Kos. Medical Referral Reg.

MEDICAL REFERRAL REGULATIONS

Part I. General Provisions.

1.1. Authority. These regulations are promulgated pursuant to Section 2.402 and 12.1104 of the Kosrae State Code.

1.2. Purpose. These regulations provide an impartial process for selecting persons genuinely needing medical treatment outside the State through a medical referral and provide for the payment of the costs of the medical referral.

1.3. Repeal. These regulations supersede the Medical Referral Regulations (Kosrae State Regulations 23-88) adopted October 21, 1988, which former regulations are hereby repealed in its entirety.

Part II. Medical Referral Procedures.

2.1. Medical Referral Committee. There shall be a Medical Referral Committee consisting of the Director of Health Services, who shall be its chairman, and all physicians employed at the Kosrae State Hospital. The Committee shall review and evaluate all cases recommended for medical referral and shall impartially select those patients to be sent outside the State for medical treatment through a medical referral. The Committee shall also select an attendant to accompany the patient if it determines that an attendant is necessary. The Committee shall convene at the request of any member. Selection shall be by unanimous vote of the Committee.

2.2. Emergency Medical Referral. In an emergency, if the Medical Referral Committee cannot be convened, the Director of Health Services or his designee shall decide if a medical referral is appropriate and whether an attendant shall accompany the patient. The Director or his designee shall attempt to consult with Committee members before making such a decision. The Director or his designee concurs to or otherwise to each and every emergency medical referrals.

2.3. Eligibility. A person who is a citizen of the Federated States of Micronesia and a domiciliary of Kosrae is eligible for consideration for medical referral.

2.3.1. Kosraeans who are physically in Kosrae during the time of referral;

2.3.2. Any State Government employee who travels on Government business who, during the course of his official travel assignment, requires specialized treatment outside the State;

2.3.3. Any State Government employee, including family members, who performs regular State Government duties outside the State who, during the course of performing those duties outside the State, requires specialized medical treatment outside the State;

2.3.4. Kosraeans who are dependents of FSM Group Health Insurance Policy holders who attend schools outside the State;

2.3.5. Kosraeans who are FSM National Government employees, and their dependents, who are members of the FSM Group Health Insurance Program.

2.4. Selection Criteria. The Medical Referral Committee shall adhere to the following criteria in selecting persons for medical treatment outside the State:

2.4.1. The patient cannot be adequately treated in Kosrae because of lack of medical equipment and/or expertise.

2.4.2. The expected prognosis for the patient following medical treatment outside the State must be reasonably optimistic.

Part III. Payment For Services.

3.1. Cost-Sharing. The medical referral patient and his or her family shall be obligated to pay fifty percent (50%) of the total medical costs, including medical and hospital bills, and other costs not otherwise covered by the patient's insurance. However, if the Director of Health Services determines that the illness or injury requiring medical referral occurred because of the fault (either through negligence, recklessness, or intent) of the patient, the patient and his or her family shall be obligated to pay the total costs of the medical bills, not otherwise covered by the patient's insurance. All medical referral patients and their attendants shall be obligated to pay One Hundred percent (100%) of their transportation and other non-medical costs.

3.2. Payment by Patients. The payment of the patient's and his family's share of the costs of the medical referral shall be pursuant to a patient payment plan as provided in the Medical and Dental Fee Regulations.

Part IV. Effective Date.

These regulations are promulgated pursuant to KC 2.406. They are effective upon signature of the Governor.

These regulations have been reviewed by the Office of the Attorney General and are found to conform with law.

Signed by Debra S. Blum, Assistant Attorney General on December 23, 1997.

The undersigned certifies that these regulations are adopted in compliance with Kosrae Code Section 2.406.

Signed by Asher Asher, Director of the Department of Health Services on December 23, 1997.

These regulations have been promulgated by the Director of Health Services in accordance with Kosrae Code Section 2.406. I hereby approve them.

Signed by Governor Moses Mackwelung on December 23, 1997.

Registered as Regulation No. 44-98 pursuant to Kosrae Code Section 2.406.

Signed by Fred S. Skilling, Chief, Public Information & Protocol on January 5, 1998.


