Resolution SBS No. 1372-2023: Amends the Title of Chapter XII: Mental and Behavioral Disorders of the Manual for Evaluation and Qualification of the Degree of Invalidity (MECGI)

Los Laureles Nº 214 - Lima 27 - Perú Telf.: (511) 6309000 Lima, April 19, 2023 Resolution S.B.S.
No. 01372 -2023

The Superintendent of Banks, Insurance, and Private Pension Fund Administrators

CONSIDERING:

That, by Supreme Decree No. 054-97-EF, the Single Consolidated Text (TUO) of the Law of the Private System of Administration of Pension Funds was approved;

That, by Supreme Decree No. 004-98-EF, the Regulation of the aforementioned Law was approved;

That, additionally, in accordance with the Third Final and Transitory Provision of the Regulation of the Law, the Superintendence is empowered to issue the complementary operational norms necessary for the proper functioning of the Private System of Administration of Pension Funds (SPP);

That, through Supreme Decree No. 061-2007-EF, Article 129 of the cited Regulation of the Law was modified, referring to the Technical Medical Commission (CTM), which establishes that this commission is responsible for reviewing the technical norms for the evaluation and qualification of the degree of invalidity, and refers to the Superintendence the proposals corresponding to the modification of the respective Manuals for Evaluation and Qualification of the Degree of Invalidity to which the Medical Committee of the AFPs (COMAFP) and the Medical Committee of the Superintendence (COMEC) must adhere, as well as to the other functions assigned to it by the Superintendence;

That, the Superintendence, jointly with the CTM, has carried out a review of the problems related to the process of evaluation and qualification of invalidity on the occasion when an affiliate is evaluated and qualified using Chapter XII: Mental and Behavioral Disorders of the Manual for Evaluation and Qualification of the Degree of Invalidity (MECGI), incorporated as Subtitle IV of Title VII of the Compendium of Regulatory Superintendence Norms of the SPP, referred to as the Norms for Evaluation and Qualification of the Degree of Invalidity, approved by Resolution No. 058-94-EF/SAFP and its amendments, and has formulated a proposal to modify the content of said chapter in order to respond to the problematic casuistry detected;

That, likewise, for the elaboration of the proposal for modification to the aforementioned Chapter XII, coordination has been carried out with the medical committees, COMAFP and COMEC, and their comments and suggestions have been collected, so it was determined, based on the evaluation carried out with the CTM, that the development of a comprehensive modification proposal for Chapter XII of the MECGI was required;

That, since COMAFP and COMEC are within the scope of numeral 7 of Article I of the Preliminary Title of the General Administrative Procedure Law, Law No. 27444, the principles established in the Single Consolidated Text of the General Administrative Procedure Law, approved by Supreme Decree 004-2019-JUS, are applicable to the invalidity evaluation and qualification procedure; therefore, their application must be included as part of the usage instructions for the norms for the evaluation and qualification of invalidity of the MECGI;

That, for the purpose of collecting public opinions regarding the modification proposals to the SPP regulations, the pre-publication of the draft resolution on the matter was ordered on the electronic portal of the Superintendence, in accordance with what is established in Supreme Decree No. 001-2009-JUS;

Having the approval of the Adjunct Superintendencies of Private Pension Fund Administrators, and of Legal Advice; and,

In exercise of the powers conferred by numeral 9 of Article 349 of the General Law of the Financial System and the Insurance System and Organic Law of the Superintendence of Banking and Insurance, Law No. 26702 and its amendments, subsection d) of Article 57 of the SPP Law, as well as by what is established in the third final and transitory provision of its Regulation;

RESOLVES:

Article First.- The title of “Chapter XII: Mental and Behavioral Disorders” of the Manual for Evaluation and Qualification of the Degree of Invalidity (MECGI), incorporated as Subtitle IV of Title VII of the Compendium of Regulatory Superintendence Norms of the SPP, approved by Resolution No. 058-94-EF/SAFP and its amending norms, is modified, changing it to “Chapter XII: Mental, Behavioral, and Neurodevelopmental Disorders”.

Article Second.- The content of Chapter XII: Mental and Behavioral Disorders of the Manual for Evaluation and Qualification of the Degree of Invalidity (MECGI), incorporated as Subtitle IV of Title VII of the Compendium of Regulatory Superintendence Norms of the SPP, approved by Resolution No. 058-94-EF/SAFP and its amending norms, is replaced by the following text:

“CHAPTER XII
MENTAL, BEHAVIORAL, AND NEURODEVELOPMENTAL DISORDERS

I. INTRODUCTION
Physical and mental health are closely related as components of human homeostasis, with the latter playing an important role in maintaining good physical health and the capacities to develop activities of daily and working life. Mental disorders are the main cause of disability, with a great impact on the shortening of life expectancy, representing a decrease of 10 to 20 years compared to the general population, even more so considering that most physical diseases are preventable.

