Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY
DEC 23 2020

ADMINISTRATIVE ORDE
No. 2020- 0040

SUBJECT: Revised Guidelines on the Implementation of the Medical

Assistance to Indigent Patients (MAIP) Program

I. RATIONALE

The Department of Health (DOH) aims to ensure Universal Health Care

(UHC) coverage and financial protection for all Filipinos. Today, while there are
increasing PhilHealth expenditures and other sources of health financing, a
significant proportion of Filipinos continue to have difficulty in accessing health
‘services due to financial constraints. Out-of-pocket expenditures continue to be high
at 53.9% (PSA, 2019) exposing patients to financial risks, catastrophic health
expenditures and impoverishment.

In the past years, the General Appropriations Act (GAA) increased the funds
available under the assistance to indigent patient's line item. Several conditions for
its implementation were set to improve the reach and coverage of the program.
Henceforth, the furtherance of extending our helping hands to indigent and
financially incapacitated patients in terms of rendering medical assistance continues
while maintaining the safeguards for its
effective, efficient, judicious and transparent
use in various healthcare facilities.

Over the years, the Philippine health care system continues to undergo
sporadic changes due to recent developments in the making of health care policies
from evidence-based researches. To be able to adapt to these deviations, the existing
operational guidelines of the program must be improved and the challenges
encountered on its implementation must be properly addressed. Consequently, there
is a need for a more strategic design and mechanism to ensure quality and adequate
delivery of health services to all indigent and financially incapacitated patients
particularly in terms of medical assistance.

To further reinforce the implementation of the Medical Assistance for

Indigent Patients (MAIP) Program, the Administrative Order No. 2017-0003 and its
corresponding amendments (A and B) must be revised and aligned with the recently
enacted Republic Act No. 11463, otherwise known as “Malasakit Act of 2019.” The
revised guidelines must be harmonized with the rules and regulations set forth by the
law such as the GAA without prejudice to other funding sources used for the
provision of medical assistance to all eligible beneficiaries. Likewise, it shall be
“ensured that processing of sensitive and personal information is in accordance with

pe a
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Republic Act No. 10173 otherwise known as “Data Privacy Act of 2012” and all |

B other rGlated issuances of National Privacy Commission.

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 IL. OBJECTIVES

This Administrative Order aims to improve the implementing guidelines and

establish new mechanisms in terms of rendering medical assistance. Specifically, it
targets to achieve the following objectives and to effect the changes or amendments
as indicated:

1. Define and ascertain the eligible beneficiaries’ access to MAIP Program and
the essential health goods and services prescribed by the physician;
2. Strengthen the existing mechanism in the provision of medical and surgical
services to eligible MAIP Program beneficiaries;
3. Realign the terms of engagement of Center for Health Development (CHD),
between/among various stakeholders as indicated herein; and
4. Harmonize all other funding sources for medical assistance with the funds of
the MAIP Program.

III. SCOPE AND COVERAGE

This Order shall apply to the following health facilities and offices: DOH
Central Office, CHDs and the Ministry of Health-Bangsamoro Autonomous Region
in Muslim Mindanao (MOH-BARMM), DOH Hospitals including Specialty and
Special, DOH-Drug Abuse Treatment and Rehabilitation Centers (DOH-DATRC),
Department of National Defense (DND) Hospitals, Department of the Interior and
Local Government (DILG) including Local Government Units (LGUs) and
Philippine National Police (PNP) Hospitals, Department of Justice (DOJ)
Infirmaries, State Universities and Colleges (SUCs) Hospitals, and other Partner
Private Hospitals/Health Facilities.

IV. DEFINITION OF TERMS

1. Basic or ward accommodation — refers to the provision of regular meal, bed in

shared room, fan ventilation, and shared toilet and bath.

7 Case Rate — refers to 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.

3. Catastrophic Disease — refers to a severe illness requiring prolonged

hospitalization or recovery. These include, but not limited to, cancer, psychiatric
conditions, heart attack or stroke. These illnesses usually involve high costs of
bills and medical expenses causing financial hardship which may incapacitate the
person from being productive.

