Legal basis and purpose
- The Circular implements obligations under the National Health Insurance Act of 2013, as referenced through Republic Act (R.A.) 7875, as amended by R.A. 9241 and R.A. 10606, requiring PhilHealth to implement the National Health Insurance Program.
- The Circular aligns with R.A. 10354 (Responsible Parenthood and Reproductive Health Act of 2012), which recognizes reproductive health as part of the right to health.
- The Circular is aimed at enabling universal access to medically-safe, non-abortifacient, effective, legal, affordable, and quality reproductive health care services, with family planning information and health services as priorities.
- PhilHealth provides benefit packages for family planning services and engages free-standing family planning clinics as accredited providers.
Coverage and scope of facilities
- The Circular covers DOH Certified Free-Standing Family Planning Clinics.
- The Circular covers the health professionals affiliated with these covered facilities.
- Free-standing family planning clinics are treated as primary care facilities without beds for accreditation purposes.
- Facilities must have a valid Certificate of Compliance as Free-Standing Family Planning (FP) Clinics issued by the Department of Health.
Definitions recognized by the Circular
- A Free-standing family planning clinic refers to health facilities that provide modern FP services such as contraceptive pills and injectables, natural FP methods, contraceptive implants, intrauterine device (IUD) and no-scalpel vasectomy.
- A Certificate of Compliance (as Family Planning Clinic) is the certificate issued by the DOH Regional Office after the facility is assessed and evaluated based on standards under DOH A.O. 2017-002.
Accreditation requirements: clinics
- Free-standing family planning clinics must:
- Have a valid DOH Certificate of Compliance as an FP clinic.
- Be managed by a physician, nurse, or midwife.
- Ensure health staff have training and proficiency on family planning.
- Clinics must be accredited as PhilHealth providers of the following benefit packages:
- Insertion of IUD
- No-scalpel vasectomy
- Subdermal contraceptive implant
- Clinics must maintain a quality improvement program and keep, within the facility, a copy of the Manual of Procedures (at least on Family Planning).
- Clinics must have a referral arrangement with higher-level facility/ies or participate in a functional Service Delivery Network (SDN) for referral of patients who warrant higher level of care.
- Clinics must follow the PhilHealth accreditation process on Provider Engagement through Accreditation and contracting of Health Services (PhilHealth Circular 54, s-2012) and subsequent revisions.
- For initial accreditation, clinics must submit:
- A valid DOH Certificate of Compliance as Free-Standing Family Planning Clinic from the DOH Regional Office
- A signed and notarized Performance Commitment
- An accomplished Provider Data Record (PDR)
- An accreditation fee of PHP 1,500.00
- A Statement of Intent (SOI) if applicable
- Electronic copies (JPEG format) of recent photos of the facility’s interior and exterior surroundings, each labeled with the facility name and date taken
- A location map
- For accreditation renewal, clinics must submit within January 1 to 31 of the succeeding year:
- A valid updated DOH Certificate of Compliance
- A signed performance commitment
- An accomplished Provider Data Record
- An accreditation fee of PHP 1,500.00
- The latest audited financial statement, to be submitted on or before June 30 of the succeeding accreditation cycle
- Clinics already PhilHealth accredited and providing family planning services are generally not required to apply for separate FP clinic accreditation, except birthing homes intending to perform and claim for no-scalpel vasectomy, which must apply for separate FP clinic accreditation.
- If a facility’s DOH Certificate of Compliance expires within the accreditation period, the facility must submit an updated DOH Certificate to PhilHealth within sixty (60) calendar days prior to the expiration date.
- Clinics must be PhilHealth Registered Employers with updated premium contributions for their staff as employers.
- For claims eligibility checking, claims submission, and claims processing, FP clinics must have:
- Access to the Health Care Institution (HCI) Portal and the ability to submit claims electronically
- Knowledgeable authorized staff to access and send information
- A computer
- A document scanner
- An internet connection
- A bank account for the Auto Credit Payment Scheme (ACPS)
Accreditation requirements: professional providers
- Qualified professional providers for free-standing family planning clinics are limited to:
- Physician
- Nurse
- Midwife
- Professional providers must have a valid license from the PRC.
- Professional providers must adhere to standards of practice and codes of ethics of their respective professions.
- Professional providers must comply with the Performance Commitment for Professionals and other requirements determined by PhilHealth.
- A professional provider may affiliate with a maximum of three (3) accredited FP clinics.
- Professional providers must be PhilHealth members with updated premium contributions.
- Professionals must follow the PhilHealth accreditation process based on PhilHealth Circular 10, s-2014 and subsequent revisions.
- Professionals must have training and competence in performing FP procedures, certified by DOH-recognized training providers.
- For initial accreditation, professional providers must submit:
- Properly accomplished Provider Data Record (PDR)
- A signed performance commitment
- A valid PRC license
- A 1 x1 photo (2)
- Proof of payment of premium contributions as members
- Certificate of good standing from the Philippine Medical Association for physicians
- Certificate of residency training for physicians, if applicable
- Certificate from specialty board for physicians, if applicable
- Certificates of training/proficiency on FP procedures from DOH-recognized training institutions for the following procedures/packages:
- Physicians
- Non-Scalpel Vasectomy (NSV): training on NSV (first case rate); (no certificate submission requirement shown for NSV insertion as first case rate)
- Subdermal Contraceptive Implant Package: certificate of training on subdermal implant insertion and removal
- Midwives
- IUD insertion as first case rate: certificate for IUD insertion as first case rate
- Subdermal Contraceptive Implant Package: certificate of training on subdermal implant insertion and removal
- Family Planning Competency Based Training (FPCBT) Level 2 or Comprehensive Family Planning Course
- Nurses
- IUD insertion: family planning competency based training (FPCBT) Level 2 or comprehensive family planning course
- Subdermal Contraceptive Implant Package: certificate of training on subdermal implant insertion and removal
- Physicians
- Professionals already accredited need not apply for another accreditation but must submit valid certificate/s of training to the nearest PhilHealth office.
- Government-employed professionals practicing in private institutions must obtain written permission to practice from the head of their agency or its representative.
- Nurses accredited as FP providers and affiliated in birthing homes and rural health units may be reimbursed for FP procedures they performed in those facilities.
- Nurses aiming to provide packages for normal deliveries and newborn care must comply with policies on “Accreditation of Nurses for Maternal and Child Health Services” (PhilHealth Circular 2017-0023).
Monitoring, evaluation, and required records
- PhilHealth monitors quality health service delivery by anchoring monitoring on the Health Care Provider Performance Assessment System of Corporation (PhilHealth Circular 2016-0026).
- Providers are monitored using set performance indicators (Annex A).
- Monitoring may consider findings from:
- DOH Regional Offices
- The Professional Regulations Commission
- Other regulatory offices
- Professional/provider organizations
- Free-standing family planning clinics must maintain logbooks and summary reports required by DOH, including Family Planning Form 1 and Monthly Summary Report/M1 Form.
- Clinics must keep and provide copies of patients’ records with complete documentation of:
- History
- Physical examination
- Services provided
- Drugs and medicines given
- Procedures performed
- Operative technique/record
- Clinics must make these documents available to PhilHealth staff at all times for monitoring and evaluation.
Repeal, amendment, and continuing effect
- All issuances and provisions of existing issuances inconsistent with PhilHealth Circular No. 2018-0005 are repealed and/or amended.
- All other rules and guidelines not contrary to the Circular remain in full force and in effect.