Implementing Guidelines of Republic Act 10754 for Provision of Medical and Health-related Discounts and Special Privileges

June 1, 2017

DOH ADMINISTRATIVE ORDER NO. 2017-0008

 

I. RATIONALE

In the pursuit of achieving "All for Health towards Health for All," the Philippine Health Agenda (PHA) defines the blueprint of the government's strategies to have an inclusive and responsive health care for all Filipinos. The PHA guarantees the provision of health services to all Filipinos especially the poor, marginalized, and vulnerable such as the persons with disabilities (PWDs). In response, the Department of Health (DOH) ensures that relevant policies and plans for the Health and Wellness Program for PWDs are crafted and implemented in accordance with the PHA and current governing laws.

The Republic Act (RA) 10754, otherwise known as "An Act Expanding the Benefits and Privileges of Persons with Disability," was enacted into law on March 23, 2016 and its corresponding Implementing Rules and Regulations (IRR) was signed on December 1, 2016. This law expands the benefits and privileges of PWDs by amending Republic Act 7277, otherwise known as the "Magna Carta for Persons with Disabilities." In particular, Section 1 of RA 10754 amends Section 32 of RA 7277 entitling the PWDs to at least twenty percent (20%) discount and exemption from the value-added tax (VAT) on the purchase of certain goods and services from all establishments for the exclusive use, enjoyment, or availment of the PWD.

As mandated in Rule IV, Secs. 6.4 and 6.5 of the IRR of RA 10754, the DOH, in coordination with Philippine Health Insurance Corporation (PhilHealth) and Food and Drug Administration (FDA), shall issue the corresponding guidelines, circulars or directives related to the purchase of health and medical goods and availment of services from medical establishments.

In this regard, the DOH is hereby repealing DOH Administrative Order (AO) 2009-0011 to include the additional benefits and privileges stated in the RA 10754 and its IRR.

II. OBJECTIVES

To provide guidelines for the implementation of at least 20% discount and VAT exemption in all medical, and health-related services for PWDs.

III. SCOPE AND COVERAGE

This Administrative Order applies to all private and government hospitals and other health facilities, health care professionals, PhilHealth, pharmacies and other establishments providing medical and health-related care and services to PWDs.

IV. DEFINITION OF TERMS

Annex A provides the relevant and pertinent definition of terms as adopted from RA 7277, RA 9442, and RA 10754.

V. GENERAL GUIDELINES

1. All PWDs are entitled to at least 20% discount and VAT exemption upon requirements determination and compliance by both the provider/establishment and PWD.

2. At least 20% discount and VAT exemption shall cover purchase of generic and branded medicines, medical and assistive devices, costs of medical, dental, and rehabilitation services, and diagnostics and laboratory fees, as prescribed by the attending physician for all PWDs.

3. Diagnosis or treatment shall be in accordance to the latest Clinical Practice Guidelines (CPGs) or hospital treatment protocols, for all service wards and pay sections of government hospitals and facilities, and in all private hospitals and medical facilities.

4. Services which are medically necessary for the prevention, diagnosis, treatment, rehabilitation, or palliation of the PWD shall be provided the discount and exemption.

5. All PWDs shall be enjoined to become PhilHealth members (member or dependent of active PhilHealth member). The national government through the National Household Targeted System or Listahan, LGUs, NGOs, or private individual and/or group shall support the PhilHealth enrollment of non-PWD members. PWDs may also opt to enroll themselves as individual paying members.

6. All government and private hospitals, medical facilities, and hospitals including drugstores and other licensed establishments dispensing medicines shall develop appropriate and strategic communication materials to disseminate information and policies set forth by this issuance accessible to all PWDs; designate express lanes for PWDs; and issue official receipts in every payment of drugs and medicines, medical/assistive devices, and other services stating the usual rates or fees, retail price, discounts and VAT exemption.

7. All health facilities shall provide holistic quality care to PWDs and their families and treat them with professional conduct and respect in support of this Order.

