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Introduced by Representative Rufus B. Rodriquez TNDEYS
House Bill No, 122
EXPLANATORY NOTE

Physiatry is the branch of medicine emphasizing the prevention, diagnosis, treatment, and
rehabilitation of disorders that produce temporary or permanent functional impairment.
Physiatry is unique among medical fields in that its area of expertise addresses the function
of the whole patient, as compared with a focus on an organ system or ‘systems. It aims to
restore the functional ability of those with physical impairments, disabilities and handicaps in
order to enhance their quality of life.

Physical Medicine and Rehabilitation physicians, also known as physiatrists, treat a wide
variety of medical conditions affecting the brain, spinal cord, nerves, bones, joints, ligaments,
muscles, and tendons.

There has been a recent rise in the number of graduates and medical professionals practicing
the said discipline. Also, there have been an increase in the number Physical and
Rehabilitation Medicine centers in the country. These centers must be headed by a Physical
and Rehabilitation Medicine Specialist who has completed a minimum of three (3) years of
training in Physical & Rehabilitation Medicine having a broad range of knowledge in
musculoskeletal, neurological, rheumatological, and cardiovascular systems that will aid them
in evaluating and treating patients from various age groups.

Aside from the competent personnel, these centers should also be given proper equipment in
order to provide the best treatment and diagnosis to patients.

This bill seeks to set standards for the training and practice of Rehabilitation Medicine. It also
aims to set technical and operational guidelines for the rehabilitation facilities and medical
professionals to ensure that the highest quality of service will be provided to the patients,
thereby protecting the interests of those who seek treatment from these centers.

In view of the foregoing, the immediate approval of this measure is eamestly requested.

RUFUS B. IGUEZ



EIGHTEENTH CONGRESS
REPUBLIC OF THE PHILIPPINES )
Second Regular Session )
HOUSE OF REPRESENTATIVES
Introduced by Representative Rufus B. Rodriguez
House Bill No. 8122

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

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

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

SEC. 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 making the delivery of expert
rehabilitative care to Filipinos suffering from neuromusculoskeletal, cardiovascular, pulmonary
and other system disorders which produce temporary or permanent disability accessible,
effective and affordable. Toward this end, standards for the effective practice of Rehabilitation
Medicine and for the establishment, management and operations of rehabilitation facilities are
hereby established.

SEC. 3. - Definitions. - As used in this Act, the following terms shall mean:
a. Physical & 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, drug administration, prognostication, manual therapy, assessment and
review of interventions, 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 & Rehabilitation Medicine uses agents
such as heat, light, water, electricity, therapeutic exercise and mechanical agents in its
treatment armamentarium.

b. Medical Rehabilitation - the process of helping a person achieve his fullest physical,
psychological, social, vocational, educational and functional potential consistent with
his or her physiologic or anatomic impairments, environmental limitations and life

ans.

©. Physical & Rehabilitation Medicine Specialist - a physician who is licensed and duly
registered with the Professional Regulation Commission and who completed three (3)
years of residency training in Physical & 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 Professional Regulation Commission and the


Accredited Professional Organization (APO) composed of Board Certified Physical &

Rehabilitation Medicine Specialists.

Philippine Academy of Rehabilitation Medicine Specialty Board (PARM SB) - is the

recognized Specialty Board by Philippine Academy of Rehabilitation Medicine tasked

with examining and certifying competent specialty practitioners.

Physiatrist — synonym for Physical & Rehabilitation Medicine Specialist They shall be

ualifed by the PARM SBas:

. Board Eligible Physical & Rehabilitation Medicine Specialist - refers to one who
completed residency training in a residency training program accredited by the
PARM Specialty Board but who has not successfully completed the PARM
Specialty Board examination.

2. Board Certified (Diplomate) - refers to those have passed Part | (written) and Part
I (oral) of the Diplomate Board Examination given by the PARM Specialty Board
examination.

Physical & Rehabilitation Medicine Center/Facility/Unit - any facility that renders

services for the rehabilitation of physical disabilities and which may be hospital-based

or free-standing

. Physical & Rehabilitation Medicine Team - a group of medical and allied health

professionals concerned with the medical rehabilitation of patients with physical
dleabitos. The team is composed of, but not limited to, the following:
Physical & Rehabilitation Medicine Specialists
it Physical Therapists
iii, Occupational Therapists
iv. Prosthetists and Orthotists
v. Rehabilitation Nurses
vi. Speech Pathologists
vii. Social Workers
viii. Vocational Counselors
ix. Recreational Therapists
x. Electromyographer
xi, Musculoskeletal Sonographer
i. Certified Strength & Conditioning Coach
xiii, SPED Teachers
xiv. Neuropsychologist
xv. Physical Therapy Aide

SEC. 4. Scope of Practice. - The practice of Physical & Rehabilitation Medicine includes:

A.

