Implementing Rules and Regulations of Republic Act No. 11563 (Mayor Hilarion A. Ramiro Sr. Medical Center)

October 11, 2021

DOH ADMINISTRATIVE ORDER NO. 2021-0048

 

I. BACKGROUND AND RATIONALE

Republic Act (R.A.) No. 4225 in 1965 created the Ozamiz City National Emergency Hospital. Batas Pambansa Bilang 777 in 1984 renamed it to Mayor Hilarion A. Ramiro Sr. General Hospital. It was devolved to the Provincial Government of Misamis Occidental in 1992, but returned under supervision and control of the Department of Health and converted to a regional teaching and training hospital by virtue of R.A. No. 7937 in 1995. It was again converted to Mayor Hilarion A. Ramiro Sr. Medical Center (MHARSMC) thru the passage of R.A. No. 10865 on October 2016.

The hospital's bed capacity continually grew through its conversions and transitions in supervision and control over the years, from 100 beds before 1992 to 150 beds to 500 beds. In 2019, MHARSMC's bed occupancy was 387 percent, far above the recommended national rate of 80 to 85 percent. Its average daily inpatients were 581, its total outpatient visits were 171,131, and emergency room visits 37,162. Legislation was proposed in 2020 to increase its bed capacity and upgrade its services and facilities, which became House Bill No. 6730 that passed in the 18th Congress.

On June 24, 2021, the President approved and signed the R.A. No. 11563, "An Act Increasing the Bed Capacity of the Mayor Hilarion A. Ramiro Sr. Medical Center in the Province of Misamis Occidental from Five Hundred (500) to One Thousand (1,000) Beds, Upgrading its Professional Health Care Services and Facilities, Authorizing the Increase of its Medical Personnel, and Appropriating Funds Therefor." Section 5 of the Act provides for the promulgation of Implementing Rules and Regulations (IRR) by the DOH. The IRR shall also be in accordance with R.A. No. 11223, Universal Health Care Act, which ensures that all Filipinos have equitable access to quality health care goods and services.

II. OBJECTIVE

This Administrative Order (A.O.) sets the Implementing Rules and Regulations of Republic Act (R.A.) No. 11563, "An Act Increasing the Bed Capacity of the Mayor Hilarion A. Ramiro Sr. Medical Center in the Province of Misamis Occidental from Five Hundred (500) to One Thousand (1,000) Beds, Upgrading its Professional Health Care Services and Facilities, Authorizing the Increase of its Medical Personnel, and Appropriating Funds Therefor," and pertains only to the provisions of this Act.

III. SCOPE

The extent of coverage of this Order shall include the operations and management of Mayor Hilarion A. Ramiro Sr. Medical Center and the implementation of R.A. No. 11563.

IV. DEFINITION OF TERMS AND ACRONYMS

A. IRR — refers to the Implementing Rules and Regulations of Republic Act 11563.

B. HDP — refers to the Hospital Development Plan, which serves as a guide for the development of health facilities throughout the country towards achieving Universal Health Care as well as guide in ensuring the rational allocation of government investments in the delivery of quality and people-centered health services.

C. Level 3 General Hospital — refers to the type of general hospital according to functional capacity as provided in A.O. No. 2012-0012 (Rules and Regulations Governing the New Classification of Hospitals and Other Health Facilities in the Philippines, as amended).

D. MHARSMC — refers to Mayor Hilarion A. Ramiro Sr. Medical Center.

V. GENERAL GUIDELINES

A. Mayor Hilarion A. Ramiro Sr. Medical Center (MHARSMC) shall provide promotive, preventive, diagnostic, curative, rehabilitative and palliative health care, research and training services in accordance with the provisions of R.A. No. 11223 (Universal Health Care Act), and related issuances such as A.O. No. 2020-0019, where roles and responsibilities are defined for DOH hospitals in the service delivery design of Health Care Provider Networks (HCPN).

B. MHARSMC shall strengthen and improve its service capability and capacity while continually serving as an end-referral hospital in Ozamiz City, the rest of the Province of Misamis Occidental, neighboring localities in Zamboanga del Norte and Zamboanga del Sur (Region IX, Zamboanga) and Lanao del Norte (Region X, Northern Mindanao), complementing the local health systems and providers therein, consistent with its Hospital Development Plan as approved by the Health Facility Development Bureau (HFDB). It shall be fully equipped with state-of-the-art equipment and facilities, complemented by adequately trained and competent human resources for health as appropriate for a licensed and accredited Level 3 General Hospital.

C. MHARSMC shall comply with standards and meet requirements in preparedness and response strategies in public health emergencies as in A.O. No. 2020-0016 (Minimum Health System Capacity for COVID-19 Preparedness and Response Strategies, as amended) which include but are not limited to allocation of beds, dedication of select services or units, and performance of enhanced protocols in infection prevention and control, patient and health worker safety, and patient navigation in the HCPN. Likewise, concordant to the country's transitioning towards the new normal, as guided by Department Memorandum No. 2020-0268 "Interim Guidelines on Health Facilities in the New Normal," it shall make certain that its plans, policies, protocols and norms ensure the continued health service delivery while maintaining the public health standards for COVID-19 disease.

VI. IMPLEMENTING MECHANISMS

The implementation of the Act shall be supported by the following guidelines:

A. Expansion of Hospital Services

MHARSMC shall formulate and submit its Hospital Development Plan (HDP) to the HFDB through the Northern Mindanao Center for Health Development (CHD). The MHARSMC's health facility development unit shall make the proper internal and external coordination for the complete and timely submission of its updated HDP. The HDP shall provide the capacity increase and capability expansion of the facility, and shall be consistent with the Philippine Health Facility Development Plan (PHFDP) leading towards a 1,000-bed Level 3 General Hospital with specialty and sub-specialty services. MHARSMC shall start its transition in becoming a Lung Care Center by year 2022. MHARSMC shall comply with the requirements for the operations of the Malasakit Center as mandated by the R.A. No. 11463 to enable eligible patients to access medical and financial assistance services.

