Title 10 — Health and Safety

(a) I Liheslatura hereby finds and declares that the cost of health care now exceeds the ability to pay for the average resident of Guam. Expanded insurance protection has been seriously retarded by uncontrolled inflation in health care costs. (b) Factors responsible for the infl…

(a) “Prepaid Health Plan” means a plan which offers a specified scope of benefits to an enrolled population for a predetermined prepaid annual rate. COL 2025-04-22 (b) “Health Maintenance Organization” means any organization of providers of personal health services with a proven …

The Health Commission is hereby created and is the regulatory body which shall set policy and determine regulations which relate to the operation of personal health service of all kinds. The Health Commission shall consist of seven (7) members, appointed by I Maga’håga/Maga’låhi …

Notwithstanding any other provisions of law, no contract for provision of health care services executed after the operative date of this Chapter between individuals and fiscal intermediaries or groups of any type and fiscal intermediaries, may be issued or renewed without approva…

The provisions of this Chapter shall apply to health maintenance organizations, as defined in Subdivision (b) of § 9102, engaged in the delivery of health care services under this Chapter. SOURCE: GC § 9990.4.

(a) Each health maintenance organization shall be required to report annually to the Commission on the cost of operation, the use of services, the current description of the location of physicians, allied health professional and health facilities and the number of persons to whom…

Laboratory services provided under the provisions of this Chapter are to be provided only in the laboratories which are approved by the Commission or the agency it so designates, in conformance with law. SOURCE: GC § 9990.6. COL 2025-04-22

Health maintenance organizations shall be certified by the Commission, and shall at least meet the conditions of participation under Federal law. SOURCE: GC § 9990.7.

Health maintenance organizations shall make those services readily available at reasonable times to all enrollees. SOURCE: GC § 9990.8.

Health maintenance organizations shall be liable for payment at the prevailing and customary fees for reasonable services as recognized by the Commission, and in conformity with law, for all out-of-area emergency services as defined in Subdivision (n) of § 9102 rendered by anothe…

Health maintenance organizations shall employ those health professionals who are qualified and licensed under the law to perform specific acts of medical care for which they are qualified and licensed. Health maintenance organizations shall require continuing education for all pr…

The ratio of physicians and other allied health professionals to enrollees in health maintenance organizations shall be set pursuant to regulations adopted by the Commission, subject to adjustment as deemed appropriate by the Commission. SOURCE: GC § 9990.11.

Health maintenance organizations shall furnish services in such a manner as to provide available and continuous care, quality care and provision of services shall include ready referral of patients to such services at such times as may be medically appropriate. Such supervision a…

Health maintenance organizations shall hold periods of open enrollment when consumers who so desire may enroll, unless a health maintenance organization can demonstrate to the satisfaction of the Commission that it is operating at maximum enrollment capacity. COL 2025-04-22 SOURC…

Health maintenance organizations shall provide a printed booklet that is available to all consumers who demonstrate an interest. The booklet shall contain a description of the available facilities, the days and hours that medical services are available, public and emergency trans…

Health maintenance organizations shall establish an enrollee grievance procedure which shall be in conformity with such procedures as defined and authorized by the Commission. SOURCE: GC § 9990.15.

Health maintenance organizations shall be subject to formalized peer review as established by the Commission. SOURCE: GC § 9990.16.

Health maintenance organizations shall not disenroll any enrollee against his wishes without cause as determined by the Commission, either through public hearings or by regulation. All eligible persons who become enrollees, shall remain enrolled in the health maintenance organiza…

Health maintenance organizations, to the extent feasible, shall organize an Advisory Board of Enrollees for the purpose of advising the health maintenance organization on matters of primary interest to the consumer. SOURCE: GC § 9990.18.

Health maintenance organizations shall provide all care including emergency medical services to their enrollees either directly or by contracting for such services in such locations as are readily available to the enrollees. Such emergency services shall include, but not be limit…

(a) The full range of personal health services is covered to include prevention, screening, annual health assessment, diagnosis and treatment of illness, both in and out of hospitals, extended care, medical rehabilitation, medically justified nursing home care and care provided i…

(a) Mandatory benefits under this Chapter applying to Prepaid Health Plans, shall include: (1) Out-patient services which are covered as follows: physicians; hospital out-patient; optometric; acupuncture; podiatric; physical therapy; and audiology, insofar as these can be encompa…

(a) Employer means any individual or body of persons, corporate or unincorporated, public or private, the government of Guam or subject to the laws of Guam, making payment of wages to employees for services performed within Guam or the person having control of the payment of such…

There shall be imposed for each taxable year upon the wages paid every employee, subject to the Consumers Health Protection Act a fixed consumers health protection premium, based on one-half of reasonable cost of care as determined by the Commission for the employee, and a fixed …

There shall be imposed for each taxable year upon the wages paid by every employer to employees, subject to the Consumers Health Protection Act a fixed consumer health protection premium, based on one- half of the reasonable cost of care as determined by the Commission for each e…

(a) There shall be imposed for each taxable year upon the business income of every individual, subject to the Consumer Health Protection Act, from which the consumer health protection premium is not deducted and withheld, a fixed consumer health protection premium based on the re…

The provisions of this Chapter shall continue to be operative, and shall be merged or rearranged in accordance with any Federal legislation that provides similar or equivalent benefits, if and when such Federal legislation is enacted. Fiscal arrangements pursuant to such enacted …

No provision of this Chapter and no amendment to the Government Code made by this Chapter, shall affect or alter any contractual or other nonstatutory obligation of an employer to provide health services to his present and former employees and their dependents or to any such pers…

For the purpose of this Chapter, the following words and phrases have the meanings assigned to them, respectively, except where the context otherwise requires: (a) “Claim” means any claim, bill, or request for payment for all or any portion of healthcare services provided by a he…

(a) This Section applies to Health Plan Administrators, as defined by this Article, organized and operating under the laws of Guam. (b) Health Plan Administrators shall reimburse a Clean Claim, or any portion thereof, submitted by a patient or Health Care Provider, that is eligib…

(a) This Section applies to Health Care Providers, as defined by this Article, duly certified, licensed, or organized and operating under the laws of Guam. (b) All claims submitted for reimbursement must be submitted on a UB-92, HCFA 1500, ADA claim, or other billing document gen…

(a) No patient receiving care from a Health Care Provider, may be billed for the same Clean claim, or portion thereof, submitted for payment to a Health Plan Administrator, unless the provider has elected to terminate that person’s efforts to collect interest penalties as provide…

In any action or proceeding for violation of the requirements of this Article, the Health Plan Administrator or the Health Care Provider shall be entitled to recover all costs of litigation or arbitration, including reasonable attorneys’ fees or arbitration costs, incurred in the…

The provisions of this Article are not exclusive. The remedies provided herein are in addition to any other remedy or procedure provided by any other law or at common law.

The provisions of this Article shall not apply to any claim filed prior to the date of enactment. The Article shall take effect sixty (60) days from the date of enactment into law, with the exception of the Government of Guam’s Medically Indigent Program (MIP) whose effective dat…

The provisions of this Article shall not supersede any contract in force between a Health Plan Administrator and a Health Care Provider as of the effective date of the Act. ---------- COL 2025-04-22