Likewise, problems with organic basis such as chronic and traumatic diseases can have a serious impact on mental health, which decreases the capacity for treatment of their pathology and recovery.

On the other hand, with the emergence of the SARS Cov2 (COVID-19) pandemic, significant impact on the mental health of infected persons has been evidenced, who have witnessed illness or death as a consequence of COVID-19. For this reason, not only criteria that can serve as support for the evaluation of impairment for already known diseases are established, but also for those that may have emerged or expressed as a result of the pandemic.

The classification of mental, behavioral, and neurodevelopmental disorders in this Chapter has been considered in accordance with international descriptive criteria based on the consultation guide of the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in its 5th version, as well as in the International Classification of Diseases in its 10th version (ICD-10), taking into account that this group of pathologies may present similar symptoms that differ in other important aspects, such as evolution, degree of impairment, or therapeutic strategy to be followed. In this same sense, significant changes have been made in the classification and nomenclature of important and highly significant pathologies, such as the designation of “intellectual disability,” replacing the extended use of the term “mental retardation” in common usage areas, such as educational, professional, legislative, journalistic, and societal levels worldwide, which has been considered in the present Chapter.

This chapter offers members of the medical committees of the Private Pension System (SPP), SPP consulting physicians, and other medical professionals participating in said system, the necessary tools to allow them to carry out an objective evaluation and adequate qualification of invalidity of SPP affiliates and/or beneficiaries, with objective, sustainable, traceable, and replicable criteria to minimize the risk of discretion in qualification, taking as reference the rating models of Latin American countries and also the normative documents issued by the Ministry of Health of Peru (MINSA).

II. OBJECTIVE
Establish a unique instrument for the comprehensive evaluation and qualification of invalidity caused by mental, behavioral, and neurodevelopmental disorders, considering advances in medicine, international public policies on invalidity, as well as national reality and context, in concordance with the autonomy possessed by the SPP Medical Committees, and in accordance with the corresponding regulations.

III. SCOPE
This Chapter must be applied to requests for evaluation and qualification of invalidity presented by SPP affiliates and/or beneficiaries who present diagnoses linked to mental, behavioral, and neurodevelopmental disorders.

IV. GENERAL PROVISIONS

1. For the purposes of this Chapter, the use of complementary factors established in the Introduction section of the MECGI is not applicable, because the tools contained in this Chapter contemplate equivalent criteria.
2. Sequelae, side effects, and adverse events not contained in this Chapter resulting from the disease or therapy must be evaluated and qualified according to the corresponding Chapter of the MECGI.

V. SPECIFIC PROVISIONS
Definitions

1. Adaptability or adaptive behavior: is the set of conceptual, social, and practical skills that the individual has learned and that allow them to respond to the circumstances of daily life.
2. Mental disability: is a cognitive or psychological condition that seriously disrupts daily life activities to the extent that special attention is required.
3. Intellectual disability: is a disorder characterized by presenting significant limitations both in intellectual functioning and in adaptive behavior, as manifested in adaptive, conceptual, and practical skills. This disability originates before the completion of the human development stage.
4. Disabling disease: is that which causes serious anatomical or functional reductions, susceptible of objective determination and predictably definitive or in some cases reversible, which decreases by at least 50% or more the capacity for work.
5. Invalidity: in accordance with subsection d) of Article 2° of Title VII of the Compendium of Regulatory Superintendence Norms of the SPP, it is the medical-administrative-laboral condition that refers to the loss of 50% or more of the affiliate's work capacity, which makes it impossible for them to perform work compatible with their capacities. Such loss or impairment has a partial or total degree and a temporary or permanent nature, according to the invalidity qualifications made by the competent medical committees, and based on the SPP norms for evaluation and qualification of the degree of invalidity.
6. Partial invalidity: in accordance with subsection e) of Article 2° of Title VII of the Compendium of Regulatory Superintendence Norms of the SPP and Article 115° of the Regulation of the SPP Law, it corresponds to that condition in which the affiliate suffers an impairment in their work capacity, and is in physical or mental incapacity of prolonged nature, in a percentage equal to or greater than 50% but less than two-thirds, according to the opinion issued by COMAFP or COMEC as appropriate.
7. Total invalidity: in accordance with subsection f) of Article 2° of Title VII of the Compendium of Regulatory Superintendence Norms of the SPP and Article 115° of the Regulation of the SPP Law, it corresponds to that condition in which the affiliate suffers an impairment in their work capacity, and is in physical or mental incapacity of prolonged nature, equal to or greater than two-thirds, according to the opinion issued by COMAFP or COMEC as appropriate.
8. Mental health: mental health reflects “our emotional, psychological, and social well-being” and affects “how we think, feel, and act.” Likewise, it has a strong impact on the ways in which we interact with others, how we handle problems, and how we make decisions.
9. Mental disorder: are conditions that affect the thought, feeling, mood, or behavior of the person. These include, but are not limited to, depression, anxiety, bipolar disorder, or schizophrenia.

