Hospitalization coverage and medical fees increase

The National Social Security Council (CNSS) authorized the increase in coverage for hospitalizations, medical fees and consultations for hospitalizationdiagnostic exams, hospitalization, as well as the use of rooms and equipment, among other health services.

In an extraordinary meeting of the Council and through resolution 563-01, an i20% increase in medical fees concerning procedures and 50% in hospitalization consultations.

The increase represents an increase of more than RD$2,700 million a year, indicated the CNSS in a note to the media, resources that would be received by doctors as of February 2023, this in addition to the other RD$2,800 million that They were increased in October 2021, the date on which an increase of 20% in medical fees and 30% in interconsultation fees was approved.

Exams and diagnostic tests
The resolution too a 7% increase in fees for examinations and diagnostic testswhich represents RD$1.2 billion a year, according to the CNSS.

Also increased a 15% for the use of room and equipmentwhich will continue to be reviewed with a periodicity of 90 days and whose increases would be in charge of the Health Care Account of the people, said "does not affect the pocket of affiliates".

The governing entity of the Dominican Social Security System, coverage also increased by 15% in the use of rooms in clinics and hospitals, per affiliate per day, which indicates represents more than RD$350 million, so "the coverage granted by the ARS will be 100% up to the amount of RD$1,725.00 and 90% in the range between RD$1,726.00 and RD$2,415.00.

over resolution
The resolution establishes that the ARS undertake to grant the codes to doctors, within a period not exceeding 30 days, from the completion of the necessary documentation and requirements.

In the case of differences, SISALRIL undertakes to make the calls that are necessary, with the objective of acting as a mediator between the ARS and the Dominican Medical Association, so that doctors can receive their respective codes in a timely manner.

The resolution details that to cover administrative expenses, it was approved to increase RD$65.00 to the monthly per capita Family Health Insurance (SFS) of the Contributive Regime (RC), charged to the Health Care Account for People of the Family Health Insurance of the Contributive Regime.

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This measure will take effect as of February 2023. The surplus, which amounts to more than 1,000 million pesos per year, will be covered by the Health Risk Administrators (ARS).

As part of the executive measures, the CNSS instructed the Superintendency of Health and Occupational Risks (SISALRIL) to guarantee that the Health Risk Administrators do not produce increases in rates for services provided as a result of the new agreements.

This measure is intended to prevent Health Service Providers (PDSS) from making simultaneous increases to the new agreed increases and that this translates into increased spending for the population affiliated with the Family Health Insurance (SFS).

Convoke Professional Fees Committee
In another vein, the resolution requests the Ministry of Labor to take steps to convene the National Committee of Professional Fees (CNHP) and contact the entities that make it up with the aim of having them send their representatives, in order to continue analyzing and studying the increase in the rates of professional fees for medical consultations.

It was established that the proposal to increase outpatient consultations, the increase in the rate for emergencies, home consultations, and the annual indexation will be known by the National Committee of Professional Fees, which will be in charge of its evaluation.

Basic Plan Review
The CNSS approved through resolution No. 562-04 the revision of the Basic Health Plan (PBS), presented by SISALRIL, assessing those considerations given by the Dominican Association of Medical Igualas and Health Risk Administrators (ADIMARS), the Dominican Association of Health Risk Administrators (ADARS), the Dominican Association of Private Clinics (ANDECLIP) and the National Health Insurance (SeNaSa) taking into account that they do not jeopardize the effectiveness, equity and financial protection of the Dominican Health System. Social Security (SDSS).


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