4. Catastrophic Health Expenditure — refers to out-of-pocket spending for health

household's income consequently
care that exceeds a certain allotted portion of a of addressing other domestic and
"rendering the household financially incapable
} related expenses.

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 5. 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.

6. Health Facility — refers to government and partner private hospitals licensed by

the DOH and/or accredited by the PhilHealth, with the capacity to subsidize
medical assistance expenses and which can comply with the MAIP Program
documentary/reportorial requirements necessary for the implementation of the
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MAIP Program as specified in Section 3;

7. MAIP Program Beneficiary — refers to an indigent and financially incapacitated

patient who demonstrates clear inability to pay or spend for necessary
expenditures for one’s medical treatment, such as patients with catastrophic
illness or any illness, which is life or limb-threatening and requires prolonged
hospitalization, extremely expensive therapies or other special but essential care
that would deplete one’s financial resources, as assessed and certified by the
Medical Social Worker (MSW).

8. MAIP Program Fund - refers to the fund intended for the medical assistance to
indigent and financially incapacitated patients.

0. Non-basic ward accommodation — refers to accommodation in the health

facility, which is not in the category of basic ward accommodation.

10. Total Charges — refer 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.

V. GENERAL GUIDELINES

1. The Malasakit Program Office (MPO), formerly known as the Public

Assistance Unit (PAU) of the Central Office, shall be responsible for the
overall management and administration of the MAIP Program.

2. The MAIP Program shall provide support for drugs, medicines,

medical/orthopedic devices, dental services (except those that are for aesthetic
purposes and not medically indicated) or other medically related needs
prescribed by the physician of a health facility for in-patients and out-patients,
in excess of the packages/case rates covered by PhilHealth or other financing
sources subject to the availability of funds. Likewise, all participating
hospitals/institutions/offices shall strictly observe the implementation process
as established by the MAIP Program.

7
3. All DOH Hospitals (including Specialty and Special Hospitals) and UP-PGH
shall use the Enhanced Web-Based Public Assistance Information System
(EWEBPAIS).

4. The DOH, through the MPO, and the CHDs in coordination with the Field
~~ -_ Implementation and Coordination Team (FICT), shall
establish linkages with
“Aother health facilities to provide efficient coordination. For the CHDs, a
-Revional MAIP Program Coordinator shall be designated to ensure that
CERTIFIED TRUE COs guidelines are strictly observed. For hospitals, the Director/Chief of the
age 3 ot 10 J
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 health facility shall assign the Head of the Medical Social Service as Hospital
‘MAIP Program Coordinator. The Coordinator shall be responsible for the
overall management, coordination, registry of patients, program monitoring
and the submission of all reportorial requirements including monthly financial
report to the CHDs, Financial Management Services (FMS), and the MPO.

The Administrative and Financial Management Team (AFMT) through the

FMS and the MPO, shall facilitate the efficient sub-allotment and transfer of
MAIP Program funds to the CHDs and Health Facilities. Release of subsequent
medical assistance by the DOH to health facilities shall be made only when at
least fifty percent (50%) of the amount previously sub-allotted/transferred has
been liquidated and submitted to the CHD concerned, certified correct by the
Accountant, approved by the Head of the office, and stamped received by the
Commission on Audit (COA). It shall also adhere to the terms of agreement set
by the DOH Central Office and CHD to ensure the smooth and orderly
implementation of the Program.

Health Facilities shall judiciously enforce a thorough screening of beneficiaries

to ensure efficient and rational use of funds and diligent documentation and
encoding of data through the system prescribed by DOH Central Office.

No medical assistance provided under the MAIP Program shall be converted

into cash.

The DOH shall post on its website the name of recipient government hospitals,
number of patients served and total amount of medical assistance provided.
The MPO and the Knowledge Management and Information Technology
Service (KMITS), as the DOH’s web administrator, or its equivalent shall be
responsible for ensuring that the said information are posted on the DOH
website.

