NINETEENTH CONGRESS OF THE 
REPUBLIC OF THE PHILIPPINES 
First Regular Session
S.B. No.
)
)
SENATE
770
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-X
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■' P*-'
72 JUL19 P 6 39
Introduced by SENATOR SONNY ANGARA
AN ACT
AMENDING CERTAIN PROVISIONS OF REPUBLIC ACT NO. 11223, 
OTHERWISE KNOWN AS THE UNIVERSAL HEALTH CARE ACT
EXPLANATORY NOTE
No less than the 1987 Constitution recognizes the right to health of every 
Filipino and mandates that the State shall instill health consciousness among its 
people. In fulfillment of this mandate, Congress passed Republic Act No. 11223 
otherwise known as the Universal Health Care Act on February 20, 2019. Among the 
objectives of the Universal Health Care Act is to ensure that all Filipinos are guaranteed 
equitable access to quality and affordable health care goods and services and 
protected against financial risk.
The Philippine Health Insurance Corporation (PhilHealth) identified certain 
provisions in the law which hinders the flexibility in the determination, fixing and 
reduction of published case rates/packages. To address this, the proposed measure 
seeks to amend Sections 9 and 34 of the Universal Health Care Act to enable PhilHealth 
to adjust the packages subject to the review, assessment, and recommendation of the 
Health Technology Assessment Council (HTAC).
In addition, during the 18th Congress, the Senate has conducted numerous 
investigations cn allegations of rampant corruption, incompetence, and inefficiency 
within PhilHealth with the end in view of reforming the country's national health 
insurance program to be more responsible and accountable with the funds provided 
by the public.
Part of the discussion was the alleged overpayment of PhilHealth to several 
health care providers (HCPs)/health care institutions (HCIs) through its Interim


Reimbursement Mechanism (IRM). Meanwhile, some hospitals who are in actual need 
of reimbursements from the Corporation have been seemingly neglected. For instance, 
the Senate Committee of the Whole discovered that PhilHealth hastily released funds 
to a specific cluster of dialysis centers while various hospitals have reached out to the 
Committee and repealed that they have not received IRM funds.
Hence, the proposed measure will also introduce an amendment to the 
Universal Health Care Act and add another layer of accountability to the release of 
reimbursement for medical claims as HCPs, HCIs, and PhilHealth will be mandated to 
execute a sworn unciertaking chat all medical claims and reimbursements are true and 
correct. This shall, in turn, be part of PhilHealth's submission to the Commission on 
Audit (COA) in order to give the public assurance that their contributions and the 
subsidy of the national government are spent responsibly and judiciously.
In view of the foregoing, the immediate passage of the bill is earnestly sought.
SONNY ANGARA


VC
- : 
of P.:c ■:.
NINETEENTH CONGRESS OF THE 
)
REPUBLIC OF THE PHILIPPINES 
)
First Regular Session 
)
S.B. No.
SENATE
770
*22 JUL19 P6 39
Introduced by SENATOR SONNY ANGARA
AN ACT
AMENDING CERTAIN PROVISIONS OF REPUBLIC ACT NO. 11223, 
OTHERWISE KNOWN AS THE UNIVERSAL HEALTH CARE ACT
3e it enacted hy the Senace and House of Representatives of the Philippines in 
Congress assem bled:
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SECTION 1. Section 9 of Republic Act No. 11223 or the Universal Health Care
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Act is hereby amended to read as follows:
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"Sec. 9. Entitlement to Benefits. - Every member shall be granted
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immediate eligibility for health benefit package under the Program:
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Provided, That PhilHealth Identification Card shall not be required in
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the availment of any health service: Provided, further. That no co-
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payment shall be charged for services rendered in basic or ward
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acCi)mmodation: '^rovidr-d, furthermore, hat co payments and co-
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insurance for amenities in public hospitals shall be regulated by the
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DOH and PhilHealth: Provided, [finally] FURTHERMORE, That the
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[eurr-ent] EXISTING PhilHealth [package] COVERAGE for
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members shall not be reduced: PROVIDED, FINALLY, THAT THE
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AMOUNTS UNDER EACH BENEFIT PACKAGE SHALL BE
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SUBJECT TO THE REVIEW AND ASSESSMENT OF THE
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HEALTH TECHNOLOGY ASSESSMENT COUNCIL PURSUANT
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TO SECTION 34 OF THIS ACT."
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SEC. 2. Section 18 of the same Act is hereby amended to read as follows:
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"Section 18. Individual-based Health Services. -


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follows:
a) XXX.
b) PhilHealth shall endeavor to shift to paying providers using
performance-driven, close-end, prospective payments based 
on Qisease or diagnosis rel.^ted groupings and validated 
costing methodologies and without differentiating facility and 
professional fees; develop differential payment schemes that 
give due consideration to service quality, efficiency and 
equity; and institute strong surveillance and audit mechanisms 
to ensure networks' compliance to contractual obligations: 
PROVIDED, 
THAT 
HEALTH 
CARE
INSTITUTIONS/HEALTH CARE PROVIDERS ARE 
MANDATED TO EXECUTE A SWORN UNDERTAKING 
THAT THE MEDICAL CLAIMS SUBMITTED TO 
PHILHEALTH FOR REIMBURSEMENT ARE CERTIFIED 
TRUE AND CORRECT: PROVIDED FURTHER, THAT 
PHILHEALTH, FOR ITS PART, SHALL LIKEWISE ISSUE 
A CERTIFICATION UNDER OATH THAT A THOROUGH 
REVIEW OF THE MEDICAL CLAIM WAS DONE AND 
THAT THE ACTUAL REIMBURSEMENT PAID TO THE 
HEALTH CARE INSTITUTIONS/HEALTH CARE 
PROVIDERS ARE TRUE AND CORRECT: PROVIDED 
FIN ALL Y, 1 HAT THIS DOCUMENl SHOULD FORM PART 
OF PHILHEALTH'S SUBMISSION TO THE COMMISSION 
ON AUDIT (COA)."
SEC. 3. Section 34 of Republic Act No, 11223 is hereby amended to read as
"Sec. 34. Health Technology Assessment (HTA). -
(a) XXX.
(b) x X X.
(c) The HTAC, to be composed of health experts, shall be created 
within the DOH and supported by a Secretariat and a Technical 
Unit for Policy, Planning and Evaluation with evidence generation


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and validation capacity. The HTAC shall: (1) facilitate provision
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of financing and/or coverage recommendations on health
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technologies to be financed by DOH and PhilHealth; (2) oversee
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and coordinate the HTA process within DOH aiid PhilHealth; and
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(3) review and assess existing DOH and PhilHealth benefit
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packages AND RECOMMEND APPROPRIATE AND
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REASONABLE AMOUNTS PER PACKAGE BASED ON
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PREVAILING TECHNOLOGIES AND/OR TREATMENT.
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Within five (5) years after the establishment and effective
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operation of the HTAC, it shall transition into an independent entity
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separate from the DOH, attached to DOST.
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(d)xxx.
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(e)xxx/'
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SEC. 3. Separability Clause. - If any provision of this Act is declared invalid
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or unconstitutional, the other provisions not affected thereby shall continue to be in
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full force and effect.
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SEC. 4. Repealing Clause. - AH laws, decrees, executive orders or rules and
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regulations contrary to or inconsistent with the provisions of this Act are hereby
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repealed or modified accordingly
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SEC. 5. Effectivity Clause. -This Act shall take effect fifteen (15) days after
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its publication in the Official Gazette or in any newspaper of the general circulation.
Approved,