Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

EIGHTEENTH CONGRESS
First Regular Session

2511

HOUSE BILL NO.

Introduced by REPRESENTATIVE JOEL MAYO Z. ALMARIO

EXPLANATORY NOTE

President Rodrigo Roa Duterte, on February 2019 signed into law Republic
Act No. 11223 otherwise known as the Universal Health Care (UHC) Act that
automatically enrolls all Filipinos in the National Health Insurance Program.
Through this, all patients are given access to health care via Philippine Health
Insurance (PhilHealth) financing and Department of Health (DOH) population-
based services.

However, despite all the foreseen benefits of UHC Act, the families of poor
and indigent patients still account for the lion's share of medical expenses. In a
survey released by the DOH in 2016 and similarly by the Philippine Statistics
Authority in 2017, it was shown that out-of-pocket expenses amounted to 54 -
55% of healthcare spending. As a result, the underprivileged seek medical
treatment only when their illnesses are at its most damaging - sometimes
incurable stage.

This bill seeks to address this situation by institutionalizing Malasakit
Centers in all Department of Health (DOH), Local Government Units (LGU),
Department of National Defense (DND) and State Universities and College (SUC)
Hospitals. Through this measure, medical and financial assistance will be given to
cover out-of-pocket expenditures of indigent and poor patients including non-
medical expenses like transportation costs.

Support for this bill is earnestly sought.

Z. ALMARIO
“epresentative

a District, Davao Oriental



Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

EIGHTEENTH CONGRESS
First Regular Session

HOUSE BILL NO. 2511

Introduced by REPRESENTATIVE JOEL MAYO Z. ALMARIO

AN ACT
INSTITUTIONALIZING MALASAKIT CENTERS TO COMPLEMENT THE
IMPLEMENTATION OF REPUBLIC ACT NO. 11223 OTHERWISE KNOWN AS
THE “UNIVERSAL HEALTH CARE ACT” BY REQUIRING PHILHEALTH TO
ESTABLISH, OPERATE AND MAINTAIN MALASAKIT CENTERS IN ALL DOH,
LGU, SUC and DND HOSPITALS IN THE COUNTRY,
PROVIDING FUNDS THEREFOR, AND FOR OTHER PURPOSES

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 “Malasakit Centers Act of
2019."

SECTION 2. Declaration of Principles- It is the declared policy of the State to
improve the delivery of health care services to the people, and to ensure financial
assistance for hospital and medical expenses are available and accessible to the
people.

SECTION 3. Definition of Terms - For purposes of this Act, the following terms

shall mean:

(a) DOH Hospital - refers to a refers to a hospital under the management
and administration of the Department of Health (DOH), including the
four (4) corporate hospitals under the Secretary of Health, namely:
Philippine Heart Center, Lung Center of the Philippines, National

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Kidney and Transplant Institute and the Philippine Children's Medical

Center;

(b) DND Hospital - refers to a hospital managed by the Department of

National Defense;

(©) Financial Assistance or Material Assistance - refers to actual cash or
check which covers burial, transportation, and other allied assistance
given by agencies as mandated by existing laws, rules and regulations

to provide such assistance;

(a) Indigent Patient - refers to patient who has no visible means of
income or whose income is insufficient for the subsistence of his/her
family as identified by the Department of Social Welfare and
Development (DSWD), LGU social worker or the medical social worker
of the health faci

(e) Local Government Unit (LGU) Hospital - refers to a hospital managed
by the local government units, usually the provincial government;

(8) Malasakit Center - refers to a processing center for PhilHealth and

one-stop-shop for Filipinos in need of medical assistance;

(g) Medical Assistance - refers to assistance for out-of-pocket
expenditure in form of coupon, stub, guaranty letter, promissory note
or voucher that has monetary value, given directly to individual

recipients or beneficiaries to address their immediate needs;

(h) Out-of-pocket expenditure - refers to medical and surgical services
not currently paid for or sufficiently reimbursed by PhilHealth under
Republic Act No. 11223 otherwise known as the Universal Health Care

Act, or other financing sources;


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(i) Poor Patient - refers to those not classified as indigent but are

otherwise considered poor or with financial difficulty to access

adequate medical care and/or pay hospital bills because of certain

unavoidable circumstance, such as but not limited to:

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Senior citizens, persons with disability (PWD), orphans,
abused women and children as defined by RA 9262 or the
Anti-Violence Against Women and Their Children Act of
2004 and RA 7610 or the Special Protection of Children
Against Abuse, Exploitation and Discrimination Act;