VI. EVALUATION CRITERIA
VI.1 CRITERIA TO BE CONSIDERED FOR THE EVALUATION AND WEIGHTING OF DAMAGE The following criteria help to carry out an objective evaluation of the group of pathologies subject to this Chapter regarding their level of severity, level of disability, and specific valuation of the incapacity to work. Likewise, these criteria must be taken into account when determining the date of occurrence of the invalidity condition and its nature, for which the following criteria must be considered:

a) Disease time of one (1) year or more diagnosed and treated by a psychiatrist with continuous treatment, in accordance with clinical practice guidelines, without having achieved stabilization or recovered their cognitive, mood, social, or labor skills. b) Take into account that symptomatology that due to its severity has warranted intense medication or hospitalization and has left disabling sequelae for labor activity. c) The reactivation of symptoms must be considered despite receiving continuous treatment. d) Consider the medication used and number of medications used for symptom control. e) Evaluate if the person's quality of life is altered, considered as incapacity to satisfy their daily life activities, evident negative symptoms, and neglect of primary cognitive functions during symptom-free intervals. f) Evaluate persistent residual symptomatology. Persistent negative symptoms of mental, behavioral, and neurodevelopmental disorders must be considered.

Likewise, medical committees may weigh the relevance of applying the aforementioned criteria in order to avoid prejudice to the rights of the administered, in accordance with what is established in the General Administrative Procedure Law, Law No. 27444 or other applicable norms; this decision must be duly substantiated in the file and in the corresponding pronouncement.

VI.2 DATE OF OCCURRENCE OF INVALIDITY
It is determined considering the information obtained from the file and based on what is described in Article 61° of the aforementioned Title VII of the Compendium of Regulatory Superintendence Norms of the SPP, as well as taking into consideration the general guidelines for the evaluation and qualification of invalidity established in this Manual for Evaluation and Qualification of the Degree of Invalidity (MECGI).

VI.3 DIAGNOSTIC AID EXAMINATIONS
These are auxiliary examinations that help to complement or elucidate the diagnosis with other non-psychiatric non-disabling conditions or even those that may be subject to simulation; and others that the medical committee considers contribute to this regard. Likewise, in this section, examinations that are already contained in the file and serve as support to evidence the pathology subject to evaluation as well as those pathologies that are congenital or hereditary are considered. The following are considered diagnostic aid examinations:

a) Basal examinations: complete blood count, urine examination, serum glucose, urea, creatinine, serum B complex, thyroid profile, among others that are considered pertinent. b) Neuroimaging: X-rays, CT, SPECT, functional SPECT, conventional and/or functional MRI, PET (positron emission tomography), SPECT (single-photon emission computed tomography), and Cerebral Angiography. c) Electrophysiological: EEG (electroencephalogram) and evoked potentials. d) Biochemical: lumbar puncture and Amniocentesis. e) Toxicological: toxicological examinations for cocaine, marijuana, ecstasy, amphetamine, methamphetamine, benzodiazepines, tricyclic antidepressants, barbiturates, morphine, and methadone. f) Genetic: conventional karyotype, mlpa (multiplex ligation-dependent probe amplification), fish (fluorescence in situ hybridization), CGH-Arrays (Genomic hybridization Microarrays), and others according to ACMG (American College of Medical Genetics).

As medical technology develops new and innovative complementary examinations, the aforementioned letters do not exempt that they may be used according to relevance and use in Peru.

VI.4 CLASSIFICATION OF MENTAL, BEHAVIORAL, AND NEURODEVELOPMENTAL DISORDERS Below is the classification of mental, behavioral, and neurodevelopmental disorders based on the consultation guide of the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in its 5th version and in the current International Classification of Diseases (ICD) in version 10. This classification and nomenclature of pathologies are subject to modification by the World Health Organization (WHO), which must be accepted by MINSA previously; modifications, if any, must be taken into account in the application of this chapter.

