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By Which The General Social Security System Reform In Health And Other Provisions

Original Language Title: Por medio de la cual se reforma el Sistema General de Seguridad Social en Salud y se dictan otras disposiciones

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LAW 1438 OF 2011

(January 19)

Official Journal No. 47.957 of 19 January 2011

CONGRESS OF THE REPUBLIC

By means of which the General System of Social Security in Health is reformed and other provisions are dictated.

Vigency Notes Summary
Effective Case-law

COLOMBIA CONGRESS

DECRETA:

TITLE I.

GENERAL PROVISIONS.

ARTICLE 1o. OBJECT OF THE LAW. This law aims to strengthen the General System of Social Security in Health, through a model of provision of the public health service that in the framework of the strategy Primary Health Care allows the coordinated action by the State, institutions and society for the improvement of health and the creation of a healthy and healthy environment, providing services of higher quality, inclusive and equitable, where the center and objective of all efforts are the residents of the country.

Provisions are included to establish the unification of the Benefit Plan for all residents, the universality of insurance and the guarantee of portability or benefit at any place in the country, within a framework of financial sustainability.

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ARTICLE 2o. ORIENTATION OF THE GENERAL SYSTEM OF SOCIAL SECURITY IN HEALTH. The General System of Social Security in Health will be oriented to generate conditions that protect the health of Colombians, with the well-being of the user the central axis and the core Policy articulator in health policies. To this end, actions of public health, health promotion, prevention of the disease and other benefits that, in the framework of a strategy of Primary Health Care, will be necessary to promote in a constant way the health of the population. To achieve this goal, the Benefits Plan will be unified for all residents, ensuring the universality of insurance, portability or benefit delivery anywhere in the country and preserving sustainability. Financial system, among others.

to fulfill the above, the National Government will define goals and indicators of health outcomes that include all levels of government, public and private institutions, and other actors participating in the system. These indicators will be based on technical criteria, which at least include:

2.1 Prevalence and incidence in morbidity and maternal perinatal and infant mortality.

2.2 Incidence of diseases of interest in public health.

2.3 Incidence of chronic non-communicable diseases and in general the prevention of high cost events.

2.4 Incidence of communicable prevalent diseases including immunopreventable diseases.

2.5 Effective access to health services.

Every four (4) years the National Government will make a comprehensive assessment of the General System of Social Security in Health based on these indicators. When this assessment shows that poor health outcomes, the Ministry of Social Protection and the National Health Superintendence will evaluate and determine the measures to be followed.

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ARTICLE 3o. PRINCIPLES OF THE GENERAL SYSTEM OF SOCIAL SECURITY IN HEALTH. Amend article 153 of Law 100 of 1993, with the following text: " They are principles of the General System of Social Security in Health:

3.1 Universality. The General System of Social Security in Health covers all residents in the country, at all stages of life.

3.2 Solidarity. It is the practice of mutual support to ensure access and sustainability to Health Social Security services, among people.

3.3 Equality. Access to Social Security in Health is guaranteed without discrimination to persons residing in the Colombian territory, for reasons of culture, sex, race, national origin, sexual orientation, religion, age or economic capacity, without discrimination. prejudice to the constitutional prevalence of children's rights.

3.4 Required. The affiliation to the General System of Social Security in Health is mandatory for all residents in Colombia.

3.5 Rights Prevalence. It is the obligation of the family, the State and the society in matters of health, to care, to protect and to assist women in the state of pregnancy and in reproductive age, to children, girls and adolescents, to guarantee their life, their health, their integrity physical and moral and its harmonious and integral development. The provision of these services will correspond to the life cycles formulated in this law, within the Benefit Plan.

3.6 differential approach. The principle of differential approach recognizes that there are populations with particular characteristics because of their age, gender, race, ethnicity, disability status and victims of violence for which the General System of Social Security in Health will offer special guarantees and efforts to eliminate discrimination and marginalisation.

3.7 Equity. The General System of Social Security in Health must guarantee access to the Plan of Benefits to the members, regardless of their ability to pay and particular conditions, avoiding that individual non-relevant benefits technical and scientific criteria put at risk the resources needed for the attention of the rest of the population.

3.8 Quality. The health services must address the patient's conditions according to the scientific evidence, provided in a comprehensive, safe and timely manner, through humanized care.

3.9 Efficiency. It is the optimal relationship between the resources available to obtain the best results in health and quality of life of the population.

3.10 Social Participation. It is the intervention of the community in the organization, control, management and control of the institutions and the system as a whole.

3.11 Progressivity. It is the graduality in the update of the benefits included in the Plan of Benefits.

3.12 Free choice. The General System of Social Security in Health will assure users freedom in the choice between Health Promoter Entities and health service providers within their network at any time.

