Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY

DRAFT VERSION 5.0 03152017

ADMINISTRATIVE ORDER
No. 2017 -____________

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 Disabled Persons". 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 prescribe the procedure and guidelines for the implementation of at least 20% discount and
VAT exemption in all health related services for PWDs.
III.COVERAGE AND SCOPE

This Administrative Order applies to all private and government hospitals and other health
facilities, health care professionals, PhilHealth, pharmacies and other establishments
dispensing medicines.

IV. DEFINITION OF TERMS

The following definition shall be adopted as stipulated in 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 mental
retardation, 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 — interaction between persons with impairments and attitudinal and

environmental barriers that hinders their full and effective participation in society on an equal
basis with others.

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 AND ASSISTIVE DEVICES — shall

refer to any drug stores, 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 may be used only under medical supervision as described and defined 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

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 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 — refers to 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 DEVICE—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 condition. 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 (USP-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;

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 b. Any article intended for use in the 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;
d. 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;
e. 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 Ito 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
f. 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— include those who have long-term physical, mental,
intellectual or sensory impairments which in interaction with various barriers may hinder their
full and effective participation in society on an equal basis with others.

V. GENERAL GUIDELINES

1. In all service wards of government facilities, all PWDs are entitled to at least twenty
percent (20%) discount and VAT exemption for the costs of medical, dental, and
rehabilitation services, diagnostic and laboratory fees, as well as psychological or
developmental tests, provided that these are in accordance with the available Clinical
Practice Guidelines (CPGs) or hospital treatment protocols. The remaining balance of
the hospital bill shall be subjected to classification by the Medical Social Worker based
on the existing DOH Guidelines. If the PWD deserves a free service after evaluation,
then such services shall be given free.

2. All persons with disability that are confined in the pay section of the government
health facilities and in all private hospitals and medical facilities are granted at least
twenty percent (20%) discount and VAT exemption for medical, dental, and
rehabilitation services, diagnostic and laboratory fees, psychological or
developmental tests, as well as professional fees of attending doctors provided that
these are in accordance with the available CPUs or hospital treatment protocols. For
outpatient, the same rule shall be followed.

3. Services which are not medically necessary for the prevention, diagnosis, treatment,
rehabilitation or palliation shall not be provided with any discount. This shall
include, but not be limited, to cosmetic surgical procedures, executive check—up
packages, and physical examinations, without clinical evidence of effectiveness and
efficiency.

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 4. The grant of at least twenty percent (20%) discount and VAT exemption shall be
provided in the purchase of generic and branded medicines as well as food for special
medical purposes in all establishments dispensing medicines for the exclusive use of the
PWDs. Also, a discount of at least twenty percent (20%) and VAT exemption is granted
to special reagents, dyes, contrast media, and radioactive isotopes used in laboratory and
diagnostic tests.

5. Consistent with RA 7875 as amended by RA 10606, otherwise known as the

National Health Insurance Act of 2013, and the Philippine Health Agenda, all
Filipinos shall be encouraged to be PhilHealth members or at least be a dependent of
active PhilHealth members. PWDs may be enrolled by the national government (if
they are included in the National Housing Target System list) or sponsored by the
LOU or an NGO or private individual/group or voluntarily enroll themselves as
individual paying members. PhilHealth must make available reimbursement
schedules to health 'care practitioners provided it is consistent with PhilHealth's
legal mandates and policies.

VI. IMPLEMENTING RULES AND MECHANISMS FOR THE AVAILMENT OF

PRIVILEGES

1. Subsidized Services in In-Patient and Out-Patient Sections of Government Health

Facilities

a. Hospital Bed
Hospital bed for a PWD confined in a service ward 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. Those
classified as Class D shall be free of charge provided that it is necessary to diagnose
and treat an illness or injury and in accordance with the available CPGs or hospital
treatment protocols.

b. Laboratories and Diagnostic Services

All in-patient and out-patient PWDs shall be given a 20% discount and VAT
exemption for laboratory and diagnostic services, provided that:
i. Diagnosis and/or treatment by the attending physician shall be in accordance
with the available CPGs or hospital treatment protocols and have been
medically necessary.
ii. Evidence-based health screening tests had been extensively tested for the
local setting and endorsed by the DOH as medically necessary for the
individual.
Hi. The laboratory and diagnostic services have been determined by his/her attending
physician as medically necessary.

Note that the balance shall be paid by the PWD based on his/her Medical Social
Worker Classification.

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 c. Dental Services
All dental services that are deemed to be medically necessary by the attending dentist
shall be granted free of charge.

d. Rehabilitation and Other Specialized Services

Twenty percent (20%) discount and VAT exemption shall be given to PWDs
requiring rehabilitation and other specialized services such as purchase of
assistive devices prescribed by attending physician or by a rehabilitation
specialist.

2. Non-Subsidized Services in Pay Services of Government Health Facilities and

Private Health Facilities

The PWDs confined in the pay sections of government accredited health facilities and
private health facilities shall be granted twenty percent (20%) discount and VAT
exemption for the following services:

a. Hospital Bed
A hospital bed in pay sections of government accredited health facilities and
private health facilities which is deemed medically necessary to diagnose and
treat an illness or injury in accordance with the available CPGs or hospital
treatment protocols.

b. Laboratories and Diagnostic Services

All in-patient and out-patient laboratory and diagnostic examinations for PWD in
pay sections of government health facilities and private health facilities shall be
granted 20% discount and VAT exemption, provided that:
i. Diagnosis and/or treatment by the attending physician shall be in accordance
with available CPGs or hospital treatment protocols.
ii. All special reagents, dyes, contrast media, and radioactive isotopes used in
laboratory and diagnostic tests shall be provided to PWD admitted to a health
facility, other than the service ward.

c. Dental Services
All dental services that are deemed to be medically necessary by the attending
dentist shall be granted a 20% discount and VAT exemption.

d. Rehabilitation and Other Specialized Services

Twenty percent (20%) discount and VAT exemption shall be given to PWDs
requiring rehabilitation and other specialized services such as purchase of .
assistive devices prescribed by attending physician or by a rehabilitation
specialist.

e. Professional Fees

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 Professional fees for in-patient and out-patient medical, dental, and other health
care professional services shall be provided with a 20% discount and VAT
exemption. The concerned physician or dentist must issue the corresponding
official receipt.

