Philippine Health Insurance Corporation

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PHIC Circular No 16, s. 2009Tooltip 01/19/2010 Hits: 25

PHILIPPINE HEALTH INSURANCE CORPORATION


PhilHealth Circular No. 16, s. 2009


PhilHealth Cataract Package

Adopted: 14 April 2009

Date Filed: 19 January 2010

Text Available at Office of the National Administrative Register,

U.P. Law Complex, Diliman, Quezon City

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PHIC Circular No 50, s. 2009Tooltip 01/19/2010 Hits: 33

PHILIPPINE HEALTH INSURANCE CORPORATION


PhilHealth Circular No. 50, s. 2009


Guidelines for Accreditation of Hospitals Using the Benchbook

Standards, New Application Form, Checklist and Warranties of

Accreditation of IHCPs and Hospital Self-Assessment Tool


Adopted: 10 Nov. 2009

Date Filed: 19 January 2010


Rule IX, Section 50 of the Revised Implementing Rules and Regulations of the National Health Insurance Act (RA 7875) as amended by RA 9241 states that “The Corporation shall implement a Quality Assurance Program applicable to all health care providers for the delivery of health services nationwide.“ The goal of this program is to achieve the desired health outcomes and member satisfaction through quality health services rendered by accredited health care providers.


In accordance with PhilHealth Board Resolution No. 453, s. 2002, the Benchbook shall be the new accreditation standards of the Corporation. Subsequent issuances provided the initial guidelines towards the full implementation of the Benchbook standards. Circular No. 12, s. 2005, adopted the Benchbook as its main reference for assessing and evaluating the performance of accredited health care providers and made it as the basis for accreditation of hospitals. It also enjoined providers to participate in trainings, workshops and orientations on Benchbook provided or organized by the Corporation. Circular 12, s. 2006 required the establishment of a continuous quality improvement (CQI) program for hospitals applying for accreditation starting 2007. In line with these, the following guidelines, checklist, forms and new warranties of accreditation for hospitals are hereby issued.


GUIDELINES FOR ACCREDITATION OF HOSPITALS:


The PhilHealth Benchbook Standards for Health Care Provider Organizations shall be the basis for accreditation of hospitals starting the 2010 accreditation year.


I. CONDUCT OF SELF-ASSESSMENT:

A hospital that intends to apply for accreditation shall determine its level of achievement/compliance in relation to the PhilHealth Benchbook standards by conducting a self-assessment of its organization, thereby determining which accreditation award it will apply for. The hospital shall institute corrective actions to address the areas for improvement identified during the self-assessment.

A self-assessment shall be conducted by a hospital prior to the submission of its application for accreditation. A copy of the self-assessment and survey form shall be secured from the PhROs or may be downloaded from the PhilHealth website at www.philhealth.gov.ph. This form is composed of three parts, namely: 1) Self-assessment and Survey Tool, 2) Score Sheet and 3) Self-assessment Summary.


II. ACCREDITATION AWARDS:

The following are the Accreditation Awards and the corresponding requirements and accreditation coverage:

Table 1: Accreditation Awards

____________________________________________________________________________

Accreditation Requirement Accreditation

Award Coverage

___________________________________________________________________________

Center of Safety a. Compliance with 100% of CORE

indicators and 1 year

b. At least 60% compliance with each of the

following performance areas:

1. Patient Rights and Organizational Ethics

2. Patient Care

3. Safe Practice and Environment

_________________________________________________________________________

Center of Quality a. Compliance with 100% of CORE indicators 2 years

and

b. At least 75% compliance with each of the

following performance areas:

1. Patient Rights and Organizational Ethics

2. Patient Care

3. Safe Practice and Environment

4. Leadership and Management

5. Human Resource Management

6. Information Management

_________________________________________________________________________

Center of Excellence a. Compliance with 100% of CORE

indicators and 3 years

b. At least 90% compliance with each of the

following performance areas:

1. Patient Rights and Organizational Ethics

2. Patient Care

3. Safe Practice and Environment

4. Leadership and Management

5. Human Resource Management

6. Information Management

7. Improving Performance

____________________________________________________________________________


III. FILING OF APPLICATIONS

1. PhilHealth shall accept only applications for accreditation with complete documentary requirements.

2. An application fee shall be charged appropriate to the level the hospital is applying for (see payment scheme below).

A. Documentary requirements for application for accreditation of hospital (Annex B*):

1. PhilHealth application form - properly accomplished. (Annex A*).

2. Warranties of Accreditation - duly notarized

3. DOH License - with validity applicable to accreditation period applied for

4. Certificate of Membership in PHA/PHAP - with validity applicable to accreditation period applied for

5. Benchbook Self-Assessment and Survey Form - fully accomplished; for 2010 accreditation period, this is optional if hospital already submitted its baseline self-assessment or accomplished Manual II.

a. Self-assessment and survey tool

b. Score sheet

c. Self-assessment summary

6. Accreditation fee - proof of payment

7. Statement of Intent (SOI) - if applicable

a. For Hospitals applying for initial/re-accreditation from January to April (see section III.E, Option A and B regarding validity of accreditation), and/or

b. For hospitals applying as Centers of Quality/Excellence (see section V.2)

Additional Documentary Requirement for Initial Accreditation:

l DOH licenses for 3 previous years or its required equivalent document/s

(Circ. No. 21 s. 2009).

