(a) I Liheslaturan Guåhan finds that the Guam Memorial Hospital Authority (GMHA), the Department of Public Health and Social Services (DPHSS), and the Guam Behavioral Health and Wellness Center (GBHWC) are in dire need of new facilities. The healthcare facilities’ structures have been used for more than five (5) decades and are showing stages of structural failure due to the age of said facilities. The structures of the healthcare facilities are also not meeting modern building codes, which creates a liability to the staff, patients, and visitors of the facilities.

(b) The need for new facilities is in demand as the U.S. Department of the Interior, Office of Insular Affairs, has funded an assessment for the U.S. Army Corps of Engineers (USACE) to

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investigate the failing structure and the long and short-term needs of the hospital. The failing structure is being used to continue operation, and addressing structural and environmental issues is outlined in the USACE reports. GMHA needs a new facility as it endangers the accreditation status of the hospital based on standards and guidelines promulgated by United States Centers for Medicare and Medicaid Services (CMS) and applicable codes. I Liheslaturan Guåhan finds that the current infrastructure of the GMHA facility is in an overall state of failure due to its age of more than fifty (50) years, environmental exposure, lack of financial resources to support the pre-planned capital infrastructure replacements, and lack of the facilities design adherence to current building codes. According to USACE, the replacement of all GMHA facilities is required to ensure renewed compliance with hospital accreditation standards and to protect the life, health, and safety of staff, patients, and visitors.

(c) I Liheslaturan Guåhan finds that the DPHSS has not been occupying its main building in Mangilao due to an electrical fire caused by aged electrical wires within the building. DPHSS services have been relocated to various commercial rentals and Government of Guam buildings in order to provide services to the people of Guam. The Mangilao facility of DPHSS has been deemed unsafe by the Chief of the Guam Fire Department as their investigation shows that multiple electrical wiring issues are present due to the age of the structure as it was built in 1973.

(d) I Liheslaturan Guåhan finds that DPHSS should have a central facility for the people of Guam to have better access to public health and social services. The Mangilao facility of DPHSS is deemed dangerous and hazardous, and rehabilitation is not possible. It is necessary for DPHSS to ensure that services are available for the people of Guam which they have been providing, with services scattered in different locations on the island.

(e) I Liheslaturan Guåhan finds that with the growing population of the island of Guam, the GBHWC needs to expand their facilities as their services evolve to meet the needs of our community. The main facility of GBHWC has outgrown its main building as the staff and patient populations have increased. The

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growing population of our island has caused the GBHWC to actively operate its services, but with the lack of facilities within their main building, various GBHWC services are scattered throughout the island; and it is deemed necessary for the Government of Guam to provide behavioral health and wellness services to our people as social issues are present within our community.

(f) Furthermore, I Liheslaturan Guåhan finds that the pandemic has reinforced the need for better healthcare facilities, such as the Guam Memorial Hospital Authority facilities, the Department of Public Health and Social Services main building, and the Guam Behavioral Health and Wellness Center facilities. I Maga’hågan Guåhan stated that she intends to allocate Three Hundred Million Dollars ($300,000,000) from the American Rescue Plan to construct a new hospital facility. The U.S. Army Corps of Engineers has stated that the replacement of the GMHA facility would cost an estimated Seven Hundred Forty-three Million Dollars ($743,000,000), including Twenty-one Million Dollars ($21,000,000) for rehabilitation of the current facility to receive accreditation. The American Rescue Plan also allows for Earned Income Tax Credits to be reimbursed to Guam at an estimated Sixty Million Dollars ($60,000,000) annually, of which an estimate of no more than Thirty-five Million Dollars ($35,000,000) would be allocated for the payments of the lease- back agreement annually.

(g) It is the intent of I Liheslaturan Guåhan to provide the people of Guam with state-of-the-art healthcare facilities which will be designed to include all healthcare agencies within the Guam Twenty-First Century Healthcare Center. The creation of the Guam Twenty-First Century Healthcare Center is to ensure that all healthcare agencies have proper facilities that follow accreditation standards, guidelines promulgated by the Centers for Medicare and Medicaid Services, and applicable codes. It will also allow for Guam to become the regional healthcare hub of Micronesia as it will open up opportunities for medical training and tourism, to and from, other Pacific islands, while increasing medical professional services and capacity within the entire region.

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(h) In an effort to overcome financing hurdles, and to provide for the healthcare needs of the people of Guam, I Liheslaturan Guåhan desires to authorize the Government of Guam to enter into a contract for the design, build, finance, lease, transfer and long-term capital maintenance of the Guam Twenty-First Century Healthcare Center with private sector contractors who can provide long-term financing.

(i) To facilitate the financing, design, construction, and maintenance of the Guam Twenty-First Century Healthcare Center envisioned by this Act, the Government of Guam will be authorized to execute a lease agreement of existing property under its inventory for up to forty (40) years on which the Guam Twenty-First Century Healthcare Center will be constructed, and the forty (40) year term shall begin immediately after the design, permitting, and construction phase has been completed.

(j) The lease of the Government of Guam property will be to the contractor/developer, who will design and construct the Guam Twenty-First Century Healthcare Center and provide funding for the design and construction through appropriations received from the reimbursement of the Earned Income Tax Credit for Fiscal Year 2022 and prospective appropriations from the General Fund annually thereafter. Upon completion of the construction, the facilities will be leased back to the Government of Guam for a period not to exceed the initial ground lease to the Guam Economic Development Authority and/or the contractor/ developer over which time the Government of Guam will amortize, as lease payments to the Guam Economic Development Authority and/or the contractor/developer, the cost of the financing, design, construction, and related expenses of the Guam Twenty-First Century Healthcare Center.

(k) The contractor/developer will also be responsible for the capital maintenance and repair of the Guam Twenty-First Century Healthcare Center constructed under this Act, whose costs shall be paid by the Government of Guam as provided for under this Act. At the expiration of the lease-back period, the Government of Guam real property and the Guam Twenty-First Century Healthcare Center constructed on the Government of Guam real

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property will revert to the Government of Guam with no further obligations to the Guam Economic Development Authority and/or the contractor/developer.

2022 NOTE: Subsection designations added pursuant to the authority of
1 Guam Code Ann. § 1606.