DOH AO 2017-0008 Implementing Guidelines of Republic Act

10754, otherwise known as “An Act Expanding the Benefits and

Privileges of Persons with Disability”, for the Provision of Medical
and Health-related Discounts and Special Privileges

Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY

                                                                                   June 01, 2017

 
ADMINISTRATIVE ORDER
No. 2017 – 0008
 
       SUBJECT:  Implementing Guidelines of Republic Act 10754,
otherwise known as “An Act Expanding the Benefits and Privileges
of Persons with Disability”, for the Provision of Medical and Health-
related Discounts and Special Privileges

I. RATIONALE
In the pursuit of achieving “All for Health towards Health for All”,
the Philippine Health Agenda (PHA) defines the blueprint of the
government’s strategies to have an inclusive and responsive health care
for all Filipinos. The PHA guarantees the provision of health services to
all Filipinos especially the poor, marginalized, and vulnerable such as the
persons with disabilities (PWDs). In response, the Department of Health
(DOH) ensures that relevant policies and plans for the Health and
Wellness Program for PWDs are crafted and implemented in accordance
with the PHA and current governing laws.

The Republic Act (RA) 10754, otherwise known as “An Act

Expanding the Benefits and Privileges of Persons with Disability”, was
enacted into law on March 23, 2016 and its corresponding Implementing
Rules and Regulations (IRR) was signed on December 1, 2016. This law
expands the benefits and privileges of PWDs by amending Republic Act
7277, otherwise known as the “Magna Carta for Persons with
Disabilities”. In particular, Section 1 of RA 10754 amends Section 32 of
RA 7277 entitling the PWDs to at least twenty percent (20%) discount
and exemption from the value-added tax (VAT) on the purchase of certain
goods and services from all establishments for the exclusive use,
enjoyment, or availment of the PWD.
As mandated in Rule IV, Secs. 6.4 and 6.5 of the IRR of RA 10754, the
DOH, in coordination with Philippine Health Insurance Corporation
(PhilHealth) and Food and Drug Administration (FDA), shall issue the
corresponding guidelines, circulars or directives related to the purchase
of health and medical goods and availment of services from medical
establishments.

In this regard, the DOH is hereby repealing DOH Administrative

Order (AO) 2009-0011 to include the additional benefits and privileges
stated in the RA 10754 and its IRR.

II. OBJECTIVES

To provide guidelines for the implementation of at least 20%

discount and VAT exemption in all medical, and health-related services
for PWDs.

III.  SCOPE AND COVERAGE

This Administrative Order applies to all private and government

hospitals and other health facilities, health care professionals,
PhilHealth, pharmacies, and other establishments providing medical and
health-related care and services to PWDs.

IV. DEFINITION OF TERMS

Annex A provides the relevant and pertinent definition of terms as

adopted from RA 7277, RA 9442, and RA 10754.

V. GENERAL GUIDELINES

1. All PWDs are entitled to at least 20% discount and VAT exemption
upon requirements determination and compliance by both the
provider/establishment and PWD.
2. At least 20% discount and VAT exemption shall cover purchase of
generic and branded medicines, medical and assistive devices, costs of
medical, dental, and rehabilitation services, and diagnostics and
laboratory fees, as prescribed by the attending physician for all PWDs.
3. Diagnosis or treatment shall be in accordance to the latest Clinical
Practice Guidelines (CPGs) or hospital treatment protocols, for all
service wards and pay sections of government hospitals and facilities,
and in all private hospitals and medical facilities.
4. Services which are medically necessary for the prevention,
diagnosis, treatment, rehabilitation, or palliation of the PWD shall be
provided the discount and exemption.
5. All PWDs shall be enjoined to become PhilHealth members (member
or dependent of active PhilHealth member). The national government
through the National Household Targeted System or Listahan, LGUs,
NGOs, or private individual and/or group shall support the PhilHealth
enrollment of non-PWD members. PWDs may also opt to enroll
themselves as individual paying members.
6. All government and private hospitals, medical facilities, and
hospitals including drugstores and other licensed establishments
dispensing medicines shall develop appropriate and strategic
communication materials to disseminate information and policies set
forth by this issuance accessible to all PWDs; designate express lanes
for PWDs; and issue official receipts in every payment of drugs and
medicines, medical/assistive devices, and other services stating the
usual rates or fees, retail price, discounts and VAT exemption.
7. All health facilities shall provide holistic quality care to PWDs and
their families and treat them with professional conduct and respect in
support of this Order.