Schizophrenia spectrum and other psychotic disorders

• Schizotypal personality disorder
• Delusional disorder
• Brief psychotic disorder
• Schizophreniform disorder
• Schizophrenia
• Bipolar type
• Depressive type
• With delusions
• With hallucinations
• Catatonia associated with another mental disorder
• Catatonic disorder due to another medical condition
• Unspecified catatonia
• Other specified schizophrenia spectrum and other psychotic disorder
• Unspecified schizophrenia spectrum and other psychotic disorder

Bipolar and related disorders

• Mild

• Moderate

• Severe

• With psychotic features

• Unspecified

• Current or most recent hypomanic episode

• Current or most recent depressive episode

• Bipolar disorder

• Cyclothymic disorder

• Bipolar and related disorder due to another medical condition

• Other specified bipolar and related disorder

• Unspecified bipolar and related disorder

Depressive disorders

• Disruptive mood dysregulation disorder
• Major depressive disorder
• Single episode
• Recurrent episode
• Persistent depressive disorder
• Premenstrual dysphoric disorder
• Depressive disorder due to another medical condition
• Other specified depressive disorder
• Unspecified depressive disorder

Anxiety disorders

• Separation anxiety disorder
• Selective mutism
• Specific phobia
• Social anxiety disorder
• Panic disorder
• Agoraphobia
• Generalized anxiety disorder
• Substance/medication-induced anxiety disorder
• Anxiety disorder due to another medical condition
• Other specified anxiety disorder
• Unspecified anxiety disorder

Obsessive-compulsive and related disorders

• Obsessive-compulsive disorder
• Body dysmorphic disorder
• Hoarding disorder
• Trichotillomania
• Excoriation disorder
• Substance/medication-induced obsessive-compulsive and related disorder
• Obsessive-compulsive and related disorder due to another medical condition
• Other specified obsessive-compulsive and related disorder
• Unspecified obsessive-compulsive and related disorder

Trauma- and stressor-related disorders

• Reactive attachment disorder
• Disinhibited social engagement disorder
• Posttraumatic stress disorder
• Acute stress disorder
• Adjustment disorder
• Other specified trauma- and stressor-related disorder
• Unspecified trauma- and stressor-related disorder

Dissociative disorders

• Dissociative identity disorder
• Dissociative amnesia
• Depersonalization/derealization disorder
• Other specified dissociative disorder
• Unspecified dissociative disorder

Somatic symptom and related disorders

• Somatic symptom disorder
• Illness anxiety disorder
• Conversion disorder
• Psychological factors affecting other medical conditions
• Factitious disorder
• Other specified somatic symptom and related disorder
• Unspecified somatic symptom and related disorder

Feeding and eating disorders

• Pica
• Rumination disorder
• Avoidant/restrictive food intake disorder
• Anorexia nervosa
• Bulimia nervosa
• Binge-eating disorder
• Other specified feeding or eating disorder
• Unspecified feeding or eating disorder

Elimination disorders

• Enuresis
• Encopresis
• Other specified elimination disorder
• Unspecified elimination disorder

Sleep-wake disorders

• Insomnia disorder
• Hypersomnia disorder
• Narcolepsy without cataplexy, but with hypocretin deficiency
• Narcolepsy with cataplexy, but without hypocretin deficiency
• Autosomal dominant cerebellar ataxia, deafness, and narcolepsy
• Autosomal dominant narcolepsy, obesity, and type 2 diabetes
• Narcolepsy secondary to another medical condition

Sleep-related breathing disorders

• Obstructive sleep apnea and hypopnea
• Idiopathic central sleep apnea
• Cheyne-Stokes respiration
• Central sleep apnea with concurrent opioid use
• Sleep-related hypoventilation
• Idiopathic hypoventilation
• Congenital central alveolar hypoventilation
• Concurrent sleep-related hypoventilation

Los Laureles Nº 214 - Lima 27 - Perú Telf.: (511) 6309000

• Circadian rhythm sleep-wake disorders
  • Non-REM sleep arousal disorders
  • Nightmare disorder
  • REM sleep behavior disorder
  • Restless legs syndrome
  • Substance/medication-induced sleep disorder
  • Other specified insomnia disorder
  • Unspecified insomnia disorder
  • Other specified hypersomnia disorder
  • Unspecified hypersomnia disorder
  • Other specified non-24-hour sleep-wake rhythm disorder
  • Non-24-hour sleep-wake rhythm disorder
    Sexual dysfunctions
• Delayed ejaculation
• Erectile disorder
• Female orgasmic disorder
• Female interest/arousal disorder
• Genito-pelvic pain/penetration disorder
• Male hypoactive sexual desire disorder
• Premature ejaculation
• Substance/medication-induced sexual dysfunction
• Other unspecified sexual dysfunction
• Unspecified sexual dysfunction
  Gender dysphoria
• Gender dysphoria in children
• Gender dysphoria in adolescents and adults
• Other specified gender dysphoria
• Unspecified gender dysphoria
  Disruptive, impulse-control, and conduct disorders
• Oppositional defiant disorder
• Intermittent explosive disorder
• Antisocial personality disorder
• Pyromania
• Kleptomania
• Other specified disruptive, impulse-control, and conduct disorder
• Unspecified disruptive, impulse-control, and conduct disorder
  Substance-related and addictive disorders
• Substance-related disorders
• Alcohol-related disorders
• Caffeine-related disorders
• Cannabis-related disorders
• Hallucinogen-related disorders
• Inhalant-related disorders
• Opioid-related disorders

