Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY
NOV 23 2023

ADMINISTRATIVE ORDER
No. 2023- 0020

SUBJECT: Implementing Rules and Regulations of Republic Act No. 11959,

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s the “Regional Specialty Centers Act”

I. RATIONALE

On August 24, 2023, Republic Act (RA) 11959, “An Act Establishing Specialty
Centers in Department of Health Hospitals in Every Region and in Government-Owned or
~Controlled Corporation Specialty Hospitals and Appropriating Funds Thereof” was enacted.
The law aims to
increase specialty care access through the establishment of Specialty Centers
in Department of Health (DOH) hospitals. This is in line with the goal of the Philippine
Health Facility Development Plan (PHFDP) 2020-2040, adopted by the Office of the
President through Memorandum Circular No. 26 s. 2023 as the overall
strategy for
infrastructure and medical investments in the country, providing equitable access to quality
and affordable healthcare services from primary to specialty care services all Filipinos. to
II. OBJECTIVE

This Administrative Order serves as the Implementing Rules and Regulations of RA

11959, otherwise known as the “Regional Specialty Centers Act”.

HOI. SCOPE OF APPLICATION

This Order shall apply to DOH Central Office bureaus, services, attached
agencies,
Centers for Health Development (CHDs), DOH hospitals, Government-Owned and
Controlled Corporation (GOCC) Specialty Hospitals, Professional Regulation Commission
(PRC), Department of Budget and Management (DBM), Civil Service Commission,
Department of Science and Technology - Health Technology Assessment Council, and other
stakeholders involved in the establishment of Specialty Centers.

IV. DEFINITION OF TERMS

For the purposes of this Order, the following terms are defined:

A. Advanced Comprehensive Specialty Center (ACSC) refers to a specialty center

that serves a full range of specialty and subspecialty clinical services at the
subnational level, and has the capacity to conduct and provide specialty and
subspecialty clinical, public health, operations research, and training.

B. Basic Comprehensive Specialty Center (BCSC) refers to a specialty center that

serves a full range of specialty clinical services at the regional level, and has the

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 capacity to conduct and provide specialty clinical, operational, and public health
research, and training.

. DOH Hospitals refer to hospitals under the direct supervision and control of the
Department of Health (DOH).

- Government-Owned and Controlled Corporation (GOCC) Specialty Hospitals

refer to hospitals that specialize in a particular organ or group of organs, or type of
patients, as mandated under their respective charters, and are attached to the DOH,
specifically pertaining, but not limited to the Philippine Heart Center, the National
Kidney and Transplant Institute, the Lung Center of the Philippines, and the
Philippine Children’s Medical Center.

- National Specialty Center (NSC) refers to a specialty center with the highest level of
expertise in clinical services, teaching, training, and public health research. The term
shall also refer to the designation by the DOH to specialty centers, DOH hospitals
mandated by law to provide specialized care in a certain specialty, and GOCC
Specialty Hospitals.

. Resource Stratified Framework (RSF) refers to a framework providing a rational

approach for the sustainability of specialty care services, human resources,
equipment, and infrastructure requirements at each level of facility across the
healthcare continuum.

- Specialty Center refers to a unit or department in a hospital that offers specialized

care addressing particular conditions and providing specific procedures and
management of cases requiring specialized training and equipment on a specific
specialty.

GENERAL GUIDELINES

. The DOH shall establish one or more functional Specialty Centers in DOH
hospitals
and in GOCC specialty hospitals pursuant to their respective mandates in
every region
complete with the appropriate services, human resources, infrastructure and
equipment, and sustainable financing.

. The establishment of Specialty Centers shall adhere to guidelines set by the DOH
on
planning and prioritizing health facilities in consultation with the designated DOH
hospitals and GOCC specialty hospitals.

. The DOH shall include the establishment of Specialty Centers in the PHFDP, which
serves as a guide for investments funded by the national government
distribution of capacity and capability of health facilities.
to
rationalize the

. The DOH shall provide appropriate specialist equipment as identified in the Resource
Stratified Frameworks and prioritize funding for capital outlay investment for
Specialty Centers through the Health Facilities Enhancement Program and other fund
sources.

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 . The establishment of Specialty Centers or any part thereof, in separate premises and
operated under the same management of a DOH hospital, shall not require a separate
license.

. The DOH, in collaboration with the NSCs, DOH hospitals, the Professional
Regulation Commission, the Department of Budget and Management (DBM), the
Civil Service Commission, the concerned accredited professional organizations and
specialty and subspecialty associations, and other relevant government agencies and
stakeholders, shall ensure the sustainability of the staffing of the Specialty Centers by
developing and implementing plans, policies, strategies, and programs concerning the
production, recruitment, training, and retention of medical specialists and expert
personnel. The DOH in collaboration with the DBM shall issue staffing standards and
organizational structure for Specialty Centers.

The NSCs and DOH hospitals with ACSCs and BCSCs,

.
are authorized to contract the
services of medical specialists or experts to provide specialty training and technical
assistance. DOH hospitals with ACSCs and BCSCs may also send medical, allied
medical, and other necessary personnel to the NSCs for training and capacity
development. The NSCs are encouraged to prioritize trainees from the designated
DOH hospitals in their training program.

