Dipattamenton Kontribusion yan Adu'ana

DEPARTMENT OF

FELIX P. CAMACHO, Governor Maga'iahi MICHAEL W. Cruz, Lt. Governor TInente Gubetnadot

REVENUE AND TAXATION ARTEMIO B. ILAGAN, Director

Direktot PAUL J. PABLO,

Acting,Deputy Director Segundo Direktot

GOVERNMENT OF GUAM

The Honorable Tina R. Muna-Bames Le~islative Secretary 30t Guam Legislature Suite 101 158 Hesler St. Hagatfia, Guahan 96910

Gubetnamenton Guahan

March 26, 2010

RE: "The Health Care Service Provider Incentive Act"

Dear Senator Muna-Bames:

'.) , -)

In accordance with §9303(b), Chapter 9,5 GCA, transmitted herewith are the original records and one (1) copy of the entire record of the public hearing conducted on the rules and regulations for the Health Care Service Provider Incentive Act. The hearing was conducted on March 24, 2010 in the main conference room at the Department of Revenue and Taxation and a recorded record is on file with the office of the Administrator, Taxpayer Service Division.

At this time, personnel with the Department of Administration, Division of Accounts, including personnel with the Business Privilege Tax Branch, DRT will be undergoing training to implement and promulgate PL 28-150.

Sincerely,

~la~~ Director

Enclosures

191Z

Post Office Box 23607, Guam Main Facility, Guam 96921 • Tel. / Telifon: (671) 635-1817 • Fax / Faks: (671) 633-2643

Dipattamenton Kontribusion yan Adu'ana

DEPARTMENT OF

FELIX P. CAMACHO, Governor Maga'IAhi MICHAEL W. Cruz, Ll Governor Tinente Gubetnadot

REVENUE AND TAXATION ARTEMIO B. ILAGAN, Director

Direktot PAUL J . PABLO,

Actlng,Deputy Director Segundo Direktot

GOVERNMENT OF GUAM Gubetnamenton Gucihan

PUBLIC HEARING March 24, 2010

5:00pm - DRT Conference Room

UThe Health Care Service Provider Incentive Act" PL 28-150

SIGN-IN SHEET

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Post Office Box 23607, Guam Main Facility, Guam 96921 • Tel. I Telifon: (671) 635-1817 • Fax I Faks: (671) 633-2643

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DiP.·. attamenton Kontribusion yan Adu'fula ~ DEPARTMENT OF REVENUE AND TAXATION

GOVERNMENT OF GUAM Gubetnamenton Guiihan ___ .:.

, ~

PUBLIC NOTICE

"The Health Care Service Provider Incentive Act" The Department of Revenue and Taxation (DRT), in conjunction with the Department of Administration (DOA) and the Department of Public H ealth & Social Services (DPHSS) has scheduled a public hearing for Wednesday, March 24,2010 at 5:00 p.m. in the Director's Conference room, 2nd floor, DRT to discuss the proposed rules and regulations for the Health Care Service Provider Incentive Act which was signed into 1 wunder Public Law 28-150.

Copies of the proposed rules and regulations are available at the Department of Revenue and Taxation for examination. Any interested party or person or his authorized representative shall be afforded an adequate opportunity to participate in the formulation of the proposed rules and regulations during the public hearing. In conformance with Chapter 9 Administrative Adjudication Law 5 GCA, copies of the Economic Impact Statement (ElS) shall also be made available for inspection prior to and during the public hearing schedule above.

For more information please contact Ms. Veronica Quan, Administrator, Technical Research & Appeals Bureau at 635-1814.

/s/ ARTEMIO B. ILAGAN Director

Public Law 28-150 "The Health Care Service Provider Incentive Act of 2006"

RULES AND REGULATIONS

Public law 28-150, §29, passed on September 30,2006, authorizes an offset against gross

receipts taxes for Physicians, Pharmacies ,Health Care Service Providers and Suppliers who

render services to recipients ofthe Medically Indigent Program.

Definitions

In these rules, the following terms shall have the following meanings:

"Clean claims" - shall mean MIP invoices processed and approved by the Department of Public

Health & Social Services (DPHSS).