VI. IMPLEMENTING RULES AND MECHANISMS FOR THE AVAILMENT OF PRIVILEGES

1. At least 20% discount and VAT exemption shall apply to the following:

a. Generic and branded medicines as well as food for special medical purposes in establishments dispensing medicines;

b. Medical and assistive devices not limited to the list enumerated in Annex B. Purchase of any the following medical devices shall be recorded in the Purchase Booklet for control and monitoring:

i. Medical and assistive devices used/consumed during check-up or confinement of a PWD regardless of the number of days of stay in the hospital or any health facilities and during recovery at home, or for monitoring of a particular ailment or disease, or to aid the maintenance of a treatment.

ii. Medical and assistive devices used during recovery at home, or for monitoring of a particular ailment or disease, or to aid the maintenance of a treatment, with the approval/referral of the physician.

c. Professional fees of attending doctors in the pay section of government and private hospitals and facilities; and

d. Costs of medical, dental, and rehabilitation services; diagnostic and laboratory services including the use of special reagents, dyes, contrast media, and radioactive isotopes; and psychological, behavioral, and developmental tests — for both in-patient and out-patient PWDs in government and private hospitals and facilities

2. The hospital bed for a PWD confined in a service ward of a government facility shall be classified based on AO 51-A s. 2001 known as the Implementing Guidelines on the Classification of Patients on Availment of Medical Social Services in government health facilities. The balance shall be paid by the PWD based on his/her Medical Social Worker Classification.

3. Discounting and computation of the 20% Discount and VAT exemption:

a. At least 20% discount and VAT exemption shall be granted upon full payment of the hospital bill. The billing statement showing the usual rates or fees and the discounted prices shall be attached to the official receipt.

b. At least 20% discount and VAT exemption shall be deducted upon purchase of the medicines and medical and/or assistive devices, with compliance to the necessary documentary requirements for the availment of discounts and exemption.

c. All PhilHealth accredited health care institutions shall first deduct 12% VAT exemption from the total health care institution charges, then deduct the 20% PWD discount from the difference. Other PhilHealth benefits shall be deducted from the remaining amount. It is only after deducting the appropriate discount from the total bill or statement of account that the accredited health care institution can file claim for benefit package.

d. The discount privileges and VAT exemption shall be non-transferable and exclusively for the benefit of the PWD.

e. Double discounts shall not be allowed. The PWD shall avail of the establishment's offered discount or at least 20% discount and VAT exemption provided herein, whichever is higher and more favorable. In cases where the person with disability is also a senior citizen entitled to a 20% discount and VAT exemption under his/her valid senior citizen identification card (ID), the person with disability shall use either his/her PWD ID Card or Senior Citizen ID card to avail of the at least 20% discount and VAT exemption.

f. Drug stores offering special discounted prices less than 20% of the regular retail price can deduct the percentage discount of their promotional campaign from the total of twenty percent (20%) discount as required by RA 10754. Thus, a total discount of 20% for PWD shall still be applied.

4. Purchase of All Medicines and Medical and Assistive Devices and Documentary Requirements for the Exclusive Use of the PWDs

A. The following documentary requirements shall support the availment of the discount and exemption for compliance of PWDs:

i. PWD identification (ID) card as issued by Local Government Unit (LGU) through the City/Municipal Social Welfare and Development Office (C/MSWDO) or the Persons with Disability Affairs Office (PDAO) of the place where the PWD resides in accordance with NCDA-Administrative Order #001. National Council on Disability Affairs (NCDA) shall issue a temporary PWD ID to PWDs in emergency situations such as but not limited to hospital confinement, provided that the PWD ID number coding shall be retained in accordance with the official residence of the PWD.

ii. Except for over-the-counter (OTC) drugs, a doctor's prescription shall be presented for medicines and food for special medical purposes. A prescription shall have the following information: (1) name of the PWD, (2) age, (3) sex, (4) address, (5) date, (6) generic name of the medicine, (7) dosage form, (8) dosage strength, (9) quantity, (10) signature over printed name of physician, (11) physician's address, (12) contact number of physician or dentist, (13) professional license number, (14) professional tax receipt number and (15) narcotic license number, if applicable. The drugstores may limit the dispensing of OTCs to not more than a week's supply. Only prescriptions that contain the above information shall be honored.