B. Health Human Resources

Based on the approved HDP, MHARSMC shall request for the required health human resources based on DBM-DOH Joint Circular No. 2013-01 (Revised Standards and Organizational Structure and Staffing Pattern of Government Hospitals, CY 2013 Edition) dated September 23, 2013 and its succeeding amendments.

MHARSMC shall honor the positions, security of tenure, and other rights of its human resource complement, re-classify and/or propose upgrading of positions, promote professional development and hire additional staff to comply and conform to the Civil Service Commission, the DOH standards, and the intent of this IRR.

C. Assets and Liabilities

All movable and immovable assets and records of the MHARSMC, as well as its liabilities and obligations shall be properly documented and be accounted for in accordance with existing policies and guidelines.

D. Equipment

MHARSMC shall make an inventory of the existing hospital equipment and undertake upgrading to conform to the DOH standards of a tertiary teaching and training hospital as provided for under A.O. No. 2012-0012 (Rules and Regulations Governing the New Classification of Hospitals and Other Health Facilities in the Philippines, as amended). Additional equipment and facilities shall be provided to complement the expansion of services consistent with the approved HDP.

E. Infrastructure

MHARSMC shall implement and seek the support of DOH for the construction, repair and/or renovation of its physical infrastructure, consistent with the approved HDP, and conforming to all existing laws, regulations, national and international standards for hospital buildings, also in line with Hospitals Safe from Disasters Program, Green and Safe Health Facilities Guidelines, among others.

F. Systems Development

MHARSMC shall conform to and sustain the standards of hospital operations to provide quality health care and safety for patients, health workers and other clientele of the hospital. It shall implement a hospital information system conforming to the basic requirements of the Integrated Hospital Operations and Management Program (IHOMP).

MHARSMC shall support, participate and adhere to the implementation of the HCPN policies and guidelines for health systems integration and complementation of health services of local and national government facilities.

G. Quality Management

Throughout the term of its HDP implementation, MHARSMC's Quality Management System shall conform to ISO 9001:2015 standards. It shall enhance operations with the implementation of the Continuous Quality Improvement Program, Patient Safety Program, Integrated People-Centered Health Services, and Manuals of Standards of Hospital Operations and Management by HFDB, policies and standards by Health Facilities and Services Regulatory Bureau (HFSRB), Food and Drug Administration (FDA), Philippine Health Insurance Corporation (PhilHealth) and other standards by international organizations that support national and local standards. Its management shall also comply with the Gender and Development (GAD) mainstreaming policies in government.

The hospital shall complete all stages and become certified with the Performance Governance System towards its organizational development and performance improvement, as guided by the DOH performance accountability measures such as the Hospital Scorecard.

VII. IMPLEMENTING STRUCTURE

A. Administrative Control

A DOH official designated by the Secretary of Health shall have oversight jurisdiction and control over the MHARSMC's operations. The designated DOH official, with the aid of the Northern Mindanao CHD, shall monitor the implementation of R.A. No. 11563, and may recommend further the necessary upgrading as guided by this Order.

The Medical Center Chief (MCC) of MHARSMC shall be accountable and responsible for the implementation of quality standard hospital operations and management. The MCC shall establish responsibility accounting as means of management control and determination of respective contributions and performances of the hospital's divisions or units. The MCC shall also submit developmental plans, financial and statistical reports to the DOH Central Office.

B. Sourcing and Use of Funds

The amount necessary to carry out the provisions of R.A. No. 11563 shall be sourced out accordingly:

1. Capital investments for infrastructure, equipment, motor vehicles and land outlays shall be sourced from the DOH General Appropriations Act (GAA), hospital income which includes PhilHealth payments, public-private partnership, and/or other financing modes or schemes subject to prevailing government rules and regulations;

2. Additional Maintenance and Other Operating Expenses (MOOE) resulting from the hospital expansion shall be sourced from the GAA, hospital income including PhilHealth payments, public-private partnership and/or other financing modes or schemes;

3. Personnel Services (PS) to carry out the full implementation of the hospital staffing pattern following the DBM-DOH Joint Circular No. 2013-01 and related issuances shall be sourced from the GAA; and

4. Release of funds from the DOH shall be approved by the appropriate authority.

VIII. REPEALING CLAUSE

Pursuant to Section 6 of Republic Act 11563, provisions of A.O. No. 2016-0037, (Implementing Rules and Regulations of Republic Act No. 10865, "An Act Converting the Mayor Hilarion A. Ramiro Sr. Regional Training and Teaching Hospital in the Province of Misamis Occidental into a Medical Center to be known as the Mayor Hilarion A. Ramiro Sr. Medical Center"), dated October 10, 2016 that are inconsistent with R.A. No. 11563 are hereby repealed, amended or modified accordingly.

IX. SEPARABILITY CLAUSE

If any provision of this Order is declared unauthorized or rendered invalid by any court of law or competent authority, those provisions not affected thereby shall remain valid and effective.

X. EFFECTIVITY

This Order shall take effect fifteen (15) days after publication in the Official Gazette, or in a newspaper of general circulation, and upon filing of three (3) certified copies with the Office of the National Administrative Register, University of the Philippines Law Center.

(SGD.) FRANCISCO T. DUQUE III, MD, MScSecretary of Health