reglab/statecodes huggingface dataset:
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 V - Health Insurance Plan (§§ 7025 — 7036e) › § 7034 - Regionalization system

The rendering of services shall be carried out following the regionalization system established by the Administration in coordination with the Department, by progressively establishing a network of participating purveyors throughout the Island, thus insuring the closest possible service to the patient.
(a) The insurer and/or health service organization shall provide in each region all secondary and tertiary services, as defined by the Department, but only those secondary and tertiary services not provided by the Commonwealth in such region or area. Participating providers shall coordinate with the Administration the extent of the secondary and tertiary services they shall provide as provided in the contract, but only those secondary and tertiary services not provided by the Commonwealth in such region or area.
(b) In the urban areas, diverse hospitals may function as a complementary service entity in order to avoid duplication, control the use of the installations, and reduce the unit cost of services.
(c) The regional facilities of the Department shall continue to render services to populations with special needs, such as detoxification services, mental health centers and others.
(d) Each municipality shall have access to an emergency system, for transportation as well as for services.
(e) In those municipal governments, which have opted to operate or continue to operate the facilities to render health services, shall be subject to the contracting of those health plans executed by the Administration.
(f) Those municipalities in which community health services operate or may operate in the future, may continue rendering services, and contract additional services with the corresponding insurers, or the Administration.
(g) The Administration shall proceed to implement, the Health Reform in the Municipality of San Juan in the measure which corresponds to it, no later than the 1st of July of 2000. To such effects, it shall arrange, negotiate and contract health insurance plans with the intention to extend to the eligible citizens of the Municipality of San Juan, the Card Health of the Government of Puerto Rico Health Insurance Plan with all the benefits and prerogatives applicable to the plan. The municipal administration of the Municipality of San Juan and its Municipal Legislature shall enable the Administration to comply with this mandate, offering whatever cooperation is necessary and within its reach, in an effort to enable the implementation of the Health Reform in San Juan.
History —Sept. 7, 1993, No. 72, Art. VI, § 10; Dec. 14, 1994, No. 139, § 1; May 24, 2000, No. 88, § 1; renumbered as § 8 and amended on Dec. 29, 2000, No. 463, § 8; July 19, 2002, No. 105, § 4; Aug. 8, 2010, No. 123, § 8.
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 V - Health Insurance Plan (§§ 7025 — 7036e) › § 7036 - Complaint; procedure

The Administration shall require insurers, providers, and health service organizations with whom it contracts to establish the procedures to handle and resolve complaints from the participating providers and the beneficiaries.
The Administration shall establish guidelines for the resolution of complaints which shall guarantee due process of law. The findings made regarding these complaints shall be appealable before the Administration, as provided by regulations or the signed contract. The final findings of the Administration shall be reviewable by the Court of Appeals.
History —Sept. 7, 1993, No. 72, Art. VI, § 12, renumbered as § 10 on Dec. 29, 2000, No. 463, § 9; July 19, 2002, No. 105, § 4; Aug. 8, 2010, No. 123, § 10.
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 V - Health Insurance Plan (§§ 7025 — 7036e) › § 7036a - Beneficiaries—Orientation

(1) Insurance companies shall be responsible for the implementation, publication and distribution of informative brochures, at their own expense, in Spanish, including a description of the health coverage and the benefits included in same. Said brochures shall be distributed to each beneficiary, along with their identification cards.
(2) Insurance companies shall be responsible for the implementation and disclosure, at their own expense, of an orientation program for the community that covers the aspects of logistics regarding the structure, use, benefits and accessibility of the health services plan for the beneficiaries in each health region.
(3) The brochures shall serve as certificates and guarantees of the benefits to which the beneficiaries are entitled, and should include, as a minimum, the following:
(a) A list of the coverage benefits.
(b) Limitations and exclusions of the benefits program.
(c) Rights of the beneficiaries.
(d) Instructions on access to the benefits for the beneficiaries.
(e) List of health care organizations and other providers-participants available to render health care services covered by the benefits program.
(f) Description of the procedures for claims.
(g) Signature of the beneficiary upon delivery and explanation of the brochure.
(h) Right to free selection of service provider.
(4) The contents of the informative brochures, as well as the plan for their distribution, shall be approved by the Administration prior to their publication and distribution.
(5) The participating providers, primary care providers, and primary services of the Government’s Healthcare system shall display an information, legible, and noticeable sign to all persons who use their facilities, that notifies that the Primary Medical Group has a Preferred Network that includes specialists, laboratories, imaging services (x-rays), and hospitals that may be used by beneficiaries without referral or copayment, as well as any other information related to the healthcare system deemed pertinent by the Administration. The contents of the sign shall be prepared and approved by the Administration.
(6) Every participating provider, primary care provider, and primary services that fails to comply with the provisions of this section or the regulations promulgated thereunder shall be subject to an administrative fine to be determined by the Administration, which under no circumstance shall exceed ten thousand dollars ($10,000).
History —Sept. 7, 1993, No. 72, added as Art. VI, § 13 on June 1, 2003, No. 133, § 1; June 13, 2012, No. 112, § 1.
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 V - Health Insurance Plan (§§ 7025 — 7036e) › § 7036b - Beneficiaries—Rights

