Universal Medical Assistance Act of 2025

TWENTIETH CONGRESS OF THE REPUBLIC OF THE PHILIPPINES First Regular Session ) 25 JUL 10 P4:18 RECI SENATE S. No. 404 Introduced by Sen. Panfilo M. Lacson AN ACT INSTITUTING THE MEDICAL ASSISTANCE TO INDIGENT AND FINANCIALLY INCAPACITATED PATIENTS (MAIFIP) UNDER THE FRAMEWORK OF THE UNIVERSAL HEALTH CARE FOR ALL FILIPINOS, AMENDING FOR THE PURPOSE REPUBLIC ACT NO. 11223, OTHERWISE KNOWN AS THE "UNIVERSAL HEALTH CARE ACT" EXPLANATORY NOTE The Constitution and laws of the land articulate and uphold the people's right to health and healthcare. The mandate that health services must be provided to "all the people at affordable cost", as stipulated in the Constitution, underscores the principles of inclusiveness and universality of the people's right to health. This is also one of the fundamental rights of the poor, as recognized and protected under many laws that mandate priority for the vulnerable and marginalized groups. Hence, the government has rolled out various social protection programs that ensure equity and accessibility of health services. The Medical Assistance to Indigent and Financially Incapacitated Patients (MAIFIP) Program of the Department of Health (DOH) serves as one of the banner social safety nets providing medical assistance to indigent and financially incapacitated patients.

Along with other medical assistance programs implemented across various government agencies, the MAIFIP must complement Republic Act No. 11223, known as the "Universal Health Care (UHC) Act," to ensure that the objectives of all medical assistance initiatives are achieved efficiently. This will also help eliminate overlaps and redundancies while maximizing overall program effectiveness and health outcomes. The Social Protection Plan 2023-2028 likewise made mention of the need to assess the existing medical assistance programs for possible duplication. With the passage of UHC, every Filipino citizen is automatically enrolled in the National Health Insurance Program. This enhances access to individual healthcare through secured financing of PhilHealth and enables the DOH to implement more effective population-based public health programs. By consolidating MAIFIP within the framework of the UHC, we can effectively address the issue of payment delays for medical services rendered by DOH-licensed and/or accredited health facilities because of political interference. The proposed legislation also aims to eliminate the politicization of the program, thus curbing the culture of mendicancy and political patronage. This was evidenced by recent news wherein private hospitals refused to honor guarantee letters issued by government officials to indigent patients under the MAIFIP program, citing unresolved outstanding payables accruing over several months. Guarantee letters, issued by governors, senators, congressmen, and other government officials, serve to facilitate the payment of hospital bills for indigent patients. However, some private healthcare facilities expressed concerns that their services might not be compensated under MAIFIP due to guarantee letters endorsed by political candidates who subsequently lost the recent midterm elections.

These issues grossly undermine the delivery of public services and cast the medical program in a negative light. Hence, this bill seeks to consolidate and harmonize MAIFIP with the Universal Healthcare Act under the unified program to be known as the Universal Medical Assistance Program (UMAP). UMAP shall be accessible to all patients, regardless of indigency status, who are financially incapacitated and unable to meet the necessary expenditures for the medical treatment of their catastrophic or life- and limb- threatening illnesses. UMAP will be in accordance with the full implementation of the No Balance Billing (NBB) and No Co-Payment policies. It shall serve as a supplementary but guaranteed source of financing to benefit qualified patients who, after having exhausted PhilHealth benefits and other subsidies, still have to incur out-of-pocket payments. The bill also penalizes political exploitation and manipulation of the program in any shape or form. To ensure its proper implementation, monitoring, and evaluation, a medical assistance database shall be in place to allow for verification, claims tracking, and program evaluation. A coherent and unified health system under Universal Healthcare must be established to effectively address the needs of indigent and marginalized families. Individuals, regardless of economic status, who suffer from catastrophic illnesses and similar medical conditions and its corresponding substantial financial burdens, should meaningfully benefit from the government's comprehensive safety net and enjoy affordable and accessible health services - free from political interventions that shamelessly exploit government programs to curry public favor. This bill aims to achieve these objectives and ensure the convergence and complementarity of medical assistance programs in pursuit of every Filipino's right to health.

