Question & AnswerQ&A (DOH Administrative Order No. 2015-0025)
The primary purpose is to provide amended guidelines for the implementation of medical assistance to indigent and poor patients in government hospitals, rationalizing the process in the allocation and utilization of the medical assistance fund.
Eligible beneficiaries are indigent or poor patients who cannot meet their basic needs or have income insufficient to fully meet their medical expenses and are seeking medical services in government hospitals.
All government hospitals owned or managed by the DOH, Local Government Units (LGUs), State Universities and Colleges (SUCs), Specialty hospitals under DOH, and other government agencies' hospitals are covered.
The Chief of Hospital can approve up to a maximum of One Hundred Thousand Pesos (P100,000.00) per patient. Any amount exceeding this requires approval of the Secretary of Health or an authorized representative.
Covered expenses include all laboratory and diagnostic procedures, surgical procedures (emergency or elective except for aesthetic procedures), dental services excluding prophylaxis and prosthesis, prescribed drugs and medical supplies, and hospital bills including professional fees up to 50% of assistance amount.
A Memorandum of Agreement (MOA) must be signed between the Department of Health and the Chief of Hospital or President of the University for SUCs and Specialty hospitals to utilize the medical assistance fund.
Applicants must present relevant documents such as Doctor's Prescription/Request, Billing Statement, Case Summary or Medical Abstract from DSWD, or Certificate of Indigency from their Barangay to the hospital's Medical Social Worker.
The Regional Office transfers funds to LGU hospitals upon submission of the bill for medical services incurred by indigent or poor patients.
Hospitals must submit a monthly fund utilization report by the 7th day of the succeeding month including patient details, type of medical assistance given, and amounts disbursed to individual patients and the total assistance amount for the month.
If any part or provision is held invalid, the other provisions not affected shall remain in full force and effect, as specified in the Separability Clause.
Yes, the Medical Assistance Fund can be used for payment of PhilHealth premiums under the Point of Care program, subject to guidelines specified in PhilHealth Circular No. 32, series of 2013.
The Medical Center Chief of the concerned government hospital is responsible and accountable for the proper utilization of the medical assistance funds consistent with the General Appropriations Act and COA guidelines.