VI. IMPLEMENTING RULES AND MECHANISM FOR THE AVAILMENT

OF PRIVILEGES

1.  At least 20% discount and VAT exemption shall apply to the
following:
a. Generic and branded medicines as well as food for special medical
purposes in establishments dispensing medicines        
b. Medical and assistive devices not limited to the list enumerated in
Annex B. Purchase of any the following medical devices shall be recorded
in the Purchase Booklet for control and monitoring:
i. Medical and assistive devices used/consumed during check-up or
confinement of a PWD regardless of the number    of days of stay in the
hospital or any health facilities and during recovery at home, or for
monitoring of a particular ailment or disease, or to aid the maintenance
of a treatment.
ii. Medical and assistive devices used during recovery at home, or for
monitoring of a particular ailment or disease, or to aid the maintenance
of a treatment, with the approval / referral of the physician.
c. Professional fees of attending doctors in the pay section of government
and private hospitals and facilities; and  
d. Costs of medical, dental, and rehabilitation services; diagnostic and
laboratory services including the use of   special reagents, dyes, contrast
media, and radioactive isotopes; and psychological, behavioral, and
developmental tests – for both in-patient and out-patient PWDs in
government and private hospitals and facilities                    
2. The hospital bed for a PWD confined in a service ward of a
government facility shall be classified based on AO 51-A s. 2001
known as the Implementing Guidelines on the Classification of
Patients on Availment of Medical Social Services in government health
facilities. The balance shall be paid by the PWD based on his/her
Medical Social Worker Classification.
3. Discounting and computation of the 20% Discount and VAT
exemption:
 
a. At least 20% discount and VAT exemption shall be granted upon
full payment of the hospital bill. The billing statement showing the
usual rates or fees and the discounted prices shall be attached to
the official receipt.

b. At least 20% discount and VAT exemption shall be deducted upon

purchase of the medicines and medical and/or assistive devices,
with compliance to the necessary documentary requirements for
the availment of discounts and exemption.

c. All PhilHealth accredited health care institutions shall first deduct

12% VAT exemption from the total health care institution charges,
then deduct the 20% PWD discount from the difference. Other
PhilHealth benefits shall be deducted from the remaining amount.
It is only after deducting the appropriate discount from the total
bill or statement of account that the accredited health care
institution can file claim for benefit package.

d. The discount privileges and VAT exemption shall be non-

transferable and exclusively for the benefit of the PWD.

e. Double discounts shall not be allowed. The PWD shall avail of the
establishment’s offered discount or at least 20% discount and VAT
exemption provided herein, whichever is higher and more
favorable. In cases where the person with disability is also a senior
citizen entitled to a 20% discount and VAT exemption under
his/her valid senior citizen identification card (ID), the person with
 disability shall use either his/her PWD ID Card or Senior Citizen
ID card to avail of the at least 20% discount and VAT exemption.

f. Drugs stores offering special discounted prices less than 20% of

the regular retail price can deduct the percentage discount of their
promotional campaign from the total of twenty percent (20%)
discount as required by RA 10754. Thus, a total discount of 20%
for PWD shall still be applied.

