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acuerdo de punto final

The progress of the end-point agreement

Foto Francisco Garcia

Francisco Jose Garcia Lara
Surgeon and Master in Health Administration
from the Javeriana University
Columnist of the newspaper La Nación de Neiva

In recent years, the state's debt with the EPS has grown substantially due to activities or interventions that were outside the Health Benefits Plan (PBS-formerly Obligatory Health Plan or POS).

Based on the development plan of the current national government (1), what was called an end-point agreement (2) was established, which in relation to the contributory regime, we intend to analyze in this blog.

What is the end-point agreement?

Taking into account that there was a debt with the EPS for the so-called No PBS, the agreement established two main components: the first, aimed at clarifying the debts and the eventual payment of these; the second, aimed at establishing strategies so that the financing of the No PBS prevents the debt for this concept from reappearing.

 

In other words, the first component focuses on solving the existing debt, or the past, while the second component aims to solve the present and the future, by preventing those debts from accumulating again.

 

The second component was analyzed in the blog "The roofs in the health system" (1), published on this web page, for which we will focus on the first component, especially what is established in Decree 521 of 2020 .

 

Obviously, the first thing to do is to clarify the debts, to know how much is owed, to whom and for what concept, which in short is to carry out a reorganization process, for which the following must be taken into account:

 

The invoices that can be collected

In Decree 521 of 2020 it was established that the invoices that are part of the sanitation process are only those in which there are inputs, activities or procedures not included in the PBS, that is, they are not financed by the Capitation Payment Unit (CPU).

 

Those invoices were classified in the aforementioned decree as follows:

 

  • “Those that are registered with the ADRES (Administrator of the Resources of the Social Security System in Health- formerly the Solidarity and Guarantee Fund or FOSYGA (2)), against which the result of the audit has not been disclosed.
  • Those that were filed with ADRES and have an audit result where a total or partial gloss was applied.
  • Those that have not been filed with ADRES.
  • Those whose items are part of the claims of the lawsuits. In this case, the recovering entity must submit to the reorganization process all the items that are the object of the same claim. "

 

In turn, the aforementioned decree establishes that the ADRES must establish reference tables based on the updates of the health benefits plan, which will specify what is included in said plan and the records authorized by INVIMA, accordingly. so that what can really be charged within sanitation is identified.

 

The EPS or entities responsible for payment (ERP) (3) must express to the ADRES their interest in availing themselves of the reorganization process and submit the invoices according to the previous classification, for which several requirements must be met, among them, a certificate signed with IPS or suppliers, in which they undertake to accept the audit process and not make legal or administrative claims for those items that are not approved in the audit.

 

The audit and the transaction contract

After receiving the invoices, ADRES will carry out the audit, directly or through a third party hired for this purpose, to verify that said invoices correspond to non-PBS supplies, procedures or activities, that are not prescribed and that the amount charged is within of the ceilings established by the commission of prices of medicines and medical devices.

 

With the result of the audit, a transaction contract will be signed between the parties (ADRES and ERP) accepting the result of the audit and the values defined in it, committing not to initiate legal or administrative collection processes for the amounts not accepted in the audit. Likewise, they are obliged to make the corresponding accounting and financial adjustments.

 

The origin of the resources for payment

Once the amount to be paid by the ADRES has been defined, this entity will issue an administrative act indicating the value recognized to each ERP.

 

The national government will recognize this value as public debt within 30 days after the certification issued by ADRES and may use the following mechanisms for payment: charged to the debt service item of the General Budget of the Nation; by issuing Class B Treasury Securities (TES); or through a combination of the two.

 

The procedure for payment

To make the payment, a differentiation must be made between the entities that are operating and those that are in the liquidation process (Saludcoop, Cafesalud and Cruz Blanca, mainly):

 

In the former, the transfer will be made directly to the IPS or provider that provided the service that was recognized in the audit. In the event that the ERP that presented the invoice has paid the recognized item, it will be turned directly to other entities to which the same ERP owes them by No PBS in order of seniority. Only when the ERP that presented the invoice does not have outstanding debts due to Non-PBS may it request that the resources be transferred to its accounts or it may request that these values be transferred directly to IPS or suppliers with whom it has debts for supplies, care or procedures. included in the PBS.

 

For entities in liquidation, the recognized value will be turned over to the liquidator, who should not include it as part of the liquidation mass. The priority of the payment is: first the items recognized in the audit and in the credit to the same IPS or supplier; then, the money from the items recognized in the audit, but not in the credit, will be used to pay the recognized debt to the same IPS or supplier; In the event that what is recognized in the audit is higher than that recognized in the credit, the surplus will be used to pay what is recognized as No PBS to other IPS or providers. If there is money left over, after the previous ones, that value will be included in the liquidation mass.

 

Money available

The Presidency of the Republic (4) has affirmed that it has $5.2 billion destined for the payment of the end-point agreement in the contributory regime.

 

In conclusion:

Any effort made to provide liquidity to the health system should be welcomed, however, the following situations should be taken into account:

 

  • According to some analyzes, the ADRES debt for the No PBS of the contributory regime would amount to about $12 trillion, that is, the money available would be enough to pay less than 50% of the presumed debt.

 

  • Both the EPS, as the IPS or suppliers, must comply with the results of the audit and undertake not to initiate judicial or administrative processes for the items not recognized in said audit.

 

In this vein, there is no precision about what would happen if the result of the audit is of a value greater than the money available, or in other words, taking into account that it must be waived What is not recognized in the audit, it could be that the recognized value ends up being adjusted to the available amount and the loss must be assumed by the IPS and the suppliers, since in the process the ERPs were simple intermediaries.

 

The foregoing may be evident by the fact that it has been established in the decree in question, that the EPS will have three years to make the accounting adjustment in the event of a substantial difference between what is recognized and what is accounted for, if this difference affects the financial conditions and solvency.

 

In the health system glosses are common, with some frequency without foundation, hopefully this is not the case, since we would be facing a debt accommodated the badly at the same value of the amount available, not because it is real, but because there is no more money.

 

In conclusion, welcome the final agreement, but it is essential that the government guarantees the payment of what it owes, and if the audit results in a higher value than the amount available, appropriates more resources. Otherwise, the loss will be assumed by the IPS and the providers for a service that was actually provided, but will not be recognized.

 

 


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References

1. Articles 237 and 230 of Law 1955 of 2019.

2. For more information on this topic, it is recommended to consult the following blog: https://www.neuroeconomix.com/de-que-se-trata-el-acuerdo-de-punto-final/

3. https://www.neuroeconomix.com/los-techos-en-el-sistema-de-salud/

4. Words in parentheses outside the text of the decree.

5. They are the entities that must pay for health services, among which are: departmental, district and municipal health directorates, health promoting entities of the contributory and subsidized regimes, adapted entities and professional risk managers .

6. https://id.presidencia.gov.co/Paginas/prensa/2019/190723-Acuerdo-Punto-Final-sanear-deudas-historicas-marcara-hito-sistema-salud-Colombia-Presidente-Duque.

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