1. 5th edition NTP MANUAL OF PROCEDURES DOTS Certification & PhilHealth Accreditation

2. DOTS certification and PhilHealth accreditation
Contents
Introduction
Objectives
Definition of Terms
Policies
Procedures
Roles and Responsibilities of Implementing Agencies

3. Certification and accreditation
Processes to ensure DOTS facility is capable of providing quality DOTS services to presumptive TB and TB patients
DOH Administrative Order  Implementing Guideline in the Conduct of the National TB Control Program – Directly Observed Treatment, Short Course NTP) Certification
DOH Administrative Order  A Revised Implementation Guideline on Certification Process to Decentralize Issuance of DOTS Certificate to the Regions in 2013
Issuance of “Certificate of Quality Service on DOTS” before was delayed because the signatory was the NTP manager and chairperson of PhilCAT at the national level. It will take time for them to convene to sign those certificates. It was ammended in 2013 to decentralized the issuance of certificate and the signatory will be the RCC-NTP (Regional Director and the Local Coalition chairperson).
This amendment will fast track PhilHealth accreditation.

4. Objective
To ensure that DOTS facilities are providing sustainable quality services

5. Definition of terms
Accreditation  a process wherein qualifications and capabilities of a health facility are verified in accordance with the guidelines, standards and procedures set by PHIC
Set by PhilHealth in consultation with stakeholders for the DOTS facility to participate in the TB-DOTS Benefit Package
Automatic accreditation  given to any institutional health care provider that is licensed or certified by DOH or other certifying body duly recognized by PhilHealth
Ex. automatic accreditation if DOTS facility is certified by the regional health office certifying team it can be accredited by PhilHealth after complying of their requirement based on PhilHealth Circular 54 s. 2012

6. Definition of terms
Certification  process wherein Regional Coordinating body (RCC-NTP) assesses and evaluates a DOTS facility, either public or private, if it has met the quality standard for DOTS implementation
Certified  certification decision when a health facility has complied with the core standards for initial certification and or re-certification
Not certified  certification decision when a DOTS facility consistently fails to demonstrate compliance with core standard for initial certification and or re-certification
Re–certification  process wherein a DOTS facility is re-issued a DOH certificate

7. Policies on DOTS certification
The Department of Health, through the RCC-NTP, shall be the lead agency in the TB-DOTS certification process.
The RCC-NTP shall be responsible for certifying TB-DOTS centers/facilities in both public and private sectors.
A health facility that provides TB-DOTS services and assumes ownership of and transparency for its operations is eligible for certification.
A DOTS facility shall be awarded certification if it meets the set of core standards prescribed by NTP.
The length of certification award has an effectivity of years.
Involvement of the local coalition is very important in the certification process. RCC-NTP must be functional

8. Core certification standards
TB-DOTS center is easily located and patients have convenient and safe access to the center.
TB-DOTS center provides for the privacy and comfort of its patients and staff.
TB-DOTS center provides for the safety of its patients and staff.
All patients undergo comprehensive assessment to facilitate the planning and delivery of treatment.
All patients have continuous access to accurate and reliable TB diagnostic test.
A care plan is developed and followed for all patients.
Certifying team must understand the core certification standards and this standards must be known to all DOTS facility and TA providers to know how to fill up their self assessment form (SAF) to be submitted to the Regional Health Office.

9. Core certification standards
Patients have continuous access to safe and effective anti-TB treatment throughout the duration of their treatment.
Policies and procedures for providing care to patients are developed, disseminated, implemented and monitored for effectiveness.
Policies and procedures for managing patient information are developed, disseminated, implemented and monitored for effectiveness.
The TB DOTS center has an adequate number of qualified personnel skilled in providing DOTS services.

