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(NAR) VOL. 7 NO. 4 / October-December 1996
[ OWWA MEMORANDUM OF INSTRUCTION NO. 008 SERIES OF 1996, July 01, 1996 ]
PRESCRIBING THE POLICY GUIDELINES IN THE PILOT TEST OF THE OUT-PATIENT SERVICES UNDER THE EXISTING MEDICARE BENEFIT PACKAGE
In the interest of the service and in view of the plan to expand the medicare benefit package of the Medical Care Program for Overseas Filipino Workers (OFWs) and their dependents, the implementing rules and regulations for the pilot test of the out-patient benefits is hereby issued for the guidance of all concerned.
I
Beneficiaries
The program shall cover all OFWs who are medicare members and their legal dependents who seek out-patient services at the Migrant Workers Evaluation and Referral Center (MWERC).
II
Package of Out-Patients Services
For the pilot-test, the following benefits/services shall be made available:
A. Consultation by Medicare physician;
B. Treatment of minor injuries requiring minor surgeries including medicines and supplies needed in the procedure;
C. Laboratory Procedures such as:
1.) Urinalysis — to determine if patient is suffering from Urinary Tract Infection (UTI) and Hermaturia (presence of blood in the urine sample)
2.) Stool Examination — to detect the presence of Amoeba and Parasites,(e.g. Ascaris) in the stool
3.) Complete Blood Count (CBC) — to determine the level of white and red blood cells.
4.) Fasting Blood Sugar (FBS) — to determine the level of sugar in the blood.
5.) Blood Typing — to determine the blood type of the patient
6.) Hemoglobin/Hematocrit (HGB/HCT) — to determine the hemoglobin level in the blood.
7.) Electrocardiogram (ECG) — to detect abnormal palpitation of the heart
8.) Anti Streptolysin O (ASO-Titer) — to detect streptococcal infection in the blood which includes rheumatic fever and acute glomerulonephritis.
9.) Hepa-B Screening — screening test for hepatitis B.
10.) Treponema Pallidum hemaglutination Assay (TPHA) — test for syphillis
11.) Pottasium Hydroxide (KOH) - skin test for presence of fungal infection
12.) Erythrocyte Sedimentation Rate (ESR) — test for presence of viral infection
13.) Pregnancy Test (PT)
14.) X-ray (Skull, Chest, Lower and Upper Extremities)
D. Vaccination or immunization
E. Health education, counselling on proper diet or exercise and family planning; and
F. Referral to tie-up hospitals by medicare physicians during regular clinic hours if confinement is deemed necessary
III
Chargeable Expenditures
The cost of all drugs/medicines/supplies/materials and other laboratory equipment necessary for the pilot-test of out-patients services shall be borne by the Medical Care Program for OCWs. The cost of vaccines and prescribed medicines except those donated by the Department of Health and private institutions shall be borne by the patients.
IV
Procedure for the Availment of Services
A. Member/legal dependent presents Medicare Eligibility Certificate (MEC) to Claims Processing Division (CPD) for verification.
B. After evaluation of MEC, CPD endorses the patient to the Migrant Workers Evaluation and Referral Center (MWERC).
C. MWERC provides the necessary services.
V
Regular Clinic Operation
The MWERC shall be opened from Monday to Friday except on public holidays from 9:00-5:00 P.M.
VI
Monitoring Procedure
1. The MWERC shall submit a detailed monthly report on all out-patient availments to Claims Processing Division.
2. MISD shall create a program on the profile of patients/services rendered/costs entailed.
The pilot test shall end one year after the signing of this memorandum after which an assessment shall be conducted to determine the feasibility of institutionalizing the out-patient services under the Medicare Package of benefits.
For immediate compliance.
Adopted: 01 July 1996
(SGD.) WILHELM D. SORIANO
Administrator
Beneficiaries
The program shall cover all OFWs who are medicare members and their legal dependents who seek out-patient services at the Migrant Workers Evaluation and Referral Center (MWERC).
Package of Out-Patients Services
For the pilot-test, the following benefits/services shall be made available:
A. Consultation by Medicare physician;
B. Treatment of minor injuries requiring minor surgeries including medicines and supplies needed in the procedure;
C. Laboratory Procedures such as:
1.) Urinalysis — to determine if patient is suffering from Urinary Tract Infection (UTI) and Hermaturia (presence of blood in the urine sample)
2.) Stool Examination — to detect the presence of Amoeba and Parasites,(e.g. Ascaris) in the stool
3.) Complete Blood Count (CBC) — to determine the level of white and red blood cells.
4.) Fasting Blood Sugar (FBS) — to determine the level of sugar in the blood.
5.) Blood Typing — to determine the blood type of the patient
6.) Hemoglobin/Hematocrit (HGB/HCT) — to determine the hemoglobin level in the blood.
7.) Electrocardiogram (ECG) — to detect abnormal palpitation of the heart
8.) Anti Streptolysin O (ASO-Titer) — to detect streptococcal infection in the blood which includes rheumatic fever and acute glomerulonephritis.
9.) Hepa-B Screening — screening test for hepatitis B.
10.) Treponema Pallidum hemaglutination Assay (TPHA) — test for syphillis
11.) Pottasium Hydroxide (KOH) - skin test for presence of fungal infection
12.) Erythrocyte Sedimentation Rate (ESR) — test for presence of viral infection
13.) Pregnancy Test (PT)
14.) X-ray (Skull, Chest, Lower and Upper Extremities)
D. Vaccination or immunization
E. Health education, counselling on proper diet or exercise and family planning; and
F. Referral to tie-up hospitals by medicare physicians during regular clinic hours if confinement is deemed necessary
Chargeable Expenditures
The cost of all drugs/medicines/supplies/materials and other laboratory equipment necessary for the pilot-test of out-patients services shall be borne by the Medical Care Program for OCWs. The cost of vaccines and prescribed medicines except those donated by the Department of Health and private institutions shall be borne by the patients.
Procedure for the Availment of Services
A. Member/legal dependent presents Medicare Eligibility Certificate (MEC) to Claims Processing Division (CPD) for verification.
B. After evaluation of MEC, CPD endorses the patient to the Migrant Workers Evaluation and Referral Center (MWERC).
C. MWERC provides the necessary services.
Regular Clinic Operation
The MWERC shall be opened from Monday to Friday except on public holidays from 9:00-5:00 P.M.
Monitoring Procedure
1. The MWERC shall submit a detailed monthly report on all out-patient availments to Claims Processing Division.
2. MISD shall create a program on the profile of patients/services rendered/costs entailed.
The pilot test shall end one year after the signing of this memorandum after which an assessment shall be conducted to determine the feasibility of institutionalizing the out-patient services under the Medicare Package of benefits.
For immediate compliance.
Adopted: 01 July 1996
Administrator