Ao2023 0016
Ao2023 0016
Department of Health
OFFICE OF THE SECRETARY
AUG 11 2023
ADMINISTRATIVE ORDER
No. 2023 - OQ
SUBJECT: New Guidelines for the Implementation of the Medical Assistance to
Indigent and Financially Incapacitated Patients (MAIFIP) Program
I. RATIONALE
As the Philippines moves towards achieving Universal Health Care (UHC), the
Medical Assistance to Indigent Patients (MAIP) Program, now the “Medical Assistance to
Indigent and Financially Incapacitated Patients (MAIFIP) Program”, was developed in
2014 to lessen the burden of out-of-pocket expenses of indigent and financially
incapacitated patients. The Department of Health (DOH), through the Malasakit Program
Office (MPO), with the aim of providing continuous access to medical assistance, intends
to expand the coverage of its beneficiaries by reaching out more to
indigent and financially
incapacitated patients in order to achieve UHC through complementing the National Health
Insurance Program (NHIP).
Special provision no. 7 of Republic Act No. 11936 or the General Appropriations
Act (GAA) of 2023 was provided for the implementation of the MAIFIP Program.
Accordingly, reforms on
the policy, its systems, and operational guidelines are issued to
strengthen and provide an effective and sound program implementation.
The sees
DOH
the
necessity to update the Administrative Order (AO) No. 2020-
0060, entitled “Revised Guidelines on the Implementation
of
the Medical Assistance to
Indigent Patients (MAIP) Program”, and its amendments, to improve utilization rate
and provide measures to ensure responsiveness, transparency, and efficiency in the
the
administration of the MAIFIP Program, consistent with the objective of RA No. 11463 or
the Malasakit Centers Act, to improve the delivery of services to the people and ensure
access and efficiency in the availment of medical and financial assistance to fund health
services.
II. OBJECTIVES
This Order aims to streamline the process of availing the benefits of the MAIFIP
Program and provide guidelines for ensuring efficiency and transparency in the
administration and
succeeding revisions.
ae of the MAIFIP Program funds within the year, up until the
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Direct Line: 711-9502 to 03 Fax: 743-1829 @ URL: htip:y/\www.doh.gov.ph; e-mail: [email protected] ph
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ae
I11.SCOPE OF APPLICATION
This Order shall apply to the following health facilities and offices: DOH Central
Office; Centers for Health Development (CHDs); Ministry of Health-Bangsamoro
Autonomous Region in Muslim Mindanao (MOH-BARMM), DOH Hospitals, including
Special and Specialty Hospitals; DOH Drug Abuse and Treatment Rehabilitation Centers
(DOH-DATRCs); Department of National Defense (DND) Hospitals; Department of the
Interior and Local Government (DILG) Hospitals; Philippine National Police (PNP)
Hospitals; Local Government Unit (LGU) Hospitals; Department of Justice (DOJ)
Infirmaries; State Universities and Colleges (SUCs) Hospitals; and other partner
government and privately operated hospitals and health facilities.
B. Case Rate — refers to the fixed rate or amount that PhilHealth will reimburse for a
specific illness/case as defined by PhilHealth Circular No. 0035 s. 2013 and other
related PhilHealth Circulars.
Compassionate Drug Use — refers to the use of drugs or medicines not included in
the Philippine National Formulary by patients with serious or life-threatening
conditions when no other treatments are available.
I. Health Facility — refers to government and partner private hospitals licensed by the
DOH and/or accredited by PhilHealth, which have the capacity to subsidize medical
assistance expenses and which have the ability to comply with the MAIFIP Program
documentary/reportorial requirements necessary for the implementation of the MAIFIP
Program as specified in Section VI of this order.
J. Indigent — refers to a patient who has no visible means of income or whose income
is insufficient for the subsistence of his/her family, as assessed by the MSW of the
health facility.
N. Total Charge — refers to the hospital bill and cost of services including, but not
limited to, medical, surgical, and professional fees incurred by a patient seeking care
in a health facility.
. GENERAL GUIDELINES
A. The Malasakit Program Office (MPO), shall be responsible for the overall management
and administration of the MAIFIP Program.