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• Sedative, hypnotic, or anxiolytic-related disorders
• Stimulant-related disorders
• Tobacco-related disorders
• Other (or unknown) substance-related disorders
• Non-substance-related disorders
  Neurocognitive disorders
• Confusional syndrome
• Major and mild neurocognitive disorders
• Major or mild neurocognitive disorder due to Alzheimer's disease
• Major or mild frontotemporal neurocognitive disorder
• Major or mild neurocognitive disorder with Lewy bodies
• Major or mild vascular neurocognitive disorder
• Major or mild neurocognitive disorder due to traumatic brain injury
• Major or mild neurocognitive disorder due to substance/medication
• Major or mild neurocognitive disorder due to HIV infection
• Major or mild neurocognitive disorder due to Parkinson's disease
• Major or mild neurocognitive disorder due to Huntington's disease
• Major or mild neurocognitive disorder due to another medical condition
• Major or mild neurocognitive disorder due to multiple etiologies
• Unspecified neurocognitive disorder
  Personality disorders
• Personality disorders: Group A
• Personality disorders: Group B
• Personality disorders: Group C
• Other personality disorders
  Paraphilic disorders
• Voyeuristic disorder
• Exhibitionistic disorder
• Frotteuristic disorder
• Sexual masochism disorder
• Sexual sadism disorder
• Pedophilic disorder
• Fetishistic disorder
• Transvestic disorder
• Other specified paraphilic disorder
• Unspecified paraphilic disorder
  Other mental disorders
• Other specified mental disorder due to another medical condition
• Unspecified mental disorder due to another medical condition
• Other specified mental disorder
• Unspecified mental disorder
  Medication-induced movement disorders and other adverse effects of medications
• Neuroleptic-induced parkinsonism
• Parkinsonism induced by other medications

Los Laureles Nº 214 - Lima 27 - Perú Telf.: (511) 6309000

• Neuroleptic malignant syndrome
• Acute medication-induced dystonia
• Acute medication-induced akathisia
• Tardive dyskinesia
• Tardive dystonia
• Tardive akathisia
• Medication-induced postural tremor
• Other medication-induced movement disorder
• Antidepressant discontinuation syndrome
• Other medication adverse effect
  Other conditions that may be a focus of clinical attention
• Relationship problems
• Family problems related to upbringing
• Other problems related to primary support group
• Abuse, neglect, and abandonment
• Child abuse and neglect problems
• Child sexual abuse
• Other circumstances related to child sexual abuse
  Child neglect
• Confirmed child neglect
• Suspected child neglect
  Other circumstances related to child neglect
  Child psychological abuse
• Confirmed child psychological abuse
• Suspected child psychological abuse
• Other circumstances related to child psychological abuse
  Adult abuse and neglect problems
• Physical violence by spouse or partner
• Neglect by spouse or partner
• Psychological abuse by spouse or partner
• Adult abuse by someone other than spouse or partner
  Educational or occupational problems
• Educational problems
• Occupational problems
  Housing and economic problems
• Housing problems
• Economic problems
  Other problems related to social environment
• Life phase problem
• Problem related to living alone
• Acculturation difficulty
• Social exclusion or rejection

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• Target of adverse discrimination or persecution
• Unspecified problem related to social environment
  Problems related to crime or interaction with the legal system
• Victim of crime
• Civil or criminal sentence without imprisonment
• Incarceration or other confinement
• Problems related to release from confinement
• Problems related to other legal circumstances
  Other encounters with counseling and medical advice services Problems related to other psychosocial, personal, and environmental circumstances Other circumstances of personal history Problems related to access to medical care and other health assistance Non-compliance with medical treatment Neurodevelopmental disorders Neurodevelopmental disorders
• Intellectual disabilities
• Communication disorders
• Autism spectrum disorder
• Attention-deficit/hyperactivity disorder
• Specific learning disorder
• Motor disorders
• Tic disorders
• Other neurodevelopmental disorders
  VII. DISABILITY EVALUATION AND CLASSIFICATION TOOL
  The disability evaluation and classification applicable to mental, behavioral, and neurodevelopmental disorders requires consideration of the nature and clinical manifestations of the damage or damages that will determine the loss of capacity to adapt to perform their activities, which are reflected in:
• Daily activities, both in the family, social, and occupational spheres;
• Range of interest regarding Activities of Daily Living (ADL) and Activities of Daily Living (ADL-work);
• Capacity to care for their personal, essential, or basic needs; and,
• Capacity to relate to other people.
  The evaluation considers clinically demonstrable signs; therefore, there must be concordance between the symptoms found and the observed homeostasis state. Additionally, those effects that could be attributed to the medication received for the treatment of these pathologies.

