SAN JUAN – Gov. Wanda Vázquez Garced announced Monday that she was calling the Legislative Assembly to convene for its fifth special session to address several measures, including ones related to healthcare and pensions.
“As I anticipated and as we committed ourselves to the people, I am convening an Extraordinary Session to attend to core issues for all, especially health. During my State Address, I made a commitment to watch over patients. In line with the public policy of procuring agile, accessible and effective health services, and doing social justice to both patients and healthcare professionals so that all citizens receive quality health services, we will be establishing two administration measures to amend the Puerto Rico Pharmacy Law and the Insurance Code in order to streamline the process of adjudication and payment of claims submitted by health service providers to insurers, ”the governor said.
Measure 128 seeks to shorten the period of time that insurers have to respond to a claim for denial of coverage for a health service or treatment from 72 to 48 hours, and in the case of controlled medications, from 36 hours to 24 hours.
“In addition,” the governor's office said, “in most cases, insurers use what is related to the fulfillment of these criteria by the health professional in the process of diagnosis and treatment as a subterfuge to stop payment for services already provided by these health providers. To address this issue, the legislation clarifies that in no circumstance can medical discretion when prescribing medication or providing a health service recognized by the standards generally accepted by the medical community, be altered by the clinical review criteria used ”by the insurer.
“From now on, it will be the sole and guiding criteria to determine the treatment to follow in a patient, and this cannot be altered by a health insurer. Health treatment and services are to be determined by the doctor and not the insurer, ”said the governor.
Meanwhile, measure 129 intends to amend Law 5-2014, known as the“ Law to Establish the ELA's Public Policy Related to the Interpretation of the Provisions of the Health Insurance Code and Issue Prohibitions ”to outline guidelines for the regulations that are enacted on the utilization review processes for medical-hospital services, so that they are more precise and efficient.  It also seeks compliance with the law regarding timely payment by insurers, which is a term of 30 days, and emphasizes the clinical review guidelines. These guidelines are used in the utilization review process cannot be replaced by medical discretion when providing health services to patients, as long as they are offered within the standards recognized by the medical community.
One of the amendments is to define what constitutes a clean invoice or “clean claim,” so that the concept of a clean invoice can be standardized, making it mandatory and binding for all contracts between the insurer and the health services provider. This will provide precise and clear terms on the minimum content that makes up a clean bill for both the insurer and the health service provider.
Senate Bill 1528, which establishes the “ Patient Protection Law against Surprise Medical Bills” and amends the Puerto Rico Health Insurance Code in order to tackle so-called "surprise billing", will also be addressed. This health plan will establish consumer protections, transparency measures, cost controls, and liability guidelines outside the provider network.
The Governor also indicated that she would submit an administrative project to elevate public servants' Retirement to a constitutional rank.
“Our public servants deserve justice. For years they worked hard, and their retirement was reduced so that they are now adversely affected. It is not fair and, therefore, they deserve that the payment of their retirement to be raised to a constitutional rank, ”said Vázquez Garced.
This initiative proposes to hold a Referendum on the day of the General Election. This process will enable the government to ask the people if they want the Constitution of Puerto Rico to be amended to: recognize the constitutional right of all public Servants and of all retired government to have access to a pension, and seeks to place the payment of the pensions of all retirees, including those of the Teacher System and those of the Judiciary in the first order of hierarchy together with the payment of interest and amortization of public debt.
“This provides for a significant amendment to the order in place , as currently the payment of pensions is lagging behind and proceeds are only made after the payment of interest and amortization of the debt, the commitments made under legal agreements, court rulings on property expropriation cases, among other kind of obligations, ”added Vázquez Garced .
Other measures that will be submitted for evaluation during the Special Session are Joint Chamber Resolution 766 to allocate $ 536 million to the Title 3 Em ergency Reserve; Joint House Resolution 737 to allocate $ 20 million in legislative donations to nonprofit organizations. Likewise, Joint Senate Resolution 547 authorizes the Secretary of the Treasury to provide Emergency Assistance to grant a loan of up to $ 185 million to CRIM to address the challenges caused by the COVID-19 pandemic. The Fiscal Oversight Board approved all of these measures.
Senate Bill 1447, which establishes the Debt Issuance Responsibility Law, will be addressed to create a uniform, transparent, and responsible debt management policy that will govern the issuance of any future debt. These debts are authorized by the government so that the debt does not come from operational expenses, but infrastructure. Other measures evaluated will include House Bill 306 to ban workplace harassment; the evaluation of the projects of Chamber 2143 and 2144, which proposes a salary increase for nurses working in both the public and private systems from 2022; and House Bill 2075, which would remove the Forensic Science Bureau from the Department of Public Security, so that it can be a separate and independent agency, and can generate its own funding.
There are two other Senate Bills, 1648 and 1649 , that the Department of the Treasury requested be evaluated, which are to modernize Mandatory Insurance and allow the use of electronic documents in government billing.
Also related to health, there is House Bill 2546 so that the Administration of Health Services and Against Addiction (ASSMCA per its Spanish acronym) can monitor cases of overdose. Additionally, Senate Bill 1223, which amends the Law to Create the Board of Examiners for Chiropractors in order to allow the practice of chiropractic students on the island.
Governor Vázquez also announced that she had signed the measure that allows the Housing Finance Authority (AFV per its Spanish acronym) to transfer repossessed homes for those affected by the earthquakes. This project amends the organic law of the AFV, which allows a property to transfer the ownership of repossessed homes to municipalities. These in turn, can provide safe homes to people who lost their properties during the seismic events that have occurred since late last year.
“This allows the municipalities of Ponce, Guánica, Yauco, Utuado, Guayanilla, and Peñuelas to donate or give in usufruct the homes to those who lost their homes, ”said Vázquez Garced.