Law Summary
Scope
- Applies to all DOH offices implementing the Medical Health Care Assistance Program (MHCAP): Central Office, CHDs, Specialty, Special, and Retained Hospitals.
Objective
- Prescribe rational management and monitoring of indigency fund allocation and utilization by DOH units to support indigent patient care.
Definition of Terms
- Indigency Fund: Special fund from GAA for medical assistance to indigents referred by Secretary of Health.
- Walk-in Patient: Patient seeking assistance directly due to unaffordable health needs.
- Indigent Patient: Individual/family below regional poverty threshold or listed in DSWD National Household Targeting System.
- Working Poor: Patients with insufficient income for complete treatment expenses.
- Specialty Hospitals: PHC, NKTI, LCP, PCMC.
- Special Hospitals: DOH hospitals providing specific clinical care.
- Retained Hospitals: DOH-run hospitals.
- Sub-Allotment: Fund transfer to operating units.
- Far Flung Hospitals: DOH hospitals distant from CHD offices.
- Unaffordable Medical Bills: Hospital expenses beyond patient’s financial capacity.
General Guidelines
- Indigency Fund from GAA and other available DOH funds used.
- PAU Central Office responsible for program management.
- PACU at CHD level supports PAU.
- Hospital Medical Social Work Departments execute implementation.
- Hospital Finance Services monitor fund use and submit financial reports.
- Staff of program to exhibit courtesy and excellent service.
- Effective, efficient management system and support for PHIC universal coverage mandated.
Implementing Mechanism
- Eligible beneficiaries: walk-in/referred patients unable to pay; indigents listed in DSWD or certified by Medical Social Workers; non-PHIC members to be enrolled via LGUs; those certified by authorized DOH officials.
- Medical assistance includes drugs, labs, diagnostics, therapies, rehabilitation, hospital expenses with documentation requirements.
- All patients (PHIC/non-PHIC) recorded in WEB-PAIS.
- PAU and PACU review and approve assistance requests, issuing Letter of Authority (LOA) with specified information and authorized signatories.
- LOA serves as authority for medical assistance, monitored for authenticity and use.
- Medical Social Work Department verifies LOA, facilitates assistance, and assesses further patient needs.
- Ceiling on medical assistance per patient generally Php2,000.00, with exceptions upon justification.
- Funds not given in cash directly to patients.
- WEB-PAIS utilized for monitoring and reporting.
Allocation, Use and Replenishment
- Central Office PAU allocates funds and oversees sub-allotments.
- Hospitals receive fund replenishment upon submission of utilization reports.
- Assistance based on patient needs and fund availability.
- Strict fund liquidation and financial management by hospital finance and MSWD.
- Reporting requirements with biannual deadlines.
Roles and Responsibilities
- PAU Central Office: Overall management, coordination with CHD/hospitals, allocation of funds, screening and evaluation, report consolidation, semi-annual program evaluation, and recommending PHIC enrollment.
- CHD PACU: Report consolidation, onsite monitoring, staffing, fund monitoring via WEB-PAIS, PHIC enrollment recommendations.
- Field Offices: Monitor strict implementation and reporting.
- DOH Financial Service: Manage disbursement vouchers and financial assistance.
- DOH Information Management Service: Maintain and upgrade WEB-PAIS and conduct related trainings.
- Specialty, Special, Retained, Far Flung Hospitals: Facilitate assistance, prepare fund reports, implement program at hospital level, monitor funds, assist PHIC enrollment, submit membership reports.
Monitoring and Evaluation
- Standard monitoring tools prepared by PAU.
- Patient satisfaction surveys distributed and consolidated for assessment.
- Program reviews to assess impact and commend partner units.
- All participating offices required to join monitoring and evaluation efforts.
Repealing Clause
- Supersedes any conflicting administrative issuances, guidelines, or regulations.
Effectivity
- Guidelines effective immediately upon approval by Secretary of Health.