Experience Requirement for Managing Health Care Professional
- The managing health care professional must have at least three years of experience as a medical director or hospital administrator in an accredited tertiary hospital or its equivalent.
- The tertiary hospital or equivalent should have been accredited by PhilHealth for at least three years during the tenure of the professional.
- Documentary proofs required include:
- Service Record for government hospitals.
- Certification of the Board or Hospital Owner for private hospitals.
- Certification of the Board for Corporations or Foundations.
- If the managing professional leaves within three years from initial operation, a qualified replacement with similar experience and documentation must be appointed.
Facility Classification and Operation Criteria
- The hospital must operate as a tertiary care facility or an equivalent under the Department of Health's classification.
- Equivalent facilities include Secondary Care Hospitals and Tertiary Care Hospitals.
Local Government Unit (LGU) Service Capability Condition
- The hospital must operate in an LGU where existing accredited health care providers cannot adequately serve the population.
- Supporting documents include:
- PhilHealth records for primary hospitals or infirmaries indicating absence of accredited facilities in the LGU.
- PhilHealth records for secondary hospitals and equivalent ambulatory facilities showing no similar accredited facility in the LGU.
Waiver of Three-Year Rule for Pro-Poor Benefit Providers
- The three-year operational experience requirement may be waived for providers offering pro-poor benefits such as:
- Outpatient Primary Care Benefits (OPB)
- TB-DOTS Benefits
- Non-hospital Maternity Care Benefits
Effectivity and Authority
- The circular becomes effective 15 days after its publication.
- Issued by Francisco T. Duque III, MD, MSc, Secretary and President and CEO of PhilHealth.
This structured provision aims to balance quality assurance through experience and service capability with accessibility considerations in underserved areas, ensuring PhilHealth accreditation is extended fairly and pragmatically.