Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City, Metro Manila

SIXTEENTH CONGRESS
Third Regular Session

House BILL No. 6103

Introduced by Honorable MARK A. VILLAR

AN ACT
PROVIDING FOR AFFORDABLE DRUG REHABILITATION TREATMENT
FOR PHILIPPINE HEALTH INSURANCE CORPORATION (PHIC)
BENEFICIARIES, FURTHER AMENDING FOR THE PURPOSE RA 7875,
AS AMENDED BY RA 9241

EXPLANATORY NOTE

Drug addiction is presently recognized as one of the most pervading social
ills. According to the United Nations Drug Report in 2012, the Philippines has the
highest abuse rate for methamphetamine hydrochloride, or shabu, in East Asia. To
deter and control violators, Philippine laws treat drug pushers, users, and even
possessors severely, by imposing the highest degree of penalty — life imprisonment.

However, current laws fail to recognize that rehabilitation is as important as
deterrence in solving the drug menace. Rehabilitation of drug dependents and
providing for such facilities and medical treatment to ensure their complete recovery
and eventual social reintegration have not been properly addressed

There are numerous rehabilitation centers, both private and government run,
across the regions all over the country. Notwithstanding, there are 1.7 million drug
users in the Philippines according to a 2008 survey conducted by the Dangerous
Drugs Board. Of this, only 2000, or less than 0.2%, underwent treatment and
rehabilitation. One of the factors contributing to the dismal number is the fact that the
cost of treatment and rehabilitation discourages families of drug dependents to avail
of the same.


This bill therefore proposes that Philippine Health Insurance Corporation (PI-
HC) beneficiaries who are drug dependents shall be provided with treatment and
rehabilitation to an accredited health care provider at an affordable cost. This is
pursuant to the constitutional mandate, “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.”

Republic Act No. 7875, an Act instituting a National Health Insurance Program
for all Filipinos and establishing the Philippine Health Insurance Corporation
(Philhealth) for the purpose was amended by Republic Act No. 9241. This
amendment highlighted the inclusion of drug abuse and dependency treatment as
among those personal services covered. It also recognized rehabilitation centers as
health institutions that are considered as health care providers.

This bill further proposes amendment to specifically include rehabilitation
treatment as among the enumerated categories of personal health services to
ensure its beneficiaries of affordable rehabilitation treatment. This bill also calls for
the application for accreditation of Rehabilitation Centers in order that Philhealth
members will be accorded the proposed benefits.

The approval of this proposed bill, is therefore, recommended

PD

MARK A. VILLAR


Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City, Metro Manila

SIXTEENTH CONGRESS
Third Regular Session

House BILL No._6103

Introduced by Honorable MARK A. VILLAR:

AN ACT
PROVIDING FOR AFFORDABLE DRUG REHABILITATION TREATMENT FOR
PHILIPPINE HEALTH INSURANCE CORPORATION (PHIC) BENEFICIARIES,
FURTHER AMENDING FOR THE PURPOSE RA 7875,
AS AMENDED BY RA 9244

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

SECTION 1. This Act shall be known as “Free Drug Rehabilitation Treatment
Act of 2015."

SEC. 2. Sec. 4 of Republic Act No. 7875 is hereby amended to read as
follows:

"Section 4. Definition of Terms - For the purpose of this Act, the
following terms shall be defined as follows:

a) Beneficiary - Any person entitled to health care benefits under this Act.
b) Benefit Package - Services that the Program offers to its members.

¢) Capitation - A payment mechanism where a fixed rate, whether per person,
family, household or group, is negotiated with a health care provider who shall
be responsible in delivering or arranging for the delivery of health services
required by the covered person under the conditions of a health care provider
contract


4) Contribution - The amount paid by or in behalf of a member to the Program for
coverage, based on salaries or wages in the case of formal sector employees,
and on household eamings and assets, in the case of self-employed, or on
other criteria as may be defined by the Corporation in accordance with the
guiding principles set forth in Article 1 of this Act

) Coverage - The entitlement of an individual, as a member or as a dependent,
to the benefits of the program.

f) Dependent - The legal dependents of a member are: |) the legitimate spouse
who is not a member; 2) the unmarried and unemployed legitimate,
legitimated, illegitimate, acknowledged children as appearing in the birth
certificate; legally adopted or step-children below twenty-one (21) years of
age; 3)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 of our support; 4) the
parents who are sixty (60) year old or above whose monthly income is below
an amount to be determined by the Corporation in accordance with the
Quiding principles set forth in Article | of this Act.