B. The medical assistance under the MAIFIP Program shall cover the costs of clinically
indicated needs as prescribed by the
physician or health professional of
a health facility
for in-patients and out-patients as stipulated in section VI.C of this Order, in excess
of the packages/rates covered by PhilHealth or other financing sources implemented in
accordance with the Order of Charging stipulated in the Joint Administrative Order No.
wae
2020-0001 or the “Operational Guidelines for the Implementation of the
4)
Financial Assistance to Indigent and Financially-Incapacitated Patients pursuant to RA
No. 11463 also known
to availability of
as
funds.
“Malasakit Centers Act of 2019” and its amendments, subject
Likewise, all participating hospitals/institutions/offices shall
strictly observe the implementation process as established by the Malasakit Program.
. The DOH, through the MPO and in coordination with the Field Implementation and
Coordination Team (FICT), CHDs, and MOH-BARM\M, shall establish linkages and
networks with other health facilities for efficient coordination. For the CHDs and
MOH-BARMM,
a Regional MAIFIP Program Coordinator and MAIFIP Program
Coordinator, respectively, shall be designated. For hospitals, the Medical Center Chief
(MCC) Chief of Hospital (COH)/head of the institution shall assign the Head of the
Medical Social Service, or its equivalent, as the Hospital MAIFIP Program
Coordinator. .
. The MPO, through the FMS and Management Service Team (MST), shall facilitate the
efficient sub-allotment and transfer of MAIFIP Program funds to the CHDs and health
facilities.
. The name of recipient hospitals and the age, gender, city/municipality, and disease of
recipient indigent and financially incapacitated patients shall be posted in the DOH
designated information system for purposes of accountability and research, in
compliance with the provisions of RA 10173 or the “Data Privacy Act of 2012.”
. The hospitals and other partner health facilities shall ensure that there is no double
charging of funds for medical assistance, and shall strictly abide by the order of
charging rules mentioned in Section VI.D of this Order to facilitate rational use of the
MAIFIP Program funds.
Not more than two percent (2%) of the total MAIFIP Program funds shall be used for
administrative expenses such as, but not limited to, salaries ofjob order personnel, lease
of office space and other services, purchase of office and information technology
equipment, and such other administrative expenses that are necessary, incidental, and
desirable for the implementation of this program, subject to the guidelines issued by
the MPO.
/°
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VI. SPECIFIC GUIDELINES
B. Availment Procedures
1, Eligibility Assessment — The registered MSW of the health facility shall assess the
eligibility of patients applying for medical assistance using the standard assessment
tool in Annex B of AO No. 2021-0044 or its latest amendments. Proof of eligibility
as stated in Section VI.A.3 shall be presented for evaluation.
Processing of Medical Assistance — The MSW shall process the needed medical
assistance based on his or her assessment and recommendation.
C. Service Coverage
The MAIFIP Program funds shall cover medicines, services, and other medical
products as prescribed by a licensed physician or health professional such as, but not
limited to the following:
st
a. Drugs and medicines;
b. Laboratory, imaging, radiological, and other diagnostic procedures including
assessment/readers fees;
c. Blood and other related blood screening/products;
d. Clinically indicated medical-surgical cases, obstetrics-gynecological cases
considered as high-risk, dental cases requiring implants, medical devices and
supplies, and other relevant procedures;
e. Prescribed post-hospitalization, rehabilitation services, aftercare program, and
appropriate mental and psychosocial support;
f. All hospital bills/charges; and
g. Professional fees, provided that the expenses for the professional fees shall not
exceed 50% of the approved amount of medical assistance.
In case the health facility has no available drugs and medicines in their
Pharmacy, the Pharmacist or Special Disbursement Officer in charge, upon the
approval of the Chief of Hospital, may avail the services outside the facility to
provide the services to the patient, subject to the strict observance of the provisions
of Republic Act No. 9184, otherwise known as the Government Procurement Reform
Act, its Implementing Rules and Regulations, and other pertinent laws and issuances.
