TB Package Certification Course

8/19/2019 TB Package Certification Course

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PhilHealth TB DOTS Out-patient

Package TB DOTS Certifcation Training

April 16, 201


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Benefts under the MDG TeamCurrentBenefts

PaymentMechanism

EngagedProvider/s

!aternit"Care !CP Ca#e rate6$%& ho#pital# '2 to'() & l"ing-in# an* '1

Ho#pital#'"ing in clinic#

+eornCare

+CP Ca#e rate1.%0

Ho#pital#'"ing in clinic#

Tuberculosis

TBDOTSPacage

Case rate!"

TB DOTS#acilities

H/A/DS OHAT Ca#e rate0 &

DOH recognie*treat3ent hu

!alaria !alariaPackage

Ca#e rate%00

4H5S ith training

4aie# ABT Ca#e ratek DOH recognie*ABCABTC


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PhilHealth

• The +ational Health /n#urance Act o8199% :4A .).%; A# A3en*e* " 4A 92(1

• +ational Health /n#urance Progra3

• Oualit" health care#erice# ithin the fr#t 1% "ear# o8 it#

i3ple3entation


5/31

Our !e3er#• ?3plo"ee# :got an* priate;

@ 3onthl" pa"3ent : #alar";

• /n*ii*uall" Pa"ing Progra3 :oluntar";

- >uarterl" pa"3ent :1,)00"ear;

• +on-pa"ing :pen#ioner;

- no pa"3ent 8or li8e

• Spon#ore* :thru +ational oern3ent an*

'5; - annual pa"3ent, eligiilit" 8or 1 "ear

• Oer#ea# orker# Progra3

- Annual pa"3ent :1,200"ear;


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ualife* Depen*ent#

• Legitimate spouse• Children

• below 21, unmarried & unemployed (legitimate,

illegitimate, legitimated or adopted)• Parents

• > ! years and wholly dependent on the member

"or support

• #tep$parents%dopti'e parents


7/31

TB DOTS PackageH/STO4E

• 199) – DOTS a# a*opte* nationi*e – PhilHealth *eelop# policie# #upporting the +TP

an* inole# the Priate Sector in PP!D

– Con#ultatie 3eeting# egan• 1999- Health Sector 4e8or3 Agen*a @ #upport#

eFpan#ion o8 coerage o8 +ational Health/n#urance Progra3 G prioritie* the +TP

– Announce3ent that the TB Outpatient BeneftPackage a# a 'aor Da" gi8t to the 7ilipino#


8/31

TB DOTS PackageH/STO4E

• 2001

– 4ecognie* that *eelop3ent o8 TBeneft package calle* 8or

co3prehen#ie polic" 3aking – Serie# o8 con#ultation#, inten#ife* eort#

toar*# fnaliation o8 TB Package

• 2002 – 7inaliation o8 C5P @I TB Package a# an

i3portant co3ponent


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TB-DOTS Package

H/STO4E• Boar* 4e#olution +o#$ ()% G (90 #erie#

o8 2002• Approal o8 the i3ple3entation o8 DOTS eneft

package into a fFe* pa"3ent rate o8 P(,000

• 200

– PhilHealth Circular +o#$ 1. G 19 #erie# o8200

• Accre*itation an* eligiilit" gui*eline#

– ?ight DOTS center# are initiall" accre*ite*


10/31

Case PaymentP !$%%%&%%

'(aid directly to theDOTS center)

Case Payment

P !$%%%&%%'(aid directly to the

DOTS center)

*st P+,ME-T

P

.$%%&%%a8ter the/nten#ie

Pha#e

*st P+,ME-T

P

.$%%&%%a8ter the/nten#ie

Pha#e

.nd P+,ME-T

P *$%%&%%a8ter the

Continuation Pha#e

.nd P+,ME-T

P *$%%&%%

a8ter theContinuatio

n Pha#e

TB DOTS P+C"+GEClaims Payment


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TB DOTS Pacage


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TB DOTS P+C"+GE

PA4T/C/PAT/O+ o8P4O/D?4S


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DOTS Accre*itation

J Proi*er# 3u#t e accre*ite* e8orethe" can proi*e care fnance* "

+H/P

J Thir* Part" Accre*itation :TPA; a#intro*uce*

@ Onl" certife* DOTS clinic# 3a" appl"

8or accre*itation JPhilippine Coalition Again#t Tuerculo#i# :PhilCAT;

J/n8ectiou# Di#ea#e OKce o8 DOH

- b # Phil0 lth


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-umber o# Phil0ealthEngaged

TB DOTS Providers

P id E t th h


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Provider Engagement through+ccreditation and Contracting #or

