Legal basis and program rationale
- Republic Act No. 7277 requires the Department of Health to institute a national health program for Persons with Disability (PWDs), establish medical rehabilitation centers in provincial hospitals, and adopt an integrated and comprehensive approach to make essential health services available at affordable cost.
- Implementing Rules and Regulations (IRR) of Republic Act No. 7277 direct the Department of Health to address health concerns of seven (7) disability categories: (1) Psychosocial and behavioral disabilities; (2) Chronic illnesses with disabilities; (3) Learning (cognitive or intellectual) disabilities; (4) Mental disabilities; (5) Visual/seeing disabilities; (6) Orthopedic/moving disabilities; and (7) Communication deficits.
- Republic Act No. 9442 adds Chapter 8 (“Other Privileges and Incentives”) to Title Two of Republic Act No. 7277, granting specific 20% discounts for medicines, and medical/dental services including diagnostic and laboratory fees.
- The order is issued to support the IRR implementation of Republic Act No. 9442, particularly in coordination with PhilHealth and consistent with the requirements on disability-related health privileges.
Objectives and coverage
- The order prescribes procedures and guidelines for implementation of the 20% discount for all health-related services for PWDs.
- The order applies to all private and government hospitals, health-related facilities, health care professionals, the Philippine Health Insurance Corporation (PHILHEALTH), and related health-care establishments, including pharmacies and other establishments dispensing medicines.
Key definitions for implementation
- Assistive Devices mean devices designed or adapted to assist a person to perform tasks for daily living (examples include hearing aides, electronic voice products, talking watches, canes, crutches, walkers, wheelchairs, and shower chairs).
- Birthing Home or Center means a facility designed for a comfortable, homelike setting during childbirth and generally less restrictive than a hospital, including permitting midwifery practice.
- Clinic means an outpatient consultation/treatment place; a clinic or dispensary with at least six (6) beds or cribs or bassinets for twenty-four (24) hour use is construed as a hospital under Republic Act No. 4226 (Hospital Licensure Act).
- Chronic Illness refers to health conditions lasting a long time and potentially becoming permanent or leading to death and affecting quality of life.
- Communication Disability means impairment in speech/language/hearing processes, including hearing impairment and speech/language impairments.
- Child with Disability means persons below eighteen (18) years of age and certain older persons with child-level mental capacity who cannot fully care for or protect themselves due to specified conditions, including a range of disabilities requiring special education and other services.
- Dental Services include oral examination, cleaning, fillings, extractions and gum treatments, restoration/replacement/repositioning of teeth, and alterations of alveolar/periodontium processes necessary for diagnosis and/or treatment.
- Diagnostic and Laboratory Tests cover diagnostic procedures including imaging (x-rays, CT, MRI, PET), blood and pathology and related tests (hematology, urine analysis, parasitology, bacteriology, serology, blood banking), diagnostic radiology and clinical laboratory exams, and include clinical psychological tests, speech assessment, hearing and visual acuity testing, learning impairment tests, and related psychosocial conditions like drug testing.
- Disability means the interaction between impairments and attitudinal/environmental barriers that hinders full and effective participation on an equal basis.
- Disability Types are the seven (7) types under Republic Act No. 7277: psychosocial, chronic illness disability, learning disability, mental disability, visual disability, orthopedic disability, and communication disability.
- Establishments Dispensing Medicines and Assistive Devices include licensed/franchised drug stores, assistive device stores, hospital pharmacies, medical clinics, optical clinics, audiology centers, and similar establishments dispensing medicines and selling assistive devices.
- Government Health Facility includes specified outpatient and diagnostic facilities operated and maintained partially or wholly by national/provincial/city/municipal government or other political unit, including DOH retained hospitals, government-owned and controlled specialty hospitals, GOCC medical clinics, and facilities owned/managed by specified government agencies.
- Government Hospital means a hospital operated and maintained by government or any department/division/board/agency thereof.
- Health Care Professional means any licensed physician, dentist, nurse, midwife, allied medical practitioner, paramedical practitioner, or other health care professional duly licensed to practice in the Philippines.
- Hearing Impairment and Hearing Disability are defined using specific decibel thresholds and age parameters.
- Hospital includes facilities primarily devoted to diagnosis, treatment, and care of illness/disease/injury/deformity and obstetrical/medical/nursing care, including institutions with beds/cribs/bassinets for twenty-four (24) hour use.
- Identification Document is any document/proof of disability used to avail benefits, including a PWD identification card signed by the Mayor, Barangay Captain, or NCWDP/NCDA chairperson during the first 3 years, and by the NCDA chairperson after that period.
- Impairment, Learning Disability, Mental Disability, Multiple Disability, Orthopedic Disability, Person with Disability (PWD), Private Hospital, Private Hospitals and Medical Facilities, Psychosocial Disability, Medical Devices, Medical Services, Medically Necessary, Medicines, Unbranded Generic Medicines, Service Ward in government facility, Behavioral testing centers, Hospices and Palliative Care Centers, and Visual Disability are defined for purposes of implementing eligibility, scope, and discount application.
