Republic of the Philippines Province of Nueva Ecija CITY OF SAN JOSE SANGGUNIANG PANLUNGSOD EXCERPTS FROM THE MINUTES OF THE EIGHTEENTH (18) REGULAR SESSION OF THE 13" HONORABLE SANGGUNIANG PANLUNGSOD OF SAN JOSE CITY, PROVINCE OF NUEVA ECIJA, HELD ON THE 9t* DAY OF DECEMBER, 2019, AT THE SP SESSION HALL. PRESENT: HON. GLENDA F. MACADANGDANG - City Vice-Mayor & SI Presiding Officer } HON. ATTY. JOSE C, FELIMON - SP Member I | HON. ATTY. RONALD LEEC. HORTIZUELA- SP Member HON. DR. SUSAN B. CORPUZ - SP Member! HON. WILFREDO P. MUNSAYAC - SP Member I HON. EDGARDO F. AGLIAM. - SP Member I HON. ROY DV. ANDRES - SP Member I HON. WILFREDO A. NUNEZ - SP Member 1 HON. RODERICK C. BRILLO - SP Member I and President, HON. MELANIE E. GARCIA - SP Member I and President, Panlungsod na Pederasyon ng Sangguniang Kabataan Liga ng mga Barangay ABSENT: HON. PATRIXIE DP. SALVADOR - SP Member I (On Leave) HON, FERDINAND V. DYSICO - SP Member! Pe HON. RYAN T. LAURETA - ‘SP Member I ORDINANCE NO. 19-100 AN ORDINANCE SETTING GUIDELINES ON THE DISTRIBUTION OF PHILIPPINE HEALTH INSURANCE CORPORATION _(PHIC) PROFESSIONAL FEES AS “POOLED FUNDS” IN THE OSPITAL NG LUNGSOD NG SAN JOSE (OLSJ). ‘WHEREAS, Section 34-A of RA 10606 entitled “An Act. Amending RA No. 7875”, otherwise known as the National Health Insurance Act of 1995 states that “All payments for professional services rendered by salaried public providers shall 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.” ‘WHEREAS, DOH Administrative Order No. 2016-0033 provides that all DOH and Government Hospitals shall pass documentation of their guidelines on the distribution of the pooled funds to the Office for Health Operations (OHO) and DOH Regional Offices respectively for monitoring purposes.in the Ospital ng Lungsod ng San Jose (OLSJ) should be observed as follows, in accordance with DOH Administrative Order No. 2016-0033 issued on June 30, 2016: 1. The entire case rate amount, including the Professional Fees (PF), shall be paid directly to the Ospital ng Lungsod ng San Jose (OLSJ) account. 2. The OLSJ shall withhold the 10% or 15% expanded withholding tax whichever is applicable as per BIR policy on payments to be made to doctors or medical practitioners for their professional fees. In addition, OLSJ shall withhold the final value added tax (VAT) on Government Money Payment (GMP), if applicable. 3- Pooling of all Professional Fee reimbursements from Philhealth shall be done to all cases admitted in the service beds/wards of OLSJ. 4. Non-salaried physicians (visiting consultants) shall not charge additional professional fee to all No Balance Billing (NBB) patients. The professional fee (PF) component of the case rate shall not be included in the pooled funds, but shall be given to the non-salaried physician visiting consultant. 5. Alldoctors and non-physician health workers who are full-time, part-time, ent, temporary, casual, contractual or from the medical pool are entitled to a share from the “pooled funds” including those: a) Attending seminars/workshops, conferences and/or lectures as covered by corresponding Department Orders and/or Hospital Orders; b) On approved vacation, sick, and other allowable leaves applicable under existing Civil Service Laws; ©) On study leave or grant provided such entitlement shall be limited to a maximum of six (6) months; and 4) Those who are detailed, in-service or lateral entry training in the hospital where they are serving; 6. oa Aad personnel shall not be entitled to a share from the pooled a) Those who are meted with disciplinary measures such as suspension or fine; b) Those who are on leave without pay; ©) Those who are detailed in other offices or institutions; 7. The distribution of the pooled funds that shall be observed is as follows: a. 50% - Doctors * Isto be shared based on the patient's case category; © Medical Case - divided equally among General Practitioners, Internists, Pediatricians and other Medical Specialties; ¢ Procedure Case ~ divided equally among Obstetricians & Gynecologists, Surgeons, Anesthesiologists and other Surgical Specialties; © Regardless