g) Drug Dependent - As defined under RA 9165 (Comprehensive Dangerous
Drugs Act of 2002), a person exhibiting a cluster of physiological, behavioral
and cognitive phenomena of variable intensity, in which the use of
psychoactive drug takes on a high priority thereby involving, among others, a
strong desire or a sense of compulsion to take the substance and the
difficulties in controlling substance-taking behavior in terms of its onset,
termination, or levels of use.

h) Diagnostic Procedure - Any procedure to identify a disease or condition
through analysis and examination

i) Emergency - An unforeseen combination of circumstances which calls for
immediate action to preserve the life of a person or to preserve the sight of
‘one or both eyes; the hearing of one or both ears; or one or two limbs at or
above the ankle or wrist

j) Employee - Any person who performs services for an employer in which either
‘or both mental and physical efforts are used and who receives compensation
for such services, where there is an employer-employee relationship.

k) Employer - A natural or juridical person who employs the services of an
employee.

!) Enrollment - The process to be determined by the Corporation in order to
enlist individuals as members or dependents covered by the Program.

m) Fee for Service - A reasonable and equitable health care payment system
under which physicians and other health care providers receive a payment
that does not exceed their billed charge for each unit of service provided.


n) Global Budget - An approach to the purchase of medical services by which

health care provider negotiations conceming the costs of providing a specific
package of medical benefits is based solely on a predetermined and fixed
budget, purchase of medical services by which health care provider
negotiations conceming the costs of providing a specific package of medical
benefits is based solely on a predetermined and fixed budget

0) Government Service Insurance System - The Government Service Insurance

System created under Commonwealth Act No. 186, as amended.

p) Health Care Provider - Refers to:

1) Ahealth care institution which is duly licensed and accredited devoted
primarily to the maintenance and operation of facilities for health
promotion, prevention, diagnosis, injury, disability, or deformity, drug
addiction or in need of obstetrical or other medical and nursing care. It
shall also be construed as any institution, building, or place where
there are installed beds, cribs, or bassinets for twenty-four hour use or
longer by patients in the treatment of diseases, injuries, deformities, or
abnormal physical and mental states, maternity cases or sanitary care;
or infirmaries, nurseries, dispensaries, rehabilitation centers and such
other similar names by which they may be designated; or

2) A health care professional, who is any doctor of medicine, nurse,
midwife, dentist, or other health care professional or practitioner duly
licensed to practice in the Philippines and accredited by the
Corporation; or

3) Ahealth maintenance organization, which is entity that provides, offers,
or arranges for coverage of designated health services needed by plan
members for a fixed prepaid premium; or

4) A community-based health organization, which is an association of
indigenous members of the community organized for the purpose of
improving the health status of that community through preventive,
Promotive and curative health services.

q) Health Insurance Identification (ID) Card - The document issued by the

Uy)

Corporation to members and dependents upon their enrollment to serve as
the instrument for proper identification, eligibility verification, and utilization
recording

Indigent - A person who has no visible means of income, or whose income is
insufficient for the subsistence of his family, as identified by the Local Health
Insurance Office and based on specific criteria set by the Corporation in
accordance with the guiding principles set forth in Article | of this Act


s) Inpatient Education Package - A set of informational services made available
to an individual who is confined in a hospital to afford him with knowledge
about his illness and its treatment, and of the means available, particularly
lifestyle changes, to prevent the recurrence or aggravation of such illness and
to promote his health in general.

t) Member - Any person whose premiums have been regularly paid to the
National Health Insurance Program. He may be a paying member, or a
pensioner / retiree member.

u) Means Test - A protocol administered at the barangay level to determine the
ability of individuals or households to pay varying levels of contributions to the
Program, ranging from the indigent in the community whose contributions
should be totally subsidized by the government, to those who can afford to
subsidize part but not all the required contributions for the Program.

v) Medicare - The health insurance program currently being implemented by the
Philippine Medical Care Commission. It consists of:

1) Program |, which covers members of the SSS and GSIS including their
legal dependents; and

2) Program II, which is intended for those not covered under Program |.

w) National Health Insurance Program - The compulsory health insurance
program of the government as established in this Act, which shall provide
universal health insurance coverage and ensure affordable, acceptable,
available and accessible health care services for all citizens of the Philippines.

x) Pensioner - An SSS or GSIS member who receives pensions therefrom.

y) Personal Health Services - Health Services in which benefits accrue to the
individual person,
These are categorized into inpatient and outpatient services.

2) Philippine Medical Care Commission - The Philippine Medical Care
Commission created under Republic Act No. 6111, as amended.

aa) Philippine National Drug Formulary - The essential drugs list for the
Philippines which is prepared by the National Drug Committee of the
Department of Health in Consultation with experts and specialists from
organized profession medical societies, medical academe and the
pharmaceutical industry, and which is updated every year.

bb) Portability - The enablement of a member to avail of Program benefits in an
area outside the jurisdiction of his Local Health Insurance Office.

