Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

FIFTEENTH CONGRESS
Second Regular Session

5270

House Bill No.

Introduced by Representatives
DIOSDADO MACAPAGAL ARROYO and GLORIA MACAPAGAL ARROYO

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

Rampant drug addiction is one of the pervading social ills hounding the
country at present. In the hopes of curtailing this, various laws were enacted to
prevent and control the drug menace. While these laws prescribed stiffer
penalties, one aspect overlooked, however, and was not properly addressed is
the rehabilitation of drug dependents, the provision of related facilities and their
corresponding medical treatment for their complete recovery and social
reintegration into mainstream society.

Across the Philippines, we can find among the regions private and
government-run rehabilitation centers. A 2009 survey revealed that there are 1.7
million drug dependents where only 2,000 underwent treatment and
rehabilitation. This low turnout is mainly due to the high cost of treatment and
rehabilitation which discourages families of drug dependents to avail of the same.

This bill therefore proposes that beneficiaries of the Philippine Health
Insurance Corporation (PHIC) or PhilHealth who are drug dependents and who
submit themselves for treatment and rehabilitation in an accredited health care
provider will be given very affordable treatment and rehabilitation. This is in


consonance with the provision of our Constitution 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 entitled, “An Act Instituting a National Health
Insurance Program for all Filipinos and Establishing the Philippine Health
Insurance Corporation (PhilHealth) for this Purpose” was amended by Republic
Act No. 9241 to include drug abuse and dependency treatment as among those
personal services covered. It also recognized rehabilitation centers not only as
health institutions but as health care providers.

This bill seeks to specifically include rehabilitation treatment as among the
enumerated categories of personal health services to ensure beneficiaries of
affordable treatment. It also calls for the application for accreditation of
rehabilitation centers in order for Philhealth members to be accorded the
proposed benefits.

In view of the foregoing, approval of this proposed bill is hereby
recommended.

i Ny
DIOSDADO whey ;AL ARROYO GLORIA MACAPAGAL ARROYO
Second District, Camarines Sur Second District, Pampanga


Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

FIFTEENTH CONGRESS
Second Regular Session

5270

House Bill No.

Introduced by Representatives
DIOSDADO MACAPAGAL ARROYO and GLORIA MACAPAGAL ARROYO

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

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

SECTION 1. Short Title. - This Act shall be known as the “Free Drug
Rehabilitation Treatment Act of 2011."

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

"Sec. 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 shalll 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.

d) 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 earnings 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: 1) 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) years old or above whose
monthly income is below an amount to be determined by the Corporation
in accordance with the guiding 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 concerning 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 healthcare
provider negotiations concerning the costs of providing a specific package
of medical benefits is based solely on a predetermined and fixed budget.

©) Government Service Insurance System - The Government Service
Insurance System created under Commonwealth Act No. 186, as
amended.

p) Health Care Provider - Refers to:

(1) a health 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 sanitarial 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 healthcare professional or
practitioner duly licensed to practice in the Philippines and
accredited by the Corporation; or

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

1) 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.

gg) 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.


ji) Social Security System - The Social Security System created under
Republic Act No. 1161, 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 for people who are terminally ill but does not include custodial and
non-skilled personal care."

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

“Section 10. Benefit Package
a) Inpatient hospital care:

4) 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) in-patient education packages;

b) Outpatient care:


1) services of health care professionals;

2) diagnostic, laboratory, and other medical examination services;
3) personal preventive services; and

4) prescription drugs and biologicals

c) Rehabilitation Treatment - In-patient care

1) 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 biologicals

d) 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 alll 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.

SECTION 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. - This Act shalll take effect fifteen (15) days after
its publication in at least two (2) newspapers of general circulation.

Approved,