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Adopted: 16 June 2015
Date Filed: 26 June 2015
I. Background and Rationale

Republic Act No. 10651, the General Appropriations Act (GAA) of FY 2015, allocated One Billion Eight Hundred Forty Nine Million Pesos (Php1,849,000,000.00) to the Department of Health (DOH). The fund shall be utilized for the grant of medical assistance to indigent and poor patients.

II. Scope

These guidelines shall apply to all offices and persons involved in the implementation of medical assistance to indigent and poor patients in government hospitals.

III. Objective

These guidelines are promulgated to rationalize the process in the allocation and utilization of the medical assistance fund.

IV. Definition of Terms

1. Government Hospitals – refers to hospitals owned or managed by the government through the DOH, Local Government Units (LGUs) and State Universities and Colleges (SUCs).
   
2. Medical Assistance Fund – represents the allocation in the 2015 GAA intended for medical assistance to indigent or poor patients.
   
3. Retained Hospitals – refers to all hospitals under the management andoperation of the DOH.
   
4. Specialty Hospitals – refers to the four (4) corporate hospitals under the DOH namely, the Philippine Heart Center (PHC), National Kidney and Transplant Institute (NKTI), Lung Center of the Philippines (LCP) and the Philippine Children’s Medical Center (PCMC).
   
5. LGU Hospitals – refers to hospitals owned or managed by LGUs.
   
6. SUC Hospitals – refers to hospitals owned or managed by SUCs.
   
7. Other government hospitals – hospitals owned or managed by other government agencies.
   
8. Indigent or Poor Patients – are persons who cannot meet their basic needs or who have income/s but are insufficient to fully meet their medical expenses, respectively, and are seeking medical services as in patient, whether confined in a ward, Intensive Care Unit (ICU) or small private room, or out patient in government hospitals.

V. Implementation Mechanisms

1. Eligible Beneficiaries. The beneficiaries shall be indigent or poor patients.
   
   
2. Implementation Process.
   
   
   1. The amount of Seven Hundred Eighty Four Million Two Hundred Four Thousand Pesos (Php 784,204,000.00) has automatically been incorporated in the budget of the DOH retained hospitals. (See Annex “A”)
      
   2. The DOH Financial Management Service shall transfer the remainder of the funds to the Regional Health Offices and DOH retained hospitals, however, for SUCs, and Specialty hospitals fund transfer shall be done after the previously downloaded funds have been liquidated in accordance with pertinent budgeting and auditing rules and regulations.
      
   3. The Regional Office shall transfer funds to LGU Hospitals upon the submission of a bill of medical services incurred by the indigent or poor patient/s.
      
   4. The Medical Assistance Fund may be utilized by SUCs, Specialty and LGU hospitals upon the signing of Memorandum of Agreement (MOA) between the following:
      
      

      Type of Hospital	Parties to the MOA
      SUCs and Specialty Hospitals	DOH and Chief of Hospital/President of the University (Annex B)
      LGU Hospitals	DOH Regional Director, Head of LGU and Chief of Hospital (Annex C)

      
      
   5. The downloaded or transferred funds shall be the responsibility and accountability of the Medical Center Chief of the concerned government hospital. He shall ensure that all the funds are properly utilized consistent with the GAA and COA guidelines.
      
   6. Medical assistance extended to beneficiaries in government hospitals requiring MOA prior to the effectivity of this Order may be reimbursed and deducted from their respective fund allocation once the MOA is signed.
      
   7. The medical assistance shall include the following:
      
      
      1. All laboratory and other diagnostic procedures, including minor and major surgical procedures, whether emergency or elective as required by the attending physician, except those that are for aesthetic purposes.
         
      2. All dental services such as examination and extraction, except prophylaxis and prosthesis;
         
      3. All drugs, medicines, and medical supplies as prescribed by the attending physician; and
         
      4. All hospital bills including professional fees, provided that the expenses for professional fees shall only be at most fifty percent (50%) of the amount of the assistance.
         
      
      
   8. All concerned government health facilities shall ensure the availability of medicines, equipment supplies, materials and other health care services needed by eligible patients. In the event of non-availability of the needed medicines, equipment supplies, materials and other health care services, the concerned government health facility may enter into contract with DOH-accredited health care providers (e.g. hospitals, pharmacies) within its area to provide the same to the eligible beneficiaries.
      
      
   9. The Medical Assistance Fund can likewise be used for the payment of PhilHealth premiums under the Point of Care program subject to the guidelines specified in PhilHealth Circular No. 32 series of 2013. (Annex D)
      
   
   
3. Approving Authority.Requests for medical assistance under the program shall be approved by the concerned Chief of Hospital.
   
   
4. Maximum Amount.The Chief of Hospital is authorized to approve a maximum amount of One Hundred Thousand Pesos (P100,000.00) per patient. Any excess shall require approval of the Secretary of Health or by his/her authorized representative.
   
   
5. Documentary Requirements.The applicant shall present pertinent documents (e.g. Doctor’s Prescription/Request, Billing Statement, Case Summary or Medical Abstract from DSWD/ Certificate of Indigency from his/her Barangay) to the concerned hospital’s Medical Social Worker (who may also issue a Case Summary/ Medical Abstract/ Case Referral in lieu of the one issued by DSWD), who will assist the patient in availing of the medical assistance.

VI. Monitoring and Evaluation

1. The concerned hospitals shall submit a monthly fund utilization report to the Financial and Management Service on or before the 7 th day of succeeding month, including (a) names and addresses of patients and medical services rendered to and/or drugs and medicines they received, (b) type of medical assistance given and other related information, and (c) the amounts given to individual patients as well as the total amount of medical assistance given for the month.
   
2. A annual Program Review shall be conducted by the DOH to assess the impact of the program on its thrusts and to commend government hospitals for their support and partnership in the utilization of the Medical Assistance Fund.

VII. Separability Clause

If any part or provision of this Order is held invalid, the other provisions not affected shall remain in full force and effect.

VIII. Effectivity Clause

This Administrative Order shall take effect upon its publication in a newspaper of general circulation or in the DOH website.

IX. Repealing Clause

All existing Memoranda of Agreement (MOA) on the medical assistance to indigent and poor patients between the parties mentioned in this MOA are hereby repealed.

(SGD) JANETTE P. LORETO-GARIN, MD, MBA-H
Secretary of Health