HULSE OF REPRESENTATIVES

Republic of the Philippines RECEIVED
HOUSE OF REPRESENTATIVES 01 AUG 2016
Quezon City, Metro Manila DATE:
ive: #

SEVENTEETH CONGRESS

HOUSE BILL NO. 216)

Introduced by Rep. Florida P. Rl

EXPLANATORY NOTE

When people suffer from physical impairments or disabilities due to acute
illness or injury such as stroke, spinal cord injuries, heart surgery, amputation,
joint replacement, sports injuries or spinal disorders, they undergo rehabilitation
to restore their health and functional abilities under the supervision of a
physiatrist or rehabilitation doctor. The sensitivity of the nature of intervention
calls for a government regulation to ensure that the patient is given proper care
according to technical standards and norms of practice. Hence, the practice of
rehabilitation medicine must be regulated through the enforcement and
implementation of guidelines based on international standards in order to

prevent any untoward complications that may result in the process.

This bill which seeks to provide for the technical standards on the
Operation and maintenance of Medical Rehabilitation Facilities in the
Philippines is in consonance with State policy to espouse an integrated and
comprehensive approach to health development which shall endeavor to make
essential goods, health and other social services available to the people. With
this said, the rehabilitation of patients to regain back or at least prevent further
deterioration of his or her physical, physiological, health should be a pivotal

concern of the government.


By providing standards in the practice of the profession of medical
rehabilitation, patients are assured that they will be in good hands. It is for this
reason that this bill should be given priority. Approval of this bill is earnestly
sought.

FLOBADA P. ROBES


Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City, Metro Manila

SEVENTEETH CONGRESS
First Regular Session

HOUSE BILLNO. 2156

Introduced by Honorable Florida P. Robes

AN ACT
PROVIDING FOR THE TECHNICAL STANDARDS ON THE OPERATION
AND MAINTENANCE OF MEDICAL REHABILITATION FACILITIES IN
THE PHILIPPINES 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.”

SEC. 2. — Definition of Terms. — As used in this Act, the following terms
shall mean:

a) Rehabilitation Medicine — is 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 of both sexes and all ages, as well as the
performance of different diagnostic procedures including but not limited to
electromyography and other electrodiagnostic techniques. Rehabilitation Medicine
involves specialized medical care and training of patients with loss of function so that
he/she may obtain his/her maximum potential, physically, psychologically, socially
and vocationally with special attention to prevent unnecessary complications or

deterioration and to assist in physiologic adaptation to disability. In addition, the

practice of Rehabilitation Medicine uses physical agents such as heat, light, water,
electricity, therapeutic exercise and mechanical agents in its treatment

armamentarium.



b) Medical Rehabilitation - is the process of “helping a person to reach the
fullest physical, psychological, social, vocational, avocational and educational
potential consistent with his or her physiologic or anatomic impairment,
environmental limitation, and life plans.

©) Physiatrist - is a physician who is licensed and duly registered with the
Professional Regulations Commissions and who has completed residency training in
Rehabilitation Medicine in a Philippine Board of Rehabilitation Medicine-accredited
training institution.

d) Philippine Academy of Rehabilitation Medicine (PARM) - an
organization of medical specialists and trainees ii: Rehabilitation that seeks to
achieve excellence in physiatric practice, education and research.

e)Philippine Board of Rehabilitation Medicine (PBRM) — a non-
stock, non-profit corporation composed of Board Vertified Rehabilitation Medicine
specialists tasked with accrediting and evaluating training institutions with a
specialty in Rehabilitation Medicine, and certifying graduates of these training
programs.

£) Board Certified Physiatrists - refers to members of good standing of the
Philippine Academy of Rehabilitation Medicine (PARM) who have passed the
Diplomate examination given by the Philippine Board of Rehabilitation Medicine
(PBRM).