VL SPECIFIC GUIDELINES

. Services

1. The DOH shall categorize the level of service capability of the Specialty Centers
to be established as NSCs, ACSCs, and BCSCs, in accordance with the Resource
Stratified Frameworks of the Philippine Health Facility Development Plan.

2. In coordination with concerned offices, the NSCs shall have the following roles
and responsibilities:
(a) Serve as the core information hub for the specializations and diseases they
cover. The NSCs shall collect or obtain pertinent information from relevant
DOH hospitals and national and international agencies such
to the following:
as, but not limited

(1) Profile and service capability of Specialty Centers including its specialty
and subspecialty services, bed capacity, human resources, training,
infrastructure, and medical equipment;
(2) Census of inpatient, outpatient, surgeries, and specialized procedures of
Specialty Centers;
(3) Data on priority disease conditions such as prevalence, incidence, risk
factors, trends, and other relevant public health data;
(4) Updates on Clinical Practice Guidelines, other relevant practice standards,
regulation, and public health interventions; and
(5) Research findings and information about published and ongoing clinical
trials.
The DOH shall issue a policy regarding the collection and sharing of the
above-mentioned data in compliance with the Data Privacy Act or RA 10173.

7 %
 (b) Lead in the development, implementation, and monitoring of policies,
protocols, and standards for the particular specialty and shall have
level of clinical services and training capability;
the
highest
(c) Provide scientific leadership by conducting specialized clinical, public health,
and operations research with a multi-disciplinary or multi-center approach, in
alignment with identified national health research priorities;
(d) Provide specialty training and technical assistance to specialty centers to
ensure the delivery of quality services and strengthen the network of care
across the country for a particular specialty; and
(e) Conduct capacity and capability assessment of the services provided by
a
ACSCs and BCSC:s for particular specialty.

3. The DOH hospitals and GOCC specialty hospitals, through their Public Health
Unit, shall endeavorto set up an organized system between the Specialty Centers
and the Health Care Provider Networks for ease of patient referrals. The
network
of health facilities may utilize telemedicine, telehealth, or any appropriate
electronic system to facilitate the provision of specialty services.

B. Medicines

1. The Department of Science and Technology - Health Technology Assessment

Council (HTAC) shall review and update Health Technology Assessment
guidelines as necessary to facilitate the timely inclusion of medicines for Specialty
Centers in the Philippine National F ormulary (PNF).

2. The DOH shall ensure the regular updating of the PNF

following the positive
recommendations of HTAC that are duly approved by the Secretary of Health.
(a) The DOH shall update the drug monographs in consultation with the NSCs
and relevant medical and allied health professional societies to
ensure the
rational use of the identified drugs and medicines.

C. Health Human Resources

1. The DOH shall determine the organizational structure and

staffing pattern of
specialty centers, in addition to the existing hospital staffing pattern, subject to the
evaluation and approval of the DBM and in accordance with civil service
laws,
rules, and regulations.

2. The DOH, in collaboration with the NSCs, DOH hospitals, the Professional
Regulation Commission (PRC), the Department of Budget and Management
(DBM), the Civil Service Commission, the concerned accredited professional
organizations and specialty and subspecialty associations, and other relevant
government agencies and stakeholders shall develop plans, provide policy
recommendations, and/or implement strategies and programs relative to the
following areas for Specialty Centers:
(2) Human resource (HR) sharing in the network of Specialty Centers;
(b) Sustainable HR production of appropriate specialized health workers required
in Specialty Centers;

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 (c) Development and/or accreditation of responsive training programs aligned
with the health needs of the population, addressing supply and demand gaps in
number of specialized health workers in priority areas;
(d) Position titles and salary grade of specialized cadre;
(e¢) Competency-based recruitment and retention of appropriate personnel for the

Specialty Centers; and

(f) Appropriate international and local learning and development interventions for
health human resources in Specialty Centers.

3. The PRC shall regulate the specialty societies and specialty boards to ensure the
responsiveness of the training programs and training accreditation guidelines to
the human resources requirement in Specialty Centers.

D. Capital Outlay Investments

1. The DOH, through the Health Facilities Enhancement Program, Public-Private

Partnerships, and other sources, shall prioritize projects for Specialty Centers from
the designated DOH hospitals in alignment with the plans of the Subnational
Technical Working Groups.
(a) Funding for capital outlay for Specialty Centers shall include projects such as
but not limited to the following:
(1) Infrastructure projects;
(2) Equipment projects (eg., medical and building equipment);
(3) Information Communication Technology (ICT) and security infrastructure
projects;
(4) Land acquisition; and
(5) Ambulance and/or patient transport vehicles for air, sea, and land travel.

(b) In regions without a Level 3 DOH hospital, the DOH shall prioritize the
upgrading of existing DOH hospitals into Level 3 hospitals and subsequently
establish their Specialty Centers.

2. In collaboration with relevant agencies or offices, the DOH shall develop ICT
standards for Specialty Centers to guide investment plans and digital health
implementation.

