Uhc Medical Assistance Program Act

So Office of the deter 25 DEC 10 P3:08 REPUBLIC OF THE PHILIPPINES REPUBLIC OF THE RESPINEE First Regular Session RECEIVED B! SENATE S. No. 1593 (In Substitution of S.B. Nos. 404, 409, 1460 and 1473) Prepared and submitted jointly by the Committees on Health and Demography, Social Justice, Welfare and Rural Development, and Finance, with Senators Lacson, Go, Marcos, Tulfo (R.) and Hontiveros as authors thereof AN ACT ESTABLISHING THE UNIVERSAL HEALTHCARE MEDICAL ASSISTANCE PROGRAM, INTEGRATING THEREWITH THE MEDICAL ASSISTANCE TO INDIGENT AND FINANCIALLY INCAPACITATED PERSONS PROGRAM, AND PROVIDING FUNDS THEREFOR 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 "UHC Medical

2 Assistance Program Act."

SEC. 2. Declaration of Policy. - It is hereby declared the policy of the State to

recognize the right of every Filipino to health and access to adequate medical care 5 regardless of financial capacity. The State shall provide medical assistance to indigent 6 and financially incapacitated persons, ensure the sustainability and transparency of such assistance, integrate and streamline existing assistance program under a unified framework in line with the realization of universal health care for all, and to ensure the provision of assistance free from political interference or administrative delays.

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

mean: a. Catastrophic Illness - a clinically severe illness or medical condition that requires prolonged, intensive, or recurrent hospitalization, treatment, recovery, and

rehabilitation. Such conditions are typically associated with high-cost medical interventions and substantial out-of-pocket expenses, often leading to financial hardship 3 or impoverishment, especially among low-income or vulnerable populations; b. Financially Incapacitated Person - a Filipino patient who is not classified as indigent but who demonstrates a clear inability to pay or spend for necessary expenditures for medical treatment, such as, but not limited to, a patient with catastrophic illness or illnesses which are life or limb-threatening and require prolonged hospitalization, illnesses that require extremely expensive treatments, or other special 9 but essential care that would deplete one's financial resources, as assessed and certified 10 by a registered social worker of the health facility; c. Indigent Person - a Filipino patient who has no visible means of income or 12 whose income is insufficient for the subsistence of their family as assessed and certified 13 by the registered social worker of the health facility; and d. Registered Social Worker- a qualified professional licensed by the Professional 15 Regulation Commission, tasked with assessing an applicant's financial and social 16 eligibility under the Program.

SEC. 4. UHC Medical Assistance Program. - With the overarching goal of

18 ensuring adequate financial protection for all Filipinos in need of medical care, there is hereby established the Universal Healthcare Medical Assistance Program (UHC MAP), which shall provide medical assistance for a range of medical services to indigent and financially incapacitated persons. The UHC MAP shall cover, but not be limited to, assistance for: a. Payment of medical and health expenses, such as, but not limited to, inpatient services, outpatient services, comprehensive check-up and diagnostics, emergency services, dental services, ambulatory care services, ophthalmology services, drugs and medicines, and professional fees; and b. Assurance of no co-payment obligations after the application of Philippine Health Insurance Corporation (PhilHealth) benefits, health maintenance organization (HMO) coverage, and other applicable deductions.

The DOH shall issue and periodically update guidelines for coverage expansion and conduct regular performance reviews.

SEC. 5. UHC MAP Eligibility, Application, and Processing. - A person shall be

eligible for medical assistance under the UHC MAP if the following criteria are met: a. A Filipino citizen; b. Certified as indigent or financially incapacitated by a registered social worker of the health facility; c. Has incurred or is about to incur medical expenses due to a catastrophic, life- 9 threatening, or limb-threatening illness; d. Has exhausted PhilHealth benefits, HMO coverages, and available government subsidies, but remains unable to fully pay the remaining medical expenses; e. Applies for assistance through participating health facilities and consents to financial and social assessment; and f. Has no record of fraud or misrepresentation in prior assistance applications. Applications shall be facilitated by the Medical Social Services Unit or its equivalent, in each health facility. This Unit shall assess, process, and monitor 17 applications for assistance. All applications shall be processed within seventy-two (72) hours upon complete submission of requirements. Denied applications may be appealed to the DOH through its designated unit. The DOH shall ensure the availability of UHC MAP Fund in all DOH-hospitals and government-owned or controlled specialty hospitals, as well as other participating health facilities, public or private, subject to applicable rules and regulations, and a Memorandum of Agreement (MOA) between the DOH and the concerned health 24 facilities, as applicable. Payments to healthcare providers shall be processed promptly upon verification 26 of eligible claims. The DOH shall set payment schedules to ensure timely reimbursement 27 and avoid cash flow delays that may affect service delivery. Participating health facilities shall ensure uninterrupted health and medical services to patients covered under the UHC MAP, provided that the DOH issues a letter 30 of guarantee, coupon, check, or voucher, whichever is applicable.

The DOH shall maintain an integrated database of all beneficiaries and claims under the UnC MAP to prevent duplication and double-charging, ensure transparency, and facilitate monitoring and reporting. All personal, financial, and medical information obtained from applicants and 5 beneficiaries shall be treated with strict confidentiality. Unauthorized disclosure shall be penalized under Republic Act No. 10173, or the Data Privacy Act of 2012.