Policy privileges: 20% discounts and conditions
- All PWDs in all service wards of government facilities are entitled to a 20% discount for costs of medical, dental, and rehabilitation services, diagnostic and laboratory fees, and psychological or developmental tests, provided services align with available Clinical Practice Guidelines (CPGs) or Hospital Treatment Protocols.
- The remaining balance of the hospital bill for service ward PWDs is subject to classification by the Medical Social Worker under existing DOH guidelines.
- If evaluation determines the PWD deserves a free service, the service is provided free of charge.
- PWDs confined in the pay sections of government health facilities are granted a 20% discount for medical and dental services and diagnostic and laboratory fees, including outpatient services under the same rule.
- PWDs in all private hospitals and medical facilities are granted a 20% discount for costs of medical, dental, rehabilitation, occupational and physical and speech therapies/services, diagnostic and laboratory fees (including x-rays, CT-scans, blood tests and others), and professional fees of attending doctors.
- No discount is granted for services not medically necessary for prevention, diagnosis, treatment, rehabilitation, or palliation, including cosmetic surgical procedures, executive check-up packages, and physical examinations without clinical evidence of effectiveness and efficiency.
- A 20% discount applies to special reagents, dyes, contrast media, and radioactive isotopes used in laboratory and diagnostic tests.
- The 20% discount is granted when purchasing branded medicines and unbranded generic medicines from establishments dispensing medicines for the exclusive use of PWDs.
- PhilHealth-related benefits are applied by requiring appropriate deduction/charging to the PWD’s PhilHealth coverage where applicable, after which accredited facilities can apply for PhilHealth reimbursement consistent with PhilHealth mandates.
How discounts are applied: government vs private
- Government facilities must classify hospital bed access for service ward PWDs based on Administrative Order No. 51-A, s. 2000, and those classified as Class D are free of charge when necessary to diagnose and treat in accordance with available CPGs or protocols.
- Government in-patient service ward diagnostics and laboratory services receive a 20% discount only when medically necessary as determined by the attending physician and consistent with CPGs/protocols; evidence-based screening tests endorsed by DOH as medically necessary are provided free by the government facility; medically unnecessary tests for the confinement diagnosis receive no 20% discount.
- Government outpatient PWD laboratory/diagnostic services receive a 20% discount with the balance paid by the PWD based on Medical Social Worker classification, subject to medically necessary determination by the attending physician, CPG/protocol alignment, DOH-endorsed screening test conditions, and requesting-physician employment rules for government facility requests.
- For dental services, medically necessary dental services granted by the attending dentist in government facilities are free of charge.
- For PhilHealth members/dependents in government facilities, government facilities must ensure charges are deducted and charged to the PWD’s PhilHealth benefits coverage first, before accredited facilities seek reimbursement for subsidized services.
- Rehabilitation and other specialized services prescribed by attending physicians or rehabilitation specialists, including purchase of assistive devices, are granted a 20% discount.
- In pay sections of government health facilities, PWDs receive a 20% discount on medically necessary hospital beds, on specified in-patient and out-patient laboratory/diagnostic examinations (subject to CPG/protocol compliance), on special reagents/dyes/contrast media/radioactive isotopes, on medically necessary dental services, and on rehabilitation and assistive device purchases.
- In private health facilities, PWDs receive a 20% discount for hospital beds (room/board accommodation deemed medically necessary; existing bed privileges accrue), inpatient and outpatient laboratory/diagnostic services (subject to CPG/protocol compliance), and medically necessary dental services.
- In private facilities, when the PWD is a PhilHealth member/dependent, the 20% discount is not charged to the PhilHealth benefits coverage, and only the 80% of fees or charges the PWD is expected to shoulder may be charged to the PWD’s PhilHealth benefits.
- Private-facility professional fees for inpatient and outpatient medical/dental and other health care professional services receive a 20% discount, and the concerned physician/dentist must issue a corresponding official receipt.
Medicine discount procedure and control
- Establishments dispensing medicines for exclusive use of PWDs must have full discretion and responsibility through their registered pharmacists in dispensing PWD-only medicines.
- A PWD medicine discount is granted only when supported by:
- A PWD identification card.
- A doctor’s prescription stating the PWD’s name, age, sex, address, date, and the generic name of the medicine, dosage form, dosage strength, quantity, and physician’s signature over printed name, physician’s address, contact number, professional license number, and professional tax receipt number and narcotic license number, if applicable.
- Only prescriptions containing the above information are honored, and a doctor’s prescription is required in purchases of over-the-counter medicines to prevent abuse.
