Republic of the Philippines
HOUSE OF REPRESENTATIVES,
Quezon City

EIGHTEENTH CONGRESS
Second Regular Session

House Bill No. 1442

Introduced by Rep. ANGELO MARCOS BARBA.
24 District, Hocos Norte

AN ACT PROVIDING STANDARDS FOR THE PRACTICE OF
REHABILITATION MEDICINE AND FOR OTHER PURPOSES

EXPLANATORY NOTE

In 1969, the international community, through Rehabilitation
International, had developed plans to promote and improve rehabilitation
services worldwide. The 1970s was even proposed to be proclaimed as the
“Decade of Rehabilitation”. This was in response to the growing need for
rehabilitation facilities and services to assist the disabled.

Decades after, rehabilitation medicine needs around the world remained
unmet. Demand for rehabilitation services, however, continues to and will
continue to increase in light of global health and demographic trends,
including population ageing and the increasing number of people living with
consequences of diseases and injury? The World Health Organization
therefore called on all nations for action towards scaling up rehabilitation
services and address the profound unmet needs that exist today.3 This was
dubbed as “Rehabilitation 2030”.

Rehabilitation plays a central role in “ensuring healthy lives and
promoting the well-being of all at all ages”.4 It is an essential part of the
continuum of care, along with prevention, promotion, treatment and
palliation.5 It should be considered as an essential component of integrated
health services.6

In line with Rehabilitation 2030 and the policy of the State to protect and
promote the right to health of all Filipinos, this bill aims to provide delivery of
expert rehabilitative care to Filipinos suffering from neuromusculoskeletal,

4 Acton, N, (1969). The Proposed Decade of Rehabilitation. Bulletin of Prosthetic Research. Retrieved on 19
‘August 2020 from https://mwwrehab research.va.gov/jour/69/6/1/1.pdf

2 Meeting Report. Rehabilitation 2030: A Call for Action, February 16-17, 2017. Retrieved on 19 August 2020,
from https://www.who.int/disabilties/care/Rehab2030MeetingReport_plain_text_version.paf

> bid,

‘ Sustainable Development Goal 3

5 Meeting Report. Rehabilitation 2030: A Call for Action, February 16-17, 2017. Retrieved on 19 August 2020,
from https://www.who int/disabilties/care/Rehab2030MeetingReport_plain_text_version.pdf

© Ibid.


30
31
32
33
34
35
36
37

bess

a2
43

45
46
47

cardiovascular, pulmonary and other system disorders which produce
temporary or permanent disability.

Given the increased presence of rehabilitation medicine centers in the
country with the intention to deliver a comprehensive and effective
rehabilitative care to patients with unique needs, it is imperative that
standards be set for the establishment, management and operation of
rehabilitation medicine facilities. It is also equally important to establish
standards for the effective training and practice of Rehabilitation Medicine in
the country. This legislation would therefore ensure the protection and
promotion of the interest of the public.

In view of the foregoing, the immediate passage of this bill is earnestly
sought.

ANGE! ‘COS BARBA


23

Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

EIGHTEENTH CONGRESS
Second Regular Session

1442
House Bill No.

Introduced by Rep. ANGELO MARCOS BARBA
2nd District, Ilocos Norte

AN ACT PROVIDING STANDARDS FOR THE PRACTICE OF
REHABILITATION MEDICINE AND FOR OTHER PURPOSES

Be it enacted by the Senate and the House of Representatives of the
Philippines in Congress assembled:

SECTION 1. Short Title. - This Act shall be known as the “Medical
Rehabilitation Standards Act”.

SECTION 2. Declaration of Policy. — It is the policy of the State to
protect and promote the right to health of the people through optimizing
function by masking the delivery of expert rehabilitative care to Filipinos
suffering from neuromusculoskeletal, cardiovascular, pulmonary and other
system disorders which produce temporary or permanent disability.

Toward this end, the State shall establish standards for the effective
practice of Rehabilitation Medicine and for the establishment, management
and operation of rehabilitation medicine facilities.

