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Rep. Winston “Winnie” Castelo seeks creation of commission to regulate HMOs

Rep. Winston “Winnie” Castelo (Liberal Party, 2nd District of Quezon City)
is seeking the creation of a commision to regulate dozens of health
maintenance organizations (HMOs), which have been largely unregulated since
their proliferation more than three decades ago.

Castelo has filed House Bill 6025, or the Health Management Organizations
Regulatory Commision of 2012, which proposes the creation of the
independent Health Management Organizations Regulatory Commission to
exercise control, supervision, and authority over all HMOs nationwide.

In the bill’s explanatory note, Castelo said he has filed the bill after
noting that the HMOs have been largely unregulated except for what he has
described an an accreditation system, where the Department of Health merely
issues a “clearance to operate” to those HMOs.

While likening the HMOs as business entities that have to comply with their
contractual obligations to include prearranged and prepaid health services
to their cardcarrying members, Castelo said bonafide cardholders were not
getting the maximum benefits by way of exemptions, whih deprive them of
ample medical services.

“There must be a regulatory commission to tke charge of the multifaceted
problems that now plague this industry as the ones that serve as medical
services providers in the broad sense of the term,” Castelo said.

According to Castelo, the proposed regulatory commission could address what
he said the cardholders’ “many humiliating experiences,” which have been
largely the result of the lack of regulatory mechanism for these HMOs.

The bill proposes that the commission initially assumes the accreditation
system, which the Department of Health exercises through its Office for
Health Facilities Standards and Regulations, and adopt the rules and
regulations on the supervision of HMOs under DoH’s Administrative Order 34.

After two years of transition, the proposed commission will evolve
automatically as “independent in its overall administrative and operational
functions as the proper regulatory agency,” Castelo said.

After the transition, the proposed commission will issue new sets of
supervisory and regulatory guidelines to implement the measure

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