-voting]
members [for-each-subeommittee]

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

(c) 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 [¢hree{3)] FOUR (4) years except for
the medico-legal expert, ethicist, and the sociologist or anthropologist who shall
serve for a term of [fowe-{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 [policies] 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
concemed|:/vovided. finally, that the Secretary of the OST shall appoint the
membersof the HTAC upon its transition into-an attached ageney-under DOST).”

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

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eIaKVeene

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“SEC. 36. Health Information System. - All health service providers and insurers
shall cach 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.

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, Scction 38 of Republic Act No. 11223 is hereby amended to read as follows:
“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.
(100,000.00) AND NOT MORE THAN FIVE HUNDRED THOUSAND PESOS,
(P500,000.00) PER VIOLATION

S THAN

(2) IMPRISONMENT FOR A TERM OF NOT LI
AND NOT MORE THAN SIX (6) YEARS; AND

F (1) YEAR

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

SEC. 16. 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. 17. 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.

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ween

SEC. 18. 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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