A hospital shall file its application for accreditation at the designated PhRO/SO where the said institution is located and pay the corresponding application fee. It shall indicate in the application form the accreditation award it is applying for, namely: Center of Safety, Center of Quality or Center of Excellence.

B. Schedule of Filing of Application

1. Applications for initial accreditation and re-accreditation may be submitted anytime of the year.

2. For 2010 renewal of accreditation, a hospital shall submit its application for accreditation starting December 1, 2009 until February 1, 2010.

3. The incentive period for filing of 2010 renewal of accreditation is December 1 to 31, 2009. The regular filing period is January 1, 2010 to February 1, 2010. Applications filed after February 1, 2010 shall be subject to a corresponding surcharge as shown in Table 2. Filing date shall be reckoned from the date of submission of complete documents.

C. Applications with Incomplete Documentary Requirements

1. Applications with incomplete documentary requirements shall be returned and a notice of deficiency/ies on documentary requirements shall be issued to the applicant according to the following schedules:

a. Walk-in applicant: immediately upon receipt of the incomplete application

b. Mailed application: within five (5) working days from receipt of incomplete application

2. The applicant hospital shall be advised to complete the required document/s within thirty (30) days from receipt of notice of deficiency/ies.

D. Payment Scheme

1. Applications for 2010 renewal of accreditation that are received during the incentive period of from December 1 to 31, 2009 shall be given a ten percent (10%) discount from the amount of the regular accreditation fees.

2. Applications for renewal of accreditation received after the prescribed filing period shall incur penalty charges in addition to the regular accreditation fee and shall be tagged as re-accreditation.

3. Schedule of Accreditation Fees.

The schedule of accreditation fees is as follows:

Table 2: Application Fees for Accreditation of Hospitals

____________________________________________________________________________

Initial and RENEWAL RE-ACCREDITATION

HOSPITAL Re-Accreditation _________________________________________________________

LEVEL (with gap) BEFORE THE PRESCRIBED APPLICATIONS FILED AFTER THE

PRESCRIBED FILING PRESCRIBED FILING PERIOD

PRIVATE/ FILING PERIOD PERIOD (additional fee)

GOVERNMENT (WITH 10% 31-90 days 1-30 days prior

INCENTIVES) prior to expiration to expiration

________________________________________________________________________________________

Level I P3,000 P1,800 P2,000 P4,000 P8,000

Level II P5,000 P3,600 P4,000 P8,000 P16,000

Level III P8,000 P7,200 P8,000 P16,000 P32,000

Level IV P10,000 P9,000 P10,000 P20,000 P40,000

__________________________________________________________________________________________

4. The application fee is non-refundable.

5. A hospital awarded as a Center of Quality or a Center of Excellence shall pay the application fee for the level and submit its updated DOH license and PHA/PHAP Certificate of Membership every January of the succeeding year, in accordance with the regular accreditation filing period. For hospitals that failed to submit their updated licenses, the rule on provisional accreditation due to absence of DOH licenses (Section VI.1 of this circular) shall apply.

E. Applications of IHCPs for initial/re-accreditation filed and surveyed within the months of January to April

As a result of the fixed accreditation period that ends on April 30 of each year, hospitals that filed their applications from January 1 to April 30, and are surveyed on or before April 30 may be granted accreditation only for four (4) months or less. Therefore, these hospitals shall have the following options:

OPTION A.

1. The start date of the accreditation shall be on the date of the last day of the conduct of pre-accreditation survey. It shall be valid until April 30 of the accreditation year. Thus, for 2010 applications, the hospitals’ accreditation shall be valid only until April 30, 2010.

2. The hospital shall renew its accreditation within thirty (30) days from receipt of the letter of approval of accreditation by submitting the following:

a. Application form for renewal of accreditation - duly accomplished

b. Warranties of Accreditation - duly notarized

c. Accreditation fee.

3. Said hospital shall be exempted from the penalty charges for late filers and therefore shall pay the applicable accreditation fee as reflected in Table 2. Prescribed Filing Period column.

4. The succeeding accreditation period shall be valid from May 1 to December 31 of the accreditation year and provisional from January 1 to April 30 of the succeeding year (See Section VI.1).

5. Hospitals that file their application for renewal of accreditation after thirty (30) days from receipt of the letter of approval may incur a gap in their accreditation and their application shall be considered as an application for re-accreditation.

OPTION B. The hospital agrees that the validity date of accreditation shall start on May 1 of the accreditation year:

1. The hospital shall inform the Corporation that in case their application for initial or reaccreditation is approved on or before April 30 of the accreditation year, they agree that the start date of their accreditation shall be valid from May 1 to December 31 of the accreditation year, by signing the statement of intent contained on Annex C. Provisional accreditation shall be granted from January 1 to April 30 of the succeeding year as a result of the pendency of the hospital license (See Section VI.1).