3. Guidelines for the Twenty Percent (20%) Discount and VAT Exemption in the
Government Health Facilities and Private Health Facilities for PhilHealth-Related
Benefits

The 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; then deduct the PhilHealth benefits 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.)

4. Guidelines for the Twenty Percent (20%) Discount and VAT Exemption in the Purchase
of All Medicines for the Exclusive Use of the PWD

a. All establishments, through their registered pharmacists, must have full discretion
and responsibility in dispensing all medicines for the exclusive use of PWD.

b. Discounts and VAT exemption shall be granted to PWDs on the purchase of all
medicines and food for special medical purposes provided that it is supported by the
following documentary requirements:

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. 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.

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 : name of the PWD, age, sex, address,
date, generic name of the medicine, dosage form, dosage strength, quantity,
signature over printed name of physician, physician's address, contract number
of physician or dentist, professional license number, professional tax receipt
number and 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 information shall be honored.

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 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
4. 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.

c. 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.

d. 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.

e. Drug stores are required to maintain a special record book for PWD subject to inspection
by the FDA and Bureau of Internal Revenue.

f. For partial filling, the establishment's pharmacists will indicate the quantity
partially filled in the purchase booklet (special record book) and the unfilled
balance on the prescription. The PWD shall retain the partially filled prescription
and present the same later to complete the prescribed quantity.

g. Drug 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 will still be observed.

h. These discount privileges and VAT exemption shall be non-transferable and exclusively
for the benefit of the PWD.

i. Double discounts shall not be allowed. The PWD shall avail of the
establishment's offered discount or the 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

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•

with disability shall use either his/her PWD ID Card or Senior Citizen ID card to avail of
the 20% discount and VAT exemption.

j. All establishments dispensing medicines and assistive devices are enjoined to comply with
the above-cited guidelines.

5. Responsibilities of Stakeholders

a. Government Facilities
All government health facilities shall post hospital room rates, laboratory tests,
diagnostic tests fees, medicine prices, and all other fees and rates in conspicuous
places near or at the main entrance to their respective facilities. The above-
described price lists shall be submitted annually to the Health Facility
Development Bureau of DOH and PhilHealth.
i. All government health facilities shall post this Administrative Order in
conspicuous places where PWDs can have access to the information and
policies set forth by this document.
ii. Official receipts shall be issued in every payment for medical and dental
services, laboratory and diagnostic tests, and medicines provided. The receipts
shall state the usual rates or fees and the discounted price; and,
iii. No "Income Means Test" or any other tests shall be applied to the PWD as a
precondition for the availment of free services as herein described.
iv. An express lane for PWDs shall be provided in all government hospitals.

b. Private Hospitals and Medical Facilities and Establishments

i. Private hospitals and medical facilities must post the price of all room rates in
the Admitting Section of all private hospitals and medical facilities. 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. Official receipts shall be issued to every payment for the medical and dental
services and medicines provided. The twenty percent discount and VAT
exemption shall be granted upon full payment of the bill. The billing statement
showing the usual rates or fees and the discounted prices shall be attached to the
official receipt.
iii. Set a grievance mechanism for PWDs to entertain questions with regard to discount
and VAT exemption on professional fees.
iv. Inform in writing, copy furnished the aggrieved party, the necessary sanction
for health professionals who refuse to grant the proper discount and VAT
exemption.
v. All health facilities shall be required to post this Administrative Order in
conspicuous places where PWDs can have access to the information and
policies set forth by this document.
vi. An express lane for PWDs shall be provided in all private hospitals and medical
establishments.

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 c. Health Care Professionals shall:
i. Inscribe his/her name and PRC number in the request for diagnostic and
laboratory tests, and prescription;
ii. Make sure 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.

d. Drugstores and other Licensed Establishments Dispensing Medicines

i. Drugstores shall make available upon the PWD's request, a generic menu card
and shall provide an official receipt for drugs and medicines, which states the
usual prices and the discounted prices and VAT exemption of the drug or
medicine.
ii. All drug retail stores shall post this Administrative Order in conspicuous places
where the PWDs can access information on the 20% discount and VAT
exemption on medicines.
iii. Drugstores shall have a designated special lane for PWDs.
iv. 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.
v. Official receipt should be issued to the PWDs for every transaction on
medicines which shall contain the Retail Price, the Discount Price and VAT
Exemption.

e. Rehabilitation Centers shall provide quality care to PWDs and their families and to
treat them with professional conduct and respect.

f Behavioral testing centers shall provide test that measures general or specific behavior
within educational, vocational, community or house settings. It shall also provide
measurements and interpretations of behavior in relation to adaptive or social skills
and appropriateness or dysfunctions within settings or situations.

g. Hospices and Palliative Care Centers shall provide a holistic quality care for patients
addressing their physical, psychosocial, emotional and spiritual pains.

6. Mechanism of Endorsement of Complaints

Section 15 of Rule VI of the IRR of RA 10754, 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.

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VII. SEPARABILITY 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.

PAULYN JEAN B. ROSELL-UBIAL, MD, MPH, CESO II

Secretary of Health

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