2 or w

Professional services related to the care of an individual patient, rendered in the
role of a physician primarily responsible for individual patient care or as a
consultant to another physician, and consists of:

. History taking, examination of patients, performance of specific diagnostic procedures

for the purpose of establishing diagnosis and evaluation of disability, impairment,
functional capacity and potential for rehabilitation;

. Prescription and rendering of appropriate medical treatment which may include any or

all, aspects or physical medicine as well as rehabilitative measures, including but not
limited to physical therapy, occupational therapy, speech therapy and orthotic and
prosthetic services.

|. Follow-up examination of patients in offices, hospitals, rehabilitation facilities, extended

care facilities or home for purposes of re-evaluation and treatment modifications;
Appropriate consultation with other medical specialists;

. Counseling and conference with non-physician health care professionals or family

members conceming conduct of patient's care or patient's progress: and

. 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

B. Professional services related to the administration of rehabilitation facilities or
units consist of:

1. Professional general supervision of rehabilitation services in a hospital-based
rehabilitation center or unit or any other freestanding units that render limited
rehabilitation services, convalescent home and private homes, for quality assurance
and appropriate utilization of services;

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 free-standing unit that render limited rehabilitation services. Convalescent home
and private homes, for quality assurance and appropriate utilization of services;

Maintenance of complete and accurate records and statistics:

Education of physicians and allied health care professionals in Rehabilitation Medicine,

both local and foreign, for programs related to Physical & Rehabilitation Medicine;

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

through research and medical education;

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 disability;

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. Setting standards for compensation of Physical & Rehabilitation Medicine services.

2 7 BY

C. Guidelines for Practice in a Physical & Rehabilitation Medicine Facility:

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

2. Medications and various other forms of treatment shall be prescribed by a physical &
rehabilitation medicine specialist.

3. The physical & rehabilitation medicine specialist has the primary responsibility of
regularly following-up on patients in his charge and modifying or terminating treatment.

4. A Physical & Rehabilitation Medicine Specialist shall head facility or unit and
collaborate with the physical & rehabilitation team in the delivery of rehabilitation
medicine services.

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

‘SEC. 5. Qualifications to Practice. - A physician who is a Board Certified/Board Eligible
Physical & Rehabilitation Medicine Specialists, of good moral character and is a member of
the Accredited Professional Organization is qualified to practice Physical & Rehabilitation
Medicine.

SEC. 6. Accreditation and Certification. - This Act aims to establish the standards for the
practice of Physical & Rehabilitation Medicine and the certification of Physical & Rehabilitation
Medicine Specialists in order to ensure the highest quality of professional medical rehabilitation
service to the public and to the medical community.

A Physical & Rehabilitation Medicine Specialist to be eligible for accreditation shall be
@ graduate of a residency training institution accredited by the Philippine Academy of


Rehabilitation Medicine Specialty Board and recognized by the Accredited Professional
Organization.

‘SEC. 7. Regulatory Authority - Technical Standards and Requirements for the Registration,
Operation and Maintenance of Rehabilitation Medicine Facilities shall be implemented and
regulated by the Department of Health (DOH) Health Facilities and Services Regulatory
Bureau.

SEC. 8. Management and Operation of a Rehabilitation Medicine Facility. - A Physical &
Rehabilitation Medicine Facility shall be headed by a Physical & Rehabilitation Medicine
‘specialist who is either a PARM Specialty Board Certified or Eligible Physical Rehabilitation
Medicine specialist in the said facility.

