Republic of the Philippines Department of Health

OFFICE OF THE SECRETARY

FEB 1 1 2021

ADMINISTRATIVE ORDER No. 2021 - 1005

SUBJECT: Standards on Basic and Non-Basic Accommodation in All Hospitals

I. BACKGROUND AND RATIONALE

One of the goals of Republic Act No. 11223 or the "Universal Health Care Act (UHC)" is to provide access to quality and affordable health care goods and services, including hospital in-patient care. The classification of in-patient accommodation in all hospitals is simplified into two (2) types: basic and non-basic accommodation. According to the UHC Implementing Rules and Regulations (IRR) Sec. 9, "no other fees or expenses, including professional fees, shall be charged to all members admitted in any basic or ward accommodations" while "members who opt for admissions in non-basic or non-ward accommodations may be charged co-payments/co-insurance for services, professional fees, and amenities".

Further, Section 29.5 to 29.7 of the UHC IRR states that "government general hospitals, regardless of size and level, are required to operate not less than ninety percent (90%) of their authorized bed capacity as basic or ward accommodation", "specialty hospitals, either single-specialty or multi-specialty government hospitals as designated by the DOH, are required to operate not less than seventy percent (70%) of their authorized bed capacity as basic or ward accommodation", and "private hospitals are required to operate not less than ten percent (10%) of their authorized bed capacity as basic or ward accommodation".

To support the goals of UHC Act and to ensure that all Filipinos have access to quality hospital in-patient care, the following standards shall serve as a guide for the development of policies for no co-payment for basic or ward accommodation and co-payment for non-basic accommodation.

II. OBJECTIVE

This Order shall set the standards on basic or ward and non-basic accommodations in all hospitals, to ensure quality and affordable hospital in-patient care for all Filipinos.

III. SCOPE OF APPLICATION

This Order shall apply to all government and private hospitals in the Philippines.

IV. DEFINITION OF TERMS

For the purposes of this Order, the following definition of terms shall be adopted:

A. Amenities refer to features of the health service that provide comfort or convenience, such as private accommodation, air conditioning, telephone, television, among others. (UHC IRR Section 4.2)
B. Basic or ward accommodation refers to the provision of regular meals, bed in shared room, fan ventilation, and shared toilet and bath. (UHC IRR Section 4.3)
C. Non-Basic or Non-ward accommodation refers to accommodation with additional amenities as defined in this Order.
D. Co-payment refers to the flat fee or predetermined rate paid at point of service, as may be determined by the Philippine Health Insurance Corporation (PhilHealth). (UHC IRR Section 4.5)
E. Special bed refers to an accommodation with additional fixtures and amenities that are essential to the provision of specialty care of patients, which includes, but are not limited to, critical care units, intensive care units, and isolation rooms.

V. GENERAL GUIDELINES

A. All hospitals shall consider the following design principles in determining basic or ward and non-basic accommodation:
- 1. People-Centered Care;
- 1. Safety;
- 1. Effectiveness;
- 1. Efficiency;
- 1. Timeliness; and
- 1. Equity
B. All hospitals shall abide by the bed ratios provided in Sec. 29(c) of the UHC Act, as follows:
- 1. All government general hospitals shall operate not less than 90% of their authorized bed capacity as basic or ward accommodation;
- 1. All government specialty hospitals, as defined in Administrative Order No. 2019-0060 or "Guidelines on the Implementation of the National Health Facility Registry", shall operate not less than 70% of their authorized bed capacity as basic or ward accommodation; and
- 1. All private hospitals shall operate not less than 10% of their authorized bed capacity as basic or ward accommodation.
C. No other fees or expenses shall be charged to patients admitted in basic accommodation, including fees for health professionals, drugs, medical devices, diagnostic imaging and laboratory tests. All necessary services and complete quality care to attain the best possible health outcomes shall be provided to these patients. In cases of unavailability of drugs, medical devices, diagnostic imaging, and laboratory tests, hospitals are responsible to provide these services and they shall be prohibited from advising patients to access these services outside their facility or network to avoid out-of-pocket expenditures.

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D. Patients who opted for admission in non-basic or non-ward accommodations shall be charged co-payment for services, professional fees, and amenities, based on the copayment guidelines issued by PhilHealth.
E. The hospitals shall adopt the following in the admission process of patients in basic or non-basic accommodation:
- 1. Patients may opt to be admitted in a basic or ward accommodation. In cases of limited beds, priority shall be given to financially incapacitated, incapable, and/or indigent patients as evaluated by the Medical Social Worker based on existing guidelines on patient classification.
- 1. In cases where patients are to be admitted in a basic or ward accommodation but no basic or ward accommodation is available and transfer to another facility is not feasible, they may be temporarily admitted in a non-basic accommodation until a basic or ward accommodation becomes available. This will be treated as an admission to basic or ward accommodation and no co-payment for services, professional fees, and amenities shall be charged to the patient.