It is for this purpose that the approval of this bill is earnestly sought. PANETKO 4. LACSON Senator

TWENTIETH CONGRESS OF THE REPUBLIC OF THE PHILIPPINES First Regular Session 25 JUL 10 P4:19 RLCI SENATE S. No. 104 Introduced by Sen. Panfilo M. Lacson AN ACT INSTITUTING THE MEDICAL ASSISTANCE TO INDIGENT AND FINANCIALLY INCAPACITATED PATIENTS (MAIFIP) UNDER THE FRAMEWORK OF THE UNIVERSAL HEALTH CARE FOR ALL FILIPINOS, AMENDING FOR THE PURPOSE REPUBLIC ACT NO. 11223, OTHERWISE KNOWN AS THE "UNIVERSAL HEALTH CARE ACT" 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 "Universal Medical

2 Assistance Act of 2025."

Sec. 2. Insert a new paragraph (e) on Section 2 of Republic Act No. 11223,

which shall read as follows: (E) A COMPREHENSIVE AND INCLUSIVE GOVERNMENT MEDICAL ASSISTANCE PROGRAM THAT PROMOTE EFFICIENCY, TRANSPARENCY, EQUITY, AND RESPONSIBLE USE OF HEALTHCARE RESOURCES.

Sec. 3. Sec. 3 of Republic Act No. 11223 is hereby amended to read as follows:

SEC. 3. General Objectives. - This Act seeks to:

(a) Progressively realize universal health care in the country through a systemic approach and clear delineation of roles of key agencies and stakeholders towards better performance in the health system; [and]

(b) Ensure that all Filipinos are guaranteed equitable access to quality and affordable health care goods and services, and protected against financial risk[-]; AND (C) ESTABLISH AN ACCESSIBLE MEDICAL ASSISTANCE PROGRAM THAT ADDRESSES THE DIVERSE HEALTH NEEDS OF ALL FILIPINOS.

Sec. 4. Sec. 4 of Republic Act No. 11223 is hereby amended to read as follows:

SEC. 4. Definition of Terms. - As used in this Act:

(a) Abuse of authority refers to an act of a person performing a duty or function that goes beyond what is authorized by this Act and Republic Act No. 7875, otherwise known as the "National Health Insurance Act of 1995", as amended, or their implementing rules and regulations (IRR), and is inimical to the public; (b) Amenities refer to features of the health service that provide comfort or convenience, such as private accommodation, air conditioning, telephone, television, and choice of meals, among others; (c) Basic or ward accommodation refers to the provision of regular meal, bed in shared room, fan ventilation, and shared toilet and bath; (D) CASE RATE REFERS TO THE FIXED RATE OR AMOUNT THAT THE PHILHEALTH WILL REIMBURSE FOR A SPECIFIC ILLNESS/CASE AS DEFINED BY PERTINENT PHILHEALTH CIRCULARS;

(E) CATASTROPHIC DISEASE REFERS TO A CLINICALLY SEVERE ILLNESS OR MEDICAL CONDITION REQUIRING PROLONGED, INTENSIVE, OR RECURRENT HOSPITALIZATION, TREATMENT, RECOVERY, AND REHABILITATION. IT IS USUALLY CHARACTERIZED BY HIGH-COST MEDICAL INTERVENTIONS AND SIGNIFICANT OUT-OF-POCKET EXPENDITURES, CAUSING FINANCIAL HARDSHIP OR IMPOVERISHMENT, PARTICULARLY FOR LOW-INCOME OR VULNERABLE POPULATIONS. THESE INCLUDE, BUT ARE NOT LIMITED TO, CANCER, PSYCHIATRIC CONDITIONS, HEART ATTACK, OR STROKE. (F) CATASTROPHIC HEALTH EXPENDITURE REFERS TO OUT-OF-POCKET HEALTH SPENDING THAT EXCEEDS A CERTAIN THRESHOLD OF A HOUSEHOLD'S INCOME OR TOTAL EXPENDITURE, SUCH THAT IT RESULTS IN FINANCIAL DISTRESS, THE DISRUPTION OF ESSENTIAL NON-HEALTH CONSUMPTION, OR MAY LEAD TO IMPOVERISHMENT. IT REFLECTS THE HOUSEHOLD'S INABILITY TO ABSORB HEALTH COSTS WITHOUT SACRIFICING BASIC NEEDS, AND SERVES AS AN INDICATOR OF INADEQUATE FINANCIAL RISK PROTECTION IN THE HEALTH SYSTEM. [(d)] (G) Co-insurance refers to a percentage of a medical charge that is paid by the insured, with the rest paid by the health insurance plan; (H) COMPASSIONATE DRUG USE REFERS TO THE USE OF DRUGS OR MEDICINES NOT INCLUDED IN THE PHILIPPINE NATIONAL FORMULARY BY PATIENTS WITH SERIOUS OR

