PHIC PHILHEALTH CIRCULAR NO. 29, S. 2004, November 22, 2004

[ PHIC PHILHEALTH CIRCULAR NO. 29, S. 2004, November 22, 2004 ]

REVISED GUIDELINES FOR ACCREDITATION FOR YEAR 2005

The Department of Health has implemented Administrative Order 147 s. 2004 effective May 15, 2004. Based on service capability, hospitals are now categorized as Infirmary, primary Care, Secondary Care and Tertiary Care. PhilHealth will still follow the old categorization as Primary, Secondary and Tertiary categories for all accredited hospitals.

For guidance of everyone concerned the equivalent categories for DOH and PhilHealth are as follows:

DOH PhilHealth

Birthing Homes (Primary) Primary Category

Birthing Homes (Secondary) Secondary Category

Infirmary Primary Category

Primary Care Secondary Category

Secondary Care Tertiary Category

Tertiary Care Tertiary Category

Per PhilHealth Board Resolution No. 723, s. 2004, the Board resolved to approve the increase in accreditation fees.

The Fees for Initial Accreditation and Re-Accreditation are as follows:

Type of Institutional Health Care Providers Fee

Primary Care Benefit or OPB Providers (inc. RHUs/HCs) P1,000

TB-DOTS providers P1,000

Non-Hospital Maternity Care Providers (inc. Birthing Homes) P1,500

Infirmary (formerly primary hospitals) P3,000

Primary Care Hospitals (formerly secondary hospitals) P5,000

Ambulatory Surgical Centers P5,000

Free Standing Dialysis Centers P5,000

Secondary Care Hospitals (formerly tertiary hospitals) P8,000

Tertiary Care Hospitals (formerly tertiary hospitals w/ Teaching & training Program) P10,000

The Fees for Renewal of Accreditation are as follows:

Type of Institutional Health Care Providers Fee

Primary Care Benefit or OPB Providers (inc. RHUs/HCs) P1,000

TB-DOTS Providers P1,000

Non-Hospital Maternity Care Providers (inc. Birthing Homes) P1,000

Infirmary (formerly primary hospitals) P2,000

Primary Care Hospitals (formerly secondary hospitals) P4,000

Ambulatory Surgical Centers P4,000

Free Standing Dialysis Centers P4,000

Secondary Care Hospitals (formerly tertiary hospitals) P8,000

Tertiary Care Hospitals (formerly tertiary hospitals w/ Teaching & training programs) P10,000

All government owned institutional health care providers shall be granted a 20% discount on the initial accreditation fees.

All institutional health care providers shall be granted 25% discount on the accreditation renewal fees provided that all renewal requirements are submitted 60 days prior to the date of expiration of the date of renewal of accreditation.

All institutional health care providers shall be granted a 10% discount on the accreditation renewal fees provided that all renewal requirements are submitted 30 days to 59 days prior to the date of expiration or of the date of renewal of accreditation.

The increase in accreditation fees and the rules on the application of discounts on fees shall take effect on all applications for initial accreditation, re-accreditation, or renewal of accreditation filed beginning January 1, 2005.

In case the hospital is licensed as Tertiary under the old DOH classification, the renewal fee shall be set at Secondary Care Hospital which is PhP 8,000 until such time that the hospital is issued a new DOH license using the new DOH classification.

Schedule in Filing of Applications for the Renewal of Accreditation of Hospitals and ASCs for the Year 2005-2006

A. It is reiterated that the current accreditation of Hospitals and Ambulatory Surgical Clinics (ASCs) will expire on the following dates:

Region Expiry Date

Regions VII, VIII, IX, X, XI, XII, CARAGA and CAR April 30, 2005

Region V June 30, 2005

National Capital Region (Rizal Province included) September 30, 2005

Regions I,II,III October 31, 2005

Regions IV-A, IV-B and VI November 30, 2005

B. To facilitate processing of applications for renewal of accreditation and the availment of discounted accreditation fee for the year 2005, hospitals and ASCs are enjoined to strictly adhere to the filing period as follows:

Region Filing Period Period of Validity

Regions VII, VIII, IX, X, XI, XII, CARAGA and CAR January 1-31, 2005 May 1, 2005 to April 30, 2006

Region V March 1-30, 2005 July 1, 2005 to June 30, 2006

National Capital Region (Rizal Province included) June 1-30, 2005 October 1, 2005 to September 30, 2006

Regions I, II, III July 1-31, 2005 November 1, 2005 to October 31, 2006

Regions IV-A, IV-B and VI August 1-31, 2005 December 1, 2005 to November 30, 2006

Please note that accreditation takes effect on the date of recommended approval by the Accreditation Committee. Claims for confinements before this date shall be automatically denied payment. However, if the application for renewal is submitted within the above stated filing periods then the privileges of accreditation of the institutional health care providers shall not be attended by a gap notwithstanding the actual date of approval of the application for renewal.

The timely submission of applications with the full compliance to accreditation requirements shall facilitate the approval of providers' accreditation and the continuous reimbursements of filed claims. In case the hospital cannot fully comply with the requirements for the renewal of accreditation for reasons beyond the control of the facilities, such application is deemed acceptable based on the decision of the AVP for PhilHealth Regional Office concerned

Procedures in filing of applications for renewal of accreditation of hospitals and Ambulatory Surgical Clinics (ASC) including the schedule are the same as in CY 2004.

Pursuant to PhilHealth Circular No. 15, s. 2004, the hospital is required to submit updated financial statements in the application for renewal of accreditation of hospitals. Again, it is reiterated that this is to determine the financial capability of hospitals in the delivery of quality health care services.

Schedule in Filing of Applications for the Renewal of Accreditation of other health care facilities for the Year 2005-2006

The renewal of accreditation of other health care providers shall follow the expiry date of current accreditation.

For guidance and strict implementation.

Adopted: 22 Nov. 2004

(SGD.) FRANCISCO T. DUQUE III, MD, MSc Secretary President and CEO