Title 10 — Health and Safety

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

This Chapter may be cited as the Medical Malpractice Mandatory Arbitration Act.

As used in this chapter: (a) Association means the American Arbitration Association or other entity organized to arbitrate disputes pursuant to this Chapter. (b) Health professional means any person licensed or certified to practice the healing arts within the territory of Guam. …

Any claim that accrues or is being pursued in the territory of Guam, whether in tort, contract, or otherwise, shall be submitted to mandatory arbitration pursuant to the terms of this Chapter if it is a controversy between the patient, his relatives, his heirs-at-law or personal …

Arbitration is initiated by a petitioner or petitioners serving a written demand for arbitration upon a respondent or respondents in the same manner provided by law for the service of summons in the Superior Court of Guam; except that the petitioner or his agent may serve the dem…

Within twenty (20) days after service of a demand for arbitration, the respondent or respondents shall file a response to the demand for arbitration and serve it upon the petitioner or petitioners, or their attorney. The response shall identify any defenses then known to the resp…

COL120106 A claim shall be waived and forever barred as against a respondent if on the date the demand is served the applicable statute of limitations would bar the claim.

The prevailing standard of duty, practice, or care by a reasonable physician in the same field practicing medicine in the community at the time of the alleged malpractice shall be the standard applied in the arbitration.

The Association shall administer a proceeding filed under this Chapter. The administrative expense shall be as agreed to by the parties and the Association, or as may be provided by the Association. The administrative costs shall be equally shared by the parties subject to an awa…

An arbitration under this Chapter shall be heard by a panel of three (3) arbitrators. The chairperson shall be decided by the three (3) panel members and shall have jurisdiction over pre-hearing procedures. The three (3) panel members shall include an attorney, a physician, prefe…

The Association shall make an initial screening for bias as may be appropriate and shall require a candidate for a particular case to complete a current personal disclosure statement under oath. In addition to other relevant information this statement shall disclose any personal …

The arbitration proceeding shall be subject to rules promulgated by the Association in conformance with this chapter. COL120106

In cases involving a common question of law or fact, when there are multiple petitioners and/or multiple respondents, the disputes, controversies, and issues shall be consolidated into a single arbitration proceeding. (a) A person who is not a party to the arbitration may join in…

Prior to the institution of a proceeding or claim by a patient, any offer of reparations and all communications incidental thereto made in writing to a patient by a health professional or health care institution are privileged and may not be used by any party to establish the lia…

(a) When a minor, or an insane or incompetent person is a petitioner, he must appear either by general guardian or a Guardian Ad Litem appointed by the Superior Court of Guam. A Guardian Ad Litem may be appointed in a claim for arbitration under this chapter when it is deemed by …

If any suit or proceeding is brought in the courts of Guam upon any issue referable to arbitration under this chapter, the court in which said suit is pending, upon being satisfied that the issue involved in such suit or proceeding is referable to arbitration under this chapter, …

The party aggrieved by the alleged failure, neglect, or refusal of another to arbitrate under this chapter, may petition the Superior Court of Guam, for an order directing that such arbitration proceed in the manner provided for in this chapter. Five (5) days notice in writing of…

Once the arbitration panel has been selected, each of the arbitrators shall be provided with a copy of the demand for arbitration and any responses thereto by the Association. Each of the arbitrators shall also be provided by the Association with the parties= notices to each othe…

The panel or its chairperson in the arbitration proceeding shall, upon COL120106 application by a party to the proceeding, and may upon its own deter- mination, issue a subpoena requiring a person to appear and be examined with reference to a matter within the scope of the procee…

A hearing shall be informal and the arbitrators shall be the sole judge of the relevancy and materiality of the evidence offered. (a) The arbitrators may receive and consider evidence in the form of an affidavit, but shall give appropriate weight to any objections made. All docum…

Within thirty (30) days after the arbitrators have been selected, any petitioner pursuing a claim against a respondent shall identify the expert witnesses that the petitioner will call at the arbitration hearing. When identifying such experts, the petitioner shall provide the nam…

Within thirty (30) days after the respondent has identified respondent's expert witnesses, the parties shall exchange a list of witnesses that they expect to call to testify at the arbitration hearing along with a summary of each witnesses' proposed testimony. The parties shall a…

Additional discovery, not otherwise provided for in this chapter, such as depositions, interrogatories and requests to produce, shall not be permit- ted unless: (a) The parties stipulate to allow additional discovery; or, COL120106 (b) A majority of the arbitrators at the pre- ar…