Authority, legal basis, and policy rationale
- The circular implements the Revised Implementing Rules and Regulations of the National Health Insurance Act of 2013 (including Republic Act No. 7875 as amended by Republic Act No. 9241 and Republic Act No. 10606).
- The implementing rules require PhilHealth to implement a Quality Assurance Program to ensure that services rendered by accredited providers achieve desired health outcomes and member satisfaction.
- The implementing rules require PhilHealth to reserve the right to issue, deny, or withdraw accreditation after evaluating the capability and integrity of the health care institution.
- The circular requires accreditation standards for health care institutions and ties this to the Department of Health (DOH) Administrative Order (AO) 2012-0012, which regulates health facilities to protect public health and assure patient and personnel safety.
- DOH AO 2012-0012 includes birthing homes among regulated facilities that require a DOH License to Operate (LTO) prior to operation.
Covered facilities and professionals
- The circular applies to all birthing homes and lying-in/maternity clinics.
- PhilHealth grants accreditation to health care institutions based on their capability and integrity.
- All health care professionals affiliated in these birthing homes/lying-in clinics who attend to deliveries, newborn care, and related procedures (i.e., family planning) must be PhilHealth accredited.
Mandatory DOH LTO for accreditation
- For initial accreditation, all birthing homes and lying-in/maternity clinics must have a valid DOH License to Operate (LTO).
- For renewal accreditation, all birthing homes and lying-in/maternity clinics must have a valid DOH License to Operate (LTO).
- For re-accreditation, all birthing homes and lying-in/maternity clinics must have a valid DOH License to Operate (LTO).
- Validated findings of fraudulent and unethical practices are considered against the provider’s integrity as a health care institution for accreditation purposes.
Documentary requirements for accreditation
- For initial and re-accreditation, birthing homes and lying-in/maternity clinics must submit the following:
- Valid and updated license to operate (LTO) from the Department of Health.
- Signed performance commitment (Annex A of PhilHealth Circular 2015-037).
- Properly accomplished Provider Data Record (PDR).
- Accreditation fee: Php1,500.00.
- Copy of updated Certificate as Newborn Screening Facility.
- Copy of updated Certificate as Newborn Hearing Screening Facility or a Memorandum of Agreement with a certified facility (if applicable).
- Electronic copies of recent photos of the facility, including the interior and outside surroundings, completely labeled with the facility name and the date taken.
- Location Map.
- Statement of intent (if applicable).
- For renewal of accreditation, submission must be made within January 1 to 31 of the succeeding year, and the birthing home/lying-in/maternity clinic must submit:
- Valid LTO from Department of Health.
- Signed performance commitment.
- Properly accomplished Provider Data Record (PDR).
- Accreditation fee: Php1,500.00.
- Copy of updated Certificate as Newborn Screening Facility.
- Copy of updated Certificate as Newborn Hearing Screening Facility or Memorandum of Agreement with a certified facility (if applicable).
- Latest audited financial statement, submitted on or before June 30 of the succeeding accreditation cycle.
Accreditation surveys and related submissions
- PhilHealth must conduct a pre-accreditation survey for birthing homes/lying-in clinics applying for initial accreditation and re-accreditation due to gap in accreditation and transfer of location.
- Birthing facilities that provide family planning services and claim PhilHealth reimbursements must submit the health staff certificates of training from DOH-recognized training providers as per PhilHealth Circular (PC) 25-2015 and PC 38-2015.
Monitoring, evaluation, and standards
- PhilHealth must continue monitoring visits to assess provider adherence to standards of care and compliance with PhilHealth policies and guidelines.
- Monitoring performance measures are based on quality of care, patient satisfaction, financial risk protection, and fraud prevention.
- Facility monitoring must be anchored on PhilHealth’s Health Care Provider Assessment System (HCP PAS) as stated in PhilHealth Circular 2016-0026.
- Facility monitoring must use DOH licensing requirements for birthing homes enumerated in Annex C of DOH AO 2012-0012.
- Facility monitoring must also use PhilHealth additional requirements listed in Annex A* of this circular for inputs and processes of care.
Repeal, amendment of inconsistent provisions, and effect on prior rules
- The circular supersedes:
- PhilHealth Circular No. 30, s-2009, Guidelines for Accreditation of Providers for Maternity and Newborn Care Package, Part A—Standards for Accreditation of Non-Hospital Facilities.
- PhilHealth Circular No. 54, s-2012, Provider Engagement through Accreditation and Contracting for Health Services, particularly:
- Section VI.A.1.b [Automatic Accreditation—Maternity Care Package (MCP) Providers certified as Basic Emergency Obstetric and Neonatal Care (BEmONC) and Newborn Screening Facility by DOH].
- Section VI.A.2 (Non-automatic accreditation) for MCP providers not BEmONC certified.
- Section VI.B.1.h (Non-automatically accredited Institutional Health Care Providers subjected to pre-accreditation survey).
- Annex A, Item 4 (Additional Requirements for Maternity Care Providers).
- Provisions of previous issuances inconsistent with the circular are amended, modified, or repealed accordingly, while provisions consistent remain valid and binding.