4. Purchase of All Medicines and Medical Assistive Devices and

Documentary Requirements for the Exclusive Use of the PWDs
A. The following documentary requirements shall support the availment
of the discount and exemption for compliance of PWDs:
i. PWD identification (ID) card as issued by Local Government Unit (LGU)
through the City/Municipal Social Welfare and Development Office
(C/MSWDO) or the Persons with Disability Affairs Office (PDAO) of the
place where the PWD resides in accordance with NCDA-Administrative
Order #001. National Council on Disability Affairs (NCDA) shall issue a
temporary PWD ID to PWDs in emergency situations such as but not
limited to hospital confinement, provided that the PWD ID number
coding shall be retained in accordance with the official residence of the
PWD.
ii. Except for over-the-counter (OTC) drugs, a doctor’s prescription shall
be presented for medicines and food for special medical purposes. A
prescription shall have the following information : (1) name of the PWD,
(2) age, (3) sex, (4) address, (5) date, (6) generic name of the medicine, (7)
dosage form, (8) dosage strength, (9) quantity, (10) signature over printed
name of physician, (11) physician’s address, (12) contact number of
physician or dentist, (13) professional license number, (14) professional
tax receipt number and (15) narcotic license number, if applicable. The
drugstores may limit the dispensing of OTCs to not more than a week’s
supply. Only prescriptions that contain the above shall be honored.
A doctor’s prescription shall also be presented for medical and assistive
devices in accordance with preceding paragraph.
iii. Purchase booklet issued by the local social/health office to PWDs for
free containing the following basic information:
1. PWD ID number
2. Booklet control number
3. Name of PWD
4. Sex
5. Address
6. Date of Birth
7. Picture
8. Signature or thumb mark of PWD
9. Information of medicine to be purchased such as name of medicine,
quantity, attending physician and his/her license number, name of
servicing drug store and name of dispensing pharmacist
10. Authorization letter of the PWD who is residing in the Philippines at
the time of purchase, currently dated and the identification card of
the authorized person or representative, in case the medicine is
bought by the representative or caregiver of the PWD. Purchase
booklets shall be used to record the kind of OTC medicine purchased,
how many, when and where it was purchased. Likewise, this shall
help the drugstores to monitor the last purchase made for a certain
medicine.
11. In cases wherein the PWD is a minor or mentally or physically
incapacitated to execute an authorization letter, the parent or legal
guardian or representative shall be allowed to make the purchase on
behalf of the PWD, upon proof of their valid identification card. The
name of the said guardian or representative shall be indicated at the
back of the PWD ID and shall be the exclusive representative of the
PWD.
B. Establishments / Providers dispensing medicines and assistive
devices
i. As a general rule, any single dispensing of medicines must be in
accordance with the prescription issued by a physician and should not
exceed one (1) month supply.
ii. Drug stores are required to maintain a special record book for PWD
subject to inspection by the FDA and Bureau of Internal Revenue.
iii. For partial filling, the establishment’s pharmacists shall indicate the
quantity partially filled in the purchase booklet (special record book) and
the unfilled balanced on the prescription. The PWD shall retain the
partially filled prescription and present the same later to complete the
prescribed quantity. Fully filled prescription shall be surrendered by the
PWD to the establishment’s pharmacists.
5. Responsibilities of Stakeholders
a. All Government Facilities shall:
i. Post hospital room rates, laboratory tests, diagnostics tests fees,
medicine prices, and all other rates and fees in noticeable or strategic
places in their respective facilities (e.g. near or at the main entrance of
facilities); and
ii. Submit the aforementioned price list annually to the Health Facility
Development Bureau of the DOH and PhilHealth; and
iii. Provide mechanisms to address queries or complaints from PWDs.
b. Private Hospitals and Medical Facilities and Establishments shall:
i. Post the price of all room rates in the Admitting Section. The prices of
diagnostics and laboratory tests based on room and board
accommodation, medical supplies and medicines shall be made available
upon request of the PWD. The list shall ensure validation of the discount
and VAT exemption granted to PWDs.
ii.Provide mechanisms to address queries or complaints from PWDs with
regard to discount and VAT exemption on professional fees; and
iii. Inform in writing,  copy furnished the aggrieved party, the necessary
sanction  for the health  professionals  who refuse to grant the proper
discount and VAT exemption.
c. Drugstores and other licensed establishments dispensing medicines
i. Drugstores shall make available upon the PWD’s request, a generic
menu card and shall issue  official receipt for drugs and medicines,
which states the  usual prices and the  discounted prices and VAT
exemption of the drug or medicine.
ii. During operating hours, all licensed establishments which dispense
medicines shall be prohibited from scheduling or limiting the time of the
PWDs to avail the discounts.
d. Health Care Professionals shall:
i. Inscribed his/her name and PRC number in the request for diagnostic
and laboratory tests, and prescription;
ii. Ensure that  prescriptions  made are for the exclusive use of the PWD
to curb abuse of availing discounts for use of non-PWD citizens;
iii. Inform the PWD of the usual fees for the services required;
iv. Provide an official  receipt for the rendered professional services to the
PWD that states the usual fees and the discounted fees and VAT
exemption.
6. Mechanism of Endorsement of Complaints
All  complaints  on  non-compliance  with  the 20% discount and VAT
exemption shall be lodged  with  the  NCDA  and/or to  the  respective
LGU-PDAO  where  the  purchase was  made  or where the PWD resides,
whichever is convenient for the PWD in accordance with Section 15 of
Rule VI of the IRR of RA 10754.
VII. SEPARATIVELY CLAUSE/REPEALING CLAUSE
This Order repeals DOH Administrative Order (AO) 2009-0011. All other
issuances that are inconsistent herewith are hereby revised or modified.
If any portion or provision of this Order is declared void or
unconstitutional, the remaining portions or provisions thereof shall not
be affected by such declaration.
    VIII. EFFECTIVITY
 This  Order shall  take effect  immediately  after  its  publication in two
(2) newspapers of general circulation.
 
