TB Package Certification Course

PhilHealth
TB DOTS Out-patient
Package
TB DOTS Certification Training
April 16, 2013
Benefits under the MDG Team

Current
Benefits
Payment
Mechanism
Engaged
Provider/s
Maternity
Care
MCP
Case rate
Hospitals
6.5K hospitals L2 to Lying in clinics
L4
8 K lying-ins and L1
Newborn
Care
NCP
Case rate
1750
Hospitals
Lying in clinics
Tubercul
osis
TB
DOTS
Packag
e
Case rate
4K
TB DOTS
facilities
HIV/AIDS
OHAT
Case rate
30 K
DOH recognized
treatment hub
Malaria
Malaria
Package
Case rate
500
RHUS with training
Rabies
ABT
Case rate
3k
DOH recognized
ABC/ABTC
PhilHealth
The National Health Insurance Act of
1995 (RA 7875) As Amended by RA 9241
National Health Insurance Program
Objective:
Provide all Filipinos with mechanism to gain
financial access to quality health care

services within the first 15 years of its
implementation
Our Members
Employees (govt and private)
monthly payment (3% salary)
Individually Paying Program (voluntary)
- quarterly payment (1,800/year)

Non-paying (pensioner)
- no payment for life
Sponsored (thru National Government and

LGU)
- annual payment, eligibility for 1 year
Overseas Workers Program

- Annual payment (1,200/year)
Qualified Dependents
Legitimate spouse
Children
below 21, unmarried & unemployed (legitimate,
illegitimate, legitimated or adopted)
Parents
> 60 years and wholly dependent on the member
for support
Step-parents/Adoptive parents
1998
TB DOTS Package
HISTORY
DOTS was adopted nationwide

PhilHealth develops policies supporting the NTP
and involves the Private Sector in PPMD
Consultative meetings began
1999
- Health Sector Reform Agenda supports
expansion of coverage of National Health
Insurance Program & prioritized the NTP
Announcement that the TB Outpatient Benefit
Package as a Labor Day gift to the Filipinos
TB DOTS Package
HISTORY
2001
Recognized that development of TB
benefit package called for
comprehensive policy making
Series of consultations, intensified efforts
towards finalization of TB Package
2002
Finalization of CUP > TB Package as an
important component
TB-DOTS Package
HISTORY
Board Resolution Nos. 485 & 490 series
of 2002
Approval of the implementation of DOTS benefit
package into a fixed payment rate of P4,000
2003
PhilHealth Circular Nos. 17 & 19 series of
2003
Accreditation and eligibility guidelines
Eight DOTS centers are initially accredited
TB DOTS PACKAGE
Claims Payment
Case
Case Payment
Payment
P
P 4,000.00
4,000.00
((paid
paid directly
directly to
to the
the
DOTS
DOTS center)
center)
11stst
PAYMENT
PAYMENT
P
P
2,500.00
2,500.00
after
after the
the
Intensive
Intensive
Phase
Phase
nd
22nd
PAYMENT
PAYMENT
P
P 1,500.00
1,500.00
after
after the
the
Continuatio
Continuatio
nn Phase
Phase
TB DOTS Package
PARTICIPATION of
PROVIDERS
TB DOTS PACKAGE
DOTS Accreditation
Providers must be accredited before
they can provide care financed by
NHIP
Third Party Accreditation (TPA) was
introduced
Only certified DOTS clinics may apply
for accreditation
Philippine Coalition Against
Tuberculosis (PhilCAT)
Infectious Disease Office of DOH
Number of PhilHealth
Engaged
TB DOTS Providers
Provider Engagement through

Accreditation and Contracting for
Health Services (PEACHeS)
PhilHealth Circular 54, s. 2012
General Guidelines
Adopts the New DOH Classification

of Hospitals and Other Facilities
Streamlines the process of
provider engagement
Automatic Accreditation
Delegation to PRO some vital steps in
accreditation process
Continuous participation
Provider Engagement through