Los Laureles Nº 214 - Lima 27 - Perú Telf.: (511) 6309000 That a person is diagnosed with a mental, behavioral, or neurodevelopmental disorder does not mean they are considered to have a disability condition in the SPP; what must be demonstrated is that there is an alteration that limits judgment and adaptation and has connotations in their daily and work activities. Likewise, it must be taken into account whether the mental condition is static, progressive, or has a good prognosis. On the other hand, the tools in this section consider those classifications, criteria, and times that are established as of the date of its issuance; therefore, they are subject to changes according to documents or regulations issued subsequently that will have repercussions on the tools described below, such as the case of disease classification, rest periods, or clinical practice guidelines. Therefore, to the extent that such changes do not have a high impact on the percentage of disability impairment, they must be deemed valid; otherwise, medical committees must carry out the relevant evaluation to determine their applicability or not, with respect to the files they have for attention.
7.1 Disability Evaluation and Classification Tool for Mental, Behavioral, and Neurodevelopmental Disorders
To determine the totals, arithmetic summation is used.
Table No. 1 of section 7.1 Disability Evaluation and Classification Tool for Mental and Behavioral Disorders
PERSONAL ASPECTS
1.- Alterations in their responsibility activities: household chores, studies, work (Maximum 15%) Percentage of disability impairment a. No alterations in the development of their activities. 0% b. Presents occasional alterations in the development of their activities. 3%
c. Occasional medical leaves up to 20 accumulated days in a year or need for occasional medical attention.
6% d. Frequent medical leaves during the year meaning more than 20 days and less than 3 months accumulated in a year or need for medical attention at least 1 time per month. 9% e. Continuous medical leaves, greater than 3 months or need for monthly medical attention. 12% f. File in the Medical Commission of Incapacity (MINSA/EsSalud) or need for continuous medical attention. 15% 2.- Alterations in their family and social life (Maximum 15%) a. Develops their daily activities without difficulty. 0% b. Presents alterations in the development of their daily activities. 3%
c. Presents difficulty developing with third parties. 6%
d. Presents difficulty developing communication with their family. 9% e. Remains in their room for most of the day. 12% f. Need for hospitalization in a care institution. 15%

Los Laureles Nº 214 - Lima 27 - Perú Telf.: (511) 6309000 3.- Emotional and support networks (Maximum 12%) a. Integrated into their family and social groups. 0% b. Integrated into their family and difficulty integrating into social groups. 1%
c. Difficulty integrating with their family and does not participate in social groups. 3%
d. Has family or third-party support to perform social activities or interaction with third parties.
6% e. Lives alone and/or isolated. 9% f. Lives in a rest center, special care center, or has no support. 12% CLINICO-THERAPEUTIC ASPECTS 4.- Time of illness, in years since treatment began (Maximum 20%) a. < 1 year 1% b. Greater than or equal to 1 year and < 5 years 5%
c. Greater than or equal to 5 years and < 10 years 10%
d. Greater than or equal to 10 years and < 15 years 15% e. Greater than or equal to 15 years 20% 5.- Use of drugs for significant symptom control (According to Clinical Practice Guidelines) (Maximum 20%) a. Does not use psychiatric drugs. 0% b. Use of one drug at low doses 1%
c. Use of one drug at high doses (antipsychotics and/or antidepressants). 5%
d. Combination of two drugs (antipsychotics and/or antidepressants) plus mood stabilizer. 10% e. Need to use electroconvulsive treatment accompanied by medication. 15% f. Need for hospitalizations. 20% 6.- Side effects of medication (including extrapyramidal) and on symptomatology (Maximum 17%) a. Adequate control of anxious, depressive symptoms, no extrapyramidal effects. 0% b. Partial control of anxious, depressive symptoms, presents mild tremor of upper extremities. 5%
c. Does not control anxious, depressive symptoms, presents marked tremor of upper extremities. 8%
d. Appearance of new symptomatology, anxious, depressive despite medication, presents generalized hypertonia. 11% e. Appearance of new symptomatology, anxious depressive despite medication, presents shuffling gait. 14% f. Presents alterations in primary cognitive functions 17%

