34th GL CLERKS OFFICE Bill HISTORY 4/20/2018 1:19 PM I Mina'Trentai Kuåttro Na Liheslaturan BILL STATUS BILL NO. SPONSOR TITLE DATE INTRODUCED DATE REFERRED CMTE REFERRED PUBLIC HEARING DATE DATE COMMITTEE REPORT FILED FISCAL NOTES NOTES 1/18/18 11:01 a.m. Committee on Appropriations and AdjudicaƟon 1/18/18 4:17 p.m. Re‐referred : Committee on Health, Tourism, Military Affairs and Senior Citizens Louise B. Muña Telena C. Nelson Therese M. Terlaje Mary Camacho Torres Régine Biscoe Lee AN ACT TO ADD A NEW § 181003 TO ARTICLE 10, CHAPTER 18, TITLE 22, GUAM CODE ANNOTATED AND TO REPEAL SUBSECTION (e) OF § 4301, ARTICLE 3, CHAPTER 4, TITLE 4, GUAM CODE ANNOTATED RELATIVE TO BREAST CANCER SCREENING COVERAGE IN HEALTH INSURANCE/BENEFIT PLANS SOLD ON GUAM AND BY MEDICAID AND THE MEDICALLY INDIGENT PROGRAM (MIP). 1/9/18 12:30 p.m. Fiscal Note Request 1/18/18 Fiscal Note Waiver 2/05/18 4/12/18 8:30 a.m. 4/20/18 10:48 a.m. 227‐34 (COR) Page 1
Re‐referred : Committee on Health, Tourism, Military Affairs and Senior Citizens
Louise B. Muña Telena C. NelsonTherese M. TerlajeMary Camacho TorresRégine Biscoe Lee
AN ACT TO ADD A NEW § 181003 TO ARTICLE 10, CHAPTER 18,TITLE 22, GUAM CODE ANNOTATED AND TO REPEAL SUBSECTION(e) OF § 4301, ARTICLE 3, CHAPTER 4, TITLE 4, GUAM CODEANNOTATED RELATIVE TO BREAST CANCER SCREENING COVERAGEIN HEALTH INSURANCE/BENEFIT PLANS SOLD ON GUAM AND BYMEDICAID AND THE MEDICALLY INDIGENT PROGRAM (MIP).
1/9/1812:30 p.m.
Fiscal NoteRequest1/18/18
Fiscal Note Waiver2/05/18
4/12/188:30 a.m.
4/20/1810:48 a.m.
227‐34 (COR)
Page 1
SENATOR DENNIS G. RODRIGUEZ, JR.
April 18, 2018
Honorable B~njamin J.F. Cruz Speaker I Mina'Trentai Kuattro Na Liheslaturan Guahan 163 Chalan Santo Papa Hagatfia, Guam 96910 /na_l(:) VIA: The Honorable Regine Biscoe L~
Chairperson, Committee on Rules
RE: Committee Report- Bill No. 227-34 (COR)
Dear Speaker Cruz:
I ...;::: t
CiO
Transmitted herewith, for your consideration, is the Committee Report on Bill No. 227-34 (COR) AN ACT TO ADD A NEW § 181003 TO ARTICLE 10, CHAPTER 18, TITLE 22, GUAM CODE ANNOTATED AND TO REPEAL SUBSECTION (e) OF§ 4301, ARTICLE 3, CHAPTER 4, TITLE 4, GUAM CODE ANNOTATED RELATIVE TO BREAST CANCER SCREENING COVERAGE IN HEALTH INSURANCE/BENEFIT PLANS SOLD ON GUAM AND BY MEDICAID AND THE MEDICALLY INDIGENT PROGRAM (MIP). As introduced, was publicly heard on April 12, 2018.
Committee votes are as follows:
/}.. TO PASS
- NOTTOPASS - ABSTAIN I/ TO REPORT OUT ONLY _... TO PLACE IN INACTIVE FILE
Senseramente,
Senator Dennis G. Rodriguez, Jr. Chairman
Attachments
Chairman, Committee on H ealth, Tourism, Militaiy Affairs and Senior Citizens Ufisi11a11 Tod11 Guam • I Mi11a' T rmtai K111ittro Na Liheslat11ra11 G111iha11 • 34th G11at11 Legislature
Ran Care Bldg., Suite B1 , 761 S. Marine Corps Drive, Tamuning, Guam 96931
Bill No. 227-34 (COR) -Sponsored by: Louise B. Muna I Telena C.
Nelson I Therese M. Terlaje I Mary Camacho Torres I Regine Biscoe Lee
Bill No. 227-34 (CORAN ACT TO ADD A NEW § 181003 TO ARTICLE 10, CHAPTER 18, TITLE
22, GUAM CODE ANNOTATED AND TO REPEAL SUBSECTION (e) OF§ 4301, ARTICLE
3, CHAPTER 4, TITLE 4, GUAM CODE ANNOTATED RELATIVE TO BREAST CANCER SCREENING COVERAGE IN
HEAL TH INSURANCE/BENEFIT PLANS SOLD ON GUAM AND BY MEDICAID AND THE
MEDICALLY INDIGENT PROGRAM (MIP).
Chairman, Committee on Health, Tourism, Military Affairs and Senior Citizens Ufisi11a11 Todtt G11a111 • I Mina' T rrmtai K11Jttro Na Lihes!at11ran Gtttihan • 34th G11am Legis!at11re
Ran Care Bldg., Suite B1, 761 S. Marine Corps Drive, Tamuning, Guam 96931 Telephone: 671-649-TODU (8638) /Facsimile: 671-649-0520 / E-mail: [email protected] / www.toduguam.com
SENATOR DENNIS G. RODRIGUEZ, JR.
