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I.    RATIONALE

The National Health Insurance Act of 2013 [Republic Act (R.A) 7875 as amended by RA 9241 and 10606] mandates PhilHealth to implement the National Health Insurance Program “to serve as a means to help people pay for health care services”. Likewise, the Responsible Parenthood and Reproductive Act of 2012 (RA 10354) recognizes that the right to health includes reproductive health. Furthermore, it guarantees universal access to “medically-safe, non-abortifacient, effective, legal, affordable and quality reproductive health care services” with family planning information and health services as priorities.

PhilHealth implements benefit packages for family planning services to enable access of members especially women to health services that will improve their health  and  well-being.  These  benefit  packages  were  being  provided  by accredited health care institutions such as hospitals and birthing homes.

The Department of Health (DOH) recognizes the role of primary care facilities as access points to safe and quality modern family planning (FP) services by issuing the “Guidelines and Procedures in the Certification of Free-Standing Family Clinics” (DOH Administrative Order (A.O.) 2017-002).

In line with PhilHealth’s goal to increase access of its members to all benefit packages including those that are related to family planning services, it shall provide mechanisms to engage these free-standing family planning clinics as accredited providers.

II.   COVERAGE

This Circular covers DOH Certified Free-Standing Family Planning Clinics and the health professionals that are affiliated with these facilities.

III.  DEFINITION OF TERMS

A.   Free-standing family planning clinics - refer to health facilities that provide modern FP services such as contraceptive pills and injectables, natural FP methods, contraceptive implants, intrauterine device (IUD) and no-scalpel vasectomy (DOH AO 2017-002).

B.   Certificate of  Compliance (as  Family Planning Clinic) -  is  the  certificate issued by the DOH Regional Office to a family planning facility after being assessed and evaluated based on a set of standards prescribed in DOH A.O. 2017-002.

IV.  GENERAL GUIDELINES

A.   Accreditation of Family Planning Clinics

1.  Family Planning Clinics shall be considered as primary care facilities without beds and shall have a valid Certificate of Compliance as Free- Standing Family Planning (FP) Clinics from the Department of Health.

2.   They shall be managed by a physician, nurse or midwife. The health staff should have training and proficiency on family planning.

3.   They shall be accredited as PhilHealth providers of the following benefit packages:

a.    Insertion of IUD;
b.    No-scalpel vasectomy; and
c.    Subdermal contraceptive implant.

4.   They shall have a  quality improvement program with  a  copy  of  the Manual of Procedures (at least on Family Planning) within their facilities.

5.   They shall have a referral arrangement with higher level facility/ies or participation in a functional Service Delivery Network (SDN) for referral of patients who warrant higher level of care.

6.  They shall follow the process of accreditation according to Provider Engagement through Accreditation and contracting of Health Services (PhilHealth Circular 54, s-2012) and any subsequent revisions.

7.   For initial accreditation, they shall submit the following requirements:

a.    Valid Certificate of Compliance as Free-Standing Family Planning Clinic from Department of Health Regional Office;
b.    Signed and notarized Performance Commitment;
c.    Accomplished Provider Data Record (PDR);
d.    Accreditation fee of Php1,500.00;
e.    Statement of Intent (SOl) if applicable;
f.    Electronic copies (in JPEG Format) of recent photos of the facility, both the interior and outside surroundings, with each picture completely labeled with the name of the facility and date taken; and
g.    Location map.

8.   For  renewal  of  accreditation,  they  shall  submit  the  following  within
January 1 to 31 of the succeeding year:

a.    Valid Certificate of Compliance as Free-Standing Family Planning
Clinic from Department of Health Regional Office;
b.    Signed performance commitment;
c.    Accomplished Provider Data Record;
d.    Accreditation fee (Php1,500.00); and
e.    Latest audited financial statement (submit on or before June 30 of the succeeding accreditation cycle).

9.  Facilities that are already PhilHealth accredited and providing family planning services arc not required to apply for separate accreditation as FP Clinics except for those birthing homes that intend to perform and claim for no-scalpel vasectomy. In this case, they have to apply for separate accreditation as FP Clinic.

10. Facilities  with  their  Certificate  of   Compliance  expiring  within  the accreditation period shall submit to PhilHealth an updated Certificate within sixty (60) calendar days prior to the expiration date.

11. Family Planning Clinic should be a PhilHealth Registered Employer with updated premium contribution (of their staff) as an employer.

