MEMORANDUM
TO : DOMINADOR M. CHIONG JR., MD, FPCS, FACS
Director, VMMC
FROM : PVAO, ADMINISTRATOR
SUBJECT : Revised VMMC Implementing Guidelines on Veterans Hospitalization and Medical Care Program series of 2017
1. References:
a. Section 7, Article XVI of the 1987 Constitution;
b. Sections 9 & 14, RA No. 65 of 1946;
c. Section 15 of Republic Act No. 6948 as amended by RA No. 7696;
d. PVAO Memoranda dated June 14, 2011, September 19, 2011, November 2, 2011, January 20, 2012, March 1, 2012, July 25, 2012 and February 11, 2013;
e. Memorandum of Agreement between DOH and DND; PVAO and Accredited Hospitals;
f. VMMC Hospital Memo No. 2012-500-01 dated April 19, 2012;
g. VMMC Memoranda dated January 24, 2012, Feb. 10, 2012; Memorandum Order Nos. 40 & 47 dated April 19, 2012 and April 20, 2012;
h. Philhealth Circular No. 16 s. 2009 re – Philhealth Cataract Package dated April 16, 2009;
i. Philhealth Circular No. 30 s. 2012 re- Case Type Z Benefit Package for Acute Lymphocytic (Lymphoblastic), Leukemia (ALL), Breast Cancer, Prostate Cancer and Kidney Transplant;
j. Hospital Memo. No. 2011-620-04 Change IV dated February 14, 2013.
2. In line with the objective of the Veterans Hospitalization and Medical Care Program to provide adequate medical and health care services to veterans and authorized dependents, and to reach-out to those who are in far flung regions, who do not have convenient access to VMMC, the following amended guidelines in the implementation of the VHMCP are hereby issued:
I. GUIDELINES
A. Reimbursement of Hospital Subsidy
1. The Accredited Hospital shall be paid based on the actual billing by the hospital net of other applicable discounts up to a maximum of P1,500.00 per day of confinement PVAO-VMMC shall pay up to a maximum of 45 days of hospital confinement per patient per year. The basis of payment shall be the Statement of Account signed by the Chief Accountant of the Hospital.
2. The veteran/veteran dependent who opted to file direct reimbursement of hospital subsidy shall likewise be paid based on the actual amount indicated in
the Official Receipt and paid to the hospital net of other applicable discounts up to a maximum of P1,500.00 per day of confinement for 45 days of
hospital confinement per patient per year.
3. The heir/s of deceased veteran/veteran dependent as claimant (Nearest Surviving Relative)– refers to the closest person related to the deceased by blood or affinity such as, the surviving spouse of the deceased. In the absence of the surviving spouse, it shall be limited to the relative by consanguinity of the nearest of kin such as children, parents, grandchildren, grandparents, brothers/sisters, aunt/uncle, niece/nephew, great grandchild, great grandparent, etc.
3.1 The heir/s of a deceased veteran/veteran dependent will be allowed to reimburse the expenses incurred by the veteran/veteran dependent for hospital benefits. Payment shall be made in the name of the payer as indicated in the official receipt.
3.2 As regards to the documentary requirements, the payer named in the official receipt that will opt for reimbursement of hospital subsidy shall submit proof of relationship with the veteran/veteran dependent and proof of identity.
3. The following documents shall be submitted by the accredited hospitals or veteran/veterans dependent to the Office of the Director, VMMC:
3.1 Accomplished Reimbursement Form or Request Letter
3.2 Statement of Accounts (with date of admission and discharge) signed by the Chief Accountant of the Hospital. Statement of Account received through email sent by the Hospital is acceptable.
3.3 Medical Certificate/Discharge Summary (indicating period of confinement) signed by the Attending Physician or Authorized signatory of the Hospital
3.4 Proof of Veteran Status, e.g. VMMC Medical Card, PVAO Pensioner’s ID, Certification from PVAO; AFP Retiree’s ID; Military Honorable Discharge Paper; Retirement Order
B. Reimbursement of additional benefits as follows:
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Cataract Surgery |
Payment of actual billing not to exceed P14,000.00 per eye
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Orthopedic implants |
at cost but not to exceed P30,000.00 per implant |
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Dentures |
at cost but not to exceed P5,000.00 (P2,500.00 for upper dentures and P2,500.00 for lower dentures)
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Hernia mesh |
at cost but not to exceed P2,000.00 per mesh
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Hearing Aid |
at cost not to exceed P30,000.00 per device
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Orthopedic braces |
at cost but not to exceed Pup 6,000.00 per piece
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Hemodialysis Treatment |
not to exceed P400.00 per treatment, cost of epoetin alfa. In excess of 90 treatments covered by Philhealth, P2,500.00 per treatment will be reimbursed |
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Cardiac Bypass |
P200,000.00
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Coronary Angiogram |
at cost but not to exceed P30,000.00
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Chemotherapeutic Agents |
P10,000.00 per cycle up to a maximum of 6 cycles.