April 18, 2018
MEMORANDUM
To: ALL MEMBERS Committee on Health, Tourism, Military Affairs and Senior Citizens
From: Senator Dennis G. Rodriguez, Jr. fJ..v Committee Chairperson
Subject: Committee Report on Bill No. 227-34 (COR)
Transmitted herewith, for your consideration, is the Committee Report Bill No. 227-34 (COR) AN ACT TO ADD A NEW § 181003 TO ARTICLE 10, CHAPTER 18, TITLE 22, GUAM CODE ANNOTATED AND TO REPEAL SUBSECTION (e) OF§ 4301, ARTICLE 3, CHAPTER 4, TITLE 4, GUAM CODE ANNOTATED RELATIVE TO BREAST CANCER SCREENING COVERAGE IN HEALTH INSURANCE/BENEFIT PLANS SOLD ON GUAM AND BY MEDICAID AND THE MEDICALLY INDIGENT PROGRAM (MIP). This report includes the following:
• Committee Voting Sheet • Committee Report Narrative/Digest • Copy of Bill No. 227-34 (COR) • Public Hearing Sign-in Sheet • Copies of Submitted Testimony and Supporting Documents • Copy of COR Referral of Bill No. 227-34 (COR), As introduced • Copy of COR Fiscal Note Request/Fiscal Note • Notices of Public Hearing (1 st and 2nd) • Copy of the Public Hearing Agenda • Related News Articles (Public hearing publication of public notice)
Please take the appropriate action on the attached voting sheet. Your attention to this matter is greatly appreciated. Should you have any questions or concerns, please do not hesitate to contact me.
Si Yu'os Ma 'ase '!
Attachments
Chairman, Committee on Health, Tourism, Military Affairs and Senior Citizens Ufisina11 Todtt G11a111 • I Mina' T re11tai K11dttro Na U heslat11ra11 G11dha11 • 34th G11am Legis!at11re
Ran Care Bldg., Suite B1 , 761 S. Marine Corps Drive, Tamuning, Guam 96931 Telephone: 671-649-TODU (8638) /Facsimile: 671-649-0520 / E-mail: [email protected] / www.toduguam.com
1otor Thomas C. Ada. e Chairperson
Sen. Dennis G. Rodriguez. Jr Membe1
~aker Benjamin J.F. Cruz. mber
Sen. Joe S. Son Agustin. Member
e Speaker Therese M. Terloje. mber
Senator Michael F.Q. Son Nicolas.
COMMITTEE ON RULES Member
1ator Fronk B. Aguon, Jr .. mber
SENATOR REGINE BISCOE LEE, CHAIR SIKRITARIAN UHESLATURAN GUAHAN • I MINA'TRENTAI KUATRO
NA LIHESLA TU RAN GU A HAN
Senator Jomes V. Espaldon. Member
1olor Telena C . Nelson. mber
Senator Mory C. Torres.
MEMO
To:
From:
Re:
LEGISLATIVE SECRETARY • 34TH GUAM LEGISLATURE
January 17, 2018
Rennae Meno Clerk of the Legislature
Attorney Julian Aguon Legislative Legal Counsel
Senator Regine Biscoe Le Chairperson. Committee on Rules
Referral of Bill No. 227-34 (COR)
Buenos yon Hcifa odai!
Committee on Rules and subject to§ 6.01 (d} ( 1}. Rule VI of our Standing Rules (see 8(3} of the pre-referral checklist}, I am foiwarding the referral of Biii No. 227-34 (COR).
Please ensure that the subject bill is referred, in my name, to Speaker Benjamin J.F. Cruz, Chairperson of the Committee on Appropriations and Adjudication. I also request that the same be foiwarded to the prime sponsor of the subject bill.
After committee review, the subject bill may be further referred by the Committee on Appropriations to the Principal Committee of subject matter jurisdiction, pursuant to § 6.01 (d} ( 1), Rule VI of our Standing Rules. If the Committee on Appropriations determines that a subsequent referral is in order, the Committee on Rules respectfully advises that the subject bill be referred to Senator Dennis G. Rodriguez, Jr., Chairperson of the Committee on Health, Tourism, Military Affairs and Senior Citizens.
Attached, please see the COR pre-referral checklist for your information, which shall be attached as a committee report item to the bill.
If you have any questions or concerns, please feel free to contact Jeanenne Cordero at 472-2461. Thank you for your attention to this important matter.
~-I
Member
ri -~~a:-d' i: ~lfil~~tp~~il. --------------
GUAM CONGRESS BUILDING I 163 CHALAN SANTO PAPA I HAGATNA, GUAM 96910 [email protected] I (671) 472-3455
/16/2018 Gmail - FIRST NOTICE OF PUBLIC HEARING on Thursday, April 12, 2018
Subject: FIRST NOTICE of PUBLIC HEARING on April 12, 2018
Hafa Adai!
The Committee on Health , Tourism , Military Affairs and Senior Citizens will conduct a Public Hearing on Thursday, April 12, 2018, at 8:30am in the Guam Congress Building Public Hearing Room in Hagatna.
The Committee will accept oral and written testimony on the following:
Bill No. 243-34 (COR) - James V. Espaldon I B. J.F. Cruz
AN ACT TO AMEND ITEMS (a) AND (b) OF§ 4301 OF 4 GCA, RELATIVE TO THE GOVERNMENT OF GUAM GROUP HEALTH INSURANCE PROGRAM.
Bill No. 227-34 (COR) - Louise B. Muna I Telena C. Nelson I Therese M. Terlaje I Mary Camacho Torres I Regine Biscoe Lee
AN ACT TO ADD A NEW§ 181003 TO ARTICLE 10, CHAPTER 18, TITLE 22, GUAM CODE ANNOTATED AND TO REPEAL SUBSECTION (e) OF§ 4301, ARTICLE 3, CHAPTER 4, TITLE 4, GUAM CODE ANNOTATED RELATIVE TO BREAST CANCER SCREENING COVERAGE IN HEALTH INSURANCE/BENEFIT PLANS SOLD ON GUAM AND BY MEDICAID AND THE MEDICALLY INDIGENT PROGRAM (MIP).
Written testimony may be addressed to Sen. Dennis G. Rodriguez, Jr., Chairman and sent via email to [email protected] or hand delivered to his office at 761 S. Marine Corps Drive Suite B1 Tamuning, Guam 96931 or the Guam Congress Building Mailroom at 163 Chalan Santo Papa Hagatna, Guam 96910.
Individuals who may require special accommodations are asked to contact the office of Sen. Rodriguez at 649-8638/0511 no later than 48 hours prior to the scheduled hearing.
For more information, please call our office.
