QuestionsQuestions (PHILHEALTH CIRCULAR NO. 2018-0005)
The Circular is anchored on the National Health Insurance Act of 2013 (R.A. 7875 as amended by R.A. 9241 and R.A. 10606), and recognizes reproductive health rights under the Responsible Parenthood and Reproductive Health Act of 2012 (R.A. 10354). Its purpose is to provide mechanisms for PhilHealth to engage DOH-certified free-standing FP clinics as accredited providers for specific family planning benefit packages.
It refers to health facilities providing modern FP services such as contraceptive pills and injectables, natural FP methods, contraceptive implants, intrauterine device (IUD), and no-scalpel vasectomy, as defined in DOH A.O. 2017-002.
It must be a DOH-certified free-standing FP clinic, considered a primary care facility without beds; be managed by a physician, nurse, or midwife with training and proficiency on FP; have a quality improvement program with a Manual of Procedures (at least on FP); and have a referral arrangement/functional SDN for cases needing higher level care.
Accreditation is for: (a) insertion of IUD; (b) no-scalpel vasectomy; and (c) subdermal contraceptive implant.
They must follow the process of accreditation according to PhilHealth Circular 54, s-2012, and any subsequent revisions.
They must submit: (1) valid DOH Certificate of Compliance as FP clinic; (2) signed and notarized Performance Commitment; (3) accomplished Provider Data Record (PDR); (4) accreditation fee of Php 1,500; (5) Statement of Intent (if applicable); (6) electronic copies of recent photos (interior and exterior) labeled with facility name and date; and (7) location map.
Within January 1 to 31 of the succeeding year, they must submit: valid DOH Certificate of Compliance; signed performance commitment; accomplished PDR; accreditation fee (Php 1,500); and the latest audited financial statement, to be submitted on or before June 30 of the succeeding accreditation cycle.
Generally, no—facilities already PhilHealth accredited and providing family planning services are not required to apply for separate FP clinic accreditation. The exception is birthing homes intending to perform and claim for no-scalpel vasectomy, which must apply for separate FP clinic accreditation.
They must submit an updated Certificate to PhilHealth within sixty (60) calendar days prior to the expiration date.
The FP clinic should be a PhilHealth Registered Employer with updated premium contributions for their staff.
They must have access to the Health Care Institution (HCI) Portal to submit claims electronically; knowledgeable staff authorized to access and send information; a computer; document scanner; internet connection; and a bank account for the Auto Credit Payment Scheme (ACPS).
A physician, nurse, or midwife.
They must have a valid PRC license and adhere to standards of practice and codes of ethics of their respective professions. They must comply with PhilHealth requirements under the Performance Commitment for Professionals and other requirements set by PhilHealth.
A maximum of three (3) accredited FP clinics.
They must be PhilHealth members with updated premium contributions.
Monitoring is anchored on PhilHealth Circular 2016-0026 (Health Care Provider Performance Assessment System). Providers are monitored based on set performance indicators (Annex A), and PhilHealth considers monitoring findings from DOH Regional Offices, PRC and other regulatory offices, and professional/provider organizations.