Issuances of the Department of Labor and Employment and its Attached Agencies

Section 1

For purposes of processing of payment for medical services provided to ODWs, the following hospitals and physicians are automatically deemed accredited by the Commission: a. Government and Private hospitals duly licensed by the Department of Health (DOH) and accredited by the Philippine Health Insurance Corporation (PhilHealth); and b. Physicians duly licensed by the Professional Regulation Commission (PRC). (as amended by Board Resolution No. 13-08-25, dated Aug. 7, 2013)

Section 2

Conditions on accredited hospitals or rehabilitation facilities and physicians or rehabilitation specialists. — (a) An accredited hospital or rehabilitation facility binds itself: (1) not to collect from the patient any amount for ward services; (2) to provide adequate services on a non-discriminating basis; (3) to limit charges for ward rates approved by the Commission, including, but not limited to, laboratory ward rates, laboratory facilities, x-rays, stools, drugs, medical attendance and the Relative Value Scale (RVS) for surgical procedures, etc.; (4) to abide by these rules on accreditation; (5) to have its house rules conform to the requirements of the Commission; (6) to subject its facilities to inspection at any time by duly authorized representatives of the Commission or the System. (b) An accredited physician binds himself: (1) not to collect from the patient any amount for ward services, (2) to provide adequate services on a non-discriminating basis; and (3) to abide by these rules on accreditation.

Section 3

(a) Every hospital or rehabilitation facility shall have a Utilization Review Committee, composed of at least two physicians or rehabilitation specialists, to help assure the most effective use of rehabilitation facilities, hospitals and services by reviewing admissions each day on a sample basis and all long stay cases. (b) The Committee shall decide in every specific case being reviewed, whether or not care in a hospital is medically necessary. In every case, the Committee shall discuss its findings with the patient's doctor before making a decision. (c) The Committee shall advise in writing the patient, his doctor and the hospital of its decision only if it has been decided that care in a hospital is not medically necessary, in which case no payment for room and board shall be made by the System.

Section 4

Payment for medical services provided to ODWs shall be granted to hospitals and physicians enumerated under Section 1 of this Rule. (as amended by Board Resolution No. 13-08-25, dated Aug. 7, 2013)

Section 5

(a) Those services which are necessary to prevent the death or serious impairment of the health of the individual, and which necessitate the use of the most accessible hospital available and equipped to furnish such services. (b) An emergency no longer exists when it becomes safe from a medical standpoint to move the patient to an accredited hospital, or to discharge him whichever occurs first. (c) The determination that the patient's condition requires emergency services or that an emergency has ended shall be based on the physician's evaluation and, when appropriate, on the patient's medical record and other additional data furnished by the hospital. (d) Claims filed by non-accredited hospital and non-accredited physicians for payment of emergency services shall be accompanied by a physician's statement. (deemed repealed by Sec. 4 of B.R. No. 13-08-25) (e) The physician's statement shall describe the nature of the emergency, furnish relevant clinical information about the condition of the patient, and state that the services rendered were necessary to prevent the death of the individual or the serious impairment of the health. A bare statement that an emergency existed is not sufficient. (f) In addition, when in-patient services are involved, the statement shall include the date when, in the physician's judgment, the emergency ceased.

Section 6

Immediately upon knowledge by the employer of his employee's injury or sickness at the workplace, he shall, in addition to the medical and dental facilities which the pertinent provisions of the Code and these Rules on Accreditation may require him to furnish, cause the employee to be brought by the fastest available means of transportation to the duly accredited physician or hospital nearest or most accessible to the employee's place of work.

Section 7

(a) An accredited hospital or physician shall be disaccredited for violation of any of the conditions and requirements under Section 1 and 2 hereof without prejudice to the imposition of penalties under Rule XIX if applicable or to any other penalty which the Commission may impose. (b) The cancellation or invalidation of accreditation of a physician or hospital shall be effective on the date of notice of the Disaccreditation. (c) In case of Disaccreditation, the physician or the hospital shall carry the disqualification wherever its physical identity is found. Mere change of legal personality shall not defeat the disqualification imposed. (d) Disaccreditation shall be lifted only on application and upon showing of good cause and effective upon approval by the Commission. As soon as accreditation is duly restored, the hospital or physician concerned shall be allowed to participate in the Employees' Compensation Program. (deemed repealed by Sec. 4 of B.R. No. 13-08-25; DOH and/or PhilHealth undertakes the licensing and regulations of physicians, clinics and hospitals)