Si Yu'os Ma'ase'!
Joseph A. Q. Mesngon Deputy Chief of Staff Office of Senator Dennis G. Rodriguez, Jr. Committee on Legislative Operations, Health, Tourism, Military Affairs and Senior Citizens I Mina' Trentai Kuattro Na Liheslat11ran Guahan 34th Guam Legislature 761 S. Marine Corps Drive Suite 81
Subject: SECOND NOTICE of PUBLIC HEARING on April 12, 2018
Hafa Adai!
The Committee on Health, Tourism, Military Affairs and Sen ior Citizens will conduct a Public Hearing on Thursday, April 12, 2018, at 8:30am in the Guam Congress Building Public Hearing Room in Hagatna.
The Committee will accept oral and written testimony on the following:
Bill No. 243-34 (COR) - James V. Espaldon I B. J.F. Cruz
AN ACT TO AMEND ITEMS (a) AND (b) OF§ 4301 OF 4 GCA, RELATIVE TO THE GOVERNMENT OF GUAM GROUP HEALTH INSURANCE PROGRAM.
Bill No. 227-34 (COR) - Louise B. Muna I Telena C. Nelson I Therese M. Terlaje I Mary Camacho Torres I Regine Biscoe Lee
AN ACT TO ADD A NEW§ 181003 TO ARTICLE 10, CHAPTER 18, TITLE 22, GUAM CODE ANNOTATED AND TO REPEAL SUBSECTION (e) OF§ 4301, ARTICLE 3, CHAPTER 4, TITLE 4, GUAM CODE ANNOTATED RELATIVE TO BREAST CANCER SCREENING COVERAGE IN HEALTH INSURANCE/BENEFIT PLANS SOLD ON GUAM AND BY MEDICAID AND THE MEDICALLY INDIGENT PROGRAM (MIP).
Written testimony may be addressed to Sen. Dennis G. Rodriguez, Jr., Chairman and sent via email to senatordrodriguez@gmai l.com or hand delivered to his office at 761 S. Marine Corps Drive Suite B1 Tamuning , Guam 96931 or the Guam Congress Building Mailroom at 163 Chalan Santo Papa Hagatna, Guam 96910.
Individuals who may require special accommodations are asked to contact the office of Sen. Rodriguez at 649-8638/0511 no later than 48 hours prior to the scheduled hearing.
For more information, please call our office.
Si Yu'os Ma'ase'!
Joseph A. Q. Mesngon Deputy Chief of Staff Office of Senator Dennis G. Rodriguez, Jr. Committee on Legislative Operations, Health, Tourism, Military Affairs and Senior Citizens I Mina' Trentai Kuattro Na Uheslat11ran Guahan 34th Guam Legislature 761 S. Marine Corps Drive Suite B1
Gmail - SECOND NOTICE OF PUBLIC HEARING on Thursday, April 12, 2018
SENATOR DENNIS G. RODRIGUEZ, JR. I Mina' TrentaiKuattronaLiheslaturanGuahan
Chainnan, Committee on Health, Towism, Military Affairs & Senior Citizens
PUBLIC HEARING AGENDA
Thursday, April 12, 2018 at 8:30AM Public Hearing Room, I Liheslatura
I. Call to order
II. Items for public consideration:
• BILL NO. 243-34 (COR) - AN ACT TO AMEND ITEMS (A) AND (B) OF ~ 4301 OF 4 GCA, RELATIVE TO THE GOVERNMENT OF GUAM GROUP HEALTH INSURANCE PROGRAM.
• BILL NO. 227-34 (COR) - AN ACT TO ADD A NEW § 181003 TO ARTICLE 10, CHAPTER 18, TITLE 22, GUAM CODE ANNOTATED AND TO REPEAL SUBSECTION (E) OF § 4301, ARTICLE 3, CHAPTER 4, TITLE 4, GUAM CODE ANNOTATED RELATIVE TO BREAST CANCER SCREENING COVERAGE IN HEALTH INSURANCE/BENEFIT PLANS SOLD ON GUAM AND BY MEDICAID AND THE MEDICALLY INDIGENT PROGRAM (MIP).
III. Adjournment
Thank you for your participation in today's hearing.
UfisinanTodu Guam 761 S. Marine Corps Drive, Suite Bl, Tamuning, Guam 96931 I Telephone: 671-649-TODU (8638) I Facsimile: 671-649-0520
S EN AT 0 R D EN NI S G. R 0 D RI GUE Z, Jr., Chairman COMMITTEE ON HEALTH, TOURISM, MILITARY AFFAIRS & SENIOR CITIZENS Mina 'trentai Kuatro Na Liheslaturan Guahan • 34rdGuam Legislature
PUBLIC HEARING Thursday, April 12, 2018 8:30 AM Guam Congress Building Public Hearing Room
ill No. 227-34 (COR)-AN ACT TO ADD A NEW§ 181003 TO ARTICLE 10, CHAPTER 18, TITLE 22, GUAM CODE ANNOTATED AND TO EPEAL SUBSECTION (e) OF§ 4301, ARTICLE 3, CHAPTER 4, TITLE 4, GUAM CODE ANNOTATED RELATIVE TO BREAST CANCER :::REENING COVERAGE IN HEALTH INSURANCE/BENEFIT PLANS SOLD ON GUAM AND BY MEDICAID AND THE MEDICALLY ~DIGENT PROGRAM (MIP).
Good morning! My name is Darlene Roberto and I am an 8-year survivor of Stage II Invasive Mucinous Carcinoma and Ductal Carcinoma in situ .. . otherwise known as breast cancer affecting both of my breasts. I was diagnosed at age 35 on September 30, 2010 when my children were just 10 and 7 years old. I found a massive and painful lump on my left breast the day after my husbands and mothers birthday on August 29, 2010, and within one month I had undergone several breast exams, an ultrasound, two mammograms, and a biopsy/lumpectomy. My whole family was in shock and scared and my two sisters ages 37 and 32 at the time had to go through an emergency screening too. I went through chemotherapy and radiation treatment on Guam and at the Breast Center at UCLA and I remember my doctor saying I'm way too young at 35 to have an old lady's disease and that she's seeing more and more patients under 40.
