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Why The Guidelines For The Development Of Telehealth Established In Colombia

Original Language Title: Por la cual se establecen los lineamientos para el desarrollo de la Telesalud en Colombia

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1419 OF 2010

(December 13)

Official Journal No. 47.922 of 13 December 2010

CONGRESS OF THE REPUBLIC

By which the guidelines for the development of Telehealth in Colombia are established.

COLOMBIA CONGRESS

DECRETA:

CHAPTER I.

OBJECT, SCOPE, DEFINITIONS, AND FUNDAMENTAL PRINCIPLES.  

ARTICLE 1o. OBJECT. This law aims to develop the TELEHEALTH in Colombia, as a support to the General System of Social Security in Health, under the principles of efficiency, universality, solidarity, integrality, unity, quality and principles These are the basic principles of this law.

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ARTICLE 2o. DEFINITIONS. For the purposes of this law, the following definitions are adopted:

Telehealth: It is the set of health-related activities, services and methods, which are carried out remotely with the help of information and telecommunications technologies. It includes, among others, Telemedicine and Teleeducation in Health.

Telemedicine: It is the provision of distance health services in the components of promotion, prevention, diagnosis, treatment and rehabilitation, by health professionals who use information technologies and the communication, which allow them to exchange data for the purpose of facilitating access and the opportunity in the provision of services to the population that presents limitations of offer, access to services or both in its geographical area.

This does not exempt health service providers and the entities responsible for the payment of such services from their responsibility to prioritize the personalized provision of health services within the framework of the General Security System. Social in Health.

Health Teleeducation: It is the use of information and telecommunication technologies for distance health education practice.

PARAGRAFO: The provisions that are provided for in this Act by Law 1151 of 2007 and Law 1122 of the 2007, without detriment to the approval of the National Development Plan, which includes 0.3 (%) of the UPC for Telemedicine services.

Editor Notes
Effective Case-law
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ARTICLE 3o. PRINCIPLES OF TELEHEALTH. The general principles of the Telehealth are efficiency, universality, solidarity, integrality, unity and participation, in the terms defined by the article 2or the Law 100 of 1993. It is also one of the principles of the quality of health care, understood as the provision of health services to individual and collective users in an accessible and equitable way, through a professional level. optimal, taking into account the balance between benefits, risks and costs, in order to achieve the adherence and satisfaction of these users.

CHAPTER II.

TELEHEALTH ADVISORY COMMITTEE.

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ARTICLE 4. TELEHEALTH ADVISORY COMMITTEE. Create the Telehealth Advisory Committee as an advisory body to the Ministry of Social Protection for the development of Telehealth programs in the country.

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ARTICLE 5o. CONFORMING. The Advisory Committee will be composed of delegates from the Ministry of Social Protection, Ministry of Communications, Ministry of National Education, Ministry of Finance and Public Credit, Ministry of Housing, Development Territorial and Environment. It will have permanent guests from scientific associations, universities and research centers.

PARAGRAFO. The National Government will regulate the conformation and operation of this Committee within twelve (12) months of the enactment of this law.

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ARTICLE 6o. FUNTIONS: The Telehealth Advisory Committee will have, among others, the following functions:

a) Provide advice to the Ministries of Social Protection, Education, Communications and Housing, Territorial Development and Environment for the Development of Telehealth in Colombia, as a State policy, for social and oriented purposes to improve the access and opportunity of the inhabitants of the national territory, to the health services, as well as the education in health, the management of the knowledge in health and the research in health.

b) To advise the Ministry of Communications regarding the connectivity needs that make the development of the Telehealth in the country viable, in all its components.

c) To provide support and support to the different programs in their stages of generation, design, compliance, quality and proposed goals, as far as Telehealth is concerned.

d) Recommend the investment priorities of the resources for the development and investigation of the Telehealth in Colombia.

e) Promote education in the use of Information and Communication Technologies applied to health.

f) The others that are necessary to guarantee the development of the Telehealth in Colombia, according to the resources and needs of the country.

CHAPTER III.

CONNECTIVITY MAP.

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ARTICLE 7o. MAP OF CONNECTIVITY. As of the enactment of this law, the Ministry of Communications, with the support of the Telehealth Advisory Committee, will develop a map of connectivity, in line with priorities in health, education, and education. digital, ICT penetration, regional development agendas and interests, taking into account the characteristics of the populations, exploring and valuing other types of connectivity that are designed for the implementation and development of the Telehealth.

CHAPTER IV.

FINANCING FOR THE DEVELOPMENT OF TELEHEALTH IN COLOMBIA.

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ARTICLE 8o. RESOURCES FOR THE DEVELOPMENT OF TELEHEALTH. As of the current law, up to 5% of the investment budget of the Communications Fund, Special Administrative Unit attached to the Ministry of Communications, will be allocated to the Ministry of Communications. financing of the investments required in connectivity to develop the Telehealth in the Public Health Institutions in Colombia, in accordance with the recommendations of the Telehealth Advisory Committee.

PARAGRAFO. The resources of the Communications Fund Special Administrative Unit of the Ministry of Communications, other ministries and international cooperation, will be articulated with the resources available to them. different actors of the General System of Social Security in Health, in accordance with the regulations in force, for the purposes provided for in this article.

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ARTICLE 9o. SERVICE OFFER. As of the current law, insurers and service providers of the General System of Social Security in Colombia, regardless of the benefits plans, will offer within their portfolios of services or capacity to offer its users, Telemedicine as a mode of service, adequate, effective and rational facilitating the free access and choice of the user of the same, which will contribute to its development and sustainability.

PARAGRAFO 1o. The insurers and service providers of the Health Social Security System in Colombia, who are already offering this mode of care, will be able to continue doing so, framed in the parameters to establish the Ministry of Social Protection under this Law.

PARAGRAFO 2o. In the term of 12 months, the Ministry of Social Protection will process the inclusion in the Social Security Health Benefits (POS, POS-S and Public Health) plans of the services provided in the modality of TELEMEDICINE, as well as the aspects necessary to comply with this law.

PARAGRAFO 3o. The provisions of this Article do not exempt health service providers and insurers from their responsibility for the personalized provision of health services within the framework of the System Social Security in Colombia, and under no circumstances can they be expected to replace them. The Ministry of Social Protection with the advice of the Committee established under this law, should regulate the harmonization of the services provided in a personalized way and those that use the resources of the telemedicine, which shall do so within a maximum of 6 months after the enactment of this law.

CHAPTER V.

KNOWLEDGE MANAGEMENT.

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ARTICLE 10. LEARNING IN TELEHEALTH. Within the respect for university autonomy, it will be promoted, by the Telehealth Advisory Committee and the competent institutions in higher education, the inclusion in the academic pensum, of the knowledge and techniques of TELEHEALTH, with its components, through a phased and progressive process, as well as the necessary training courses for teachers.

PARAGRAFO 1o. It is recommended to include the knowledge in TELEHEALTH, in the pensum of studies of the careers of the areas of health; in addition, in the programs of Systems Engineering, Telecommunications, Electrical, Electronics and Mechatronics, among others. With this same criterion, it will be offered by specialization in TELEHEALTH, and other components, as graduate programs in the Colombian universities, prior study and corresponding evaluation by the competent entities.

PARAGRAFO 2o. The Ministries of Education and Social Protection, will encourage the teaching of the Telehealth, in the induction courses, prior to the implementation of the compulsory social service, in the professions in the area of health.

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ARTICLE 11. TELEHEALTH NETWORKS. The Ministry of Social Protection, with the support of the Telehealth Advisory Committee, will contribute to the development of knowledge networks, which are supported by information and communication technologies, good practice, research and scientific studies, in order to improve in a continuous manner the services offered.

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ARTICLE 12. VALIDITY. This law governs from its publication and repeals those that are contrary to it.

The President of the honorable Senate of the Republic,

ARMANDO ALBERTO BENEDETTI VILLANEDA

The Secretary General of the honorable Senate of the Republic,

EMILIO RAMON OTERO DAJUD

The President of the honorable House of Representatives,

CARLOS ALBERTO ZULUAGA DIAZ

The Secretary General of the honorable House of Representatives,

JESUS ALFONSO RODRIGUEZ CAMARGO.

COLOMBIA-NATIONAL GOVERNMENT

Publish and comply

In compliance with the provisions of Judgment C-593 of 2010 proposed by the Constitutional Court, the sanction of the bill is appropriate, since the said Corporation orders the referral of the case to the Congress of the Republic, to continue the legislative process of rigor and its subsequent submission to the President of the Republic for the effect of the corresponding sanction.

Dada en Bogotá, D. C., at 13 December 2010.

JUAN MANUEL SANTOS CALDERÓN

The Minister of Finance and Public Credit,

JUAN CARLOS ECHEVERRY GARZON.

The Minister of Social Protection,

MAURICIO SANTAMARIA SALAMANCA.

CONSTITUTIONAL COURT

General Secretariat

Bogotá, D. C., nineteen (19) November two thousand ten (2010)

Trade number CS-363

Doctor

ARMANDO BENEDETTI VILLANEDA

President

Senate of the Republic

City

Reference: OP-l19 FILE STATEMENT C-593/10. Bill No. 218 of 2007 Senate, 309 of 2007 House, for which the guidelines for the development of telehealth in Colombia are established. JORGE I. PRETELT CHALJUB.

Dear Doctor:

Comedies, and pursuant to article 16 of Decree 2067 of 1991, I allow myself to send you a copy of the C-593 2010 judgment of twenty-seven (27) July of two thousand ten (2010), proffered within the reference process.

The legislative file is sent with 405 folios.

Cordially,

MARTHA VICTORIA SACHICA MENDEZ

General Secretariat

Attachment copy of the statement with 57 folios.

It is appended to the Legislative file with 405 Foles.

CONSTITUTIONAL COURT

C STATEMENT-593/10

Ref.: Expedient OP-119

Official review of the government objections presented to bill No. 218 of 2007 Senate, 309 of 2007 House, " for which the guidelines for the development of the Telehealth in Colombia are established.

Rapporteur Magistrate:

JORGE IGNACIO PRETELT CHALJUB

Bogotá, D. C., twenty-seven (27) of July two thousand ten (2010).

The Full Court of the Constitutional Court, in compliance with its constitutional powers and the requirements and procedures laid down in Decree 2067 of 1991, has given the following sentence, with base on the following

1. BACKGROUND

On December 23, 2008, the then President of the Senate of the Republic, Dr. Hernan Andrade Serrano, sent this Corporation a copy of the bill number 218 of 2007 Senate, 309 of 2007 , establish the guidelines for the development of the Telehealth in Colombia, in order for this control body to resolve the objections of unconstitutionality that the President of the Republic made regarding the Article 2o of the aforementioned draft, which were declared unfounded by the Senate plenary sessions and House.

2. THE BILL PARTIALLY OBJECTED

The full text of the bill is as follows, in which the Government's objections are highlighted and highlighted:

" Law number _____________________

"by which the guidelines for the development of Telehealth in Colombia are established."

" THE CONGRESS OF COLOMBIA

" DECCRETA:

CHAPTER I.

" OBJECT, SCOPE, DEFINITIONS, AND FUNDAMENTAL PRINCIPLES.

" ARTICLE 1o. OBJECT. This law aims to develop Telehealth in Colombia, in support of the General System of Social Security in Health, under the principles of efficiency, universality, solidarity, integrality, unity, quality and basic principles. referred to in this law.

" ARTICLE 2o. DEFINITIONS. For the purposes of this law, the following definitions are adopted:

Telehealth: It is the set of health-related activities, services and methods, which are carried out remotely with the help of information and telecommunications technologies. It includes, among others, Telemedicine and Teleeducation in Health.

"Telemedicine: It is the provision of distance health services in the components of promotion, prevention, diagnosis, treatment and rehabilitation, by health professionals who use information technologies and the communication, which allow them to exchange data for the purpose of facilitating access and the opportunity in the provision of services to the population that presents limitations of offer, access to services or both in its geographical area.

This does not exempt health service providers and entities responsible for the payment of such services from their responsibility to prioritize the personalized delivery of health services, within the framework of the system. General of Social Security in Health.

" Health Teleeducation: It is the use of information and telecommunication technologies for distance health education practice.

Paragraph. T likewise as of this law the provisions that for effect contemplate Law 1151 of 2007 and the Law 1122 , 2007, to the detriment of the National Development Plan's approval of 0.3 (%) of the UPC for Telemedicine services.

" Article 3o. Principles of Telehealth. The general principles of the Telehealth are efficiency, universality, solidarity, integrality, unity and participation, in the terms defined by Article 2or Law 100 of 1993. It is also one of the principles of the quality of health care, understood as the provision of health services to individual and collective users in an accessible and equitable way, through a professional level. optimal, taking into account the balance between benefits, risks and costs, in order to achieve the adherence and satisfaction of these users.

" CHAPTER II.

"Telehealth Advisory Committee.

" Article 4o. The Telehealth Advisory Committee. Create the Telehealth Advisory Committee as an advisory body to the Ministry of Social Protection for the development of Telehealth programs in the country.

" Article 5o. Conformation. The Advisory Committee shall be composed of delegates from the Ministries of Social Protection, Ministry of Communications, Ministry of National Education, Ministry of Finance and Public Credit, Ministry of Housing, Territorial Development and Environment. It will have permanent guests from scientific associations, universities and research centers.

PARAGRAFO. The National Government will regulate, the conformation and operation of this Committee within twelve (12) months of the enactment of this law.

" Article 6o. Functions. The Telehealth Advisory Committee will have, among others, the following functions:

a) Provide advice to the Ministries of Social Protection, Education, Communications and Housing, Territorial Development and the Environment for the Development of Telehealth in Colombia, as a State Policy, for social and oriented to improve the access and opportunity of the inhabitants of the national territory, to health services, as well as health education, knowledge management in health and health research;

b) Advise the Ministry of Communications regarding the connectivity needs that make the development of Telehealth in the country viable, in all its components;

c) Providing support and support to the different programs in their proposed stages of generation, design, compliance, quality and goals, as far as Telehealth is concerned;

d) Recommend investment priorities for resources for the development and research of Telehealth in Colombia;

e) Promote education in the use of Information and Communication Technologies applied to health;

f) The others that are necessary to guarantee the development of the Telehealth in Colombia, according to the resources and needs of the country.

" CHAPTER III.

" Connectivity Map.