0ealth Services 'PE+C0eS)PhilHealth Circular %(, #$ 2012

• eneral ui*eline#

–A*opt# the +e DOH Cla##ifcation

o8 Ho#pital# an* Other 7acilitie# –Strea3line# the proce## o8

proi*er engage3ent

• Auto3atic Accre*itation• Delegation to P4O #o3e ital #tep# in

accre*itation proce##

• Continuou# participation

Pro ider Engagement thro gh


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Provider Engagement through+ccreditation and Contracting #or

0ealth Services 'PE+C0eS)PhilHealth Circular %(, #$ 2012• eneral ui*eline#

– ?#tali#he# that the Per8or3ance Co33it3enti# a contractual arrange3ent eteen

PhilHealth an* /n#titutional Health CareProi*er :/HCP;

– ?ngage3ent 3a" eFten* to a group o8 /HCP#un*er one 3anage3ent :Health S"#te3

Proi*er# – 5ni8or3 perio* o8 ali*it" 8or all /HCP# #tarting201 :Lanuar" to Dece3er;

– ?ngage3ent inole# accre*itation an*

participation


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+utomatic vs -on1+utomatic+ccreditation

+utomatic -on1automatic

'icen#e* or certife* "DOHCHD

5ncertife* " CHD

Government/(rivate #acilitiesPCB

B?3O+C certife* !CPCertife* +S7Ho#pital#

DOH certife* TB DOTSASC G 7DCABTCABC/HCP accre*ite* " a r* part"accre*itor recognie* " PH/C

!CP not B?3O+C certife* TB DOTS proi*er not

PhilCAT certife*


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+utomatic vs -on1+utomatic+ccreditation

+utomatic -on1automatic

+o #ure" Sure" :PAS;

+o *elieration Delierate* "Accre*itationSuco33ittee

+o #ure" Sure"


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S(ecifc re2uirements

3-ST3T4T3O-S DOC4ME-TSHo#pital#

DOH licen#eASC

7DC

PCB a$ !OA ith re8erral8acilitie# :i8applicale;

$ 'ocation 3ap

TB DOTS a$ DOHcertifcation

$ 'ocation 3ap


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Continuous Partici(ation

ninterrupted engagement o"

*CPs with Phil*ealth until su+h

engagement is withdrawn orterminated based on the rules set

by P*C


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• Su3it e8ore Lanuar" 1 eer" "ear

– 5p*ate* DOH licen#e

– Per8or3ance co33it3ent

– 5p*ate* certifcate# i##ue* " DOHCHD :TBDOTS Certifcate;

– 'ate#t au*ite* 7S

– Participation 8ee

• Shoul* e #u3itte* " en* o8 7eruar"

• 7ailure to #u3it @ *enie* clai3# #tarting!arch


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• /8 certifcate eFpire# ithin the"ear

–60 *a"# ithin hich to #u3it theup*ate* licen#e or certifcate

– /8 not= clai3# eginning on 61#t *a"

#hall e *enie* until /HCP #u3itthe re>uire3ent#


23/31

TB DOTS P+C"+GE

Clai3# Pa"3ent


24/31

DOTS PAC&A?

REQUIREMENTS FOR FILING

• Phil*ealth orm 1

• Phil*ealth orm 2

• -.P .reatment Card• #upporting do+uments

– Proo" o" +ontribution "or sel"$employed

– Proo" o" dependen+y• /0g0

– arriage +erti"i+ate "or spouse

– irth +erti"i+ate "or +hildren


25/31

7ir#t Su3i##ion=4egi#tration

NTP

TREATMENT

CARD

(photocopy)

Upon

enrollment

TB-Clinical

Information

Sytem

!ARPD"Phil#ealth

Room $%&'

in*&

+ay


26/31

Secon* Su3i##ion= 1#t Pa"3ent

NTPTreatment

Car+

(photocopy)

After Inteni,e

Phae

TB-DTS

Pac.a/e

Claim 0orm 1

ClaimsDepartment

PhilHealth

Phil#ealth

Claim 0orm $

in

*&

+ay


27/31

Thir* Su3i##ion= 2n* Pa"3ent

NTPTreatment

Car+

(photocopy)

After

Contin2ation

Phae

TB-DTS

Pac.a/e

Claim 0orm 1

ClaimsDepartment

PhilHealth

Phil#ealth

Claim 0orm $

in

*&

+ay


28/31

TB DOTS C'A/!S PAE!?+T

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

.,01.,000$00

20,20,000$00

2%,%6,000$00

2),9(,000$00

29,90,000$00

12,1%9,%00$00


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7uture Direction#

• ?Fpan* to coer categor" //

• Pa"3ent at the en* o8

treat3ent :co3pletion;• 4e>uire tru#t 8un* 8or TB

DOTS pa"3ent


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TB Package Certification Course

Documents

Transcript of TB Package Certification Course