V1. SPECIFIC GUIDELINES

1. Eligibility and Documentary Requirements

a. All MAIP Program beneficiaries defined in Section IV.7 of this Order shall
be eligible for medical assistance under the Program subject to the terms and
conditions specified in this Order.

b. All patients availing of medical assistance under the MAIP Program shall go
to the Medical Social Service or the Designated Officer of the health facility
for presentation of documents, proper assessment and evaluation. In
addition, a referral may be issued to the patient by the Central Office and
CHD.

C. The following documentary requirements shall be submitted as applicable:

c.1. In-patient — Total charges and assessment of the MSW of the
Hospital or Municipal/City Social Welfare Officer for those in LGU
Hospitals.
~~ Pe

2. Out-patient — Physician's prescription/request and assessment of the

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 c.3. Referred Patient — Inter-agency referral form with attached
physician’s prescription or request or protocol, and either Medical
Certificate or Clinical Abstract. Patients who are requesting drugs
and medicines shall be examined by the physician of the recipient
hospital. For non-ambulatory patients, a physician’s certificate
attesting to the veracity of the physical condition of the patient is
required.

2. Availment Procedures

a. Eligibility Assessment — The Medical Social Worker (MSW) of the health

facility shall assess patients applying for medical assistance under the
Program using the standard psychosocial assessment form. Proof of
eligibility as stated in Section V1.1.c shall be presented for evaluation.

Processing of Medical Assistance — The MSW shall then process the

needed medical assistance based on their assessment and recommendation.

Provision of Service —Health facilities shall provide the necessary

health/medical services based on patient needs and document provision of
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the same.

3. Service Coverage

The MAIP Program fund shall cover essential and life-saving medicines,
services and other medical products as prescribed by a licensed physician or
health professional such as but not limited to the following:

a. Drugs and medicines included in the Philippine National Formulary and

those which qualify for compassionate drug use in compliance with the
criteria or requirements set by the Food and Drug Administration;

Laboratory, imaging, radiological and other diagnostic procedures;

Blood and other related blood screening/products;

All clinically indicated medical, surgical, high risk cases of obstetrics -

gynecological, ophthalmological, dental, implants, medical devices and
supplies, and other relevant procedures;

In case of non-availability of clinically indicated drugs and medicines,

services and procedures, and lack of available beds in the government
health facility as certified by the Chief of Hospital or his/her designated
official, the concerned health facility may enter into a Memorandum of
Agreement with DOH licensed and Philhealth accredited
government/private health facility to provide the needs of the patient
charged to MAIP Program funds, subject to the guidelines set by the DOH
and COA’s accounting rules and regulations;

Prescribed post-hospitalization, rehabilitation services, aftercare program,

appropriate mental and psychosocial support; and
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 g. All hospital bills including professional fees, provided that the expenses for
the professional fees shall not exceed 50% of the approved amount of
medical assistance.

Order of Charging
The MAIP Program funds shall cover the essential and life-saving
medicines, total charges, fees, services and other medical products provided
that coverage from other funding sources for medical assistance has already
been deducted in consonance to the issued Joint Administrative Order No.
2018-0001 “Streamlining Access to Medical Assistance Funds of the
Government” and its amendments. |

Terms and Conditions

Access to and utilization of the MAIP Program funds shall be subject to

the following terms and conditions:

a. MAIP Program beneficiaries shall be admitted to basic or non-private ward

accommodation and may be admitted to the next available private
accommodation only on the following conditions:

1. Non-availability of basic or non-private ward accommodation as

certified by the hospital;
11. Emergency cases;
iii. Communicable diseases requiring isolation including Public Health
Emergencies of International Concern (PHEIC);
iv. Cases requiring intensive care; and
Vv. Chronic and catastrophic cases requiring prolonged admission

b. Patient confined in non-basic ward accommodation who is requesting

medical assistance may be covered by MAIP Program funds upon the
submission of documents as stated in Section VI.1.c. of this Order subject
to the availability of funds.

c. MAIP Program funds shall be valid from the date of issuance until
December 31 of the same year of issuance except for MAIP Program funds
transferred to LGU hospitals which have a validity period based on
National Budget Circular (NBC) No. 578 dated January 6, 2020.

d. Not more than one percent (1%) of the total MAIP Program funds shall be
used for administrative expenses which shall be controlled and monitored
by the DOH Central Office.