All beneficiaries shall be entitled, among others, to the following:
(1) Receive quality medical services when needed.
(2) Easy access to medical services.
(3) Select their health care services organization.
(4) Select their primary physician.
(5) Select a specialist physician, jointly with the primary physician.
(6) Change their primary physician or their health care services organization.
(7) Not to be denied services under their coverage.
(8) Easy and immediate access to emergency services.
(9) Receive the necessary instructions and information to know all the benefits offered by the health insurance.
(10) Not to be discriminated against.
(11) Initiate a formal claim procedure before the insurer, if there is a claim or concern regarding the health care services offered by the plan.
(12) Appeal any final determination of the insurer before the Administration.
(13) Select their pharmacy and laboratory.
History —Sept. 7, 1993, No. 72, added as Art. VI, § 14 on June 1, 2003, No. 133, § 2.
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 V - Health Insurance Plan (§§ 7025 — 7036e) › § 7036c - Beneficiaries—Duties

The beneficiaries shall be required to:
(1) Maintain their eligibility information updated when same is required by the Administration.
(2) Maintain their good health by keeping a healthy lifestyle.
(3) Once notified of being eligible for the program, they shall go to the location indicated by the insurer to complete the subscription process and receive their identification card as beneficiaries.
(4) Notify the insurer of any problems that may arise when receiving the benefits under coverage.
(5) Appeal any final determination of the insurer before the Administration.
History —Sept. 7, 1993, No. 72, added as Art. VI, § 15 on June 1, 2003, No. 133, § 3.
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 V - Health Insurance Plan (§§ 7025 — 7036e) › § 7036d - Providers—Rights

Under this plan, providers have the right to:
(1) Be paid for claims pursuant to the terms set forth in their contract with the insurer.
(2) Appeal any final determination by the insurer before the Administration.
History —Sept. 7, 1993, No. 72, added as Art. VI, § 16 on June 1, 2003, No. 133, § 4.
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 V - Health Insurance Plan (§§ 7025 — 7036e) › § 7036e - Providers—Duties

Providers are legally bound to:
(1) Render optimum quality services when necessary and without delay to the beneficiaries of the program.
(2) Render the necessary services for the health care of the beneficiaries.
(3) Not discriminate against the beneficiaries of their other patients for any reason.
(4) Notify the insurer of the problems that may arise in the rendering of services to the beneficiaries.
(5) Notify the insurer or the Administration of any situation that constitutes abuse, misuse or fraud by the beneficiaries.
History —Sept. 7, 1993, No. 72, added as Art. VI, § 17 on June 1, 2003, No. 133, § 5.
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 VI - Reports (§§ 7040 — 7040a) › § 7040 - Statistical reports

Within ninety (90) days after the closing of each fiscal year, the Administration shall submit reports to the Governor and to the Legislature on its activities, including the following:
(a) A summary of the work carried out during the fiscal year, in compliance with the purposes of this chapter, including a copy of the contracts awarded for health services, as well as a work plan, including specific projects and activities for the following year.
(b) Financial statements audited in accordance with generally accepted accounting principles for government bodies.
(c) A list of capital investments.
History —Sept. 7, 1993, No. 72, Art. VII, § 1; Oct. 20, 2009, No. 128, § 2.
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 VI - Reports (§§ 7040 — 7040a) › § 7040a - Reports by insurers