SECTION 3. Definition of terms. — As used in this Act, the following
terms shall mean:

a. Physical and Rehabilitation Medicine — the branch of medicine which
deals with the prevention, diagnosis, treatment and rehabilitation of
neuromusculoskeletal, cardiovascular, pulmonary and other system
disorders, which produce temporary or permanent disability in patients
as well as the performance of different diagnostic and therapeutic
procedures, including, but not limited to medical prescription,
procedures, injections, neuropsychology, nutrition, provision of
equipment and assistive devices, physical modalities, electromyography,
musculoskeletal sonology, manual therapy, therapeutic exercises,
prosthetics and orthotics. It also involves specialized medical care and
training of patients with loss of function so that he or she may obtain
his or her maximum potential, physically, psychologically, socially and
vocationally, providing special attention and care to prevent
complications or deterioration, and to assist in physiologic adaptation
of disability, impairment or handicap. In addition, the practice of
Physical and Rehabilitation Medicine uses agents such as heat, light,


a8

water, electricity, therapeutic exercise and mechanical agents in its
treatment armamentarium.

b. Medical Rehabilitation - the process of helping a person achieve his or

her fullest physical, physiological, social, vocational, educational and
functional potential consistent with his or her physiologic and anatomic
impairments, environmental limitations and life plans;

c. Physical and Rehabilitation Medicine Specialist — a physician who is

licensed and registered with the Professional Regulation Commission
(PRC) and who completed three (3) years of residency training in
Physical and Rehabilitation Medicine in a training institution
accredited by the Philippine Academy of Rehabilitation Medicine
Specialty Board.

d. Philippine Academy of Rehabilitation Medicine (PARM) — a non-stock,

non-profit corporation, duly recognized by the PRC and Accredited
Professional Organization (APO) composed of Board Certified Physical
and Rehabilitation Medicine Specialists.

e. Philippine Academy of Rehabilitation Medicine Specialty Board

(PARMSB) — the recognized Specialty Board by PARM tasked with
examining and certifying competent specialty practitioners.

Physical and Rehabilitation Medicine Center/Facility/Unit — any
facility that renders services for the rehabilitation of physical
disabilities and which may be hospital-based or freestanding.

. Physical and Rehabilitation Medicine Team — a group of medical and
allied health professionals concerned with the medical rehabilitation of
patients with disabilities. The team is composed of, but not limited to,
the following:

i. Physical and Rehabilitation Medicine Specialists
|. Physical Therapists

. Occupational Therapists

iv. Prosthetists and Orthotists

. Rehabilitation Nurses

|. Speech Pathologists

|. Social Workers.

iii. Vocational Counselors

ix. Recreational Therapists
 Electromyographer

i, Musculoskeletal Sonographer

|. Certified Strength and Conditioning Coach
|. SPED teachers

iv, Neuropsychologist

Physical Therapy Aide

SECTION 4. Scope of Practice. - The practice of Physical and

Rehabilitation Medicine includes that following:


A. Professional services related to the care of an individual patient,

rendered in the role of a physical primarily responsible for individual
patient care or as a consultant to another physician, namely:

1. History taking, examination of patients and/or performance of
specific diagnostic procedures like Electromyography and Nerve
Conduction velocity studies, Neuromusculoskeletal Ultrasound,
and Bone Densitometry for the purpose of establishing diagnosis
and evaluation of disability, impairment, functional capacity and
potential for rehabilitation;

2. Prescription and rendering of appropriate medical treatment which
may include any or all aspects of physical medicine as well as
rehabilitative measures, including but not limited to physical
therapy, occupational therapy, orthotic and prosthetic services,
joint and trigger point injections, ultrasound guided interventional
procedures;

3. Follow-up examination of patients in offices, _ hospitals,
rehabilitation facilities, extended care facilities or home for
purposes of re-evaluation and treatment modifications;

4, Appropriate consultation with other medical specialists;

5. Psychological counseling and conference with non-physical health
care professionals or family members concerning conduct of
patient’s care or patient's progress; and

6. Examination of patient's records, preparation of reports, designing,
planning, and implementation of health programs for the
maintenance of health and prevention of disability; and
correspondence as well as appearance in court or providing
testimony pertaining to a patient.

