Commission VII of the House of Representatives has already approved the bulk of health reform in the first debate, 84.2% of the 139 articles that make up the bill.
Apart from the functions of the ADDRESS, one of the points that has generated the most controversy is that of the EPS, as Article 49 of the bill was approved to establish that the EPS currently operating in the country would continue to do so. So for a period of two years, as long as they satisfy the conditions of permanence. Then, they will become health and life managers.
This change, according to the bill, is not its liquidation, but a dissolution process.
“The assets, liabilities, inheritance, with subordination of all duties, rights and obligations shall pass in a block to the Health and Life Management Unit, in such terms as the National Government regulates it. EPS which changes in the rules of social health insurance have become such, shall be determined by the National Government”.
Las EPS convertidas en gestoras como la aprueba la Comisión de la Cámara quedarán de lobistas o mandaderas ante los centros estatales de salud. Las serias seguramente no estarán interesadas en esa burla.
Seguimos avanzando en la recolección de firmas que rechaza esto
— Álvaro Uribe Vélez (@AlvaroUribeVel) May 19, 2023
If it is law, it will be the National Health Superintendence, which will, through an administrative act, authorize the operation of the EPS, which, through its transformation, are interested in the management of medium and high complexity services for the populations assigned to them . Authorized and fulfillment of contracts and other functions.
Other articles referring to the EPS that have already been approved in the Chamber are 53 and 54, which deal with the inspection, monitoring and control of the said entities and their administrative expenses.
Article 51 was also approved, which establishes that EPS that are authorized to operate and meet the requirements to become a manager must notify the Ministry of Health and Social Security of their intention in writing, or Change should not be accepted.
What will be the functions of the managers?
According to Article 50 of the reform, health and life managers shall be entities of a private, public or hybrid nature, contributing to comprehensive risk management in the specified health sector. He has been entrusted with 19 specific administrative functions:
coordination with departmental and district directorates with the necessary support by the Ministry of Health and Social Security in the organization of a comprehensive and integrated network of health services for health areas; Contribute to the strategic planning of the development of a comprehensive and integrated network of health services; implement effective mechanisms for coordinating support within a comprehensive and integrated network of health services;
They must also perform network performance monitoring and evaluation activities in the complementary component, under the direction of regional entities and ADDRESS; apply situational rooms that allow the analysis of information; To provide periodic reports on the operation of the supplementary component of the network.
He will participate in the Advisory Council for the planning and evaluation of a comprehensive and integrated network of health services; They will contribute to the efficient, rational and optimal use of financial resources; They will manage training plans to strengthen the operations of the complementary component; They will provide support to the members of the network.
Its functions include access to complementary components of Riiss, in coordination with CAPs, through referral and counter-referral systems and with the support of integrated public health information systems; and guarantees timely and prompt access to health services and drug services.
They will apply technical tools to interoperate with information systems; They will conduct quality audits of the medical accounts and health services concurrent benefits of the supplemental component of Riss; They will validate the billing; they will give an account; And they will manage to pay for the economic benefits.