Accreditation and Contracting for
Health Services (PEACHeS)
PhilHealth Circular 54, s. 2012
General Guidelines
Establishes that the Performance Commitment

is a contractual arrangement between
PhilHealth and Institutional Health Care
Provider (IHCP)
Engagement may extend to a group of IHCPs
under one management (Health System
Providers
Uniform period of validity for all IHCPs starting
2013 (January to December)
Engagement involves accreditation and
participation
Automatic vs Non-Automatic
Accreditation
Automatic
Licensed or certified by
DOH/CHD
Non-automatic
Uncertified by CHD
Government/private facilities MCP not BEmONC certified

PCB
TB DOTS provider not
BEmONC certified MCP
PhilCAT certified
Certified NSF
Hospitals
DOH certified TB DOTS

ASC & FDC
ABTC/ABC
IHCP accredited by a 3rd party
accreditor recognized by PHIC
Automatic vs Non-Automatic
Accreditation
Automatic
Non-automatic
No survey
Survey (PAS)
No deliberation
Deliberated by
Accreditation
Subcommittee
No survey
Survey
Specific requirements
INSTITUTIONS
DOCUMENTS
Hospitals
ASC
DOH license
FDC
PCB
a. MOA with referral

facilities (if
applicable)
b. Location map
TB DOTS
a. DOH
certification
b. Location map
Continuous Participation
Uninterrupted
engagement
of
IHCPs with PhilHealth until such
engagement is withdrawn or
terminated based on the rules set
by PHIC
Submit before January 31 every year
Updated DOH license
Performance commitment
Updated certificates issued by DOH/CHD (TB
DOTS Certificate)
Latest audited FS
Participation fee
Should be submitted by end of February

Failure to submit denied claims starting
March
If certificate expires within the
year
60 days within which to submit the
updated license or certificate
If not: claims beginning on 61st day
shall be denied until IHCP submit
the requirements
Claims Payment
TB DOTS PACKAGE
DOTS PACKAGE
REQUIREMENTS FOR FILING
PhilHealth Form 1
PhilHealth Form 2
NTP Treatment Card
Supporting documents
Proof of contribution for self-employed
Proof of dependency
E.g.
Marriage certificate for spouse
Birth certificate for children
First Submission:
Registration
TB-Clinical
Information
System
w/in
NTP
60
TREATMENT days
CARD
(photocopy)
Upon
enrollment
QARPDG
PhilHealth
Room 1204
Second Submission: 1st

Payment
PhilHealth
Claim Form 1
NTP
Treatment
Card
(photocopy)
After Intensive
Phase
TB-DOTS
Package
Claim Form 5
w/in
60
days
Claims
Department
PhilHealth
Third Submission: 2nd Payment

PhilHealth
Claim Form 1
NTP
Treatment
Card
(photocopy)
After
Continuation
Phase
TB-DOTS
Package
Claim Form 5
w/in
60
days
Claims
Department
PhilHealth
TB DOTS CLAIMS PAYMENT

29,390,000.0
28,394,000.0 0
0
25,536,000.0
0
20,203,000.0
0
12,159,500.0
0
7,017,000.00
Source: TFI, as of Oct 2012, based from date of admission
Future Directions
Expand to cover category II
Payment at the end of
treatment (completion)
Require trust fund for TB
DOTS payment

TB Package Certification Course

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PhilHealth

Benefits under the MDG Team

RHUS with training

financial access to quality health care

Individually Paying Program (voluntary)

- quarterly payment (1,800/year)

Sponsored (thru National Government and

Overseas Workers Program

DOTS was adopted nationwide

Eight DOTS centers are initially accredited

Provider Engagement through

Adopts the New DOH Classification

Provider Engagement through

Establishes that the Performance Commitment

Government/private facilities MCP not BEmONC certified

DOH certified TB DOTS

a. MOA with referral

Should be submitted by end of February

Second Submission: 1st

Third Submission: 2nd Payment

TB DOTS CLAIMS PAYMENT

Source: TFI, as of Oct 2012, based from date of admission

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