Coverage of hospitalization and medical fees increased
Santo Domingo, DR.
The National Social Security Council (CNSS) authorized an increase in coverage for hospitalization, medical fees and consultations for hospitalization, diagnostic tests, hospitalization, and the use of rooms and equipment, among other health services.
In an extraordinary meeting of the Board and by means of Resolution 563-01, an increase of 20% was approved for medical fees for procedures and 50% for inpatient consultations.
The increase represents an increase of more than RD$2.7 billion a year; the CNSS indicated in a note to the media resources that would be received by the doctors as of February 2023, in addition to the other RD$2.8 billion that was increased in October 2021, the date on which a 20% increase in medical fees and 30% in inter consultation fees were approved.
Examinations and diagnostic tests
The resolution also increases fees for examinations and diagnostic tests by 7%, which represents RD$1.2 billion a year, according to the CNSS.
It also increased by 15% for the use of rooms and equipment, which will continue to be reviewed every 90 days and whose increases would be charged to the Health Care Account of the people, which it said: “does not affect the pockets of the affiliates.”
The governing entity of the Dominican Social Security System also increased the coverage by 15% in the use of rooms in clinics and hospitals per member per day, which represents more than RD$350 million, so that “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.
More of the resolution
The resolution establishes that the ARSs undertake to grant the codes to the doctors within a term not exceeding 30 days as soon as they complete the necessary documentation and requirements.
In the case of differences, the SISALRIL undertakes to make the necessary calls to act as a mediator between the ARSs and the Dominican Medical Association so that the doctors may 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 of the Family Health Insurance (SFS) of the Contributory Regime (RC), charged to the Health Care Account of the Individuals of the Family Health Insurance of the Contributory Regime.
This measure will take effect as of February 2023. The surplus, which amounts to more than 1 billion 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 Labor Risks (SISALRIL) to ensure that the Health Risk Administrators do not increase the rates for services rendered due to the new agreements.
This measure aims to prevent the Health Service Providers (PDSS) from making simultaneous increases to the new increases agreed upon. This would increase expenses for the population affiliated with Family Health Insurance (SFS).
Convening of the Professional Fees Committee
In another aspect, the resolution requests the Ministry of Labor to take the necessary steps to convene the National Professional Fees Committee (CNHP) and to contact its member entities so that they can send their representatives to continue analyzing and studying the increase in the rates of professional fees for medical consultations.
It was established that the proposal for the increase of outpatient consultations, the increase of the fee for emergencies, home consultations, and the annual indexation would be discussed by the National Committee on Professional Fees, which will be in charge of its evaluation.
Revision of the Basic Plan
The CNSS approved through Resolution No. 562-04 the revision of the Basic Plan. 562-04 the revision of the Basic Health Plan (PBS), presented by SISALRIL, evaluating those considerations given by the Dominican Association of Medical Equalization 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 efficiency, equity and financial protection of the Dominican Social Security System (SDSS).