Clarification/Amendment on Issuances Related to the Engagement of Institutional Health Care Providers

March 26, 2013 PHILHEALTH CIRCULAR NO. 011-13 TO : All Regional Vice-Presidents, Engaged Institutional Health Care Providers and All Others Concerned SUBJECT : Clarification/Amendment on Issuances Related to the Engagement of Institutional Health Care Providers (IHCPs) and Other Applicable Issuances In the adoption of the Department of Health's Administrative Order 2012-0012 re: "Rules and Regulations Governing the New Classification of Hospitals and Other Health Facilities in the Philippines" and with the implementation of PhilHealth Circular 54 s. 2012, "Provider Engagement Through Accreditation and Contracting of Health Services", the following issues concerning engagement of institutional health care providers are hereby clarified and amended: 1. PhilHealth Circular (PC) 21 s. 2009, "Amendment to PC 30 s-2004 on Conditions to Qualify a Hospital for Initial Accreditation which has not Operated for at Least 3 Years", states that hospitals, ambulatory surgical clinics and freestanding dialysis clinics may qualify for initial application provided that its medical director/administrator/Chief of Facility has a 3-year work experience in a similar, analogous or at least the same level of institution it is applying for. As an additional qualifier, a managing health care professional who does not fulfill the 3-year work experience but has finished Master on Hospital Administration is acceptable to qualify these facilities to apply for initial participation. Further, all Level 2 and 3 hospitals based on the new DOH classification, that apply for initial participation are exempted from the 3-year rule requirement. All conditions to qualify a hospital, ambulatory surgical clinics and freestanding dialysis clinic for initial participation which has not operated for at least 3 years (PC 21 s. 2009) shall remain. 2. The Corporation has already adopted automatic accreditation. One of the basis for granting such to all government facilities is the General Appropriations Act (GAA) of 2012; however, GAA 2013 does not specifically mention the automatic accreditation of these facilities thus, rendering all government facilities not requiring license like health centers/rural health units, which are the primary providers of the Primary Care Benefit (PCB) 1 package, not automatically accredited. As such, PCB 1 that shall apply for initial participation shall undergo pre-accreditation survey following the requirements provided in Annex C1 "Standards of Accreditation of PhilHealth Primary Care Package Providers" of PhilHealth Circular 10 series 2012 until such time that the DOH has implemented licensing of RHUs and health centers. The effectivity of engagement shall be on the date of full compliance to the standards of accreditation of the facility. 3. PCB providers and Animal Bite Package Providers which are already granted engagement with PhilHealth for CY 2013 shall no longer undergo pre-accreditation survey; however, they shall be monitored by PhilHealth to ensure compliance to standards/requirements of the Corporation. 4. The following are provider profile updates that shall require submission of appropriate document/s and payment of corresponding participation fee: Table 1. Provider Profile Updates Requiring Appropriate Documents per Type of IHCP Provider Profile Update Applicability Documentary Requirements 1. Previous engagement has lapsed For all types of Refer to PC 54 series of regardless of the length of gap IHCPs 2012 "Requirements for Basic Participation" 2. Previous continuous participation was withdrawn 3. Transfer of location 4. Additional service 5. Resumption of operation after closure/cease of operation 6. Upgrading of Level For hospitals only 7. Change in Classification (e.g., general hospital to specialty hospital) 8. Increase in beds License only 9. Change of ownership For ASC, FDC and Letter request Hospitals only Proof of change in ownership e.g., SEC, Deed of Sale, DTI certificate For private MCP, TB Mayor's permit DOTS, ABPP Relative to this, a pre-accreditation survey shall be conducted only with PCB providers, uncertified MCPs, ABPP and TB DOTS providers in the following situation: a. Transfer of location b. Resumption of continuous participation after it was withdrawn c. Resumption of operation after closure/cease of operation. 5. As an amendment to PhilHealth Circular No. 31 s. 2012, all IHCPs which apply for initial participation or for updating of its Provider profile within the last quarter of the current year shall sign the Statement of Intent (Annex A) as to when the effectivity of its application shall start. All applications filed prior to October need not sign the statement of intent. 6. Beginning 2014 and every year thereafter, all MCP providers applying for initial and continuous participation are required to submit an updated license-to-operate. Otherwise, the application shall either be returned for completion or a ground for withdrawal of Basic participation. 