LIFE-THREATENING CONDITIONS WHEN NO OTHER TREATMENTS ARE AVAILABLE. [(e)] (1) Co-payment refers to a flat fee or predetermined rate paid at point of service; [(Đ] (J) Direct contributors refer to those who have the capacity to pay premiums, are gainfully employed and are bound by an employer-employee relationship, or are self-earning, professional practitioners, migrant workers, including their qualified dependents, and lifetime members; (K) DOUBLE CHARGING REFERS TO CHARGING OF FUNDS TO PARTICULAR HEALTH SERVICES PROVIDED TO PATIENTS WHICH HAVE ALREADY BEEN PAID AND SHOULDERED BY ANOTHER ENTITY/ AGENCY. [(g)] (L) Emergencyrefers to a condition or state of a patient wherein based on the objective findings of a prudent medical officer on duty, there is immediate danger and where delay in initial support and treatment may cause loss of life or permanent disability to the patient, or in the case of a pregnant woman, permanent injury or loss of her unborn child, or a non- institutional delivery; [(h)] (M) Entitlement refers to any singular or package of health services provided to Filipinos for the purpose of improving health; [(4)] (N) Essential health benefit packagerefers to a set of individual-based entitlements covered by the National Health Insurance Program (NHIP) which includes primary care; medicines,

diagnostics and laboratory; and preventive, curative, and rehabilitative services; (O) FINANCIALLY INCAPACITATED PATIENTS ARE PATIENTS WHO ARE NOT CLASSIFIED AS INDIGENTS BUT WHO DEMONSTRATE INABILITY TO PAY OR SPEND FOR NECESSARY EXPENDITURES FOR THEIR RESPECTIVE MEDICAL TREATMENT SUCH AS, BUT NOT LIMITED TO, CATASTROPHIC ILLNESS OR ILLNESSES WHICH ARE LIFE OR LIMB-THREATENING AND REQUIRE PROLONGED HOSPITALIZATION, ILLNESSES THAT REQUIRE EXTREMELY EXPENSIVE TREATMENTS, OR OTHER SPECIAL BUT ESSENTIAL CARE THAT WOULD DEPLETE ONE'S FINANCIAL RESOURCES, AS ASSESSED AND CERTIFIED BY THE MEDICAL SOCIAL WORKER [6)] (P) Fraudulent act refers to any act of misrepresentation or deception resulting in undue benefit or advantage on the part of the doer or any means that deviate from normal procedure and is undertaken for personal gain, resulting thereafter to damage and prejudice which may be capable of pecuniary estimation; [(k)] (Q) Health care provider refers to any of the following: (1) A health facility, which may be public or private, devoted primarily to the provision of services for health promotion, prevention, diagnosis, treatment, rehabilitation and palliation of individuals suffering from illness, disease, injury, disability, or deformity, or in need of obstetrical or other medical and nursing care; $

(2) A health care professional, who may be a doctor of medicine, nurse, midwife, dentist, or other allied professional or practitioner duly licensed to practice in the Philippines; (3) A community-based health care organization, which is an association of members of the community organized for the purpose of improving the health status of that community; or (4) Pharmacies or drug outlets, laboratories and diagnostic clinics. H91 (R) Health care provider network refers to a group of primary to tertiary care providers, whether public or private, offering people- centered and comprehensive care in an integrated and coordinated manner with the primary care provider acting as the navigator and coordinator of health care within the network; [(m)] (S) Health Maintenance Organization (HMO) refers to an entity that provides, offers, or covers designated health services for its plan holders or members for a fixed prepaid premium; [(A)] (T) Health Technology Assessment (HTA) refers to the systematic evaluation of properties, effects, or impact of health- related technologies, devices, medicines, vaccines, procedures and all other health-related systems developed to solve a health problem and improve quality of lives and health outcomes, utilizing a multidisciplinary process to evaluate the social, economic, organizational, and ethical issues of a health intervention or health technology; [(o)] (U) Indirect contributors refer to all others not included as direct contributors, as well as their qualified dependents, whose

