REPUBLIC OF THE PHILIPPINES
HOUSE OF REPRESENTATIVES
Quezon City

SEVENTEENTH CONGRESS

ome, APRTS iu

Introduced by MAGDALO Party-List Representative
HON. GARY C. ALEJANO

EXPLANATORY NOTE

In the past decade, Rehabilitation Medicine as a specialty has experienced growth in all
aspects. The number of trainees, graduates, and certified diplomats and fellows has increased
tremendously.

Alarming, however, is the fast pace at which rehabilitation centers have sprouted throughout
the country, all with the noble intent of delivering expert rehabilitative care to Filipinos
suffering from neuromusculoskeletal, cardiovascular, pulmonary, and other system disorders
which produce temporary or permanent disability. Unfortunately, not all these rehabilitation
centers are rendering what they purport to render.

Moreover, many of these rehabilitation centers are not headed by a physiatrist - a medical
specialist who has trained a minimum of three (3) years in Rehabilitation Medicine - but by
other medical and allied health professionals. By the nature of their training, physiatrists are
in the best position to head rehabilitation centers and supervise the allied rehabilitative
professionals: physical therapist, occupational therapists, speech therapist, orthotists, and
prosthetists.

In the medical field, it is a physiatrist who is the specialist in medical rehabilitation and who
is thus tasked to evaluate and treat patients with physical disabilities from the rehabilitation
standpoint, and to manage and administer Rehabilitation Medicine departments, center,
clinics or other similar facilities.

It is the objective of the proposed Rehabilitation Medicine Standard Act to set standards for
the training and practice of Rehabilitation Medicine. This bill further sets technical and
operational standard for rehabilitation centers which will function at the highest level of
standard and be headed and supervised by duly trained and certified medical specialists in
rehabilitation medicine, thereby protecting the interest of the Filipino patients who seck
treatment from these centers.

In view of the foregoing, immediate approval of this bill i



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REPUBLIC OF THE PHILIPPINES
HOUSE OF REPRESENTATIVES
Quezon City

SEVENTEENTH CONGRESS
First Regular Session

_ 5472

House Bill No.

Introduced by MAGDALO Party-List Representative
HON. GARY C. ALEJANO

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."

SEC. 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.

SEC 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 tasked with accrediting and 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
concemed 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.


1 SEC. 4. Scope of Practice. - The practice of Rehabilitation Medicine includes:
>
3 A) Professional services related to the care of an individual patient, either as a
4 physician primarily responsible for individual patient care or as a consultant to
3 another physician namely
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1 1) History taking, examination of patients and/or performance of
8 specific diagnostic procedures for purposes of establishing
9 diagnosis and/or evaluation of disability, impairment, functional
10 capacity and potential for rehabilitation;
nN
12 2) Prescription and/or rendering of appropriate medical treatment
13 which may include any or all aspects of physical medicine as well
4 as rehabilitative measures, including but not limited to physical
15 therapy, occupational therapy, speech therapy and orthotic and
16 prosthetic services;
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18 3) Follow-up examination of patients in offices, hospitals,
19 rehabilitation facilities, extended care facilities or home for
20 purposes of reevaluation and treatment modifications;
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22 4) Appropriate consultation with other medical specialists;
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24 5) Counseling and conference with non-physician health care
25 professionals or family concerning conduct of patient's care or
26 patient's progress; and
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28 6) Examination of patient's records, preparation of reports and
29 correspondence, appearance in testimony pertaining to patient.
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31 B) Professional services related to the administration of rehabilitation facilities or
32 limits, namely:
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34 1) Professional general supervision of rehabilitation services in a
35 hospital-based rehabilitation center or unit, or any other free
36 standing units that render limited rehabilitation services,
37 convalescent home and private homes, for quality assurance and
38 appropriate utilization of services;
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40 2) Planning, establishment and management of facilities, equipment
41 and personnel for functions and activities for rehabilitation
42 department or unit, or any other free standing unit that render
43 limited rehabilitation services, convalescent home and private
44 homes, for quality assurance and appropriate utilization of services;
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46 3) Maintenance of adequate records and statistics;
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48 4) Education of physicians and allied health care professionals of
49 Rehabilitation Medicine;
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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 an
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.

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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.

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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.

SEC 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

SEC. 6. Accreditation and Certification.- This Act aims to establish the standards for
the 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

©) 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

©) 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

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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 Rehabilitation Medicine 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.

SEC.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.

SEC. 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).

SEC. 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 psychiatrist;


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2. At least one (1) allied 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. Atleast 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.

4) A tertiary Rehabilitation Medicine facility shall have the following

1. Atleast 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 category 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

SEC. 10. Management and Operation of a Rehabilitation Medicine Facility. -
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

SEC. 11. 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 with the DOH-BHFS 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

SEC. 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.

SEC. 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 (P50,000.00) 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

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

SEC. 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.

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 regulations inconsistent
with the provision of this Act are hereby repealed or modified accordingly

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

Approved,