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Republic of the Philippines RECEI VED a
HOUSE OF REPRESENTATIVES OATE he St 1
Quezon City rime, 286 ]

EIGHTEENTH CONGRESS
First Regular Session
2213
HOUSE BILL NO.

Introduced by Representative Ferdinand L. Hernandez

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

EXPLANATORY NOTE

Rehabilitation Medicine, also known as physiatry, is a branch of medicine that aims to
restore the functional ability of those with physical impairments and disabilities in order to
enhance the quality of their living. It has experienced tremendous growth over the past
several years, as seen in the rise of the number of graduates and medical professionals
practicing the said discipline.

Rehabilitation centers are also fast emerging throughout the country, with the intent to
deliver expert and comprehensive rehabilitative care to each patient’s unique needs. In
order to become effective in providing safe and patient-centered treatment plans, these
centers must be headed by a physiatrist- a medical specialist who has completed a
minimum of three (3) years of training in Rehabilitative Medicine. Physiatrists have 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. Also,
they are capable of supervising the allied medical professionals and other integral members
of the care team, including but not limited to physical therapists, occupational therapists,
speech therapists, orthotists, and prosthetists.

Also, it is vital that these facilities are furnished with the right equipment and medical tools
in order to make an accurate diagnosis and implement a specific treatment plan to help the
patients restore their physical mobility and function and eventually maximize their
independence in their daily activities.

This proposed Rehabilitation Medicine Standard Act seeks to set standards for the training
and practice of the Rehabilitation Medicine. Furthermore, it is also the objective of the bill
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 interest of all those who seek treatment from these centers.



In view of the foregoing, the immediate passing of this bills is earnestly sought.

HERNANDEX



Republic of the Philippines
HOUSE OF REPRESENTATIVES
Quezon City

EIGHTEENTH CONGRESS
First Regular Session

HOUSE BILL No. 2213
Introduced by Representative Ferdinand L. Hernandez

AN ACT PROVIDING FOR THE STANDARD 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 of 2017.”

Section 2. Declaration of Policy. — It is the policy of the State to protect and promote
the right to health of the people by an accessible delivery of expert rehabilitative care to
Filipinos suffering from neuromusculoskeletal, cardiovascular, pulmonary, and other system
disorders which produce temporary or permanent disability. This shall be realized by
standardizing the practice of Rehabilitation Medicine and standardizing the establishment,
management, and operational aspects of rehabilitation facilities.

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

A) 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 procedures,
including but not limited to, electromyography and other electro diagnostic
techniques. It also involves specialized medical care and training of patients with loss
of function so that s/he 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 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 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;


C) Physiatrist — a physician who is licensed and duly registered with the Professional
Regulation Commission and who has completed three years of residency training in
Rehabilitation Medicine in a Philippine Board Rehabilitation Medicine-accredited
training institution,

D) Philippine Board of Rehabilitation Medicine (PBRM) ~ a non-stock, non-profit,
corporation, duly recognized by the Professional Regulation Commission and the
Philippine Medical Association, composed of Board Certified Rehabilitation
Medicine Specialists taked with accrediting, evaluating training institutions with a
specialty in Rehabilitation Medicine, and certifying graduates of these training
programs;

E) Rehabilitation Medicine Practitioner/Physiatrist — a licensed physician who has
completed a residency training program in Rehabilitation Medicine in a Philippine
Board of Rehabilitation Medicine (PBRM) accredited training institution. They shall
be qualified by the PBRM as

1) Board Eligible Physiatrist — refers to those who have completed the
residency training in a PBRM-accredited residency training program but who
have not successfully completed the specialty board examination; and

2) Board Certified (Diplomate) ~ refers to those who have passed Part I
(written) and Part II (oral) of the Diplomate Board Examination given by the
Philippine Board of Rehabilitation Medicine (PBRM).

F) Rehabilitation Medicine Center/Facility/Unit — any facility that renders services for
the rehabilitation of physical disabilities. This may be hospital-based or free standing;
and

G) Rehabilitation Medicine Team ~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;

2) Occupational Therapists;
3) Prosthetists and Orthotists;
4) Rehabilitation Nurses,

5) Speech Pathologists;

6) Social Workers;

7) Vocational Counselors; and
8) Recreational Therapists.