A doctor's prescription shall also be presented for medical and assistive devices in accordance with preceding paragraph.

iii. Purchase booklet issued by the local social/health office to PWDs for free containing the following basic information:

1. PWD ID number

2. Booklet control number

3. Name of PWD

4. Sex

5. Address

6. Date of Birth

7. Picture

8. Signature or thumb mark of PWD

9. Information of medicine to be purchased such as name of medicine, quantity, attending physician and his/her license number, name of servicing drug store and name of dispensing pharmacist

10. Authorization letter of the PWD who is residing in the Philippines at the time of purchase, currently dated and the identification card of the authorized person or representative, in case the medicine is bought by the representative or caregiver of the PWD. Purchase booklets shall be used to record the kind of OTC medicine purchased, how many, when and where it was purchased. Likewise, this shall help the drugstores to monitor the last purchase made for a certain medicine.

11. In cases wherein the PWD is a minor or mentally or physically incapacitated to execute an authorization letter, the parent or legal guardian or representative shall be allowed to make the purchase on behalf of the PWD, upon proof of their valid identification card. The name of the said guardian or representative shall be indicated at the back of the PWD ID and shall be the exclusive representative of the PWD.

B. Establishments/Providers dispensing medicines and assistive devices

i. As a general rule, any single dispensing of medicines must be in accordance with the prescription issued by a physician and should not exceed one (1) month supply.

ii. Drug stores are required to maintain a special record book for PWD subject to inspection by the FDA and Bureau of Internal Revenue.

iii. For partial filling, the establishment's pharmacists shall indicate the quantity partially filled in the purchase booklet (special record book) and the unfilled balance on the prescription. The PWD shall retain the partially filled prescription and present the same later to complete the prescribed quantity. Fully filled prescription shall be surrendered by the PWD to the establishment's pharmacists.

5. Responsibilities of Stakeholders

a. All Government Facilities shall:

i. Post hospital room rates, laboratory tests, diagnostic tests fees, medicine prices, and all other rates and fees in noticeable or strategic places in their respective facilities (e.g., near or at the main entrance of facilities); and

ii. Submit the aforementioned price list annually to the Health Facility Development Bureau of the DOH and PhilHealth; and

iii. Provide mechanisms to address queries or complaints from PWDs.

b. Private Hospitals and Medical Facilities and Establishments shall:

i. Post the price of all room rates in the Admitting Section. The prices of diagnostics and laboratory tests based on room and board accommodation, medical supplies and medicines shall be made available upon request of the PWD. The list shall ensure validation of the discount and VAT exemption granted to PWDs.

ii. Provide mechanisms to address queries or complaints from PWDs with regard to discount and VAT exemption on professional fees; and

iii. Inform in writing, copy furnished the aggrieved party, the necessary sanction for the health professionals who refuse to grant the proper discount and VAT exemption.

c. Drugstores and other licensed establishments dispensing medicines

i. Drugstores shall make available upon the PWD's request, a generic menu card and shall issue official receipt for drugs and medicines, which states the usual prices and the discounted prices and VAT exemption of the drug or medicine.

ii. During operating hours, all licensed establishments which dispense medicines shall be prohibited from scheduling or limiting the time of the PWDs to avail the discounts.

d. Health Care Professionals shall:

i. Inscribe his/her name and PRC number in the request for diagnostic and laboratory tests, and prescription;

ii. Ensure that prescriptions made are for the exclusive use of the PWD to curb abuse of availing discounts for use of non-PWD citizens;

iii. Inform the PWD of the usual fees for the services required;

iv. Provide an official receipt for the rendered professional services to the PWD that states the usual fees and the discounted fees and VAT exemption.