premium shalf be subsidized by the national government including those who are subsidized as a result of special laws; [(P)] (V) Individual-based health services refer to services which can be accessed within a health facility or remotely that can be definitively traced back to one (1) recipient, has limited effect at a population level and does not alter the underlying J^ cause of illness such as ambulatory and inpatient care, medicines, laboratory tests and procedures, among others; (W) MEDICAL ASSISTANCE BENEFICIARY REFERS TO AN INDIVIDUAL WHO IS EITHER INDIGENT OR FINANCIALLY INCAPACITATED, AND WHO HAS BEEN ASSESSED AND CERTIFIED BY A LICENSED MEDICAL SOCIAL WORKER TO HAVE LIMITED OR NO MEANS TO AFFORD NECESSARY MEDICAL CARE. THIS INCLUDES PATIENTS WITH CATASTROPHIC ILLNESSES OR ANY LIFE- OR LIMB- THREATENING CONDITION REQUIRING PROLONGED HOSPITALIZATION, HIGH-COST THERAPIES OR TREATMENTS, OR OTHER ESSENTIAL BUT FINANCIALLY BURDENSOME INTERVENTIONS, THE COST OF WHICH WOULD SIGNIFICANTLY DEPLETE THE PATIENT'S OR FAMILY'S FINANCIAL RESOURCES. (X) MEDICAL ASSISTANCE TO INDIGENT AND FINANCIALLY INCAPACITATED PATIENTS (MAIFIP) PROGRAM REFERS TO THE EXISTING DOH MEDICAL ASSISTANCE PROGRAM FOR INDIGENT AND FINANCIALLY INCAPACITATED PATIENTS FUNDED THROUGH THE GENERAL APPROPRIATIONS ACT; (Y) NO BALANCE BILLING (NBB) REFERS TO THE POLICY, WHICH PROVIDES THAT NO OTHER FEES OR EXPENSES SHALL BE CHARGED OR BE PAID FOR BY THE INDIGENT PATIENTS ABOVE AND BEYOND THE PACKAGED RATES

PROVIDED BY PHILHEALTH DURING THEIR CONFINEMENT PERIOD. [(4)] (Z) Population-based health services refer to interventions such as health promotion, disease surveillance, and vector control, which have population groups as recipients; [(r)] (AA) Primary carerefers to initial-contact, accessible, continuous, comprehensive and coordinated care that is accessible at the time of need including a range of services for all presenting conditions, and the ability to coordinate referrals to other health care providers in the health care delivery system, when necessary; [(S) (BB) Primary care provider refers to a health care worker, with defined competencies, who has received certification in primary care as determined by the Department of Health (DOH) or any health institution that is licensed and certified by the DOH; [ft>] (CC) Private health insurance refers to coverage of a defined set of health services financed through private payments in the form of a premium to the insurer; and [(u)] (DD) Unethical actrefers to any action, scheme or ploy against the NHIP, such as overtoiling, upcasing, "harboring ghost patients or recruitment practice, or any act contrary to the Code of Ethics of the responsible person's profession or practice, or other similar, analogous acts that put or tend to put in disrepute the integrity and effective implementation of the NHIP.

Sec. 5. Sec. 6 of Republic Act No. 11223 is hereby amended to read as follows:

