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Chapter 03 - Medical Treatment

Chapter 03 - Medical Treatment

11.0301 Uninsured hospital and medical charges-Authority.


The rule codified in this section and 11.0302 ASAC is adopted under authority of 13.0601 and 13.0602 ASCA.

11.0302 Uninsured hospital and medical charges-Designated.


(a) Charges for patients for hospital and medical services not covered by insurance who are entitled to medical attention free of charge under 13.0601 ASCA are as follows:

(1) A charge of $7.50 per inpatient day for the use of facilities at the LBJ Tropical Medical Center; and

(2) A charge of $2 per outpatient visit for the use of facilities at the LBJ Tropical Medical Center and Government dispensaries. Any person who may be entitled. to free treatment pursuant to Section 13.0601 ASCA must present proof that he or she has resided in American Samoa for at least six months prior to the date that treatment is sought.

(b) Charges for patients for hospital and medical services not covered by insurance who are not entitled to medical attention free of charge under 13,0601 ASCA are as follows:

(1) An all-inclusive charge of $60 per in-patient day for use of facilities and medical services at the LBJ Tropical Medical Center; and

(2) A charge of $2 per outpatient visit for the use of facilities at the LBJ Tropical Medical Center and Government dispensaries, and a charge of cost plus 25%;: ! or $1. whichever is greater, for each drug or medicine obtained at such visit, whether prescribed by a physician or medical officer or nonprescription in nature. These charges shall be waived for United States citizens, their spouses and dependent children who present proof of residence in American Samoa for at least six months prior to the date that treatment is sought. Such persons shall pay the charges established in subsection (a) above.

(c) For purposes of this rule, "insurance" means health, accident. motor vehicle liability, workmen's compensation and other insurance coverage of hospital and medical charges and coverage of such charges authorized or permitted by law in place of insurance,

11.0303 Insured hospital and medical charges-Authority.


The rule codified in this section and 11.0304 ASAC is adopted under authority of Article IV, Section 6 of the Revised Constitution of American Samoa.

11.0304 Insured hospital and medical charges-Designated.


(a) Charges for patients at the LBJ Tropical Medical Center for hospital and medical services covered by insurance or payable under health care programs of the United States Government applicable to American Samoa are as follows:

(1) An all-inclusive charge of $201.00 per inpatient day for hospital and medical services; and

(2) An all-inclusive charge of $17.80 per out-patient visit for hospital, clinic and medical services.

(b) For purposes of this section, "insurance" means health, accident, motor vehicle liability, workmen's compensation and other insurance coverage of hospital and medical charges and coverage of such charges authorized or permitted by law in place of insurance.

11.0310 Restriction to unavailable services.


Only patients in need of medical services that cannot be provided at the LBJ Tropical Medical Center will be referred for off-island medical care.

11.0311 Qualifications.


To qualify for off-island medical referral, the patient must come within one of the categories set forth in 13.0601

(a) ASCA. These categories include:

(1) American Samoans, as defined in 41.0202(1)(c) ASCA, and their spouses and dependent children who are residing in American Samoa at the time medical services are needed.

(2) Contract employees and independent contractors of the American Samoa Government and their spouses and dependent children as provided by their contracts.

(3) Civil service employees of the United States Government, and, their spouses and dependent children; provided, that the American Samoa Government will pay only for round-trip transportation and not the medical expenses of such persons, unless they are qualified under other provisions of this section.

(4) NonAmerican Samoans who are lawfully residing in American Samoa at the time medical services are needed and have been lawfully residing in the territory continuously, except for vacations or visits for periods not to exceed 6 consecutive months, for 10 years.

(5) U .S. citizens, their spouses and dependents, whose hospital and medical services charges are waived under 11.0302 ASAC, shall be entitled to off-island medical care to the same extent furnished to American Samoans by the government; provided, that the citizen, spouse or dependent will be required to use and apply entitlement to hospital, medical and dental care benefits which he or she may have as a veteran of the armed forces or as a participant under any other program or insurance plan.

(b) In all cases of off-island medical referral, the American Samoa Government will be responsible for payment of hospital and medical services in excess of the cost of those services covered by insurance or payable under health care programs of the United States Government applicable to American Samoa. For purposes of this subsection, "insurance" means health, accident, motor vehicle liability, workers' compensation and other insurance coverage of hospital and medical charges and coverage of such charges authorized or permitted by law in place of insurance.

11.0312 Authorization and processing.


(a) The chief of service immediately concerned rills out an off-island medical referral form and sends it to the office of the director of health.

(b) The medical referral committee (chiefs of various services) will meet to review each proposed referral case, and after discussing each case, will recommend approval or disapproval according to policies, procedures, and criteria governing this process,

(c) The referral form, and the medical referral committee's recommendations are given to the director of health with the patient's medical record for review and decision.

(d) If approved, the referral form is given to the patient coordinator, who:

(1) confirms that the patient meets eligibility requirements;

(2) obtains the patient's signature (or legal guardian's signature if the patient is a minor), which obligates the patient to accept the treatment recommended by the physician to whom referred and ascertains that patient understands the document-being signed;

(3) ensures that the patient's immigration papers (passport and visa) are valid and in possession;

(4) obligates funds for the patient's travel and off-island medical care;

(5) prepares the travel authorization and obtains the air travel ticket for the patient's transportation; and

(6) advises an ambulatory patient of the telephone numbers of American Samoa Office-Hawaii and the patient coordinator's residence and that after checking through U.S. Immigration and Customs in Honolulu to call these numbers in case no one is at the airport to meet him or her.

11.0313 Transportation from airport to hospital-Ambulance.


When an ambulance is necessary to transport a patient from the Honolulu International Airport to the Tripler Army Medical Center, prior arrangements will be made by the director's office, by telephone or telex, for the TAMC ambulance to meet the patient. The American Samoa Government will not pay for ambulance service arranged for by the patient, the patient's relative, or anyone else.

11.0314 Transportation from airport to hospital-Directness of travel.


It is imperative that the patient proceed directly from the Honolulu International Airport to the Tripler Army Medical Center, Patients must not be transported to the homes of relatives or friends and subsequently transported to TAMC,

11.0315 Medical attendants-Children's parents or guardians.


As a general rule, the American Samoa Government will not pay the airfare, room, or meals for relatives or friends to accompany the patient. If the patient's condition requires a medical attendant in transit, the department of health will provide a qualified nurse or physician to accompany the patient. However, if the patient is under 18 years of age, and if deemed necessary by the director of health the American Samoa Government will pay only the round-trip airfare of 1 parent or guardian of the patient.

11.0316 Care without referral.


(a) Except as officials and employees of the American Samoa Government in official travel status may be authorized, the American Samoa Government will not pay for the medical care of any patient who presents himself to the Tripler Army Medical Center or any other health care institution without referral until authorized by the director of health by telephone, telex, or letter.

(b) The American Samoa Government will not pay for the medical care of any patient who goes to Tripler Army Medical Center or any other institution while on a vacation, family, or village affair .

11.0317 Applicability of provisions to Letterman Army Medical Center.


The references to Tripler Army Medical Center in this article shall apply in the same manner in the event of referral to Letterman Army Medical Center in San Francisco.

11.0318 Care in private institution.


If the patient chooses to go to a private health care institution, the American Samoa Government will pay no more than the Tripler Army Medical Center rate. The government will not make any agreement to pay the excess amount while the patient pays back on any installment plan. The patient or his family shall payor make financial arrangements with the institution directly,