Resolution SBS No. 4121-2017: Amend the Manual for Evaluation and Qualification of the Degree of Invalidity (MECGI)

Lima, October 19, 2017

Resolution S.B.S.
No. 4121-2017

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

CONSIDERING:

That, by Supreme Decree No. 054-97-EF, the Unified Text of Ordinance (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 Unified Text of Ordinance was approved;

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

That, by Supreme Decree No. 061-2007-EF, Article 129 of the aforementioned 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, extending to the Superintendent 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 AFP (COMAFP) and the Medical Committee of the Superintendent (COMEC) must adhere, as well as to the other functions assigned to it by the Superintendent;

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 Invalidity (MECGI), approved by Resolution No. 058-94-EF/SAFP and its amendments;

That, the Superintendent, through Office No. 29330-2017-SBS, requested the CTM to review a proposal for the modification of the Rheumatology Chapter, specifically the module on systemic lupus erythematosus, 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 Superintendent, has carried out the technical review of the proposed modification, validating the corresponding normative modification proposal;

Having 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 the Organic Law of the Superintendence of Banks and Insurance, Law No. 26702 and its amendments, subsection d) of Article 57 of the Unified Text of Ordinance of the Law of the Private System of Administration of Pension Funds, 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 amendments;

RESOLVES:

Article First.- Incorporate numeral 3.11 in Chapter III Rheumatology of the Manual for Evaluation and Qualification of the Degree of Invalidity (MECGI), approved by Resolution No. 058-94-EF/SAFP and its amendments, as follows:

“3.11 EVALUATION OF IMPAIRMENT DUE TO SYSTEMIC LUPUS ERYTHEMATOSUS

1.- PERSONAL ASPECTS (max impairment 10%)

Aspects to value (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 the environment (family or other) No support | 2% Partial support | 1% Complete/good support | 0% Labor Situation: Unemployment, or if working: subsidy time 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.

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

DISEASE ACTIVITY - see SLEDAI annex (max. 20%) Score < 3 | Mild or inactive disease | 7% Score ≥ 3 and ≤ 12 | Moderately active disease | 14% Score > 12 | Severe or very active disease | 20% Score = | Assigned Percentage =

IRREVERSIBLE DAMAGE - see SLICC/ACR annex (max. 20%) Score < 10 | Mild Structural Damage | 7% Score ≥ 10 and < 25 | Moderate Structural Damage | 17% Score ≥ 25 and ≤ 50 | Severe Structural Damage | 20% Score = | Assigned Percentage =

DISEASE SEVERITY - see KATZ annex (max. 20%)
Score < 4 | Mild | 7%
Score ≥ 4 and < 8 | Moderate | 14%
Score ≥ 8 and ≤ 13 | Severe | 20%

Score = | Assigned Percentage =

THERAPEUTIC ASPECTS (max. 5%)

Assessment of response to administered treatment (max. 3%) Good: suppression of pain and improvement of functionality | Mild | 1% Regular: partial relief of pain and partial improvement of functionality | Moderate | 2% Poor: no improvement in pain or functionality | Severe | 4%

Assessment of adverse effects of treatments (max. 2%) Gastric effects | Mild ≤ 1 adverse effect | 0.5% Immunosuppressive effects | Moderate = 2 or 3 effects | 1% Other: HTA, increased transaminases…etc. | Severe > 3 effects | 2%

Treatment response score=
Adverse effects score=
Global score=
Impairment percentage =

In case of not undergoing treatment, the assessment will not be applied until treatment is initiated and carried out for at least 3 months.

ASSOCIATED COMORBIDITIES (max. 9%)

Increased cardiovascular risk: Diabetes Mellitus, HTA, Dyslipidemia | Yes No Mild: at least 1 of the associated pathologies | 3%

Multiorgan systemic affection: neurological, psychiatric, renal, bone, infectious, etc. | Yes No Moderate: at least 2 or 3 of the associated pathologies | 6%

Other: neoplastic | Yes No
Severe > 3 associated pathologies | 9%

Percentage of impairment associated with comorbidities=

Global percentage of impairment in clinical-therapeutic aspects =

3.- LABOR ASPECTS (max impairment 5%)

Score	Percentage	Incapacity
0 – 54	1%	Mild
55 – 108	3%	Moderate
109 – 156	5%	Severe

Final score = Impairment percentage = Degree =

CHECK LIST-LABOR SITUATION

Tasks	Score (between 0 - 6)
Not applicable	1/3 shift
Manual handling of loads
MMC less than or equal to 5 kg	0

(Total maximum score = 156)

Score in the case evaluated:

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

SF 36 Score | Quality of life- Total Health | Percentage --- | --- | --- < 25 | Poor | 10% ≥ 25 < 50 | Regular | 6% ≥ 50 < 75 | Good | 4% ≥ 75 ≤ 100 | Very Good | 0%

Score obtained= Impairment percentage =

Article Second.- Repeal any provision that contradicts the provisions contained in the first article of this resolution.

Article Third.- Approve Annex No. 1, which forms part of the provisions approved by Article First, and which is published on the institutional portal (www.sbs.gob.pe), in accordance with what is provided for in Supreme Decree No. 001-2009-JUS.

FINAL COMPLEMENTARY PROVISION

Sole Provision.- This resolution will enter into force as of October 23, 2017.

Register, communicate, and publish,

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