7. Outpatient clinics located in a Geographically Isolated and Depressed Areas (GIDA) as certified by the DOH, which could not comply with the licensing/certification requirements, are qualified for Basic participation and shall undergo pre-accreditation survey. Deliberation of applications shall be at the level of the Regional Vice-Presidents. 8. The audited financial statement as one of the requirements for participation aims to determine the financial impact of PhilHealth reimbursement to the over-all operations of the facility. Thus, it shall not be required for facilities applying for initial participation. 9. The following are clarifications on the application of Senior Citizen's Discount Relative to PhilHealth Reimbursement (PhilHealth Circular 56 s. 2012): a. Proper application of VAT exemption (12%) and Senior Citizens Discount (20%) shall follow the guidelines set forth by the Bureau of Internal Revenue (BIR) in their Revenue Memorandum Circular 38-2012 among others and DOH Administrative Order No. 2012-0007: Guidelines on the grant of Twenty Percent (20%) Discount to Senior Citizens on Health Related Goods and Services. b. The VAT exemption of 12% shall only be deducted when applicable. All other existing issuances inconsistent with this circular are hereby repealed and/or amended accordingly. This circular shall take effect fifteen (15) days after its publication in the Official Gazette or in a newspaper of general circulation. (SGD.) ENRIQUE T. ONA, M.D. Secretary of Health/Chairman of the Board and OIC-President and CEO ATTACHMENT (Pro-forma) STATEMENT OF INTENT AUTOMATIC ACCREDITATION (For All IHCPs) Date: __________________ Name of Health Facility: _____________________________ Address: _________________________________________ Sign the applicable items if you agree with the statements below: 1. For applications for Initial Participation or Provider Profile Update requiring payment and appropriate documents that are filed during the last quarter of the current year: OPTION A: I agree with the following provisions: 1. To pay for the participation fees equivalent to two (2) engagement cycles. 2. That the start date of participation of our health facility shall be before January 1 of the succeeding year when it has complied with the requirements for registration and participation. The 2nd participation fee shall cover for the next engagement cycle which is from January 1 to December 31 of the succeeding year. ____________________________ Signature over Printed Name of the Authorized Person OPTION B: I agree with the following provisions: 1. To pay the participation fee equivalent to one (1) engagement cycle. 2. That the start date of participation of our health facility shall be on or after January 1 of the succeeding year when it has complied with the requirements for registration and participation. ____________________________ Signature over Printed Name of the Authorized Person (Pro-forma) STATEMENT OF INTENT NON-AUTOMATIC ACCREDITATION (filed from October to December of the current year) Date: __________________ Name of Health Facility: _____________________________ Address: _________________________________________ Sign the applicable items if you agree with the statements below: For Initial Participation or Provider Profile Update which requires payment and appropriate document/s filed during the last quarter of the current year: OPTION A: I agree with the following provisions: 1. To pay for the participation fees equivalent to two (2) engagement cycles. 2. That the start date of participation of our facility shall be before January 1 of the succeeding year when it has complied with the requirements for registration and participation. The 2nd participation fee shall cover for the next engagement cycle which is from January 1 up to December 31 of the succeeding year. 3. That in case my application for initial participation/provider profile update is denied, the participation fee for the 2nd engagement cycle may be used as payment for its next participation in the NHIP. Failure to register within one (1) year from receipt of notice of denial of participation shall forfeit the said registration fee in favor of the Corporation. 4. That if I submit the performance commitment and other documents for the 2nd engagement of the health facility beyond thirty (30) days from receipt of notice of approval of participation, the start date shall be on the day when the PHIC receives our signed performance commitment and/or complies other documentary requirements. ____________________________ Signature over Printed Name of the Authorized Person OPTION B: I agree with the following provisions: 1. To pay the participation fee equivalent to one (1) engagement cycle. 2. That the start date of participation of our facility shall be on or after January 1 of the succeeding year when it has complied with the requirements for registration and participation. ____________________________ Signature over Printed Name of the Authorized Person