. Order of Charging
g hy
and Financially-Incapacitated Patients pursuant to RA No. 11463 also known as the
“Malasakit Centers Act of 2019,” and its amendments or latest issuance/s.
to
Access utilization of the MAIFIP Program funds shall be subject to the
and
2. MAIFIP Program funds shall be valid from the date of issuance until December 31
of the same year of issuance, subject to the provisions of the GAA of the current
year; and
F. Fund Authorization
The following are the officials authorized to approve the corresponding allowable
amount:
Health Facilities
Chief of Hospital of LGU hospitals or Medical Maximum of Php 250,000.00 per approval/transaction
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Director of selected private health facilities,
DOH-DATRC, or his/her duly authorized Maximum of Php 500,000.00 per approval/ transaction
representative (Health Facilities under the MM-CHD)
Chief of Hospital / Medical Center Chief / Maximum of Php 1,000,000.00 per approval/transaction
Medical Director of DOH Hospital, Specialty
Hospital, DND Hospital, and PNP Hospital or
his/her duly authorized representative
DOH
CHD Director and/or duly authorized Maximum of Php 1,500,000.00 per approval/transaction
representative
G. Transfer/Release of Funds
1. Funds shall be transferred by the FMS through Sub-Allotment Advice to the CHDs
and DOH Hospitals. In case the sub-allotted fund is in the regional office and not
yet obligated or transferred to the parmered health facility, the said funds shall be
reverted back to Central Office upon the submission of justification and a request
to the MPO.
However, when funds are already obligated or transferred to health facilities, they
cannot be reverted back to the Central Office/CHD, and the health facility shall
utilize the transferred amount through MAIFIP Program, unless the reversion of
funds is otherwise initiated by proper authorities such as the MPO, Financial
Management Service or the Commission on Audit subject to usual process and
procedure.
2. Subject to accounting and auditing rules and regulations, the CHDs shall:
a. Transfer funds to Specialty and SUC Hospitals through a MOA between the
and/or CHD Director and Medical Director of the health facility;
DOH
(1
3. The request for replenishment of funds shall be made after the facility has complied
with the requirements specified in Section V.E of this Order. A heaith facility
requesting for replenishment of funds shall submit a letter of request to the MPO
and CHD concerned containing the following:
Rationale;
Number of patients that the hospital can cater;
gpaggss
Number of assisted patients per year through the MAIFIP Program;
Classification of the hospital (Level 1, 2, 3, etc.); and
Requested amount.
4. The number of
funds to be transferred shall depend on the absorptive capacity of
the hospital/facilities, subject to the recommendation and approval of the FICT
cluster head, MPO/FMS, or
CHD. :
5. The release of subsequent funds by the DOH for the medical assistance to the
facilities shall be made only when at least fifty percent (50%) of the amount
previously sub-allotted/transferred has been liquidated and submitted, certified
correct by the Accountant, approved by the Head of the office, and stamped
received by the Commission on Audit. It shall adhere to the terms of the agreement
and guidelines set by the DOH Central Office and the CHD to ensure smooth and
orderly implementation of the program.
1. In accordance with the special provision of the GAA, the DOH and/or its CHDs
through their respective CHD Directors, may enter into a MOA with Specialty
Hospitals, State Universities and Colleges (SUC) Hospitals, and Local Government
Unit (LGU) Hospitals for health and medical services intended for the indigent and
financially-incapacitated patients.
2. Likewise, the DOH and/or CHDs may also enter into a MOA with private hospitals
for health and medical services intended for the indigent and financially-
incapacitated patients, which the government hospitals are unable to provide
accommodation due to the voluminous number of patients in their facilities:
Provided, that the Chief of Hospital or his authorized representative shall certify
the same and provide justification. The medical assistance to the indigent and
financially incapacitated patients shall also apply to emergency cases handl¢d by
/™
4)
private health facilities: Provided, that the private health facility where the patient
is brought to is the closest in distance from the patient needing medical treatment
at the time of the emergency; Provided further, that the accepting health facility
shall certify that it is the closest health facility to the location of the patient during
the time of emergency.
In case the private hospital closest in distance refuses to enter into a MOA, the CHD
concerned shall find another available private hospital to provide assistance to the
emergency patient.
3 fp Only DOH-licensed health facilities shall be qualified to enter into a MOA with the
DOH
in
and/or CHDs the implementation of this Order.
4]. All MOA entered into by the DOH and/or CHD under this Order for the purpose of
access to utilization of
or MAIFIP Program funds shall be valid and effective upon
execution thereof and shall remain in force and in effect depending on the
effectivity of General Appropriations Act (GAA).
58. For this purpose, the MOA shall be cleared by the DOH Legal Service or the Legal
ft Section/Unit of the CHD and/or DOH Hospitals, as the case may be. \
rb §. Entering into a MOA with a partner health facility shall be subject to the usual
accounting, auditing rules and regulations, and submission of the monthly FUR.