SEC. 9. Classification of Facilities - Rehabilitation Medicine facilities shall be classified
according to the institutional character, and extent of services offered. The bases for the
classification of the different categories of Rehabilitation facilities are: (1) 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.
A. Categories
i. As to institutional character, a 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).
ji. Asto the extent of services, a Physical and Rehabilitation Medicine facilities
maybe primary, secondary.tertiary, or home-based.
ili. As to function, a Physical and Rehabilitation Medicine facility may be
utilized for training services and research or for services alone.
iv. As to services, a rehabilitation Medicine facility can also be either general
or specialized.
BA Poimeny rehabilitation Medicine facility shall have the following:
Atleast one (1) PARM Speciaity Board eligible physiatrist;
i At least one (1) allied rehabilitation health professional;
ili, Physical & Rehabilitation Medicine consultation and management with
physical therapy services;
iv. Physical set-up;
v. Medical consultation area;
vi. Treatment area to include at least an electrotherapy device and superficial
heating modality, and activities of daily living (ADL) training devices;
vii. Gym area, to include parallel bars, mirror, weights and assistive devices
such as canes, crutches, and walkers among others;
vil, Evaluation too!
e Adequate utilities such as water, electricity and consumables; and
First Aid kit with basic CPR equipment
CA secondary Rehabilitation Medicine facility shall have the following:
At least one (1) PARM Specialty Board certified Physiatris
At least one (1) licensed therapist and occupational therapist;
Rehabilitation Medicine consultation and management, physical and
occupational therapy services; and
iv. Compliance with the primary category set-up plus deep heating modality,
manual _ traction and therapeutic exercise equipment for the gym area.
D. A tertiary Rehabilitation Medicine facility shall have the following:
i, Atleast one (1) PARM Specialty Board certified Physical & Rehabilitation
Medicine Specialist
li, At least one (1) licensed physical therapist and occupational therapist;



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

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

v. A Training/Service and Research facility, which shall fulfill all the
fequirements as a residency training institution in accordance with PARM
SB guidelines.

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

SEC. 10. Management and Operation of a Rehabilitation Medicine Facility. - A Physical
and Rehabilitation Medicine Facility shall be headed by a Physical & Rehabilitation Medicine
specialist who is either a PARM SB Certified or Eligible Physical and Rehabilitation Medicine
specialist in the said facility. An adequate and effective system of documentation, recording
and recordkeeping must be maintained for all consultations and services in the facility. The
rales for consultation and services shall be in accordance with the standards of the Accredited
Professional Organization and PhilHealth.

SEC. 11. Application for Registration and Issuance of License. -Applications for
registration and issuance of a license shall be filed by the owner of the facility or his duly
authorized representative with the Department of Health (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 together with
the license fee, the PARM technical committee team will inspect the facilty within sixty (60)
days. Certificates of licenses shall be issued and approved by the Head of the Department of
Health (DOH) Health Facilities and Services Regulatory Bureau. A provisional license may be
granted to facilities with insufficient requirements for special cases for a period of one (1) year.

SEC. 12. Terms and Validity of License. — The license to operate valid for a 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 should also be readily available. In any violation of the standards
provided, the license to operate may be revoked. Investigation of all charges or complaints
against a Physical and Rehabilitation Medicine facility or any of its personnel shall be made to
the Accredited Professional Organization (when complaint is against the Physical &
Rehabilitation Medicine Specialist) and to the Department of Health (DOH) Health Facilities
and Services Regulatory Bureau for appropriate investigation.

SEC. 13. Penalties. — Any person, partnership, association, or corporation who establishes,
‘operates, conducts, manages or maintain a rehabilitation medicine facility within the meaning
of this Act without first obtaining a license or violates any provision of this Act or its
Implementing Rules and Regulations shall be liable to fine of not less than Forty Thousand
Pesos (Php 40,000.00) but not to exceed One Hundred Thousand Pesos (Php 100,000.00)
for the first offense, and not less than One Hundred Thousand Pesos (Php 100,000.00) but
not to exceed One Hundred Thousand Pesos (Php 100,000.00) for the second offense, and
not less than Two Hundred Thousand Pesos (Php 200,000.00) but not to exceed Four
Hundred Thousand Pesos (Php 400,000.00) for the third and each 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
Department of Health (DOH) Health Facilities and Services Regulatory Bureau, upon the


approval of the Secretary of Health, may summarily order the closure of any rehabilitation
medicine facility found without license.

SEC. 14, Implementing Rules and Regulations (IRR). to implement provisions of this Act,
The Department of Health (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
rehabilitation medicine facilities, within ninety (90) days after the effectivity of this Act.

SEC. 15. Separability Clause. —if any part or provision of the Act shall be held unconstitutional
or invalid, other Provisions hereof which are not affected hereby shall continue to be in full
force and effect.

SEC. 16. Repealing Clause. — All laws, decrees, rules and regulation inconsistent with the
provision of this Act hereby repealed or modified accordingly.

SEC. 17. Effectivity. - This shall take effect after fifteen (15) days from its publication in two
(2) national newspaper of the general circulation.

Approved.