" Article 7o. Connectivity Map. From the enactment of this law, the Ministry of Communications, with the support of the Telehealth Advisory Committee, will develop a map of connectivity, according to priorities in health, education, digital literacy, penetration of the ICT, regional development agendas and interests, taking into account the characteristics of the populations, exploring and valuing other types of connectivity that are designed for the implementation and development of the Telehealth.

" CHAPTER IV.

" Financing for the Development of Telehealth in Colombia.

Article 8or. Telehealth development resources. From the time of this law, up to 5% of the investment budget of the Communications Fund, Special Administrative Unit attached to the Ministry of Communications, will be allocated to the financing of the investments required in the connectivity to develop Telehealth in the Public Health Institutions in Colombia, in accordance with the recommendations of the Telehealth Advisory Committee.

" Paragraph. The resources of the Communications Fund Special Administrative Unit of the Ministry of Communications, other ministries and international cooperation, will be articulated with the resources that the different actors of the General System of Social Security in Health, in accordance with current regulations, for the purposes provided for in this Article.

"Article 9o Services Offering. As of this law, the insurers and service providers of the General System of Social Security in Colombia, regardless of the benefit plans, will offer within their portfolios of services or capacity The invention also concerns the use of Telemedicine as a service modality, suitable, effective and rational, facilitating the free access and choice of the user of the same, which will contribute to its development and sustainability.

" Paragraph 1o. The insurers and service providers of the Health Social Security System in Colombia, who are already offering this mode of care, will be able to continue doing so, framed in the parameters established by the Ministry of Health Social protection under this law.

" Paragraph 2o. In the term of 12 months, the Ministry of Social Protection will process the inclusion in the Social Security Health Benefits (POS, POS-S and Public Health) plans, of the services provided in the Telemedicine modality, as well as the aspects necessary for the implementation of this law.

" Paragraph 3o. The provisions of this Article do not exempt health service providers and insurers from their responsibility for the personalized provision of health services within the framework of the Social Security System in force in Colombia, and under no circumstances can they be expected to replace them. The Ministry of Social Protection with the advice of the Committee established under this law, should regulate the harmonization of the services provided in a personalized way and those that use the resources of the telemedicine, which shall do so within a maximum of 6 months after the enactment of this law.

" CHAPTER V.

" Knowledge management.

" Article 10. Learning in Telehealth. Within the respect for university autonomy, the inclusion in the academic pensum, of the knowledge and techniques of Telehealth, will be promoted by the Telehealth Advisory Committee and the competent entities in the field of higher education. its components, through a phased and progressive process, as well as the necessary training courses for teachers.

" Paragraph 1o It is recommended to include knowledge in Telehealth, in the pensum of studies of the careers of the areas of health; in addition, in the programs of Systems Engineering, Telecommunications, Electrical, Electronics and Mechatronics, among others. With this same criterion, it will be offered by the specialization in Telehealth, and the other components, as graduate programs in the Colombian universities, prior study and corresponding evaluation, by the competent entities.

" Paragraph 2o. The Ministries of Education and Social Protection will encourage the teaching of the Telehealth, in the induction courses, prior to the realization of the compulsory social service, in the professions of the area of health.

"Article 11. Telehealth networks. The Ministry of Social Protection, with the support of the Telehealth Advisory Committee, will promote the development of knowledge networks, which, supported by information and communication technologies, will enable the development of good practices, research and scientific studies, in order to improve the services offered in a continuous manner.

" Article 12. Effective. This law governs from its publication and repeals those that are contrary to it ".

3. THE LEGISLATIVE PROCEDURE

The legislative process of the proposed bill was as follows:

3.1. The project was presented on April 16, 2007, to the Secretariat of the Senate of the Republic, by Senator Nestor Ivan Moreno Rojas. It was published in the Congress Gazette number 118 of April 17, 2007[1]

3.2. The project was referred to the Sixth Constitutional Commission of the Senate of the Republic, whose board of directors appointed Senator Nestor Ivan Moreno Rojas as the rapporteur[2]

3.3. The report and the text proposed for the first debate in the Sixth Commission of the Senate of the Republic, presented by Senator Rapporteur Nestor Ivan Moreno Rojas, was published in the Congress Gazette number 198 of May 18, 2007[3].

3.4. According to the substantiation report signed on June 14, 2007 by the General Secretariat of the Sixth Constitutional Commission of the Senate of the Republicthe Republic of Mexico [4], the draft was discussed and approved by the Commission. during the session of May 23, 2007, as stated in the Act number 31 of that date, published in the Congress Gazette number 392 of August 16, 2007, in which it is noted that the approval was given by unanimity[5].

The aforementioned report also certifies that the approval of the project was previously announced, in accordance with Article 8or the Legislative Act 01 of 2003, in the session of the Sixth Senate Committee of the Republic that took place on May 22, 2007, as stated in minutes number 30 of the same date, published in the Congress Gazette number 392 of August 16, 2007, in which it reads:

" Announcement for discussion and voting, for the following Session, of the First Debate Ponts of the following Bills: (...) 8. Bill No. 218 of 2007 Senate. " And in the end it is observed: "Manifest that the propositions are accepted and being 11 and 17 minutes lifts the session and convenes for tomorrow Tuesday, May 23 a 9 a.m."[6].

in the second debate in the Senate of the Republic, Senators Nestor Ivan Moreno Rojas (as coordinator), Carlos Julio Gonzalez, Gabriel Acosta Bendek, Plinio Edilberto Olano Becerra, Oscar Suarez Mira, Carlos Roberto Ferro and Jorge Hernando Pedraza[7]The presentation for the second debate in the Senate of the Republic was published in the Congress Gazette number 274 of June 13, 2007[8].

3.5. According to the substantiation report signed by the Secretary General of the Senate of the Republic [9] the bill was discussed and approved with the quorum required by the Plenary of the Senate of the Republic, in the session it had place on June 14, 2007, as stated in Act number 66 of that date, published in the Congress Gazette number 415 of August 28, 2007[10].

The same report certifies that such approval was made prior to its announcement, made at the Plenary Session of June 12, 2007, as stated in the 65th act corresponding to that meeting, published in the Gazette of the Congress number 414 of August 28, 2007[11], which reads:

On the instructions of the Presidency and in accordance with Legislative Act number 01 of 2003, the Secretariat announces the projects to be discussed and approved at the next session: (...) Bill 218 of 2007 Senate (...) "[12].

3.6. The draft was referred to the Sixth Permanent Constitutional Committee of the House of Representatives, whose board of directors appointed as rapporteurs the representatives Marino Paz Ospina (Coordinator), Jaime Restrepo Cuartas, Berner Leon Zambrano Erazo and Buenaventura Leon Leon.

3.7. The report and the text proposed for the first debate in the Sixth House Committee of the House of Representatives was published in the Congress Gazette number 252 of May 14, 2008) [13]

3.8. The project was discussed and approved with modifications by the said Commission during the session on May 20, 2008, as stated in the 29th Act of that date, which appears published in the Congress Gazette number 844 of November 21, 2008[14]' approval was given "by unanimity of 14, votes"[15]and was previously announced, pursuant to Article 8or Legislative Act 01 of 2003, at the sitting of the Sixth Committee of the House of Representatives, which took place on 14 May 2008, as stated in the 28th act corresponding to that session, published in the Congress Gazette number 843 of November 21, 2008[16]. The announcement was made in the following terms:

President:

" Announce projects Mr. Secretary.

Secretary.

To debate and approve at next session: Bill No. 309 of 2007 House, 218 of 2007 Senate. " And at the end it reads: " the session is closed, being three and forty in the afternoon (3:40 p. m.) and is called for next Tuesday at 9:00 AM ".

3.9. For presentation in the second debate in the Chamber, the representatives of Marino Paz Ospina (Coordinator), Jaime Restrepo fourth, Berner Leon Zambrano Erazo and Buenaventura Leon Leonappointed again [17]. debate in this legislative chamber was published in the Congress Gazette number 316 corresponding to June 4, 2008[18].

3.10. According to the substantiation report signed by the Secretary General (e) of the House of Representatives[19], the bill was discussed and approved in the fourth debate with modifications to the text approved by the Senate of the Senate. the Republic, in the session that took place on June 10, 2008, as signed in Act No. 116 of that date, published in the Congress Gazette number 421 of July 17, 2008[20]. The same report certifies that such approval was made prior to its announcement, made at the Plenary Session of June 4, 2008, as stated in the Act number 115 corresponding to that meeting, which is published in the i_aj">Congress Gazette number 414 of July 17, 2008[21] in which it reads:

" First announce the projects for next Tuesday Mr. Secretary, and then open the registry to verify the quorum. Bill number 309 of 2007 House 218 of 2007 Senate". At the end it is observed:" The session is closed and is called for the next Tuesday at 3:00 p. m. ".

3.11. For the purpose of reconciling the texts approved by the Senate of the Republic and the House of Representatives, a conciliation committee was appointed by the Senators Nestor Ivan Moreno Rojas, Gabriel Zapata and Carlos Julio Gonzalez Villa; and Representatives of the Representatives Jaime Restrepo Cuartas, Julián Silva Meche, and Mariano Paz Ospina, who presented a conciliation report in which they proposed to accept the text approved by the House of Representatives, but including some Provisions adopted by the Plenary of the Senate of the Republic[22]. That report was published in the Congress Gazette number 378 of June 18, 2008[23].

3.12. According to a report of substantiation by the Secretary General (e) of the House of Representatives[24], in plenary session held on June 19, 2008, the conciliation report presented by the Commission was considered and approved. Accidental Mediation, as stated in the Act number 120 of that date. The approval was made prior to its announcement at the ordinary plenary session on June 18, 2008, according to Acta number 119, which is published in the Congress Gazette number 424 of July 17, 2008. 2008.

3.13. According to a report of substantiation by the Secretary General of the Senate of the Republic[25], in plenary session held on June 19, 2008 (Minutes number 58), the conciliation report presented by the Accidental Mediation Commission, prior to its announcement in the ordinary plenary session on June 18, 2008, according to Acta number 57, published in the Congress Gazette number 564 August 29, 2008[26].

3.14. Through its own initiative dated June 24, 2008, received at the Administrative Department of the Presidency of the Republic on 9 the same year, the Secretary General of the Senate of the Republic referred the Bill to the President of the Republic for his executive sanction[27].

3.15. Through its own initiative dated July 15, 2008, the bill was returned by the National Government to the then President of the Senate of the Republic, without the corresponding executive sanction, for objections of unconstitutionality. The letter was received at that Corporation on 16, 2008[28]. The objections are published in the Congress Gazette number 473 of July 30, 2008[29].

3.16. By letter dated December 9, 2008, Senators Nestor Ivan Moreno Rojas and Carlos Julio González V. and the Representatives Marino Paz Ospina, Jaime Restrepo Cuartas and Julian Silva Meche, presented a report on the objections. government to the bill, in which they requested their rejection[30]. This report appears published in the Congress Gacetas numbers 914 of December 9, 2008[31] and 266 of April 30, 2009[32].

3.17. According to a report of substantiation signed by the Secretary General of the Senate of the Republic, the previous report was considered and approved by the Plenary of the Senate on December 10, 2008 (Acta number 34, published in the Congress Gazette number 207 of April 15, 2009[33]), prior to its announcement at the plenary session on December 9 of the same year, according to Acta 33, published in the Congress Gazette number 149 of March 19, 2009[34].

3.18. Dismissed the objections by the Senate of the Republic, by trade dated December 23, 2008, received at this Judicial Corporation on January 26, 2009, the President of the Senate of the Republic referred to the Court the to decide on its exequability[35].

3.19. According to the statement of substantiation signed by the Secretary General of the House of Representatives36], in compliance with Auto Number 063 of 10 February 2009 of the Constitutional Court, that legislative corporation considered and approved the report of objections at its plenary session held on May 12, 2009 (Act 176, published in the Congress Gazette number 650 of July 30, 2009[37]), prior to its announcement in the plenary session held on May 7 of the same year, according to the 175 minutes published in the Gazette of Congress number 567 of July 10, 2009[38].

3.20. The initial Chief Judge, Mauricio González Cuervo, proposed a self-order of January 28, 2009, through which he knew about the government objections and asked the General Secretariat of the Senate of the Republic and the House of Representatives The representatives of the representatives of the representatives of the representatives of the representatives of the representatives of the representatives of the representatives of the representatives of the representatives of the representatives of the European Union and the The Head of the Law Section of the Senate of the Republic, by trade of 2 February 2009, sent the requested evidence.

3.21. The Full Room of the Constitutional Court, by order number 063 of February 10, 2009, ordered to return " the bill number 218 of 2007 Senate, 309 of 2007 House, to the President of the House of Representatives, for the Plenary The approval procedure of the Presidential Objections Report, as required by Article 167 of the Charter, will not be decided as long as required.

3.22. By trade of May 14, 2009, the Secretary General of the Senate of the Republic referred to the bill of law " including the approval of the report of presidential objections in the Plenary Session of the House of Representatives. 12 May 2009 ". However, it did not include the copy of the Congress Gazette in which the objections report was published before the House of Representatives, as well as the minutes of the session in which it was approved, or the report of approval, with the respective certifications on dates, quorum, announcements and results of the vote.

3.23. In trades dated June 30, July 21, August 26, and September 30, 2009, the Judge Substantiator Ordered the General Secretariat of the House of Representatives to make the minutes of the plenary sessions the respective approval constances and the gazettes in which they were published. By means of offices of 7 July, 11 August, 31 August 2009, 2 December 2009, and finally, 29 April 2010, the General Secretariat of the Chamber referred the required information to this Corporation.

3.24. On October 6, 2009, the Chief Judge, Mauricio González Cuervo, indicated his impediment to studying in depth the process of the reference, which was accepted in session of the Plena Room held on October 7, 2009 and was The now rapporteur Dr. Jorge Ignacio Pretelt Chaljub has been drawn as a Substantive Magistrate[39].

4. CONTENT OF GOVERNMENT OBJECTIONS

4.1. By means of communication of 15 July 2008, the President of the Republic, with the signature of the Ministers of Finance and Public Credit and Social Protection, formally presented a memorial of governmental objections for unconstitutionality. with respect to the paragraph of Article 2o of the bill No. 218 of 2007 Senate, 309 of 2007, House, establishing guidelines for the development of Telehealth in Colombia, [40] objections that were declared unfounded by the Senate and House plenaries. These objections were raised as follows:

4.2. Estimates the National Government that the paragraph of article 2 of the bill violates article 48 of the Political Constitution[41].