3.13 Sustainability. The benefits that the system recognizes will be financed by the resources allocated by the law for this purpose, which must have an agile and expeditious flow. The decisions to be taken under the General System of Social Security in Health should consult the criteria of fiscal sustainability. Administration of system funds may not affect the flow of resources of the system.

3.14 Transparency. The conditions for the provision of services, the relationship between the different actors of the General System of Social Security in Health and the definition of health policies, must be public, clear and visible.

3.15 Administrative Decentralization. In the organization of the General System of Social Security in Health the management will be decentralized and of it will take part the territorial addresses of health.

3.16 Complementarity and concurrency. It will be possible for the actors of the system in the various territorial levels to complement themselves with actions and resources in the achievement of the goals of the General System of Social Security in Health.

3.17 Corresponsibility. Everyone should be able to promote self-care, care for the health of their family and community, a healthy environment, the rational and adequate use of resources the General System of Social Security in Health and fulfill the duties of solidarity, participation and collaboration. Public and private institutions will promote ownership and compliance with this principle.

318 Irrenunciation. The right to Social Security in Health is indispensable, it cannot be renounced completely or partially.

3.19 Intersectoriality. It is the joint and coordinated action of the different sectors and organizations that directly or indirectly, in an integrated and continuous way, affect the determinants and the state of health of the population.

3.20 Prevention. It is the precautionary approach that applies to risk management, to the assessment of procedures and the provision of health services.

3.21 Continuity. Any person who has entered the General System of Social Security in Health has a vocation to remain and should not, in principle, be separated from it when his quality of life and integrity are in danger.

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ARTICLE 4. RECTORY OF THE HEALTH SECTOR. The direction, direction and direction of the Health Sector will be in the head of the Ministry of Social Protection, as the governing body of this sector.

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ARTICLE 5o. COMPETENCIES OF THE VARIOUS LEVELS OF PUBLIC ADMINISTRATION. Add to Article 42 of Law 715 of 2001 the following numerals:

42.22. Approve the Public Investment Plans, for the provision of health services, departments and districts, in terms determined by the Ministry of Social Protection, in accordance with the policy of health services.

42.23. Design indicators to measure health achievements, determine the methodology for their application, as well as the distribution of resources according to them, when the law so authorizes. The indicators must measure the achievements of the General System of Social Security in Health, in front of all the actors in the system.

Modify the following numerals of 43 and 44, of Act 715 of 2001, as follows:

43.2.7. Endorse the Public Health Investment Plans of the municipalities of their jurisdiction, in the terms defined by the Ministry of Social Protection, in accordance with the policy of providing health services, whose consolidated constitutes the Biennial Plan of Public Investment Departmental.

43.3.4. Formulate and implement the Plan of Departmental Collective Interventions.

43.3.9. To assist technically and supervise the municipalities, in the provision of the Plan of Collective Interventions, and the actions of individual public health that are carried out in their jurisdiction. The Ministry of Social Protection will regulate the technical assistance process, with financial, technological, human resources, process management and expected results.

43.4.3. Co-finance the affiliation to the subsidized regime of the poor and vulnerable population.

Editor Notes

44.3.1. Adopt, implement and adapt public health policies and plans in accordance with the provisions of the national and departmental order, as well as formulate, execute and evaluate, plans for collective interventions.

Add to article 43 and 44 of Act 715, 2001 the following numerals:

43.3.10. Coordinate and control the organization and operation of health services under the Primary Health Care strategy at the departmental and county level.

44.3.7. Coordinate and control the organization and operation of health services under the primary health care strategy at the municipal level.

TITLE II.

PUBLIC HEALTH, PROMOTION AND PREVENTION AND PRIMARY HEALTH CARE.

CHAPTER I.

PUBLIC HEALTH.

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ARTICLE 6o. TEN-YEAR PLAN FOR PUBLIC HEALTH. The Ministry of Social Protection will draft a Decennial Plan for Public Health through a broad process of social participation and in the framework of the primary health care strategy, in which they must to bring together sectoral policies to improve the state of health of the population, including mental health, ensuring that the process of social participation is effective, through the promotion of the training of citizens and social organisations.

The Plan will define the objectives, goals, actions, resources, sector leaders, monitoring indicators, and evaluation mechanisms of the Plan.

The Ministry of Social Protection will be able to make modifications to the Decennial Plan according to the health priorities according to the analysis of the public health interest events that are presented.

TRANSIENT TRANSIENT. The first Decennial Plan should be implemented in 2012.

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ARTICLE 7o. INTERSECTORAL COORDINATION. For the development of the Decennial Health Plan in the framework of the primary care strategy, all the bodies that are part of the Social Protection System and other actors will be present. for the intervention on health determinants, in a coordinated manner, under the guidelines, criteria and mechanisms of the National Council for Social Policy (CONPES) and the Ministry of Social Protection.