"Participate" - shall mean meeting a ten percent (10%) quota of the cumulative number of

patients or clients serviced in a given month who are recipients of the Medica"y Indigent

Program.

"Health Care Service Provider" - shall mean any business providing medical equipment or

supplies; pharmaceutical health care services and products; medical health care services; dental

health care services; behavioral health care services; and allied health care services, including a

clinic, hospital, specialized health care facility, licensed practitioner, hospital, health care

provider or business that is licensed under the laws of Guam and recognized by the Medica"y

Indigent Program in providing medical and health care assistance, products or services to

recipients of the Medica"y Indigent Program.

Offset Against Gross Receipts Taxes for Past Due MIP Billings

(1) A health care service provider that renders services and products to recipients ofthe

Medica"y Indigent Program shall be entitled to an offset equal to the value of services

provided against the Gross Receipts Taxes the provider owes for any given month. The

value for services, equipments and prescriptions shall be the Medica"y Indigent

Program rates for the actual amount of any and all clean claims that are filed and

approved by the government.

(2) Non-payment of clean claims owed for health care, medical services or supplies which

remain unpaid by the government for a period of over ninety (90) days from the due

date as invoiced shall qualify health care service providers with the Gross receipts Tax

incentives provided herein.

(3) Any unused offset against total Gross Receipts Taxes owed for any given month not used

in the current tax period may be carried over into subsequent tax periods until such

offset is exhausted.

(4) The total offset against total Gross Receipts Taxes owed for any given month pursuant

to the Act shall not exceed the actual dollar amount of that expenditure on the service,

equipment, supplies and prescription by a health care service provider.

(5) The government shall not be obligated to make payments to vendors for services in

which an offset against total Gross Receipts Taxes owed for any given month has been

exercised.

(6) Any health care service provider that renders services and products entitled to an offset

against Gross Receipts Taxes owed must "participate" and provide services to recipients

of the Medically Indigent Program in order to qualify for any offsets against the total

Gross Receipts Taxes owed for any given month.

PROCEDURES TO CLAIM OFFSET

A) For the current month, you may claim the MIP offset on line 45 of Form GRT. On the

backside of Form GRT under Basis for Tax CreditS/Adjustments - note PL 28-150 or MIP

Offset. If the type of credit/adjustment is not noted, the credit may be denied and the

taxes with applicable interest and penalties will be assessed.

B) For tax periods with outstanding liabilities, you may obtain an "MIP Offset Request

Form" to file a claim to offset your outstanding Gross Receipts Tax liability.

C) When a request for an MIP Offset is filed, the Form GRT or MIP Offset request will be

processed as soon as possible and a notice will be sent to acknowledge the offset or

deny the request, whichever is applicable.

D) You may not amend any Form GRT already filed and paid to claim the offset. This is for

existing or current gross receipts tax liabilities only.

Reimbursements

The Department of Revenue and Taxation shall be reimbursed for all reductions in GRT

collections as a result of Gross Receipts Tax offsets. The Department of Revenue and Taxation

shall assess the DPHSS or other government agency responsible for the amount of the tax offset

taken by the vendor.

• DEPARTMENT OF REVENUE AND TAXATION Page 1 of 2 • GOVERNMENT OF GUAM FORM GRT-1 MONTHLY GROSS RECEIPTS. USE AND OCCUPANCY TAX RETURN 1111111111111111111111111111111111111111

NAME OF LICENSEE MONTH I YEAR ENDING FOR OFFICIAL USE

EINISSN GRT ACCOUNT NUMBER .......... ORIGINAL RETURN

.... :.,: AMENDED RETURN

ADDRESS TELEPHONE NO,

" (A) GROSS RECEIPT VALUE (8) EXH1PTION OR DEDUCTION I IC) TAXABLE Ar.lOurn

PARln : GROSS RECEIPTS TAX @ 4% 0.04 Attactl ScheQula GRT·

1. I'.1-IOlfSAUNG

2. RETAUNG

3. SERVICE

4. RENTAL REAL PROP.

5. RENTAL OTHERS

6. PROR:SSION

7. COMMISSION

8. INSURANCE PREMIUM

9. CONTRACTING (LOCAL)

10. CONTRACTING IUS)

11. INTEREST

12. AMUSEMENT

13. OTHERS

16. LOCAL PURCHASES

17. INVENTORY USED

19. HOTEL / MOTEL

20. OTHERS

• GRT1P1

Under the penalties of perjury, I declare that I have examined this return, including accompanying schedule and statements, and to the best of my knowledge and belief it is true, correct and complete . If prepared by a person other than taxpayer, his declaration is based on all information of which he has any knowledge.

