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I.    BACKGROUND

The  PhilHealth Outpatient HIV/AIDS Treatment (OHAT) Package provides a mechanism  for  people  living  with  HIV  (PLHIV)  to  have  access  to  effective

HIV/AIDS treatment and care in PhilHealth accredited health care institutions that are designated HIV treatment hubs and satellite treatment hubs by the Department of Health (DOH).

To bring the essential health services closer to the key affected population, more treatment hubs and satellite treatment hubs were established by DOH. However, some of them function as “stand-alone” facilities dedicated to deliver HIV/AIDS related health services only.

To increase access to the PhilHealth OHAT Package, PhilHealth shall define policies and procedures for accreditation of these health care institutions.

For the purpose of this circular, stand-alone HTV treatment hubs and satellite treatment hubs arc defined as health care institutions operating independently from a PhilHealth-accredited facility. They are recognized by the Department of Health through an official issuance to provide anti-retroviral treatment and other services to PLHIV based on the current treatment guidelines. In latest DOH list, satellite treatment hubs are also called primary HIV Care Facilities.

II.   SCOPE AND COVERAGE

This  Circular  shall  apply  to  stand-alone  HIV  treatment  hubs  and  satellite treatment hubs/primary HIV care facilities.

III.  GENERAL GUIDELINES

1.    The health care institution shall be a DOH-recognized HIV treatment hub or satellite treatment hub/ Primary HIV Care Facilities. It shall be included on the official updated DOH list of recognized HIV treatment facilities.

2.    The health care institution shall be accredited as providers of PhilHealth OHAT Package. It shall follow the rules and regulations set by PhilHealth and shall comply with the guidelines on benefit availment and claims processing prescribed in PhilHealth Circular 011-2015 “Outpatient HIV/AIDS Treatment (OHAT) Package” and their subsequent revisions.

3.    It shall follow the latest Department of Health’s “Policies and Guidelines on the Use of Antiretroviral Therapy (ART) Among People Living with Human Immunodeficiency Virus (HIV) and HIV Exposed Infants”.

4.   The health care institution shall be able to provide the following services to PLHIV:

a.   Laboratory services to monitor drug toxicity and response to treatment including CD4  testing and  viral  load  determination or  referral arrangement with other laboratory or treatment hubs which is documented through a memorandum of agreement;
b.   Adherence and psychosocial counseling;
c.   Management of PLHIV based on the current treatment guidelines;
d.   INH and Co-trimoxazole prophylaxis; and
e.   Referral mechanism to other services such as but not limited to: other treatment hubs; laboratories; hospital admissions; TB DOTS/PMDT treatment; and management of other co-infections and opportunistic infections.

5.    It shall follow the process of accreditation according to Provider Engagement through Accreditation and Contracting of Health Services (PhilHealth Circular 54, s-2012) and its subsequent revisions. requirements to the nearest PhilHealth Office:

a.   Performance Commitment - signed and properly accomplished;
b.   Provider Data Record (PDR) - properly accomplished;
c.   Participation fee (Php1,000.00);
d.   Electronic copies of recent photos of the facility (both interior and outside surroundings;
e.   Location Map; and
f.    Certification    from    DOH    as    Treatment    Hub/Satellite    Treatment Hub/Primary HIV Care Facility or a copy of the latest DOH Department Memorandum on the list of recognized facilities.

7.    For renewal of accreditation, it shall submit the following requirements to the nearest PhilHealth Office (within January 1 to 31 of the succeeding year):

a.   Performance Commitment - signed and properly accomplished;
b.   Provider Data Record (PDR) - properly accomplished;
c.   Participation fee (Php1,000.00);
d. Certification  from  DOH  as  Treatment  Hub/Satellite  Treatment Hub/Primary HIV Care Facility or a copy of the latest DOH Department Memorandum on the list of recognized facilities;
e.   Latest audited financial statement (submit on or before June 30 of the succeeding accreditation cycle).

8.    The health care facility shall be exempted from the three (3) year operation requirement for accreditation.

9.   The physicians providing the health services shall be PhilHealth-accredited.

10. PhilHealth-accredited health care institutions which are also designated as HIV treatment hub and/or satellite treatment hub shall no longer apply for separate accreditation. They shall only submit an updated and signed Performance Commitment indicating OHAT as one of their services and a copy of Certification from DOH as treatment hub or the latest DOH Department Memorandum listing the treatment hubs and satellite treatment hubs.

11. The health care institutions shall use their reimbursement from OHAT Package only for providing health services to their PLHIV clients.

12. The Health Care Institution shall have a DOH-certified Electronic Medical Record or Hospital Information System.

IV.  MONITORING AND EVALUATION

Monitoring  and  evaluation  shall  be  based  on  the  Health  Care  Provider Performance Assessment System (PhilHealth Circular 2016-0026).

The facility shall maintain a minimum set of information (electronic or paper based) for each patient including medical records, copies of HIV test results, summary of laboratory results particularly CD4 count, viral load and specific labs for  monitoring  of  ART  toxicity;  schedule  of  refills  (with  pill  count/treatment regimen booklet); and referral slips (if applicable) and filled-up client satisfaction forms. They shall be readily available to PhilHealth for monitoring and evaluation.

V.   REPEALING CLAUSE

All other existing issuances and provisions of previous 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 fifteen (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.