6. Mechanism of Endorsement of Complaints

All complaints on non-compliance with the 20% discount and VAT exemption shall be lodged with the NCDA and/or to the respective LGU-PDAO where the purchase was made or where the PWD resides, whichever is convenient for the PWD in accordance with Section 15 of Rule VI of the IRR of RA 10754.

VII. SEPARABILITY CLAUSE/REPEALING CLAUSE

This Order repeals DOH Administrative Order (AO) 2009-0011. All other issuances that are inconsistent herewith are hereby revised or modified.

If any portion or provision of this Order is declared void or unconstitutional, the remaining portions or provisions thereof shall not be affected by such declaration.

VIII. EFFECTIVITY

This Order shall take effect immediately after its publication in two (2) newspapers of general circulation.

(SGD.) PAULYN JEAN B. ROSELL-UBIAL, MD, MPH, CESO IISecretary of Health

ANNEX A

Definition of Terms

As adopted from the Implementing Rules and Regulations of RA 7277, RA 9442, and RA 10754

1. ASSISTIVE DEVICES — any device that is designed, made, or adapted to assist a person to perform a particular task or activity for daily living.

2. CHILD WITH DISABILITY — shall refer to persons below eighteen (18) years of age who have disabilities or those over but with mental capacity as that of a child and are unable to fully take care of themselves or protect themselves because of intellectual impairment, hearing impairments including deafness, speech or language impairments, visual impairments including blindness, serious emotional disturbance, orthopedic impairments, autism, traumatic brain injury, other health impairments or specific learning disabilities who by reason thereof need special education and other services.

3. DISABILITY — shall mean (1) a physical or mental impairment that substantially limits one or more psychological, physiological or anatomical function of an individual or activities of such individual; (2) a record of such an impairment; or (3) being regarded as having such an impairment.

4. ESSENTIAL DRUG/MEDICINE — drug/medicine that satisfies the priority health care needs of the population and which is selected based on the evidence of its efficacy, safety and comparative cost effectiveness.

5. ESSENTIAL DRUG LIST OR NATIONAL FORMULARY — a list of drugs prepared and periodically updated by the DOH on the basis of health conditions obtained in the Philippines as well as on internationally accepted criteria.

6. ESTABLISHMENTS DISPENSING MEDICINES, MEDICAL DEVICES AND ASSISTIVE DEVICES — any drug stores, assistive device stores, government or private hospital pharmacies, medical clinics, optical clinics, audiology centers, and similar establishments dispensing medicines and selling assistive devices duly licensed or franchised by the FDA and/or the local government unit (LGU).

7. FOODS FOR SPECIAL MEDICAL PURPOSES — category of foods for special dietary uses which are specially processed or formulated and presented for the dietary management of patients and may be used only under medical supervision as described and defined in FDA Codex STAN 180-1991. They are intended for the exclusive or partial feeding of patients with limited or impaired capacity to take, digest, absorb or metabolize ordinary foodstuffs or certain nutrients contained therein, or who have other special medically-determined nutrient requirements, whose dietary management cannot be achieved only by modification of the normal diet, by other foods for special dietary uses, or by a combination of the two.

8. HEALTH CARE PROFESSIONAL — any licensed physician, dentist, nurse, midwife, allied medical practitioner, paramedical practitioner, or other health care professional or practitioner duly licensed to practice in the Philippines.

9. IMPAIRMENT — any loss, diminution or aberration of psychological or physiological function with or without an accompanying anatomical structural defect.

10. MEDICAL DEVICES — an instrument, apparatus, equipment, machine, contrivance, implant, in vitro reagent, or other similar or related article, including a component part, or accessory which is: (1) intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease, in persons with disabilities; and (2) intended to affect the structure or any function of the body of PWDs, and which does not achieve any of its primary intended purposes through chemical action within or on the body of man or other animals and which is not dependent upon being metabolized for the achievement of any of its primary intended purposes.