All of these procedures and treatments required Co-payments and because my health insurance was from my husbands private commercial insurance, these were manageable costs with no deductible. If I had a government plan at that time I would have had to pay the co-payments and/or my deductible before the 20% kicked in. At 35 years old I faced my own mortality and for one day only I thought I was going to die leaving my family to take care of all the financial obligations that I left behind. I was stressed out just thinking about how much this was going to cost and how embarrassed I would be to ask my family and friends to help me ..... . and this is all after my diagnosis ... ! already started my race to save my life!
In these past 8 years I have used my experience in navigating this journey to help and mostly just listen to many of my family, friends, and colleagues going through exactly what I went through and all of them barely out of their 30s and 40s. There would always be a point in the conversation about money and how they need to have another diagnostic test after another diagnostic test and maybe how the radiology company just wants their money. It's so sad because I have to tell them that their life is worth more than anything and knowing is the first step. So they pay for these tests because who is not going to do whatever they can to make sure they are going to be ok.
Stress makes you sick, you can even develop cancer from it...let's take this out of the equation from the beginn ing and allow young women, young mothers to know early on if they will need to put on those running shoes and superhero cape to save their life without having to worry about co-payments or deductibles. Having breast cancer is no longer a death sentence when detected early.
On Saturday, April 14, I will celebrate my 43rd birthday and my wish is for this bill to pass and become law.
Sent from my iPhone
SENATOR DENNIS G. RODRIGUEZ, JR.
COMMITTEE VOTING SHEET
Bill No. 227-34 (COR) AN ACT TO ADD A NEW§ 181003 TO ARTICLE 10, CHAPTER 18, TITLE 22, GUAM CODE ANNOTATED AND TO REPEAL SUBSECTION (e) OF § 4301, ARTICLE 3, CHAPTER 4, TITLE 4, GUAM CODE ANNOTATED RELATIVE TO BREAST CANCER SCREENING COVERAGE IN HEALTH INSURANCE/BENEFIT PLANS SOLD ON GUAM AND BY MEDICAID AND THE MEDICALLY INDIGENT PROGRAM (MIP).
DENNIS G. RODRIGUEZ, Jr. Chairman JOE S. SAN AGUSTIN Vice Chairman FERNANDO B. ESTEVES Vice Chairman on Health
BENJAMIN J.F. CRUZ
THERESE M. TERLAJE
FRANK B. AGUON, JR.
THOMAS A. MORRISON
WILLIAM M. CASTRO
LOUISE BORJA MUNA
NOT SIGNATURE TO TO ABSTAIN
PASS PASS
Chairman, Committee on Health, Tourism, Military Affairs and Senior Citizens Ufisit1a11 Tod11 Guam • I Mi11a' T rwtai K11tittro Na Liheslat11ra11 G11aha11 • 34th G11atJJ Legislature
Ran Care Bldg., Suite B1, 761 S. Marine Corps Drive, Tamuning, Guam 96931
OVERVIEW: The Committee on Health, Tourism, Military Affairs and Senior Citizens conducted a Public Hearing on April 12, 2018. The hearing convened at 08:30am in I Liheslatura's Public Hearing Room. Among the items on the agenda was the consideration of Bill No. 227-34 (COR) AN ACT TO ADD A NEW§ 181003 TO ARTICLE 10, CHAPTER 18, TITLE 22, GUAM CODE ANNOTATED AND TO REPEAL SUBSECTION (e) OF§ 4301, ARTICLE 3, CHAPTER 4, TITLE 4, GUAM CODE ANNOTATED RELATIVE TO BREAST CANCER SCREENING COVERAGE IN HEALTH INSURANCE/BENEFIT PLANS SOLD ON GUAM AND BY MEDICAID AND THE MEDICALLY INDIGENT PROGRAM (MIP).
I. Public Notice Requirements Notices were disseminated via hand-delivery/fax and/or email to all senators and all main media broadcasting outlets on March 29, 2018, and April 5, 2018.
Senators Present Senator Dennis G. Rodriguez, Jr. Senator Benjamin Cruz Senator James Espaldon Senator Louis Muna Senator Therese Terlaje
Chairman
II. SUMMARY OF TESTIMONY & DISCUSSION
Hearing for Bill 227-34 (COR)- Thursday, April 12, 2018
Speaker Cruz: No you're not at the wrong hearing. This is the Committee on Health, Tourism, Military Affairs, and Senior Citizens. The Chairman has asked me to convene this morning's meeting and hearing and start it. He like a couple of witnesses is stuck in traffic caused by accidents. But I know there are some people here who want to read their testimonies so they can return back to work. And we'll continue the hearing when the rest of the witnesses show up.
Notices for this hearing were sent out to the media on Thursday March 29th and the second notice was sent out on April the 5th. We have two items on the agenda and one of them is Bill No. 227-34. I will have the sponsor Senator Louise Muna to introduce and explain her bill to us.
Senator Muna: Thank you Mr. Speaker. My very sincere appreciation to all the people who came out here to testify on Bill No. 227-34. The intent ofBill 227-34 is to require that all health insurance companies provide coverage for breast cancer screening for both women and men within a certain age group without co-payment or deductible provisions. The bill's recommendations are patterned
Chairman, Committee on H ealth, Tourism, Military Affairs and Senior Citizens Ufisi11an Tod11 G11a111 • I Mi11a' T rentai K11Jttro Na Liheslat11ran G11Jha11 • 34th G11a1JJ Legislat11re
Ran Care Bldg., Suite Bl , 761 S. Marine Corps Drive, Tamu ning, Guam 96931 Telephone: 671-649-TODU (8638) /Facsimile: 671-649-0520 / E-mail: senatordrodriguez@gmail .com / www.toduguam.com
SENATOR DENNIS G. RODRIGUEZ, JR. companies provide coverage for breast cancer screening for both women and men within a certain age group without co-payment or deductible provisions. The bill's recommendations are patterned after the Medicare guidelines since Medicare is the largest health insurer in the United States. Medicare covers a baseline mammogram at age 35, an annual screening at age 40. This age range is consistent with the commencement age for the government of Guam group health insurance mandate for baseline and annual screening a mandate that has been in effect since 1991. In effect the bill adopts the age provisions of Medicare and the no payment, no deductible requirements of the US Preventative Services Task Force. Certain provisions of this bill differ from the grade A recommendations of the USPSTF are not supported by some of our health insurers. A close examination of the date and the reasoning behind the USPSTF recommendations and the recommendations of experts in the area of breast cancer show. However, the provisions ofBill 227-34 are in the best interest of our community. Thank you, Mr. Chair.