SIGNATURE (TAXPAYER OR AUTHORIZED AGENT) PRINT NAME DATE

CONTINUED ON PAGE 2 - PART 4 MJlSI BE COMPLETED **00 NOT PHOTOCOPY** DEPARTMENT OF REVENUE AND TAXATION FORM GRT·' (NOV 2008)

• • •

• DEPARTMENT OF REVENUE AND TAXATION Page 2 of 2 • GOVERNMENT OF GUAM FORM GRT-1 MONTHLY GROSS RECEIPTS, USE, AND OCCUPANCY TAX RETURN 1111111111111111111111111111111111111111 •

GRT1P2

NAME OF LICENSEE MONTH I YEAR ENDING EINISSN GRT ACCOUNT NUMBER

[]ART 4:,JOTALS . _______ -"-.------7]

42. TAX DUE: Enter total from Tax Due Worksheet below.

If you did not have any activity for the period enter "0" here-. . . . . • . . . . . • . . . . . . . . . . . . . . . . . . . ... 42.

43. PENALTY: ............•.....•.................................•...•.•............... 43.

44. INTEREST: .•...................•............•............................•......... 44.

45. CREDIT OR ADJUSTMENT: 45.

46. BALANCE TAX DUE: ................................................................ 46.

TAX DUEWORKS~HC=E;-;;E~T;:--~~""""'------------------''''''--------'-

,.':!.i:iii,'&i11i'h X TAX RATE =

1. Enter the amount from Part 1, Hne 14 . $--------------------- x 0.04 $

2. Enter the amount from Part 2, line 18 .. $------------------------ x 0.04 $

3. Enter the amount from Part 3, line 19 . $----------------------- x 0.11 $

4. Enter the amount from Part 3, line 20 . $----------------------- x 0.10 $

TOTAL - Add lines 1 . 4. Enter the result here and on line 42 above. . . . . . . . . . . . . . . . . . . . . . . . . . . .. ... $

FOR OFFICIAL USE

DEPARTMENT OF REVENUE AND TAXATION "DO NOT PHOTOCOPY" FORM GRT~1 (NOV 2008) • • •

NAME:

ADDRESS

Dipattamenton Kontribusion yan Adu'ana

DEPARTMENT OF

FELIX P. CAMACHO, Governor Maga'iahi MICHAEL W. Cruz. Lt. Governor Tiftente Gubetnadot

REVENUE AND TAXATION ARTEMIO B. ILAGAN, Director

Direktot PAUL J. PABLO,

Acting,Deputy Director Segundo Direktot

GOVERNMENT OF GUAM Gubetnamenton Guahan

MIP OFFSET REQUEST

EMPLOYER IDENTIFICATION NUMBER or SOCIAL SECURITY NUMBER:

GRT ACCOUNT #

VENDOR#

Please indicate the tax period and the amount of your qualified MIP costs to be used to offset your Gross Receipts Tax due. The amounts indicated below will be verified with the Accounts Payable Division of the Department of Administration.

TAX PERIOD (MONTH & YEAR)

Signature of Taxpayer or Authorized Representative

PRINT NAME: ------------------------------

AMOUNT TO BE USED FOR OFFSET

Date

Contact Number: -------------

Post Office Box 23607, Guam Main Facility, Guam 96921 • Tel. I Telifon: (671) 635-1817 • Fax I Faks: (671) 633-2643

Name Address Address

GRT# Vendor # EIN #

The processing of your MIP Offset request dated has t

been completed. Below is a list of~e amount(s} approved for the tax

period(s} requested.

