Statement of Policy

The Legislature declares that medicaid recipients receiving medical assistance under Title XIX [federal law] and those persons enrolled under the Medicaid Program of the Social Security Act whose premiums are being paid for by the government of Guam shall be given the opportunity to be enrolled in prepaid health plans as a means of affording them comprehensive health care and related remedial and preventive services. Prepaid Health Plan

(PHP)as used herein means a multi-specialty group practice or an individual practice association developed to provide medical services on a prepaid basis. The Department of Public Health and Social Services shall contract with a qualified Prepaid Health Plan pursuant to this Chapter and shall award such contract on a non-bid basis. Each Prepaid Health Plan shall furnish to the Department such information and reports as the Department may find necessary in performing its functions under this Chapter. Such information and reports shall include, but shall not be limited to, statistical information regarding utilization of services, age and sex, specific mortality and morbidity rates, services supplied, manpower resources and costs of health care and administration, compiled from a basic data system as the Department may require. The Prepaid Health Plan and the Department shall maintain such records and afford access thereto to verify the information and reports which may be required under this Chapter. The Department shall annually conduct a survey of beneficiaries to determine their satisfaction with the services provided by the Prepaid Health Plan. All health care services available under this Chapter shall be equivalent to the level and basic scope of services required under public assistance programs. It is the objective of this legislation that health care, as provided COL120106 CH. 6 GUAM MEDICAL ASSISTANCE PLAN in Guam under Title XIX of the Social Security Act, be available and accessible at all times to all qualified recipients. It is further the intent of this Chapter such care shall be of the highest quality.