Speaker Cruz: Thank you, Senator. We have three individuals that signed up- Lisa Geisinger, Marissa Rosario, and Darlene Roberto. Please join us at the table.
Darlene Roberto: (Written testimony provided)
Senator Rodriguez: Good morning, Thank you so much for your testimony. And happy advanced birthday to you! We'll move on . . .. do you wish to speak? Go ahead ma'am.
Marissa Rosario: Good morning, Senator Cruz, Senator Muna, Senator Espaldon, and Senator Rodriguez. My name is Marissa Rosario . I didn't come with anything prepared. I think I've spoken my story many times that I've practically memorized it. But I was diagnosed with Stage 3 Breast Cancer at age 39. My baby was only 1. I'd have an 18-year old by then and four boys in between so my life then just took a whirlwind and I needed to decide what I was going to do. Fortunately for me, I was active duty military so my procedures, everything I've done on Guam by the way was covered. I had a double mastectomy, I went through chemo and I went through radiation. I've been in remission since August 2015. Not cancer free yet because of the advancement of the cancer but I have hope now. I'm here because my daughter, she's 21, so no longer going to be a military dependent under myself and she's going to be one of the ladies out there who needs to get screened because of our history. My mom is also a breast cancer survivor, she's going to need to be screened early on and she's only 21. Now the gene that I have is not the BRCA, it's called ATM and it is passed down by our parents. So I had a 50/50 percent chance of getting breast cancer and now my daughter has a 50% chance of getting breast cancer and that's extraordinary ... that's significantly high in my book. So it's either you get it or you don't. Now that she's entering the workforce after college, I need her to be in that population where she won't have to worry about getting screened or paying these deductibles at a young age. I am for it and I really hope that this bill gets passed and you for the better of the community. Thank you.
Chairman, Committee on H ealth, Tourism, Military Affairs and Senior Citizens Ufisi11a11 Tod11 G11a1J1 • I Mi11a' T re11tai K11attro N a Llheslat11ra11 G11aha11 • 34th G11all! Legislat11re
Ran Care Bldg., Suite Bl , 761 S. Marine Corps Drive, Tamuning, Guam 96931 Telephone: 671-649-TODU (8638) / Facsimile: 671-649-0520 / E -mail: [email protected] / www.toduguam.com
SENATOR DENNIS G. RODRIGUEZ, JR. Senator Rodriguez: Thank you so much, Marissa. Ma'am?
Lisa Geisinger: (Written testimony provided)
Senator Rodriguez: Si yu'os ma'ase. Thank you very much, ma'am. Does the sponsor have any questions or would you like to speak?
Senator Muna: I don't have really any questions. But I want to say, congratulations to all of you for being survivors and still continuing on that path. And I did want to let everyone know that I did not have a short list of people to contact. ... to come out and support this bill. It's astounding how many breast cancer patients we have here on island that we detected even under the age of 40. It just amazed me that even the people I knew or and I just met Marissa today but there's just so many of us and we need to figure out how to prevent it and this is one of the ways that I'd like for it to happen. It already currently is covered under Government of Guam insurance and we'd like to continue that and follow the Medicare guidelines since there are so many difference guidelines out there and everyone's confused, we're not sure when do we get screened and I think for the most vital part is communicating with your physician and I think if we have that opportunity, to go out there and talk to them and not be afraid, this bill will help that happen so I just want to thank you all for being here today. I know you took time out of your schedule to be here to talk about it and my blessings and prayers to you. Thank you, Senator.
Senator Rodriguez: Thank you, Senator. Mr. Speaker? Vice Speaker, do you have any questions or comments? Thank you very much for your testimony this morning. lfthere is anyone else who wish to provide oral testimony on Bill No. 227-34. If you're interested please come forward if you would like to present any testimonies. If not the committee will accept any testimonies after the hearing today. Okay we'll now move on to Bill 243-34.
III. Fiscal Note: Attached
III. FINDINGS AND RECOMMENDATIONS
The Committee on Health, Tourism, Military Affairs fe'd Senior Ci9zens, h=; reports out Bill No. 227-34 (COR) with the recommendation to ~a-r/' M ~ .
Chairman, Committee on Health, Tourism, Military A ffairs and Senior Citizens Ufisi11a11 Tod11 Guam • I Mina' T re11tai K11attro Na Llheslat11ran G11aha11 • 34th G11am Legislat11n
Ran Care Bldg., Suite B1 , 761 S. Marine Corps Drive, Tamuning, Guam 96931 Telephone: 671-649-TODU (8638) /Facsimile: 671-649-0520 / E -mail: [email protected] / www.toduguam.com
I MINA 'TRENTAI KUATTRO NA LIHESLATURAN GUAHAN 2o1 8 ( second )Regular Session
Bill No.Z.2--- 7 -34 (COR)
Introduced by : Louise B. Mufia~ Telena Cruz Nelso~~ Therese M. Terlaje( )\19\ . ,
Mary Camacho Torres ( Re ine Biscoe Lee
AN ACT TO ADD A NEW § 181003 TO ARTICLE 10, CHAPTER 18, TITLE 22, GUAM CODE ANNOTATED AND TO REPEAL SUBSECTION (e) OF§ 4301, ARTICLE 3, CHAPTER 4, TITLE 4, GUAM CODE ANNOTATED RELATIVE TO BREAST CANCER SCREENING COVERAGE IN HEALTH INSURANCE/BENEFIT PLANS SOLD ON GUAM AND BY MEDICAID AND THE MEDICALLY INDIGENT PROGRAM (MIP).
BE IT ENACTED BY THE PEOPLE OF GUAM:
2 Section 1. Legislative Findings and Intent. I Liheslaturan Guahan finds that breast
3 cancer is the most common non-skin cancer in women and the second leading cause
4 of cancer death of women in the United States (lung cancer is the leading cause of
5 cancer death for both sexes). Every woman is at risk, and this risk increases with age.