12. For eligibility checking, claims submission, and processing, FP clinics shall have the following capabilities, facilities and equipment:

a.    Access to Health Care Institution (HCI) Portal and submit claims electronically;
b.    Knowledgeable staff authorized to access and send information;
c.    Computer;
d.    Document scanner;
e.    Internet connection; and
f.    Bank account for Auto Credit Payment Scheme (ACPS).

B.   Accreditation of Professional Providers

1.   The following are qualified professional providers in free-standing family planning clinics:

a.    Physician;
b.    Nurse; and
c.    Midwife.

2.   They  shall  have  a  valid  license  from  the  Professional  Regulation Commission (PRC).

3.   They shall adhere to the standards of practice and codes of ethics of their respective professions.

4.  They shall comply with the provisions set forth in the Performance Commitment for Professionals and other requirements that may be determined by PhilHealth.

5.  The professional providers shall be allowed affiliation to a maximum of three (3) accredited FP clinics.

6.   They shall be PhilHealth members with updated premium contributions.

7.   They  shall  follow  the  PhilHealth  accreditation  process  based  on PhilHealth Circular 10, s-2014 and any subsequent revision.

8.   They  shall  have  the  training  and  competence  in  performing  FP procedures as duly certified by DOH recognized training providers.

9.   For initial accreditation they shall submit the following requirements:

a.    Properly accomplished provider data record (PDR);
b.    Signed performance commitment;
c.    Valid PRC license;
d.    1 x1 photo (2);
e.    Proof of payment of premium contributions (as members)
f.    Certificate of good standing from Philippine Medical Association (for physicians);
g.    Certificate of residency training (for physicians, if applicable);
h.    Certificate from specialty board (for physicians, if applicable); and
i.    Certificates of training or proficiency on family planning procedures from DOH recognized training institutions on the following:

 

Professional Providers	Procedure	Certificate of Training to Submit
Physicians	Non - Scalpel Vasect o my (NSV)	Tra i ni ng on NSV
	I UD insertion as first case rate	Non e
	Subdermal Contracepti ve Implant Package	Certifi cate of Trai ni ng on Subder m al I m pl ant Insertion and Removal
Midwives	IUD insertion as first case rate	Family Planning Competency Based Training (FPCBT) Level 2 or Comprehensive Family Planning Course
	Subdermal Contraceptive Implant Package	Certificate of Training on Subder m a l I m pl ant I nserti on and Re m oval
Nurse s	IUD i nsertion	Fa m ily Pl anni ng Co m pet ency Based Trai ni ng (FPCBT) Level 2 or Co m prehensi ve Fa mily Pl anni ng Course
	Subdermal Contraceptive Implant Package	Cer tifi cate of Trai ni ng on Subder m a l I m pl ant I nserti on and Re m oval

10. Professionals who are already accredited need not apply for another accreditation. However, they shall have to submit a valid Certificate/s of Training to the nearest PhilHealth office.

11. Professionals employed by the government who will practice in private institutions shall have a written permission (to practice their profession) from the head of their agency or its representative.

12. Nurse’s who are accredited as providers of FP services and affiliated in birthing homes and rural health units may be reimbursed for FP procedures they performed in these facilities. However, those who also aim to be providers of packages for normal deliveries (e.g. Maternity Care Package) and newborn care shall comply with the policies on “Accreditation of Nurses for Maternal and Child Health Services” (PhilHealth Circular 2017-0023).

C.   Monitoring and Evaluation

To ensure provision of quality health services to PhilHealth members and their dependents, monitoring of utilization of benefits and performance of providers shall be anchored on the Health Care Provider Performance Assessment System of Corporation (PhilHealth Circular 2016-0026). The providers shall be monitored based on set of performance indicators (Annex A*). PhilHealth shall also consider the monitoring findings of DOH Regional Offices; Professional Regulations Commission  and  other  regulatory  offices;  and  professional/provider organizations.

Free-Standing Family Planning Clinics shall maintain logbooks and summary reports as required by DOH including Family Planning Form 1, Monthly Summary Report/M1 Form; and copies of patient’s records with complete documentation of history, physical examination, services provided, drugs and medicines given, procedures performed and operative technique/record. These documents shall be made available to PhilHealth staff at all times for monitoring and evaluation.

V.   REPEALING CLAUSE

All other issuances and provisions of existing issuances inconsistent with this Circular are hereby repealed and/or amended. All other rules and guidelines not contrary to this Circular shall remain in full force and in effect.

VI.  EFFECTIVITY

This circular shall take effect after 15 days following 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.