Q: What is the timeline for the implementation of No-copayment?

PhilHealth is still implementing the rules on No Balance Billing (NBB) until the implementing guidelines on copayment
is issued. Under the No Balance Billing Policy (PHIC No 2017-017) only those under the five (5) membership
categories are eligible of NBB, this were 1) Indigent, 2) Sponsored, 3) Kasambahay, 4) Senior Citizen, and 5) Lifetime
members. These membership categories shall not be charged out-of-pocket when admitted under ward
accommodation.

PhilHealth will yet to issue the implementing guidelines for no copayment and this will be anchored based on the
accommodation type as per UHC law. In 2020, PhilHealth issued PC No 2020-0024 "Governing Policy on No-
copayment/NBB" to inform the stakeholders in order for them to prepare their facilities specially on the bed allocation
based on UHC. Further, as per AO No 2021-0015, the DOH will align relevant licensing standards and requirements
for hospitals as to standards for basic and non-basic accommodation including appropriate bed allocation mandated
by the law. The implementation of no-copayment shall start once the implementing guidelines pertinent to this policy
has been issued by PhilHealth.

Should the allocated bed capacity for basic ward be full, in accordance with AO No 2020-0015 Section V.E 10%, the
hospitals shall adopt the following in the admission process of patients in basic or non-basic accommodation:

1. Patients may opt to be admitted in a basic or ward accommodation. In cases of limited beds, priority shall
be given to financially incapacitated, incapable, and/or indigent patients as evaluated by the Medical Social
Worker based on existing guidelines on patient classification.
2. In cases where patients are to be admitted in a basic or ward accommodation but no basic or ward
accommodation is available and transfer to another facility is not feasible, they may be temporarily admitted
in a non-basic accommodation until a basic or ward accommodation becomes available. This will be treated
as an admission to basic or ward accommodation and no co-payment for services, professional fees, and
amenities shall be charged to the patient.

PhilHealth will also be enhancing its systems for the auditing of claims and the monitoring and evaluation of
performance of health care providers and will also be developing indicators to monitor overall performance and
compliance of healthcare providers (HCPs) to the policies and standards set for the implementation of the
DRGs/compliance of HCPs to the implementing guidelines.

Q: Do the Department of Budget and Management earmark the money that could be downloaded to the
Special Health Fund?
The additional funds that will be provided to the LGUs as a result of the Supreme Court Ruling on the Mandanas-
Garcia petitions and EO 138 will go directly to the General Fund of the LGUs and cannot be earmarked for health
under the SHF. Furthermore, transfer of funds from the General Fund of the LGUs to the SHF is not mandatory and is
subject to the decision of the concerned SP. However, it is important to note that the LGUs would still have to allocate
budget for health, and that the increase in their share from the National Tax Allocation (NTA) means that more budget
will be available at the local level to finance health expenditures.

For the granting of global budget to healthcare facilities, the GBP estimates shall primarily be based on Diagnosis
Related Groups (DRGs) for direct medical services and prospective payment based on a pre-determined rates.
Payments shall also be based on the achievement of key health and efficiency performance targets, as indicated in
the performance commitment and contract of the participating Health Care Providers (HCP) or Health Care Provider
Network (HCPN). For monitoring PhilHealth, shall develop a monitoring and evaluation framework for the
implementation of Global Budget Payments in both HCPs and HCPNs.
Q: When is the timeline for the full implementation of SHF and how to efficiently manage it?
The Universal Health Care (UHC) Act provided that the UHC Integration Sites shall manifest financial integration in
the last half of the six-year transitory period. Although we are already monitoring the ongoing efforts of the UHC IS in
terms of financial integration through the LHS ML annual monitoring, there are still policies and mechanisms that
have to be finalized by concerned National Government Agencies, thus full implementation will commence once all
policies from different agencies are issued to assist Local Government Units in implementing SHF. While component
LGUs are not required/mandated to contribute funds to the SHF, they are still required to allocate budget for health
coming from their share from the National Tax Allocation, according to their ordinance on budget appropriations.

Currently, the UHC Law, its Implementing Rules and Regulations, and the Joint Memorandum Circular on SHF
specifically stipulated the allowable uses for the SHF funds which are for health-related purposes only unlike before
wherein PhilHealth income goes to the General Fund and can be used for other purposes apart from health. The
planning and budgeting for the use of SHF will also have to be approved by the Provincial/City Health Board.

To avoid charging the same activities on the General Fund and SHF, the LGUs should be guided by the LIPH/ AOP
which should clearly reflect the funding source for a particular PPA during planning and budgeting. Please be guided
that the LIPH is the strategic plan for health while the AOP is the operational plan for health of the LGUs. The charging
of these activities against PhilHealth funds will depend on the LGU's contractual arrangement with PhilHealth. The
utlilization of remaining funds after efficient utilization will highly depend on the decision of the P/CHB, guided by the
policies to be issued by COA and PhilHealth, and contracts of the P/CHB with PhilHealth.

Q: What would be the implication of the non - participation of these LGUs as to SHF, resource sharing.?
The contribution of funds by component LGUs to the SHF is not mandatory, and should not have any disadvantages,
even if they commit to integrate into Province-wide Health Systems. The contribution of funds by component LGUs
to the SHF, if any, will depend on the agreement among the Province and component LGUs as reflected in their inter-
LGU MOA. An example of this is the fund contribution of LGUs of inter-local health zones in the common health trust
funds.

The financial contribution of component LGUs (particularly higher income LGUs) to the SHF will enable the pooling
of funds at the province-wide level that can be used by the PHB for pooled procurement of commodities and also to
support lower income LGUs. However, it might be difficult for component LGUs to fully transfer their whole budget
for health to the SHF, since they still have to finance the operations of their Rural Health Units and Health Centers,
such as for salaries of personnel and mandatory expenses. The UHC Law stipulates that only additional health
workers can be funded through the SHF, and not existing health workers. The contribution of funds by component
LGUs to the SHF is not mandatory, and should not have any disadvantages, even if they commit to integrate into
Province-wide Health Systems. However, they should still allocate budget for health from their General Fund, as will
be appropriated by their Sanggunian, for the maintenance and operations of their RHUs and Health Centers.

Q: What will be the monitoring mechanism for the proper and efficient use of Special Health Fund?
An SHF utilization tracking system will be developed to track its utilization while discussions with Dep. Discussing
with Department of Finance – Bureau of Local Government Finance on the use of Electronic Statement of Receipts
and Expenditures (Esre) to monitor SHF as well. Should the eSRE be sufficient, the SHF utilization tracking system
may not be developed anymore. The monitoring and evaluation framework shall include the standard performance
indicators for all contracted HCPs or HCPNs, as set by the Corporation.
These are all options as part of the ongoing technical groundwork for the ongoing reforms.

In addition, the Special Health Fund is also subject to government accounting and auditing rules and regulations.
Discussions with COA are already ongoing regarding the issuance of auditing and accounting guidelines on SHF and
global budget as an advance payment as well as the corresponding penalties on the use of SHF for disallowed
expenditure items