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Angioplasty |
P100,000.00 for single stent and only up to a maximum of P150,000.00 for two or more vessel stents
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Endoaneurysmectomy for Thoracic/ Abdominal Aortic Aneurysm
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up to a maximum of P40,000.00 for vascular graft only |
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Pacemaker placement |
P20,000.00 for temporary pacemaker placement and P180,000.00 for permanent pacemaker placement, all inclusive
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Cranial CT Scan |
not to exceed P4,000.00 with or without contrast
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Other CT Scan and MRI procedures
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amount to be reimbursed will be based on VMMC rate/approved fees and charges |
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Colonoscopy |
not to exceed P2,000.00
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Extra corporal Shock Wave Litotripsy (ESWL)
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not to exceed P40,000.00
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Peritoneal Dialysis (IPD and CADP) |
not to exceed P5,000 per week up to a maximum of P20,000.00 per month
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Rehabilitation services |
P350.00 per treatment session maximum of 3 treatment session per week
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Ventilator rental
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at cost but not to exceed P300.00 per day
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kidney transplant |
not to exceed P200,000.00 net of Philhealth coverage and senior citizen discount |
1. No professional fee shall be charged for procedures performed in the Veterans Memorial Medical Center.
2. All special procedures and medical/surgical interventions shall pass through the VMMC Medical Screening Committee for evaluation and validation.
C. Reimbursement of Drugs and Medicines
1. Medicines (antibiotics) of confined veteran / veteran dependent patients classified as critical or non-critical cases
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Critical case |
at cost but not to exceed P20,000.00 per confinement |
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Non-critical case |
at cost but not to exceed P10,000.00 per confinement |
2. OPD Maintenance Medicines for hypertension, diabetes mellitus, hypercholesterolemia, prostate and anti-psychotic drugs.Amount to be reimbursed shall be based on the current Drug Price Reference Index (PDRI) – Annex A
3. Anti-rejection drugs - P20,000.00 per month net of senior citizen and Philhealth discount
4. The request for reimbursement of drugs and medicines of confined veteran or veteran dependent as well as reimbursement of OPD
maintenance medicines and oral antibiotics shall pass through the VMMC Medical Screening Committee for evaluation and validation prior to
processing of payment by offices concerned.
D. Documentary Requirements
The following documents shall be submitted to the Office of the
Director, VMMC:
1. Accomplished Request for Reimbursement Form- available at Medical Administrative Section, VMMC and downloadable in the VMMC website –www.vmmc.gov.ph; and PVAO website – www.pvao.mil.ph
or
Letter request signed by the veteran patient/veteran dependent or heir/claimant of the deceased veteran
2. Medical Certificate/Medical Abstract indicating period of confinement (if hospitalized), issued by the attending physician or authorized signatory of the Hospital
3. Official Receipt/s issued by the Hospital/Clinic/Supplier
4. For reimbursement of drugs and medicines
4.1 Prescription Form signed by the Physician of the Accredited Hospital (if drugs and medicines were not indicated in the detailed Statement of Account- SOA)
5. Additional (applicable) documentary requirements:
i. Certificate of Documented Sensory-Neural Hearing Loss issued by any Accredited Hearing Aid Center for hearing aid reimbursement
ii. Birth Certificate/legal adoption papers or VMMC Medical Card (whichever is available) for children below 18 years old
iii. PVAO Pensioner ID or Photocopy of Death Certificate of Veteran and Marriage Contract (whichever is available) - if the veteran is deceased and the claimant is the spouse (wife)
iv. Photocopy of Death Certificates of the Patient and the Spouse and Affidavit of the Nearest of Kin (NOK) – if both the veteran and spouse are deceased and the claimant is one among the children
v. Notarized Waiver or Deed of Assignment from the siblings of the claimant – if both the veteran and spouse are deceased and the claimant is one among the children
vi. Photocopy of the ID of the claimant
vii. Notarized Special Power of Attorney (SPA) - if the claimant is a representative of veteran or veteran dependent/payee
E. PVAO Administrator may authorize reimbursement of procedures and items not included in the list of additional benefits of the program as follows:
1. procedure/intervention to include drugs and medicines for life threatening conditions
2. Medical expenses World War II Veterans, awardees of medal valor, dependents of soldiers killed in action (KIAs) and prisoners of war
3. for patients requiring longer confinement beyond 45 days
F. Processing of Reimbursement
1. Payment for hospitalization subsidy to accredited hospitals, veterans or veteran dependents shall be prioritized over personal reimbursement for additional benefits.
1.1 Accredited Hospitals may file reimbursement of hospital subsidy on annual basis.
2. Reimbursement of additional benefits and personal/direct filing of hospital subsidy must be submitted to PVAO/VMMC within one hundred eighty (180) days from the date of hospital discharge and/or from the date the procedure has been performed.