Tax Period Amount of Offset Approved

If there is a difference between the approved offset and the taxes due, you are still liable for the tax plus interest and penalties if applicable. If you should have any questions you may contact our office at 635-7699.

Sincerely,

ARfEMIO B. I LAGAN , Director

BY: (Name of person processing)

Name Address Address

GRT# Vendor # EIN #

The MIP offset request you filed on has been denied. We have no records of you or your company filing a claifu for payment with the Department of Public Health.

Any gross receipt taxes claimed using the offset must be paid in full. Interest and penalties will apply as required by law. If you should have any questions. you may contact us at 635-7699 extensions 753 or 754.

Sincerely.

ARTEMIO B. lLAGAN. Director

BY: Name of person processing

· ,

Dipattamenton Kontribusion yan Adu'ana

DEPARTMENT OF

FELIX P. CAMACHO, Governor Maga'IAhi MICHAEL W. Cruz, Ll Governor Tiilente Gubetnadot

REVENUE AND TAXATION ARTEMIO B. ILAGAN, Director

Dlrektot PAUL J. PABLO,

Acting,Deputy Director Segundo Direktot

GOVERNMENT OF GUAM Gubetnamenton Guahan

"The Health Care Service Provider Incentive Act"

Economic Impact Statement (EIS)

The Department of Revenue and Taxation (DRT), in coordination with the Department of Administration (DOA) and the Department of Public Health & Social Services (DPHSS), and in conformance with Chapter 9 Administrative Adjudication Law 5 GCA provides the following Economic Impact Statement relative to the "The Health Care Service Provider Incentive Act. "

Purpose and Need The purpose and need for rules and regulations is to implement and administer Section 29 of Public Law 28-150 relative to providing a means to offset past due Medically Indigent Program (MIP) billings against Gross Receipts Taxes. The Government of Guam continues to experience severe cash shortfalls and is unable to make timely payments to MIP service providers. In an effort to continue MIP services for the medically indigent, PL 28-150 seeks to offer some remedy to MIP service providers by allowing offsets against GRT.

Financial Impact DPHSS provides DOA with MIP billings and certifies "qualified providers" under the MIP offset program. DOA accounts for the invoices and tracks payments made to MIP vendors. This data is then provided to DRT. Currently the total amount for providers who qualify for the MIP offset program is three million eight hundred sixty-six thousand forty five dollars and forty four cents ($3,866,045.44) (refer to attachment]. This amount will change based on GovGuam' s finances and ability to pay MIP service providers in a timely manner. Notwithstanding however, there is also included in PL 29-180 under Section 29 (b) a provision for reimbursement for all reductions in GRT collections as a result of GRT offsets under this program. Based on this section the financial impact on the Government of Guam will be minimized.

Beneficial Impact While the financial impact will be minimized as stated above, the beneficial impact would allow the Government of Guam to continue to provide much needed health care services to the medically indigent under the Health Care Service Provider Incentive Act. This would result in the continued availability of goods and services by qualified MIP service providers on Guam directly or indirectly attributable to the proposed rules and regulations.

There will be no direct or indirect impact upon employment on Guam or any increase or decrease in the availability of a particular job or jobs, nor will there be any increase or decrease in the cost of doing business on Guam which is attributable to the proposed rules and regulations .

Post Office Box 23607, Guam Main Facility, Guam 96921 • Tel. / Telifon: (671) 635-1817 • Fax / Faks: (671) 633-2643

· , ' ..

Summary of MIP Claims by Provider FY2009

All Providers

GMHA Off-Island Providers Qualified Providers for MIP Offset

Total Billed to DPHSS 19,111,643.13

10,343,503.68 4,902,094.01 3,866,045.44

Note: Data derives from MIP claims sent from October 1, 2008 to September 30, 2009

MIP Funding per Budget Law

2006 2007 2008 2009 2010

Fiscal year

Note: as Of 02/26/2010

Appropriation

15,694,275.00 15,087,111.00 15,857,533.00 10,482,599.94 15,622,907.43

Source: Department of Administration, Division of Accounts

Expenditures

15,693,736.71 15,087,1 09.35 15,757,432.40 10,482,599.46 6,509,528.92

Dipattamenton KOI ousion yan Adu'ana

DEPARTMENT OF

FELIX P. CAMACHO, Governor Maga'hihl MICHAEL W. Cruz, It Governor TIllente Gubetnadot