SEC. 6. Service Coverage. -(a) Every Filipino shall be granted

immediate eligibility and access to preventive, promotive, curative,

rehabilitative, and palliative care for medical, dental, mental and emergency health services, delivered either as population-based or individual-based health services: Provided, That the goods and services to be included shall be determined through a fair and transparent HTA process; (b) Within two (2) years from the effectivity of this Act, PhilHealth shall implement a comprehensive outpatient benefit, inciuding outpatient drug benefit and emergency medical services in accordance with the recommendations of the Health Technology Assessment Council (HTAC) created under Section 34 hereof; (c) The DOH and the local government units (LGUs) shall endeavor to provide a health care delivery system that will afford every Filipino a primary care provider that would act as the navigator, coordinator, and initial and continuing point of contact in the health care delivery system: Provided, That except in emergency or serious cases and when proximity is a concern, access to higher levels of care shall be coordinated by the primary care provider; [and] (d) Every Filipino shall register with a public or private primary care provider of choice. The DOH shall promulgate the guidelines on the licensing of primary care providers and the registration of every Filipino to a primary care provider[=]; AND (E) THE DOH SHALL PROVIDE DIRECT, ACCESSIBLE, AND EQUITABLE MEDICAL ASSISTANCE TO INDIGENTS OR FINANCIALLY INCAPACITATED PATIENTS THROUGH THE MEDICAL ASSISTANCE TO INDIGENT AND FINANCIALLY INCAPACITATED PATIENTS (MAIFIP) PROGRAM IN ACCORDANCE WITH THE FULL IMPLEMENTATION OF THE NO BALANCE BILLING (NBB) AND NO CO-PAYMENT POLICIES

UNDER THIS ACT; PROVIDED, THAT SUCH MEDICAL ASSISTANCE SHALL COVER ALL NECESSARY EXPENDITURES, AS CERTIFIED BY MEDICAL PRACTITIONERS, THAT ARE NOT SUFFICIENTLY COVERED BY PHILHEALTH, LOCAL GOVERNMENT UNIT (LGU) HEALTH PROGRAMS, OR OTHER SUBSIDY FUNDS, TO ENSURE THAT MEDICAL ASSISTANCE BENEFICIARIES DO NOT INCUR OUT-OF-POCKET EXPENSES.

Sec. 6. Insert a new paragraph on Sec. 7 of Republic Act No. 11223, to read as

9 follows: (C) THE NATIONAL GOVERNMENT SHALL FINANCE THE UNIVERSAL MEDICAL ASSISTANCE PROGRAM FOR INDIGENTS OR FINANCIALLY INCAPACITATED PATIENTS.

Sec. 7. Insert a new Chapter V, with new sections, on Republic Act No. 11223,

to read as follows: CHAPTER V UNIVERSAL MEDICAL ASSISTANCE PROGRAM (UMAP) =

SEC. 19. COVERAGE. - ALL FILIPINOS, WHETHER IN-

PATIENTS OR OUT-PATIENTS, WHO ARE QUALIFIED AS MEDICAL ASSISTANCE BENEFICIARIES, SHALL BE ENTITLED TO RECEIVE MEDICAL ASSISTANCE FROM THE DON TO COVER CLINICALLY INDICATED NEEDS AS PRESCRIBED BY A HEALTH CARE PROVIDER LICENSED BY THE DOH AND/OR ACCREDITED BY THE PHILHEALTH. THE EXISTING MEDICAL ASSISTANCE TO INDIGENT AND FINANCIALLY INCAPACITATED PATIENTS (MAIFIP) SHALL BE SUBSUMED UNDER THIS PROGRAM AND SHALL BE FULLY HARMONIZED WITH THE PROVISIONS HEREOF AND ITS CORRESPONDING IMPLEMENTING RULES AND REGULATIONS.

SEC. 20. SERVICES COVERED. - THE MEDICAL ASSISTANCE

SHALL COVER MEDICINES, SERVICES, OTHER MEDICAL PRODUCTS AS PRESCRIBED BY A DOH-LICENSED AND/OR PHILHEALTH ACCREDITED PHYSICIAN OR HEALTH PROFESSIONAL, SUCH AS, BUT NOT LIMITED TO THE FOLLOWING: (A)DRUGS AND MEDICINES AS APPROVED BY THE FOOD AND DRUG ADMINISTRATION (FDA); (B)LABORATORY, IMAGING, RADIOLOGICAL, AND OTHER DIAGNOSTIC PROCEDURES INCLUDING CORRESPONDING ASSESSMENT/ READERS FEES; (C)BLOOD, BLOOD PRODUCTS AND BLOOD SCREENING SERVICES; (D) CLINICALLY INDICATED MEDICAL-SURGICAL CASES, HIGH-RISK OBSTETRICS-GYNECOLOGICAL CASES, DENTAL PROCEDURES REQUIRING IMPLANTS, MEDICAL DEVICES AND SUPPLIES, AND OTHER MEDICALLY NECESSARY INTERVENTIONS; (E) PRESCRIBED POST-HOSPITALIZATION SERVICES, INCLUDING REHABILITATION SERVICES, AFTERCARE PROGRAMS, AND APPROPRIATE MENTAL AND PSYCHOSOCIAL SUPPORT; (F) ALL HOSPITAL BILLS OR CHARGES INCURRED DURING CONFINEMENT OR TREATMENT; AND (G) PROFESSIONAL FEES, PROVIDED THAT SUCH FEES SHALL NOT EXCEED FIFTY PERCENT (50%) OF THE TOTAL APPROVED AMOUNT OF MEDICAL ASSISTANCE. SUBJECT TO THE GUIDELINES OF THE FOOD AND DRUG ADMINISTRATION (FDA), THE COST OF DRUGS AND MEDICINES AUTHORIZED FOR COMPASSIONATE USE FOR

