Republic of the Philippines
HOUSE OF REPRESENTATIVES
Constitution Hills, Quezon City

EIGHTEENTH CONGRESS
First Regular Session

707
House Bill No. oy

Introduced by REPRESENTATIVE ERIC L. OLIVAREZ

EXPLANATORY NOTE

In the World Health Organization’s Declaration of Alma Ata
in 1978, four healthcare strategies were recognized: promotion,
prevention, cure or treatment, and rehabilitation. Of the four
strategies, Rehabilitation strategies had received the least
attention. However, due to the rapidly aging world population,
resulting from better healthcare and increased survival,
noncommunicable diseases are becoming the primary source of
mortality. People are living longer but with more disability.

Physical and Rehabilitation Medicine is the health strategy
that will address the increasing prevalence of disability. The focus
of Physical and Rehabilitation Medicine is to improve the lives of
people living with health condition, whether it is acute, chronic or
progressively debilitating.

The objective of Physical and Rehabilitation Medicine is
specifically to optimize people’s intrinsic health capacity, including
strengthening psychological resources, facilitating the person’s
immediate environment and in the process improving his function
and state of health.

World Health Organization (WHO) has recently concluded
that demographic and epidemiological trends are in the process of
transforming rehabilitation into the key health strategy of the 21st
Century. In 2010, the WHO has described five main health care
strategies: curative, rehabilitative, maintenance or supportive,


preventive and palliative strategies. Rehabilitation strategy aim to
reduce the burden of disease and improve function.

As our population age, we need to produce more Physical and
Rehabilitation Medicine Physicians and Centers in the community,
primary, secondary and tertiary level to ensure that every Filipino
will be able to optimize their function, community participation
and productivity despite their disability.

In February 2017, WHO hosted “Rehabilitation 2030: A Call
to Action”, a meeting that brought about more than 200
rehabilitation experts from 46 countries. The stakeholders
concluded that there is an increasing global unmet need for
rehabilitation, calling for coordinated action and commitment
amongst stakeholders to raise the profile of rehabilitation as a
health strategy relevant to all people from all ages across the
continuum of care.

The key actions identified were improving rehabilitation
management and _ investment, building a high-quality
rehabilitation workforce and services; and enhancing data
collection on rehabilitation.

With this proposed measure, it will empower the Department
of Health to standardize Physical and Rehabilitation Medicine
centers, help produce more Physical and Rehabilitation Medicine
specialists and paramedical professionals, improve delivery of safe
and accessible physical and rehabilitation medicine services,
increase public awareness through nationwide information,
communication and education campaign on how Physical and
Rehabilitation Medicine can minimize disability and optimize
function.

The passage of this measure is earnestly sought.

eau COW,

ERIC OLIVAREZ


Republic of the Philippines
HOUSE OF REPRESENTATIVES
Constitution Hills, Quezon City

EIGHTEENTH CONGRESS
First Regular Session

5707
House Bill No.

Introduced by REPRESENTATIVE ERIC L. OLIVAREZ

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 of 2019"

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 accessible, effective and affordable to Filipinos suffering from
neuromusculoskeletal, cardiovascular, pulmonary and other
system disorders which produce temporary or permanent
disability. 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 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, 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
and 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 plans.

c. Physical and 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 and Rehabilitation Medicine in a
training institution accredited by the Philippine Academy of
Rehabilitation Medicine Specialty Board. They shall be qualified by
the PARM Specialty Board as:

mh Board Eligible Physical and 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.

ii. Board Certified (Diplomate) - refers to those have passed
Part I (written) and Part II (oral) of the Diplomate Board


Examination given by the PARM Specialty Board
examination.

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 and Rehabilitation Medicine Specialists.

e. 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.

f.  Physiatrist - synonym for Physical and Rehabilitation
Medicine Specialist.

g. Physical and Rehabilitation Medicine Facility — any facility
that renders services for the rehabilitation of physical disabilities
and which may be hospital-based or free-standing.

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

i. Physical and Rehabilitation Medicine Specialists
ii, 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.

xii.

xiii.

xiv.

xv.