Patients with catastrophic illness or any illness as a primary
condition that is life or limb-threatening and requires
prolonged hospitalization, extremely expensive therapies or
other special but essential care that would deplete one's
financial resources, unless covered by special health funding

policies;
Unemployed or without gainful employment;

Suspected or confirmed victims of torture as defined by
Republic Act No. 9745 or the Anti-Torture Act of 2009;

Soldiers and police rendered disabled to be gainfully
employed and their dependents and dependents of soldiers

and police killed in action;
Rebel returnees, prisoners of war and their dependents;
Victims of calamities or disasters such as but not limited to

typhoons, earthquake, whose place of residence are officially

under a state of emergency or calamity.


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(i) SUC Hospital - refers to hospitals managed by State Universities
and Colleges.

SECTION 4. Malasakit Center - To complement the implementation of Republic
Act No. 11223, otherwise known as the Universal Health Care Act, there shall be
established a Malasakit Center in each DOH, LGU, DND and SUC hospital in the
country which shall serve as: (a) processing center for all PhilHealth concerns
regarding coverage, billing, health benefits packages, patient navigation and
referral to the health care provider network, and (b) one-stop-shop medical

assistance to cover out-of-pocket medical expenses of indigent and poor patients.

The PhilHealth shall administer and manage the Malasakit Centers in close
coordination with the DOH and DSWD. Each Malasakit Center shall consist of duly
designated representatives from the PhilHealth, DOH and DSWD with the
following delegation of functions:

1 The PhilHealth representative shall be in charge of the over-all
operation of the Malasakit Center. He/she shall assist and process
the concerns of both direct and indirect contributors to PhilHealth
regarding the implementation of Republic Act No. 11223, including
but not limited to coverage, billing, health benefits packages,
financial concerns. The PhilHealth representative shall also assist in

patient navigation and referral to the health care provider network;

I The DOH representative shall be in charge of providing medical

assistance to indigent and poor patients; and

Ill, The DSWD representative shall be in charge of providing financial

or direct assistance to indigent and poor patients.

SECTION 5. Provision of medical assistance - The DOH shall provide medical
assistance to indigent and poor patients through the Malasakit Center which shall


be charged from the annual appropriation of the DOH for assistance to indigent

patients.

‘The DOH may also augment medical assistance using the following sources:
a) Other appropriations earmarked by national government agencies and local
government units purposely for medical assistance to indigent and poor patients:
Provided, That appropriations earmarked for a specific hospital shall only be used

for that specific hospital; and b) Donations and grants-in-aid: Provided, That
donations and grants donated for a specific hospital shall only be used for that
specific hospital: Provided further, That the donations ang grants shall only be

used for the purpose specified by the donor.

The DOH shall issue guidelines for the proper implementation of the
medical assistance to indigent and poor patients which shall include order of
charging from the aforementioned sources of financing, availment procedures,
transfer and release of funds, recording and reporting, monitoring and evaluation,

partnerships with private hospitals, among others.

The DOH shall make a quarterly report to the Office of the President and
Congress regarding the expenditures or disbursement of the medical assistance to

indigent and poor patients.

SECTION 6. Medical assistance - The Medical Assistance shall cover medical and
surgical services not currently paid for or sufficiently reimbursed by PhilHealth in
accordance with Republic Act No. 11223 or other financing sources, and shall be
used for the following drugs, medicines, goods and other services prescribed by
the physician of the health facility such as but not limited to:

a. Laboratory, imaging and all other diagnostic procedures;

b. Drugs and medicines included in the Philippine National Drug Formulary

(exemptions to be cleared by Pharmaceutical Division);


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©. Supplies, orthopedic/assistive devices, prosthesis, blood and blood
products;

d. Dental services, except those that are for aesthetic purpose and not

medically indicated;

e. All clinically indicated medical and surgical procedures, whether

emergency or elective;

f. Prescribed post-hospitalization rehabilitation services, aftercare
program, appropriate mental and psychological support, including those

done on an outpatient basis;

g, In case of non-availability of clinically indicated drugs, medicines, tests,
services or procedures in government health facilities, the concerned
government health facility may enter into contract with DOH-accredited

private health facility to provide the needed drug, test, service or
procedure to the patient, charged against the DOH hospital;

h, All hospital bills including professional fees, provided that the expenses
for professional fees shall not exceed fifty percent (50%) of the approved

assistance; and

i. All other medical, health, documentary and related services billed by the
hospital. Provided; That medical assistance to patients shall be based on
need as recommended by the medical social worker attending physician,
approved by the Chief of Hospital/Medical Center Chief of the institution
involved and DOH authorized officials, subject to availability of funds.

