Strengthening CRES as the Technical Agency for the Regulation of the Social Security System in Health, with the necessary independence to develop its processes and the autonomy to make its own decisions.
In accordance with Article 7 of Law 1122 of 2007, the Health Regulation Committee shall exercise the following functions:
1. Define and modify the Compulsory Health Plan (POS) that Health Promoting Entities (EPS) ensure to their members under the rules of the contributive and subsidized regimes.
2. Define and review at least once a year, the list of essential and generic drugs that will be part of the Benefit Plans.
3. Define the value of Capitation Payment Unit of each scheme, in accordance with this law. If by December 31 of each year the Commission has not approved a rise in the value of the UPC, this value will automatically increase by the inflation.
4. Define the value per beneficiary of the subsidies in health, their benefits and mechanisms to implement the grant.
5. Define the criteria for the moderating rate mentioned in paragraph 3, Article 160 and Articles 164 and 187 of Law 100 of 1993.
6. Define the rules to be applied by EPS for the recognition and payment of disability caused in general diseases or maternity leave, according to the rules of the Contributory Scheme.
7. Establish and update a rate system that must have among other components, a manual of minimum rates to be reviewed each year, including professional fees. If it’s not revised, it will be indexed by the inflation.
8. Present in front of the Seventh commission of the House of Representatives and Senate, an annual report on developments in the Social Security System in Health and the recommendations for its improvement.
9. Recommend bills or mandatory decrees when they consider those are required in the health field.
10. Have its own regulations.
11. Any other assigned by law.
Paragraph 1: The value of co-payments and UPC will be reviewed at least once a year, before starting the next fiscal year, and the new value is determined on the basis of previous technical studies.
Paragraph 2: In rare cases, caused by health emergencies that may affect public health, the Ministry of Social Welfare will temporarily assume the functions of the Health Regulation Committee.
Paragraph 3: The decisions taken by the Health Regulatory Commission related to tax regime should take into account the financial balance, according to the sustainable projections in a medium and long term, and those for the subsidized regime, in any case they must be compatible with the medium term Fiscal Framework.
Additionally, Article 14, ibid, harmonizes some functions conferred by Article 7 ibid,:
“…e) The Health Regulatory Commission will annually update the Compulsory Health Plan seeking the progressive approach of the contents in both plans of the two systems with a trend towards the one in the contributory scheme.
“…f) In case of high-cost diseases that require drugs that are not included in the insurance system’s benefit plan, the EPS will lead to consideration of the Scientific Technical Committee such requirements. If the EPS does not study such requests nor timely filed those before the respective committee and the services is require by a legal action, the costs shall be borne equally between the EPS and Fosyga. The Ministry of Social Welfare will regulate the present article, within the six (6) months after the current law is in force. In any case, when the Fosyga makes the recognition, the payment will be made based on the minimum rates set by the Health Regulation Commission”
Finally, Article 22, ibid, gives the Health Regulation Commission the following function:
“…Paragraph: The subsidy to the contribution price, once it is defined by the Health Regulation Commission, will keep the beneficiaries at least a year”.