QuestionsQuestions (Republic Act No. 9410)
The circular cites the Revised Implementing Rules and Regulations of the National Health Insurance Act of 2013 (RA 7875 as amended by RA 9241 and RA 10606), which require PhilHealth to implement a Quality Assurance Program and allows it to issue, deny, or withdraw accreditation based on capability and integrity. It also cites DOH Administrative Order (AO) 2012-0012 for licensing of regulated health facilities, including birthing homes.
It applies to all birthing homes and lying-in/maternity clinics.
They must have a valid Department of Health License to Operate (DOH-LTO).
Yes. All health care professionals affiliated with the birthing home/lying-in clinic who attend to deliveries, newborn care, and related procedures (e.g., family planning) must be PhilHealth accredited.
They must submit: (1) valid and updated DOH LTO; (2) signed performance commitment (Annex A of PhilHealth Circular 2015-037); (3) properly accomplished Provider Data Record (PDR); (4) accreditation fee (Php 1,500.00); (5) copy of updated Certificate as Newborn Screening Facility; (6) copy of updated Certificate as Newborn Hearing Screening Facility or MOA with a certified facility (if applicable); (7) electronic copies of recent labeled photos of the facility (interior and exterior); (8) location map; and (9) statement of intent (if applicable).
Renewal requires: valid DOH LTO; signed performance commitment; properly accomplished PDR; accreditation fee (Php 1,500.00); updated Certificates for newborn screening and (if applicable) newborn hearing screening (or MOA); and the latest audited financial statement to be submitted on or before June 30 of the succeeding accreditation cycle. Renewal applications must be submitted within January 1 to 31 of the succeeding year.
PhilHealth conducts pre-accreditation surveys for birthing homes/lying-in clinics applying for initial accreditation and re-accreditation due to a gap in accreditation and/or transfer of location.
Validated findings of fraudulent and unethical practices are considered against the provider’s integrity as a health care institution.
Monitoring is anchored on PhilHealth’s Health Care Provider Assessment System (HCP PAS) stated in PhilHealth Circular 2016-0026. PhilHealth also uses DOH licensing requirements for birthing homes enumerated in Annex C of DOH AO 2012-0012, plus PhilHealth additional requirements in Annex A of the circular, to assess inputs and processes of care.
The circular states measures based on: quality of care, patient satisfaction, financial risk protection, and fraud prevention.
The facility must submit the health staff certificates of training from DOH recognized training providers, as specified in PhilHealth Circulars PC 25-2015 and PC 38-2015.
It supersedes specified portions of prior PhilHealth circulars: (1) PhilHealth Circular 30, s-2009 (Guidelines for Accreditation of Providers for Maternity and Newborn Care Package, Part A—Standards for Accreditation of Non-Hospital Facilities); and (2) PhilHealth Circular 54, s-2012 (Provider Engagement through Accreditation and Contracting for Health Services), including specified sections and annex items that are amended/modified/repealed if inconsistent.
It specifically mentions Section VI.A.1.b (Automatic Accreditation for certain MCP providers certified by DOH); Section VI.A.2 (Non-automatic accreditation); Section VI.B.1.h (Non-automatically accredited providers subject to pre-accreditation survey); and Annex A, Item 4 (Additional Requirements for Maternity Care Providers).
It takes effect 15 days after its publication in any newspaper of general circulation. After publication, it must be deposited with the National Administrative Register at the UP Law Center.
In the rationale, the circular explains that DOH AO 2012-0012 requires regulated health facilities (including birthing homes) to have a DOH license prior to operations. In the general guidelines, PhilHealth treats the DOH-LTO as evidence of capability for accreditation.
Initial accreditation and re-accreditation applicants must secure and submit a valid updated DOH-LTO plus additional documentary requirements (including evidence of newborn screening/hearing capabilities and facility photos). Renewal has a narrower set with a specified submission window and requires the latest audited financial statement submitted on or before June 30 of the succeeding accreditation cycle.