Title 10, Health and Safety

In situations where a person’s health insurance will not be able to cover a particular condition or procedure, and the condition or procedure is within the scope of services covered by the Program, the person may apply for assistance. If found eligible, only the uncovered procedu…

If otherwise insured, any household member at the time of application must maintain the member’s insurance. Any household member who is discontinued from insurance coverage for reasons beyond that person’s control may be eligible for Program coverage if eligibility criteria are m…

(a) The Administrator may: (1) prescribe uniform forms to be used by all Providers and shall prescribe and furnish uniform forms and procedures, including methods of identification of members, to be used for determining and reporting eligibility of members; and COL 2025-12-23 (2)…

The Medically Indigent Program will provide the following medical, dental and mental health services when medically necessary, and subject to the stated benefit limitations and exclusions. SOURCE: Added by P.L. 25-163:2 (Sept. 21, 2000), repealed/reenacted by P.L. 27-030:2 (Sept.…

(a) The Medically Indigent Program shall cover only the following medically necessary in-patient services: (1) maximum of sixty (60) days inpatient hospitalization per illness. If confinement is medically necessary after the sixty (60) days, prior authorization is required from M…

(a) The following out-patient medical services shall be covered when medically necessary and as otherwise stipulated: (1) Physician Evaluation and Management Services; (2) Laboratory Diagnostic Services; (3) Diagnostic Radiology, Ultrasound and Mammography Screening Services, to …

(a) Coverage shall include: (1) physician evaluation and management services on an in-patient and out-patient basis; (2) consultation services; and (3) specialty services. (b) Physician Services Not Covered. The following services will not be covered: (1) elective cosmetic surger…

(a) Skilled nursing and intermediate care shall be covered. The Program shall provide skilled nursing care coverage for one hundred eighty (180) days per year for recipients. (b) Services Not Covered. The following services are not covered under skilled nursing facilities and int…

Within ninety (90) days after the enactment hereof, the Director of Public Health and Social Services shall submit a report to I Maga’hågan/Maga’låhen Guåhan and the Speaker of I Liheslaturan Guåhan on the following: (a) a statistical profile of client utilization of the MIP that…

(a) Emergency dental services (restoration, extraction and root canal treatment) which are necessary to alleviate severe pain and annual routine treatment (dental exams and cleaning) are covered for all persons age seventeen (17) and above. MIP clients are responsible for twenty …

The Administrator shall issue prior authorization for elective or specialized surgical procedures, off Guam care and certain other services as follows: (a) prior authorization must be obtained prior to rendering of hospital services, except in emergency situations; and (b) all se…

Prior authorization is required for patients to be admitted to the hospital prior to the date of surgery. A justification by the attending physician must be submitted to the Program. SOURCE: Added by P.L. 25-163:2 (Sept. 21, 2000), repealed/reenacted by P.L. 27-030:2 (Sept. 30, 2…

Medically Indigent Program recipients in need of the above services must submit to the Medically Indigent Program a copy of the attending physician’s treatment plan, which includes the patient’s name, diagnosis, type of frequency and the suggested regime. An authorization for the…

Before an authorization for coverage is issued, a justification for the need of the service by the attending physician must be submitted to the Program. SOURCE: Added by P.L. 25-163:2 (Sept. 21, 2000), repealed/reenacted by P.L. 27-030:2 (Sept. 30, 2003).

(a) Prior Authorization is required before any MIP Program recipient may receive care and services at an off Guam treatment facility. (b) Failure to obtain an authorization prior to the rendering of care and services will result in the denial of assistance from the Program. (c) O…

(a) The Medically Indigent Program will provide the following mental health benefits to Program recipients: (1) maximum of thirty (30) days inpatient hospitalization per illness, (2) out-patient facility/day treatment; (3) maintenance counseling; (4) chemical dependency services …

The benefits provided for under the Medically Indigent Program shall be subject to the following annual limitations, unless otherwise specified: (a) There will be a ten percent (10%) co-insurance for the following services: (1) Radiation Therapy; (2) Cardiac Related Services; COL…

(a) Optometrist services are covered for an eye refractive examination not to exceed one (1) examination every year. This benefit is limited to Fifty Dollars ($50.00). (b) Lenses are limited to lenses that are medically necessary, not to exceed one (1) set every two (2) years; pr…