. Professional services related to the administration of rehabilitation

facilities or units, namely:

1. Professional general supervision of rehabilitation services in a
hospital-based rehabilitation center or unit or any other
freestanding units;

2. Planning, establishment and management of facilities, equipment,
and personnel for the performance of functions and activities of a
rehabilitation department or unit, or any other freestanding unit
that render limited rehabilitation services;

3. Maintenance of complete and accurate records and statisti



4. Education of physicians and allied health care professionals in
Rehabilitation Medicine, both local and foreign, for programs
related to Physical and Rehabilitation Medicine;

5. Education of the public on health care issues pertaining to
Rehabilitation Medicine;

6. Promoting professional development of Rehabilitation Medicine
through research and medical education;

7. Designing, planning, and implementing health programs for
maintenance of health and prevention of disabili

8. Establishing linkages with government and non-government
agencies, both local and foreign, for programs related to
Rehabilitation Medicine;

9. Promotion of the team approach among medical and allied medical
health care professionals in the holistic care of patients; and

10. Selling standards for compensation of Physical and Rehabilitation
Medicine Services.

. Guidelines for Practice in a Physical and Rehabilitation Medicine

Facility:

1. Every patient shall be examined and diagnosed by a Physical and
Rehabilitation Medicine Specialist. The Physical and Rehabilitation
Medicine Specialist recommends an individual treatment plan in
collaboration with the Physical and Rehabilitation Medicine team.
The treatment plan and rehabilitation program shall be regularly
reviewed on a team basis.

2. Medications and various forms of treatment shalll be prescribed by
a Physical and Rehabilitation Medicine Specialist.

3. The Physical and Rehabilitation Medicine Specialist has the
primary responsibility of regularly following-up patients in his or
her charge and modifying or terminating treatment.

4. A Physical and Rehabilitation Medicine Specialist shall head the
facility or unit and collaborate with the Physical and Rehabilitation
Team in the delivery of rehabilitation medicine services. In areas
where there are no Physical and Rehabilitation Medicine Specialists,
a licensed physician shall head the facility or unit.

5. The Physical and Rehabilitation Medicine Specialist shall charge
professional fees in accordance with the standards of the Philippine
Medical Association and the Philippine Health Insurance System.


50

6. The Physical and Rehabilitation Medicine Specialist shall conduct
himself or herself in a manner consistent with the Code of Ethics of
the Accredited Professional Organization (APO).

SECTION 5. Qualifications to Practice Physical and Rehabilitation

Medicine. - A physician is qualified to practice Physical and Rehabilitation
Medicine if he or she is a Board Certified/Board Eligible Physical and
Rehabilitation Medicine Specialist, who is of good moral character, and is a
member of the APO.

SECTION 6. Accreditation and Certification. — To ensure the highest

quality of professional medical rehabilitation service to the public and to the
medical community, the standards for the practice of Physical and
Rehabilitation Medicine and the certification of Physical and Rehabilitation
Specialists are hereby established.

A. Accreditation of the Physical and Rehabilitation Medicine Specialist

1. The physical and rehabilitation medicine practitioner is a graduate of a

PARMSB-accredited Physical and Rehabilitation Medicine Training
Institution and certified by the PARMSB as:

a. Board certified (Diplomate); and
b. Board eligible

2. A physical and rehabilitation medicine practitioner is duly recognized

as PARM Specialty Board-Certified upon compliance with and/or
submission of the following requirements:

a. Authenticated PRC ID as duly registered physician;
b. Certificate of completion of training in a PARMSB-accredited

Physical and Rehabilitation Medicine Training Institution; and
c. Certificate from PARMSB.

3. A physical and rehabilitation medicine practitioner is duly recognized

as PARM Specialty Board-Eligible upon compliance with and/or
submission of the following requirements
a. Authenticated PRC ID as duly registered physician;
b. Certificate of completion of training in a PARMSB-accredited.
Physical and Rehabilitation Medicine Training Institution; and
c. Certificate of eligibility from PARMSB.