10. Policies on PhiHealth accreditation
DOTS facilities that are eligible for accreditation include but are not limited to the following:
a. LGU health units d. Factory clinics
b. Hospital-based clinics e. Church-based clinics
c. HMO f. School-based clinics
TB-DOTS Benefit Package providers duly certified by DOH are qualified for automatic accreditation (PhilHealth Circular 54 s. 2012).
PhilHealth shall provide the benefit package for qualified adult and child TB from any accredited DOTS facility.
The health care provider shall determine the PhiHealth member’s eligibility and compliance with the requirement for the availment of benefits as prescribed by PhilHealth.

11. Policies on PhiHealth accreditation
The benefit package shall follow the rate and allocation scheme recommended by DOH 
25% for consultation services of the referring physician during the course of treatment
35% for the health staff, including the treatment partner
40% for the operational costs involved in providing quality care of TB patients
Payment for TB Diagnostic Committee and quality assurance for sputum microscopy, expenses for training of staff, cost of additional laboratory supplies and drugs will be included in the operational costs.
In case there is no referring physician, 25% shall be alloted to operational cost.
PhilCAT recommended allocation of PhilHealth benefit package in 2003 which create a lot of issues and misunderstanding among health staff including municipal employees. This policy will be an eye opener among municipal employee that this benefit package is for the use of TB control program to ensure sustainability.

12. Policies on PhiHealth accreditation
Accredited TB-DOTS facilities may continuously participate as provider until such participation is withdrawn or terminated based on the rules set by PhilHealth.
Annual requirements by January 31
Updated DOH certificate
Performance commitment
Latest audited financial statement (for private facilities only)
Proof of payment of the participation fee
Updated business permit (for private facilities only)

13. Policies on PhiHealth accreditation
Failure to submit the above requirements by the end of February shall cause denial of claims starting March 1.
If the requirements are submitted after February, the health care institution shall apply for re-accreditation.
If the certificate of the TB-DOTS provider expires within the year, the facility is given 60 days within which to submit the updated certificate.
Failure to submit within 60 days shall cause denial of claims beginning on the 61st day and onwards (based on treatment start date) until the facility submits the certificate.

14. Procedures for certification
Cycle
Procedure
Concerned Agency
Self-Assess-ment
Filling-up of Self-assessment Form (SAF)
Request for technical support from the Technical Assistance (TA) team from the province/city composed of the Provincial/City NTP Coordinators, DOH representatives and private/NGO representatives
SAF is accomplished and ready for use by the certifying team upon their visit
Head of DOTS center/facility
Applicat- ion
Submission of a written Letter of Intention on Certification (LOIC) to DOH RO

15. Procedures for certification
Cycle
Procedure
Concerned Agency
Certification
On-site validation of the health facility by the certifying team
Reporting of the certifying team’s findings, rating and over-all decision to the DOTS facility utilizing the “Summary Report on DOTS Certification” and reporting of the same to RCC-NTP
Approval/Disapproval for certification
Application for PhilHealth accreditation in case of approval
Notification of TA team in case of disapproval
Re-application for certification in case of disapproval
Joint monitoring of facility after 3 consecutive failure to qualify for certification
Certifying team
Head of DOTS center/facility
CHD/Prov/City Coordinator
CHD Coordinator
Head of DOTS center/facility 
NCC-NTP, RCC-NTP, CHD/Prov/City Coordinators

16. Registrat-ion and Issuance
Procedures for certification
Cycle
Procedure
Concerned Agency
Registrat-ion and Issuance
Registration of the facility in the official registry
Issuance of Certificate of Quality Service on DOTS
RCC-NTP
Follow-up
Yearly monitoring of certified TB-DOTS centers/facilities s
Renewal of certification after 3 years
CHD/Prov/City NTP Coordinators, TA team
Head of DOTS center/facility

17. Flowchart of DOTS certification process

18. Flowchart of DOTS certification process

19. Flowchart of DOTS certification process

20. Roles and responsibilities of implementing agencies
Agency
Roles and responsibilities
NCC - NTP
Recieve and consolidate reports on the number of DOTS facilities certified by respective RCC-NTP in each regions
Serve as an oversight body in resolving issues and concerns beyond the jurisdiction of RCC-NTP
Conduct joint monitoring of TB-DOTS center/facilities with concerned party as needed
RCC-NTP
Oversee the certification process at the regional level
Identify and designate the members of certifying team
Review and approve the final result of assessment by the certifying team
Mediate concerns should the certifying team fail to come up with a concrete decision on the approval for certification