REVENUE AND TAXATION ARTEMIO B. ILAGAN, Director

Direklot PAUL J . PABLO,

Actlng,Deputy Director Segundo Direklot

GOVERNMENT OF GUAM

The Honorable Felix P. Camacho Governor of Guam Office of the Governor of Guam P.O. Box 2950 Hagatfia, GU 96932

Gubetnamenton Guilhan

March 10, 2010

RE: "The Health Care Service Provider Incentive Act"

Dear Governor Camacho:

Pursuant to §9303 Chapter 9 Administrative Adjudication Law 5 GCA transmitted herewith are the proposed rules and regulations and economic impact statement for "The Health Care Service Provider Incentive Act" which was signed into law under PL 28-150.

A public hearing has been scheduled for March 24, 2010 and a copy of the entire record of the hearing on the proposed rules and regulations will be filed with the Legislative Secretary of the Guam Legislature accordingly.

Sincerely,

Q~~wr---Artemio B. Ilagan Director

Enclosures

Post Offi~ Box 23607, Guam Main Facility, Guam 96921 • Tel. / Telifon: (671) 635-1817 • Fax / Faks: (671) 633-2643

Dipattamenton Kontribusion yan Adu'ana

DEPARTMENT OF

FEUX P. CAMACHO, Governor Maga'lihi MICHAEL W. Cruz, LL Governor Tinente Gubetnadot

REVENUE AND TAXATION ARTEMIO B. ILAGAN, Director

Direktot PAUL J. PABLO,

Acting,Deputy Director Segundo Direktot

GOVERNMENT OF GUAM

The Honorable Tina R. Muna-Barnes Le~islative Secretary 30t Guam Legislature Suite 101 158 Hesler St. Hagatfia, GU 96910

Gubetnamenton Guahan

March 10, 2010

RE: "The Health Care Service Provider Incentive Act"

Dear Senator Muna-Barnes:

Pursuant to §9303 Chapter 9 Administrative Adjudication Law 5 GCA transmitted herewith are the proposed rules and regulations and economic impact statement for "The Health Care Service Provider Incentive Act" which was signed into law under PL 28-150.

A public hearing has been scheduled for March 24, 2010 and a copy of the entire record ofthe hearing on the proposed rules and regulations will be filed with the Legislative Secretary of the Guam Legislature accordingly.

Sincerely,

();Jimw~& ArtemioB. Hagan ~ Director

Enclosures

Post Office Box 23607, Guam Main Facility, Guam 96921 • Tel. I Telifon : (671) 635-1817. Fax I Faks: (671) 633-2643

Dipattamenton Kontribusion yan Adu'ana

DEPARTMENT OF

FELIX P. CAMACHO, Governor Maga'iahi MICHAEL W. Cruz, Ll Governor Tlilente Gubetnadot

REVENUE AND TAXATION ARTEMIO B. ILAGAN, Director

Direktot PAUL J. PABLO,

Acting,Deputy Director Segundo Direklot

GOVERNMENT OF GUAM

Office of the Attorney General Alicia G. Limtiaco Attorney General of Guam 287 West O'Brien Drive Hagatfia, GU 96910

Gubetnamenton Guahan

March 10,2010

RE: "The Health Care Service Provider Incentive Act"

Dear Attorney General Limtiaco:

Pursuant to §9303 Chapter 9 Administrative Adjudication Law 5 GCA transmitted herewith are the proposed rules and regulations and economic impact statement for "The Health Care Service Provider Incentive Act" which was signed into law under PL 28-150.

A public hearing has been scheduled for March 24,2010 and a copy ofthe 'entire record of the hearing on the proposed rules and regulations will be filed with the Legislative Secretary ofthe Guam Legislature accordingly.