Within sixty (60) days after the closing of each fiscal year, all insurers shall submit to the Administration a statistical report on their activities. Once such information has been compiled and analyzed by the Administration, if required, the Administration shall submit such report to the Governor and the Legislative Assembly. Such statistical report shall at least include the following:
(a) Statistical data on patient access to preventive-outpatient services.
(b) Statistical data on patient access to primary services.
(c) Statistical data on patient access to specialized services.
(d) Statistical data on patient access to emergency rooms.
(e) Statistical data on volume and services rendered to patients with any kind of cancer.
(f) Statistical data on volume and services rendered to patients with heart conditions.
(g) Statistical data on volume and services rendered to patients with hypertension.
(h) Statistical data on volume and services rendered to patients with asthma.
(i) Statistical data on volume and services rendered to patients with drug, nicotine or alcohol addiction.
(j) Statistical data on volume and services rendered to mentally ill patients.
(k) Statistical data on volume and services rendered to patients with diabetes.
(l) Statistical data on volume and services rendered to patients with sexually transmitted diseases.
(m) Statistical data on volume and services rendered to pregnant women, including an account of their ages and marital status.
(n) Statistical data on volume and services rendered to infants.
(o) Statistical data on the number of births.
(p) Statistical data on vaccination of infants, children, teenagers, and adults.
(q) Statistical data on the kinds of diseases treated the most.
(r) Statistical data on medications, which shall include all prescribed medications and an account of their cost.
Any person or insurer who refuses to provide the information described above, or who refuses to produce any document upon request, shall incur a misdemeanor that shall entail a penalty of not more than one thousand dollars ($1,000) and not less than one hundred dollars ($100) or imprisonment for not more than twelve (12) months and not less than one (1) month, or both penalties. The Executive Director of the Administration may resort to the Court of First Instance of Puerto Rico, San Juan Part, in order to compel disclosure of the information thus requested.
(s) Statistical data on volume and services rendered to overweight or obese persons.
History —Sept. 7, 1993, No. 72, added as art. VII, § 2 on Oct. 20, 2009, No. 128, § 2.
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 VII - General Provisions (§§ 7041 — 7044) › § 7041 - Exemptions

The Administration shall be exempted from all types of taxes, tariffs, fees, imposts, duties or charges, including licenses, imposts or those levied by the government or any political subdivision thereof, including all its operations, its real or personal properties, capital, income and surpluses. Said exemption shall not be transferable.
The Administration is hereby exempted from the payment of all types of tariffs or fees required by law for the execution of judicial procedures, the issuing of certifications in government offices and dependencies, and political subdivisions, as well as in granting of public documents and their registration in any Public Registry of Puerto Rico.
History —Sept. 7, 1993, No. 72, Art. VIII, § 1.
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 VII - General Provisions (§§ 7041 — 7044) › § 7042 - Exclusions and regulations

The Administration shall be excluded from the provisions of §§ 1301 et seq. of Title 3, known as the “Puerto Rico Public Service Personnel Act”, the Commonwealth of Puerto Rico Purchases and Supplies Act, and from all the regulations promulgated by virtue of said acts.
Nevertheless, it shall approve General Regulations to implement the provisions of this chapter within six (6) months following the effective date hereof. Within that same term, it shall also approve Personnel Regulations based on the merit principle, as well as Regulations for Purchasing, Supplies and Contracting of Services.
History —Sept. 7, 1993, No. 72, Art. VIII, § 2.
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 VII - General Provisions (§§ 7041 — 7044) › § 7043 - Office of the Comptroller

The Comptroller shall have full power to audit the operation of the Administration, in order to verify the legality of its transactions. It may, likewise, compel the presentation of documents, and testimony of persons or private entities, when it is indispensable to conduct an audit or intervention in the Administration, or in companies which operate under contract with the Administration in those matters related to the contract.
History —Sept. 7, 1993, No. 72, Art. VIII, § 3.
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 VII - General Provisions (§§ 7041 — 7044) › § 7044 - Exchange of information

Every insurer, health service organization or any other entity that renders health services in Puerto Rico, contracting with the Administration and other entities of the Government of Puerto Rico, shall be bound to provide the latter with any information requested, and in the event of noncompliance, it shall be subject to the penalties provided under § 257 of Title 26, known as the “Insurance Code of Puerto Rico”.
If, after the Administration has verified the information furnished, it arises that a Medicaid Program beneficiary is also a private health plan beneficiary or that the services rendered should have been paid by a third party or health plan financed by the Government, other than the Medicaid Program, the Administration or its duly authorized Subcontractor, shall initiate a payment recovery action against the beneficiary’s primary plan and such information shall be sent to the Medicaid Office. The beneficiary shall not be responsible for such payment. None of the provisions of this Act shall be construed as a waiver of confidentiality under the “Health Insurance Portability and Accountability Act (HIPAA)”. Provided, That a payment recovery action shall be initiated within two (2) years as of the rendering of services to the beneficiary.
History —Sept. 7, 1993, No. 72, added as Art. VIII, § 4 on Dec. 30, 2010, No. 227, § 1.
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) › § 7051 - Contracts