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7.2 Neurodevelopmental Disorders Evaluation and Classification Tool (Includes Down Syndrome, Asperger's, and Mental Disability)
To determine the totals, arithmetic summation is used.
Table No. 1 of section 7.2 Neurodevelopmental Disorders Evaluation and Classification Tool (Includes Down Syndrome, Asperger's, and Mental Disability)
PERSONAL ASPECTS
1.- Alterations in their responsibility activities: household chores, studies, work (Maximum 15%) Percentage of disability impairment a. No alterations in the development of their activities or in their assigned responsibilities. 0% b. Presents alterations in the development of any of their activities or in their assigned responsibilities. 3%
c. Presents intermittent alterations in the development of their activities and in their assigned responsibilities.
6% d. Presents limited difficulty in the development of their activities and in their assigned responsibilities.
9% e. Presents extensive difficulty in the development of their activities and in their assigned responsibilities.
12% f. Presents generalized difficulty in the development of their activities and in their assigned responsibilities.
15%
2.- Alterations in their daily living activities (Maximum 15%) a. Develops their activities without difficulty and normally, without interference. 0% b. Presents alterations in the development of their activities, unusual or excessive interest, but does not interfere with their behavior. 3%
c. Presents intermittent difficulty requiring supervision by another person, and presents interference in the context of their behavior.
6% d. Presents limited difficulty requiring the supervision and assistance of another person or presents significant interference in the context of their behavior. 9% e. Presents extensive dependence and requires assistance of another person with marked interference in the context of their behavior. 12% f. Presents generalized dependence on the assistance of another person with marked interference in daily life in the context of their behavior. 15% 3.- Emotional and family support networks (Maximum 12%) a. Integrated into their family and social groups, may have peculiar or isolated behavior, but without interference in the context of their behavior. 0% b. Presents difficulty and needs intermittent support to integrate into their family environment and social groups. 1%

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c. Presents difficulty and needs limited support to integrate into their family environment and social groups. 3%
d. Presents great difficulty and needs extensive support to integrate into their family environment and social groups. 6% e. Presents great difficulty and needs generalized support to integrate into their family environment and social groups. 9% f. Family or third-party rejection to perform joint activities or minimal social communication. 12% CLINICO-THERAPEUTIC ASPECTS 4.- Time since medical treatment or physical medicine and rehabilitation began, by period: (Maximum 20%) a. < 1 year 1% b. Greater than or equal to 1 year and < 5 years 5%
c. Greater than or equal to 5 years and < 10 years 10%
d. Greater than or equal to 10 years and < 15 years 15% e. Greater than or equal to 15 years 20% 5.- Use of drugs and/or rehabilitation therapy for significant symptom control: (Maximum 20%) a. Does not use psychiatric drugs and/or does not receive rehabilitation therapy. 0% b. Use of one drug and/or rehabilitation therapy allows adequate integration into their family and environment. 1%
c. Use of one drug at high doses and rehabilitation therapy allow adequate integration into their family and environment.
5% d. Combination of drugs and rehabilitation therapy allow limited integration into their family and environment. 10% e. Drugs and rehabilitation therapy allow integration only to their family. 15% f. Drugs nor rehabilitation therapy allow integration into their family. 20% 6.- Motor alterations (Maximum 17%) a. No presence of motor alterations. 0% b. Presents mild alteration in gross motor coordination 5%
c. Presents mild alteration in gross and fine motor coordination. 8%
d. Presents moderate alteration in gross and fine motor coordination. 11% e. Presents severe alteration in gross and fine motor coordination. 14% f. Presents complete alteration of gross and fine motor coordination. 17% Classes established from the obtained disability impairment percentages:
CLASSES Percentage of disability impairment
CLASS I 1% - 20%
CLASS II 21% - 40%