Enclosures

Sincerely,

~lb~atr Artemio B. Bagan Director

Post Office Box 23607, Guam Main Facility, Guam 96921 • Tel. / Telifon : (671) 635-1817 • Fax / Faks: (671) 633-2643

FELIX P. CAMACHO Governor

MICHAEL W. CRUZ, M.D. Lieutenant Governor

GOVERNMENT OF GUAM

DEPARTMENT OF PUBLIC HEALTH & SOCIAL SERVICES (DIPATTAME NTON SALUT PUPBLEKO YAN SETBISION SUSIAT)

123 Chalan Kareta * Mangilao, Guam 96913-6304

DEC 2 9 L009

J. PETER ROBERTO, ACSW Di rector

MEMORANDUM

To: Director, Department of Revenue and Taxation (DRT)

From: Director, Department of Public Health and Social Services

Subject: Public Law (P.L.) 29-19 Section 23

Buenas yan Saluda! This is in response to memorandum, dated December 9, 2009, regarding your request for a point of contact in the coordination and implementation of Public Law 29-19 Section 23. Ms. Teresita Gumataotao, Bureau of Health Care Financing Administration/Program Coordinator IV, is the designated staff for the Medically Indigent Program (MIP). Her telephone number and e-mail address are 735-7231 and teres ita. gumataotao@ dphss.guam.gov.

If you have any questions, please call Ms. Ma. Theresa Arcangel, Bureau of Health Care Financing Administrator, at 735-7282. Dangkulo na agradesimento.

Sincerely,

/ } ' /1' )-~ ~7?~6?/t-/{/L~l/'--/

J. PETER ROBERTO, ACSW Director

TEL: (67 1) 735 -72821 FAX: (671) 734-6R60

Paul Terlaje

From: Sent:

Gaudencio A Rosario [goody.rosario@doa.guam.gov] Friday, February 26,20102:38 PM

To: Paul Terlaje Cc: Joanne MA Flores; Kathrine B Kakigi; Corey P. Diaz; Teresita C Gumataotao;

theresa. arcangel@dphss.guam.gov Subject: FW: MIP Offset - Financial Info ... Attachments: MIP Claims FY09.xls

Hi Paul,

Please disregard the email as revision is needed according to Tess from DPHSS. Data given to me was not fully explained therefore it was interpreted incorrectly. I will send the revise report soon.

Thanks, Goody

Gaudencio "Goody" A. Rosario

General Accounting Supervisor Division of Accounts Department of Administration P.O. Box 884 Hagatna, Guam 96932 Tel: 671-475~1117 Fax: 671-472~483 Email: goody.rosario@doa.guam.gov

From: Gaudencio A Rosario Sent: Friday, February 26, 2010 1:06 PM To: 'Paul Terlaje' Cc: Joanne MA Flores; Kathrine B Kakigi; Corey P. Diaz; Teresita C Gumataotao; 'theresa.arcangel@dphss.guam.gov' Subject: MIP Offset - Financial Info ...

Hi Paul,

Please see attached schedule where you can find total MIP claims/charges processed within one fiscal year which is about $48M in total. Per summary, we are looking at about $18M can possibly be qualified for GRT offset which may bring a great impact to the General Fund's cash flow. Please let me know should you need additional information.

Thanks, Goody

Gaudencio "Goody" A. Rosario

General Accounting Supervisor Division of Accounts Department of Administration P.O. Box 884 Hagatna, Guam 96932

el: 671-475-1117

1

Summary of MIP Claims by Provider FY2009

All Providers GMHA Off-Island Providers Qualified Providers for MIP Offset

Total Charges 47,963,451 .15 22,155,703.83 7,361 ,364.09

18,446,383.23

Total Claims Total Patients 44,532 17,366

Note: Data derives from MIP claims sent from October 1, 2008 to September 30, 2009

MIP Funding per Budget Law

2006 2007 2008 2009 2010

Fiscal year Appropriation

15,694,275.00 15,087,111 .00 15,857,533.00 10,482,599.94 15,622,907.43

Expenditures

15,693,736.71 15,087,109.35 15,757,432.40 10,482,599.46 6,509,528.92 as of 02/26/2010

Note: MIP Claims from GMH can be offset from GMHA Pharmaceuticals Fund up to 6.19% of GRT Co

