Republic ofthe Philippines

HOUSE OF REPRESENTATIVES /)’ RECEIVED
Quezon City, Metro Manila "2 CATEMAR 9 9 20
EIGHTEENTH CONGRESS
First Regular Session
wouse eu. no. °°29

Introduced by ACT-CIS Party-list Representative Rowena Nifia O. Taduran

EXPLANATORY NOTE

Physical & Rehabilitation Medicine, also known as Physiatry, is a branch of medicine that aims to
restore the functional ability of those with physical impairments, disabilities and handicaps in order to
enhance their quality of life. The specialty 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.

Physical and Rehabilitation Medicine centers are also fast increasing throughout the country, with
the noble 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 Physical and Rehabilitation Medicine Specialist who has completed a minimum of three (3)
years of raining 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. Also, they are capable of collaborating with other allied medical
professional and other integral members of the rehabilitative 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 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 Physical & Rehabilitation Medicine Standard Act seeks to set standards for the
training and practice of 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 interests of those who seek
treatment from these centers.

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



Republic ofthe Philippines
HOUSE OF REPRESENTATIVES
Quezon City, Metro Manila

EIGHTEENTH CONGRESS
First Regular Session

. 6515
HOUSE BILL NO.__

Introduced by ACT-CIS Party-list Representative Rowena Nifia O. Taduran

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 "Rehabilitation Medicine Standards Act of 2019"

Section 2. Declaration of Policy. - itis 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 Flipinos 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.

Section 3. - Definitions. - 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 rehabilitaion 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, 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 disabilty, impairment or
handicap. In addition, the practice of Physical & Rehabilitation Medicine uses agents such as heat, light,
water, electricity, mechanical agents and therapeutic exercise 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 & 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.

e. Philppine 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 & Rehabilitation Medicine Specialist
They shall be qualified by the PARM Specialty Board as:

‘A) 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.

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

a. Physical & Rehabilitation Medicine Center/Facility/Unit - any facility that renders services for the
Tehabilitation of physical disabilities and which may be hospital-based or free-standing.

b. Physical & Rehabilitation Medicine Team - a group of medical and allied health professionals
concemed with the medical rehabilitation of patients with disabilities. The team is composed of, but
Not limited to, the following:

1. Physical & Rehabilitation Medicine Specialists

2. Physical Therapists

3. Occupational Therapists

4. Prosthetists and Orthotists

5. Rehabilitation Nurses

6. Speech Pathologists

7. Social Workers

8. Vocational Counselors

9. Recreational Therapists

10. Electromyographer

11. Musculoskeletal Sonographer

12. Certified Strength & Conditioning Coach

13. SPED Teachers

14. Psychologist

15. Allied Health Technician or Associate

16. Wheelchair Technician and Assessor

Section 4. Scope of Practice. - The practice of Rehabilitation Medicine includes:


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

1, 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 disabiity, impairment, functional
capacity and potential for rehabilitation;

2. 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.

3. Follow-up examination of patients in ofices, hospitals, rehabilitation facilities, extended care facilities
or home for purposes of re-evaluation and treatment modifications;

4. Appropriate consultation with other medical specialists;

5. Psychological counseling and conference with non-physician health care professionals or family
members concerning conduct of patient's care or patient's progress: and

6. 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;

3. Maintenance of complete and accurate records and statistics:

4. Education of physicians and allied health care professionals in Rehabilitation Medicine, both local and
foreign, for programs related to Physical & Rehabilitation Medicine;

‘5. Education of the public on health care issues pertaining to Rehabilitation Medicine through research and
medical education;

6. 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
disabil

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.
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)

Section 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.

Section 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. Accreditation of the Physical & Rehabilitation Medicine Specialist.

Physical & Rehabilitation Medicine Specialist eligible for accreditation is a graduate of a residency training

institution acoredited by the Philippine Academy of Rehabilitation Medicine Specialty Board and recognized
by the Accredited Professional Organization.

Section 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.

Section 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 facilty.

Section 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 facities are: (1) Physical and Rehabilitation Medicine Specialist qualification, (2)
Aled Health personnel staff qualification, (3) Physical and Rehabilitation Medicine services available and (4)
Physical set-up and equipment.

a. Categories

1. As to institutional character, a Physical and Rehabilitation Medicine facilites are either hospital-
based (if operating within a hospital set-up) or freestanding (if operating on its own or part ofa facility other
than a hospital).

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

3. As to function, a Physical and Rehabilitation Medicine facility may be utilized for training services and
research or for services alone.

4. As to services, a rehabilitation Medicine facility can also be either general or specialized.
b. A Primary Physical & Rehabilitation Medicine facility shall have the following:



1. At least one (1) PARM Specialty Board Certified or Board eligible Physical & Rehabilitation Medicine
Specialist;
2. At least one (1) allied rehabilitation health professional;
3. Physical & 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 electrotherapy device and superficial heating modality,

and activities of daily living (ADL) training devices;

7. Gym area, to include parallel bars, mirror, weights and
walkers among others;

8. Evaluation tools;

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

10. First Aid kit with basic CPR equipment

c. A Secondary Physical & Rehabilitation Medicine facility shall have the following:

1. At least one (1) PARM Specialty Board certified or Board Eligible Physical & Rehabilitation Medicine
specialist;

2. At least one (1) licensed therapist and occupational therapist;

3. Rehabilitation Medicine consultation and management, physical 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) PARM Specialty Board certified Physical & Rehabilitation Medicine Specialist
2. At least one (1) licensed physical therapist and occupational therapist;

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

4. 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.

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

6. 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.

Section 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 Specialty Board Certified or Board Eligible Physical and Rehabilitation Medicine specialist in
the said faciity. An adequate and effective system of documentation, recording and recordkeeping must be
maintained for al consultations and services in the facity. The rates for consultation and services shall be in
accordance with the standards of the Accredited Professional Organization and PhilHealth,

tive devices such as canes, crutches, and



Section 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 Faciliies and Services Regulatory Bureau, together with an information
sheet to be filed up by the Physical and Rehabilitation Medicine Specialist-in-charge. Upon receipt ofthe
‘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 icense may be granted to
facilies with insufficient requirements for special cases for a period of one (1) year.

Section 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 ofthe 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 is
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.

Section 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
obiaining 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) forthe 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 Facities 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.

Section 14, Implementing Rules and Regulations (IRR). - to implement provisions of this Act, The
Department of Health (DOH) Health Faciliies 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 ofthe rehabilitation medicine facilies, 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 regulation inconsistent with the provision of
this Act hereby repealed or modified accordingly.

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

Approved.