4.3. To state the reasons for this constitutional violation, the Government recalls that the paragraph that objects to the bill incorporates the rules of Laws 1122 and 1151 of 2007, concerning the Telehealth and Telemedicine. In particular, it refers to article 6or Act 1151 of 2007 and paragraph 2 of article 26 of Law 1122 of the same year[42].

States that " is not financially viable that, without technical support, resources are allocated (0.3% of the UPC of both the Contributory and the subsidized Regime)

for the financing of Telemedicine activities, without consideration or assessment of their suitability in relation to the other alternatives of health service delivery, and without regard to the necessary costs for that service ". It adds that when resources are allocated for the financing of a few services, without regard to those others that are left unfunded, and without addressing criteria of universality, solidarity, efficiency and effectiveness, He does not know what is foreseen in article 48 of the Political Constitution, according to which Social Security is a public service that will be provided in accordance with these principles.

the other hand, in the Government's view, the allocation of Social Security resources for an activity that does not correspond to the insurance of the population or the direct provision of the health service ignores the prohibition to refers to the 5o point in the same top 48 article, according to which " will not be able to allocate or use the resources of the Security institutions Social for purposes other than her ". In addition, the special destination of the parafiscal resources of the aforementioned Health System is also unknown, since " the resources that citizens contribute to their own health would be diverted to a private law person (the national entity that agremia the municipalities and districts) for a purpose other than that for which the resources are provided ". Similarly, with respect to the subsidized regime, the project mandates "a participation of national income" in favor of a person of private law who agremia territorial entities. Finally, the Government denounces that " the law of Law 1155 of 2007 that is incorporated in the text of this bill, contemplates the inspection, surveillance and control so that the resources are transfer to the entity that agremia the territorial entities, but does not allow the supervisory entity to interfere in the management of these resources ". In this way, the reference to Law 1151 of 2007 conmine the State " to use all the mechanisms of supervision to ensure that a particular person can receive public income for develop activities that are not part of their social object and do so without any supervision, which they violate in article 365 of the Political Constitution, in accordance with article 189 numeral 22, al allow a portion of the resources to be funded by the public health service to be left out of their control and surveillance ".

In addition to the above, it says the statement of objections that the objecting paragraph ignores that the value of the UPC that is recognized to the EPS must be defined by the National Council of Social Security in Health (and in the future by the National Commission of Social security in health), according to technical and scientific criteria, which is only possible if such decisions are taken by the legally competent authorities. In this sense, a percentage (0.3% of the Payment Per Capitation Unit) of the Social Security System resources in Health to finance Telemedicine services, generates "inflexibility in the allocation of these resources". resources ".

In short, it says that government that " this paragraph, like the content in article 6or Law 1151 of 2007, superimpose the service of Telemedicine to the correct and complete financing of the provision of health services of the members of the Contributory And Subsidized Scheme in relation to other alternatives which could be more cost-effective and allocates resources of the UPC without considering the criteria to be applied for the definition of the services which are most convenient to include in the services " . In this way, the Committee on Health Regulation (CRES), and currently the National Council for Social Security in Health, is left with no possibility of making adjustments to the Mandatory Health Plan (POS) or the UPC, as required by the affiliated population.

Therefore, the objectionable paragraph, says the Government, does not know the items 48, 49, 151, 154, 189, 209, 341, 365 and 366 of the Political Constitution.

5. INSISTENCE OF THE CONGRESS OF THE REPUBLIC

5.1. The boards of the Senate of the Republic and the House of Representatives appointed as rapporteurs the report on the government objections to the Senators Nestor Ivan Moreno Rojas and Carlos Julio Gonzalez V. and the Representatives of the Representatives of the Representatives of the Marine Peace Ospina, Jaime Restrepo, and Julian Silva Meche, who presented a joint report on December 9, 2008, in the sense of not accepting the government's objections to the unconstitutionality. The reasons they supported are the following:

5.2. States the objections report, which the commission appointed to study them detected that in Judgment C-714 of 2008[43] this Judicial Corporation settled the demand for partial unconstitutionality directed-among other provisions-against paragraph 23 of article 6, paragraph 3.3or Law 1151 of 2007, "for which the 2006-2010 National Development Plan is issued" [44]. States that in that providence the Court is pronounced "in the face of the charge related to the supposed destination of social security resources for purposes other than it", concluding that Telemedicine is a concept relating to useful activities and services necessary for the provision of health services, which is why it is included in the concept of Social Security in Health.

5.3. In the same way, the report of objections says that in the same sentence above mentioned, this Judicial Corporation referred to the possible violation of the article 48 above, due to the fact that the Law on charges ordered that Social Security resources be transferred to an entity governed by private law (the Colombian Federation of Municipalities) in order for it to administer them in order to cover expenses incurred by the provision of Telehealth services. He then recalled the report that said that such a transfer of resources, for those purposes, did not contradict the Constitution, but that in any case these activities had to be carried out through the institutions of the Health (IPS) or companies specialized in the provision of this class of services, in both cases subject to state inspection and surveillance through the National Superintendence of Health and the Comptroller General of the Republic; in such a virtue, the The constitutionality of the provision was conditioned in the previous sense.

5.4. Finally, the objections report refers to the government's claim that the allocation of 0.3% of the Contributive and subsidized UPC for the financing of Telemedicine activities generates a fiscal impact that defunds the Health service delivery and leave the National Health Insurance Commission with no possibility of making adjustments to the POS and the value of the UPC that are necessary. In this regard, the Congress has countered this argument, pointing out that "through TELEMEDICINE, the use of scarce resources for the prevention and delivery of health services, breaking access barriers, can be rationalized. that the current system has not been able to bring down and that millions of Colombians are deprived of their health. And, retaking of the aforementioned C-714 statement of 2008, concludes that Telemedicine is another resource in the service of the Social Security System in Health that, within the principles of efficiency, Universality, solidarity, integrality, unity and participation, contributes to achieving the access of the entire population to services of quality and relevance. Service to be financed by the UPC, so it does not cause disruption to the balance of the Public Investment plan.

Thus, considering that the government objections focus exclusively on the referral that the proposed bill makes to provisions of Law 1151 of 2007, in respect of which it is The judicial corporation has already defined its exilibility, the Congress concludes that such reproaches of unconstitutionality are completely distorted.

6. CITIZEN INTERVENTION

According to the report of the General Secretariat of this Corporation, during the term of the list, only Juan Manuel Diaz-Granados Ortiz, a citizen of the Colombian Association of Colombian Companies of Integral Medicine, ACEMI.

In the case of the intervener citizen, in the draft law objecting " guidelines are established for the development of the Telehealth in Colombia, without preevaluating the destination of social security resources. for the effect, contributes to an adequate and efficient utilization of those resources, as required by Articles 48 and 49 of the Constitution Policy and the principle of efficiency enshrined by the legislator in the Article 2or Act 100 of 1993 ". Additionally, it is not assessed whether insurers and service providers have administrative and financial capacity to offer within their portfolios the Telemedicine as a service mode, not if the delivery of the same will affect the efficiency of the EPS in the contributory and subsidized systems.

" 3.3.1 Improving accessibility to health services and the state's response capacity to emergencies and disasters.

The intervener estimates that " the allocation of resources of the Payment by Capitation Unit (UPC) for the provision of telemedicine services, disfinances the provision of health services. In this sense, the measure would force to increase the contributions or to reduce the contents of the Mandatory Health Plan (POS) which clashes with the concept of better utilization of the economic resources so that the social security in health is provided in an appropriate, timely and sufficient manner ". In its opinion, the above is contrary to the principle of efficiency of social security, for which it states that it is necessary that, prior to the approval of the bill on the development of the Telehealth in Colombia, it be assessed whether to allocate resources of Social security for its development and support is supported by the efficient use of Social Security resources in Health.

7. CONCEPT OF THE NATION ' S ATTORNEY GENERAL

7.1. The Attorney General of the Nation, Dr. Alejandro Ordonez Maldonado, intervened in the legal opportunity provided by the Attorney General's Office. Law number 218 of 2007 Senate, 309 of 2007 House, "by which the guidelines for the development of the Telehealth in Colombia are established". As the basis of this request, the following arguments were presented:

7.2. As a preliminary request, the tax court asks the Constitutional Court " exercise its evidentiary function to specify the exact dates in which Bill 218 of 2007, Senate, 309 of 2007, House, was received in the Presidency of the Republic and returned to the Congress of the Republic, to determine whether the President of the Republic exercised his power to object to the Draft Law within the constitutional terms established for it (Political Charter, Article 166) ". The foregoing as to " in the copy of received in the Presidency of the Republic that works on the record of the content of the presidential objections of the reference is not observed the date of received. The same is true in relation to the letter of objections presented by the President of the Republic, according to Folios 10 to 13 and 15 to 18 of the file submitted to the Attorney General of the Nation by the President of the Senate. Republic ". He adds that such an accuracy is relevant, because the office of referral to the Casa de Narino signed by the Secretary General of the Senate of the Republic is dated 24 June 2008 and the government objections were based on the Congress of the Republic by letter dated July 15, 2008 and published in the Official Journal number 47052 of 16 July 2008; thus, given that, " in the present case the President of the Republic only had six (6) days to object to the Indicated Bill because it consists of 12 articles, if The Constitutional Court must declare that the president made use of that power extemporaneously, the Constitutional Court must declare the same impropriety for lack of competence and, consequently, order the sanction of the relevant law in the terms of the which was approved by the Congress of the Republic ".

Likewise, the Attorney General states that the Court should verify whether the approval of the report of the government objections by the House of Representatives was actually given, because the file does not appear to be certified. issued by the secretary of that legislative chamber.

7.3. However, the previous questions, the tax view goes into the material examination of the government objections, and in this regard he points out that the same must be considered unfounded " because with respect to his The Constitutional Court has already stated its exequability ".

Certainly, explains the tax concept, that " the contested normative content was the subject of ordinary procedural control by the Constitutional Court by way of the C-714 judgment of 2008, declaring the content of the 2007 Law 1151 on telemedicine and charges similar to those that were formulated by the President "; adds that the content of the paragraph Article 2 of the Proposed Bill " "Self-identity and independent in the face of the future law, so any questioning that you want to carry out against those norms must be done by the way of the ordinary demand of constitutionality". Highlights that the object of the paragraph is to go to the regulatory referral technique " for the purposes of applying in due form the definitions of telehealth, telemedicine and teleeducation in health, contained in Article 2 of the Bill in relation to what is established in this respect in Laws 1122 and 1151 of 2007 ".

7.4. Additionally, the Public Ministry rules out the objection that the reproach rule prevents surveillance and control over the resources for the Telehealth, more when the constitutionality of the Law 1151 of 2007 as regards Telemedicine was conditioned precisely on the existence of such governmental controls, as in the resolutive part of the aforementioned Judgment C- 714 2008 was said to be exequible item 23 of the numeral 3.3 and the numeral 3.3.1 of the article 6or Act 1151 of 2007, " on the understanding that the national entity that agremia the Colombian municipalities and districts will provide the activities referred to in these rules, through IPS health service providers, or specialised companies which are duly constituted and subject to all the controls which are normally applicable to persons and entities authorised to provide health services and those which collect or administer parafiscal resources ".

Based on the foregoing considerations, the tax court asks the Constitutional Court to declare unfounded the governmental objections that are the subject of analysis within the present process.

8. CONSTITUTIONAL LACORTE CONSIDERATIONS

8.1. COMPETITION

This Corporation is competent to hear about the government objections to unconstitutionality presented by the President of the Republic against the paragraph of Article 2 of the bill No. 218 of 2007-Senate-, 309 of 2007 -Camara- "by which the guidelines for the development of the Telehealth in Colombia"are established, in accordance with the provisions of Articles 167 and 241-8 of the Political Constitution.

8.2. VERIFICATION OF THE CONSTITUTIONALITY OF THE PROCESSING OF OBJECTIONS

As constitutional case law has pointed out, " the examination of form in the framework of presidential objections should be limited to the processing of the objections themselves and not to the law object[45]. The procedure for the approval of the law is therefore open to actions of unconstitutionality for vices so that they can be presented within the year following their enactment[46]" [47].

8.3. THE PROCESS OF GOVERNMENTAL OBJECTIONS AND THE INSISTENCE OF THE CONGRESS OF THE REPUBLIC.

8.3.1. Opportunity for objections.

8.3.1.1. As outlined above, the draft law of the reference was discussed and approved in the first debate at the session of the Sixth Commission of the Senate of the Republic, held on the day May 23, 2007[48]. project was discussed and approved in the plenary session of the Senate of the Republic that took place on 14, 2007,stated in the Minutes number 66 of that date, published in the Congress Gazette 415 of 2007. For its part, the Sixth Committee of the House of Representatives discussed and approved the bill during the session of May 20, 2008, contained in the 29th Act corresponding to that meeting, which appears published in the I_aj">Congress Gazette number 844, 2008, and then passed in the plenary session of that House held on June 10, 2008[49]. Later, in plenary session of the Senate of the Republic (Minutes number 58) and of the House of Representatives (Act number 120) held on 19, 2008, the report of conciliation was considered and approved presented by the Accidental Commission of Mediation.

8.3.1.2. As was also said earlier, through its own office dated June 24, 2008, received at the Administrative Department of the Presidency of the Republic on 9 the same year, the Secretary General of the Senate of the Republic referred the bill to the President of the Republic for his executive sanction[50].

8.3.1.3. Through its own initiative received on 16, 2008,bill was returned by the National Government to the President of the Senate of the Republic, without the corresponding executive sanction, due to objections of unconstitutionality[51].

8.3.1.4. Pursuant to article 166 of the Political Constitution, the Government has six (6) business days[52] and complete to return with objections any project that does not have more than twenty articles. Bill No. 218 of 2007 Senate, 309 of 2007 House, has twelve (12) articles, so in application of the constitutional precept, the Government had up to six (6) working days to file objections.

8.3.1.5. The bill was received at the Presidency of the Republic on July 9, 2008. As these are complete days, the 6-day term should start counting from July 10. The lapse for the filing of the objections would expire on July 17. Thus complying with the provisions of Article 166 Superior, as they were received at the Presidency of the Senate of the Republic on 16 July 2008.