Los Laureles Nº 214 - Lima 27 - Perú Telf.: (511) 6309000 CLASS III 41% - 60% CLASS IV 61% - 80% CLASS V > or equal to 81% Third Article.- Incorporate subsection IV as part of the instructions contained in the introduction for the use of the norms for the evaluation and classification of disability of the Manual for Evaluation and Classification of Disability Degree (MECGI), incorporated as Subtitle IV of Title VII of the Compendium of Norms of the Superintendent of Regulatory Supervision of the SPP, approved by Resolution No. 058-94-EF/SAFP and its modifying norms, in the following manner:
“IV. GENERAL GUIDELINES FOR THE EVALUATION AND CLASSIFICATION OF DISABILITY a) In the evaluation and classification of the affiliate and/or beneficiary's disability, medical committees may consider additional criteria to those contained in this manual, of a clinical, medical, administrative, and/or legal nature, and, in case there is more than one criterion to apply, these must be interpreted in favor of the claimant's pretension, in concordance with the principles of administrative procedure established in Article IV of the Preliminary Title of the Single Ordained Text of the General Administrative Procedure Law. When such a situation arises, the decision must be supported in the file and the application of the additional criteria must be duly motivated in the pronouncement issued. b) Medical committees are responsible for the attention of disability files, on which they must issue the corresponding pronouncement. The clinical stage, state of treatment, or other clinical aspects do not constitute an impediment to giving the respective attention through pronouncement. The non-attention of disability files represents a violation of due process. c) Medical committees have autonomy in the exercise of their functions and are subject to the common norms of public law, as established in numeral 7 of Article I of the Preliminary Title of the Single Ordained Text of the General Administrative Procedure Law, Law 27444. d) The evaluation of the files must be integral, personalized, and evidence-based, taking into consideration that the reaction is different against the same pathology and/or treatment. The affiliate's disability must be evaluated based on the affectation that the disease or pathology can exert on work capacity as a consequence of the medical, surgical, or biological treatment process and/or subsequent, so the granted classification must be duly supported by the motivation of the opinion or other document issued regarding this matter. e) Medical committees must support their pronouncements regarding the evaluation and classification of disability based on the content of the file subject to attention, which must contain the results of the clinical evaluation, the results of the evaluation by consulting physicians or others, which must be supported by Evidence-Based Medicine (EBM). The support of the pronouncement, in concordance with the motivation referred to in the General Administrative Procedure Law, Law No. 27444, must be oriented to facilitate the understanding of the medical committee's pronouncement by the affiliate and/or beneficiary, within whose framework committees must explain those technical-medical, legal, and/or administrative terms of a specialized nature. f) Medical committees must have processes and procedures for the attention of disability requests, such as clinical practice guides or equivalents and formats of

Los Laureles Nº 214 - Lima 27 - Perú Telf.: (511) 6309000

Summary: Resolution SBS No. 1372-2023 amends the title of Chapter XII of the Manual for Evaluation and Classification of Disability Degree (MECGI) to

Los Laureles Nº 214 - Lima 27 - Perú Telf.: (511) 6309000 request for report with specific information to be considered by the consulting physician on the occasion that gives attention to the evaluation requests assigned to them. g) The clinical considerations for the use of the tools are contained in the Clinical Practice Guidelines (CPG) that medical committees must take into account. h) Medical committees must analyze the reports of consulting physicians in full concordance with the content of the entire file subject to evaluation and qualification of disability. i) When there are discrepancies in the content of the file, caused even by a consulting physician's report, an opinion must be requested from another consulting physician to serve as the basis for the final pronouncement. Likewise, the consulting physician whose opinion is requested can in no circumstance also be the attending physician of the affiliate. j) When there are 2 or more pathologies that cause disability, the combined sum protocol is used. k) Medical committees must verify that the date of occurrence is determined according to the pathology subject to evaluation and considering the criteria established in Article 61 of Title VII of the Compendium of Regulatory Supervisory Norms of the SPP, as well as the aforementioned general guidelines where applicable. The pronouncement on the date of occurrence must have the due and respective motivation, according to the clinical, evidence-based medicine, and technical-administrative criteria, which are understandable to the professionals who require their analysis and easy to understand for the affiliate.”
Article Fourth.- The following subtitles
of Title VII of the Compendium of Regulatory Supervisory Norms of the SPP, approved by Resolution No. 232-98-EF/SAFP and its modifying norms, are renamed, as follows:
a) Subtitle IV “Operative Procedure for Access to Pension Benefits for Terminal Illness or Cancer”, incorporated by SBS Resolution No. 2740-2016, by Subtitle V “Operative Procedure for Access to Pension Benefits for Terminal Illness or Cancer”. b) Subtitle V “Process of Payment of Retirement Pensions for Life Annuities under Insurance Companies”, incorporated by SBS Resolution No. 4409-2018, by Subtitle VI “Process of Payment of Retirement Pensions for Life Annuities under Insurance Companies”.
Article Fifth.- This Resolution enters
into force ninety (90) calendar days after publication in the Official Journal “El Peruano”.
TRANSITORY COMPLEMENTARY PROVISION
Sole.- The provisions of this Resolution apply to those requests for evaluation and qualification of disability presented to the AFPs, from its entry into force. Register, communicate and publish, MARIA DEL SOCORRO HEYSEN ZEGARRA Superintendent of Banking, Insurance and AFPs