In order to facilitate reimbursement of claims on confinements for psychiatric conditions, the following rules are hereby issued:

1. Claims for mental and behavioral disorder shall be compensable only for patients with acute attacks or episodes admitted for any of the following reasons:

a. When aggressive or assaultive behavior presents danger to self or others;
b. When the patient is suicidal;
c. When the patient becomes manic or depressed and there is gross impairment in judgment and reality testing;
d. When medication side effects became disabling or potentially life threatening (e.g. severe parkinsonism, sever tardive dyskinesia, neuroleptic malignant syndrome);
e. For special medical procedures such as electroconvulsive therapy

2. Hospitals are also required to submit PhilHealth Claim Form 3 and properly accomplished Mental Status Examination (MSE) Form (see sample MSE Form in Annex A^* ) if the main diagnosis or primary condition is classified as mental and behavioral disorder.

3. In cases wherein the main condition is non-psychiatric illness, management of mental and behavioral disorder may also be reimbursed provided that such condition is indicated in the admitting and/or final diagnosis with appropriate codes. In such cases, Claim Form 3 and Mental Status Examination shall not be required.

4. The rule on 45-day allowance per year applies to this benefit.

5. Claims for cases not requiring admissions remains non-reimbursable.

This Circular shall take effect for all claims with admission dates starting April 1,2010.

All other provisions of previous issuances remain in full force and effect.

Please be guided accordingly.

(SGD.) DR. REY B. AQUINO
  President and CEO

---

^* Text Available at Office of the National Administrative Register, U.P. Law Complex, Diliman, Quezon City