Santo Domingo.- The National Social Security Council (CNSS) approved this Thursday, through resolution No. 563-01, an increase in coverage for hospitalizations, medical fees and consultations for hospitalization, diagnostic tests, hospitalization, as well as the use rooms and equipment, among other health services.
During an extraordinary meeting, the Council approved a 20% increase in medical fees related to procedures and a 50% increase in hospitalization consultations. This increase represents an increase of more than 2,700 million pesos a year that would be received by doctors as of February 2023, this in addition to the other 2,800 million pesos that was increased in October 2021, the date on which approved a 20% increase in medical fees and 30% in interconsultation fees.
In another aspect, the resolution increases the fees for examinations and diagnostic tests by 7%, which represents 1,200 million pesos a year. At the same time, there was an increase of 15% due to the use of the room and equipment, which will continue to be reviewed with a periodicity of 90 days and whose increases would be in charge of the Health Care Account of the people, which does not affect the pocket of the affiliates.
The governing entity of the Dominican Social Security System also increased coverage by 15% in the use of rooms in clinics and hospitals, per member per day, which represents more than 350 million pesos. In this sense, the coverage granted by the ARS will be 100% up to the amount of RD$1,725.00 and 90% in the range between RD$1,726.00 and RD$2,415.00.
The resolution establishes that the ARS undertake to grant the codes to doctors, within a period not exceeding 30 days, from the completion of the necessary documentation and requirements. In the case of differences, SISALRIL undertakes to make the calls that are necessary, with the objective of acting as a mediator between the ARS and the Dominican Medical Association, so that doctors can receive their respective codes in a timely manner.
The resolution details that to cover administrative expenses, it was approved to increase RD$65.00 pesos per month per capita of the Family Health Insurance (SFS) of the Contributive Regime (RC), charged to the Health Care Account of Family Insurance Persons of Health of the Contributory Regime. This measure will take effect as of February 2023. The surplus, which amounts to more than 1,000 million pesos per year, will be covered by the Health Risk Administrators (ARS).
As part of the executive measures, the CNSS instructed the Superintendency of Health and Occupational Risks (SISALRIL) to guarantee that the Health Risk Administrators do not produce increases in rates for services provided as a result of the new agreements. This measure is intended to prevent Health Service Providers (PDSS) from making simultaneous increases to the new agreed increases and that this translates into increased spending for the population affiliated with the Family Health Insurance (SFS).
In another vein, the resolution requests the Ministry of Labor to take steps to convene the National Committee of Professional Fees (CNHP) and contact the entities that comprise it, in compliance with the provisions of Paragraph II of Article 173 of the Law 87-01, with the objective that they send their representatives, in order to continue analyzing and studying the increase in the rates of professional fees for medical consultations.
It was established that the proposal to increase outpatient consultations, the increase in the rate for emergencies, home consultations, and the annual indexation will be known by the National Committee of Professional Fees, which will be in charge of its evaluation.
Review of the Basic Health Plan (PBS)
The CNSS approved through resolution No. 562-04 the revision of the Basic Health Plan (PBS), presented by SISALRIL, assessing those considerations given by the Dominican Association of Medical Igualas and Health Risk Administrators (ADIMARS), the Dominican Association of Health Risk Administrators (ADARS), the Dominican Association of Private Clinics (ANDECLIP) and the National Health Insurance (SeNaSa) taking into account that they do not jeopardize the effectiveness, equity and financial protection of the Dominican Health System. Social Security (SDSS).
The resolution instructs SISALRIL to form a Sectoral Technical Committee, made up of: the Ministry of Public Health and Social Assistance (MISPAS), ADARS, ADIMARS, ANDECLIP, SeNaSa, Specialized Medical Societies, CMD, Social Security Treasury (TSS) , National Health Service, Health Service Providers (PSS), the technical part of Health of the CNSS and SISALRIL, as well as other actors linked to the SDSS.
Said Sectoral Technical Table will be in charge of the review work, analysis of cost, effectiveness, inclusion of benefits and follow-up for the consensual construction of a methodology for the review of the PBS, based on the initial proposal presented by SISALRIL and the suggestions made by the key actors.