TERMINALLY OR SERIOUSLY ILL PATIENTS SHALL LIKEWISE BE COVERED UNDER THIS MEDICAL ASSISTANCE PROGRAM.

SEC. 21. COORDINATED CARE. - THE UTILIZATION OF

UMAP AND ITS APPROPRIATIONS SHALL PRIMARILY COVER QUALIFIED UMAP BENEFICIARIES SEEKING CARE IN GOVERNMENT HEALTH FACILITIES. IN CASE OF NON- AVAILABILITY OF CLINICALLY INDICATED DRUGS AND MEDICINES, PROCEDURES, OR SERVICES, OR LACK OF AVAILABLE BEDS, A GOVERNMENT HEALTH FACILITY MAY REFER A MEDICAL ASSISTANCE BENEFICIARY TO ANOTHER GOVERNMENT HEALTH FACILITY OR PHILHEALTH ACCREDITED PRIVATE HEALTHCARE PROVIDER; PROVIDED, THAT SUCH REFERRAL SHALL GIVE PRIORITY AND PREFERENCE TO A GOVERNMENT HEALTH FACILITY. PRIVATE HEALTH FACILITIES MAY PROVIDE THE CLINICALLY INDICATED NEEDS OF THE QUALIFIED BENEFICIARIES ONLY UNDER COMPELLING CIRCUMSTANCES, SUCH AS WHEN SERVICES ARE UNAVAILABLE, INACCESSIBLE, OR INADEQUATE IN GOVERNMENT FACILITIES. IN SUCH CASES, REIMBURSEMENT OR PAYMENT TO THE ACCREDITED PRIVATE HEALTHCARE PROVIDER SHALL BE PROCESSED WITHIN SIXTY (60) CALENDAR DAYS FROM THE RECEIPT OF THE BILLING STATEMENT AND SUPPORTING DOCUMENTS, IN ACCORDANCE WITH DOH FINANCIAL AND ADMINISTRATIVE GUIDELINES.

