QuestionsQuestions (EXECUTIVE ORDER NO. 192)
To transfer the regulation and supervision of Health Maintenance Organizations (HMOs) from the Department of Health (DOH) to the Insurance Commission (IC), direct its implementation, and provide for related matters to streamline regulation.
The Insurance Commission (IC).
Following DOH Administrative Order No. 34 (s. 1994), an HMO is a juridical entity organized to provide or arrange pre-agreed or designated health care services to enrolled members for a fixed pre-paid fee over a specified period.
It cites the President’s authority under Article VII, Section 17 of the Constitution and the continuing reorganization authority under EO 292 (s. 1987), plus provisions mandating DOH regulation of health facilities (Admin Code of 1987). It also anchors IC supervision on the Insurance Code (PD 612, as amended) and the Pre-Need Code (RA 9829).
Authorize the IC, in coordination with the Department of Budget and Management, to streamline and augment its human resources so it can effectively regulate and supervise HMOs.
Examples include: (1) issuing rules/guidelines on capitalization, net worth, reserves, and security deposits; (2) approving/amending/renewing/declining/suspending/revoking licenses or authority; (3) fixing/assessing/collecting/utilizing regulatory fees; (4) regulating and monitoring HMO operations to ensure compliance; (5) issuing orders to prevent fraud and injury; (6) ordering examinations of records; (7) imposing sanctions/penalties; (8) deputizing law enforcement; (9) appointing conservators/receivers/liquidators when necessary.
The IC may order examination of documents, papers, files, tax returns, books of accounts, and other records—whether in any form—of any entity/person/HMO under investigation, including those with related interests.
HMOs must comply with regulatory requirements and procure a License to Operate from the IC.
From the current appropriations of the IC.
DOH and IC may enter into inter-agency agreements for full transfer of functions, including temporary detail of DOH personnel to the IC for transition.
Within ninety (90) days from the effectivity of the Order.
They continue their service with the DOH, but may be detailed to the IC for efficient transition and effective discharge of functions.
An Oversight Committee composed of the Secretary of Finance (Chairman), Secretary of Health, and the Insurance Commissioner. It exists until 30 June 2016.
All issues relating to medical matters, including medical practice, medical procedures and standards, and health programs/policies/services/facilities, are referred to the DOH.
The IC must formulate, adopt, and implement necessary rules, regulations, and issuances to effectively implement EO 192.
All orders, issuances, or parts thereof inconsistent with EO 192 are repealed or modified accordingly.
It takes effect immediately upon publication in a newspaper of general circulation.