Likewise, in compliance with the above and being within the constitutional term, the Presidency of the Republic of the Republic published the draft object at that time on the Official Journal number 47,052 of 16 July 2008. The full text of the objections is published in the Official Journal of the European Union.

8.3.1.6. Based on the foregoing considerations, the Court concludes that the government objections to the draft law of the reference were timely and published.

8.3.2. Procedure for discussion and approval of objections.

8.3.2.1. As already mentioned, the text of the objections was received at the Presidency of the Senate of the Republic on 16, 2008.was published in the Congress Gazette number 473 of July 30, 2008. 2008. The sending of the governmental objections to the Presidency of the Senate of the Republic to be studied by the plenaries offers no qualms of unconstitutionality, as has been admitted by this Corporation, " as this is imposed Since the Constitutional Court declared the aside from article 179 of the Law 5th of 1992 that required the return, not to the plenary, but to the permanent constitutional commission of the chambers, the partial objections to bills " [53].

8.3.2.2. By appointing the Senate and House boards, the accidental commission charged with making the study and issuing a concept on government objections was made up of Senators Nestor Ivan Moreno Rojas and Carlos Julio Gonzalez V. and Representatives Marino Paz Ospina, Jaime Restrepo Cuartas, and Julian Silva Meche.

8.3.2.3. The publication of the report of government objections to the bill of reference in the Senate of the Republic and in the House of Representatives was made in the congressional gazettes numbers 914 of 9 December 2008 and 266 of April 30, 2009, respectively.

8.3.2.4. The announcement of the vote on the report of the government objections in the Senate of the Republic was made at the plenary session of the day December 9. This is stated in minutes 33 of that same date, published in the Congress Gazette number 149 of March 19, 2009[54]. The text of the announcement is as follows:

" On the instructions of the Presidency and in accordance with Legislative Act number 01 of 2003, the Secretariat announces the projects to be discussed and approved at next session.

If Mr. President, projects to discuss and vote at the next Plenary Session.

(...)

Project with Object Report

Bill 218 of 2007 Senate, 309 of 2007 House, by which the guidelines for the development of the Telehealth in Colombia are established and request for approval of the reconciled text " [55]

And at the end of the session it reads:

" Being 10:45 p. m., the Presidency lifts the session and convenes for the day Wednesday 10 December 2008, at 12:00 m. ".

8.3.2.5. In effect, the objections report to the Senate of the Republic was approved at the following session, Wednesday December 10, 2008, as stated in minutes 34 of the same date, published in the I_aj">Congress Gazette number 207 of April 15, 2009[56]The report was approved by the majorities required in the Constitution and the Congress ' Rules of Procedure, "with the corresponding constitutional quorum" [57]. This approval was given in the following terms:

" Bill 218 of 2007 Senate, 309 of 2007 House, by which the guidelines for the development of the Telehealth in Colombia are established and request for approval of the reconciled text.

The Presidency grants the use of the word to the honorable Senator Nestor Ivan Moreno Rojas.

The words of the honorable Senator Nestor Ivan Moreno Rojas.

With the coming of the Presidency, the honorable Senator Nestor Ivan Moreno Rojas, who is reading the report for the second debate presented by the Accidental Commission appointed by the Presidency, is using the word to study The discrepancies made by the Executive Branch of Bill 218 of 2007 Senate, 309 of 2007, by which the guidelines for the development of the Telehealth in Colombia and the request for approval of the reconciled text are established.

Thank you President, this bill number 218 of 2007 Senate, 309 of 2007 House, establishes the guidelines for the development of the Telehealth in Colombia, for which a Accidental Commission of Senator Carlos was constituted Julio González, from 3 Representatives to the House and, to me, was also part of this Accidental Commission in which a judicious analysis was made of the case law that exists as is the case of the href="c-714_2008.html#INICIO"> 714 of July 16, 2008, with respect to the application of Article 6o of the Development Plan number 3.3 in which it has a direct relation to one of the articles in question, on which the National Government has considered that the corresponding objections should be submitted.

This ruling is very clear to the extent that it gives viability to those instruments that exist today in communications to the service of medicine, as is telemedicine in order to guarantee the proper delivery of the service health care, the possibility of reaching those retired places of municipalities, that do not have the way to have a specialist in different areas and that through the medicine with the platforms of the communications technology, They can have a real-time communication with the specialized centers anywhere This is not only going to allow us to be more precise in the diagnoses, but to avoid a large number of deaths in this country, and to achieve the healing of a large number of Colombians and Colombians.

That is why this Commission considers that the objections cannot be accepted and therefore in the report that is duly published in the Gazette of the Congress, the proposal in which this Corporation is requested is presented. " To declare unfounded the presidential objections of Senate Bill 218 of 2007, 309 of the House, for which the guidelines for the development of the Telehealth in Colombia are established, insisting on their approval obviously with the text already reconciled by the Senate and the House of Representatives. This report rests with the Secretariat and is duly published and I would therefore be grateful if we could put it into consideration.

The Presidency submits to the plenary the report read and, closed its discussion postpones its approval, until the decision-making quorum is constituted.

(...)

By Secretariat is reported to have registered a decision quorum.

Read and closed the discussion of the report in which the objections presented by the Executive to Bill 218 of 2007 Senate, 309 of 2007 House, are declared unfounded, the Presidency submits it to consideration of the plenum, and it gives it its approval " [58]. (Room Refers).

8.3.2.6. Dismissed the objections by the Senate of the Republic, by trade dated December 23, 2008, received at this Judicial Corporation on January 26, 2009, the President of the Senate of the Republic referred to the Court the to decide on its exilibility, without the report of objections being previously approved by the House of Representatives.

By virtue of the above, the Plena Chamber of the Constitutional Court, by order number 063 of 2009 of February 10, 2009, ordered to return " the bill number 218 of 2007 Senate - 309 of 2007 Chamber, to the Speaker of the House of Representatives, for the Plenary to take up the approval of the Presidential Objections Report, as required by article 167 of the Letter ", abstaining from deciding while required[59].

In compliance with what was ordered by this Corporation, by trade on May 14, 2009, the Secretary General of the Senate of the Republic referred to the file of the bill " including the approval of the Presidential objections in plenary session of the House of Representatives on May 12, 2009 "

.

8.3.2.7. The announcement of the vote on the report of the government objections in the House of Representatives was made at the plenary session of the day 7 May 2009. This is in the minutes number 175 of that same date, published in the Congress Gazette number 567 of July 10, 2009[60]. The text of the announcement is as follows:

" The following projects are announced for the Plenary Session of the day May 12, 2009 or for the next plenary session in which bills or legislative acts are debated, according to the legislative act number 1 of July 3, 2003:

(...)

Report on objections, Bill 309 of 2007 House, 218 of 2007 Senate, laying down guidelines for the development of Telehealth in Colombia. " [61]

8.3.2.8. Effectively, the objections report to the House of Representatives was approved[62] in session on 12 May 2009, as stated in the minutes number 176 of the same date, published in Gazette number 650 of July 30, 2009[63]. The approval of the report was done in the following terms:

" Report on objections. Bill 309 of 2007 House, 218 of 2007 Senate, for which the guidelines for the development of the Telehealth in Colombia are established. Giving compliance to Auto number 063 of February 10, 2009, offered by the honorable Constitutional Court. Published in the Congress Gazette number 266 of 2009 announced on May 7, 2009 and which it says.

"Report of presidential objections to the bill, which establishes guidelines for the development of the Telehealth in Colombia and request for approval of the reconciled text."

The Secretariat informs the honorable representatives that this bill was sent to the Constitutional Court by the Senate of the Republic, without having been dealt with the objections in the House.

For that reason, the Constitutional Court, by means of a car, refrained from deciding on the aforementioned objections and sent it to the House so that the Chamber would fulfill the procedure of giving the aforementioned study and approval to the aforementioned objections. In the Senate, he was sent directly without waiting for the House to evacuate this procedural point.

Proposition. Request to the plenaries of the Corporation to declare unfounded the presidential objections to the bill laying down the guidelines for the development of the Telehealth in Colombia. Firman Nestor Ivan Moreno, Carlos Julio Gonzalez, Marino Paz, Jaime Restrepo and Julian Silva.

report has been read, Mr. President, giving compliance to the order of the Constitutional Court on February 10, 2009.

House Speaker, Dr. German Varon Cotrino:

The report presented by the committee is considered, Dr. Morales has the floor.

Honorable Rep. Jorge Ignacio Morales Gil:

Mr. President thank you very much. Today we had in the Seventh House Committee, a debate on Telemedicine, and unfortunately despite having been passed this bill and being ratified in the Constitutional Court's Judgment T- 714 , The Ministry of Social Protection, took the determination not to implement the bill.

Hopefully, this issue of Telehealth, which is fundamental for Colombia, will not suffer the same end. At this time, we believe that these projects must be supported, but we have to leave the record that the government legislates at the same time, violates the law's normativity permanently at its whim, as is the National Development Plan, which has It was totally unknown to the Minister of Social Protection, hiring with other companies and directly, taking silver out of his account of the ECAT in order not to comply with the law.

El ComercioWe as Parliamentarians have to leave the record, that the law here is selective, that the sentences of the Constitutional Court are passed through the strip, we have to defend in this case the Telehealth, which does not suffer the same end as Telemedicine is suffering. Thank you President.

House Speaker, Dr. German Varon Cotrino:

report is submitted to the plenary, and its discussion is opened, announced that it will be closed, is closed, does the Plenary approve?

Secretary General of the House of Representatives, Dr. Jesus Alfonso Rodriguez Camargo:

the report Mr. President. " [64] (Out-of-Text Negrels).

8.3.2.9. Likewise, the Court finds that the formal requirements required for the announcement of the vote are met. In this respect, Article 8or Legislative Act 01 of 2003 provides the following:

" No bill will be put to a vote in session other than that previously announced. The notice that a project will be put to the vote will be given by the chair of each chamber or commission in session other than the one in which the vote will be held. "

According to the previous provision, and with the interpretation that has been made by the case law, the announcement to which she refers seeks to avoid the surprise vote of the bills, in order to ensure that the Congress knows about in advance the content of the cases to be decided in subsequent sessions[65]. According to the court, the purpose of the announcement is to "allow the Congressmen to know in advance which bills or reports of presidential objections will be put to the vote, assuming full knowledge of them." and avoiding, therefore, that they are caught with bad votes " [66]. The Court has also explained that the announcement "provides citizens and social organizations that have an interest in influencing the formation of the law and the fate of the law, exercising their rights to participate in political participation. (article 40 C. P.) in order to influence the outcome of the vote, which is important in order to make the principle of participatory democracy effective (articles 1or and 3or C.P.) " [67].

The Court has pointed out that the content of Article 8or Legislative Act 01 of 2003 shows that the requirements of the notice are as follows:

1. The ad must be present in the vote on every bill.

2. The announcement must be made by the chair of the chamber or the committee in a separate session prior to the vote on the draft.

3. The date of the vote must be true, that is to say, determined or, at least, determinable.

4. A bill cannot be voted on in a session other than that for which it has been announced. [68]

In the case that takes its attention, the Court finds that the announcements made for the vote on the government objections met the stated requirements.

8.3.2.10. As said, the report on government objections was passed in the Senate on December 10, 2008 and in the House on May 12, 2009. Since the text of the report is identical, the Court finds the requirement of bicameral coincidence, imposed by constitutional article 167 , fulfilled.

" Art. 167 (...) Except for the case in which the project is objectionable as unconstitutional. In such an event, if the Cameras insist, the project will move to the Constitutional Court so that she, within six days of the following decision, will decide on her exequability. "

The higher standard requires matching in the congressional position over government objections, so this requirement is also understood to be fulfilled.

8.3.2.11. The constitutional jurisprudence has also indicated that Congress must deal with government objections within a period of less than two legislatures, in accordance with the requirement laid down in Article 162 constitutional, which confers the same term for the processing of the bill. On the particular, the Court has held:

" The constitutional doctrine established by this Corporation regarding the temporary limit that the Chambers have for the presentation of the insistences to the objections presented by the President of the Republic to a " The bill has stated that the term with which the Congress of the Republic counts in order to rule on the presidential objections cannot be in any case higher than the term for which the law is formed. In that sense, the Court has recently stated that ' [d] and compliance with article 162 above the presidential objections still draft law must be estimated or rejected by the Congress within two legislatures. It ended that it must be taken into account in addition to that of the first two legislatures that Congress had to issue the text that the president objected to. In short, an extensive interpretation of article 162 of the Constitution allows us to state that Congress has at most two legislatures to make a law, and two legislatures. "[69]. [70].

Government objections to the reference project were published in the Official Journal number 47,052 of 16 July 2008. The reports on government objections were approved by the Senate and the House on 10 December 2008 and 12 May 2009 respectively. The reports were received at the Constitutional Court on January 26 and May 14, 2009. All of the above indicates that the insistence of the Congress was produced in less than two legislatures, so this requirement is fulfilled.

8.3.2.12. According to the foregoing, the Chamber warns that both the Senate of the Republic and the House of Representatives are satisfied with the requirements imposed by the Political Charter for the processing of the analysis. Thus, (i) the advertising requirement was met, to the extent that the report was published in the Congress Gazette prior to the initiation of the debate (article 157, Act 5th/92); (ii) the announcement that it treats the final paragraph of article 160 C.P. was done in session before the the date on which the discussion and vote on the report were taken, the vote being verified on the date determined by the notice; and (iii) the approval of the objections report had the required constitutional majorities, according to the certification by the Secretaries-General in the above-mentioned substantiation reports and the procedure developed during the sessions. These are the respective plenaries, which were mentioned.

8.3.2.13. As a last point, it should be noted that the constitutional case law has estimated that " the congressional insistence on presidential objections must meet a minimum of argumentative support. Without it being necessary to exhaust a thorough conviction about the reasons that lead Congress to disagree with the government, the Court has said that it cannot advance a proper constitutionality study if the Chambers do not provide Minimum trial elements that allow evidence of a legal opposition between Congress and the President " [71]. Thus, the Chamber passes to verify whether this requirement of procedure, relative to the insistence of the Congress support at a minimum of support, is met at this opportunity.

8.3.2.14. In the case in its attention, the Court considers that in respect of the objections put forward by the Government against the paragraph of Article 2o of Bill 218 of 2007-Senate-, 309 of 2007-House-" ", the insistence of the Congress is based on an argument that, although brief, is sufficient as it provides a minimum of reasons for the rejection of the government objections.

