Law Summary

1. Licensing and Accreditation Overview

The Department of Health (DOH), through the Bureau of Health Facilities and Services, has established a streamlined process for the issuance of hospital licenses to operate and ancillary licenses via a one-stop-shop licensing system.

• Legal Principle: The issuance of licenses is automatic once required documents are submitted.
• Delegation of Authority: Centers for Health Development are authorized to issue these licenses.
• Monitoring: The status of licenses is subject to change based on DOH monitoring.

2. Impact of License Status on Accreditation

The accreditation status of institutional health care providers is directly linked to the DOH license status as per Section 55 of the Implementing Rules and Regulations (IRR) of R.A. 7875, amended by R.A. 9241.

• Key Definitions:

  • Accreditation: The endorsement of hospitals based on compliance with specific standards.
  • License Status: The operational standing of a health facility as determined by the DOH.

• Requirements:

  • Mandatory submission of the DOH license for hospitals is required for accreditation.
  • Changes in the license status (revocation, suspension, downgrading) directly affect accreditation status.

3. Changes in License Status

Changes in the DOH one-stop-shop license can occur during the accreditation validity period due to monitoring activities.

• Important Procedures:

  • PHIC will note any changes in the license status, which will consequently alter the accreditation status.

• Covered Changes:

  • Revocation, suspension, downgrading, and decrease in authorized beds are included.

• Excluded Changes:

  • Upgrading, increase in accredited beds, and specific policy issuances are not addressed in this circular.

4. Claims Reimbursement and Payment Mechanisms

The circular outlines relevant policies regarding claims reimbursement linked to the accreditation status of health care institutions.

• Claims Processing:

  • Claims for services filed by hospitals after a change in category will be paid according to the new category rates.
  • If a member is confined during a change of category, claims will be assessed at the higher category rate.

• Cross-Reference:

  • This is governed by Rule VIII, Section 47 of the IRR of R.A. 7875, as amended by R.A. 9241.

5. Implementation and Compliance

The circular is effective as of March 18, 2008, and mandates compliance from all relevant health care providers.

• Key Dates:
  • Adopted on March 18, 2008, by Lorna O. Fajardo, Acting President and CEO.

Key Takeaways

• The DOH has implemented a streamlined process for hospital licensing and accreditation.
• The accreditation status of health care providers is dependent on the status of their DOH license.
• Changes to license status can significantly impact accreditation and claims reimbursement.
• Providers must comply with these regulations as outlined for continued accreditation and operational capability.