6 Breast cancer usually can be treated successfully if it is detected early.
7 I Lihes latura fmiher finds that Public Law 21-3 3 that was signed into law on May 1 7,
8 1991 required health insurance companies who provide coverage for Government of
9 Guam employees and retirees to cover mammograms for women on the following
10 schedule: one base-line mammogram at age 35 and annual mammograms beginning
11 at age 40 . This benefit is subject to co-payments or deductibles depending on the
12 plan the employee opted for.
' '°
I Liheslatura forther finds that the breast cancer screenmg recommendations for
2 Affordable Care Act compliant policies are based on the United States Preventive
3 Services Task Force (USPSTF) recommendation are Grade B that begins biennial
4 screening at age 50 and Grade C which begin screen at ages younger than 50. These
5 screenings are free from co-payments or deductibles.
6 I Liheslatura further finds that the breast cancer screening recommendation of the
7 American Cancer Society is annual mammograms for women at ages 45 to 55 and
8 biennial mammograms at age 56 and older.
9 I Liheslatura further finds that the breast cancer screening for Medicare patients is
10 women 40 years of age and older are eligible for a screening mammogram every 12
11 months. Medicare covers screening mammograms and digital technologies to check
12 for breast cancer before a patient or a doctor may be able to find it manually.
13 Medicare also covers one baseline mammogram for women between ages 35-39.
14 I Liheslatura further finds that the screening recommendation of the National
15 Comprehensive Cancer Network (NCCN) recommends men at higher risk for breast
16 cancer, starting at 40: (1) have a clinical breast exam every year (2) learn how to do
17 breast self-exam and (3) mammography screening. Men at higher risk (those with a
18 relative, within one degree of consanguinity, who were diagnosed with breast cancer
19 under the age of 40 or with a BRCAl or BRCA2 [breast cancer 1 or 2] gene
20 mutation) for breast cancer should also be aware of the warning signs of and screen
21 for breast cancer.
22 It is the intent of I Liheslatura to expand the Government of Guam mammogram
23 coverage mandates to all health insurance policies sold on Guam but to include the
24 recommendations for Medicare, the American Cancer Society and the USPSTF for
25 screenings that are free of co-payments and deductibles. It is also the intent of I
1 Liheslatura to extend mammogram coverage for men who are at higher risks for
2 breast cancer.
3
4 Section 2. A new Section 181003 is added to Article 10, Chapter 18, Title 22 Guam
5 Code Annotated to read as follows:
6 "§ 181003. Breast Cancer Screening benefit in every health insurance policy.
7 (a) Every policy of health insurance issued or renewed to a resident of Guam on
8 or after January 1, 2018, except a policy that provides coverage only for specified and
9 limited benefits, shall provide coverage for screening by low-dose mammography for
10 occult breast cancer as follows:
11 (1) For women thirty five (35) to thirty nine (39) years of age, one baseline
12 mammogram;
13 (2) For women f01iy (40) years of age and older, an annual mammogram;
14 (3) For a woman of any age and for men of beginning at age forty ( 40) who
15 have a first-degree consanguineous relative that was diagnosed to have
16 developed breast cancer at foiiy ( 40) years of age or younger, mammogram
17 screening may be performed as recommended by the patient's physician but
18 not more than once annually.
19 The services provided in this section are not subject to any comsurance or
20 deductible provisions which may be in force in such policies, contracts, plans or
21 agreements for routine x-ray examinations.
22 (b) The term, "low-dose mammography" means the x-ray examination of the
23 breast using equipment dedicated specifically for mammography, including but not
24 limited to the x-ray tube, filter, compression device, screens, films, and cassettes,
25 with an average radiation exposure delivery of less than one rad mid-breast, with two
26 views for each breast or digital breast tomosynthesis (DBT) or full-field digital
27 mammography (FFDM). "Digital breast tomosynthesis (DBT)," is a form of breast
1 imagmg, or mammography:, that uses a low-dose x-ray system and computer
2 reconstructions to create three-dimensional images of the breasts. "Full-field digital
3 mammography (FFDM)," is a mammography system in which the x-ray film is
4 replaced by electronics that convert x-rays into mammographic pictures of the breast.
5 (c) To the extent permitted by federal law, rules and regulations, the provisions of
6 this section, supra, shall apply to persons covered by the Medicaid without the
7 requirement for prece1iification. The provisions of this section, supra, shall apply to
8 persons covered by the Medically Indigent Program (MIP) without the requirement
9 for precertification."
10
11 Section 3. Subsection (e) of § 4301 Article 3, Chapter 4, Title 4, Guam Code
12 Annotated is repealed:
13 ~1ammogram to be included as a benefit in every health insurance policy.
14 Every policy of health insurance issued to a female resident of Guam on or after
15 July 1, 1991, except a policy that provides coverage only for specified and limited
16 benefits, shall provide coverage for screening by 10\v dose mammography for
17 occult breast cancer as follov1s:
18 ( 1) For women 3 5 to 3 9 years of age, one baseline mammogram;
19 (2) For v./omen 40 to 49 years of age, a mammogram every two
20 years;
21 (3) For women 50 years of age and older, an annual mammogram;
22 anti
23 (4) For a woman of any age with a history of breast cancer or v1hose mother or
24 sister has mcperienced breast cancer, a mammogram upon the recommendation of
25 the woman's physician.
26
27 The services provided in this subparagraph (e) are subject to any comsurance
1 17rovisions which may be in force in such policies, contracts, plans or agreements.
2 The director, with the advice of the Director of Public Health and Social Services,
3 shall annaally reviev.,,r the age and frequency guidelines for mammographic screening
4 recommended by tfl.e-American Cancer Society, and shall accordingly adjust the age
5 ood frequency reqHirements under subitems (1) through (4), by rule, if necessary.