8) Board Eligible (BE) Physiatrists - refer to those who have completed
residency training in a PBRM-aceredited residency training program and who have
not been qualified by the PBRM as diplomate.

h) Rehabilitation Mediene Center/Facility/Unit — any facility that
renders services for the rehabilitation of physical disabilities. this maybe hospital
based or free standing.

i) Rehabilitation Medicine Team ~ is a group of medical and allied health
professionals concerned with the medical rehabilitation of patients with physical


disabilities. the team is headed by a physiatrist and is composed of, but not limited

to the following:

1. Physical Therapists
.. Occupational Therapists

. Prosthetists And Orthotists
.. Rehabilitation Nurses

. Speech Therapists

. Social Workers

. Vocational Counselors

SY AGRO LW

. Recreational Therapists
SEC. 3. - Guidelines for practice in a Rehabilitation Medicine

Facility:

4,

Every patient shall be examined and diagnosed by a board certified or board
eligible physiatrist. The board certified or board eligible physiatrist
recommends, prescribes and supervises an individual treatment plan. The
treatment plan and rehabilitation program shall be regularly reviewed on a
team basis.

.. Medications and various other therapies shall be prescribed by a physiatrist.
. The board certified or board eligible physiatrist has the primary responsibility

of regularly following patients in his charge and modifying or terminating,
treatment.

. A board certified or board eligible physiatrist shall head the facility/unit and

shall supervise the delivery of rehabilitation medicine services rendered by
other members of the rehabilitation medicine team.

Ifa board certified or board eligible physiatrist is not competent to manage a
patient, he shall consult or refer to another physiatrist or physician specialist
who is competent in the particular disease or condition he is treating.

. In the absence of a board certified physiatrist, a board eligible physiatrist may

head the facility, provided he conforms with the requirements of the PBRM.

. The board certified or board eligible physiatrist shall charge professional fees

in accordance with the standards of the PARM and the Philippine Health
Insurance System (PhilHealth).

The board certified or board eligible physiatrist shall conduct himself in a
manner consistent with the code of ethics of the Philippine Medical
Association.


SEC. 4. - Qualifications to Practice - A Physician is qualified to Practice
Rehabilitation Medicine if he/she is a Board Certified or Board Eligible physiatrist
who is of good moral character; and is a member of good standing of the Philippine
Medical Association and the Philippine Academy of Rehabilitation Medicine.

SEC. 5. - Technical Standards and Requirements for the
Registration, Operation and Maintenance of Rehabilitation Medicine
Facilities in the Philippines - shall apply to all entities performing the activities
and funetions of Rehabilitation Medicine facilities. ‘These shall include the
evaluation, and treatment of all conditions requiring rehabilitation of physical
disabilities. These standards and requirements are formulated to protect and
promote the health of the people by the operation of standard, properly managed and
adequately supported Rehabilitation Medicine facilities.

SEC. 6. - Regulatory Authority - Implementation of the Technical
Standards and Requirements for the Registration, Operation and Maintenance of
Rehabilitation Medicine Facilities in the Philippines shall be regulated by the
Department of Health ~ Bureau of Health Facilities and Services (DOH-BHFS)
through a technical committee with representatives from the Philippine Academy of
Rehabilitation Medicine (PARM).

SEC. 7. — Classification of Facilities - Rehabilitation Medicine Facilities
shall be classified according to its institutional character, extent of services offered.
The bases for the classification of the different categories of Rehabilitation facilities
are: (1) Board Certified or Board Eligible Physiatrist qualification, (2) Allied Health
personnel staff qualification, (3) Rehabilitation Medicine services available and (4)

Physical set-up and equipment.

A. Categories
1, As to institutional character, Rehabilitation Medicine facilities are either
hospital-based (if operating within a hospital set-up) or freestanding Gf
operating on its own or part of a facility other than hospital)
2. As to extent, a Rehabilitation Medicine facility maybe primary, secondary or
tertiary, or home-based.


B.

D.

3. As to function, a Rehabilitation Medicine facility may be utilized for training,
service and research, and or service alone.
4. As to service, a Rehabilitation Medicine facility can also be either general or
specialized.
Aprimary Rehabilitation Medicine facility shall have the following:
1, At least one Philippine Board of Rehabilitation Medicine (PBRM) eligible
Physiatrist

2. At least one licensed allied rehabil
3. Rehabilitation Medicine Consultation and Management with Physical or
Occupational Therapy services

ation health professional.

4. Physical set-up

5. Medical Consultation area

6. Treatment area to include at least an electrotherapy device and superficial
heating modality and ADL training devices.

