NGOS or any nonprofit private organizations, shall be paid by the DSWD and the funds necessary for their inclusion in the Program shall be included in the annual budget of the DSWD. "(b) The needed premium contributions of all barangay health workers, nutrition scholars and other barangay workers and volunteers shall be fully borne by the LGUs concerned. "(c) The annual premium contributions of househelpers shall be fully paid by their employers, in accordance with the provisions of Republic Act No. 10361 or the 'Kasambahay Law'." SEC. 21. A new Section 29-B shall be added to read as follows: "SEC. 29-B. Coverage of Women About to Give Birth. -The annual required premium for the coverage of unenrolled women who are about to give birth shall be fully borne by the national government and/or LGUs and/or legislative sponsor which shall be determined through the means testing protocol recognized by the DSWD." SEC. 22. Section 32 of the same Act is hereby further amended to read as follows: "SEC. 32. Accreditation Eligibility.-All health care providers, as enumerated in Section 4(0) hereof and operating for at least three (3) years may apply for accreditation: Provided, That a health care provider which has not operated for at least three (3) years may likewise apply and qualify for accreditation if it complies with all the other accreditation requirements of and further meets any of the following conditions: "(a) Its managing health care professional has had a working experience in another accredited health care institution for at least three (3) years; "(b) It operates as a tertiary facility or its equivalent; "(c) It operates in a LGU where the accredited health care provider cannot adequately or fully service its population; and "(d) Other conditions as may be determined by the Corporation. "A health care provider found guilty of any violation of this Act shall not be eligible to apply for the renewal of accreditation." SEC. 23. Section 34 of the same Act is hereby amended to read as follows: "SEC. 34. Provider Payment Mechanisms. The following mechanisms for public and private providers shall be allowed in the Program: "(a) Fee-for-service paymentspayments made by the Corporation for professional fees or hospital charges, or both, based on arrangements with health care providers. This fee shall be based on a schedule to be established by the Board which shall be reviewed periodically but not less than every three (3) years; care "(b) Capitation of health professionals and facilities, or networks of the same including HMOs, medical cooperatives, and other legally formed health service groups; "(c) Case-based payment; "(d) Global budget; and "(e) Such other provider payment mechanisms that may be determined and adopted by the Corporation. "Subject to the approval of the Board, the Corporation may adopt other payment mechanism that are most beneficial to the members and the Corporation. "Each PhilHealth local office shall recommend the appropriate payment mechanism within its jurisdiction for approval by the Corporation. Special consideration shall be given to payment for services rendered by public and private health care providers serving remote or medically underserved areas." SEC. 24. A new Section 34-A shall be added to read as follows: "SEC. 34-A. Other Provider Payment Guidelines. No other fee or expense shall be charged to the indigent patient, subject to the guidelines issued by the Corporation. "All payments for professional services rendered by salaried public providers shall be allowed to be retained by the health facility in which services are rendered and be pooled and distributed among health personnel. Charges paid to public facilities shall be retained by the individual facility in which services were rendered and for which payment was made. Such revenues shall be used to primarily defray operating costs other than salaries, to maintain or upgrade equipment, plant or facility, and to maintain or improve the quality of service in the public sector." SEC. 25. Section 35 of the same Act is hereby deleted and replaced with a new section to read as follows: "SEC. 35. Reimbursement and Period to File Claims. - All claims for reimbursement or payment for services rendered shall be filed within a period of sixty (60) calendar days from the date of discharge of the patient from the health care provider. "The period to file the claim may be extended for such reasonable causes determined by the Corporation." SEC. 26. Section 36 of the same Act is hereby deleted and replaced with a new section to read as follows: "SEC. 36. Role of Local Government Units (LGUs). — Consistent with the mandates for each political subdivision under Republic Act No. 7160 or 'The Local Government Code of 1991', LGUS shall provide basic health care services. "To augment their funds, LGUs shall invest the capitation payments given to them by the Corporation on health infrastructures or equipment, professional fees, drugs and supplies, or information technology and database: Provided, That basic health care services, as defined by the DOH and the Corporation, shall be ensured especially with the end in view of improving maternal, infant and child health: Provided, further, That the capitation payments shall be segregated and placed into a special trust fund created by LGUs and be accessed for the use of such mandated purpose." SEC. 27. Section 41 of the same Act is hereby amended to read as follows: "SEC. 41. Grievance and Appeal Procedures. A member, a dependent, or a health care provider may file a complaint for grievance based on any of the above grounds, in accordance with the following procedures: "(a) A complaint for grievance must be filed with the Corporation which shall refer such complaint to the Grievance and Appeal Review Committee. The Grievance and Appeal Review Committee shall rule on the complaint through a notice of resolution within sixty (60) calendar days from receipt thereof. "(b) Appeals from the decision of the Grievance and Appeal Review Committee must be filed with the Board within thirty (30) calendar days from receipt of the notice of resolution. "**" SEC. 28. Section 42 of the same Act is hereby amended to read as follows: "SEC. 42. Grievance and Appeal Review Committee. - The Board shall create a Grievance and Appeal Review Committee, composed of five (5) members, hereinafter referred to as the Committee, which, subject to the procedures enumerated above, shall receive and recommend appropriate action on complaints from members and health care providers relative to this Act and its implementing rules and regulations. "The Committee shall have as one of its members a representative of any of the accredited health care providers as endorsed by the DOH." SEC. 29. Section 44 of the same Act is hereby further amended to read as follows: "SEC. 44. Penal Provisions.