Implementation Procedures and Replication Rules
- For LGUs outside priority zones, the following conditions apply:
- Percentage of Rural Health Units/Health Centers (RHUs/HCs) capable of implementing the package.
- Accessibility of LGU-owned hospitals from RHUs/HCs, based on fare and travel time.
- Enrollment threshold of indigent households, at least 200 households per RHU/HC or as determined by PhilHealth.
- Implementation in priority areas requires a signed Memorandum of Agreement between PhilHealth and the Local Chief Executive.
- Pre-assessment of RHUs/HCs will be conducted by PhilHealth to determine operational setup.
Expanded Benefits
- Additions to existing OPB benefits include preventive services such as:
- Visual acetic acid screening for cervical cancer.
- Regular blood pressure monitoring.
- Annual digital rectal examination.
- Body measurements.
- Periodic clinical breast examinations.
- Smoking cessation counseling.
- Lifestyle modification counseling.
- These are preventive services with minimal or no cost implications.
Accreditation Exceptions and Referral Systems
- In exceptional cases, the requirement for on-site medical technologist and laboratory equipment may be replaced by an operational referral system to a central or zonal laboratory.
- Referral laboratories may be attached to hospitals or independent LGU entities.
- Compliance with PhilHealth Circular No. 30, series of 2001 is required for such substitutions.
Payment for Referred Diagnostic Services
- Payments for diagnostic services referred to a central or zonal laboratory are charged against the PhilHealth Capitation Fund (PCF) of the RHU.
- Payment aligns with provisions regarding referred chest x-rays under PhilHealth Circular No. 30, series of 2001.
- LGUs are responsible for establishing the referral and payment systems.
Hospital Authorization Standards
- Hospitals authorized to provide OPB services must:
- Be owned and managed by an LGU.
- Be accredited by PhilHealth.
- Have service and human resource capability to deliver OPB services.
- Be accessible to non-accredited RHUs/HCs.
- These requirements apply under the transitory provisions of the OPB Guidelines.
Disposition and Use of PhilHealth Capitation Fund (PCF)
- 20% of the total PCF is allocated for administrative expenses.
- The administrative expenses are split between:
- 50% accruing to physicians.
- 50% covering other administrative expenses of RHU personnel involved in OPB services.
Partial Implementation Allowance
- Partial implementation is allowed for provinces and their component cities/municipalities.
- Partial implementation requires a Memorandum of Agreement between the collective LGUs and PhilHealth.
- Individual assessment of city/municipality RHUs/HCs and accessibility of accredited hospitals determines execution.
Monitoring and Reporting System
- The Corporation's Health Finance Policy and Service Sector leads monitoring and evaluation.
- Benefits Development Office monitors package delivery.
- Accreditation Department and regional units oversee facility compliance.
- The previous Monthly Report Form is replaced by a new form and transmittal form attached to the circular.
- Reports must be submitted to PhilHealth Regional Offices by the 7th calendar day of the first month of the quarter following implementation and in subsequent quarters.
Separability and Alternative Arrangements
- LGUs may propose alternative arrangements for the disbursement/disposition of the PCF.
- Such proposals must not compromise OPB objectives.
- Alternative arrangements must be specified in the Memorandum of Agreement.
Effectivity
- The guidelines take effect immediately upon issuance on April 18, 2002.
- Signed by the President and CEO of PhilHealth, Francisco T. Duque III, MD, MSc.