SEC. 22. EQUITABLE FINANCING. - MEDICAL ASSISTANCE

FOR THE SERVICES ENUMERATED UNDER SECTION 20 OF THIS ACT SHALL BE GRANTED ONLY UPON VERIFICATION

THAT SUCH SERVICES ARE NOT SUFFICIENTLY COVERED BY THE APPLICABLE PHILHEALTH CASE RATE, EXISTING HEALTH SERVICE SUBSIDIES OF THE LGU, OR OTHER GOVERNMENT MEDICAL ASSISTANCE FUNDS, INCLUDING BUT NOT LIMITED TO THE CANCER ASSISTANCE FUND AND THE PHILIPPINE CHARITY SWEEPSTAKES OFFICE (PCSO) PROGRAMS. DOUBLE CHARGING OF CLAIMS ACROSS FUNDING SOURCES SHALL BE STRICTLY PROHIBITED. THE DOH, PHILHEALTH AND ACCREDITED PUBLIC AND PRIVATE HEALTH FACILITIES SHALL STRICTLY ADHERE TO THE NO BALANCE BILLING AND NO CO-PAYMENT POLICIES. TAKING INTO CONSIDERATION THE PREVAILING HEALTH BENEFIT SCHEDULES, COSTS OF MEDICAL SERVICES AND MEDICINES, LGU-FUNDED HEALTH SERVICES, AND OTHER RELEVANT GOVERNMENT MEDICAL ASSISTANCE PROGRAMS, THE DOH SHALL SUBMIT TO CONGRESS AN ANNUAL UMAP FINANCING STRATEGY. THE NATIONAL GOVERNMENT SHALL DIRECTLY APPROPRIATE TO ALL PUBLIC HOSPITALS, INCLUDING SPECIALTY HOSPITALS AND HOSPITALS OPERATED BY STATE UNIVERSITIES AND COLLEGES (SUCS), THEIR ANNUAL APPROPRIATIONS FOR MEDICAL ASSISTANCE UNDER THE UMAP. AS PROVIDED UNDER THE REPORTING AND RECORDING REQUIREMENTS OF MAIFIP IN PREVIOUS YEARS, THE MONTHLY FUND UTILIZATION REPORTS, NUMBER OF INDIGENT AND FINANCIALLY INCAPACITATED PATIENTS ASSISTED, AND THE STATUS OF THE IMPLEMENTATION OF THE UMAP OF EACH GOVERNMENT HEALTH FACILITY OF DOH, INCLUDING

SPECIALTY HOSPITALS AND SUCS, SHALL BE USED IN THE DELIBERATION AND FINAL DETERMINATION OF THEIR RESPECTIVE BUDGETS. SUCH FUNDS SHALL BE EXCLUSIVELY APPLIED TO COVER THE COST OF SERVICES ENUMERATED UNDER SECTION 20 OF THIS ACT THAT ARE NOT FULLY PAID OR REIMBURSED THROUGH EXISTING PHILHEALTH CASE RATES, LGU HEALTH SERVICE SUBSIDIES, OR OTHER MEDICAL ASSISTANCE PROGRAMS. IN NO CASE SHALL UMAP FUNDS BE CONVERTED INTO CASH OR RECEIVED DIRECTLY BY PATIENTS OR THEIR RELATIVES OR REPRESENTATIVES. PROVIDED, THAT PRIVATE HEALTH FACILITIES ATTENDING TO PATIENTS QUALIFIED UNDER THE UMAP SHALL BE ENTITLED TO REIMBURSEMENT OF INCURRED EXPENSES, CHARGEABLE AGAINST THE APPROPRIATIONS OF THE DEPARTMENT OF HEALTH (DOH) UNDER THIS ACT, AND SUBJECT TO THE RULES AND PROCEDURES AS MAY BE PRESCRIBED IN THE IMPLEMENTING GUIDELINES TO BE ISSUED BY THE DOH. THE UNIVERSAL MEDICAL ASSISTANCE PROGRAM SHALL FUNCTION AS A SUPPLEMENTARY BUT GUARANTEED SOURCE OF FINANCING TO ENSURE THAT NO QUALIFIED BENEFICIARY IS DENIED ACCESS TO CLINICALLY NECESSARY SERVICES OR REQUIRED TO PAY OUT-OF- POCKET. IT SHALL BE UTILIZED ONLY AFTER THE EXHAUSTION OR INSUFFICIENCY OF PHILHEALTH BENEFITS, LGU HEALTH SUBSIDIES, AND OTHER AVAILABLE GOVERNMENT MEDICAL ASSISTANCE PROGRAMS. IN NO CASE SHALL THE PATIENT OR THEIR

FAMILY BE REQUIRED TO PAY THE BALANCE OF ANY COVERED SERVICE. PHILHEALTH SHALL ENSURE THE MAXIMIZATION OF ITS SUPPORT VALUE AND BENEFIT COVERAGE, AND IN NO CASE SHALL UMAP SERVE AS THE PRIMARY SOURCE OF FINANCING FOR MEDICALLY INDICATED SERVICES.