-Any violation of the provisions of this Act, after due notice and hearing, shall suffer the following penalties: "(a) Violation by an Accredited Health Care Provider-Any accredited health care provider who commits a violation, abuse, unethical practice or fraudulent act which tends to undermine or defeat the objectives of the Program shall be punished with a fine of not less than Fifty thousand pesos (P50,000.00) but not more than One hundred thousand pesos (P100,000.00) or suspension of accreditation from three (3) months to the whole term of accreditation, or both, at the discretion of the Corporation: Provided, That recidivists may no longer be accredited as a participant of the Program; "(b) Violations of a Member-Any member who commits any violation of this Act independently or in connivance with the health care provider for purposes of wrongfully claiming NHIP benefits or entitlement shall be punished with a fine of not less than Five thousand pesos (P5,000.00) or suspension from availment of NHIP benefits for not less than three (3) months but not more than six (6) months, or both, at the discretion of the Corporation. "(c) Violations of an Employer "(1) Failure/Refusal to Register/Deduct/ Remit the Contributions-Any employer who fails or refuses to register employees, regardless of their employment status, or to deduct contributions from the employee's compensation or remit the same to the Corporation shall be punished with a fine of not less than Five thousand pesos (P5,000.00) multiplied by the total number of employees of the firm. "Any employer or any officer authorized to collect contributions under this Act who, after collecting or deducting the monthly contributions from his employee's compensation, fails to remit the said contributions to the Corporation within thirty (30) days from the date they become due shall be presumed to have misappropriated such contributions. "(2) Unlawful Deductions-Any employer or officer who shall deduct directly or indirectly from the compensation of the covered employees or otherwise recover from them his own contribution on behalf of such employees shall be punished with a fine of Five thousand pesos (P5,000.00) multiplied by the total number of affected employees. "If the act or omission penalized by this Act be committed by an association, partnership, corporation or any other institution, its managing directors or partners or president or general manager, or other persons responsible for the commission of the said act shall be liable for the penalties provided for in this Act. "(3) Misappropriation of Funds by Employees of the Corporation-Any employee of the Corporation who receives or keeps funds or property belonging, payable or deliverable to the Corporation, and who shall appropriate the same, or shall take or misappropriate or shall consent, or through abandonment or negligence shall permit any other person to take such property or funds wholly or partially, shall likewise be liable for misappropriation of funds or property and shall be punished with a fine not less than Ten thousand pesos (P10,000.00) nor more than Twenty thousand pesos (P20,000.00). Any shortage of the funds or loss of the property upon audit shall be deemed prima facie evidence of the offense. "(d) Other Violations-Other violations of the provisions of this Act or of the rules and regulations promulgated by the Corporation shall be punished with a fine of not less than Five thousand pesos (P5,000.00) but not more than Twenty thousand pesos (P20,000.00). "All other violations involving funds of the Corporation shall be governed by the applicable provisions of the Revised Penal Code or other laws, taking into consideration the rules on collection, remittances, and investment of funds as may be promulgated by the Corporation. "The Corporation may enumerate circumstances that will mitigate or aggravate the liability of the offender or erring health care provider, member or employer. "Despite the cessation of operation by a health care provider or termination of practice of an independent health care professional while the complaint is being heard, the proceeding against them shall continue until the resolution of the case. "The dispositive part of the decision requiring payment of fines, reimbursement of paid claim or denial of payment shall be immediately executory." SEC. 30. A new Section 56 is hereby added to read as follows and the numbering of the succeeding sections are adjusted accordingly: systematic evaluation of the Program's performance, impact or accomplishments with respect to its objectives or goals. The Oversight Committee shall be composed of five (5) members from the Senate and five (5) members from the House of Representatives to be appointed by the Senate President and the Speaker of the House of Representatives, respectively. The Oversight Committee shall be jointly chaired by the Chairpersons of the Senate Committee on Health and Demography and the House of Representatives Committee on Health. "The National Economic and Development Authority, in coordination with the National Statistics Office and the National Institutes of Health of the University of the Philippines shall undertake studies to validate the accomplishments of the Program. Such validation studies shall include an assessment of the enrollees' satisfaction of the benefit package and services provided by the Corporation. These validation studies, as well as an annual report on the performance of the Corporation, shall be submitted to the Congressional Oversight Committee. "The Corporation shall annually transfer 0.001% of its income in the previous year for the purpose of conducting these studies." "SEC. 56. Requisites for Issuance or Renewal of License or Permits.Notwithstanding any law to the contrary, all government agencies issuing hereby amended to read as follows: professional or business license or permit, shall require all applicants to submit certificate or proof of payment of PhilHealth premium contributions, prior to the issuance or renewal of such license or permit." SEC. 32. Section 49 of the same Act is SEC. 31. Section 54 of the same Act is hereby further amended to read as follows: "SEC. 54. Oversight Provision. There is hereby created a Joint Congressional Oversight Committee to conduct a regular review of the NHIP which shall entail a "SEC. 49. Implementing Rules and Regulations.-Within sixty (60) days from the effectivity of this Act, the Corporation, in coordination with the DOH, shall issue the necessary rules and regulations for its effective implementation." SEC. 33. Separability Clause.-If any part or provision of this Act shall be held unconstitutional or invalid, other provisions which are not affected thereby shall continue to be in full force and effect. SEC. 34. Repealing Clause. All laws, issuances or parts thereof inconsistent with this Act are hereby repealed or modified accordingly. SEC. 35. Effectivity. This Act shall take effect fifteen (15) days after its publication in the Official Gazette or in at least two (2) newspapers of general circulation. Approved: June 19, 2013 |