- A purchase booklet issued to PWDs for free by the local social/health office containing the PWD ID number, booklet control number, PWD name, sex, address, date of birth, picture, signature of PWD, medicine purchase information (name, quantity, attending physician, license number, servicing drug store name, dispensing pharmacist name), and an authorization letter scenario where a representative/caregiver buys medicines for a PWD.
- As a general rule, each single dispensing of medicine must not exceed a one (1) month supply and must be in accordance with the physician’s prescription.
- Drugstores must maintain a special record book for PWD medicines, subject to inspection by BFAD and BIR.
- For partial filling, pharmacists must record the partially filled quantity in the special record book and note the unfilled balance on the prescription; the PWD retains the partially filled prescription and later presents it to complete the prescribed quantity.
- Drugstores offering special discounted prices less than 20% of the regular retail price may deduct promotional discount percentage from the total 20% discount required by the law while still observing a total 20% PWD discount.
- PWD medicine discount privileges are non-transferable and exclusive for PWD benefits.
- For verification, hospitals must require PWDs to present a PWD ID card signed by the Barangay Captain, Mayor, or NCDA chairperson (as applicable under the identification document rules).
Requirements, posted rates, receipts, and stakeholders
- Government facilities must post hospital room rates, laboratory tests, diagnostic tests fees, medicine prices, and all other fees and rates in conspicuous places near or at the main entrance.
- Government facilities must submit the posted price lists annually to the National Center for Health Facility Development - DOH and PHIC.
- Government facilities must post this administrative order in conspicuous places where PWDs can access the information and policies.
- Government facilities must issue official receipts for every payment for medical and dental services, laboratory/diagnostic tests, and medicines, and receipts must state usual rates/fees and the discounted price.
- Government facilities must not apply an Income Means Test or any other tests as a precondition for free services provided under the order’s rules.
- Private hospitals and medical facilities must post room rates at the Admitting Section, and make available upon request the diagnostics/laboratory fee lists based on room and board accommodation, medical supplies, and medicines, ensuring validation of discounts.
- Private hospitals and medical facilities must issue official receipts for medical/dental services and medicines; the 20% discount must be granted upon full payment of the bill, and the billing statement showing usual rates/fees and discounted prices must be attached to the receipt.
- Private hospitals and medical facilities must set a grievance mechanism for PWD questions regarding professional fee discounts.
- Private hospitals and medical facilities must inform in writing the aggrieved party of the necessary sanction for health professionals who refuse to grant proper discounts.
- Health care professionals must:
- Inscribe their name and PRC number in diagnostic/laboratory test requests and prescriptions.
- Ensure prescriptions are for exclusive use of the PWD to curb abuse of the discount privilege.
- Inform the PWD of the usual fees.
- Provide official receipts stating usual fees and discounted fees.
- Drugstores must provide a generic menu card upon request and issue official receipts stating usual prices and discounted prices.
- Drugstores must provide a designated special lane for PWDs.
- Rehabilitation centers must provide quality care to PWDs and their families with compassion and respect.
- Behavioral testing centers must provide measurements of general or specific behavior in educational, vocational, community, or home settings and provide interpretations relating to adaptive/social skills.
- Hospices and palliative care centers must provide holistic quality care addressing physical, psycho-social, emotional, and spiritual pains.
Penalties and corporate accountability
- Any person who violates any provision of the guideline faces:
- For the first violation: a fine of not less than PHP 50,000 but not exceeding PHP 100,000 and imprisonment of not less than six (6) months but not more than two (2) years.
- For subsequent violations: a fine of not less than PHP 100,000 but not exceeding PHP 200,000 and imprisonment of not less than two (2) years but not more than six (6) years.
- Abuse of the privileges: a fine of not less than PHP 5,000 but not more than PHP 50,000 and imprisonment of not less than six (6) months.
- If the offender is an alien or foreigner: deportation immediately after service of sentence without further deportation proceedings.
- If the offender is a corporation, organization, or similar entity, the officials directly involved are liable.
- Upon filing of an appropriate complaint and after due notice and hearing, proper authorities may cause cancellation or revocation of business permit, permit to operate, franchise, and other similar privileges for any business entity that fails to abide by the provisions.
Funding, repeal, and effectivity rules
- Initial implementation funding is sourced from the Philippine Charity Sweepstakes Office budget allocation for government hospitals providing free medical services to PWDs.
- Starting CY 2010, national government agencies or LGUs must include in their budget proposals the funding necessary to implement programs and services required by the order.
- For government-owned and controlled corporations, total discounts granted to PWDs are charged to the Quantified Free Service.
- For private health facilities, the cost of the discount is funded through deduction of the discount from gross income for the same taxable year it is granted, with claimed tax deductions (net of VAT if applicable) included in gross sales receipts for tax purposes and subject to proper documentation and the National Internal Revenue Code as amended.
- Provisions from previous issuances inconsistent or contrary to the order are rescinded and modified accordingly.
- The order’s effectivity is immediately after publication in two (2) national newspapers of general circulation.