SIXTEENTH CONGRESS OF THE) 
REPUBLIC OF TI-IE PHILIPPINES) 
First Regular Session 
) 
SENATE 
Senate Bill No. _ ~lL 
JilL . 
INTRODUCED BY SENATOR VICENTE C. SOTTO III 
EXPLANATORY NOTE 
One of the pervading social ills at present is rampant drug addiction. 
Various laws have been passed to prevent and control this drug menace. What 
has been overlooked however and has not been properly addressed is the 
rehabilitation of drug dependents, providing for such facilities and medical 
treatment to ensure their complete recovery and eventual social reintegration. 
All over the Philippines, across the regions are private and government-
run rehabilitation centers. However, based on a 2009 survey, there are 1.7 
million drug dependents. Of this, only 2000 underwent treatment and 
rehabilitation. 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 and who submit to treatment 
and rehabilitation to an accredited healt.h care provider shall be 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 Healtb Insurance 
Program for all Filipinos and establishing tbe Pbilippine Health Insurance 
Corporation (Philbealth) 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 treatmenl. 
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 therefa e, recommended. 
u~6k~" 
VICENTE C. SOTTO III 
~ 


SIXTEENTH CONGRESS OF THE) 
REPUBLIC OF THE PHILIPPINES) 
First Regular Session 
) 
SENATE 
Senate Bill No.3 
~'1411tt 
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INTRODUCED BY SEN. VICENTE SOTTO III 
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 Representatiues of the Philippines in 
Congress assembled: 
SECTION I. This Act shall be known as, "Free Drug Rehabilitation Treatment 
Actof2013." 
SECTION 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. 
c) 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. 
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. 


e) Coverage - The entitlement of an individual, as a member or 
as a dependent, to the benefits of the program. 
fJ Dependent - The legal dependents of a member are: I) 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 I 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. 
I) 
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.34urchase 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. 
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) 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 health care 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. 
r) Indigent - A person who has no visible means of income, or 
whose incomc 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 I 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. I-Ie 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: 
(I) Program I, 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 I. 
v) 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. 
w) Pensioner - An SSS or GSIS member who receives pensions 
therefrom. 
x) Personal Health Services - Health Services in which benefits 
accrue to the individual person. 
These are categorized into inpatient and outpatient services. 
y) Philippine Medical Care Commission -
The Philippine 
Medical Care Commission created under Republic Act No. 
6111, as amended. 
z) 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. 


aal Portability - The enablement of a member to avail of 
Program benefits in an area outside the jUrisdiction of his Local 
Health Insurance Office. 
bbl 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. 
ccl 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. ddl 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. 
eel Residence - The place where the member actually lives. 
ftl Retiree - A member of the Program who has reached the age 
of retirement or who was retired on account of disability. 
ggl Self-employed - A person who works for himself and is 
therefore both employee and employer at the same time. 
hhl Social Security System - The Social Security System 
created under Republic Act No.1 161, as amended. 
iii Treatment Procedure - Any method used to remove the 
symptoms and cause of a disease. 
jjl Utilization Review - A formal review of a patient utilization or 
of the appropriateness of health care services, on a prospective, 
concurrent or retrospective basis. 
kkl Rehabilitation Center - Refers to 
l. 
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 ji-om 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. 


II) Home Care and Medical Rehabilitation Services - Refer to 
skilled nursing care, which members get in their homes/ clmics 
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: 
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: 
I) 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 
deterniine 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: 
I) 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 I 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. 
Section 4. Repealing Clause - All laws, rules, regulations and other issuance or 
parts thereof which are inconsistent with this Act are hereby ,cpealed or 
modified accordingly. 
Section 5. Effectivity. This Act shall" take effect immediately upon its approval. \ 
Approved,