of status of employment — Permanent, Job Orders, Casual, and Contract of Service; * The physician must be duly accredited by Philhealth as Professional Healthcare Provider; * The physician must have rendered at least three (3) months of continuous service; + With signed recommendation by the Head of the Service; b. 50% Non-physician health workersWHEREAS, the same further provides that compliance to the Administrative Order shall be part of the accreditation and licensing requirements of Government Hospitals in their respective DOH Regional Licensing Offices; NOW THEREFORE, on joint motion of Councilors Atty. Jose C. Felimon and Atty. Ronald Lee C. Hortizuela, unanimously seconded by all the other members present. BEIT ORDAINED AND PROMULGATED BY THIS HONORABLE BODY DURING ITS REGULAR SESSION ASSEMBLED: SECTION 1. DEFINITION OF TERMS a. Pooled Funds ~ refers to funds representing all Philhealth Professional Fees, for services rendered to service Philhealth patients including NBB patients that are pooled and distributed among hospital staff. h. Health Worker ~ as defined in RA No. 7305, all persons who are engaged in health and health-related work, and all persons employed in all hospitals, sanitaria, infirmaries, health centers, rural health units, barangay health stations, clinics and other health-related establishments owned and operated by the Government or its political subdivisions with original charters and shall include, medical, allied health professional, administrative and support personnel employed regardless of their employment status. ¢, No Balance Billing (NBB) patients - members and dependents of the following categories of membership: d. Indigent — a person who has no visible means of income, or whose income isinsufficient for family subsistence, as identified by the Department of Social Welfare and Development (DSWD) based on specific criteria set for this purpose in accordance with the guiding principles set forth in Article I of the National Health Insurance Act of 2013, e. Sponsored — a member whose contribution is being paid by another individual, government agency (including Online Registration Enrolment) or private entity according to the rules as may be prescribed by the Philippine Health Insurance Corporation (PHIC). This also includes patients identified and entered under the Point of Care Program. f. Household Help or “Kasambahay” as defined in RA 10361 refers to any person engaged in domestic work within an employment relationship such as, but not limited to, the following: general househelp, nursemaid or “yaya”, cook, gardener, or laundry person, but shall exclude any person who performs domestic work only occasionally or sporadically and not on an occupational basis. g. Senior Citizen and Lifetime Members eligible for NBB availment. h, Medical Case ~ case category that covers groups of medical conditions based on International Statistical Classification of Diseases and Related Health Problems, 10" Revision (ICD 10). i, Procedure Case — case category that covers procedures or surgical interventions which are based on the Relative Value Scale (KVS). SECTION 2. DISTRIBUTION OF THE POOLED FUNDS. The distribution of the Philippine Health Insurance Corporation (PHIC) Professional Fees as pooled funds«Is to be shared equally based on gross amount among all hospital personnel regardless of status of employment ~ Permanent, Job Orders and Casual in all service areas * The personnel must have rendered at least three (3) months of continuous service © With signed recommendations by the Head of the Service/Section 8. The PF pool shall be distributed to OLSJ personnel within 30 calendar days from the date of receipt of reimbursement SECTION 3. REPEALING CLAUSE. All City Ordinances, Executive Orders, Rules, Regulations or Resolutions inconsistent herewith are hereby repealed and / or modified accordingly. SECTION 4. EFFECTIVITY. This Ordinance shall take effect upon approval. ENACTED, December 9, 2019. Thereby certify to the correctness of the foregoing. RACHEL [ZUELA Secretary to fhe Sanggunian APPROVED: HON, - SALVADOR ity Mayor