Scope and Coverage
- Applies to Health Care Institutions (HCIs) intending to provide PD services.
- Includes currently accredited HCIs wishing to enter into contracts as PD First Z Benefit providers.
- Covers both initial and continued accreditation processes for PD services.
Accreditation General Guidelines
- Applies PhilHealth Circular 54 s. 2012 on Provider Engagement and Accreditation.
- Initial accreditation exempt from three years operation rule but requires compliance and pre-accreditation survey (PAS).
- Currently accredited HCIs adding PD must submit new Provider Data Record (PDR) and Performance Commitment plus undergo PAS.
- No separate accreditation needed in subsequent cycles once PD included.
- Letter of Intent (LOI) required for HCIs wanting PD First status, following PhilHealth Circular 18 s. 2014 guidelines.
- HD clinics encouraged to provide PD services.
- PD clinics must be led by a PhilHealth-accredited physician.
- One physician may head up to three dialysis units (HD or PD).
- PD clinics must have a Memorandum of Agreement (MOA) with at least a Level 1 accredited hospital as a referral institution.
Standards for Accreditation
- Human Resources: Must have adequate qualified and competent staff for efficient PD service delivery.
- Minimum Service Capability: Must provide minimum service quality standards desired for PD.
- Physical Plant: Facilities must ensure safety of staff, patients, and relatives with adequate space.
- Equipment and Supplies: Availability and operational status of necessary PD procedure equipment, including desktop with internet and functional HCI portal.
- Records: Maintain patient record systems to provide readily available information.
- Protocols: Written procedures for routine PD care and management of common PD issues.
Requirements for Accreditation
- HCIs must complete and submit Provider Data Record (PDR) along with all documentary requirements to apply.
Monitoring and Evaluation
- PhilHealth will conduct regular monitoring and assessment for implementation adequacy and continuous improvement.
- Monitoring based on Health Care Provider Performance Assessment System (PhilHealth Circular 31, 2014).
- Evaluation parameters include quality of care, access, patient satisfaction, financial risk protection, and fraud detection.
Legal Provisions
- Repealing Clause: Prior inconsistent provisions of earlier issuances are amended, modified, or repealed.
- Separability Clause: If any part is invalidated by a court or authority, unaffected provisions remain valid.
- Effectivity: Circular takes effect fifteen (15) days after publication in an official gazette or newspaper of general circulation and applies to ongoing applications.
Annexes
- Annex A: Definitions of terms related to this policy.
- Annex B: Standards for Accreditation specific to PD clinics.
- Annex C: Requirements for Accreditation for PD services.
These annexes can be accessed online at the official PhilHealth website.