6
7 For purposes of this subparagraph (e), the term ,,low dose mammography" means
8 the x ray examination of the breast using equipment dedicated specifically for
9 mammography, including but not limited to the x ray tube, filter, compression device,
1 o screens, films, and cassettes, '.Vith an average radiation exposure delivery of less than
11 one ra&-mid breast, '<Vith tvlo vim.vs for each breast. An insurer may provide the
12 services required by this subparagraph (e) through contracts with providers; provided,
13 that the contract is determined to be a cost effective means of delivering the services
14 without sacrifice of quality and meets the approval of the Director of Public Health
15 and Social Services.
----------- -- -
Senator Thomas C. Ado. Vice Choirpe~on
Speaker Benjamin J.F. Cruz. Member
Vice Speaker Therese M. TerlaJe. Member
8 . . .
-COMMITTEE ON RULES
SENATOR REGINE BISCOE LEE, CHAIR · SIKRITARIAN LIHESLATURAN GUAHAN
Senator Dennis G. Rodriguez. Jr .• Member
Senator Joe S. Son Agustin. Member
Senator Michael F.Q. Son Nicolas. _M~mber
Senator Jomes v . Espoldon. Senator Fronk B. Aguon. Jr .. Me.mber · ·
Senator Telena C. N"e!Son. Member
'.. I MINA'TRENTAI KUATIRO ;NA LIHESLATU0
RAN GUAHA-N LEGIS~ATIVE SECRETARV • 34rH GUAM LEGISLATUR_E
M~mber
Senator Mary ·camacho Torres. · •. • Member ·
PRE-REFERRAL CHECKLIST
BILL NO. 227-34 (COR) , AN ACT TO ADD A NEW§ 181003 TO ARTICLE 10, CHAPTER 18, TITLE 22, GUAM CODE ANNOTATED AND TO ' REPEAL SUBSECTION (e) OF§ 4301, ARTICLE 3, CHAPTER 4. TITLE 4, GUAM CODE ANNOTATED RELATIVE TO BREAST
CANCER SCREENING COVERAGE IN HEALTH INSURANCE/BENEFIT PLANS SOLD ON GUAM AND BY MEDICAID AND THE MEDICALLY INDIGENT PROGRAM (MlP).
1 Introduced b : Louise B .. Mu_iia , Telena C. Nelson, Therese M. Terla e, Ma _Camacho Torres, Re lne Biscoe lee
~~f/Oljo),2 G~A § 2108(0)] . 1\IKF, .,Jill~ q' All~@Q:fi?ri .. . a NO (Return to Prime. Sponsor) _,.,, r (2) Conform to Standing R·ules·as to form Qnd style?
_ [~ R §§ 6.02(b) and (d), 6.b'.3(d)J ~YES , , o NO eturn to Prime S · nsor ··
(1) Does tbe Bill contain appropriations or a4fhorizations for . appropriations from any fund
· Completed by Legal Bureau:
~-,~ p,~ltJ@~:~. ~ . . - :
• sources? Notice to OFB:
.. ~YE:. )(No TtKb.,~. _ _q._./?DltD. 0. -_ .2:rff; .. m. (2) Does the Bill contain an ~ ~ a~thorlzOtlpn·to expend · · · ·· ·
~~~nme~~ds? o N/A wal~~~\Of~~\O: (3) Does the Bill contain provisions ,
· that have potential fiscal impacts on the government of Guam budget?
YES c NO o N/A
Is the fiscal impact revenue negative to the government of Guam budget? n YES
fRefer to Committee on _ Appropriations)
"fs..NO I oN/A
, Completed by:
n. - ~ ~~~~L-~~~~~ -OUA.M CONGRESS BUILDING • 163 CHALAN SANTO PAPA • HAGAT~A. GUAM 96910
BILL NO. 227-34 (COR) AN ACT TO ADD A NEW § 181003 TO ARTICLE 10, CHAPTER 18, TITLE 22, GUAM CODE ANNOTATED AND TO
REPEAL SUBSECTION (e} OF §~01, ARTICLE 3, CHAPTER 4, TITLE 4, GUAM CODE ANNOTATED RELATIVE TO BREAST CANCER SCREENING COVER GE IN HEALTH IN.SURANCE/BENEFIT PLANS SOLD ON GUAM AND BY MEDICAID AND
~ THE MEDICALLY INDIGENT PROGRAM {MIP) . • ~ • Introduced bv: Louise B. Muna , Telena C. Nelson, Therese M. Terlale, Marv Camacho Torres, Regine Biscoe Lee
(C) DEBT
(1) SR § 6.01 (b )(1 )(A) £N/A Land, Infrastructure, o YES Building Projects, Capital
o NO (Return to Prime Sponsor) Received by: Improvement Projects {Signature, Date & Time) . (2) SR § 6.01 (b )(1 )(8) ,IN/A ~~ \ "'\'\ -\'6@ } ">Lt ¥·ID• Refinancing of existing o YES debt (not less than 23) o NO (Return to Prime Sponsor)
~/A Completed by:
(3) SR § 6.01 (b)(2) (Signature, Date & Time) Authorize public debt to o YES (Return to Prime Sponsor}
~\·\')·\lb~· &~~!£ y·m .. fund operations of agency, oNO instrumentality, public o Waived (per official state of corporation emergency, as attached) . .
, - o Return to Prime Spon~ .J Refer to: Wt_. m . · ... Date & Time:
Pursuant to COR decision ,.mID (COR Meeting, April 3, 2017):
For COR Office Completed within five (5) working
Use Only 7vs? ES lfNO:
o NO Provide letter of explanation (see attached).
GUAM CONGRESS BUILDING • 163 CHALAN SANTO PAPA • HAGAT~A, GUAM 96910 Telephone: (671) 1-72-3455 • Email address: [email protected]
Page 2 ot 2 ' ·
.
Senator Thomas C. Ada, Vice Chairperson
Speaker Benjamin J.F. Cruz, Member
Vice Speaker Therese M. Terlaje, Member
Senator Frank B. Aguon, Jr .. Member
Senator Telena C. Nelson. Member
MEMO
8-.,
~ ; ~ ~
COMMITTEE ON RULES SENATOR REGINE BISCOE LEE, CHAIR
SIKRITARIAN LIHESLATURAN GUAHAN I MINA'TRENTAI KUATTRO NA LIHESLATURAN GUAHAN
LEGISLATIVE SECRETARY• 341H GUAM LEGISLATURE
February 5, 2018
To: Rennae Meno
From:
Re:
Clerk of the Legislature
Senator Regine Biscoe Lee Chairperson, Committee on Rules
Fiscal Note Waiver
Buenos yon Hafa adai.
