FIFTEENTH CONGRESS OF THE REPUBLIC)

OF THE PHILIPPINES )
First Regular Session )

SENATE
S.No.

Introduced by Senator Miriam Defensor Santiago

EXPLANATORY NOTE.

‘The offering and operation of health plans is a growing and profitable industry in the
Philippines. Many organizations are either engaged in this business or subscribe to one. People
subscribe to these health plans and pay substantial sums for guaranteed access to quality health
care when they need it,

One of the critical factors that ensure quality health care is a patient's access to all
relevant information necessary to make appropriate decisions about their health care. Open
medical communication between health care providers and their patients is a key to prevention
and early diagnosis and treatment, as well as (0 informed consent and quality, cost-effective care,
therefore open medical communications are in the best interests of patients. It is critical that
health care providers continue to exercise their best medical, ethical, and moral judgment in
advising patients without interference from health plans.

‘This bill seeks to establish a national standard that protects medical communications

between health care providers and patients.’

’
dston, MN panes Re
«MIRIAM DE! ISOR S.

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* This bill was originally filed during the Thirtéenth Congress, First Regular Session

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FIFTEENTH CONGRESS OF THE REPUBLIC)
OF THE PHILIPPINES
First Regular Session )

S.No. “Y891

amepwen me

Introduced by Senator Miriam Defensor Santiago

AN ACT
PROTECTING CERTAIN TYPES OF MEDICAL, COMMUNICATIONS
BETWEEN A HEALTH CARE PROVIDER AND A PATIENT
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 “Patient’s Right to Know Act.”

SECTION 2. Definitions of Terms. -For the purposes of this Act, the term:

(A) “Health Care Provider” means anyone licensed or certified under Philippine law to
provide health care services and who is operating within the scope of such license;

(B) “Hlealth insurance issuer” means any company, corporation, association or
organization that offers any policy, contract or agreement that stipulates to provide for the
insured either medical attention, medicine, care during disability, or money necessary for any
such purposes; and

(©) “Health plan” means a group health plan and any individual health insurance
operated by a health insurance and includes any other health care coverage provided through a
private or public entity. In the case of a health plan, that is an employee welfare benefit plan, any
third party administrator or other person with responsibility for contracts with health care
providers under the plan shall be considered, for purposes of enforcement under this section, to
be a health issuer operating such health plan; and

(D) “Medical communication” means any communication made by a health care
provider with a patient of the health care provider or the guardian or legal representative of such
patient with respect to:

(1) The patient’s health status, medical care, or legal treatment options;
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(2) Any utilization review requirements that may affect treatment options for the
patient; or
(3) Any financial incentives that may affect the treatment of the patient.
‘The term does not include a communication by a health care provider with a patient of
the health care provider or the guardian or legal representative of such patient if the

communication involves a knowing or wilful mistepresentation by such provider.

SECTION 3. Prohibition of Interference with Certain Medical Communications. -
(A) Prohibition. -

(1) General Rule. - The provisions of any contract or agreement, or the operation
of any contract or agreement, between an entity operating a health plan (including any
partnership, association, or other organization that enters into or administers such @
contract or agreement) and a health care provider (or group of health care providers) shall
not prohibit or restrict the provider from engaging in medical communications with his or
her patient.

(2) Nullification, - Any contract provision or agreement described in paragraph
(1) shall be null and void.

(3) Prohibition on Provisions. - Effective on the date described in Section 7, a
contract or agreement described in paragraph (1) shall not include a provision that
violates paragraph (1).

(B) Rules of Construction, -Nothing is this Act shall be construed -

(1) To prohibit the enforcement, as part of a contract or agreement to which a
health care provider is a party, of any mutually agreed upon terms and conditions,
including terms and conditions requiring a health care provider to participate in, and
cooperate with, all programs, policies, and procedures developed or operated by a health
plan to assure, review, or improve the quality and effective utilization of health care
services, if such utilization is according to the guidelines or protocols that are based on

clinical or scientific evidence and the professional judgment of the provide, but only if

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the guidelines or protocols under such utilization do not prohibit or restrict medical
communications between providers and their patients; or

(2) To permit a health care provider to misrepresent the scope of benefits covered
under a health plan or to otherwise require the plan to reimburse providers for benefits

not covered under the plan.

SECTION 4, Penalty Clause. - An entity operating a health plan in the Philippines that
violates Section 3(A) shall be subject to a fine of up to Two Hundred Thousand Pesos

(P200,000.00) for each such violation.

SECTION 5. Separability Clause. - If any provision or part hereof, is held invalid or
unconstitutional, the remainder of the law or the provision not otherwise affected shall remain

valid and subsisting.

SECTION 6. Repealing Clause. - Any law, presidential decree or issuance, executive
order, letter of instruction, administrative order, rule or regulation contrary to or inconsistent

with, the provision of this Act is hereby repealed, modified or amended accordingly.

SECTION 7. Effectivity Clause. - This Act shall take effect fifteen (15) days after its

publication in at least two (2) newspapers of general circulation.

Approved,