Resolution SBS No. 3232-2017: Amend Chapter III Rheumatology of the Manual for Evaluation and Qualification of Degree of Invalidity (MECGI)

Los Laureles Nº 214 - Lima 27 - Perú Telf. : (511)6309000 Fax: (511) 6309239 Lima, August 16, 2017

S.B.S. Resolution
No. 3232-2017

The Superintendent of Banking, 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 Pension Fund Administration was approved;

That, by Supreme Decree No. 004-98-EF, the Regulations of said Consolidated Text were approved;

That, additionally, in accordance with the Third Final and Transitory Provision of the Regulations of the Law, the Superintendency is empowered to issue complementary operational norms necessary for the proper functioning of the Private System of Pension Fund Administration;

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

That, the evaluation and qualification of invalidity are carried out by the COMAFP or COMEC, based on uniform criteria and methods established by the CTM for the assignment of impairment derived from physical or mental impediments, contained in the Manual for Evaluation and Qualification of the Degree of Invalidez (MECGI), approved by Resolution No. 058-94-EF/SAFP and its modifications;

That, the Superintendency through Office No. 17590-2017-SBS requested the CTM to review a proposal for modification of the Rheumatology Chapter, specifically regarding the ankylosing spondylitis module, in order to improve the criteria and establish procedures that represent a higher degree of objectivity for the evaluation of impairment and qualification of corresponding invalidity, incorporating advances in medical science in the matter;

That, in this regard, the CTM, as part of the tasks entrusted by the Superintendency, has carried out the technical review of the proposed modification presented, validating the corresponding normative modification proposal;

Los Laureles Nº 214 - Lima 27 - Perú Telf. : (511)6309000 Fax: (511) 6309239 Having obtained the approval of the Deputy 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 Banking and Securities Superintendency, Law No. 26702 and its modifications, subsection d) of article 57 of the Single Consolidated Text of the Law of the Private System of Pension Fund Administration, approved by Supreme Decree No. 054-97-EF and based on the exceptional conditions provided for in numeral 3.2 of article 14 of Supreme Decree No. 001-2009-JUS and its modifications;

RESOLVES:

Article First.- Incorporate numeral 3.10 in Chapter III Rheumatology of the Manual for Evaluation and Qualification of the Degree of Invalidez (MECGI), approved by Resolution No. 058-94-EF/SAFP and its modifications, as follows:

“3.10 EVALUATION OF IMPAIRMENT DUE TO ANKYLOSING SPONDYLITIS

1. PERSONAL ASPECTS

1.- PERSONAL ASPECTS (max impairment 10%)

Aspects to be valued
(Prognostic Factors) Scales Percentage Mark what corresponds

Age
Less than or equal to 30 years 0%
Greater than 30 and less than 50 years 1% Greater than or equal to 50 years 2%

Education Level
Elementary studies 2%
Secondary studies 1%
Higher studies 0%

Economic Situation
Poor 2%
Medium 1%
Good 0%

Support from environment (family or other type) No support 2% Partial support 1% Complete/good support 0%

Labor Situation:
Unemployment, or if working:
time of subsidy 1 in the last year
Unemployment 1%
No subsidy 0%
Less than 3 months 0.5%
Greater than or equal to 3 and less than or equal to 5 months 1% Greater than 5 months 2%

Global percentage of impairment attributable to personal aspects =

1 Subsidy: Must be understood as temporary incapacity established by EsSalud.

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2. CLINICAL-THERAPEUTIC ASPECTS

2.- CLINICAL-THERAPEUTIC ASPECTS (max impairment 74%)

DISEASE ACTIVITY - ASDAS QUESTIONNAIRE - see annex (max 20%) Score < 1.3 Inactive disease 0% Score ≥ 1.3 < 2.1 Disease with moderate activity 6% Score ≥ 2.1 ≤ 3.5 Disease with high activity 13% Score >3.5 Disease with very high activity 20% Score = Percentage of impairment =

FUNCTIONAL CAPACITY. BASFI QUESTIONNAIRE. See annex (max 20%) Score 0 - 3 Good functional capacity 0% Score 4 - 6 Moderate functional capacity 6% Score 7 - 9 Poor functional capacity 13% Impossible 10 Null functional capacity 20% Score = Assigned percentage =

AXIAL MOBILITY*. BASMI-3 QUESTIONNAIRE. See annex (max 20%) Score 0-3 Good mobility 0% Score 4-6 Moderate mobility 10% Score 7-10 Poor mobility 20%

Los Laureles Nº 214 - Lima 27 - Perú Telf. : (511)6309000 Fax: (511) 6309239 Score = Assigned percentage =

*The final result is the sum of the five parameters (0–10, without decimals)

THERAPEUTIC ASPECTS (max 5%)
Assessment of response to administered treatment (max 3%) Good: pain suppression and improvement of functionality Mild 1% Regular: partial pain relief and partial improvement of functionality Moderate 2% Bad: does not improve pain or functionality Severe 3% Assessment of adverse effects of treatments (max 2%) Gastric effects Mild ≤ 1 adverse effect 0.5% Immunosuppressive effects Moderate = 2 or 3 effects 1% Others: HTA, increase of transaminases, etc. Severe > 3 effects 2%

Treatment response score = Adverse effects score = Global Score = Percentage of impairment =

In case of not undergoing treatment, the assessment will not be applied until it starts and carries at least 3 months with it.