Cc) Prescription Drug - A drug which has been approved by the Bureau of Food
and Drug and which can be dispensed only pursuant to a prescription order
from a physician who is duly licensed to do so.


dd) Public Health Services - 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

ee) Quality Assurance - A formal set of activities to review and ensure the quality
of services provided. Quality assurance includes quality assessment and
corrective actions to remedy any deficiencies identified in the quality of direct
patient, administrative, and support services.

ff) Residence - The place where the member actually lives.

9g) Retiree - A member of the Program who has reached the age of retirement or
who was retired on account of disability,

hh) Self-employed - A person who works for himself and is therefore both
employee and employer at the same time.

ii) Social Security System - The Social Security System created under Republic
Act No.1 161, as amended

jj) Treatment Procedure - Any method used to remove the symptoms and cause
of a disease.

kk) Utilization Review - A formal review of a patient utilization or of the
appropriateness of health care services, on a prospective, concurrent or
retrospective basis.

Il) Rehabilitation Center - Refers to:

1) A facility, which undertakes rehabilitation of drug dependents. It
includes institutions, agencies and the like which have for their
purpose, the development of skills, or which provides counseling, or
which seeks to inculcate, social and moral values to clientele who have
a drug problem with the pain of weaning them from drugs and making
them drug-free, adapted to their families and peers, and readjusted into
the community as law abiding, useful and productive citizens.

2) A facility accredited by the Philippine Health Accreditation Board

mm) Home Care and Medical Rehabilitation Services - Refer to skilled
nursing care, which members get in their homes/ clinics for the treatment of
an illness or injury that severely affects their activities or daily living. Home
care and medical rehabilitation services include hospice or palliative care form
people’ who are terminally ill but does not include custodial and non-skilled
personal care."


SEC. 3. Section 10 of Republic Act No. 7875 is hereby amended to read as
follows:

"Section 10. Benefit Package
a) Inpatient hospital care’
1) room and board;
2) services of health care professionals;
3) diagnostic, laboratory, and other medical examination services;
4) use of surgical or medical equipment and facilities;

5) prescription drugs and biologicals; subject to the limitations stated in
Section 37 of this Act;

6) inpatient education packages;
b) outpatient care:

41) services of health care professionals;

2) diagnostic, laboratory, and other medical examination services;

3) personal preventive services; and
4) prescription drugs and biological

c) Rehabilitation Treatment- in-patient care
4) room and board
2) services of health care professionals
3) diagnostic, laboratory, and other medical examination services;
4) use of medical facilities
5) prescription drugs and biologicals;

d) Rehabilitation Treatment -Out-patient Care
1) services of health care professionals;
2) diagnostic, laboratory, and other medical examination services;
3) personal preventive services; and

4) prescription drugs and biological


5) Emergency and transfer services; and

e) Such other health care services that the Corporation shall determine to be
appropriate and cost-effective: Provided, That the Program, during its initial
phase of implementation, which shall not be more than five (5) years, shall
provide a basic minimum package of benefits which shall be defined
according to the following guidelines:

1) the cost of providing said packages is such that the available national
and local government subsidies for premium payments of indigents are
Sufficient to extend coverage to the widest possible population.

2) the initial set of services shall not be less than half of those provided
under the current Medicare Program | in terms of overall average cost
of claims paid per beneficiary household per year

3) the services included are prioritized, first, according to its cost-
effectiveness and, second, according to its potential of providing
maximum relief from the financial burden on the beneficiary: Provided,
That, in addition to the basic minimum package, the Program shall
provide supplemental health benefit coverage to beneficiaries of
Contributory funds, taking into consideration the availability of funds for
the purpose from said contributory funds: Provided, further, That the
Program progressively expand the basic minimum benefit package as
the proportion of the population covered reaches targeted milestone so
that the same benefits are extended to all members of the Program
within five (5) years after the implementation of this Act. Such
expansion will provide for the gradual incorporation of supplementary
health benefits previously extended only to some beneficiaries into the
basic minimum package extended to all beneficiaries: and Provided,
finally, That in the phased implementation of this Act, there should be
no reduction or interruption in the benefits currently enjoyed by present
members of Medicare.

SEC. 4. Repealing Clause - All laws, rules, regulations and other issuance or
parts thereof which are inconsistent with this Act are hereby repealed or modified
accordingly.

SECTION 5. Effectivity Clause. -This Act shall take fifteen (15) days
following its publication in the official Gazette or in at least two (2) newspapers of
general circulation

Approved,