In those contracts executed by the Administration when contracting health service purveyors directly, the Administration may contract with the insurers for them to adjudicate in the processing of payments for services in those contracts between the Administration and the participating purveyors.
History —Sept. 7, 1993, No. 72, added as Art. IX, § 1 on July 19, 2002, No. 105, § 5; Dec. 29, 2003, No. 334, § 2, eff. 30 days after Dec. 29, 2003.
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) › § 7051b - Evaluation criteria

The evaluation process performed by the Administration shall be determined taking into consideration the regional area for which direct contracting is requested, the number of persons for whom the rendering of services is requested, physical facilities, financial capacity, capital for the financing of services, and the ability to provide risk management services. The following elements shall be considered in the evaluation process:
(a) Capacity, efficiency and pertinence of the information system used to register appointments and to process claims electronically.
(b) Availability and efficiency of cost control programs, including the review of use and quality control programs.
(c) Administrative and financial capacity of the proponent organization, including the network of coordinated care providers.
(d) Availability of preventive medicine programs.
(e) Availability of primary physicians and specialists.
(f) Availability of emergency rooms.
(g) Availability of beneficiary complaints and grievances programs, and compliance plan pursuant to applicable local and federal statutes.
History —Sept. 7, 1993, No. 72, added as Art. IX, § 3 on Dec. 29, 2003, No. 334, § 2, eff. 30 days after Dec. 29, 2003.
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) › § 7052 - Demonstrative model; authorization

Complemented by, and without impairing the provisions of this chapter, the Administration is hereby authorized to execute pilot plans for direct contracting with health purveyors, within the year counting from the effective date of the act that creates this Article IX, with the purpose of allowing the negotiation and contracting of health insurance plans by the Administration with purveyors of the health services as defined by this chapter. Every six (6) months from the approval of this act, the Administration shall inform the Legislature of Puerto Rico on the evaluation, viability and the possibility of extending it to other areas or regions of the Island.
History —Sept. 7, 1993, No. 72, added as Art. IX, § 2 on July 19, 2002, No. 105, § 5; renumbered as § 4 on Dec. 29, 2003, No. 334, § 2, eff. 30 days after Dec. 29, 2003.
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) › § 7053 - Payment

Pursuant to the provisions of the above § 7052 of this title, the Administration shall consider transferring to the health services provider the premium dollar percent appropriated to the medical sub-fund; without prejudice to same for invoices and/or charges related to the other items of the medical fund, such as ancillary services for emergency room and hospital visits, laboratories, X-rays, pharmacies, support physicians, and other health services providers.
The Administration shall also consider taking charge of the Catastrophic Illness Fund, the Institutional Fund and the ancillary services mentioned above. With regard to the safety measures taken by the Administration, they shall be limited exclusively to reserves that are proportional to the actuarial risk assumed in the contracting.
Likewise, the Administration shall consider the negotiation of rates with different supporting physicians based on the methods of paying for services rendered or per capita payment, having to its credit, the administration and reserves funds in order to mitigate the fluctuations of payments.
History —Sept. 7, 1993, No. 72, added as Art. IX, § 3 on July 19, 2002, No. 105, § 5; renumbered as § 5 and amended on Dec. 29, 2003, No. 334, § 2, eff. 30 days after Dec. 29, 2003.
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) › § 7054 - Medications

The Administration is hereby authorized to call for bids as necessary, pursuant to its own regulations, for the purchase of medications and medical products. Medications and medical products shall be those published in the forms as established by the Administration. Such bidding shall be held as soon as the direct contracting project includes fifty percent (50%) of the total number of lives in the health reform.
History —Sept. 7, 1993, No. 72, added as Art. IX, § 6 on Dec. 29, 2003, No. 334, § 2, eff. 30 days after Dec. 29, 2003.
2023 Laws of Puerto Rico › TITLE TWENTY-FOUR - Health and Sanitation (§§ 1 — 15010) › PART IX - Health Insurance (§§ 7001 — 7075) › Chapter 302 - Anesthesia and Hospitalization Coverage in Dental Procedures (§§ 7061 — 7062) › § 7061 - Anesthesia and hospitalization coverage in dental procedures