SEC. 6. UHC MAP Institutional Arrangements. - There is hereby created an

8 Advisory Council to oversee the UHC MAP, composed of representatives from the DOH, 9 as Chair, and from PhilHealth, the Department of Social Welfare and Development 10 (DSWD), the Philippine Charity Sweepstakes Office (PCSO), the Department of Budget and Management (DBM), public and private hospital associations, leagues of local 12 government units, and patients and basic sector organizations, as members. The Advisory Council, as a consultative body, shall provide policy guidance, review program performance, recommend policy changes, and submit an annual report 15 to Congress. The DOH shall designate a UHC MAP unit at both central and regional offices to be responsible for the overall management and administration of the UHC MAP, and for ensuring efficient coordination for implementation at all levels. The DOH, through the UHC MAP Unit and Advisory Council, shall develop and implement a Monitoring and Evaluation Framework with key performance indicators, 21 quarterly progress reports, and beneficiary satisfaction surveys to assess program effectiveness and guide improvements. The DOH, in coordination with DSWD and academic institutions, shall conduct regular training programs for registered social workers and personnel involved in UHC MAP implementation, covering assessment procedures, ethics, data privacy, and beneficiary management.

SEC. 7. UHC Medical Assistance Program Fund. - There is hereby established a

fund to be known as the UHC Medical Assistance Program Fund (UHC MAP Fund), to be administered by the DOH, exclusively for the provision of medical assistance to indigent and financially incapacitated persons eligible under the UHC MAP.

It shall be subject to audit by the Commission on Audit (COA), with publicly accessible reports. Misuse shall be penalized in accordance with applicable laws.

SEC. 8. UHC MAP Fund for Integrated Local Health Systems. - At least thirty

percent (30%) of the UHC MAP Fund shall be allocated to Level 2 and Level 3 hospitals operated by local government units (LGUs) and state universities and colleges based on the DOH-assessed maturity and performance of their Province- or City-Wide Health 7 Systems (P/CHWS). The DOH, in coordination with the Department of the Interior and Local 9 Government (DILG), shall establish clear criteria and tools to assess P/CWHS maturity, 10 including network integration, referral improvements, financial management, and health 11 outcomes. LGUs receiving funds shall ensure transparent and accountable use of allocations, 13 subject to DOH and Advisory Council oversight.

SEC. 9. UHC MAP Emergency Medical Assistance. - During state of public health

emergencies, calamities or disasters, the DOH may expedite application processing and 16 allocate additional funds to meet increased demand for medical assistance and to ensure continuous financial protection in the availment of health and medical services.

SEC 10. Protection from Political Interference. - No public official or candidate

for public office shall use any component of the UHC MAP for political patronage, including credit-claiming or personal promotion. This includes, but is not limited to, the issuance of guarantee letters or promises of assistance in a personal capacity. Medical Social Service Unit personnel and program implementers shall be guaranteed protection from threats, coercion, or reprisal in the performance of their duties under this Act.

SEC. 11. UHC MAP Anti-Fraud and Accountability Measures. - Any person found

guilty of fraud or abuse of the UHC MAP shall be subject to penalties under applicable administrative, civil, or criminal laws, including, but not limited to, the Revised Penal Code and the Anti-Graft and Corrupt Practices Act. The DOH shall establish confidential reporting mechanisms.

SEC. 12. Appropriations, - The initial amount necessary to implement the

provisions of this Act shall be charged against the current year's appropriations for the Medical Assistance to Indigent and Financially Incapacitated Patients (MAIFIP) Program under the DOH, subject to existing budgeting, accounting, and auditing rules and regulations. Thereafter, such amount necessary to effectively carry out the provisions of this Act shall be included in the annual General Appropriations Act, subject to the usual budget processes.

SEC. 13. Transitional Provision. - The existing MAIFIP Program shall be

10 subsumed under the UHC MAP within six (6) months from the effectivity of this Act. 11 Existing applications and beneficiaries shall continue to receive assistance without delay 12 or disruption.

SEC. 14. Sunset Provision. - Unless otherwise extended by an Act of Congress,

this Act shall remain in force for ten (10) years from the date of its effectivity. At least one (1) year prior to the expiration of the said period, the DOH, in coordination with the Advisory Council, shall conduct a comprehensive review and impact assessment of the implementation of the UHC MAP, including its financial sustainability, effectiveness in reaching target beneficiaries, and overall contribution to the goals of universal health care. The findings and recommendations of the review shall be submitted to Congress 21 to inform its decision on whether to amend, extend, or terminate the Program.

SEC. 15. Implementing Rules and Regulations. - The DOH, in consultation with

the PhilHealth, DSWD, PCSO, DBM, DILG, public and private hospital associations, leagues of LGUs, and patients and basic sector organizations, shall, within ninety (90) days from the effectivity of this Act, promulgate the rules and regulations necessary for the proper implementation of this Act.

SEC. 16. Separability Clause. - If any provision of this Act is declared invalid or

unconstitutional, the other provisions not affected shall remain in full force and effect.

SEC. 17. Repealing Clause. - All laws, decrees, executive orders, issuances, and,

rules and regulations, or parts thereof which are inconsistent with this Act are hereby 3 repealed or modified accordingly.

SEC. 18. Effectivity. - This Act shall take effect fifteen (15) days after its

publication in the Official Gazette, or in two (2) newspapers of general circulation. Approved,