The governor Pedro Pierluisi revealed this Thursday the entities that will administer the Health Reform for the next three years, starting next January, and what are the main changes that the coverage will have, which includes an increase in the fees for medical specialists and health professionals, in the Medicare and hospital fees.
The president together with the Secretary of Health, Carlos Melladooffered the details of the new cover. He stressed that the increase in fees for medical specialists and health professionals will be 70% and for Medicare it will be 80% of the so-called “Medicare Fee Schedule”.
The insurers selected in the new contract are MMM Multihealth, First Medical, Mennonite Health Plan and Triple SPierluisi reported at a press conference in La Fortaleza.
“While the Medicare rate will be increased to 100% for the following subspecialties: neonatologists, neurologists, psychiatrists, orthopedic surgeons, rheumatologists, otorhinolaryngologists, cardiovascular surgeons, among others. On the other hand, an additional increase of 5% will be applied to the more than 70 hospitals in Puerto Rico. This increase represents approximately $102 million between the 5% increase retroactive to October 2021 plus an additional 5% to January 2023. Billing methods are also simplified, reducing payment methods from 72 to 11″, said the governor.
“The total premium increase for 2023 will be approximately and 5% in order to meet these increases. This increase in compensation is part of the programmatic commitment that we have been working with the medical class, providers and health professionals, since day one of this administration. These measures, without a doubt, will allow us to retain our medical services professionals and be more attractive to attract those who are outside of Puerto Rico, which will result in better benefits for the participants of the Plan Vital”, maintained, for his part, the head of Health.
He pointed out that the adjustment in the payment of health professionals tries to stop the flight of doctors from the island.
“We are also going to ensure that a newly graduated doctor is not filled out with a contract (with the reform). It can’t be that you have to wait years. That is over now,” Mellado said.
The process for selecting the new insurers began on May 20 with the publication of a public notice in newspapers requesting proposals. Initially, nine entities showed interest, but only five formalized their proposals, it was reported, although they were not specified.
The final report was presented last Friday, August 26, 2022 for the consideration of the Board of Directors of the Health Insurance Administration (ASES). Three days later the award was reported and the due notifications were made to the participating insurers.