B. Continuing Certification of the Physical and Rehabilitation Medicine
Specialist — A certified Diplomate of the PARMSB shall undergo
re-certification every three (3) years through PARMSB in order to be
duly recognized as Physical and Rehabilitation Medicine Specialist.

SECTION 7. Regulatory Authority. — Technical standards and

requirements for the registration, operation, and maintenance of
rehabilitation and medicine facilities shall be implemented and regulated by


the Department of Health (DOH) ~ Health Facilities and Services Regulatory
Bureau.

SECTION 8. Management and Operation of a Rehabilitation Medicine
Facility. — A physical and rehabilitation medicine facility shall be headed by a
Physical and Rehabilitation Medicine Specialist who is either a PARM
Specialty Board-Certified or PARM Specialty Board-Eligible in the said
facility.

A Board-certified Physical and Rehabilitation Medicine Specialist may
head not more than three (3) Rehabilitation Medicine facilities. In the absence
of a board-certified Physical and Rehabilitation Medicine Specialist, a
Board-eligible Physical and Rehabilitation Medicine Specialist may head the
facility, provided that he or she conforms with the requirements of PARM.

SECTION 9. Classification of Facilities. — Rehabilitation medicine
facilities shall be classified according to the institutional character, and extent
of services offered, as follows:

(a) As to institutional character, Physical and Rehabilitation
Medicine facilities are either hospital-based, if operating within a
hospital set-up; or freestanding, if operating on its own or part of
a facility other than a hospital.

(2) As to extent of services, Physical and Rehabilitation Medicine
facilities may be primary, secondary, tertiary, or home-based.
(3) As to function, Physical and Rehabilitation Medicine facilities,
may be utilized for training services and research or for services

alone.

(4) As to services, Physical and Rehabilitation Medicine facilities can
also be either general or specialized.

The bases for classification of the different categories of rehabilitation are:
(a) Physical and Rehabilitation Medicine Specialist qualification, (2) Allied
Health personnel staff qualification, (3) Physical and Rehabilitation Medicine
Services available and (4) Physical set-up and equipment.

SECTION 10. Primary Physical and Rehabilitation Medicine Facilities.
— A primary physical and rehabilitation medicine facility shall have the
following:

1. At least one (1) PARM Specialty Board Certified or Eligible Physical
and Rehabilitation Medicine Specialist;

2. At least one (1) allied health professional;

3. Physical and Rehabilitation Medicine consultation and management
with physical therapy services;

.. Physical set-up;

Medical consultation area;

. Treatment area to include at least an electrotherapy device and
superficial hearing modality, and activities of daily living (ADL)
training devices;

ane


21
22
23
24
25
26
7
28
29
30
31
32
33
34
35
36
37
38
39
40
a
42

45
46
a7
48
49
50
51

7. Gym area, to include parallel bars, mirror, weights and assistive
devices such as cranes, crutches, and walkers, among others;

8. Evaluation tools;

9, Adequate utilities such as water, electricity and consumables; and

10. First aid kit with basic CPR equipment.

SECTION 11. Secondary Physical and Rehabilitation Medicine Facilities.
— A secondary physical and rehabilitation medicine facility shall have the
following:

1. Atleast one (1) PARM Specialty Board Certified or Eligible Physical and
Rehabilitation Medicine Specialist;

2. At least one (1) licensed therapist and occupational therapist;

3. Physical and Rehabilitation Medicine consultation and management,
physical and occupational therapy services; and

4. Compliance with the primary category set-up, plus deep heating
modality, manual traction and therapeutic exercise equipment for the
gym area.

SECTION 12. Tertiary Physical and Rehabilitation Medicine Facilities. —
A tertiary physical and rehabilitation medicine facility shall have the
following:

1. At least one (1) PARM Specialty Board Certified or Eligible Physical
and Rehabilitation Medicine Specialist;

2. Atleast one (1) licensed therapist and occupational therapist;

3. Physical and Rehabilitation Medicine consultation and management,
physical and occupational therapy, speech therapy, prosthetics, and
orthotics in-house or referral services;

4. Compliance with the secondary category set-up and equipment, with
two (2) additional superficial heating modalities, medium frequency
modality, ultraviolet or cold laser intermittent compression unit,
mechanized intermittent traction and tilt table with additional gym
equipment;

5. A training service and research facility, which shall fulfill all the
requirements as a residency training institution in accordance with
PAMSB guidelines; and

6. A specialized facility which should cater to subspecialty condition in
rehabilitation medicine, including cardiac, pain, pediatric, pulmonary,
sports, among others, shall be hospital-based facility with a
multi-disciplinary set-up.

