2023 Laws of Puerto Rico › TITLE TWENTY-FOUR - Health and Sanitation (§§ 1 — 15010) › PART IX - Health Insurance (§§ 7001 — 7075) › Chapter 301 - Health Insurance Administration (§§ 7001 — 7054) › Subchapter VIII - Contracting with Health Purveyors (§§ 7051 — 7054) › § 7051a - Contracting process

All direct contracting procedures with healthcare service providers shall be carried out pursuant to the provisions of this section. Every medical group or provider wishing to contract directly, pursuant to the provisions of Act No. 105 of July 19, 2002, shall submit a written application that shall include the following:
(a) Cover letter: An official letter that shall include the name and address of the proponent organization, the date of submission of the proposal; and the signature and title of the corporate officer that authorizes the proposal.
(b) Cover page: The artistic rendering of the cover page shall be determined by the proponent organization and shall include the name of the organization.
(c) Title page: This page shall include the letterhead of the organization.
The title of the proposal shall be the following:
PROPOSAL FOR THE DEMONSTRATION PROJECT OF THE RENDERING OF HEALTH SERVICES THROUGH AN AGREEMENT FOR DIRECT CONTRACTING OF PROVIDERS
(d) Executive summary: Description of the coordinated care model under an organizational structure similar to that of Health Care Organizations (HCOs), which includes all the components of an integrated health system, the proposed services, and the benefits they represent for beneficiaries and participating providers.
Specific activities to be held to comply with the proposed objectives. Areas in the main body of the proposal shall be itemized in such a way to make the analysis of the areas of greatest impact easier for the Evaluation Committees.
(e) Table of contents: Itemized list of the main topics and the pages in which they are found.
(f) Contents of the proposal: Clear and brief information on each item specified in each chapter.
Chapter 1: Organization
Chapter 2: Financial Information
Chapter 3: Model for Rendering of Services
Chapter 4: Information Systems
Chapter 5: Quality Improvement
Chapter 6: Customer Service
Glossary of Terms
Attachments
(g) Binding: The proposal shall be submitted in the original and 3 copies in 2 inch wide, 3-ring binders. The content shall be written in double-spaced 13 CG Times New Roman [font].
Every proposal duly submitted to the Administration shall be studied and analyzed for contracting purposes within a strictly unpostponable term of thirty-five (35) working days.
(h) A certification on the absence of any outstanding debt or on the existence of a payment plan with the Puerto Rico Medical Services Administration (ASEM) attesting to the fact that the plan is being complied with and is not past due. The date of issue of said certification shall not exceed sixty (60) days prior to the proposed effectiveness of the contract to be awarded by the Puerto Rico Health Insurance Administration (ASES). The applicability of this subsection shall be contingent upon the Puerto Rico Medical Services Administration’s certification of the corresponding debt. Furthermore, the contracting healthcare service provider or insurer shall not be eligible for contracting if it has any debt that has been over sixty (60) days past due, as certified by the Puerto Rico Medical Services Administration (ASEM); additionally, it shall satisfy any other requirement set forth in §§ 8611—8615 of Title 3. For purposes of this subsection, debt shall be understood as any contractual obligation that entails the payment of a certain and specific amount of money that has become due and payable by the insurer or healthcare service provider.
The foregoing notwithstanding, an obligation shall not be deemed to be an overdue debt if there is an ongoing process of invoice and payment reconciliation between the insurer or the healthcare service organization and the Puerto Rico Medical Services Administration (ASEM).
History —Sept. 7, 1993, No. 72, added as Art. IX, § 2 on Dec. 29, 2003, No. 334, § 2, eff. 30 days after Dec. 29, 2003; July 19, 2013, No. 65, § 2.