2.1 Processing of request beyond 180 days prescriptive period may be allowed subject to the approval of PVAO Administrator. Provided that the claimant shall submit an Affidavit of Delayed Claim explaining/justifying the reason for the delay.
2.2 For personal reimbursement (direct filing) of additional benefits and reimbursement of hospital subsidy by veteran/veteran dependent, the date when the request was mailed and/or received by VMMC/PVAO FSEOs shall be considered in the counting of days.
G. Subject to availability of funds, outreach activities under the Veterans Hospitalization and Medical Care Program shall be conducted to extend the medical services being provided by VMMC including provision of drugs an medicines
3. Responsibilities of the following offices :
Medical Administrative Section
i. The Medical Administrative Section (MAS) shall evaluate the submitted documents.
ii. The Patient’s Control Unit (MAS) shall prepare Budget Utilization Request (BUR) and Disbursement Voucher payable to the veteran/veteran dependent or accredited hospital and submit to the Accounting Section for processing of payment attached thereto all necessary documents.
iii. In case, the DV was returned by the Accounting Section due to incomplete documentary requirements or discrepancies, MAS shall return the same to PVAO/Hospital/claimant concerned for their information and compliance. In this connection, receipts/documents of items not considered/approved for reimbursement shall be returned intact to the claimant for whatever purpose it may serve them.
iv. Shall take charge of the mailing of all communications of the program
Accounting Section
i. The Accounting personnel shall assign a DV control number upon receipt of Disbursement Voucher
ii. Supporting documents shall be evaluated as to authenticity and accuracy, prior to submission to the Budget Section for funding.
iii. The Chief/Assistant Chief of the Accounting Section shall approve the DV after approval of funds prior to submission to Cash Section for check preparation.
iv. The Accounting Section shall be responsible to all necessary book entries.
v. Monthly, quarterly and annual liquidation reports shall be prepared by the Assistant Chief, Accounting Section for submission to the Office of the Secretary of National Defense, Philippine Veterans Affairs Office and concerned offices, with all the relevant documents attached thereto.
Budget Section
i. The Budget Officer shall verify availability of funds prior to approval upon receipt of DV from Accounting Section.
ii. The Chief, Budget Section shall approve the BUR and then return it to the Processing Unit of the Accounting Section.
iii. Budget Officer shall be responsible to all necessary entries to the Registry of Budget Utilization.
Cash Section
i. Upon receipt of approved DV from Accounting Section, a check shall be prepared in favor of the Claimant.
ii. The Cash Section shall be responsible for the preparation and release of VHMCP checks to the claimants.
Medical Social Work Service
i. The VHMCP Committee together with the Medical Social Workers shall be responsible for the information dissemination of the program.
ii. Shall evaluate and determine the status/proof of the veteran/veteran dependent if the claimant has not yet been issued a VMMC Medical Card or PVAO ID.
Public Relations Unit
i. Shall serve as Secretariat of the Veterans Hospitalization and Medical Care Program
ii. Shall take charge of all communications regarding the implementation of the Program and other VHMCP concerns
iii. Shall prepare the Revised PRIMER of VHMCP
iv. Shall update the website relative to the Veterans Hospitalization and Medical Care Program
v. Shall publish VHMCP updates in the VMMC News Bulletin
VII. FUNDING SOURCE
1. A quarterly fund cash transfer from Philippine Veterans Affairs Office shall be released to Veterans Memorial Medical Center for the Veterans Hospitalization and Medical Care Program
2. Sixty percent (60%) of the quarterly fund release shall be earmarked for the hospitalization subsidy, while the remaining forty percent(40%) shall be used for additional benefits.
3. All unused funds for hospital subsidy may be realigned for additional benefits/reimbursement or vice-versa prior to the close of the quarter.
VIII. Releasing of Claims
Upon receipt of the check for reimbursement of hospitalization subsidy to accredited hospital and/or reimbursement of additional benefits, Cash Section shall immediately notify the claimant through text message or phone call if the claimant is within Metro Manila or send the check through registered mail if the claimant is outside Metro Manila.
IX. Periodic Review, Evaluation, and Adjustments
This Hospital Memorandum including the Philhealth case rates, processes and procedures shall be subject to regular evaluation and adjustments as necessary. Such review and evaluation shall be done six (6) months after the effectivity of this Memorandum and yearly thereafter unless revoked, modified, amended or repealed.
X. RESPONSIBILITY
The VMMC Committee on Veterans Hospitalization and Medical Care Program in coordination with the different Clinical Departments and Offices concerned shall be responsible in the implementation of this Hospital Memorandum.
XI. RESCISSION CLAUSE
All earlier publications that are inconsistent with the herein guidelines are hereby superseded or rescinded.
This shall take effect immediately.
LT. GEN. ERNESTO G. CAROLINA AFP (RET)
Administrator, PVAO