Section 4. Scope of Practice. — The practice of Rehabilitation Medicine includes:
A) Professional services related to the care of an individual patient, either as a

physician 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 for purposes of establishing diagnosis and/or evaluation
of disability, impairment, functional capacity and potential for rehabilitation;

2) Prescription and/or 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,
speech therapy and orthotic and prosthetic services,

3) Follow-up examination of patients in offices, hospitals, rehabilitation
facilities, extended care facilities or home for purposes of reevaluation and
treatment modifications;

4) Appropriate consultation with other medical specialists;

5) Counseling and conference with non-physician health care professionals or
family concerning conduct of patient's care or patient’s progress; and

6) Examination of patient's records, preparation of reports and
correspondence, appearance in testimony pertaining to patient.

B) Professional services related to the administration of rehabilitation facilities or
limits, namely:

1) Professional general supervision of rehabilitation services in a hospital-
based rehabilitation center or unit, or any other free standing 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 functions and activities for 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;

3) Maintenance of adequate records and statistics;

4) Education of physicians and allied health care professionals of
Rehabilitation Medicine,

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

6) Providing professional development of Rehabilitation Medicine through
research and medical education;

7) Designing/planning/implementing of health programs for maintenance of
health and prevention of disability;


8) Linkages with government and non-governmental agencies, both local and
abroad, 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 Rehabilitation Medicine services
rendered.

C) Guidelines for Practice in a Rehabilitation Medicine Facility

1) Every patient shall be examined and diagnosed by a physiatrist. The
physiatrist. recommends, prescribes and supervises and individual
treatment plan. The treatment plan and rehabilitation program shall be
regularly reviewed on a team basis.

2) Medications and other various therapies shall be prescribed by a physiatrist.

3) The physiatrist has the primary responsibility of regularly following
patients in his charge and modifying or terminating treatment.

4) A physiatrist shall head the facility/unit and shall supervise the delivery of
rehabilitation medicine services rendered by other members of the
Rehabilitation Medicine team. In areas where there is no physiatrist, a licensed
physician shall head the facility or unit.

5) If a physiatrist is non-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

6) A Board Certified physiatrist may head not more than three (3)
Rehabilitation Medicine facilities. In the absence of a Board Certified
physiatrist, a Board eligible physiatrist may head the facility, provided that
he conforms with the requirements of the PBRM

7) The physiatrist shall charge professional fees in accordance with the
standards of the Philippine Medical Association and the Philippine Health
Insurance System (PhilHealth).

8) The physiatrist shall conduct himself in a manner consistent with the Code
of Ethics of the Philippine Medical Association

Section 5. Qualifications to Practice. — A physician is qualified to practice
Rehabilitation Medicine if s/he is a Board Certified/Board Eligible physiatrist, who is of good
moral character, and is a member of the Philippine Medical Association.

Section 6. Accreditation and Certification. - This Act aims to establish the
standards for practice, and certification of Rehabilitation Medicine practitioners in order to
ensure the highest quality of professional rehabilitation service to the public and to the


medical community
A) Accreditation of the Physiatrist

1) The Rehabilitation Medicine Practitioner is a graduate of a Philippine
Board of Rehabilitation Medicine (PBRM) — accredited Rehabilitation
Medicine training institution and certified by the PBRM as.

a) Board certified (Diplomate); and
b) Board Eligible

2) A Rehabilitation Medicine Practitioner is duly recognized as PBRM Board
Certified upon compliance with and/or submission of the following
requirements:

a) Authenticated Professional Regulation Commission (PRC) ID as
duly registered physician;

b) Certificate of completion of training in a PBRM accredited
Rehabilitation Medicine training institution; and

c) Certificate from the Philippine Board of Rehabilitation Medicine
(PBRM).

3) A Rehabilitation Medicine Practitioner is duly recognized as PBRM Board
Eligible upon compliance with and/or submission of the following
requirements

a) Authenticated Professional Regulation Commission (PRC) ID as
duly registered physician;

b) Certificate of completion of training in a PBRM accredited
Rehabilitation Medicine training institution, and

c) Certificate of eligibility from PBRM

4) A Rehabilitation Medicine Practitioner, who is duly recognized as PBRM
Board Eligible, must upgrade himself to PBRM Board Certified status within
five (5) years after graduation from a PBRM-accredited Rehabilitation
Medicine training institution. Forfeiture of this Board eligibility status is
incumbent upon review and evaluation of the PBRM Board of Governors.