Fund Authorization

go /
The following are the officials authorized to approve the
‘corresponding allowable amount:

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 Approving authority Allowable amount
Health Facilities
Chief of Hospital of LGU hospitals or Maximum of Php 50, 000.00 per
selected private health facilities, DOH- approval/transaction
DATRC or his/her duly authorized |

representative Maximum of Php 100,000.00 per

approval/transaction (MM-CHD)
Chief of Hospital / Medical Center
Chief / Medical Director of DOH
Hospital, Specialty Hospital, SUC Maximum of Php 500,000.00 per
Hospital, DND Hospital and PNP approval/transaction
Hospital, or his/her duly authorized
representative
DOH
CHD Director Maximum of Php 500,000.00
per approval/transaction
Maximum of Php 1,000,000.00
| |

AFMT Undersecretary or Head

Executive Assistant per approval/transaction
Secretary of Health or designated Above Php 1,000,000.00
Chief of Staff per approval/transaction

7. Transfer/Release of Funds

a. Funds shall be transferred by the FMS through Sub-Allotment Advice to

the CHDs and DOH Hospitals.

b. Subject to the accounting and auditing rules and regulations the CHD shall:
b.1. Transfer funds to Specialty and SUC hospitals through a MOA
between the CHD Director and Medical Director of the Health
Facility.

b.2. Transfer funds to government partner health facility or LGU hospitals

through a MOA between or among the CHD Director, Local Chief
Executive, and Chief of LGU Hospital

b.3. Reimburse total charges to government/private partner health facility

through a MOA between or among the CHD Director, Chief of LGU
hospital, Medical Director, and Local Chief Executive upon
submission of documents as stated in Section VI.1.c of this Order
and other supporting documents.

Contract/Agreement with Government/Private |

Partner Health
Facility/Hospital
In accordance with the special provisions of the GAA, the CHD may
and
enter into a MOA with government/private partner health facility for health
medical services for indigent and financially incapacitated patients. For this
Service or the Legal
purpose, the MOA shall be cleared by the DOH Legal
ST

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"~ Section/Unit under the Management Support Services Division of the CHD, as
Co ~the case may be.
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 9. Recording and Reporting

a. Government/Private partner health facility, including Specialty Hospitals

and SUCs, shall submit monthly fund utilization report to the CHD
concerned. Likewise, DOH hospitals shall submit said report directly to the
MPO. They shall also report issues and concerns that hamper the effective
implementation of the Program. Submission shall be every 10" day of the
following month.

b. CHD shall submit to the MPO a Monthly Summary Report on the status of
the implementation of the MAIP Program. The Monthly Report shall
contain information on the number of patients served, type of assistance,
and the actual amount utilized. Submission shall be every 15" day of the
following month.

c. The MPO shall consolidate and validate reports submitted by the CHDs and
hospitals.

d. The MPO shall submit to the AFMT a Quarterly Summary of Fund

Utilization Reports and the status of the implementation of the MAIP
Program.

e. The MPO, through the AFMT, shall provide the Secretary of Health a
Monthly Report of the number of indigent and financially incapacitated
patients assisted under the MAIP Program.

10. Monitoring and Evaluation

a. A Composite team from the DOH Central Office/CHDs shall conduct

monitoring of partner hospitals every year using the MAIP Program
monitoring tool to ensure smooth and proper implementation of the
Program.

b. A periodic Program Implementation Review shall be conducted by the

MPO/CHDs to assess the impact of the Program.

c. 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 MAIP Program in accordance
with existing guidelines.