Certainly, as far as Congress ' insistence on the objection is concerned, the Court has elements of judgment to verify that there is real opposition between Congress and the President, legally supported, in the on the constitutionality of this provision. In fact, while the Government considers that (i) the allocation of 0.3% of the Payment Unit by Capitation of the contributory and subsidized schemes for the financing of Telemedicine activities, without consideration or evaluation of its The principles of efficiency, universality and solidarity referred to in Article 48 of the European Union's health services are in breach of the other alternatives for the provision of health services. Political Constitution, and (ii) in addition, the transfer of social security resources to a In the case of a person under private law to incur expenses for an activity which does not correspond to the insurance of the population or to the direct provision of the health service, the constitutional prohibition of using the resources of security The Congress believes that these accusations of unconstitutionality have already been analyzed by this Judicial Corporation in the judgment. C-714 , 2008, when you analyzed the targeted demand against the content of the 2007 Law 1151 on telemedicine, which is charged on charges similar to those on which the Government has now raised objections.

Thus, the Court finds the requirement that the insistence of the Congress be supported by a minimum of argumentative support. In such a virtue, it moves to make the material examination of the objections.

8.4. Material analysis of the government objections raised in relation to the paragraph of Article 2o of Bill 218 of 2007-Senado-, 309 of 2007-House-, " laying down guidelines for development of the Telehealth in Colombia "

8.4.1. The legal problem to be studied by the Court:

8.4.1.1. As in the history of this providence, the National Government objected to the paragraph of Article 2 of the draft law of the reference, according to which it must be taken as the text of the law that comes to be sanctioned. provisions that on Telehealth are included in Laws 1151 and 1122 of 2007, without detriment to the approval of the National Development Plan that includes 0.3 (%) of the UPC for Telemedicine services.

As it was seen, the Government bases its objection on three considerations: first, it argues that when the objectionable paragraph refers, in particular, to Article 6or Law 1151 of 2007 and to the paragraph 2 of Article 26 of Law 1122 of the same year, does not know the superior article 48 , since it is not financially viable that, without technical supports and without Consideration and assessment of convenience in relation to other alternatives, Resources equivalent to 0.3% of the UPC of both the Contributory and the subsidized regime, for the financing of the activities of Telemedicine. This sort of destination is opposed, says the executive, to the principles of universality, solidarity, efficiency and effectiveness referred to in the aforementioned article 48 of the Constitution. In addition, the competent authorities are left with no financial means to make adjustments to the Mandatory Health Plan-or in the Pay per Capitation Unit -UPC-to the extent required by the affiliated population.

Second, it says the letter of objections that the paragraph of Article 2 of the draft law, when referring to the laws mentioned therein, allows the resources of the Social Security in Health to be destined to an activity that does not correspond the health service's direct delivery or delivery, which does not know the prohibition of paragraph 5or of the same article 48 above, according to which ) " shall not be used or used by the resources of the institutions of the Security Social for purposes other than her ". Furthermore, as soon as these resources are administered by a private law entity (the Colombian Federation of Municipalities) and aimed at fulfilling a purpose other than that for which they were contributed, the special destination of parafiscal resources.

Third, the government objection adduces that the transfer of public resources to the aforementioned private legal entity allows a portion of the resources to be financed by the public health service to be left to the margin of an appropriate monitoring and surveillance system.

8.4.1.2. The Congress responds to these objections by stating that the same reproaches of unconstitutionality were analyzed by this Corporation when in Judgment C-714 of 200872 it settled the lawsuit filed against Article 6or Law 1151 of 2007, "for which the 2006-2010 National Development Plan is issued". Occasion in which the Court declared the the constitutionality of the standard analysed, conditional on the activities of Telemedicine was met through the Health Care Institutions (IPS-) or from companies specialized in the provision of this kind of services, in both cases subject to state inspection and surveillance through the Superintendence. National of Health and the Comptroller General of the Republic.

8.4.1.3. The only citizen intervention that occurred in the process helps the government's objections, stating that the Congress did not evaluate (i) whether the destination of social security resources for the Telehealth contributes to an adequate and efficient use of the same, as required by Articles 48 and 49 of the Political Constitution, (ii) if the insurers and pradestors of services have administrative and financial capacity to offer these services and (iii) if such resource allocation does not defund the provision of health services.

8.4.1.4. For its part, the fiscal visit supports the insistence of the Congress, because it seems to be true that the normative content questioned by the government has already been the subject of constitutional control by the C- 714 of 2008, where similar charges were analyzed for those that are now filed under the form of objections for unconstitutionality.

8.4.1.5. Thus, to analyze the objections of unconstitutionality presented on this occasion by the President of the Republic, the Court will first examine the normative scope of the paragraph now objected to, in order to determine if it agrees with the legal provisions that were examined in Judgment C-714 of 2008; if so, it will recall what is considered and resolved on that occasion, and finally determine whether the objections are justified or unfounded.

8.4.2. The normative scope of the objecting paragraph, as opposed to the legal provisions that were analyzed in the C-714 Statement of 2008.

8.4.2.1. The paragraph of Article 2o of Bill 218 of 2007-Senado-309 of 2007-House, in respect of which the President of the Republic makes objections of unconstitutionality, falls within a legislative proposal that in general seeks, as the name implies, to establish "the guidelines for the development of Telehealth in Colombia". In this sense, the bill to which it belongs, in its first article, indicates its purpose, indicating that it intends to develop the Telehealth in Colombia, " as a support to the General System of Health Social Security, under the principles of efficiency, universality, solidarity, integrality, unity, quality and the basic principles enshrined in this law. "

The second article, which is part of the objectionable paragraph, defines the notions of "Telehealth", "Telemedicine" and "Health Teleeducation". From the systematic reading of the standard, it is colige that the legislator seeks that, within the context of the Social Security System in Salud73, and in accordance with the principles that rigen74, the Telehealth understood as . This concept of Telehealth involves the activities of Telemedicine, that is, " the provision of distance health services in the components of promotion, prevention, diagnosis, treatment and rehabilitation, by professionals of the health of the use of information and communication technologies, and Teleeducation, which consists of "the use of information and telecommunications technologies for the educational practice of health at a distance". In any case, this second article gives greater importance to personalized health care, indicating that the Telehealth " does not exempt health service providers and the entities responsible for the payment of such services. services of their responsibility to prioritize the personalized delivery of health services, within the framework of the General System of Social Security in Health. "

Within this regulatory environment, the objectionable paragraph contains two prescriptions: on one side, it refers to the rules of the 2007 Laws 1151 and 1122 related to the Telemedicine concept, to indicate that the same will be "as text of this law". On the other hand, it clarifies that this regulatory referral will be made "without detriment to the approval of the National Development Plan, which includes 0.3 (%) of the UPC for Telemedicine services".

Regarding the first, that is to say of the reference to Laws 1151 and 1122 of 2007, the Court observes the following: Law 1151 of 2007, for which the National Plan is issued Development 2006-2010, in its article 6or concerning the "Description of the Main Investment Programs", in the numeral 3.3., referring to the "Social Protection System", includes an item that is the only standard of this law on the topic of Telehealth, which is available:

" To ensure the provisions set out in paragraph 2 of Article 26 of Law 1122 of 2007, the Promotoras de Salud, EPS, of the Subsidized And Contributory Scheme, will dedicate 0.3% of the Unit of Payment by Capitation to the coordination and financing of Telemedicine services with national coverage, for both health promotion and for the attention of its affiliates; the municipalities and districts, through the institution national that the agremia, will make possible the provision of this service. Also, the National Health Superintendence will verify compliance with the provisions of this article to authorize or renew the operation of the EPS, in particular at the time of verifying their service networks ". (Negrillas out of the original).

For its part, Article 26 of Law 1122 of 2007, the only rule of this law regarding Telehealth, to which the objectionable paragraph also refers, is of the following tenor.

" Article 26. The provision of services by the Public Institutions. The provision of health services by public institutions will only be provided through State Social Enterprises (ESE) that may be formed by one or more health service providers or units. In any event, any public health service unit must be part of a State Social Enterprise, except the units for the provision of health services that are part of the industrial and commercial enterprises of the State. State and public entities whose object is not the provision of health services. In each municipality there will be an ESE or a service provider unit of an ESE.

" Paragraph 1o. When under the market conditions of their area of influence, the ESE is not financially sustainable in terms of efficiency, the territorial entities will be able to transfer resources that seek to guarantee the basic services required by the population, under the conditions and requirements laid down in the Regulation.

" Paragraph 2o. The Nation and the territorial entities will promote Telemedicine services to contribute to the prevention of chronic diseases, training and the reduction of costs and improvement of the quality and opportunity of providing services such as the case of diagnostic imaging. Special interest will have the departments of Amazonas, Casanare, Caqueta, Guaviare, Guainia, Vichada and Vaupes ". (Negrillas and underscores out of the original).

Now, the Chamber observes that as to the second prescription included in the objectionable paragraph, that is, that according to which the normative remission to Laws 1151 and 1122 2007 is done "to the detriment of the National Development Plan's approved by 0.3 (%) of the UPC for Telemedicine Services", which is actually intended by the The defendant is to reiterate the aforementioned rule contained in the National Development Plan in force until 2010. However, the Court also finds that the paragraph objected by the executive is not the only provision of the bill concerning the financing of the Telehealth, since Article 8 of the same bill, in relation to the public entities of health, notes:

" Article 8o. Resources for the development of the Telehealth. From the time of this law, up to 5% of the investment budget of the Communications Fund will be allocated. Communications, to the financing of investments required in connectivity to develop Telehealth in Public Health Institutions in Colombia, in accordance with the recommendations of the Telehealth Advisory Committee.

" Paragraph. The resources of the Communications Fund Special Administrative Unit of the Ministry of Communications, other ministries and international cooperation, will be articulated with the resources that the different actors of the General System of Social Security in Health, in accordance with current regulations, for the purposes provided for in this Article. "

Out of those provisions, the bill deals with other issues such as the creation of an advisory body to the Telehealth and its shaping and functions[75], the design of a "Connectivity Map" [76] and, under the title "Knowledge Management" refers to the mechanisms of Teleeducation.

8.4.2.2. Given the above contextual analysis of the paragraph of Article 2 of the draft law, which the National Government objected to, it is possible to conclude that the scope of the crossed-out provision of unconstitutional is to incorporate into the law the normative prescriptions contained in the 2007 laws 1151 and 1122 , specifically those that (i) order the Health Promoter Companies, EPS, of the Subsidized And Contributory Scheme, to dedicate 0.3% of the Payment Unit per Capitation to the Coordination and funding of Telemedicine services with national coverage[77], (ii) indicate that municipalities and districts, through the national entity that the agremia, will make possible the provision of this service[78], (iii) they assign to the National Health Superintendence competencies to monitor the completion of the above, and (iv) instruct the Nation and the territorial entities to promote the services of Telemedicine to contribute to the prevention of chronic diseases, training, reduced costs and improved quality and service delivery opportunity as is the case for diagnostic imaging, especially in those departments where it is most difficult to access these capabilities[79].

8.4.2.3. Similar findings provide the study of the legislative history of the contested provision. In fact, when reading the paper for the first debate in the Senate to Bill 218 of 2007-Senado-it is observed that the Congress was fully aware of the existence, for that moment, of an incipient regulatory legal framework concerning the Telemedicine in Colombia, but which wanted to complement and deepen the regulation, in order to develop Telemedicine in Colombia and articulate it to the platform of information and knowledge technologies. Certainly, in this paper the following recount is made about the regulatory framework in force for that time, specifically regarding the Telehealth:

" II. Constitutional and Legal

" ...

" (f) Law 1122 of 2007, in addition to seeking universal access by Colombians to health services, specifically in paragraph 2 of Article 26 of the services by public institutions, establishes: The Nation and the territorial entities will promote the services of Telemedicine to contribute to the prevention of chronic diseases, training and the decrease of costs and improving the quality and opportunity of service delivery as is the case with images diagnostic. Special interest will have the departments of Amazonas, Casanare, Caqueta, Guaviare, Guainia, Vichada and Vaupes;

" j) Finally, in the Development Plan Act for the period 2006-2010, it is established that in order to guarantee the provisions of paragraph 2 of Article 26 of Law 1122 of 2007, the Health-promoting companies, EPS, of the subsidized and contributory scheme, will dedicate 0.3% of the Unit of Payment for Capitation to the coordination and financing of the services of Telemedicine with national coverage, both for the promotion of health as for the attention of its affiliates; the municipalities and districts, through the national entity that the agremia, shall make possible the provision of this service. Likewise, the National Superintendency of Health will verify compliance with the provisions of this article to authorize or renew the operation of the EPS, in particular at the time of verifying its service networks. "

And on the regulatory insufficiency of Telemedicine and the need to adopt complementary norms to existing ones that will drive this policy, the same paper says:

" The legislation has not been able to adapt to the pace of development, but it has already been defined principles that serve as guidance for the implementation and development of Telemedicine, as well as resolutions by the Ministry of Social Protection, with general guidelines for its implementation, more not on its impulse and development, as a State Policy, which could contribute to improve the coverage of health services and the access of patients to quality care ".

8.4.2.4. Thus, within the context of a draft law which seeks to supplement the existing provisions relating to the Telehealth, but not to repeal them, the objecting paragraph incorporates into the text of the bill the normative prescriptions contained In 2007 Laws 1151 and 1122 relating to Telemedicine, in particular Articles 6or, numeral 3.3, paragraph 26 of Law 1151 of 2007, and article 26, paragraph 2o, of the Law 1122, 2007.

It is not enough to clarify that inclusion as part of the new law, of article 6or, numeral 3.3, paragraph 26 of Law 1151 of 2007, for which the National Development Plan 2006-2010 was issued, makes that It is a willingness to have an indefinite stay in time, overcoming its old four-year term, determined by its inclusion in the current Development Plan.

Now, given that article 6or, numeral 3.3, paragraph 26 of Act 1151 of 2007 was examined by the Court in Judgment C-714 of 2008, and that such a provision of law in its The text indicates that it was issued to guarantee the provisions of paragraph 2 of Article 26 of Law 1122 of 2007, it is necessary for the Chamber to remember what was said on that occasion.