B) Continuing Certification of the Reh: ine Specialist. — A certified
Diplomate of the Philippine Board of Rehabilitation Medicine, in order to be duly
recognized as a Rehabilitation Medicine Specialist, must undergo recertification every
three (3) years through PBRM accreditation

Section 7. Technical Standards and Requirements for the Registration,


Operation and Maintenance of Rehabilitation Medicine Facilities in the Philippines. ~
Technical standards and requirements for the registration, operation and maintenance of
rehabilitation medicine facilities shall apply to all entities performing the activities and
functions of Rehabilitation Medicine facilities. These shall include the evaluation and
treatment of all conditions requiring rehabilitation of physical disabilities. These standards
and requirements shall be formulated to protect and promote the health of the people by the
operation of standards, properly managed and adequately supported Rehabilitation Medicine
facilities.

Section 8. Regulatory Authority. - Technical standards and requirements for the
registration, operation and maintenance of Rehabilitation Medicine facilities in the
Philippines shall be implemented and regulated by the Department of Health — Bureau of
Health Facilities and Services (DOH-BHFS).

Section 9. Classification of Facilities. — Rehabilitation Medicine facilities shall be
classified according to its institutional character, and extent of services offered. The bases for
the classification of the different categories of Rehabilitation facilities are (1) 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 (if
operating on its own or part of a facility other than a hospital);

2. As to extent, Rehabilitation medicine facilities maybe primary, secondary or
tertiary, or home-based;

3. As to function, Rehabilitation Medicine facilities may be utilized for
training, service and research, or service alone; and

4. As to service, Rehabilitation Medicine facilities can also be either general or
specialized

b) A primary Rehabilitation Medicine facility shall have the following:

1. At least one (1) Philippine Board Rehabilitation Medicine (PBRM) eligible
physiatrist;

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

3. Rehabilitation Medicine Consultation and Management with Physical
Therapy services;

4, Physical set-up;

5. Medical consultation area;


6. Treatment area to include at least an electro-therapy 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); and
10. First aid kit with basic CPR equipment
©) A secondary Rehabilitation medicine facility shall have the following
1. At least one (1) PBRM Board certified physiatrist;
2. At least one (1) licensed Physical therapist and Occupational therapist

3. Rehabilitation Medicine Consultation Management, Physical Therapy 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

d) A tertiary Rehabilitation Medicine facility shall have the following:
1. At least one (1) PBRM Board certified physiatrist;
2. At least one (1) licensed Physical therapist and 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); and

4. Compliance with secondary set-up and equipment, with additional two
superficial heating modalities, medium frequency modality, mechanized
traction, ultraviolet of 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 PBRM
guidelines;

6. A specialized facility, which should cater to sub-specialty conditions in
rehabilitation Medicine (Cardiac, Pain, Pediatric, Pulmonary, Sports, among
others), shall be a hospital-based facility with a multi-disciplinary set-up.

Section 10. Management and Operation of a Rehabilitation Medicine 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 consultations and
services in the facility. The rates for consultation and services shall be in accordance with the
standards of the Philippine Medical Association and PhilHealth.

Section 11. Application for Registration and Issuance of License. ~ Applications
for registration and issuance of license shall be filed by the owner or his duly authorized
representative with the DOH-BHES 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, a
technical committee team will inspect the facility within sixty (60) days. 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 for
special cases for a period of one (1) year.

Section 12, 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 regulations 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 Medicine facility or any of its personnel shall be made to
the PBRM (when complaint is against the physiatrist) and to the Department of Health-
Bureau of Health Facilities and Services for appropriate investigation.

Section 13. 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 (PS0,000.000) but not to exceed One
Hundred Thousand Pesos (P100,000.00) for the second offense, and not less than One
Hundred Thousand Pesos (P100,000.00) but not to exceed Two Hundred Thousand Pesos
(P200,000,.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 Bureau, upon the
approval of the Secretary, may summarily order the closure of any rehabilitation medicine
facility found operation without a license

Section 14. Implementing Rules and Regulations (IRR). — To implement the
provisions of this Act, the Department of Health — Bureau of Health Facilities and Services
(DOH-BHFS), 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 rehabilitation medicine facilities, within ninety (90) days after the effectivity
of this Act.

Section 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.

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

Section 17. Effectivity. — This shall take effect after fifteen (15) days from its
publication in two (2) national newspapers of general circulation.

Approved,