PhilHealth Diagnosis of Tuberculosis (TB) in Children Aged Zero to Nine Years Old

I.    RATIONALE

In support to the -United Nation's Millennium Development Goals (MDGs) to reduce prevalence and mortality of TB by 5O%, and to the objectives of Philippine Plan of Action to Control Tuberculosis (PhilPACT) to scale up and sustain coverage of DOTS implementation and reduce out-of-pocket expenses related to TB care, PhilHealth hereby issues these guidelines for the reimbursement of claims on TB in children. II.    DECLARATION OF POLICY AND OBJECTIVES

In compliance to DOH Administrative Order No. 2008-0011, direct sputum smear microscopy shall no longer be requited for children zero to nine years old who cannot expectorate. For children zero to nine years old with no or negative sputum smear microscopy, three out of five criteria must be satisfied:

1) TB symptomatic — at least 3 of the following signs and symptoms provided by DOH AO 2008-0011:

1. Cough/wheezing for 2 weeks or more
2.  Unexplained fever for 2 weeks or more after common causes such as malaria or pneumonia have been excluded
3. Loss of weight/failure to gain weight/weight faltering/loss of appetite
4. Failure to respond to 2 weeks of appropriate antibiotic therapy for lower respiratory tract infection
5. Failure to gain previous state of health 2 weeks after a viral infection or exanthema (e.g., measles)
6. Fatigue/reduced playfulness/lethargy
   

2) History of exposure to TB case/s
3) Positive Tuberculin Skin Testing (TST)
4) Positive Chest X-ray
5) Other laboratory findings suggestive or indicative of TB

III. OTHER RULES

1)    Copy of the National Tuberculosis Program (NTP) Form for children should be attached to the claims for TB DOTS for children (see attached).
2)    All provisions of previous issuances that are not inconsistent with any provisions of this Circular remain in full force and effect.

IV. EFFECTIVITY

This Circular shall take effect for all claims on maintenance phase and intensive phase fifteen (15) days after publication in the Official Gazette or in a newspaper of general circulation and shall be deposited thereafter with the National Administrative Register at the University of the Philippines Law Center. - https://www.affordablecebu.com/