PARAGRAFO 1o. For the purposes of coordination, create a Public Health Intersectoral Commission that will meet every six (6) months to follow up the actions for the management of determinants in health, which will inform the CONPES.

PARAGRAFO 2o. At the level of the territorial entities this coordination will be carried out through the Territorial Councils of Social Security in health with the participation of the institutions and organizations committed to the determinants in health.

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ARTICLE 8o. NATIONAL HEALTH OBSERVATORY. The Ministry of Social Protection will create the National Health Observatory, as a dependency of the National Institute of Health. The National Government shall establish by regulation the conditions for the organization and operation of the National Health Observatory, the technical and human equipment for its operation and appropriate the resources for its implementation.

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ARTICLE 9o. FUNCTIONS OF THE NATIONAL HEALTH OBSERVATORY. The National Health Observatory shall be responsible for the following functions:

9.1 The National Health Observatory will be responsible for monitoring public health indicators for each municipality and department, and will allow for the disaggregated information of results by Insurers, Prestador and Ente Territorial. The results and impact trends achieved will be released semi-annually and basis for the impact assessment of results management of all the System actors.

9.2 Track the health conditions of the Colombian population by analyzing the variables and indicators recommended by health practice and public policy regarding health conditions and priorities in Colombia. Research and development in the field. Such variables and indicators may be disaggregated by sex, age, region, race and ethnicity.

9.3 To serve as technical support to the authorities of the country, in matters of analysis of the health situation, for the decision-making.

9.4 To carry out, directly or indirectly, periodic evaluations of the health situation of the regions of special population groups, and to make public the results.

9.5 Strengthen the Epidemiological Information System, with an emphasis on border areas.

9.6 Generate Result Discussion and Proposal Building Spaces.

9.7 Formulate recommendations, proposals, and follow-up warnings to the Ministry of Social Protection and the Health Regulatory Commission, or to the entity that does its own times.

9.8 Submit reports to the Joint Committee, in the Chamber and the Senate, before the end of each legislature on all the periodic evaluations to be carried out.

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CHAPTER II.

PUBLIC HEALTH ACTIONS, PRIMARY HEALTH CARE AND PROMOTION AND PREVENTION.

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ARTICLE 10. USE OF PROMOTION AND PREVENTION RESOURCES. The National Government will be responsible for public health policy and ensure the execution and results of actions to promote health and disease prevention as pillars. of the Primary Health Care strategy, for which it will determine the priority in the use of the resources that for this purpose administer the territorial entities and the Health Promoter Entities.

The Ministry of Social Protection and territorial entities will establish objectives, goals, indicators of monitoring on results and impacts on public health of health promotion activities and the prevention of the disease.

PARAGRAFO. The above does not exclude the co-responsibility of the Health Promoter Entities, supported by the epidemiological profile and cost deviation.

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ARTICLE 11. PUBLIC HEALTH AND PROMOTION AND PREVENTION ACTIONS. Public health and promotion and prevention actions will be implemented in the framework of the primary health care strategy, in accordance with the Territorial Health Plan and shall be recruited and executed in an articulated manner. The resources of the territorial entities referred to in this Article shall continue to be rotated and managed in the Master Accounts of the literal B, of article 13 of Law 1122 of 2007.

The governors and mayors will contract the collective public health actions of their competence with the networks formed in the population space determined by the municipality based on the regulations established by the Ministry of Education. Social protection, for the provision of health services, in accordance with the primary health care strategy.

The Health Promotion Entities will ensure the provision of health promotion, early detection, specific protection, epidemiological surveillance and health care interventions, of the Plan of Benefits with defined networks for a given population and space.

The networks articulated by the municipalities and the Health Promoter Entities in the population spaces for the provision of health services, will be enabled by the competent departmental or district entities, in the framework of the Compulsory Quality Assurance System, in accordance with the regulations established by the Ministry of Social Protection for this purpose.

The procurement will include coverage by age group, goals, results, impact indicators and follow-up that will be verified with the Individual Services Provision Records (RIPS).

The government will regulate the inclusion of health education programs and the promotion of healthy practices since the first school years, which will be aimed at generating a culture of self-care throughout the population.

TRANSIENT TRANSIENT. Until such time as the conditions for enabling the networks are verified, the contracting of collective actions of public health and those of promotion and prevention will continue to be carried out in accordance with the current rules for the promulgation of the present law.

CHAPTER III.

PRIMARY HEALTH CARE.

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ARTICLE 12. OF PRIMARY HEALTH CARE. Adopt the Primary Health Care Strategy, which will consist of three integrated and interdependent components: health services, cross-sectoral/cross-sectoral health care, and social, community and citizen participation.