VII. ROLES AND RESPONSIBILITIES

1. Department of Health

a. Administrative and Financial Management Team

Oversees the overall implementation of the Program
1.
Reviews requests and authorizes release of funds as specified in
2.
Ea Section V1.7 of this Order
3. Provides technical direction to the Program
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Department oi Health
 Financial Management Service
1. Provides technical assistance on matters pertaining to financial
management
2. Facilitates timely transfer/sub-allotment of funds to CHD and health
facilities in coordination with the MPO
3. Monitor the fund utilization reports of the CHDs and other health
facilities

Malasakit Program Office

1. Facilitates policy development and formulates monitoring tool for the
implementation and evaluation of the MAIP Program
2. Coordinate with DOH Hospitals and other partner health facilities for
referral of patients and other related financial and administrative
matters arising from the implementation of the Program
Consolidate program evaluation and utilization reports and submit
findings to the AFMT and Office of Secretary annually
4, Oversees the implementation of the MAIP Program and its fund
utilization in the Malasakit Centers.
5. Report any suspected abuse or mishandling of funds to the AFMT.

Field Implementation and Coordination Team

1. Ensures smooth coordination with and extends necessary assistance to
concerned CHDs and DOH Hospitals, including BARMM,
particularly in the establishment of linkages with other health care
facilities for the efficient implementation of the MAIP Program;
Ensures that referral of MAIP-related assistance requests received at
the level of DOH-Central Office is forwarded to the MPO or
concerned CHDs as may be deemed applicable.

Center for Health Development

transfer to partner
1. Manages allocated funds and facilitates efficient
health facility under their jurisdiction
2. Designates CHD Coordinator who shall primarily handle program
implementation and ensure administrative support (e.g
designation/hiring of MAIP Program point person/coordinator,
provision of internet connectivity etc.) for the effective
implementation of the Program
Reviews requests and authorizes release of funds as specified in
Section V1.7 of this Order
Conducts monitoring and evaluation with partner health facilities.
hi
Submits a quarterly summary report on the status of the MAIP
Program and other related reports mentioned in Section VI1.9.b of this
Order
Coordinate with the LGUs under their jurisdiction to cascade
information or campaigns to enhance people’s awareness regarding
the MAIP Program
Reports 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 maybe
Submits the list of government and private partner hospitals with
MOA to the MPO for monitoring and also in accordance with
government transparency act,

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 f. Knowledge Management and Information Technology Service
1. Facilitates posting of the required information as indicated in this
Order.
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2. Ensures that personal sensitive information and other data of the

EWEBPAIS system are properly kept at all times.
3. Repairs and maintains the MAIP Program-EWEBPALIS.
4. Designates staff who shall provide technical assistance for the
EWEBPAIS.

2. Government and Private Health Facilities

a.Assess and screen the eligibility of all patients thoroughly and ensure
completeness and authenticity of documents prior to MAIP Program
availment as specified in Section V1.1 of this Order
b. Facilitate provision of quality medical assistance requests and ensure the
compassionate delivery of necessary services to the MAIP Program
beneficiary
c. Ensure monthly reporting of fund utilization and program
implementation, and other monitoring and evaluation reports every 10%
day of the following month
d. Ensure administrative support (e.g. designation/hiring of MAIP Program
point person/coordinator, provision of internet connectivity) for the
effective implementation of the program as indicated in VL.5.d.
Report any suspected abuse or mishandling of funds to the MPO
ro
Facilitate issuance of internal policy that will support the implementation
of this Order.

VIII. REPEALING AND SEPARABILITY CLAUSE

This Order repeals DOH Administrative Order No. 2017-0003 and its
corresponding amendments (A and B). All other issuances inconsistent with the
provisions of this Order are also hereby amended.

Nothing in this Order shall be construed as a limitation or modification of

*

existing laws or legal precedents. If any part or provision of this Order is declared
invalid or unconstitutional, any part or provision not affected thereby shall remain
valid and effective.

IX. EFFECTIVITY CLAUSE

This Order shall take effect after fifteen (15) days following its publication in
a newspaper of general circulation, posting in the DOH website and upon filing with
the University of the Philippines Law Center of three (3) certified copies of this
Order.

ISCO DUQUE 111, MD, MSc

¥.

Secretary of Health

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