To facilitate the implementation of the Outpatient Consultation and Diagnostic Benefit Package, PhilHealth Circular No. 040, series of 2000, is hereby amended, as follows:

I. COVERAGE

Article 1.3 of the Outpatient Consultation and Diagnostic Benefit Package (OPB) is hereby amended, to wit:

As a strategy towards the achievement of the Corporation's mandate of universal coverage, the Outpatient Consultation and Diagnostic Benefit Package shall be implemented nationwide, subject to the health service capability of Local Government Units (LGUs) and the Corporation's work program, to cover all Indigent Program members. Priority shall be given to Local Government Units identified as Health Sector Reform Agenda (HSRA) Convergence Sites and Urban Areas defined in Article II, Paragraph C of PhilHealth Circular No. 21, series of 2001.

II. IMPLEMENTING PROCEDURE/REPLICATION RULES

1. Implementation in LGUs other than the priority areas shall be subject to the following parameters:
   
   a. The percentage of Rural Health Units/Health Centers (RHUs/HCs) with capability to implement the package;
   b. The accessibility of LGU-owned and managed hospitals from RHUs/HCs, based on fare and travel time, without capability to implement the package; and
   c. The number of indigent households enrolled in the LGU (enrollment threshold), which should be greater than or equal to two hundred (200) households per RHU/HC or a reasonable number as may be determined by the Corporation in OPB priority areas.
   
   
2. Implementation in identified priority areas shall be undertaken as soon as a Memorandum of Agreement is signed by the PhilHealth President and CEO and the concerned Local Chief Executive. However, pre-assessment of RHUs/HCs shall be undertaken by PhilHealth to determine the operational set-up by which the OPB services shall be provided.

III. BENEFITS

The following shall be added to the existing benefits provided under article 2.1 of the OPB Guidelines.

Preventive services with minimal or no cost implications such as health screening activities, health education and counseling including:

1. Visual acetic acid screening for cervical cancer;
2. Regular blood pressure measurements;
3. Annual digital rectal exam;
4. Body measurements;
5. Periodic clinical breast examination;
6. Counseling for cessation of smoking; and
7. Lifestyle modification counseling.

IV. RHU/HC ACCREDITATION

In exceptional cases, the requirement for a medical technologist and laboratory equipment and supplies pertinent to the delivery of the OPB may be substituted with an operational referral system to a central or zonal laboratory subject to the provisions of PhilHealth Circular No. 30, series of 2001. The laboratory maybe an attached facility of a hospital or RHU/HC or it maybe an independent entity owned and managed by the LGU.

V. PAYMENT OF REFERRED DIAGNOSTIC SERVICES

Pursuant to PhilHealth Circular No. 30, series of 2001, payment of diagnostic services referred by an accredited RHU to a central or zonal laboratory shall be in consonance with the payment of referred chest x-ray under Article 2.4 thereof. Henceforth, the payment of referred diagnostic services shall be charged against the PhilHealth Capitation Fund of the accredited RHU. It shall be the responsibility of the LGU concerned to enact the referral and payment system required therefor.

VI. STANDARD FOR HOSPITAL AUTHORIZATION

A hospital should satisfy the following requirements to be authorized as a provider of the Package under the transitory provisions of the OPB Guidelines:

1. The hospital is owned and managed by an LGU;
2. The hospital is accredited by PhilHealth;
3. The hospital has the service and human resource capability to provide the OPB services; and
4. The hospital is accessible to non-accredited RHU/HC.

VII. DISPOSITION OF PHILHEALTH CAPITATION FUND (PCF)

Twenty percent (20%) of the total PCF shall mandatorily be utilized for the provision of administrative expenses. It shall be divided among the personnel of the RHU, fifty percent (50%) of which shall accrue to the physician/s while the remaining fifty percent (50%) to other administrative expenditures of RHU personnel directly involved in the provision of OPB services.

VIII. PARTIAL IMPLEMENTATION

The OPB may partially be implemented in a Province and its component cities and municipalities who have collectively entered into a MoA with the Corporation depending on the individual assessment of the city/municipality-owned RHUs/HCs and the accessibility of accredited LGU owned and managed hospitals.

IX. MONITORING AND REPORTING SYSTEM

The Health Finance Policy and Service Sector of the Corporation shall spearhead the monitoring and evaluation of the package. Its Benefits Development Office shall monitor and evaluate the delivery of the Package while its Accreditation Department and the Accreditation and Quality Assurance Unit of the PhilHealth Regional Offices shall monitor the compliance of facilities to the requirements of the Package.

The Monthly Report Form, Annex D of PHilHealth Circular No. 040, series of 2000 is hereby replaced by the attached Monthly Report Form^* and Transmittal Form. It shall be submitted to the PhilHealth Regional Offices on or before the 7th calendar day of the first month of the succeeding calendar quarter following the date of OPB implementation and the succeeding calendar quarters thereon.

X. SEPARABILITY CLAUSE

Any other arrangement proposed by the LGU with respect to the disbursement/disposition of the PCF shall be considered, provided it does not compromise the objectives of the OPB Package. Such arrangement shall be specifically provided for in the Memorandum of Agreement for the implementation of the OPB.

XI. EFFECTIVITY

This Order shall take effect immediately.

Adopted: 18 Apr. 2002

(SGD.) FRANCISCO T. DUQUE III, MD, MSc.
President and CEO

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^* Text Available at Office of the National Administrative Register, U.P. Law Complex, Diliman, Quezon City