Assumptions: Total Charges $ 48,000,000.00 Funding Source: MIP $ 15,500,000.00 MIP GMH offset thru Pharmaceutical Fund $ 12,800,000.00 MIP GRT Offset $ 18,500,000.00 Total Source $ 46,800,000.00

Possible Shortfall $ 1,200,000.00

Paul Terlaje

From: Sent: To: Cc:

Subject: Attachments:

Paul,

Gaudencio A Rosario [goody.rosario@doa.guam.gov] Friday, March OS, 2010 4:52 PM pterlaje@revtax.gov.gu Kathrine B Kakigi; theresa.archangel@dphss.guam.gov; teresita.gumataotao@dphss.guam.gov; Joanne MA Flores; Corey P. Diaz MIP Offset MIP Claims FY09 revised.xls

Please see attached revised schedule. The first report reflects total charges of providers but I was informed by Thess that I need to pick up "Total To Pay" amount which represents "Total Billed to DPHSS-MIP".

Thanks, Goody Rosario 475-1117

1

Summary of MIP Claims by Provider FY2009

All Providers

GMHA Off-Island Providers Qualified Providers for MIP Offset

Total Billed to DPHSS 19,111,643.13

10,343,503.68 4,902,094.01 3,866,045.44

Note: Data derives from MIP claims sent from October 1, 2008 to September 30, 2009

MIP Funding per Budget Law

2006 2007 2008 2009 2010

Fiscal year

DOA

Appropriation

15,694,275.00 15,087,111.00 15,857,533.00 10,482,599.94 15,622,907.43

Expenditures

15,693,736.71 15,087,109.35 15,757,432.40 10,482,599.46 6,509,528.92

GovGuam DOA Total Accounts Payable - MIP As of 3/24/2010

Purpose: To document all vendors payable relating to MIP

VENDORNAME 1 AC MICRO, LLC 2 AMERICAN MEDICAL CENTER, LLC 3 AMERICAN DIALYSIS CENTER, INC. 4 ADVANCED CARDIOTHORACIC 5 AMERICAN MULTI-SPECIALTY GROUP 6 ABRISHAMI, BABAK "BOB" 7 AUDIOLOGICAL ASSOCIATES 8 AGAHAN, MARGIE A 9 MARIANAS PHYSICIANS GROUP

10 BIOSCRIP PHARMACY SERVICES 11 CANCER CARE CONSULTANTS 12 C R NEWTON COMPANY, LTD 13 CALIFORNIA LUNG ASSOC 14 CHIU'S OPTICAL 15 ROSS HEARING AID SERVICE 16 DIAGNOSTIC LAB SVCS, INC 17 GRILEY, EDMUND A, M 0 18 FRIEDMAN, SAMUEL M.D. 19 SAGISI, GLOCRITO G, M 0 20 GUAM RADIOLOGY CONSULTANTS 21 GUAM SURGICENTER, LLCIAC 22 RSA-GUAM,LLC DBA GUAM DIALYSIS 23 RSA-GUAM, LLC DBA GUAM RENAL 24 GUAM MEDICAL IMAGING CTR. LLC 25 GUAM MEDICAL EQP & SUP LLC 26 IDEAL OPTICAL DIV OF: SALPAT 27 GUAM MEMORIAL HOSP AUTH 28 GARCIA OPTICAL 29 HAFA ADAI SPECIALIST GROUP 30 HEAVEN MAN EARTH ORIENTAL 31 HEALTH PARTNERS, LLC 32 HEDAYATI-RAD, AMIR H., MD 33 HO, JASON S. M.D. 34 HEAL THCARE SPECIALTIES 35 HOSPITAL OF THE GOOD SAMARITAN 36 HARMON DRUGS