Primary Health Care is the intersectoral coordination strategy that allows for integrated and integrated care, from public health, health promotion, disease prevention, diagnosis, treatment, Patient rehabilitation at all levels of complexity in order to ensure a higher level of well-being in the users, without prejudice to the legal competences of each of the actors of the General System of Social Security in Health.

Primary care makes use of scientifically grounded and socially accepted methods, technologies, and practices that contribute to the equity, solidarity, and cost effectiveness of health services.

For the development of primary health care, the Ministry of Social Protection must define and implement tools for its systematic use as electronic health records throughout the national territory and other instruments. technical.

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ARTICLE 13. IMPLEMENTATION OF PRIMARY HEALTH CARE. To implement primary care in the General System of Health Social Security, the following elements will be taken into account:

13.1 The Primary Health Care System will be governed by the following principles: universality, interculturality, equality and differential approach, integrated and integrated care, cross-sectoral health action, social participation Community and decision-making citizenship and parity, quality, sustainability, efficiency, transparency, progressiveness and irreversibility.

13.2 Emphasis on health promotion and disease prevention.

13.3 Intersectoral Actions to Impact Health Determinants.

13.4 Culture of Self-Care.

13.5 Individual, family and community orientation.

13.6 Comprehensive, integrated and continuous care.

13.7 Interculturality, which includes among others the elements of traditional, alternative and complementary practices for health care.

13.8 Human Talent organized in multidisciplinary, motivated, sufficient and qualified teams.

13.9 Strengthening the low complexity to improve resolvability.

13.10 Active community participation.

13.11 Territorial approach.

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ARTICLE 14. STRENGTHENING LOW-COMPLEXITY SERVICES. The National Government will formulate the policy of strengthening low-complexity services to improve its resolutive capacity, so that the demands can be resolved more effectively. common in the health care of the population.

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ARTICLE 15. BASIC HEALTH EQUIPMENT. The territorial entity, in accordance with the regulations of the Ministry of Social Protection, will define the optimal requirements to enable the formation of the Basic Health Teams, as a functional concept and This is an organizational structure that will facilitate access to health services in the framework of the Primary Health Care strategy. For the financing and constitution of these teams, the human talent and inter-institutional resources of the health sector will be available for public health and other sectors that participate in the health determinants.

The constitution of basic equipment implies the functional reorganization, training and progressive adaptation of human talent. The basic equipment must be adapted to the needs and requirements of the population.

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ARTICLE 16. BASIC HEALTH EQUIPMENT FUNCTIONS. Basic health teams will have the following functions:

16.1 Make the family diagnosis, according to the unified tab that is defined at the national level.

16.2 Individual, family and community risk identification of users by age, gender, race and ethnicity.

16.3 Report on the portfolio of services of social protection in health to families according to their needs and to the policies and regulations of these services.

16.4 Promote affiliation to the system, the full identification of families, so that by identifying a person not affiliated to the system, the membership process will be initiated so that they can access social protection services.

16.5 Driving the demand for services of events related to public health priorities and those that cause a high public health impact.

16.6 Facilitate the provision of basic health services, education, prevention, treatment and rehabilitation.

16.7 267 of Law 1753 of 2015 >

Vigency Notes
Previous Legislation

TITLE III.

PREFERENCE AND DIFFERENTIAL CARE FOR CHILDHOOD AND ADOLESCENCE.

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ARTICLE 17. PREFERRED CARE. The Benefit Plan will include a special and differentiated part that will ensure effective prevention, early detection, and appropriate treatment of children's and adolescents ' illnesses. It must be structured according to the life cycles of birth: prenatal to under six (6) years, six (6) to under fourteen (14) years and fourteen (14) to under eighteen (18) years.

The Commission on Health Regulation or who will do its time will define and update this special and differentiated part every two years, which will provide health services for children and adolescents, guarantee the promotion, effective prevention, early detection and appropriate treatment of diseases, emergency care, physical and psychological reestablishment of impaired rights and rehabilitation of the physical and mental abilities of children, and adolescents in a disability situation, taking into account their life cycles, the profile epidemiological and the burden of the disease.

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ARTICLE 18. SERVICES AND MEDICINES FOR CHILDREN AND ADOLESCENTS WITH DISABILITIES AND CERTIFIED CATASTROPHIC DISEASES. The services and medicines of the special and differentiated part of the Plan of Benefits for children and adolescents with physical, sensory and cognitive disabilities, catastrophic and ruinous diseases that are certified by the treating physician, will be free for children and adolescents of Sisben 1 and 2.