ASSOCIATED COMORBIDITIES (max 9%)
Ophthalmological (uveitis) Yes No Mild ≤ 1 of the associated pathologies 3% Digestive (Inflammatory bowel disease) Yes No Moderate= 2 0 3 of the associated pathologies 6% Other Yes No Severe > 3 associated pathologies 9%

Percentage of impairment of comorbidities = Global percentage of impairment in clinical-therapeutic aspects =

3. LABOR ASPECTS

3.- LABOR ASPECTS (max impairment 5%)

Score Percentage Incapacity
0 - 54 1% Mild
55 - 108 3% Moderate
109 - 162 5% Severe

Final score = Percentage of impairment = Grade =

Los Laureles Nº 214 - Lima 27 - Perú Telf. : (511)6309000 Fax: (511) 6309239

CHECK LIST-LABOR SITUATION
Tasks
Score (between 0 - 6)
Not applicable
1/3 shift
2/3 shift
Full shift
Manual handling of loads
MMC less than or equal to 5 kg 0 1 2 3
MMC greater than 5 and less than or equal to 10 kg 0 2 3 4 MMC greater than 10 and less than or equal to 25 kg 0 3 4 5 MMC greater than 25 kg 0 4 5 6 Repetitive movements MR Shoulder elevation > 90º 0 2 4 6 MR flexo-ext or pronation-supination of wrist 0 2 4 6 Flex-ext. Trunk 0 2 4 6 Prolonged postures Prolonged ambulation 0 2 4 6 Continuous sitting 0 2 4 6 Continuous standing 0 2 4 6 Work organization Continuous work without alternation of tasks in your job 0 2 4 6 Performs repetitive/monotonous tasks 0 2 4 6 Fixed postures without alternation of positions in your job 0 2 4 6 Cannot take breaks to rest during work 0 2 4 6 Is able to finish the tasks assigned to him/her in his/her job 0 2 4 6 Has shift work/night work (evaluate monthly shift) 0 2 4 6 Working conditions The workload is inadequate (excessive, irregular, not adapted to their capabilities…) 0 2 4 6 The environmental conditions of your work (temperature, humidity…) worsen your clinical condition 0 2 4 6 Does not have support elements in his/her tasks (devices, instruments, machines...) 0 2 4 6 Performs work at height (>3 m) 0 2 4 6 Performs work in confined spaces (tunnel, drainage, pit…) 0 2 4 6 Performs electrical work under tension 0 2 4 6 Has to drive in his/her job 0 2 4 6 Handles risky machines or tools 0 2 4 6 Handles dangerous chemical substances 0 2 4 6 Is exposed to biological contaminants 0 2 4 6 Performs tasks requiring high attention/concentration 0 2 4 6 (Total maximum score = 6 x 27 = 162) Score in the case evaluated:

Los Laureles Nº 214 - Lima 27 - Perú Telf. : (511)6309000 Fax: (511) 6309239

4. SOCIAL ASPECTS-QUALITY OF LIFE

4.- SOCIAL ASPECTS-QUALITY OF LIFE (max impairment 10%)

ASQoL Score (0-18) Degree of limitation/incapacity Percentage 0 - 5 Mild 0% 6 - 11 Moderate 5% 12 - 18 Severe 10%

Score obtained = Percentage of impairment in the evaluated case =

ASQoL - specific questionnaire quality of life in ankylosing spondylitis* Question Yes No 1- My health status prevents me from going to some places 2- Sometimes I feel like crying 3- I have difficulty dressing 4- I have to make an effort to do tasks at home 5- It is impossible for me to sleep 6- I cannot perform activities with family or friends 7- I always feel tired 8- I have to stop what I am doing to rest 9- I have unbearable pain 10- It takes me a long time to start in the morning 11- I am incapable of performing tasks at home 12- I get tired easily 13- I often feel frustrated 14- The pain is always there 15- I feel like a loser 16- I find it hard to wash my hair 17- My illness lowers my morale 18- I worry about demoralizing the people around me Total score =

*Each question with an affirmative answer adds 1 point

Article Second.- Modify subsection A. Personal aspects of numeral 3.9 of Chapter III Rheumatology of the Manual for Evaluation and Qualification of the Degree of Invalidez (MECGI), approved by Resolution No. 058-94-EF/SAFP and its modifications, as follows:

Los Laureles Nº 214 - Lima 27 - Perú Telf. : (511)6309000 Fax: (511) 6309239

“3.9 EVALUATION OF IMPAIRMENT DUE TO RHEUMATOID ARTHRITIS

A. PERSONAL ASPECTS

PERSONAL ASPECTS (max impairment 10%)

Aspects to be valued
(Prognostic Factors) Scales Percentage Mark what corresponds of the Invalidity.

Less than or equal to 30 years 0%
Greater than 30 and less than 50 years 1% Greater than or equal to 50 years 2%

Education Level
Elementary studies 2%
Secondary studies 1%
Higher studies 0%

Economic Situation
Poor 2%
Medium 1%
Good 0%

Support from environment
(family or other type)
No support 2%
Partial support 1%
Complete/good support 0%

Labor Situation:
Unemployment, or if working:
time of subsidy 2 in the last year
Unemployment 1%
No subsidy 0%
Less than 3 months 0.5%
Greater than or equal to 3 and less than or equal to 5 months 1% Greater than 5 months 2%

Global percentage of impairment in personal aspects =

(…)”

Article Third.- Repeal any provision that contradicts the provisions contained in articles first and second of this resolution.

Article Fourth.- Annex No. 1 which forms part of the provisions approved by Article First, is published on the institutional Portal (www.sbs.gob.pe), in accordance with what is established in Supreme Decree No. 001-2009-JUS.

Article Fifth.- This resolution shall enter into force on August 21, 2017.

Register, communicate and publish

SOCORRO HEYSEN ZEGARRA
Superintendent of Banking, Insurance and Private Pension Fund Administrators

2 Subsidy: Must be understood as temporary incapacity established by EsSalud.