I.    RATIONALE

The  Revised  Implementing  Rules  and  Regulations  of  the  National  Health Insurance Act of 2013 (Republic Act (RA) 7875 as amended by RA 9241 and RA 10606) provides that PhilHealth shall implement a Quality Assurance Program which œshall ensure that the health services rendered to the members by accredited health care providers are of the quality necessary to achieve the desired health outcomes and member satisfaction . It further states that the Corporation œreserves the right to issue, deny, or withdraw the accreditation after an evaluation of the capability and integrity of the health care institution.  Accordingly, PhilHealth shall prescribe the requirements for* the accreditation of health care institutions.

Likewise, the Department of Health (DOH) Administrative Order (AO) 2012-0012 defines the rules and regulations of regulated health facilities for the purpose of protecting and promoting the health of the public and to assuring the safety of patients and personnel. The policy includes birthing homes among the facilities required to have a license from the DOH prior to their operations.

II.   SCOPE AND COVERAGE

This circular shall apply to all birthing homes and lying-in/ maternity clinics.

III.  GENERAL GUIDELINES

A.   PhilHealth shall grant accreditation to health care institutions based on their capability and integrity.

1.   As an evidence of their capability to provide the health services, all birthing homes and lying-in/maternity clinics that are applying for initial, renewal and re-accreditation shall have a valid DOH License to Operate (LTO).

2.   Validated  findings  of  fraudulent  and  unethical  practices  shall  be considered against their integrity as health care institutions.

B.   All health care professionals affiliated in these birthing homes/lying-in clinics who attend to deliveries, newborn care and other related procedures (i.e. family planning) shall be PhilHealth accredited.

C.   The birthing homes and maternity/lying-in clinics shall submit the following documents:

1.   For initial and re-accreditation:

a.    Valid and updated license to operate (LTO) from the Department of Health
b.    Signed performance commitment (Annex A of PhilHealth Circular 2015-037)
c.    Properly accomplished provider data record (PDR)
d.    Accreditation fee (Php1,500.00)
e.    Copy of updated Certificate as Newborn Screening Facility
f.    Copy of updated Certificate as Newborn Hearing Screening Facility or Memorandum of Agreement with a certified facility (if applicable)
g.    Electronic copies of recent photos of the facility including the interior and outside surroundings, completely labeled with the name of the facility and date taken
h.    Location Map
i.    Statement of intent (if applicable)

2.   For renewal of accreditation (to be submitted within January 1 to 31 of the succeeding year):

a.    Valid LTO from Department of Health b.    Signed performance commitment
c.    Properly accomplished Provider Data Record (PDR)
d.    Accreditation fee (Php1,500.00)
e.    Copy of updated Certificate as Newborn Screening Facility
f.    Copy of updated Certificate as Newborn Hearing Screening Facility or Memorandum of Agreement with a certified facility (if applicable)
g.    Latest audited financial statement (submit on or before June 30 of the succeeding u accreditation cycle)

D.   PhilHealth shall conduct pre-accreditation survey to birthing homes/lying-in clinics that are applying for initial accreditation and re-accreditation due to gap in accreditation and transfer of location.

E.   Birthing  facilities  that  provide  family  planning  services  and  claim  for PhilHealth reimbursements shall submit their health staffs certificates of training from DOH recognized training providers as per PhilHealth Circular (PC) 25-2015 and PC 38-2015.
 
IV.  MONITORING AND EVALUATION

PhilHealth shall continue its monitoring visits to assess the providers ™ adherence to the standards of care and compliance to PhilHealth policies and guidelines. The measures of performance are based on the quality of care, patient satisfaction, financial risk protection, and fraud prevention.

The monitoring of the facilities shall be anchored on PhilHealth ™s Health Care Provider Assessment System (HCP PAS) as stated on PhilHealth Circular 2016-0026. Also, PhilHealth shall use the DOH licensing requirements for birthing homes enumerated in Annex C of DOH AO 2012-0012, and PhilHealth additional requirements listed in Annex A* of this Circular in monitoring the inputs and processes of care.

V.   REPEALING CLAUSE

This Circular supersedes the following provisions of these circulars:

1. PhilHealth Circular 30, s-2009 Guidelines for Accreditation of Providers for Maternity and Newborn Care Package, Part A- Standards for Accreditation of Non-Hospital Facilities.

2. PhilHealth Circular 54, s-2012 Provider Engagement through Accreditation and Contracting for Health Services particularly:

a.   Section  VI.A.1.b  [Automatic  Accreditation  -  Maternity  Care  Package (MCP) Providers certified as Basic Emergency Obstetric and Neonatal Care (BEmONC) and Newborn Screening Facility by DOH];
b.   Section  Vl.A.2  (Non-automatic  accreditation  -  which  includes  MCP
providers that are not BEmONC Certified);
c.   Section VI.B.1.h (Non-automatically accredited Institutional Health Care
Providers shall be subjected to pre-accreditation survey); and
d.   Annex A, Item 4 (Additional Requirements for Maternity Care Providers).

Provisions of previous issuances inconsistent with this PhilHealth Circular are hereby amended, modified or repealed accordingly. Those that are consistent shall remain valid and binding.

VI.  EFFECTIVITY

This circular shall take effect 15 days after its publication in any newspaper of general circulation. It shall be deposited thereafter with the National Administrative Register at the University of the Philippines Law Center.