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ARTICLE 19. RESTORATION OF THE HEALTH OF CHILDREN AND ADOLESCENTS WHOSE RIGHTS HAVE BEEN VIOLATED. Services for the physical and mental rehabilitation of children and adolescents victims of physical or sexual violence and all forms of violence abuse, which are certified by the competent authority, will be totally free for the victims, regardless of the membership regime. They will be designed and implemented ensuring comprehensive care for each case, until the recovery of the victims is medically certified.

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ARTICLE 20. CO-RESPONSIBILITY. The State, parents or legal representatives of children and adolescents are responsible for their care and to manage timely and comprehensive care for the health of their children or represented minors, and to require the System Social Security in Health services established in the special and differentiated part of the Plan of Benefits.

The State and the institutions of the General System of Social Security in Health will establish the legal, administrative and budgetary mechanisms to give effective and timely compliance to the special and differentiated part of the Plan of Benefits and to provide timely, effective and quality services.

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ARTICLE 21. OBLIGATION TO REPORT POSSIBLE VIOLATION OF RIGHTS, ABUSE OR NEGLECT. The Health Promoter Entities and Health Care Institutions must notify the Colombian Family Welfare Institute (ICBF) to the family stations. or, failing that, to the police inspectors or municipal or district persons, cases where there may be negligence of the parents or adults responsible for the care of the children, girls and adolescents, and also to report to the Attorney General of the Nation when they detect signs of physical, psychological or sexual violence.

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TITLE IV.

ASSURANCE.

CHAPTER I.

GENERAL PROVISIONS.

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ARTICLE 22. NATIONAL PORTABILITY. All Health Promoter Entities shall ensure access to health services in the national territory, through agreements with health service providers and Health Promoter Entities. The Health Promotion Entities will be able to offer the benefits plans in the two regimes, preserving the attributes of continuity, quality, integrality, and individual and family affiliation to the basic health and network equipment. integrated services.

Access to health care will be through the citizenship card or other identity card.

TRANSIENT TRANSIENT. This provision shall enter into force no later than the first (1o) of June 2013.

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ARTICLE 23. ADMINISTRATIVE EXPENSES OF HEALTH-PROMOTING ENTITIES. The National Government shall fix the percentage of administrative expenditure of the Health Promotional Entities, based on efficiency criteria, actuarial and financial studies, and technical criteria. Health-promoting entities that do not comply with this percentage will enter into a causal intervention. This factor shall not exceed 10% of the Payment per Capitation Unit.

Health care resources cannot be used to acquire fixed assets or in activities other than the provision of health services. Nor will the Subsidized Regime be able to do so.

TRANSIENT TRANSIENT. The provisions of this Article shall be regulated so that the maximum percentage of administration shall take effect by 1 January 2013 at the latest. The National Government will have six (6) months to make the necessary revisions based on technical studies on the maximum percentage indicated in this article and could make the modifications to the case. Until such time as the Subsidized Regime is defined, it will continue to handle 8%.

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ARTICLE 24. REQUIREMENTS OF THE FUNCTIONING OF THE HEALTH PROMOTING ENTITIES. The National Government will regulate the conditions for the Health Promoter Entities to have a minimum number of affiliates to guarantee the necessary scales for the management the risk and the solvency margins, the financial, technical and quality capacity to operate in an appropriate manner.

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ARTICLE 25. BENEFIT PLAN UPDATE. The Benefit Plan must be updated integrally once every two years (2) years on the basis of changes in the epidemiological profile and burden of population disease, availability of resources, balance and extraordinary non-explicit medicines within the Benefit Plan.

The methodologies used for the definition and updating of the Plan of Benefits should be published and explicit and consult the opinion, among others, of the entities that integrate the General System of Social Security in Health, organizations of health professionals, members and scientific societies, or organisations and entities deemed to be relevant.

The Benefit Plan may only be updated by the competent administrative authority for this purpose.

PARAGRAFO. The Benefit Plan must be updated in a comprehensive manner before the first (1o) December 2011.

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ARTICLE 26. TECHNICAL-SCIENTIFIC COMMITTEE OF THE HEALTH PROMOTER. To access the provision of services by special, extraordinary and necessary conditions, the prescription of the treating health professional must be submitted to the Technical-Scientific Committee of the Health Promotion Entity with autonomy of its members, which shall decide on the insufficiency of the explicit benefits, the need for the provision of extraordinary services, within a period not exceeding two (2) calendar days from the application of the concept.

Scientific and Scientific Committees should be integrated or made up of medical and treating physicians. Under no circumstances will the administrative staff of the Health Promoter Entities integrate these committees, so be they doctors.

PARAGRAFO. The formation of the Scientific and Scientific Committees must guarantee the interdisciplinarity between the specialized pairs of the professional of the treating health and the full professional autonomy in their decisions.