Attached, please find the fiscal note waiver for the following bill:
Bill No. 227-34 (COR)
Senator Dennis G. Rodriguez, Jr., Member
Senator Joe S. San Agustin, Member
Senator Michael F.Q. San Nicolas, Member
Senator James V. Espaldon, Member
Senator Mary Camacho Torres. Member
Please forward the same to Management Information Services (MIS) for posting on our website.
For any questions or concerns, please feel free to contact Jean Cordero, Committee on Rules Director, at 472-2461 .
Thank you for your attention to this important matter.
Respectfully,
Senator Regine Biscoe Lee Chairperson, Committee on Rules
GUAM CONGRESS BUILDING • 163 CHALAN SANTO PAPA • HAGATNA, GUAM 96910 Telenhone: (671) 472-3455 • Email address: [email protected]
BUREAU OF BUDGET & MANAGEMENT RESEARCH
EDDIE BAZA CALVO GOVERNOR
RAY TENORIO LIEUTENANT GOVERNOR
OFFICE OF THE GOVERNOR
Post Office Box 2950, HagAtfia Guam 96932
LESTER L. CARLSON, JR. ACTING DIRECTOR
FEB 01 2018
Senator Regine Biscoe-Lee Legislative Secretary and Chairperson, Committee on Rules I Mina 'Trentai Kuattro na Liheslaturan GuAhan 34th Guam Legislature Guam Congress Building 163 Chalan Santo Papa Hagatiia, Guam 96910
Hafa adai! Senator Biscoe-Lee:
The Bureau requests that Bill No. 227-34 (COR) be granted a waiver pursuant to Public Law 12-229 as amended for the following reason(s):
The intent of this proposed legislation is to add a new Section 181002 to Article 10, Chapter 18, Title 22 Guam Code Annotated (GCA) and to repeal Subsection (e) of Section 4301, Article 3, Chapter 4, Title 4, GCA. The proposed new Section 181002 is seeking to provide low-dose mammography, not subject to any coinsurance or deductible provisions, for occult breast cancer as the basis for breast cancer screening for women and men, using new criteria. The repeal of Section 4301 is to eliminate existing health insurance criteria for breast cancer screening to be replaced with the breast cancer screening criteria under the proposed new Section 181002. This proposed legislation is administrative in nature.
Senator Thomas C. Ada , Vice Chairperson
Speaker Benjamin J.F. Cruz, Member
Vice Speaker Therese M. Terlaje, Member
COMMITTEE ON RULES SENATOR REGINE BISCOE LEE, CHAIR
Senator Dennis G. Rodriguez, Jr., Member
Senator Joe S. San Agustin, Member
Senator Michael F.Q. San Nicolas, Member
Senator James V. Espaldon, Member Senator Frank B. Aguon, Jr.,
Member
SenatorTelena C. Nelson, Member
SIKRITARIAN LIHESLATURAN GUAH~N • I MINA' TRENTAI KUATTRO NA LIHESLATURA GUAHAN
UGISLATIVE SECRETARY• 34rH GUAM LE SLATUR E Senator Mary C. Torres,
Member
COMMITTEE REPORT CHECKLIST Part 1 I 1
BILL NO. 227-34 (COR) AN ACT TO ADDA NEW§ 181003 TO ARTICLE 10, CHAPTER 18, TITLE 22, GUAM CODE ANNOTATED AND TO REPEAL SUBSECTION (e) OF§ 4301, ARTICLE 3, CHAPTER 4, TITLE 4, GUAM CODE ANNOTATED RELATIVE TO BREAST CANCER SCREENING COVERAGE IN HEA L TH INSURANCE/BENEFIT PLANS SOLD ON GUAM AND BY MEDICAID AND THE MED/CALLY INDIGENT PROGRAM (MIP) -sponsors: Louise B. Muna, Telena C. Nelson, Therese M. Terlaje, Mary Camacho Torres, Regine Biscoe Lee
REFERRED TO: Senator Dennis G . Rodriguez, Jr., Chairman Cmte on Health, Tourism, M ilitary Affairs & Senior Citizens
(A) FISCAL NOTE or WAIVER
{J) Requested by COR " YES o NO
(~) Received by COR ef, YES o NO
(3.)'Waived by COR pr'YES o NO
(4) Bill contains appropriations or authorizations for appropriations from any fund sources? o YES ,/NO
Date & Time:
Jo.n . t <&, iovi ~ \ l :qo {k.(11.
Date & Time:
Date & Time: fpb. 5. ~\i ~ \G:sq f\·th -If YES: {4/5){a) Funding Availability Note/Waiver {OFB) attached? o YES
D NO (Unable to file CMTE Report)
{4/5){b) Funding source identified? 2 GCA § 9101
1----------------1 o YES
o NO (Proceed to (A) (6))
( 5) Bill contains an authorization to expend gov7rnment funds?
{4/5){c) Funds available and sufficient? 2 GCA § 9101
o YES ./J NO o YES
o NO (Proceed to (A) (6))
(6) Restrictions Against Unfunded Appropriations (2 GCA § 910 l) o Identifies specific alternate funding source
o De-appropriates from previous
appropriation with available funds and fiscal note
o Written certification by CMTE Chair tha t a situation exists which "threatens the safety, health and welfare of the communitv"
If no boxes checked:
UNABLE TO PLACE ON
SESSION AGENDA 2 GCA § 9102
GUAM CONGRESS BU I LDING • 163 CHALAN SANTO PAPA • llAGATNA, GUAM 96910 T·lcµhonc: (671) 472-3455 • Email addre ss : corguamleg islarurc@gma il.co m
Committee Report Checklist on Bill No. 227-34 (COR)
Part 1 I 1
(B) PUBLIC HEARING
(1) HEARING NOTICES SR§§ 6.04(a)(l) and 6.04(a)(2), Open Government Law (5 GCA, Ch. 8)
J (a) Five (5) working days prior (A L Senators & ALL Media)