(Original Signed)
PAULYN JEAN B. ROSELL-UBIAL, MD, MPH, CESO II
Secretary of Health
 
ANNEX A – Definition of Terms
 As adopted from the Implementing Rules and Regulations of RA 7277,
RA 9442, and RA 10754
1. ASSISTIVE DEVICES – any device that is designed, made, or
adapted to assist a person to perform a particular task or activity for
daily living.
2. CHILD WITH DISABILITY shall refer to persons below eighteen
(18) years of age who have disabilities or those over but with mental
capacity as that of a child and are unable to fully take care of
themselves or protect themselves because of intellectual impairment,
hearing impairments including deafness, speech or language
impairments, visual impairments including blindness, serious
emotional disturbance, orthopedic impairments, autism, traumatic
brain injury, other health impairments or specific learning disabilities
who by reason thereof need special education and other services.
3. DISABILITY – shall mean (1) a physical or mental impairment that
substantially limits one or more psychological, physiological or
anatomical function of anatomical function of an individual or
activities of such individual; (2) a record of such is impairment; or (3)
being regarded as having such impairment.
4. ESSENTIAL DRUG/MEDICINE – drug/medicine that satisfies the
priority health care needs of the population and which is selected
based on the evidence of its efficacy, safety and comparative cost
effectiveness.
5. ESSENTIAL DRUG LIST OR NATIONAL FORMULARY – a list of
drugs prepared and periodically updated by the DOH on the basis of
health conditions obtained in the Philippines as well as on
internationally accepted criteria.
6. ESTABLISHMENTS DISPENSING MEDICINES, MEDICAL
DEVICES AND ASSISTIVE DEVICES – any drugstores, assistive
device stores, government or private hospital pharmacies, medical
clinics, optical clinics, audiology centers, and similar establishments
dispensing medicines and selling assistive devices duly licensed or
franchised by the FDA and/or the local government unit (LGU).
7. FOODS FOR SPECIAL MEDICAL PURPOSES – category of foods
for special dietary uses which are specially processed or formulated
and presented for the dietary management of patients and maybe
used only under medical supervision as described and define in FDA
Codex STAN 180-1991. They are intended for the exclusive or partial
feeding of patients with limited or impaired capacity to take, digest,
absorb or metabolize ordinary foodstuffs or certain nutrients
contained therein, or who have other special medically-determined
nutrient requirements, whose dietary management cannot be
achieved only by modification of the normal diet, by other foods for
special dietary uses, or by a combination of the two.
8. HEALTH CARE PROFESSIONAL – any licensed physician, dentist,
nurse, midwife, allied medical practitioner, paramedical practitioner,
or other health care professional or practitioner duly licensed to
practice in the Philippines.
9. IMPAIRMENT – any loss, diminution or aberration of psychological
or physiological function with or without an accompanying anatomical
structural defect.
10. MEDICAL DEVICES – an instrument, apparatus, equipment,
machine, contrivance, implant, in vitro  reagent, or  other similar  or
related  article,  including a component part, or  accessory which is:
(1) intended for  use in the diagnosis of disease or other conditions, or
in the cure, mitigation, treatment, or prevention of disease, in persons
with disabilities; and  (2) intended to affect the structure or any
function of the body of PWDs, and which does  not achieve  any of its
primary intended  purposes through chemical action within or on  the
body of man or other  animals and which is not dependent upon being
metabolized for the achievement of any of its primary intended
purposes.
11. MEDICAL SERVICES – shall refer to the hospital room
accommodation, hospital services, medical supplies, professional
services of health care professionals, diagnostic services, and
laboratory  services that are  necessary for the prevention, diagnosis,
treatment,  rehabilitation, and  palliation of a persons’ disability,