Vigency Notes
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ARTICLE 27. REQUEST FOR SERVICES NOT PROVIDED FOR IN THE PLAN OF BENEFITS AND CREATION OF THE TECHNICAL BOARD-PEER SCIENTIST. 116 of Decree 19 of 2012. The new text is as follows: > The provision of services not provided for in the Plan of Benefits, which are required in need and are relevant in the particular case according to the prescription of the treating health professional, must be submitted by the Health Promotion Entity to the Scientific Technical Committee or to the Technical-Scientific Board of Pairs of the National Health Superintendence, in accordance with what is determined by the regulation.

Both the Scientific Technical Committees and the Technical-Scientific Boards of the National Superintendency of Health, with the autonomy of its members, will decide on the insufficiency of the explicit benefits, the need and the relevance of the provision of extraordinary services, within a period not exceeding seven (7) calendar days from the complete application of the concept, which shall be established by the regulation and in accordance with the medical conditions of the patient.

Editor Notes

The National Health Superintendence will have a list of specialist physicians and other specialized professionals to form the Scientific Technical Board.

The formation of the Scientific Technical Board should ensure interdisciplinarity among the specialized peers of the treating health professional and full professional autonomy in their decisions.

In cases where the National Government determines that the provision of services, not provided for in the benefit plan, is decided by the Scientific Technical Board, the Health Promotion Entity must send the request to the Technical Board. Scientific not later than the day after receipt of the prescription from the health professional.

Scientific technical committees should be integrated or made up of specialist physicians and other specialized professionals. Under no circumstances will the administrative staff of the Health Promoter Entities integrate these committees, so be they physicians.

The shaping of scientific-technical committees should ensure interdisciplinarity among the specialized peers of the treating health professional and full professional autonomy in their decisions.

TRANSIENT PARAGRAPH. The National Government shall issue the regulations within six (6) months of the duration of this decree.

Article 26 of Law 1438 of 2011 shall continue to apply until the entry into force of the regulation ordered by this Article.

Vigency Notes
Editor Notes
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ARTICLE 28. PRESCRIPTION OF THE RIGHT TO REQUEST REIMBURSEMENT OF ECONOMIC BENEFITS. The right of employers to request to the Health Promoter Entities the reimbursement of the value of the economic benefits prescribed in the term of three (3) years from the date on which the employer made the payment for the worker.

CHAPTER II.

ADMINISTRATION OF THE SUBSIDIZED REGIME.

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ARTICLE 29. ADMINISTRATION OF THE SUBSIDIZED REGIME. The territorial authorities will administer the Subsidized Regime by monitoring and controlling the insurance of the affiliates within their jurisdiction, guaranteeing the timely and quality access to the Plan of Benefits.

The Ministry of Social Protection will directly rotate, in the name of the Territorial Entities, the Unit of Payment by Capitation to the Health Promoter Entities, or it will be able to make direct payments to the Institutions of Health with the legal instrument defined by the National Government. In any case, the Ministry of Social Protection will be able to make the direct turn based on the information available, without prejudice to the responsibility of the territorial entities in the performance of their legal competences. The Ministry of Social Protection will define a plan for the progressive implementation of the direct turn.

The Nation will be able to collaborate with municipalities, districts, and departments, when it applies, with the identification and registration of beneficiaries of the Subsidized Regime.

TRANSIENT TRANSIENT. The districts and municipalities of more than one hundred thousand inhabitants (100,000) will be able to continue managing the resources of the subsidized regime until thirty-one (31) December 2012, using the legal instrument defined in the present Article.

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ARTICLE 30. SECUREMENT IN TERRITORIES WITH GEOGRAPHICALLY DISPERSED POPULATION. The National Government will define the dispersed population territories and the mechanisms to improve access to the health services of these communities and strengthen the securement.

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ARTICLE 31. MECHANISM FOR RAISING AND TURNING THE RESOURCES OF THE SUBSIDIZED REGIME. The National Government will design a system of resource management and can hire a financial mechanism to directly raise and rotate the resources they finance and co-finance the subsidized Health Regime, including those of the General System of Participations and the resources under which Article 217 of Law 100 of 1993 deals. In the case of the territorial effort, the financial mechanism may be contracted with the financial system and/or the Institutes for Regional Development and Development (FADs).

There will be an individual account for each district, municipality and department, in which the values derived from the resources referred to in the previous paragraph will be recorded, the holders of which are the territorial entities, which will have to budget and execute them without funds. For these purposes, the territorial entities shall be understood to commit the expenditure by determining the beneficiaries of the subsidies and to implement the appropriation by means of the money made by the Nation in accordance with this law.

From the individual account these resources will be directly rotated to the Health Promoter Entities and/or to the health service providers. The turn to the Health Promoter Entities will be done by the payment of a Payment Unit by Capitation, for each of the members that has registered and validated by means of the instrument defined for this purpose. In the case of service providers, the direct turn of the resources shall be based on the instrument defined for that purpose.