2. Failure of the hospital to sign the statement of intent contained on Annex C regarding the start date of the validity of accreditation shall result in the application of Option A.

IV. PRE-ACCREDITATION SURVEY

1. PhilHealth shall conduct pre-accreditation survey only in hospitals that have submitted applications with complete documentary requirements.

2. The hospital shall be notified within thirty (30) days from receipt of its complete application for accreditation regarding the date of the conduct of pre-accreditation survey.

3. The PhilHealth Survey Team shall utilize the same survey tool used by the hospital to validate its compliance to the Benchbook Standards.

4. The pre-accreditation survey shall be conducted for a maximum duration of one (1) day for a Level 1 hospital, two (2) days for a level 2 hospital and three (3) days for a Level 3 or 4 hospital.

5. The PhilHealth survey team shall provide feedback to the hospital management regarding their findings from the survey.

6. Pre-accreditation survey results shall be valid for six (6) months from the last day of the survey. Therefore, the PhRO may not conduct another pre-accreditation survey for subsequent application filed unless necessary.

V. DELIBERATION OF APPLICATIONS FOR ACCREDITATION

1. All applications evaluated shall be deliberated by the Accreditation Committee or the PhRO Accreditation Sub-committee within thirty (30) days from the last day of the pre-accreditation survey.

2. A hospital that does not qualify for the accreditation award it is applying for may be downgraded to the accreditation award it is compliant with as reflected in the statement of intent signed by the authorized hospital representative upon filing its application for accreditation. Otherwise, the said application shall be denied by the Corporation.

3. If the accreditation is denied or downgraded, the hospital is given the opportunity to seek for a review of the decision through a motion for reconsideration (MR) on the final decision of the Corporation within thirty (30) days from receipt of notice on the status of its application for accreditation. The PhRO may conduct a survey within two (2) weeks from receipt of the MR to validate the compliance of a hospital whose application for accreditation was denied or downgraded. Should the hospital decide not to file an MR, it may file another application for accreditation.

VI. VALIDITY OF ACCREDITATION

The accreditation granted by the Corporation to hospitals is valid in accordance with the following schedule:

Table 3: Validity of Accreditation

__________________________________________________________________________________

Type of Start Date End Date Provisional

Accreditation Accreditation

__________________________________________________________________________________

Initial Date of the last day of conduct December 31 of January 1 -

Re-Accreditation of pre-accreditation survey the accreditation year April 30 of the

______________________________________ succeeding

Renewal May 1 of the accreditation year year

___________________________________________________________________________

A provisional accreditation may be granted for a period as may be determined by the Corporation in accordance with the following conditions:

1. Secondary to DOH - One Stop Shop license

Accreditation of hospitals for the succeeding year (January 1 to April 30) shall be provisional pending the submission of their updated DOH licenses and PHA/PHAP Certificate of Membership. Processing of claims shall be put on hold beginning January 1 admissions. Failure to submit the said documents before the end of the filing period (month of January) shall invalidate the provisional accreditation. Claims filed for admissions during the said period shall not be paid .

2. Secondary to partial compliance of the Benchbook Standards

The Corporation may grant provisional accreditation for six (6) months to a DOH-licensed hospital based on any of the two (2) following conditions:

a. Compliance with the Benchbook standards:

1. At least 70% but below 100% compliance to core indicators or

2. Below 60% compliance to any of the following performance areas, with no scores less than 50% to each:

a. Patient Rights and Ethics

b. Patient Care

c. Safe Practice and Environment

b. The hospital is located in a far flung area as determined by the Corporation

Upon compliance with accreditation standards and requirements within the six (6) month period, the hospital shall be granted accreditation as a Center of Safety. In ability of the hospital to achieve compliance within the duration of its provisional accreditation shall result in the termination of its accreditation.

The hospital may apply for initial or re-accreditation anytime.

VII. performance of hospitals

Accredited hospitals are enjoined to show improvement of its compliance with the Benchbook standards upon filing of applications for subsequent renewals of accreditation.

Hospitals are responsible and solely accountable for the quality of their services and overall performance. In order to improve and sustain the level of performance of accredited hospitals, PhilHealth shall conduct monitoring activities on hospitals in accordance with the Benchbook standards.

VIII. UPGRADING OF HOSPITALS

A currently accredited hospital may apply for re-accreditation for upgrading for the following reasons:

1. The DOH has issued a license to the hospital for a higher level of service capability, or

2. The hospital has achieved a higher level of performance such that it now aspires for a higher award e.g., Center of Quality or Center of Excellence.

IX. CERTIFICATES AND LETTERS OF ACCREDITATION

1. A Certificate of Accreditation reflecting the Accreditation Award and the date of validity shall be issued for all approved applications.

2. The PhROs shall send the Certificates of Accreditation and all communications to the concerned hospital within five (5) working days from the date of approval of accreditation by the Corporation.

All existing policies, orders and other issuances that are inconsistent with this Circular are hereby repealed and/or amended accordingly.

This circular shall take effect immediately.

(sgd.) dr. rey b. aquino

President and CEO

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