SEC. 23. MEDICAL ASSISTANCE DATABASE. - ALL

BENEFICIARIES OF MEDICAL ASSISTANCE SHALL BE REQUIRED TO SUBMIT THEIR PHILSYS CARD NUMBER (PCN) WHICH SHALL BE INTEGRATED INTO THE DOH CENTRAL BENEFICIARY DATABASE. THE DOH SHALL INSTITUTIONALIZE AND MAINTAIN A SECURE, INTEROPERABLE, AND CENTRALIZED DIGITAL REGISTRY OF BENEFICIARIES TO SUPPORT ELIGIBILITY VERIFICATION, CLAIMS TRACKING, AND PROGRAM EVALUATION. SUBJECT TO THE PROVISIONS OF REPUBLIC ACT NO. 10173, OR THE "DATA PRIVACY ACT OF 2012," AND IN ACCORDANCE WITH APPLICABLE GOVERNMENT DATA- SHARING GUIDELINES, THE DOH SHALL ESTABLISH A MECHANISM FOR REAL-TIME, PRIVACY-COMPLIANT DATA SHARING WITH PHILHEALTH, ACCREDITED HEALTH FACILITIES, AND OTHER GOVERNMENT AGENCIES OR INSTITUTIONS PROVIDING MEDICAL ASSISTANCE. SUCH SHARING SHALL BE LIMITED TO THE EXTENT NECESSARY TO FACILITATE SERVICE DELIVERY, PREVENT DUPLICATION OF BENEFITS, AND SUPPORT EVIDENCE- BASED HEALTH FINANCING.

Sec. 8. All succeeding chapters and sections of Republic Act No. 11223 are

2 renumbered accordingly.

Sec. 9. Insert a new section on Republic Act No. 11223, to read as follows:

SEC. 43. PROHIBITION AGAINST POLITICAL

EXPLOITATION AND MANIPULATION. - NO PUBLIC OFFICIAL OR GOVERNMENT EMPLOYEE SHALL INTERFERE WITH, INFLUENCE, OR REPRESENT THEMSELVES, WHETHER DIRECTLY OR INDIRECTLY, AS HAVING CONTROL OR INFLUENCE OVER ANY ASPECT OF THE IMPLEMENTATION OF THIS PROGRAM. LIKEWISE, NO PUBLIC OFFICIAL OR EMPLOYEE SHALL ENDORSE, RECOMMEND, OR INTERVENE IN THE INCLUSION OR EXCLUSION OF ANY INDIVIDUAL AS A BENEFICIARY OF THE PROGRAM. ONLY DULY AUTHORIZED PERSONNEL OF THE DON OR DESIGNATED HEALTH FACILITY STAFF MAY PARTICIPATE IN THE ADMINISTRATION AND IMPLEMENTATION OF THE PROGRAM. ALL ASSISTANCE PROVIDED UNDER THIS ACT SHALL BE EXPLICITLY IDENTIFIED AS FUNDED BY PUBLIC RESOURCES COMING FROM TAXPAYERS' MONEY. NO PUBLIC OFFICIAL SHALL CLAIM, IMPLY, OR REPRESENT THAT SUCH FUNDS WERE PERSONALLY DONATED OR ALLOCATED THROUGH HIS OR HER INDIVIDUAL INITIATIVE OR DISCRETION. ANY PERSON FOUND TO HAVE VIOLATED THIS PROVISION SHALL BE PENALIZED WITH PERPETUAL ABSOLUTE DISQUALIFICATION FROM HOLDING PUBLIC OFFICE,

WITHOUT PREJUDICE TO THE FILING OF OTHER CRIMINAL, CIVIL, OR ADMINISTRATIVE CHARGES UNDER EXISTING LAWS.

Sec. 10. All succeeding sections of Republic Act No. 11223 are renumbered

accordingly.

Sec. 11. Appropriations. - The amount necessary to carry out the provisions of

this Act shall be sourced from Annual appropriations of the DOH included in 8 the General Appropriations Act.

Sec. 12. Implementing Rules and Regulations. - Within three (3) months from

10 the effectivity of this Act, the Secretary of the DOH shall, in coordination with appropriate government departments and agencies with the participation of the local government units, promulgate the necessary rules and regulations to carry out the provisions of this Act.

Sec. 13. Separability Clause. - Should any provision of this Act be found

unconstitutional by a court of law, such provision shall be severed from the remainder of this Act, and such action shall not affect the enforceability of the remaining provisions of this Act.

Sec. 14. Repealing Clause. - All laws, decrees, letters of instruction, resolutions,

orders or parts thereof which are inconsistent with the provisions of this Act are hereby repealed, modified or amended accordingly.

Sec. 15. Effectivity Clause, - This Act shall take effect fifteen (15) days following

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