7. Gym area to include parallel bars, mirror, weights and assistive devices
(canes, crutches and walker)

8. Evaluation tools

9. Adequate utilities (water, electricity and consumables)
10. First aid kit with Basic CPR equipment
A secondary Rehabilitation Medicine facility shall have the following:
1, At least one PBRM board certified Physiatrist
2. At least one licensed Physical Therapist and Occupational Therapist
3. Rehabilitation Medicine consultation and Management, Physical Therapy
and Occupational Therapy services.
4. Compliance with the primary category set-up plus deep heating modality,
manual traction and therapeutic exercise equipment for the gym area
. A tertiary Rehabilitation Medicine facility shall have the following:
1, At least one (1) Board Uertified Physiatrist
2. At least two (2) licensed Physical Therapists and one licensed Occupational

Therapist

3. Rehabilitation Medicine Consultation and Management, Physical,
Occupational Therapy, Prosthetist/Orthotist in house or referral services,
speech therapy in house or referral services.

4. Compliance with the secondary category set-up and equipment, with
additional two superficial heating modalities, medium frequency modality,


mechanized traction, ultraviolet or cold laser intermittent _ compression
unit, mechanized intermittent traction and tilt table with additional gym
equipment.

. A Training / Service and Research facility, which shall fulfill have all the
requirements as a residency training institution in accordance with PBRM

9

guidelines.
.. Specialized facility, the facility should cater to a subspecialty condition in
Rehabilitation Medicine (Cardiac, Pain, Pediatric, Pulmonary, Sports,
among others). Shall be a hospital-based facility with a multidiseiplinary
set-up.
7. A freestanding clinic must be headed by a board certified or board eligible
phys
certificate in Basic Life Support.

2

trist with at least one (1) licensed allied health professional with a

SEC. 8. - Management and Operation of a Rehabilitation Facility — a
Rehabilitation Medicine Facility shall be headed by a Rehabilitation Medicine
specialist who is either a Philippine Board of Rehabilitation Medicine certified or
eligible Rehabilitation Medicine Specialist who must assume technical and
administrative supervision and control of the activities in the said facility, An
adequate and effective system of documentation, recording, and records keeping
must be maintained for all consultation and services shall be in accordance with the
standards of the PARM and the PHILHEALTH.

SECT. 9. - Application for Registration and Issuance of License —
Applications for registration and issuance of a license shall be filed by the owner or
his duly authorized representative to DOH-Bureau of Facilities and Services together
with an Information sheet to be filled up by the Physiatrist in charge. Upon receipt
of the said application together with the license fee, o technical committee team will
inspect the facility. Certificates of licenses shall be issued and approved by the Head
of the Bureau of Health Facilities and Services. A provisional license may be granted
to facilities with insufficient requirements or for special cases for a period of one (1)
year.

SEC. 10. - Terms and Validity of License - ‘The license to operate will
only be 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 regulation should also
be readily available. Upon violation of the standards provided, a license may be
revoked. Investigation of all charges or complaints against a Rehabilitation facility or
any of its personnel shall be made to the PARM and the PBRM (when complaint is
against the physiatrist) and to the Department of Health-Bureau of Health Facilities
and Services for appropriate investigation.

SEC. 11. ~ Penalties — Any person, partnership, association, or corporation
who establishes, operates, conducts, manages or maintains 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 a
fine of not less than twenty thousand pesos (P20,000.00) but not to exceed fifty
thousand pesos (P50,000.00) for the first offense, and not less than fifty thousand
pesos (P50,000.00) but not to exeeed one hundred thousand pesos (P100,000.00)
for the second offense, and not less than one hundred thousand pesos (100,000.00)
but not to exceed two hundred thousand pes:

's (P200,000.00) for the third and each
subsequent offense. Each day that the health 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, may summarily order the closure of any rehabilitation
medicine facility found operating without a license.

SEC. 12. — Separability Clause — If any part or provision of the Act shall
be held unconstitutional or inv:

other provisions hereof which are not affected
hereby shall continue to be in full force and effect.

SEC. 13. — Repealing Clause — All laws, orders, decrees, rules and
regulations inconsistent with the provision of this Act are hereby repealed or
modified accordingly.

SEC. 14. ~ Effectivity — This Act shall take effect fifteen (15) days after its

approval.

Approved,