	MEDICAL REFERRAL REGULATIONS Part I. General Provisions. 1.1. Authority. These regulations are promulgated pursuant to Section 2.402 and 12.1104 of the Kosrae State Code. 1.2. Purpose. These regulations provide an impartial process for selecting persons genuinely needing medical treatment outside the State through a medical referral and provide for the payment of the costs of the medical referral. 1.3. Repeal. These regulations supersede the Medical Referral Regulations (Kosrae State Regulations 23-88) adopted October 21, 1988, which former regulations are hereby repealed in its entirety. Part II. Medical Referral Procedures. 2.1. Medical Referral Committee. There shall be a Medical Referral Committee consisting of the Director of Health Services, who shall be its chairman, and all physicians employed at the Kosrae State Hospital. The Committee shall review and evaluate all cases recommended for medical referral and shall impartially select those patients to be sent outside the State for medical treatment through a medical referral. The Committee shall also select an attendant to accompany the patient if it determines that an attendant is necessary. The Committee shall convene at the request of any member. Selection shall be by unanimous vote of the Committee. 2.2. Emergency Medical Referral. In an emergency, if the Medical Referral Committee cannot be convened, the Director of Health Services or his designee shall decide if a medical referral is appropriate and whether an attendant shall accompany the patient. The Director or his designee shall attempt to consult with Committee members before making such a decision. The Director or his designee concurs to or otherwise to each and every emergency medical referrals. 2.3. Eligibility. A person who is a citizen of the Federated States of Micronesia and a domiciliary of Kosrae is eligible for consideration for medical referral. 2.3.1. Kosraeans who are physically in Kosrae during the time of referral; 2.3.2. Any State Government employee who travels on Government business who, during the course of his official travel assignment, requires specialized treatment outside the State; 2.3.3. Any State Government employee, including family members, who performs regular State Government duties outside the State who, during the course of performing those duties outside the State, requires specialized medical treatment outside the State; 2.3.4. Kosraeans who are dependents of FSM Group Health Insurance Policy holders who attend schools outside the State; 2.3.5. Kosraeans who are FSM National Government employees, and their dependents, who are members of the FSM Group Health Insurance Program. 2.4. Selection Criteria. The Medical Referral Committee shall adhere to the following criteria in selecting persons for medical treatment outside the State: 2.4.1. The patient cannot be adequately treated in Kosrae because of lack of medical equipment and/or expertise. 2.4.2. The expected prognosis for the patient following medical treatment outside the State must be reasonably optimistic. Part III. Payment For Services. 3.1. Cost-Sharing. The medical referral patient and his or her family shall be obligated to pay fifty percent (50%) of the total medical costs, including medical and hospital bills, and other costs not otherwise covered by the patient's insurance. However, if the Director of Health Services determines that the illness or injury requiring medical referral occurred because of the fault (either through negligence, recklessness, or intent) of the patient, the patient and his or her family shall be obligated to pay the total costs of the medical bills, not otherwise covered by the patient's insurance. All medical referral patients and their attendants shall be obligated to pay One Hundred percent (100%) of their transportation and other non-medical costs. 3.2. Payment by Patients. The payment of the patient's and his family's share of the costs of the medical referral shall be pursuant to a patient payment plan as provided in the Medical and Dental Fee Regulations. Part IV. Effective Date. These regulations are promulgated pursuant to KC 2.406. They are effective upon signature of the Governor. These regulations have been reviewed by the Office of the Attorney General and are found to conform with law. Signed by Debra S. Blum, Assistant Attorney General on December 23, 1997. The undersigned certifies that these regulations are adopted in compliance with Kosrae Code Section 2.406. Signed by Asher Asher, Director of the Department of Health Services on December 23, 1997. These regulations have been promulgated by the Director of Health Services in accordance with Kosrae Code Section 2.406. I hereby approve them. Signed by Governor Moses Mackwelung on December 23, 1997. Registered as Regulation No. 44-98 pursuant to Kosrae Code Section 2.406. Signed by Fred S. Skilling, Chief, Public Information & Protocol on January 5, 1998.