8.4.3. The C-714 Statement of 2008.

By Statement C-714 of 2008[80] this Corporation settled the claim for directed unconstitutionality-among other provisions-against paragraph 23 of the numeral 3.3., of the article 6or and the numeral 3.3.1 of the same article in Law 1151 of 2007, "for which the 2006-2010 National Development Plan is issued". These rules provide the following:

" Article 6o Description of major investment programs

(...)

3. Poverty reduction and promotion of employment and equity

(...)

3.3 Social Protection System

(...)

23:

In order to guarantee the provisions of paragraph 2 of Article 26 of Law 1122 of 2007, the Promotoras de Salud, EPS, of the Subsidized And Contributory Scheme will dedicate 0.3% of the Unit of Payment by Capitation to the coordination and financing of Telemedicine services with national coverage, both for health promotion and for the attention of its affiliates; the municipalities and districts, through the national entity that the agremia, shall make possible the provision of this service. Likewise, the National Health Superintendence will verify compliance with the provisions of this article to authorize or renew the performance of the EPS, in particular at the time of verifying their service networks. "

(...)

" 3.3.1 Improving accessibility to health services and the state's response to emergencies and

To develop a comprehensive air transport system medicalized as part of the national strategy of improving and guaranteeing accessibility to the health services of all Colombians who are in the territory national. This system will ensure:

1. Ambulances medicalized and certified by the competent authority in Health and the Aerocvil, in terms of its competence, for the transfer of critical patients with air travel requirements according to evaluation and referral by the health system.

2. Healthy air routes from high complexity centers in health care to cover the inhabitants of distant municipalities.

3. Provide air support for health brigades in the most difficult access areas of the national territory with a minimum frequency of three times a year.

4. Support for the emergency response due to traffic accidents in the 5 regions: the Caribbean coast, the central part of the country, the west and the coffee-growing axis, Antioquia Choco, the Colombian Oriente and the Amazon.

5. Support in the impact phase in case of emergencies due to natural disasters in the country.

The entity that will be nationally agremia the Colombian municipalities will develop, organize and operate this service within the next six months from the sanction of this law. To this end, it will develop a four-year plan that will be presented to the health regulatory body and its development will be under the supervision of the Ministry of Social Protection and will be monitored by the health and aviation control agencies. Civil in the competition. This service will be financed monthly with 2% of the UPC of the Subsidized And Contributory Scheme, which receive the EPS and the special regimes with the exception of the Military Forces.

To the financing of this system will be the sectors that demand this service and that have covered these types of risks.

PARAGRAFO. To ensure the operation of this system, the Civil Aeronautics will adjust the airport operation and the other authorities will contribute to the operation of this service. "

One of the charges of unconstitutionality was that of the lack of unity of matter between the rules transcribed and the rest of the Law of the Plan for the Four-Year 2006 2010; the concrete reasons why the plaintiff estimated that the In the case of the Court of First instance, the Court of First instance held that the Court of First instance held that Court of First instance held that the Court of First which, as established in the case-law of this Court, are parafiscal resources whose purpose cannot be changed or unknown by the legislator. " It also questioned the fact that "the law has attributed the organization and operation of these services to the entity that agremia the Colombian municipalities and districts". In sum, the complainant highlighted that "these normative decisions would have no place within the limited thematic framework that the Development Plan Act can refer to."

The Court sent this accusation of unconstitutionality impropriety, considering that " the articles of article 6o on whose exilibility is now decided do not violate the principle of unity of matter in which the 158 top item, nor the content of item 339 ibid. On the contrary, it notes that the services and activities to which these rules refer are relevant, and therefore, are inserted without difficulty, in the overcoming of several of the problems explicitly raised by the legislator in relation to the issues of poverty, employment and equity, so this position would not be called to prosper ".

Now, apart from ruling out the charge for the alleged violation of the principle of unity of matter, the Court also added the following considerations around the constitutionality of the rules it examined:

"this respect, and without prejudice to reiterating the character of parafiscal contributions that these resources have in effect, as well as the impossibility of taxing them with taxes, the Court should emphasize that the allocation of these percentages of the UPC to the financing of the above mentioned services does not constitute a prohibited act to the legislator, which moreover is the organ of whose decision depends the creation of this type of contributions ".

Likewise, within the charges of unconstitutionality analyzed on this occasion, the Court examined the case concerning the alleged destination of social security resources for purposes other than that. The plaintiff considered that the articles of article 6or of Law 1151 of 2007 by the defendant allowed the destination of social security resources for purposes other than it, and questioned the management of those by a private entity, not belonging to such a system, both of which would be contrary to the provisions of paragraph 5 of Article 48 of the Political Constitution. The support of this position was constructed on the basis of the parafiscal contribution character that both the law and the case law have recognized to the Unit of Payment by Capitation (UPC), however the services of Telemedicine would be available to the generality of the population, and not only to people affiliated with the social security system.

To rule out the previous unconstitutionality charge, the Court has, among other things, the following considerations, which now need to be transcribed in extensive:

" In relation to the essence of the services whose financing is sought to guarantee through the rules here demanded, the Telemedicine has to be, according to normative definition brought by the same actor[81]' consists of " the provision of distance health services, in the components of promotion, prevention, diagnosis, treatment or rehabilitation, by health professionals using technology the information and communication, which allow them to exchange data for the purpose of facilitating the access of the population to services that present limitations of offer, access to services or both in their geographical area ".

" For its part, the so-called medicalized air transport can be defined from the activities listed in the same text of the standard demanded, which includes, among others, the service of medicalized air ambulances. for the transfer of critical patients according to assessment and referral by the health system, the realization of health brigades in areas of difficult access, the aid-transported to emergencies resulting from traffic accidents, and the support in the emergency impact phase caused by natural disasters.

As of these brief descriptions, for this corporation it is evident that these are useful activities and services, and in many cases indispensable, to make it possible to provide adequate health services, In situations where, otherwise, the latter would not fulfil their purpose of seeking to prevent diseases, their timely detection, the overcoming of emergencies involving a vital or other danger, and in general, the soon and complete restoration of the health of all the people who for some reason the have been affected.

" In this sense, the services related to Telemedicine and the medicalized air transport, whose effective delivery they pursue the demanded norms, are called to have a multiplier effect on the equitable the availability of health services by the entire population, based on the overcoming of the often insurmountable difficulties that arise from the need to move from places of difficult access and limited supply of services doctors, to the urban centers and/or specific places where the availability of such services, from the most elementary to the most specialized, that the inhabitants of the Colombian territory can get to require.

" On the other hand, for the Court it is irrelevant that the persons benefited by these services are or are not affiliated with the social security system, since it is a right of all Colombians, and the coverage of the universal is precisely one of the aspirations to which the State must be directed in accordance with the provisions of the article 48 above, through the progressive enlargement of the that.

" For all of the above, for the Court is clear that these services and activities must then be considered as an integral part of the concept of social security in health provided for in Law 100 of 1993 and the rules that develop, complement, and regulate. This is because, far from referring to activities outside the health service, it is a question of actions that will contribute to the expansion of the coverage of this service for all Colombians, which is certainly in line with the principles of universality, efficiency and solidarity that govern the social security system.

"Constantly that the financing of these services is not unrelated to the concept of social security, and that the alleged violation of the article 48 constitutional, subtracts only to analyze the entity to which the organization and guarantee of delivery of these services are responsible.

"First of all, no objection is due to the fact that these resources, which as has been accepted, have the character of a parafiscal contribution, are administered by a private entity. In this regard, the Court recalls that the usual thing in the Colombian legal tradition is that these contributions be administered by organizations representing the community of beneficiaries of the services that through the The aim of the project is to finance the contribution of private entities, which is often the case for private entities.

" As it has been peacefully accepted by the case law, both the Supreme Court and this corporation, this does not, in any way, result in the legal nature of these types of contributions, or nor to any constitutional precept. Moreover, that same case-law has emphasized that, provided that it observes the due constitutional parameters, the legislator is autonomous to regulate, in the most convenient way, all the defining elements of a determined parafiscal contribution[82].

" At the same time, as regards the applicant's demand for the funds in this contribution to be handled only by entities belonging to the social security system, it should be noted that the The restriction contained in the constitutional rule underpinning the charge under study consists in the use of "resources of the institutions of social security for purposes other than it", being the determining factor, for the purposes of not to transpose this mandate, the nature of the activities financed from these resources [83]. In this respect, and as it has been said, in the analysis of this same charge, the Court considers that the services to be financed under these rules are undoubtedly part of the concept of social security in health, which is precisely the concept that is intended to be financed by the so-called "Pay for Capitalization Unit" (UPC).

"Therefore, this corporation concludes that it is not questionable, in the face of the content of the top article 48 , that the rules demanded by the entity that is nationally agremia to the Colombian municipalities, the responsibility to organize and to put into operation the service of medicalized air transport and of telemedicine.

" Thus established the constitutionality of these precepts, it cannot be left without mention the fact that, in reason of the nature of its object and the presumed lack of experience in health activities, that it could affect the (a) the Member State of the European Union, which is responsible for organizing and operating these services, may have difficulties which may affect the frequency, quality or timeliness of such services. For these reasons, as pointed out by the complainant as an example, the regulations in force prior to this law[84] provided that only the services of telemedicine could be provided by the institutions Health Services (IPS) providers that meet certain standards and requirements.

"all of this, attention to the specialized and high-responsibility nature of these services, and to the fact that resources will be administered to prosecutors, the Court considers it necessary to condition, the exequibility of these services rules, warning that these activities must be carried out by means of the Institutions of Health Services or of companies specialized in the provision of the same, all of which will be subject to the respective control and surveillance (a) the rules governing the application of the rules of procedure The National Health Superintendence, the Comptroller General of the Republic and the Public Ministry are in place. (Refers and underscores outside the original).

8.4.4. Existence of a relevant precedent that determines that governmental objections are unfounded.

As stated above, what the National Government is specifically objecting to is the prescription contained in the paragraph of Article 2 of the bill laying down guidelines for the development of the Telehealth in Colombia, according to which the provisions on the same subject of Telehealth are included in Laws 1151 and 1122 of 2007.

Those rules, as seen, are in particular paragraph 23 of the numeral 3.3. of article 6or of Law 1151 of 2007, "for which the 2006-2010 National Development Plan is issued" which was the subject of a constitutionality study by the C-714 judgment of 2008[85], and paragraph 2 of Article 26 of Law 1122 of 2007.

In turn, referred to in paragraph 23 of article 3.3. of article 6or Act 1151 of 2007 indicates in its own text that its purpose is to " to ensure that set forth in paragraph 2 of Article 26 of Act 1122 of 2007 ", according to which the Nation and territorial entities will promote Telemedicine services.

Now, from the study that was made in the foregoing considerations of this same judgment, it is possible to establish that almost all the objections that the Government makes to the normative reference contained in the paragraph of Article 2 of the Bill under examination coincide with the unconstitutionality charges that were filed within the process that culminated in the 2008 C-714 judgment, and that were dismissed by this Corporation, as shows in the following table:

Objections
government
Charges formulated in the process that culminated with the C- 714 of 2008 Court Considerations in C-statement 714 2008
The paragraph of Article 2o of the Bill, when referring to the Telemedicine rules included in the Laws 1122 and 1151 from 2007, allows Health Social Security resources to be allocated to an activity that does not correspond to either the population securement or the direct delivery of the health service, which does not know the principles of Universality, efficiency and solidarity that preside over social security, as well as the prohibition of paragraph 5 of the article 48 higher.
The items in the article 6or in Law 1151 of 2007 relating to the Telehealth permits the destination of social security resources for purposes other than it, a circumstance that is contrary to the provisions of Article 48 (5) of the Political Constitution. " ... for the Court is a palmary that these services and activities (Telemedicine) should then be considered as part of 100 1993 and the standards that develop it, complement each other and regulate. "
This is because, " far from referring to activities outside the health service, it is about actions that will contribute to the expansion of the coverage of this service for all Colombians, which is undoubtedly the case. in accordance with the principles of universality, efficiency and solidarity that govern the social security system.
As to how much resources for Telemedicine will be administered by a private law entity (Federation Colombia of Municipalities) and aimed at fulfilling a different purpose from that for which they were contributed, the special destination of the parafiscal resources is unknown. funds from the parafiscal contribution for the social security system must be handled only by entities belonging to that system. " ... no objection is due to the fact that these resources, which as accepted, have the character of a contribution parafiscal, be administered by a private entity "
The transfer of public resources to the aforementioned private law legal person allows a portion of the resources that the public health service should be funded outside an adequate surveillance control system. there is an equivalent charge. " ... attention to the specialized and high-responsibility character of these services, and to which resources will be administered parafiscal, the Court considers it necessary to condition the exequibility of these norms, warning that these activities must be fulfilled through the institutions of the Prestators of Health Services or of specialized companies in the provision of the same, all of which will be subject to the respective monitoring and surveillance as provided for in this case, in particular those that comply with the current rules of the National Health Superintendence, the Comptroller General of the Republic and the Public Ministry.

As can be observed, in Judgment C-714 of 2008 the Court ruled on: (i) that the activities of Telemedicine should be considered as an integral part of the concept of Social Security, The purpose of the Social Security System's resources for such purpose is not contrary to Article 48 (48 of the Political Constitution, according to which ; (ii) the same higher standard is not known for the fact that the resources for Telemedicine are administered by a private law entity (Colombian Federation of Municipalities); and (iii) that in any case, the constitutionality of the provisions establishing the allocation of resources of the Social Security System in Health for the financing of Telemedicine, is conditioned to these activities being comply with the Institutions of Health Services (IPS) or companies specialized in the provision of these services, and are subject to the control and surveillance normally provided for in the effect, particularly exercised by the National Superintendence of Health, the Comptroller General of the Republic and the Ministry of Health Public.

Thus, the Court considers that, in the present opportunity, with respect to the previous objections of unconstitutionality raised by the government, there is a precedent case law that must now be reiterated, on the basis of which the Objections which again propose the same legal problem previously examined by this Corporation, should be considered unfounded.

8.4.5. The Government presents an additional objection that proposes a legal problem that has not been analyzed by this Corporation.

8.4.5.1. The Chamber notes that the National Government has an objection of unconstitutionality that proposes a legal problem that has not yet been examined by this Corporation. In fact, the executive says that when the objecting paragraph refers, in a concrete manner, to article 6or Law 1151 of 2007 and paragraph 2 of article 26 of Law 1122 of the same year, does not know the article 48 above, since it is not financially viable that, without technical supports and without consideration or assessment of convenience in relation to other alternatives, resources equivalent to 0.3% of the UPC of both the contributory and the The Commission will also be able to provide the Commission with a view to ensuring that the Commission is able to take the necessary steps to ensure that the Commission is able to take the necessary steps to ensure that the the extent required by the affiliated population.