PARAGRAFO 1o. The departments, districts and municipalities will be able to turn to their account, in the payment system established by the Nation or to the Health Promoter Entities, the resources that co-finance the subsidized Health Regime with corresponding resources. the territorial effort itself and the assigned revenues, which will be rotated to the Health Promoter Entities to affiliate those persons that have not been covered with the resources administered by the system of payments contracted by the Nation and/or the providers of health services for payment of services that have been capitulated.

PARAGRAFO 2o. The costs and expenses of the administration, technical support, audit and the remuneration necessary to finance the mechanism provided for in this Article shall be paid out of the financial returns of these or with the resources of the Fund Solidarity and Guarantee, if the former are not enough.

PARAGRAFO 3o. The National Government will unify the system of administration and payments of the resources of the contributory and subsidized regimes through the financial mechanism to be determined for this purpose.

The Nation's resources and those determined by the regulations may be made directly by the General Treasury of the Nation or the Fosyga as the case may be.

The form and operating conditions of the Subsidized Regime will be determined by the National Government in a similar way to the Contributory Regime.

TRANSIENT PARAGRAPH 1o. TERM FOR THE SETTLEMENT OF THE CONTRACTS. The Governors or Mayors and the Health Promoter Entities shall proceed within the term of three (3) calendar months counted from the date of entry into force of this Law, to be settled. by mutual agreement the contracts entered into before 1 April 2010. If the settlement is not carried out within the established terms, the territorial entity based on its supports and those of the Health Promoter Entity, if it has them, will proceed to the unilateral liquidation within the thirty (30) calendar days following the expiry of the term described in this Article.

Failure to comply with these terms will result in the reporting to the control bodies and the respective disciplinary sanctions, and the amount of the contract will be the reference amount to which the tax liability of the agent will be determined. of the State. The monitoring and surveillance bodies concerned shall be informed of the non-compliance.

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TRANSIENT PARAGRAPH 2o. DEBT FOR THE PURPOSES OF SETTLED CONTRACTS. The amount in favour of the Health Promoter Entity contained in the settlement act of mutual agreement of the contracts of administration of the Subsidized Scheme or in the act of unilateral liquidation in force at the date of entry into force of this law and those arising out of compliance with it, must be rotated to the Health Promoter Entity, by the Territorial Entity, within thirty (30) days following the issue of the This law, which will be made directly to the Institutions of Health Services in the case in which the Health Promoter Entities give them resources, the remaining amount, if any, will be turned to the Health Promoter Company within the same period.

The balances that remain in favor of the territorial entity, will be rotated by the Health Promotion Entity to the master accounts, within the same term.

In the event that the territorial entities do not pay the debts for settled contracts, the National Government in order to safeguard the sustainability of the System and the guarantee of access to the affiliates, will be deducted from the resources allocated to that municipality by royalties, by the Petroleum Savings and Stabilization Fund (FAEP) or other municipal sources that are available at the national level, the amounts due and will be rotated to the respective Health Promoter Entities in the terms set out in this Article. The National Government shall regulate the procedure for this purpose by requiring the winding-up proceedings where the resources collected are recorded.

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CHAPTER III.

UNIVERSALIZATION OF INSURANCE.

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ARTICLE 32. UNIVERSALIZATION OF INSURANCE. All residents in the country must be affiliated with the General System of Social Security in Health. The National Government will develop mechanisms to guarantee membership.

When a person requires health care and is not affiliated, it will proceed as follows:

32.1 If you have a payment capacity, you will cancel the service and you will be contacted with the Health Promoter of the contributory scheme of your preference.

32.2 If the person shows no ability to pay, it will be met. The initial affiliation will be made to the Health Promotion Entity of the Subsidized Scheme by means of the simplified mechanism that will be developed for this purpose. The affiliation, the Health Promoter Entity, will verify within a period not greater than eight (8) working days if the person is eligible for the health allowance. If not, the affiliation will be cancelled and the Health Promotion Entity will proceed to recover the services provided. Membership of the Subsidiary Scheme may be reactivated when the conditions giving entitlement to the allowance are credited. In any case, the payment of the health services provided will be cancelled by the Health Promoter Entity if it is effectively affiliated to it; if it does not take hold, it will be paid with resources of offer to the institution of the health services, of compliance with the general regulations in force for the payment of health services.

If you do not have an identity card, you will take the fingerprint and the identification data, following the procedure established by the Ministry of Social Protection in coordination with the National Registry of the Civil State for the processing of the membership.

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32.3 The cases not established in this article to achieve the universalization of insurance will be regulated by the Ministry of Social Protection in a term not greater than one (1) year.