SECTION 7. Provision of medical assistance - The DSWD shall provide financial
assistance through the Malasakit Center to indigent and poor patients, individuals
in emergency situations, under distress or are in need of supplemental financial
support due to health or medical conditions, sickness or disease; funeral and

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burial concerns, which also includes the most direct and economical

transportation expense to or from place of residence or specific destination.

The provision of financial assistance through Malasakit Centers shall be
charged to the annual appropriation of the DSWD for assistance to individuals and
families in difficult circumstances. The DSWD shall issue policies and guidelines

on the release of such assistance for the proper implementation of the program.

SECTION 8, Establishment of malasakit centers - The PhilHealth and DOH shall,
in the establishment of the Malasakit Centers, undertake consultations with all
DOH, LGU, DND and SUC hospitals; Provided, That in the establishment of the
Malasakit Centers, highest priority shall be given to those economically-depressed

areas or provinces.

Within three (3) years from the effectivity of this Act, the PhilHealth and
DOH shall establish Malasakit Centers down to the Primary and Secondary Care
level to help facilitate the adoption of appropriate health seeking behaviors, assist
primary care providers in encouraging medical consultation at the health centers,
monitor patient compliance, and ensure proper patient referral and availment of
benefits.

Private hospitals are hereby encouraged to establish Malasakit Centers.
The PhilHealth and DOH may enter into a Memorandum of Agreement with
private hospitals for the establishment of Malasakit Centers which shall cater to
indigent and poor patients of the private hospital.

SECTION 9. Donations from non-governmental organizations and the
private sector - The DOH may solicit and receive donations from the private
sector for medical assistance to indigent and poor patients. Such donations shall
be exempt from income or donor's tax and all other taxes, fees and charges
imposed by the government: Provided, That donations from the private sector for
a particular hospital shall only be used for the benefit of the patients of the
particular hospital: Provided further, That the donations ang grants shall only be

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used for the purpose specified by the donor. As such, the donor may send his or
her representatives to the Malasakit Center for the provision of the medical
assistance donated by the donor in the particular hospital. Receipts from
donations, whether in cash or in kind, shall be accounted for in the books of the
DOH in accordance with accounting and auditing rules and regulations. The
receipts from cash donations and proceeds from sale of donated commodities
shall be deposited with the National Treasury and recorded as a special account
in the General Fund and shall be available to the DOH through a special budget
pursuant to Section 35, Chapter 5, Book VI of Executive Order No. 292.

Donations with a term not exceeding one (1) year shall be treated as trust receipts.
The DOH shall submit the quarterly reports of all donations received, whether in
cash or in kind, and expenditures or disbursements thereon with electronic
signature to the DBM, through the Unified Reporting System, and to the Speaker
of the House of Representatives, the President of the Senate of the Philippines, the
House Committee on Appropriations, the Senate Committee on Finance and the
Commission on Audit, by posting such reports on the DOH website for a period of
three (3) years. The head of the DOH shall send written notice to the said offices
when said reports have been posted on its website which shall be considered the

date of submission.

SECTION 10. Appropriations - The amount necessary to establish Malasakit
Centers shall be included in the General Appropriations Act. Additionally, there
shall be an annual appropriation for the assistance to indigent patients under the
DOH specifically for medical assistance to indigent and poor patients as provided
for in Section 5 of this Act, and an annual appropriation for assistance to
individuals and families in difficult circumstances under the DSWD budget for
financial assistance to indigent and poor patients as provided for in Section 7 of
this Act.

SECTION 11. Implementing rules and regulations - Within ninety (90) days
from the approval of this Act, PhilHealth, DOH, DSWD, in coordination with
Department of Interior and Local Government shall jointly issue the implementing

rules and regulations of this Act.


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SECTION 12. Separability clause - Any portion or provision of this Act that is
declared unconstitutional shall not have the effect of nullifying other portions or
provisions hereof as long as such remaining portions can still subsist and be given

effect in their entirety.
SECTION 13. Repealing clause - All laws, ordinances, rules, regulations, other
issuances or parts thereof, which are inconsistent with this Act, are hereby

repealed or modified accordingly.

SECTION 14. Effectivity - This Act shall take effect fifteen (15) days after its

publication in the Official Gazette or in a newspaper of general circulation.

Approved. j