In this regard, the Court observes that, contrary to the statement of objections, the Congress did study and analyze the issue of financing and the sustainability of the Telemedicine activities that it intends to promote, and that, in addition, the Financial resources referred to by the objecting paragraph are not the only ones under which the draft law proposes to finance such activities.

In effect, in the presentation for the second debate in the Senate of the Republic, the following considerations and analyses were included:

" IV. Financing and Sustainability

" Necessarily, the development of the Telemedicine model requires resources to optimize connectivity; it is essential to have broadband, which allows the opportunity, efficiency and privacy required by the medical records, regardless of the medium used to capture and transfer them. A powerful Intranet for Telemedicine. In addition to ensure the connection in the network of providers, so that it does not fail and be sustainable; many hospitals have today connectivity but are not permanent for payment problems. Good-state computer equipment is needed to facilitate the exchange of information and images. For the development of content, the country has an excellent human resource.

" 4.1 Communications Fund

" The project defines as the main source of funding, 10% of the Communications Fund resources[86].

" The Communications Fund is a Special Administrative Unit attached to the Ministry of Communications, created by Decree-Law 129 of 1976 and restructured through the Decrees 1130 of 1999 and 2324 of 2000. The Fund aims to finance the plans, programmes and projects to facilitate the access of all inhabitants of the national territory to the telecommunications and social postal services so as to support the activities of the Ministry and the improvement of its administrative, technical and operational capacity for the performance of its functions, as well as the financing and execution of programs aimed at the expansion of Information Technologies, using as source of funding the resources it receives for the payments that the operators of The telecommunications sector is responsible for granting concessions, authorizations and the use of radio spectrum, among other resources, which must be fully reversed in the sector and in support of social communications. Telemedicine is framed within these purposes.

" As is well known, the resources of this Fund are not fully implemented, given that the Ministry of Finance does not tour, if not a small percentage, because of the fiscal problems facing the nation. This is a situation that must be solved definitively, since such funds are indispensable for the development of communications technologies and in particular, Telemedicine, to be a tool for inclusion in health.

" ...

" 4.2 Other Sources

a) Ministry of Social Protection;

b) Connectivity providers and teams through service contributions. Social responsibility of the operators in 2006 generated 7.216 million dollars in Colombia;

c) The 0.3% Payment Per Capitation Unit, contributory and subsidized, Development Plan Act, 2006-2010, which is currently being sanctioned by the Presidency of the Republic " [87] (Footer page out of the original).

As can be observed, contrary to what the National Government said, Congress did study and analyze the issue of financing and sustainability of Telemedicine activities and prior to the money destined for this project. As a main source, a portion of the resources of the Communications[88], which is a Special Administrative Unit attached to the Ministry of Communications, will have as its object, among others, the financing of the plans, programmes and projects to facilitate the access of all inhabitants of the national territory to the telecommunications services and the financing and implementation of programmes aimed at the expansion of Information Technologies.

8.4.5.2. However, with respect to the resources from the 0.3% Capitation, contributory and subsidized Payment Unit, which will contribute to the financing of the Telemedicine activities, it is true that the Congress did not include a detailed analysis of the in which such destination could affect the possibility of making adjustments in the Mandatory Health Plan -POS- or in the UPC, to the extent required by the affiliated population[89]. Nevertheless, in the Court's view, this circumstance does not determine the unconstitutionality of the provision objected to by the National Government.

In fact, first of all, it should be noted that the contested paragraph, in the time it reiterates the provision contained in Law 1151 of 2007, according to which the 0.3% Unit of Payment by Capitation will be allocated to the The financing of Telemedicine is not ordering public expenditure, but partly by changing-and at least a minimum-the allocation of a parafiscal contribution, in any case to engage in an activity which, as defined by this Corporation in the pluricited C-714 statement of 2008, must be considered as an integral part of the concept of Social Security in Health. Partial redefinition of the destination of such a contribution, which this Corporation, in the same judgment, found did not constitute " an act prohibited to the legislator, which is moreover the organ of whose decision the creation of this type depends effect, the tax authority is constitutionally rooted in the head of the legislator, to whom it is the responsibility of "to impose fiscal or parafiscal contributions" (C. Q. Art. 338); this being so, you can also define the destination of the parafiscal contributions you create, as long as they are directed to finance the same sector within which you are collected, for as is known, such contributions "are charged only to a specific guild or collectivity and are intended to cover the needs or interests of such union or community." [90] Thus, the power Legislative tax allows you to partially vary the way you invest resources from a parafiscal contribution, provided that their specific destination is respected, that is, as long as it continues to be in the exclusive interest of the sector for which they were created, which, as has already been seen, occurs in this sector. case.

And second, the Chamber estimates that the analysis of the fiscal impact that the General System of Social Security in Health can have the destination of the 0.3% Unit of Payment by Capitation for the financing of Telemedicine, was a The issue of the issue that the executive was considering to analyze the executive during the congressional procedure, whose omission of study does not affect the constitutionality of this procedure. Even if the government now considers that the allocation of resources is inconvenient or disproportionate, this opinion cannot constitute a veto of the legislative decision.

To the above conclusions, the Chamber is based on the case-law that, on a matter of close, not identical, has been granted by this Corporation. In fact, referring to the need for Congress to comply with the provisions of Article 7or Law 819 of 2003, which imposes on that legislative corporation the duty to study the tax impact of the rules The Court has held that while this obligation constitutes an important tool for the tax and tax benefits and to analyze its compatibility with the Fiscal Framework of the Medium-Term Fiscal Framework dictated each year by the National Government, the Court has held that The rationale of the legislative process, this analysis is mainly to the Minister " It is the one that on the data, the teams of officials, and the economic expertise. Therefore, in the event that the congressmen process a project incorporating erroneous estimates on the fiscal impact, on how to address these new expenses or on the compatibility of the project with the Fiscal Framework of the Medium Term; It is up to the Finance Minister to intervene in the legislative process to illustrate to the Congress about the economic consequences of the project. And the Congress will have to receive and value the concept issued by the Ministry. However, the burden of proving and convincing the congressmen about the incompatibility of a certain project with the Fiscal Framework of Medium Term falls on the Minister of Finance. " [91]

in any case, the case law has concluded that in the event that the Minister of Finance and Public Credit does not intervene in the legislative process or omit to conceptualize the economic viability of the bill, this is not the old thing of unconstitutionality, since this requirement cannot be understood as a veto power over congressional action or a barrier for the Legislator to exercise its legislative function[92].

Now, if that has been the conclusion of the case law regarding bills ordering public spending, the Court estimates that the same reasons should be taken into account in cases such as the present, where the bill does not mandate public expenditure, but only determines a partial destination of the parafiscal contribution for the Social Security System in Health, to an activity such as Telemedicine which, as established by this Corporation, forms an integral part of the of the concept of social security. In such a virtue, the lack of study on the impact of the objectionable provision regarding the possibility of making adjustments in the Mandatory Health Plan -POS- or the UPC, to the extent required by the affiliated population, does not affect the constitutionality of the same.

8.4.5.3. Finally, as regards the Government's objection that the paragraph of Article 2o of the draft law now under review was passed by the Congress " without consideration or assessment of its appropriateness in relation to the other " Court considers that the reproach is not of a constitutional hierarchy, but of mere convenience, so it does not fall within its sphere of competence to analyze it.

8.4.5.4. Finally, the Sala also dismissed as improper the presidential objection, based on the fact that the reproached rule prevents surveillance and control over the resources destined for the Telehealth, taking into account that the constitutionality of paragraph 23 of the numeral 3.3. of article 6or Act 1151 of 2007, standard incorporated as text of the bill by the paragraph of article 2o, here objected, in Judgment C-714 of 2008 was conditioned to the existence of such governmental controls. In fact, as was seen, this constitutionality was declared " in the understanding that the national entity that agremia the Colombian municipalities and districts will lend the activities referred to in these rules, through IPS health service providers, or specialised companies which are duly constituted and subject to all the controls which are normally applicable to persons and entities authorised to provide health services and those which collect or administer parafiscal resources ".

For all of the above, the Chamber finds that this objection of unconstitutionality is unfounded.

IX. Decision

On the merits of the above, the Plena Chamber of the Constitutional Court, on behalf of the people and by mandate of the Constitution,

RESOLVES:

First. Lift the suspension of the term to give judgment, ordered by the Plena Chamber of this Court by Order 063 of ten (10) February 2009.

Second. To declare unfounded the governmental objections are presented in respect of the paragraph of article 2o of Bill 218 of 2007-Senate-, 309 of 2007-House-, " by which the guidelines for the development of the Telehealth in Colombia ", in respect of the matters examined in this Judgment.

Notify, copy, contact the President of the Republic and the President of the Congress, post and comply.

The President,

MAURICIO GONZÁLEZ CROW.

Maria Victoria Calle Correa, Juan Carlos Henao Perez, Gabriel Eduardo Mendoza Martelo, Jorge Ivan Palacio Palacio, Nilson Pinilla Pinilla, Jorge Ignacio Pretelt Chaljub, Humberto Antonio Sierra Porto (absent with permission), Luis Ernesto Vargas Silva, Magistrates.

The General Secretariat,

MARTHA VICTORIA SACHICA MENDEZ.