21. Roles and responsibilities
Roles and responsibilities of implementing agencies
Agency
Roles and responsibilities
RCC-NTP
Issue the “Certificate of Quality Service of DOTS,” duly signed by the Chair and Co–Chair of RCC-NTP and affix the committee’s dry seal
Update status of DOTS certification to facilitate PhilHealth accreditation
Maintain an official registry of all certified DOTS facilities in the region and submit a quarterly report of the number of facilities certified to NCC-NTP
Recommend, designate a representative from the private sector and appoint a substitute in his/her absence
Conduct joint-monitoring of TB DOTS centers/facilities with concerned parties as needed

22. Roles and responsibilities
Roles and responsibilities of implementing agencies
Agency
Roles and responsibilities
Certifying Team
Validate the findings of the facility on-site based on the accomplished Self-Assessment Form (SAF)
Recommend to RCC-NTP whether the facility will be given approval for DOTS certification or shall be recommended for re–assessment
Prepare a written report detailing the team’s findings, rating per standard, and the team’s overall decision, and submit the copy to the health facility and RCC-NTP
Technical Assistance Team
Provide technical assistance to the DOTS facility prior to application and in case of re-assessment

23. Roles and responsibilities
Roles and responsibilities of implementing agencies
Agency
Roles and responsibilities
CHD Coordinator
Facilitate all the requirements for certification
Coordinate with the member of certifying team regarding the schedule of actual certification visits
Notify PhilHealth regarding the DOTS certification status of the facility and assist facility in applying for PhilHealth accreditation
Ensure that the feedback of the result of the certification process is provided to the TA team of the facility needed for re-assessment
Monitor all certified DOTS facilities together with the provincial TA team
DOH Represent-ative
Facilitate the submission of all documents to the province/city CHD and vice versa within the set time frame
Assist the facility by providing adequate and appropriate technical support to the DOTS facility, and ensure that the SAF is properly filled-up.
Provide technical assistance as needed

24. Procedures in applying for PhilHealth accreditation
Secure an application form for accreditation from any PhilHealth office or download from PhilHealth website
Prepare the following documents:
Performance Commitment  duly signed by LCE/owner and head of the facility/Medical Director/Chief of Hospital
Provider data record
Participation fee
Electronic copies in JPEG format of recent photos of the facility, both the interior and outside surroundings

25. Procedures in applying for PhilHealth accreditation
Prepare the following documents (cont’d):
Statement of intent (if applicable)  this is for health care institutions that submitted their application in the 4th quarter of the year
The statement of intent gives the TB-DOTS facility a prerogative to choose the preferred starting date of their accreditation.
Updated TB-DOTS certificate
Location map
Updated business permit (for private HCIs only)

26. Procedures in applying for PhilHealth accreditation
Submit to the PhilHealth regional office or local Health Insurance Office the complete documents and pay the accreditation fee.
Upon approval of application, PhilHealth shall issue a certificate of accreditation and letter of approval that will be sent to the facility.
For any concerns regarding accreditation, the facility may inquire at the nearest PhilHealth Regional Office or local Health Insurance Office in their area.

27. Procedures on PhilHealth claims processing
Claims shall be filed within 60 calendar days after completion of prescribed treatment.
The following documents must be submitted in filing claims:
Claim Form 1
Claim Form 2
Copy of NTP treatment card
Other documents required by PhilHealth
TB DOTS claims should have the correct ICD-10 Codes and Package Codes.
Claims shall be processed based on the existing PhilHealth guidelines.
PhilHealth staff who recieve the PhilHealth claim documents should review the documents for completeness and accuracy before sending DOTS staff home to prevent delay of their claims

28. ICD-10 Coding Guidelines for TB