SECTION 13. Documentation, Recording, and Recordkeeping. — An
adequate and effective system of documentation, recording, and
recordkeeping shall be maintained for all consultations and services in the
facility. The rates for consultation and services shall likewise be recorded and
shall be in accordance with the standards of the APO.

SECTION 14. Application for Registration and Issuance of License for
Physical and Rehabilitation’ Medicine Facilities. — Applications ‘for
registration shall be filed by the owner of the facility or his or her duly


authorized representative with the DOH-Health Facilities and Services
Regulatory Bureau, together with an information sheet to be filled-up by the
Physical and Rehabilitation Medicine Specialist in-charge.

Upon receipt of the said application and payment of the license fee, the
PARM technical committee team will inspect the facility within sixty (60) days.
Certificates of licenses shall be issued and approved by the Head of the
DOH-Health Facilities and Services Regulatory Bureau. A provisional license
may be granted to facilities with incomplete requirements in special cases for
a period of one (1) year.

SECTION 15. Terms, Conditions, and Validity of the License. - The
license to operate a physical and rehabilitation medicine facility shall be for
period of two (2) years. Application for renewal of the license shall be made
during the last six (6) months of validity. The license must be placed in a
conspicuous place within the facility. A copy of the rules and regulations shall
be made readily available.

Investigation of all charges or complaints against a physical and
rehabilitation medicine facility shall be made to the APO, when the complaint
is against a Physical and Rehabilitation Medicine Specialist; and to the
DOH-Health Facilities and Services Regulatory Bureau (Bureau) for
appropriate investigation.

In case of violation of any of the standards provided in this Act, the license
to operate may be revoked.

SECTION 16. Penalties. - Any person, partnership, association, or
corporation, who establishes, operates, conducts, manages, or maintains a
physical and rehabilitation medicine facility, within the definition provided in
this Act, without first obtaining a license, or violates any provision of this Act
or its Implementing Rules and Regulations, shall be liable for a fine of not less
than Forty Thousand Pesos (PhP 40,000.00) but not to exceed One Hundred
Thousand Pesos (PhP100,000.00) for the first offense; not less than One
Hundred Thousand Pesos (PhP100,000.00) but not to exceed Two Hundred
Thousand Pesos (PhP200,000.00) for the second offense; and not less than
Two Hundred Thousand Pesos (PhP200,000) for the third and subsequent
offense. Each day that a facility or other related facility shall operate after the
first violation shall be considered a subsequent offense.

In addition to the penalties specified in the preceding paragraph, the
Bureau, upon the approval of the Secretary of Health, may summarily order
the closure of any physical and rehabilitation medicine facility found
operating without a license.

SECTION 17. - Implementing Rules and Regulations. — In order to
effectively implement the provisions of this Act, the DOH-Health Facilities
and Services Regulatory Bureau, in coordination with the national
professional organization duly recognized by the Professional Regulation
Commission shall promulgate the rules and regulations, including the
technical standards and requirements for the registration, operation and


maintenance of the physical and rehabilitation medicine facilities, within
ninety (90) days after effectivity of this Act.

SECTION 18. Separability Clause. - If any provision of this Act is
declared invalid or unconstitutional, the other provisions not affected by such
declaration shall remain in full force and effect.

SECTION 19. Repealing Clause. — All laws, executive orders,
administrative orders, and rules and regulations inconsistent with this Act are
hereby repealed or amended accordingly.

SECTION 20. Effectivity Clause. - This Act shall take effect fifteen days

after its publication in the Official Gazette or in two (2) newspapers of general
circulation.

Approved,