AMOUNT 486.39

3,289.12 628.84

3,393.20 31,776.64

388.72 2,254.19

363.79 11,309.13 2,469.90 4,603.42

21,212.70 849.77

1,066.50 3,794.26

210,971.71 3,341.66

62,988.43 858.50

365,243.85 15,303.01 92,479.18

132,648.07 11,140.00 7,397.10 2,386.06

1,861,386.05 10,676.44 38,120.96

2,300.00 2,747.91 1,479.45 5,866.38

22,601.80 794,734.28

7,065.34

37 ITC PHARMACY 38 ISLA HOME INFUSION 39 ISLAND EYE CENTER 40 INPATIENT MANAGEMENT GRP (IMG) 41 IDEAL VISION CENTER, LLC 42 RICHTER, JAROSLA V K, MD 43 LANDSTROM, JERONE T, MD 44 LABTECH, INC.lMEDPHARM 45 LlU, MING W. 46 LOPEZ, RICHARD MD 47 LIN, CHUN-NAN 48 ARGUELLES, LUIS G, M 0 49 HAZEN, LARRY W, 0 P M 50 LOS ANGELES CARDIOLOGY 51 MEGA DRUGS 52 MARIANO PRIME LTD. LlAB. CO. 53 SAGUA MANAGU, LLC 54 MEDQUEST MEDICAL SUPPLY 55 MEDICAL PROFESSIONALS PC 56 MARTINEZ, ROGER 57 MATHEW ANNAKUTTY, M 0 58 NATIONAL CORNERSTONE 59 NASIR, JEFFREY M. M.D. 60 GUAM ORTHOPAEDIC ASSOCIATES 61 CRUZ, OLIVIA, M 0 62 PACIFIC CARDIOVASCULAR ASSN 63 PACIFIC MEDICAL GROUP 64 PARKS M.D., DAVID J 65 PRIME CARE, INC. 66 PINE, STEPHEN 67 PMC ISLA HEALTH SYSTEM 68 POL YMEDIC PHARMACY 69 PACIFIC RADIOLOGY, INC. 70 HONG, RAI BOK, MD 71 RICHARDSON, DARIUS A. DMD,M.D. 72 RETINA CENTER OF GUAM, LLC 73 RENAL CENTERS OF GUAM, LLC 74 ROSS, IAN 75 RAN CARE INC. DBA EXPRESS MED 76 PLATT, RORY P, M 0 77 DR. RONALD KOBAYASHI 78 SAMONTE, ROMEO M, M 0 79 SPECTRA LABORATORIES 80 SERV U PHARMACY INC.

286.36 17,259.58

151,300.31 5,259.83 4,528.44

14,647.52 13,367.59

1,216.54 1,598.93 6,403.70 2,984.80

341.23 748.58 295.79 948.76

43.60 13,655.25 19,781.62 7,602.78

350.00 7,564.85

446,499.35 30.00

7,050.18 35,782.87

60.57 83,759.98 26,767.57 72,234.62

2,413.78 137.14

13,244.81 2.40

4,523.28 1,852.75

13,439.91 163,224.43

2,331.68 410.79

4,082.40 29,861.89

1,431.43 17,310.23 4,922.48

81 SOUTH VALLEY RADIOLOGY 82 SAMARITAN IMAGING CENTER 83 SENEVIRATNE, LASIKA M.D. 84 SAMARITAN ANES MED GROUP 85 CAREPLUS CVSIPHARMACY #2915 86 WISHNER, STANLEY H, M D 87 SEVENTH DAY ADVENTIST 88 SUPER DRUGS 89 SCHAEFER AMBULANCE SVC 90 ST DOMINIC SR CARE HOME 91 HAYASHIDA, STEVEN F, M D 92 GUAM VISITING NURSES 93 20/20 VISION CTR., INC. 94 THE DOCTORS' CLINIC 95 PACIFIC SLEEP CENTER 96 USC UNIVERSITY HOSPITAL 97 COMMANDING OFFICER 98 FREEMAN, WILLIAM S, M D 99 X-RAY PRO.

100 CHANG, YOUNG K, M D 101 YANG, ROBERT J

Grand

56.24 7,320.38 3,276.42 3,710.15

50,229.91 2,499.61

21,118.51 115,087.12

1,116.45 893,780.30

248.38 40,398.83

9,038.72 22,285.65

7,478.58 1,159.03

26,129.70 37,422.40

94.06 422.99

26,284.17 6,210,340.95