illness or injury. This should not be limited to hospital services but
should include clinics and other health facilities.   Further,  it refers
to health services  which include but not limited to prevention of
disability through immunization, nutrition, environmental protection
and preservation; genetic  counseling; early detection of disability; and
timely intervention, medical or surgical,  to arrest  the disabling    
Intervention includes rehabilitation and provision of assistive devices.
12. MEDICALLY NECESSARY – services required to preserve and
maintain the health status of a person in accordance with accepted
standards of the medical practice in the medical community. This
includes services which are absolutely necessary in treating a patient
and which could adversely affect the patient’s condition if it were
omitted.
13. MEDICINE / DRUG – any chemical compound or biological
substance, other than food, intended for use  in the  treatment,
prevention  or diagnosis of disease in humans or animals, including
but not limited to:
a. Any article recognized in the official United States Pharmacopoeia –
National Formulary (USN-NF), official Homeopathic Pharmacopoeia of the
United States, Philippine Pharmacopoeia, Philippine National Formulary
(PNF), British Pharmacopoeia, European Pharmacopoeia, Japanese
Pharmacopoeia, Indian Pharmacopoeia, any national compendium or any
supplement to any of them;
b. Any article intended for  use in diagnosis,  cure, mitigation,  treatment
or prevention of disease in humans or animals. Any article other than
food intended to affect the structure or any function of the human body
or animals;
c. Any article intended for use as a component of any of the articles
specified in clauses (a), (b) and (c) not including devices or their
components, parts or accessories;
d. Herbal and/or  traditional drugs which are articles of plant or animal
origin used in folk medicine which are:  1) recognized in the PNF; 2)
intended for use in the treatment  or cure or mitigation of disease
symptoms, injury or body effects  in humans; 3) other than food,
intended to affect the structure or any function of the human body; 4) in
finished or ready-to-use dosage form; and 5) intended for use as a
component of any of the articles specified in items 1 to 4. For herbs to be
classified under this definition, levels and amounts as well as registration
status are required when indicated for therapeutic use; and
e. This may also include vitamins and minerals provided that these are
in accordance with  the FDA’s prevailing cut-off on vitamins and
minerals classified as drug/medicine i.e. product containing more than
150% of water- soluble vitamins and more than 102% of fat soluble
vitamins.
14. PERSONS WITH DISABILITY – are those suffering from restriction
or different abilities, as a    result of a mental, physical or sensory
impairment, to perform an activity in the manner or within the range-
considered normal for a human being.
ANNEX B – List of Medical and / or Assistive Devices
 The medical devices includes, but not limited to the following: cane,
crutches, walkers, diaper, wheelchair  whether  manual or  electric-
powered,  commode  chair,  bed pan, body support, fracture, sock,
medical support stockings, oxygen therapy unit (gauge and tank set), IV
fluid and stand,  forceps, swabs,  hospital bed,  walker, urine bag,
bandage, hearing aid, eye glasses, intraocular  pen injector, hot/cold
pack, therapeutic massager, therapeutic mattress/pad, all prosthesis,
catheter, therapeutic warmer, glucometer set including lancets and test
strips, insulin syringe and needle, thermometer, blood pressure
apparatus, syringe and needles, IV set, dialyzer, adhesive strip, mask,
gauze, gloves, dressing, cotton, brace, and other essential medical
supplies, accessories,  kits,  equipment  including the  use of  radiation
devices, dental and laboratory, hospital implement or apparatus and
other devices for the use of persons with disability.
This also includes the purchase of eyeglasses, hearing aids, dentures,
and prosthetics, artificial bone replacements like steel and which include
implants, plates, rods and screws.