Question & AnswerQ&A (PHILHEALTH CIRCULAR NO. 2018-0002)
The main purpose is to mandate the requirement of a valid Department of Health License to Operate (DOH-LTO) for the accreditation of birthing homes and maternity/lying-in clinics starting CY 2018, ensuring quality assurance of health services provided to members.
The circular applies to all birthing homes and lying-in/maternity clinics that seek PhilHealth accreditation.
The Revised Implementing Rules and Regulations of the National Health Insurance Act of 2013 (Republic Act 7875 as amended by RA 9241 and RA 10606) provides the basis.
They must have a valid DOH License to Operate (LTO) as evidence of their capability to provide health services.
All healthcare professionals attending deliveries, newborn care, and related procedures, such as family planning, must be PhilHealth accredited.
Required documents include: valid and updated DOH LTO, signed performance commitment, properly accomplished provider data record (PDR), accreditation fee of Php1,500.00, updated certificates as Newborn Screening and Hearing Screening Facilities (or MOA with certified facility), recent photos of the facility, location map, and statement of intent (if applicable).
For renewal, the latest audited financial statement must be submitted on or before June 30 of the succeeding accreditation cycle.
PhilHealth conducts monitoring visits based on their Health Care Provider Assessment System (HCP PAS) to assess quality of care, patient satisfaction, financial risk protection, and fraud prevention.
Validated findings of fraudulent and unethical practices will be considered against their integrity and may result in denial or withdrawal of their PhilHealth accreditation.
It supersedes PhilHealth Circular 30, s-2009 on Guidelines for Accreditation of Providers for Maternity and Newborn Care Package, and certain provisions of PhilHealth Circular 54, s-2012 on Provider Engagement.