2. CHDs shall submit to the MPO a Monthly Summary Report on the status of the
implementation of the MAIFIP Program. The Monthly Report shall contain
information on the number of patients served, name of recipient hospitals and the
age, gender, city/municipality and disease/diagnosis, breakdown of medical
expenses allocated per patient, and the actual amount utilized. The submission of
the Monthly Summary Report shall be every 15th day of the following month. df
4%
3. The MPO shall consolidate and validate the reports submitted by the CHDs and
concerned hospitals.
4. The MPO, through its Cluster Head, shall provide the Secretary of Health an
Annual Report of the number of
indigents and financially incapacitated patients
assisted under the MAIFIP Program and the status of its implementation.
1. A composite team from the DOH Central Office/CHDs shall conduct monitoring
of partner hospitals/health facilities every year using the MAIFIP Program
monitoring tool to ensure smooth and proper implementation of the Program.
3. The Internal Audit Service (IAS) of the DOH may conduct a random audit in the
CHDs and partner health facilities to ensure the judicious use of funds and the
effective implementation of the MAIFIP Program in accordance with existing
guidelines.
li
a)
2. Provide technical assistance and financial guidance to the MPO regarding the
implementation of the MAIFIP program.
3. Monitor the fund utilization reports of the CHDs and other health facilities.
. Review requests and authorize the release of funds as specified in Section VII
this Order;
of
. Submit required summary reports on the status of the MAIFIP Program and
reports mentioned in Section VL9. b of this Order;
other related
into a MOA enforce this Order for the effectiveness of the MAIFIP Program
implementation;
=
. Coordinate with the LGUs under their jurisdiction to cascade information or
campaigns to enhance people’s awareness regarding the MAIFIP
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9. Report any suspected abuse or mishandling of funds to the MPO and
recommend the next course of action, depending on the surrounding
circumstances, as the case may be; and
Submit the list of government and private partner hospitals with MOAs to
the
MPO
act.
for monitoring and also in accordance with the government transparency
3. Designate staff who shall provide technical assistance for the Information
System and other systems to be developed;
4, Repair and maintenance of the MAIFIP Program Information System; and
5. Ensure compliance with the Data Privacy Act of 2012 at all times.
G. Government and Private Health Facilities shall:
1. Thoroughly assess and screen the eligibility of all patients and ensure
completeness and authenticity of documents prior to MAIFIP Program
availment, as specified in Section VI. 1 of this Order;
2. Facilitate the provision of quality medical assistance requests and ensure the
compassionate delivery of necessary services to the MAIFIP Program
beneficiary;
4. Ensure administrative support such as, but not limited to, the designation/hiring
of a MAIFIP Program point person/coordinator, and provision of internet
connectivity;
6. Facilitate the creation of internal policies that will support the implementation
of this Order such as but not limited to:
jm
4 4
a. Ensure the release of medicines and nutritional products only on the
prescribed number orquantity of the physician;
b. Advisory of any announcement related to the MAIFIP Program;
c. Policy on providing justification for patients to be referred to other health
facilities to provide health services to patients;
d. Policy on accepting referred/walk-in patients to get medicines/services that
e.
the referring hospital cannot provide
Policy on regulating the charging
to
of
the patients; and
Professional fees to MAIFIP (eq.
Uniform/standard amount of PF per service/operation per patient, etc.).
7. Raise issues and concerns concerning the program to the Central Office and
CHD.
Any person who commits fraud, misrepresentation, and/or any illegal transaction
as mentioned under Section 11 of the RA 11463 shall, after due notice and hearing, be held
liable and shall suffer the same penalties provided in the said Act, and shall be held civilly,
criminally, and/or administratively liable in accordance with the applicable laws, rules, and
issuances.
Administrative Order No. 2020-0060 and its amendment are hereby repealed. All
Orders, issuances, rules, and regulations inconsistent with the provisions of this Order are
hereby repealed accordingly.
. SEPARABILITY CLAUSE
Should any provision of this Order be declared unconstitutional by any court of law
or competent jurisdiction, all other provisions not affected by the declaration shall remain
in full force and effect.
This Order shall take effect fifteen (15) days from its publication in a newspaper of
general circulation and upon the filing of three (3) certified copies of this Order with the
University of the Philippines Law Center.
TEGBORO J/HERBOSA, MD
of Health
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