PARAGRAFO 1o. For those who enter the country, are not residents and are not insured, they will be encouraged to purchase health insurance or a Voluntary Health Plan for their care in the country if necessary.

PARAGRAFO 2o. Those who enjoy the special and exceptional regimes shall remain in them; the administrative entities of these regimes shall provide periodic information requested by the Ministry of Social Protection.

TRANSIENT TRANSIENT. As of January 1, 2012, there will be no period of lack in the General System of Social Security in Health.

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ARTICLE 33. PRESUMPTION OF ABILITY TO PAY AND OF INCOME. Is presumed to be capable of payment and, consequently, they are obliged to join the Contributory Regime or they may be affiliated officiously:

33.1 Natural persons declare income tax and supplementary, sales tax and industry and trade tax.

33.2 Those who have income and withholding certificates that reflect the income established to belong to the Contributory Scheme.

33.3 Those who comply with other indicators established by the National Government.

The above, without prejudice to being able to be classified as eligible for the subsidy through the Sisben, according to the rules on the matter.

The National Government will regulate a system of presumption of income based on information about economic activities. In the event of differences between the declared values before the National Customs and Tax Directorate (DIAN) and the contributions to the system, the latter must be adjusted.

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ARTICLE 34. PARTIAL CONTRIBUTION TO THE CONTRIBUTION. The persons eligible for the partial contribution to the contribution not affiliated with the General System of Social Security in Health shall pay on a basis income of a contribution of a legal minimum wage in force and a percentage Of the 10.5% contribution, or equivalent contribution according to the regulations issued by the National Government. These persons shall be entitled to a partial subsidy from their contribution to the subsidized scheme or the contributory scheme in which case it shall not include economic benefits. This subsidy will be 67% of the contribution or equivalent contribution from the resources of the Fosyga Compensation sub-account in the case of the members of the Contributory Regime and the Sub-account of Solidarity in the case of the Subsidiary. 33% of the contribution or equivalent contribution must be paid in advance by the affiliate.

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ARTICLE 35. STAY IN THE SUBSIDIZED REGIME. Those affiliated with the Subsidized Regime will be able to remain in the subsidized regime when they obtain a labor contract and become labor-related. In these cases, the employers or the affiliates will pay the contributions that should be paid in the Contributory Scheme to the same Health Promotion Entity and will be compensated monthly to the solidarity sub-account of the Solidarity and Guarantee Fund (Fosyga). In this event, the affiliate will be entitled to economic benefits.

When a temporary worker, whose monthly allowance does not reach a current minimum statutory salary, does not wish to be disengaged from the subsidized regime due to his employment relationship, the employer will have to contribute to the subsidized regime. the value equivalent to the payment which the worker would have to pay to the contributory scheme. In this case you will not be entitled to financial benefits.

If the employer does not comply with the obligation to pay the contribution, at the end of the employment relationship, the employer must pay the contributions to the General System of Social Security in Health.

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ARTICLE 36. PARTIAL BENEFIT PLANS. By unifying the benefit plans, no partial benefit plans may exist.

CHAPTER IV.

VOLUNTARY HEALTH PLANS.

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ARTICLE 37. VOLUNTARY HEALTH PLANS. Replace article 169 of Act 100 of 1993, with the following text:

" Article 169. Health Volunteer Plans. The Health Volunteer Plans may include health care coverage related to health services, will be contracted voluntarily and fully funded by the affiliate or the companies that establish it with resources. other than the compulsory contributions or the contribution to the contribution.

The acquisition and permanence of a Voluntary Health Plan implies prior affiliation and continuity through the payment of the contribution to the contributory regime of the General System of Social Security in Health.

Such Plans may be:

169.1 Additional Care Plans of the Mandatory Health Plan issued by the Health Promoter Entities.

169.2 Plans for Prepaid Medicine, Pre-Hospital Care or prepaid ambulance services, issued by Prepaid Medicine entities.

169.3 Insurance policies issued by insurance companies monitored by the Financial Superintendency.

169.4 Other plans authorized by the Financial Superintendency and the National Health Superintendence. "

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ARTICLE 38. APPROVAL OF VOLUNTARY HEALTH PLANS. The approval of the Voluntary Health Plans and of the rates, in relation to the Health Promoter Entities and the prepaid medical entities, will be in charge of the National Superintendence of Health, which shall record the plans, within a period not exceeding thirty (30) calendar days and shall carry out subsequent verification. The deposit of the plans will be brought before the National Superintendence of Health.

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ARTICLE 39. CREATION OF VOLUNTARY PLANS AND HEALTH INSURANCE. The National Government will encourage the creation, design, authorization and operation of voluntary and health insurance plans, both individual and collective.

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