Scope
- The guidelines apply to all offices and personnel involved in providing medical assistance to indigent and poor patients in government hospitals.
Objective
- To rationalize the process related to the allocation and utilization of the medical assistance fund.
Definitions
- Government Hospitals: Owned or managed by the DOH, Local Government Units (LGUs), and State Universities and Colleges (SUCs).
- Medical Assistance Fund: The designated budget allocation under the 2015 GAA for medical aid to indigent or poor patients.
- Retained Hospitals: Hospitals under DOH management.
- Specialty Hospitals: The four DOH corporate hospitals: Philippine Heart Center, National Kidney and Transplant Institute, Lung Center of the Philippines, Philippine Children’s Medical Center.
- LGU Hospitals: Owned or managed by LGUs.
- SUC Hospitals: Owned or managed by SUCs.
- Other Government Hospitals: Owned or managed by other government agencies.
- Indigent or Poor Patients: Persons unable to meet basic needs or medical expenses fully, seeking inpatient or outpatient services.
Eligibility and Beneficiaries
- Beneficiaries must be indigent or poor patients.
Implementation and Funding Mechanisms
- Php 784,204,000 automatically incorporated into DOH retained hospitals' budget.
- Remaining funds transferred to Regional Health Offices and DOH retained hospitals; SUCs and Specialty hospitals receive funds after liquidation of prior funds.
- Regional Offices transfer funds to LGU hospitals upon presentation of medical service bills.
- Use of funds by SUCs, Specialty, and LGU hospitals conditioned on signing a Memorandum of Agreement (MOA) involving relevant parties (e.g., DOH and hospital heads).
- Medical Center Chiefs are accountable for proper fund utilization per GAA and COA guidelines.
- Prior medical assistance given before the MOA's effectivity can be reimbursed and deducted from allocations.
Scope of Medical Assistance
- Coverage includes all necessary lab and diagnostic tests, minor and major surgeries (emergency or elective) except for aesthetic purposes.
- Dental services limited to examination and extraction; excludes prophylaxis and prosthesis.
- All prescribed drugs, medicines, and medical supplies.
- Hospital bills and professional fees, with professional fees capped at 50% of the assistance amount.
- Government health facilities must ensure availability of medicines, equipment, supplies, and services; if unavailable, may contract with DOH-accredited providers locally.
- Fund can be used for PhilHealth premiums under the Point of Care program.
Approving Authority and Limits
- The Chief of Hospital approves medical assistance requests.
- Maximum of Php 100,000 per patient may be approved by the Chief of Hospital.
- Amounts exceeding Php 100,000 require approval from the Secretary of Health or authorized representative.
Documentary Requirements
- Applicants must present documents such as doctor’s prescriptions/requests, billing statements, case summaries or medical abstracts from DSWD, and certificates of indigency from barangays.
- Medical Social Workers assist patients in availing medical assistance and can issue necessary case summaries/abstracts as substitutes.
Monitoring and Evaluation
- Hospitals submit monthly fund utilization reports by the 7th day of the succeeding month.
- Reports must include patient names and addresses, medical services or medicines received, types of assistance given, amounts per individual, and total monthly assistance disbursed.
- An annual Program Review by DOH assesses program impact and recognizes hospital contributions.
Separability Clause
- Invalidity of any provision does not affect the validity of remaining provisions in the order.
Effectivity Clause
- The Order takes effect upon publication in a newspaper of general circulation or on the DOH website.
Repealing Clause
- Existing MOAs concerning medical assistance to indigent and poor patients among the parties mentioned are repealed.