3. The DOST-HTAC shall review and update its guidelines as necessary to ensure
the timely inclusion of medical equipment in the Philippine Essential Medical
Devices List.

E. Licensing and Bed Capacity

1. The DOH hospitals and GOCC specialty hospitals may establish Specialty Centers
on separate premises preferably in the same province or city, without the need for
a separate license, subject to the regulatory guidelines issued by the DOH.

2. The DOH hospitals and GOCC specialty hospitals shall determine the bed
capacity of the Specialty Centers that will be established in alignment with their
enabling laws, provided that they shall comply with the prescribed bed allocation

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 for basic and non-basic accommodation pursuant to the Universal Health Care
Act.

F. Sustainable Financing

1. The amount necessary for the initial implementation of this Act shall be charged
against the current year’s appropriation of the DOH. Thereafter, the DOH shall
include in the Department’s program the establishment and operationalization of
the Specialty Centers in DOH hospitals, the funding of which shall be included in
the budget of the DOH under the annual General Appropriations Act.

The funding for the operations of Specialty Centers shall be integrated into the
annual budget of the respective DOH hospitals and GOCC specialty hospitals.

The PhilHealth, in collaboration with the NSCs, shall ensure commensurate

payments for individual-based specialty services including those rendered
through telemedicine or telehealth in functional Specialty Centers.

G. Designated DOH Hospitals

1. The DOH shall prioritize the establishment of Specialty Centers for the following
specialties: cancer care, cardiovascular care, lung care, renal care and kidney
transplant, brain and spine care, trauma care, burn care, orthopedic care, physical
rehabilitation medicine, infectious disease and tropical medicine, toxicology,
mental health, geriatric care, neonatal care, dermatology, eye care, and ear, nose
and throat care.
(a) The DOH may develop Specialty Centers for other specialties provided that it
undergoes thorough evaluation, stakeholder consultation, and DOH Executive
Committee approval.

The DOH shall plan and prioritize DOH hospitals and GOCC specialty hospitals
that will establish Specialty Centers following the criteria:
(a) Upgrading of hospitals based on the Resource Stratified Framework
developed by DOH for each specialty care;
(b) Evidence of the health needs and demands, including disease burden, in the
catchment population of the DOH facilities;
(c) Service capability of hospitals and geographic or physical access;
(d) Appropriate level of specialized healthcare provider role in the continuum of
care, including roles of the DOH hospitals as referral facilities for
province-wide and city-wide healthcare provider networks;
(¢) Availability of competent health human resources for specialized healthcare;
(f) Operational and financial performance of the DOH facilities, including
accreditation to avail of specialized healthcare packages from the Philippine
Health Insurance Corporation; and
(g) Evidence-based Hospital Development Plans as approved by DOH.

H. Philippine Health Facility Development Plan

The PHFDP shall include the following targets for the establishment of Specialty
Centers:

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 1. at least one (1) functional Specialty Center shall be established in
every region
within five (5) years upon effectivity of this Act, based on the top burden of disease
and special needs in the area;
2. atleast one (1) functional Specialty Center of all seventeen (17) priority
specialties
in every subnational catchment area namely, North
Luzon, National Capital
Region and Central Luzon, South Luzon, Visayas, and Mindanao;
3. functional National Specialty Center for the seventeen
(17) priority specialties; and
4. functional Specialty Centers for additional
specialties, as deemed necessary.
I. Monitoring and Evaluation
1. The DOH shall monitor the implementation of the
development plans of the
designated DOH hospitals and GOCC specialty hospitals.

2. The DOH shall provide Congress, through the Committee

on Health of the House
of Representatives and the Committee on Health and Demography of the
Senate,
an annual report of the activities, accomplishments, and operational
plans of the
Specialty Centers. The DOH, in close coordination with the NSCs and the TWGs
ofthe priority specialties, shall oversee the monitoring of the Specialty Centers
and annually prepare a report, including but not limited
to the following:
(a) Status of the functionality of the Specialty Centers
according to the Resource
Stratified Framework;
(b) Annually funded and unfunded targeted capital
outlay projects; and
(c) Status of human resources in Specialty Centers.
The said report shall be uploaded to the
transparency seal page of the official DOH
and hospital websites.

3. Five (5) years after the start of the effectivity

of the Act, the Committee on Health
of the House of Representatives and the Committee on Health and
Demo graphy of
the Senate shall conduct a systematic
evaluation of the implementation,
accomplishments, and impact of the Act, as well as the performance
of established
specialty centers, for purposes of determining remedial
legislation.

VII. SEPARABILITY CLAUSE

If any part or provision of this Order is rendered invalid

by any court of law or
competent authority, the remaining parts or provisions not affected shall remain valid and
effective.

VIII. REPEALING CLAUSE

All issuances inconsistent or contrary to the

provisions of this Order are hereby
repealed, amended, or modified accordingly.

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IX. EFFECTIVITY

This Order shall take effect fifteen (15) days from the date of its publication in the
Official Gazette or in any national newspaper of general circulation, with three (3) certified
copies to be filed with the Office of the National Administrative Register (ONAR) of the UP
Law Center.