GovGuam agencies not entirely on-board with federal healthcare resolution

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(PNC photo)

Guam – The Guam Memorial Hospital, Department of Public Health and Social Services, and Department of Administration provided testimony on Resolution 98-35. The resolution seeks the support of Congressman Michael F.Q. San Nicolas in addressing Guam’s healthcare issues with federal authorities.

The resolution, introduced by Senator James Moylan, wants to address seven healthcare issues:

  • Guam Memorial Hospital reimbursement rates and fee schedules;
  • Medicaid matching for Guam;
  • Cancer assistance grants for Guam;
  • Individual health insurance subsidies;
  • Modernizing healthcare system communications;
  • The high cost of prescription drugs, and;
  • Out of hospital procedures.

During a public hearing on Monday, May 13, three GovGuam agencies delivered mixed testimonies on the resolution’s proposal to fix these issues.

On the reimbursement rates and fee schedules, Public Health director Linda DeNorcey, said the rates and fees do not affect Medicare reimbursements rates in Part A, which pertains to in-patient care claims. However, it does affect part B, which is outpatient care claims to an extent.

According to the resolution, “it is recommended that the Medicare reimbursement rates be updated or revised to be closer to what is allowed at GRMC and allow Medicare and Medicaid to compensate GMH at current rates.”

DeNorcey said the recommendation is impractical. “There are two hospitals, and they have different Medicare cost reports. So, the Medicare interim rate will not be the same.”

The Medicare cost report is a standard calculation designed to arrive at the reimbursement rate for costs incurred by the patient.

DeNorcey said that GRMC has a higher reimbursement rate because investment costs result in higher reimbursement rates.

DeNorcey cited the Tax Equity and Fiscal Responsibility Act (TEFRA) which changed the Medicare reimbursement. TEFRA does not apply to the U.S. Territories because of this, Guam continues to be reimbursed at pre-TEFRA rates.

DeNorcey also mentioned another concern with regard to a recommendation for the issuance of a special waiver to territorial health insurers.

“Our comment to this section is – it would be a disadvantage for health insurance plan subscribers if the carriers were permitted to exclude high-risk customers or alter the current prohibition of lifetime maximums,” she said.

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Jolene Toves
Jolene joined the PNC team in 2017, as a producer, co-anchor and investigative reporter covering law enforcement, courts and crimes. Notable coverage includes the Ehlert case, the Mark Torre Jr. trial, the Allan Agababa trial, exclusive pieces on the Life of a Drug Dealer/Addict, and Life behind bars...the story of Honofre Chargualaf and Kevin Cruz. In 2019, she was promoted to Assistant News Director and Lead Anchor. From 2015 to 2017 she served as Public Relations and Promotions Manager, for the Hotel Nikko Guam handling local radio and advertorial promotions, as well as produced and directed tv commercials for the hotel. Prior to this she worked with KUAM for three years as a reporter and segment host. She began her journalism career in 2012, working with Glimpses of Guam contributing to the Guam Business Magazine, R&R magazine, MDM magazine and the Marianas Business Journal.