PHIC PHILHEALTH CIRCULAR NO. 13, S. 2002

Explanation: The OPB is aimed at achieving universal coverage for all indigent program members, with a focus on specific areas.
Key Definitions:
- Indigent Program Members: Individuals eligible for health services due to their economic status.
Requirements:
- Implementation is nationwide, contingent on the capacity of Local Government Units (LGUs).
- Priority is given to LGUs identified as Health Sector Reform Agenda (HSRA) Convergence Sites and Urban Areas.
Timeframes:
- Implementation in priority areas begins once a Memorandum of Agreement (MoA) is signed.

Explanation: Guidelines for implementing the OPB in LGUs outside of priority areas.
Requirements:
- Assess the percentage of Rural Health Units/Health Centers (RHUs/HCs) capable of implementing the package.
- Evaluate accessibility of hospitals from RHUs/HCs.
- Minimum enrollment threshold of 200 indigent households per RHU/HC.
Consequences: Implementation may be delayed until criteria are met.

Explanation: Additional preventive services have been incorporated into the OPB.
Key Additions:
- Health screening, education, and counseling services.
- Specific screenings for cervical cancer, blood pressure checks, and lifestyle counseling.
Requirements: Services are to be provided at minimal or no cost to the patients.

Explanation: Criteria for Rural Health Units/Health Centers to be accredited for OPB service delivery.
Requirements:
- An operational referral system may substitute for on-site medical technologists and laboratory supplies.
- Laboratories may be affiliated with hospitals or independent facilities managed by LGUs.

Explanation: Guidelines for reimbursing diagnostic services referred by accredited RHUs.
Requirements:
- Payments for referred services will be charged against the PhilHealth Capitation Fund (PCF).
- LGUs are responsible for establishing a referral and payment system.

Explanation: Hospitals must meet specific criteria to be authorized as OPB service providers.
Requirements:
- Must be LGU-owned and PhilHealth accredited.
- Must demonstrate the capability to deliver OPB services and be accessible to non-accredited RHUs/HCs.

Explanation: Guidelines on the allocation of the PCF for administrative expenses.
Requirements:
- 20% of the total PCF is to be used for administrative expenses.
- Allocation: 50% to physicians and 50% to other administrative personnel involved in OPB services.

Explanation: Conditions under which the OPB may be partially implemented.
Requirements:
- Collective MoA required from provinces and municipalities.
- Implementation is based on assessments of facilities and accessibility.

Explanation: Structure for monitoring and evaluating the OPB implementation.
Responsibilities:
- The Health Finance Policy and Service Sector will oversee monitoring, with specific offices managing compliance.
Timeframes: Monthly reports are to be submitted by the 7th day of the first month of the subsequent quarter.

Explanation: Provision for alternative arrangements regarding PCF disbursement.
Requirements:
- Any alternative must not compromise OPB objectives and must be documented in the MoA.

The OPB is aimed at providing universal health coverage to indigents, with priority given to specific LGUs.
Implementation criteria are stringent, including assessments of local health services and household enrollment.
Additional preventive health services have been incorporated, enhancing the overall benefit package.
Strong emphasis is placed on the accreditation of RHUs and hospitals, alongside a structured monitoring system for compliance.
The framework allows for flexibility in funding allocations while ensuring that the core objectives of the OPB are met.