11. MEDICAL SERVICES — shall refer to the hospital room accommodation, hospital services, medical supplies, professional services of health care professionals, diagnostic services, and laboratory services that are necessary for the prevention, diagnosis, treatment, rehabilitation, and palliation of a persons' disability, illness or injury. This should not be limited to hospital services but should include clinics and other health facilities. Further, it refers to health services which include but not limited to prevention of disability through immunization, nutrition, environmental protection and preservation; genetic counseling; early detection of disability; and timely intervention, medical or surgical, to arrest the disabling condition. Intervention includes rehabilitation and provision of assistive devices.

12. MEDICALLY NECESSARY — services required to preserve and maintain the health status of a person in accordance with accepted standards of the medical practice in the medical community. This includes services which are absolutely necessary in treating a patient and which could adversely affect the patient's condition if it were omitted.

13. MEDICINE/DRUG — any chemical compound or biological substance, other than food, intended for use in the treatment, prevention or diagnosis of disease in humans or animals, including but not limited to:

a. Any article recognized in the official United States Pharmacopoeia — National Formulary (USP-NF), official Homeopathic Pharmacopoeia of the United States, Philippine Pharmacopoeia, Philippine National Formulary (PNF), British Pharmacopoeia, European Pharmacopoeia, Japanese Pharmacopoeia, Indian Pharmacopoeia, any national compendium or any supplement to any of them;

b. Any article intended for use in the diagnosis, cure, mitigation, treatment or prevention of disease in humans or animals. Any article other than food intended to affect the structure or any function of the human body or animals;

c. Any article intended for use as a component of any of the articles specified in clauses (a), (b) and (c) not including devices or their components, parts or accessories;

d. Herbal and/or traditional drugs which are articles of plant or animal origin used in folk medicine which are: 1) recognized in the PNF; 2) intended for use in the treatment or cure or mitigation of disease symptoms, injury or body effects in humans; 3) other than food, intended to affect the structure or any function of the human body; 4) in finished or ready-to-use dosage form; and 5) intended for use as a component of any of the articles specified in items 1 to 4. For herbs to be classified under this definition, levels and amounts as well as registration status are required when indicated for therapeutic use; and

e. This may also include vitamins and minerals provided that these are in accordance with the FDA's prevailing cut-off on vitamins and minerals classified as drug/medicine i.e., product containing more than 150% of water-soluble vitamins and more than 102% of fat soluble vitamins.

14. PERSONS WITH DISABILITY — are those suffering from restriction or different abilities, as a result of a mental, physical or sensory impairment, to perform an activity in the manner or within the range-considered normal for a human being.

ANNEX B

List of Medical and/or Assistive Devices

The medical devices includes, but not limited to the following: cane, crutches, walkers, diaper, wheelchair whether manual or electric-powered, commode chair, bed pan, body support, fracture, sock, medical support stockings, oxygen therapy unit (gauge and tank set), IV fluid and stand, forceps, swabs, hospital bed, walker, urine bag, bandage, hearing aid, eye glasses, intraocular pen injector, hot/cold pack, therapeutic massager, therapeutic mattress/pad, all prosthesis, catheter, therapeutic warmer, glucometer set including lancets and test strips, insulin syringe and needle, thermometer, blood pressure apparatus, syringe and needles, IV set, dialyzer, adhesive strip, mask, gauze, gloves, dressing, cotton, brace, and other essential medical supplies, accessories, kits, equipment including the use of radiation devices, dental and laboratory, hospital implement or apparatus and other devices for the use of persons with disability.

This also includes the purchase of eyeglasses, hearing aids, dentures, prosthetics, artificial bone replacements like steel and which include implants, plates, rods and screws.

Published in The Philippine Star on June 11, 2017.