* * *

State, with the participation of individuals, will progressively expand coverage of the Social security to include the provision of services in the manner determined by the Law.
1 View Folios 270 a 275 of test notebook number 2
2 Cfr. Folio 278 of notebook number 2
3 Cfr. Folios 261 to 269 of notebook number 2
4 Cfr. Folios 278 and 279 of notebook number 2
5 The Congress Gazette number 392 of 2007 did not work on the file, but was consulted by the office of the investigating magistrate at the following e-mail address: http://servoaspr. imprenta.gov.co:7778/gacetap/gaceta.level_3
6 The Congress Gazette number 392 of 2007 did not work on the file, but was consulted by the office of the investigating magistrate at the following e-mail address: http://servoaspr. imprenta.gov.co:7778/gacetap/gaceta.level_3
7 See report of substantiation signed on June 14, 2007 by the General Secretariat of the Sixth Permanent Constitutional Constitutional Commission of the Senate of the Republic, in the pages 278 and 279 of the number 2 test log
8 Copy of the Gazette work in the case to folio 105 of the test notebook number 6
9 Cfr. Folio 225 of test notebook number 2
10 Copy of the Gazette work on the case to folio 264 of the test notebook number 6
11 Copy of the Gazette work in the case to folio 185 of the test notebook number 6
12 View pages 73, 74, and 80 of the Gazette in folios 256, 257 , and 263 of the number 6 test notebook
13 Folios 144 to 156 of test notebook number 2
14 The Congress Gazette number 844 of 2008 does not work on the file, but was consulted by the office of the investigating magistrate in the following electronic address: http://servoasprimprenta.gov.co: 7778lgacetap/gaceta.level_3
15 Cfr. Certification that works in the case to the number 2 Evidence Notebook 127
16 The Congress Gazette number 843 of 2008 does not work on the file, but was consulted by the office of the investigating magistrate at the following e-mail address: http://servoaspr. imprenta.gov.co:7778/gacetap/gaceta.level_3
17 View Substantiation Report from the House Sixth Commission, Folios 127 to 129 from the Number 2 Test Notebook
18 The Congress Gazette number 316 of 2008 does not work on the file, but was consulted by the office of the investigating magistrate at the following e-mail address: http://servoaspr. imprenta.gov.co:7778/gacetap/gaceta.nive_3
19 Cfr. Folios 63 and 68 of the number test notebook.
20 The Congress Gazette number 421 of 2008 does not work on the file, but was consulted by the office of the investigating magistrate in the following electronic address: http://servoaspr.imprenta.gov.co:7778/gacetap/gaceta.nivel_3
21 The Congress Gazette number 414 of 2008 does not work on the file, but was consulted by the office of the investigating magistrate at the following e-mail address: http://servoaspr. imprenta.gov.co:7778/gacetap/gaceta.level_3
22 View Reconciliation Accidental Commission Report in Foles 45 to 52 of Test Notebook number 2
23 The Congress Gazette number 378 of 2008 does not work on the file, but was consulted by the office of the investigating magistrate in the following electronic address: http://winaricaurte.imprenta.gov.co:7778/gacetap/gaceta.nivel_3
24 View Portfolio substantiation Report 53 in Test Notebook number 2
25 Cfr. Folio 44 in notebook number 2
26 The Congress Gazette number 564 of 2008 does not work on the file, but was consulted by the office of the investigating magistrate in the following electronic address: http://winaricaurte.imprenta.gov.co:7778/gacetap/gaceta.nivel_3
27 Cfr. Portfolio 19 of the main case notebook
28 View trade in folios 468 to 471 of the main notebook.
29 Copy of this Gazette work on the record to folio 3 of the notebook number 6
30 View folios 19 to 25 of test notebook number 2
31 Copy of this Gazette work on the record to folio 3 of notebook number 3
32 Copy of this Gazette work in the case to folio 8 of notebook number 9
33 Copy of this Gazette work on the record to folio 27 of notebook number 3
34 The Congress Gazette number 149 of 2009 does not work on the file, but was consulted by the office of the investigating magistrate in the following electronic address: http://winaricaurte.imprenta.gov.co:7778/gacetap/gaceta.nivel_3
35 Cfr. Folio 1 of the main case notebook.
36 Cfr. Folio 3 of notebook number 9
37 Copy of this Gazette in the case to folio 12 of the 5
38 Copy of this Gazette work on the record to folio 2 of notebook number 8
39 View Certification of the General Secretariat of the Constitutional Court, Dr. Martha Victoria Sachica Méndez, in folio 462 of the notebook file principal.
40 The objections were published by the Presidency of the Republic in the Official Journal number 47,052 of 16 July 2008
41 C.P. ARTICLE 48. Social Security is a public service of a mandatory that will be provided under the direction, coordination and control of the State, in accordance with the principles of efficiency, universality and solidarity, in the terms that establish the Law.
inhabitants are guaranteed the inalienable right to Social Security.
Security may be provided by public or private entities, in accordance with the law.
Cannot allocate or use the resources of the Social Security institutions for different ends to her.
The law will define the means for pension resources to maintain their power Constant purchasing.
42 The numeral 3.3. of the article 6or of Law 1151 of 2007, for which the National Development Plan 2006-2010 is issued, contains a paragraph (paragraph 23) of the following tenor:
" To ensure the provisions of paragraph 2 of the Article
of Law 1122 of 2007, the Health Promoters, EPS, of the Subsidized And Contributory Scheme, will dedicate 0.3% of the Unit of Payment for Capitation to the coordination and financing of Telemedicine services with national coverage, both for health promotion and for the attention of its affiliates; the municipalities and districts, through the national entity that the agremia, will make possible the provision of this service. Likewise, the National Health Superintendence will verify compliance with the provisions of this article to authorize or renew the operation of the EPS, in particular at the time of verifying their service networks ".
For its part, paragraph 2o of the article
26 of Law 1122 of 2007, " by which some modifications are made in the General System of Social Security in Health and other provisions ", reads as follows:
" PARAGRAFO 2o. The Nation and the territorial entities will promote the services of Telemedicine to contribute to the prevention of chronic diseases, training and the reduction of costs and improvement of the quality and opportunity of delivery of services as is the case with diagnostic imaging. Special interest will have the departments of Amazonas, Casanare, Caqueta, Guaviare, Guainia, Vichada and Vaupes ".
43 M. P. Nilson Pinilla Pinilla.
44 On this occasion the demand was against the following provisions of Law 1151 of 2007:
" Article
6or Description of major investment programs
(...)
3. Poverty reduction and promotion of employment and equity
(...)
3.3 Social Protection System
(...)
Paragraph 23:
To ensure that set forth in paragraph 2 of the article
26 of the Act 1122 of 2007, the Promotoras de Salud, EPS, of the Subsidized And Contributory Scheme, will dedicate 0.3% of the Payment Unit by Capitation to the coordination and financing of Telemedicine services with national coverage, for the promotion of health and for the attention of its members; municipalities and districts, through the national entity that the agremia, will make possible the provision of this service. Likewise, the National Health Superintendence will verify compliance with the provisions of this article to authorize or renew the operation of the EPS, in particular at the time of verifying their service networks. "
(...)
Develop a comprehensive, medicalized air transport system as part of the national strategy for improvement and guarantee of accessibility to health services for all Colombians in the country. national territory. This system will ensure:
1. Air ambulances medicalized and certified by the competent authority in Health and the Aerocvil, in terms of its competence, for the transfer of critical patients with air travel requirements according to assessment and referral by the health system.
2. Healthy air routes from high complexity centers in health care to cover the inhabitants of distant municipalities.
3. Provide air support for health brigades in the most difficult access areas of the national territory with a minimum frequency of three times a year.
4. Support for the emergency response to traffic accidents in the 5 regions: the Caribbean coast; the central part of the country, the west and the coffee-growing axis, Antioquia Choco, the Colombian Oriente, and the Amazon.
5. Support in the impact phase in case of emergencies due to natural disasters in the country.
The entity that will be nationally agremia the Colombian municipalities will develop, organize and operate this service within the next six months from the sanction of this law. To this end, it will develop a four-year plan that will be presented to the health regulatory body and its development will be under the supervision of the Ministry of Social Protection and will be monitored by the health and aviation control agencies. Civil in the competition. This service will be financed monthly with 2% of the UPC of the Subsidized And Contributory Scheme, which receive the EPS and the special regimes with the exception of the Military Forces.
To the financing of this system will be the sectors that demand this service and that have covered these types of risks.
PARAGRAFO. In order to guarantee the operation of this system, the Civil Aeronautics will adjust the airport operation and the other authorities will be giving priority to the operation of this service. "
(...)
" ARTICLE 146. The National Government will establish a manual of minimum rates of compulsory application for companies managing profit plans and providers of public and private health services, for the purchase and sale of activities, interventions, procedures in health and hospital services, contained in the Mandatory Health Plan of the Contributory Regime and the Subsidized Regime. PARAGRAFO. The minimum rates shall be set at current minimum wages and shall be issued no later than 6 months after this law is issued.
45 Court should first of all notice that the Court will limit itself to examining the procedure given in the Congress of the Republic to the presidential objections and to the insistence of the Congress of the Republic. Therefore, he will omit the analysis of the entire previous legislative process, taking into account that he himself is susceptible to new citizens ' demands. " (Judgment C-985 2006 M. P. Marco Gerardo Monroy Goat).
46 Political Constitution, article 242-5.
47 C-1040 statement 2007. M. P. Marco Gerardo Monroy Cabra.
48 Act number 31 of that date, published in the Congressional Gazette number 392 of 2007.
49 Act number 116 of that date, published in the Congressional Gazette number 421 of 2008.
50 Cfr. Folio 19 of the main case notebook.
51 Cfr. Folios 468 to 471 of the file's main notebook.
52 Statement C-433 2004 M.P. Jaime Córdoba Trivino. Also, remember what was established in judgment C-579 of 2008 (M.P. Jaime Araujo Renteria): " In accordance with the provisions of the article 166 of the Constitution, the National Government has the term of six (6) days to return with objections any project when it does not consist of more than twenty (20) articles. This term must be computed on business days, based on the general rule contained in the Art. 62 of Law 4th of 1913, which subrogated the Art. 70 of the Civil Code, according to which "within the time limits specified in the laws and official acts, the holidays and vacancies are understood to be suppressed, unless the contrary (...) ", and according to the case law of this corporation".
53 statement C-1040 2007, M.P. Marco Gerardo Monroy Cabra.
54 The Congress Gazette number 149 of 2009 does not work on the file, but was consulted by the office of the investigating magistrate at the following e-mail address: http://winaricaurte. imprenta.gov.co: 7778/gacetap/gaceta.level_3.
55 View pages 100, 101, and 120 of the Gazette.
56 Copy of this Gazette work in the case to folio 27 of notebook number 3.
57 View substantiation on the report of objections subscribed by the Secretary General of the Senate of the Republic, in folio 18 of the notebook of tests number 2.
58 Pages 9 to 13 of the Congressional Gazette number 207 of 2009 (folios 35 to 39 of the number 3 evidence notebook).
59 View Auto of February 10, 2009, in folios 425 to 427 of the case's main notebook.
60 Copy of this Gazette work in the case to folio 2 of notebook 8.
61 View pages 41 and 42 of the cited Gazette, in foles 42 and 43 of notebook number 8.
62 According to certification issued by the Secretary-General of the House of Representatives in folio 3 of the number 9 notebook of evidence, in this The session was attended by 158 representatives.
63 Copy of this Gazette work on the record to folio 12 of notebook number 5.
64 View page 34 of Gazette No. 650 of 2009, in folio 35 of the test notebook number 5.
65 Cfr. Statement C-644 2004, M.P. Rodrigo Escobar Gil.
66 Cfr. Auto 038 of 2004 M. P. Manuel José Cepeda Espinosa and Judgment C-533 of 2004 MP. Alvaro Tafur Galvis.
67 Auto A-089 of M. P.: Manuel José Cepeda Espinosa; SV: Jaime Araujo, Alfredo Beltrán, Jaime Córdoba and Clara Ines Vargas.
68 Cfr. Statement C-576 of 2006 M. P. Manuel José Cepeda Espinosa SV Jaime Araujo Renteria.
69 This Court thesis regarding the term of Congress for the pronouncement on presidential objections, was exposed in Statement C-068 , 2004, Magistrate Rapporteur Jaime Araujo Renteria, in which the Magistrate Rodrigo Escobar Gil saved his vote, because in his concept it cannot be deduced from the Political Constitution a term for the Congress to rule on presidential objections. The arguments underpinning that position are found in the vote-save of the cited statement. "
70 C-885 statement 2004 M. P. Alfredo Beltran Sierra.
71 C-1146 statement 2003, M. P. Marco Gerardo Monroy Cabra. Reiterated in C-1040 2007, M.P. Marco Gerardo Monroy Cabra.
72 M. P. Nilson Pinilla Pinilla.
73 That the legislator looks for the Telehealth to develop within the context of the Health Social Security System is something that results obvious when reading the article 9or the law, as follows:
" Article 9o Services Offering. As of this law, the insurers and service providers of the General System of Social Security in Colombia, regardless of the benefits plans, will offer within their portfolios of services or capacity It offers its users, Telemedicine as a mode of service, adequate, effective and rational, facilitating the free access and choice of the user of the same, which will contribute to its development and sustainability.
" Paragraph 1o. The insurers and service providers of the Health Social Security System in Colombia, who are already offering this mode of care, will be able to continue doing so, framed in the parameters established by the Ministry of Protection. Social, under this law.
" Paragraph 2o. Within 12 months, the Ministry of Social Protection will process the inclusion in the Social Security Health Benefits (POS, POS-S and Public Health) plans, of the services provided in the Telemedicine modality, as well as the necessary aspects for the fulfilment of this law.
" Paragraph 3o. The provisions of this article do not exempt health service providers and insurers from their responsibility for the personalized provision of health services, within the framework of the Social Security System in force in Colombia, and under no circumstances can they be expected to replace them. The Ministry of Social Protection with the advice of the Committee established under this law, should regulate the harmonization of the services provided in a personalized way and those that use the resources of the telemedicine, which shall do not less than 6 months after the enactment of this law.
74 The reading of article 3o of the bill shows that the legislator wants the Telehealth to be guided by the same principles that govern the Social Security System in Health. In fact, this rule is as follows: " Article 3o, Principles of Telehealth. They are general principles of the. Telehealth efficiency, universality, solidarity, integrality, unity and participation, in the terms defined by the 2or the Law 100 of 1993. Likewise, it is one of the principles of the quality of health care, understood as the provision of health services to individual and collective users in an accessible and equitable way, through a optimal professional level, taking into account the balance between benefits, risks and costs, in order to achieve the adherence and satisfaction of these users.
75 These matters refer to articles 4, 5 and 6 of the project, relating to the "Telehealth Advisory Committee".
76 In this respect article 7o of the project says:
" Article 7o. Map of connectivity. From the enactment of this law, the Ministry of Communications, with the support of the Telehealth Advisory Committee, will develop a map of connectivity, according to priorities in health, education, digital literacy, penetration of the ICT, regional development agendas and interests, taking into account the characteristics of populations, exploring and valuing other types of connectivity that are designed for the implementation and development of Telehealth.
77 Act 1151 of 2007, article 6or, numeral 3.3, paragraph 26.
78 Ibidem.
79 Act 1122 of 2007, article 26, paragraph 2o.
80 M. P. Nilson Pinilla Pinilla.
81 Art. 2or Resolution 1448 of May 8, 2006, issued by the Ministry of Social Protection.
82 Cfr. about these topics especially the C-678 statements of 1998 (M. P. Alfredo Beltran Sierra) and C-840 of 2003 (M. P. Clara Inés Vargas Hernández).
83 The Court has given a particular statement on this topic, in the same sense that it now does, among others, in the C-179 of 1997 (M. P. Fabio Moron Diaz), C-655 from 2003 (M. P. Rodrigo Escobar Gil), C-349 and C-1002 from 2004 (on both M. P. Marco Gerardo Monroy Cabra).
84 Art. 9or the aforementioned resolution 1448 of May 8, 2006, issued by the Ministry of Social Protection.
85 M. P. Nilson Pinilla Pinilla.
86 Finally, 5% of the resources of that Fund were approved.
87 Ponance for Second Senate Debate to Bill 218 of 2007-Senado-, 309 of 2007-House-, "by which the guidelines for the development of the Telehealth in Colombia are established", Gazette of the Congress number 274 of 13 June 2007.
Almost identical considerations were included in the presentation for the second debate in the Chamber of Representatives, appearing in the 3316 Congress Gazette of June 4, 2008, where it reads:
" VIII. Financing and Sustainability
Necessarily, the development of the Telemedicine model requires resources to be optimized connectivity; it is essential to have broadband, which allows the opportunity, efficiency and privacy required by medical records, regardless of the means used to capture and transfer them. A powerful Intranet for Telemedicine. In addition to ensure the connection in the network of providers, so that it does not fail and be sustainable; many hospitals have today connectivity but are not permanent for payment problems. Good-state computer equipment is needed to facilitate the exchange of information and images. For the development of content the country has an excellent human resource.
The project defines as the main source of financing, up to 5% of the Fund's resources Communications.
The Communications Fund is a Special Administrative Unit attached to the Ministry of Communications, created by Decree-Law 129of 1976 and restructured through the Decrees 1130of 1999 and 2324of 2000. The Fund aims to finance the plans, programs and projects to facilitate the access of all the inhabitants of the national territory to the telecommunications and social postal services as well as to support the activities of the Ministry and the improvement of its administrative, technical and operational capacity for the performance of its functions, as well as the financing and execution of programs aimed at the expansion of Information Technologies, using the Source of funding the resources it receives for the payments that the telecommunications operators make concessions, authorisations and use of radio spectrum, among other resources, which must be fully reversed in the sector and in support of social communications. Telemedicine is framed within these purposes.
it is well known, the resources of this fund are not fully executed, since the Ministry of Finance does not tour, if not in a small percentage, because of the fiscal problems facing the nation. This is a situation that must be solved definitively, since such funds are indispensable for the development of communications technologies and in particular, Telemedicine, to be a tool for inclusion in health.
...
Other Sources
) Ministry of Social Protection and others, as soon as they have competence in the development of Telehealth in Colombia
b) Connectivity providers and teams through service inputs. Social responsibility for operators in 2006 generated $7.216 million in Colombia:
The 0.3% Payment Per Capitation Unit, contributory and subsidized, Development Plan Act, 2006-2010, which is currently being sanctioned by the Presidency of the Republic.
88 Finally, 5% of the resources of that Fund were approved.
89 " The 0.3% Unit of Payment for Capitation, contributory and subsidized, Law of the Development Plan, 2006-2010, which is currently being sanctioned by the Presidency of the Republic. ' See: Ponencia for second debate in Senate number 218 of 2007-Senadoo, 309 of 2007 -Camara-, "for which the guidelines for the development of the Telehealth in Colombia are established", Gazette of the Congress number 274 of 13 of June 2007.
90 C-040 statement 1993, M.P. Ciro Angarita Baron.
91 Statement C-502 2007. M. P. Manuel José Cepeda Espinosa.
92 Cfr. Statement C-662 of 2009, M. P. Luis Ernesto Vargas Silva.
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