VI. SPECIFIC GUIDELINES

A. All hospitals shall follow the minimum standards for basic or ward accommodation:
- 1. Space requirement for each ward bed shall be at least 7.43 square meters and each patient bed should be placed at least 1 meter apart.
- 1. All basic or ward accommodation shall have at least the following features and fixtures available per patient:
  - a. Individual patient bed, with linens and pillow, in shared room;
  - b. Fixture to support eating, such as an overbed table;
  - c. Fixture to store personal belongings, such as bedside cabinet;
  - d. Fixture to accommodate carer, such as chair or couch;
  - e. Fixture to aid getting up to bed, such as foot stool;
  - f. Fixture to ensure privacy and safety, such as rail and partitions (i.e. curtains);
  - g. Adequate ventilation, at least fan ventilation;
  - h. Shared access to toilet and bath and individual bed pans for those who are unable to walk;
  - i. Individual IV stands, if necessary; and
  - j. Availability of waste bins.
- 1. All basic or ward accommodation shall have at least the following provisions:
  - a. Three (3) regular meals a day; and
  - b. Access to potable or safe drinking water.
- 1. Hospitals may set their own standards for their basic accommodation provided that they comply with the minimum standards set in this Order.

1. Special beds as defined in this AO shall be treated as basic or ward accommodation for patients who opted to be admitted in a basic or ward accommodation.
B. For non-basic or non-ward accommodation, the following shall be observed:
- Rooms considered as non-basic or non-ward accommodation shall have all the features and fixtures of the hospital's basic accommodation with additional amenities as defined in this Order. Charges to the patient shall be subject to the co-payment guidelines of PhilHealth.
- Costing and rate setting for these non-basic or non-ward accommodations shall be in accordance with the guidelines set by DOH and PhilHealth. These rates shall be posted by the hospitals in conspicuous places for public access in accordance with the UHC IRR.

VII. ROLES AND RESPONSIBILITIES

A. Health Facility Development Bureau
- 1. Develop, review, and update plans, policies, programs, projects and strategies, related to the standards of basic or ward and non-basic accommodation.
B. Philippine Health Insurance Corporation
- 1. Set guidelines to determine appropriate co-payment rates for non-basic accommodation.
- Establish monitoring tools to measure compliance of hospitals to no copayment policy for basic or ward accommodation and co-payment for non-basic accommodation and ensure enforcement of the UHC IRR in terms of co-payment.
C. Health Facilities and Services Regulatory Bureau
- 1. Align relevant licensing standards and requirements for hospitals to the following:
  - Standards for basic and non-basic accommodation set in this Order; and
  - b. Appropriate bed allocation as stated in the UHC IRR and this Order.
D. Health Facilities Enhancement Program Management Office
- 1. Develop, review, and update guidelines for hospital planning and design.
E. Hospitals
- 1. Ensure compliance to the standards as indicated in this Order.
- 1. Ensure that all pertinent, relevant, and up-to-date information regarding the prices of health services, and all goods and services readily accessible to the public and patients, as well as submitted to DOH and PhilHealth, based on available guidelines.

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VIII. REPEALING CLAUSE

All orders, rules, regulations, and other issuances inconsistent with or contrary to this Order are hereby repealed, amended, or modified accordingly. All provisions of existing issuances which are not affected by this Order shall remain valid and in effect.

SEPARABILITY CLAUSE IX.

In the event that any provision or part of this Order is declared unauthorized or rendered invalid by any court of law or competent authority, those provisions or parts not affected by such declaration shall remain valid and in effect.

X. INTERPRETATION

Any doubt or inconsistency in the interpretation of this Order shall be resolved in a manner that will serve the purpose of this Order.

Questions on any provision of this Order shall be addressed to DOH- Health Facility Development Bureau for resolution in coordination with the relevant offices.

XI. EFFECTIVITY

This Order shall take effect 15 days upon publication to the Official Gazette or in any newspaper of general circulation and upon filing with the University of the Philippines Law Center (UPLC) of three (3) certified copies of this Order.

FRANCISCO T. JUQUE III, MD, MSc Secretary of Health

AO 2021-0015: Basic and Non-Basic Services

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