RATIONALIZING THE RATE OF REIMBURSEMENT FOR HEMODIALYSIS AND AMENDING ECC BOARD RESOLUTION NO. 98-09-0564 (1998)
WHEREAS, Article 185 of P.D. No. 626, as amended, provides that the Employees’ Compensation Program (ECP) shall provide such medical services and appliances to an employee who contracts work related sickness or injury as the nature of his sickness or injury and progress of his recovery may require, subject to the expense limitation provided by the Commission;
WHEREAS, in September 25, 1998, ECC Board Resolution No. 98-09-0564 prescribed the rate for reimbursement for each session of hemodialysis treatment as follows:
- For New Dialyzer
Bicarbonate: Php 3,340.00
Acetate: Php 3,000.00
Professional Fee: Php 300.00
- For Re-Use Dialyzer
Bicarbonate: Php 3,200.00
Acetate: Php 2,000.00
Professional Fee:Php 300.00;
WHEREAS, the Philippine Health Insurance Corporation (PHIC), through its Circular No. 024 s. 2015 revised its case rate for hemodialysis (RVS Code 90935) from Php 4,000.00 to Php 2,600. 00 per session and the coverage was distributed accordingly as:
Health Care Institution Fee: Php 2,250.00
Professional Fee: Php 350.00
Total Case Rate: Php 2,600.00
WHEREAS, the PHIC, in revising its case rate for hemodialysis conducted consultation meetings with different stakeholders and recognized the fact that the previous case rate amount was more than enough to cover for each session of hemodialysis in the majority of cases;
WHEREAS, the Commission discussed the proposal to revise the ECC prevailing reimbursement rate for hemodialysis by adopting the new PHIC case rate for hemodialysis in order to rationalize the amount of benefit provided between the ECP and National Health Insurance Act of 2013 (RA 7875 as amended by RAs 9241 and 10606);
WHEREAS, Board Resolution No. 15-11-51 “Directing the Systems to Adopt a System of Paying EC Medical Benefit for Dialysis of Persons with Work-Related Disabilities (PWRDs) taking into consideration the PhilHealth Coverage” dated November 3, 2015 which provides that the Systems shall reimburse the cost of dialysis after PhilHealth coverage has been exhausted;
NOW THEREFORE, ON MOTION DULY MADE AND SECONDED
This Commission RESOLVES as it hereby RESOLVED to revise the prevailing rate of reimbursement of hemodialysis to Php2,600.00 per session and that coverage shall
be distributed as follows:
Health Care Institution Fee: Php 2,250.00
Professional Fee: Php 350.00
RESOLVED FURTHER, that the reimbursement for Health Care Institution Fee shall cover facility and dialysis machine use, drugs and medicines (0.9% sodium chloride, bicarbonate or acetate hemodialysis solution, e-cart drugs), supplies and others (fistula kits, blood tubing set, dialyzer (low flux), syringe and gauze).
RESOLVED FINALLY, that this Resolution shall take effect fifteen days after its
publication in a newspaper of general circulation and that copies of the same shall be furnished to the SSS and GSIS for guidance and compliance.
APPROVED in the City of Makati, this 29th day of January 2016.
(SGD.) CIRIACO A. LAGUNZAD
Chairperson-Alternate
Department of Labor and Employment
(SGD.) BRENDA P. VIOLA
Member-Designate
Social Security System
(SGD.)DIONISIO C. EBDANE, JR.
Member – Designate
Government Service Insurance System
(SGD.) CARLITO P. ROBLE
Member
Employees’ Sector
(SGD.) ALEXANDER A. PADILLA
Member-Designate
Philippine Health Insurance Corporation
(SGD.) STELLA ZIPAGAN-BANAWIS
Member
Employees’ Compensation Commission – Secretariat
(PENDING PUBLICATION)