With the exception of the Regional Community Health Centers of the Department of Public Health & Social Services (DPHSS), the Medically Indigent Program shall not reimburse other DPHSS programs for services provided or rendered. It is further provided, that services provided or r…

Audiological exams that are medically necessary will be covered. Benefit is limited to One Hundred Dollars ($100.00) per visit. SOURCE: Added by P.L. 25-163:1 (Sept. 21, 2000), repealed/reenacted by P.L. 27-030:2 (Sept. 30, 2003). 2017 NOTE: This section was originally entitled “…

Hearing aids as are medically necessary shall be covered; provided, that all available community resources for such hearing aids have been exhausted. Benefit is limited to a maximum of Five Hundred Dollars ($500.00) per hearing aid. SOURCE: Added by P.L. 25-163:1 (Sept. 21, 2000)…

Chronic orthopedic conditions along with internal or external prostheses are covered to a benefit maximum of Fifty Thousand Dollars ($50,000.00) per year. SOURCE: Added by P.L. 25-163:1 (Sept. 21, 2000), repealed/reenacted by P.L. 27-030:2 (Sept. 30, 2003). 2017 NOTE: This sectio…

Voluntary sterilization services with physician counseling for those eighteen (18) years and above are covered. SOURCE: Added by P.L. 25-163:1 (Sept. 21, 2000), repealed/reenacted by P.L. 27-030:2 (Sept. 30, 2003). 2017 NOTE: This section was originally entitled “Orthopedic Condi…

(a) The following home health services shall be covered by MIP for one hundred (100) days per year when medically necessary and ordered by a licensed physician: (1) home health visits by licensed practitioner or home health aide; (2) prescribed medical supplies not otherwise avai…

(a) The following drug prescriptions shall be covered: (1) Out-patients prescribed drugs are provided in accordance with the Drug Formulary. COL 2025-12-23 (2) Medically Indigent Program clients will have to pay a Two Dollars and Fifty Cents ($2.50) co-payment charge per prescrip…

(a) Physical therapy when medically necessary is covered; provided, that the therapy must be to restore a bodily function that once existed, or has been lost or damaged due to disease or accidental injury. Coverage is only to the extent that it restores function to the status of …

(a) Occupational therapy when medically necessary is covered; provided, that the therapy must be to restore a bodily function that once existed, or has been lost or damaged due to disease or accidental injury. Coverage is only to the extent that it restores function to the status…

The Medically Indigent Program does not cover the following services: (a) voluntary abortions, abortions and interrupted pregnancy that are not medically necessary; (b) elective cosmetic surgery, except as provided for in the Women’s Health Act; (c) custodial care, domiciliary ca…

Effective May 1, 2004, all MIP members shall seek primary care services at the Southern or Northern Medical Clinics within the Department of Public Health and Social Services. If the services cannot be provided by the primary care physician at any one of the clinics described abo…

A change in primary physician may be approved upon the member’s written request to the Medically Indigent Program. This change will take effect on the first day of the following month. If the selected primary care physician is not available, the member may see another physician w…

On behalf of the Program, as the collector of co-insurance, deductibles and premiums, all hospital Providers shall advise the MIP member, or eligible person, that if the visit to the Emergency Room is not for an emergency condition, as determined by the hospital, the member or el…

(a) The Director, in consultation with the Administrator, shall establish, subject to the Administrative Adjudication Law and the provisions of this Article, a grievance and appeal procedure to cover grievances arising pursuant to this Article. The grievance and appeal procedure …

(a) Reimbursements to Providers and Non-Providers shall be in amounts not to exceed the following: (1) for in-patient hospital services, the Program shall reimburse services in accordance with the annual Medicare per diem rates set for the hospital’s in-patient services; (2) for …

(a) The Administrator, subject to the Administrative Adjudication Law, shall develop by rule and regulation a standard for Providers to use in monitoring the quality of health care received by members. Each Provider shall adopt and use such standard. (b) The Administrator shall p…

(a) The Department shall continue to administer the Catastrophic Illness Program, as established by Public Law Number 18-8, as further amended by Public Law Numbers 18-31 and 23-76, and as further regulated by the rules and regulations previously adopted by the Department pursuan…

This shall become effective upon enactment of this Act. COL 2025-12-23

If any provision of this Law or its application to any person or circumstance is found to be invalid or contrary to law, such invalidity shall not affect other provisions or applications of this Law which can be given effect without the invalid provisions or application, and to t…