Question & AnswerQ&A (PHIC PHILHEALTH CIRCULAR NO. 21, S. 2009)
It is an amendment to PhilHealth Circular 30, S. 2004, which sets conditions to qualify a hospital for initial accreditation that has not operated for at least three years.
Providers of the following pro-poor benefits are exempted: Out-Patient Benefit Package (OPB), Anti-TB/DOTS Package, and Maternity Care Package (MCP).
They may qualify if the managing health care professional (Medical Director, Administrator, or Chief of Facility/Hospital) has at least three years of relevant work experience in a similar or equivalent institution.
They must submit either a service record if from government facilities or certification from the Board (if corporation) or from the facility owner (if single proprietorship) for private facilities.
They must be immediately replaced by another professional with the same qualifications. Failure to comply will lead to termination of accreditation effective on the date of vacancy.
Conditions include: operating as a tertiary facility; for ASCs and FSDCs, no similar accredited facility exists in the same locality; for hospitals, no same level/category facility in the locality as certified by PhRO and validated by the Central Office; or existing facilities cannot adequately provide healthcare services as certified by the Local Chief Executive and evidenced by a Certificate of Need issued by the DOH.
The concerned PhilHealth Regional Office (PhRO) certifies this, validated by the Accreditation Department, Central Office.
A Certificate of Need (CON) issued by the Department of Health (DOH) and recommended by the respective PhilHealth Regional Office is required, along with certification by the Local Chief Executive.
It takes effect 15 days after publication in the Official Gazette or any newspaper of general circulation.
All previous policies, guidelines, and administrative issuances with provisions inconsistent with this circular are repealed or amended accordingly.