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

Musculoskeletal Sonographer

Certified Strength and Conditioning Coach
Special Education (SPED) Teachers
Neuropsychologist

Physical Therapy Aide

a. 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:

af

iii.

iv.

vi.

History taking, examination of patients, 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;

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, orthotic and
prosthetic services, joint and trigger point injections,
ultrasound guided interventional procedures;
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;
Psychological counseling and conference with non-
physician health care professionals or family members
concerning 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


b.

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 consist of:

a

ii.

vi.

vii.

viii.

xi.

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;

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 and
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;
Designing, planning and implementing health programs
for maintenance of health and prevention of disability;
Establishing linkages with government and non-
government agencies, both local and foreign, for
programs related to Rehabilitation Medicine;

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

Setting standards for compensation of Physical and
Rehabilitation Medicine services.


(a Guidelines for Practice in a Physical and Rehabilitation
Medicine Facility:

i, 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.

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

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

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

v. The Physical and 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 Physical and Rehabilitation Medicine Specialists,
of good moral character and is a member of the Accredited
Professional Organization is qualified to practice Physical and
Rehabilitation Medicine.

SEC. 6. Accreditation and Certification. — A Physical and
Rehabilitation Medicine Specialist eligible for accreditation should
be a graduate of a residency training institution accredited by the
Philippine Academy of Rehabilitation Medicine Specialty Board
and recognized by the Accredited Professional Organization (APO).

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 and Rehabilitation Medicine
Facility shall be headed by a Physical and 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).

iii As to the extent of services, a Physical and
Rehabilitation Medicine facilities maybe primary,
secondary, tertiary, or home-based.

iii. 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.

b. A Primary Physical and Rehabilitation Medicine Facility
shall have the following:
i. At least one (1) PARM Specialty Board Certified or Board

eligible Physical and Rehabilitation Medicine Specialist;

ii, At least one (1) allied rehabilitation health professional;

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

iv. Physical set-up;

v. Medical consultation area;


vi.

vii.

viii.

ix,

x

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

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

Evaluation tools;

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

First Aid kit with basic CPR equipment

¢. A Secondary Physical and Rehabilitation Medicine Facility
shall have the following:

oh
ii.
iii.

iv.

aA
following:
Ay

ii,

iv.

At least one (1) PARM Specialty Board certified or Board
Eligible Physical and Rehabilitation Medicine specialist;
At least one (1) licensed therapist and occupational
therapist;

Rehabilitation Medicine consultation and management,
physical and occupational therapy services; and,
Compliance with the primary category set-up plus deep
heating modality, manual traction and therapeutic
exercise equipment for the gym area,

Tertiary Rehabilitation Medicine Facility shall have the

At least one (1) PARM Specialty Board certified Physical
and Rehabilitation Medicine Specialist;

At least one (1) licensed physical therapist and
occupational therapist;
Physical and Rehabilitation Medicine consultation and
management, physical therapy, occupational therapy,
speech therapy, prosthetics and orthotics in-house or
referral services;

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 tilt table with additional gym
equipment;

A Training/Service and Research facility, which shall
fulfill all the requirements 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 and Rehabilitation Medicine
specialist who is either a PARM Specialty Board Certified or Board
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 rates 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 facility 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 and
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:

First offense - not less than Forty Thousand Pesos (Php
40,000.00) but not to exceed One Hundred Thousand Pesos (Php
100,000.00);

Second offense ~ not less than One Hundred Thousand Pesos
(Php 100,000.00) but not to exceed One Hundred Thousand Pesos
(Php 100,000.00);

Third and each subsequent offense — not less than Two
Hundred Thousand Pesos (Php 200,000.00) but not to exceed Four
Hundred Thousand Pesos (Php 400,000.00).

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 aforementioned penalties, 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 a
license.

SEC. 14. Implementing Rules and Regulations (IRR). — to
implement the 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 section shall
be declared unconstitutional or invalid, such declaration shall not
affect the other parts or sections of this Act.

SEC. 16. Repealing Clause. - All laws, decrees, rules and
regulations inconsistent with any provision of this Act shall be
deemed 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 or in the Official Gazette.

Approved.