The health services company or insurer that provides coverage for general anesthesia services, hospitalization services and dental services in the subscriber’s service contract, shall not be able to exclude or deny coverage for general anesthesia to be administered by an anesthesiologist and hospitalization services, in the following cases:
(a) When a pediatric dentist, an oral or maxillofacial surgeon who is a member of the medical faculty of a hospital, licensed by the Government of Puerto Rico, pursuant to §§ 81 et seq. of Title 20, determines that the condition or ailment of the patient is significantly complex according to the criteria established by the American Academy of Pediatric Dentistry;
(b) when the patient, because of his/her age, impediment, or disability, is unable to resist or tolerate pain, or cooperate with the treatment indicated in the dental procedures;
(c) when the infant, boy, girl, adolescent, or person with a physical or mental impediment has a medical condition in which it is indispensable to carry out dental treatment under general anesthesia in an ambulatory surgical center or in a hospital, and that otherwise could pose a significant threat to the patient’s health;
(d) when local anesthesia is ineffective or contraindicated because of an acute infection, anatomic variation, or allergic condition;
(e) when the patient is an infant, a boy, a girl, an adolescent, or a person with physical or mental disability, and is in a state of fear or anxiety that prevents performing the dental treatment under the procedure traditionally used in dental treatments and the condition is so critical that postponing or deferring treatment would result in pain, infection, loss of teeth, or dental morbidity;
(f) when a patient has received an extensive and severe dental trauma where the use of local anesthesia would jeopardize the quality of the services or would be ineffective to handle the pain and apprehension.
History —Dec. 22, 1999, No. 352, § 1.
2023 Laws of Puerto Rico › TITLE TWENTY-FOUR - Health and Sanitation (§§ 1 — 15010) › PART IX - Health Insurance (§§ 7001 — 7075) › Chapter 302 - Anesthesia and Hospitalization Coverage in Dental Procedures (§§ 7061 — 7062) › § 7062 - Preauthorization

Every health services company or insurer that requires the preauthorization from the subscriber to provide the general anesthesia and hospitalization services coverage, as determined by a pediatric dentist, oral or maxillofacial surgeon, shall approve or deny it within two (2) days from the date the subscriber submits all the documents required by the health services company or insurer.
The required documents shall be:
(a) The patient’s diagnosis;
(b) the patient’s medical condition, and
(c) the reasons that justify for the patient to receive general anesthesia to perform the dental treatment according to what is provided in § 7061 of this title.
History —Dec. 22, 1999, No. 352, § 2.
2023 Laws of Puerto Rico › TITLE TWENTY-FOUR - Health and Sanitation (§§ 1 — 15010) › PART IX - Health Insurance (§§ 7001 — 7075) › Chapter 303 - Treatment of Morbid Obesity (§§ 7071 — 7075) › § 7071 - Definitions

For the purposes of this chapter, the following terms and phrases shall have the meaning stated below:
(a) Morbid obesity. — The excess of fat in the body as determined by a Body Mass Index (BMI) equal to or higher than 35.
(b) Bariatric surgery. — A surgical procedure to control obesity, which may be performed by employing any of four (4) techniques: gastric bypass, adjustable band, intragastric balloon or sleeve gastrectomy. The intragastric balloon surgery shall not be covered.
History —Aug. 9, 2008, No. 212, § 1, eff. 90 days after Aug. 9, 2008.
2023 Laws of Puerto Rico › TITLE TWENTY-FOUR - Health and Sanitation (§§ 1 — 15010) › PART IX - Health Insurance (§§ 7001 — 7075) › Chapter 303 - Treatment of Morbid Obesity (§§ 7071 — 7075) › § 7072 - Bariatric surgery—Options

Every health insurance company, health services organization and health maintenance organizations as defined in subsection (x) of Section 1 of Act No. 101 of June 26, 1965, as amended [sic], doing business in the jurisdiction of the Commonwealth of Puerto Rico, shall provide, subject to preauthorization, in its policy for the payment of one of the types of bariatric surgery authorized in this chapter for treating morbid obesity. The Health Insurance Administration of Puerto Rico, health insurers, health services organizations and health maintenance organizations as defined in subsection (x) Section 1 of Act No. 101 of June 26, 1965, as amended [sic], may require within the policies that insurers and beneficiaries comply with a waiting period, which shall not exceed twelve (12) months, before covering the benefits set forth in this chapter, unless a physician certifies that the life of the patient is in imminent danger.
History —Aug. 9, 2008, No. 212, § 2, eff. 90 days after Aug. 9, 2008.
2023 Laws of Puerto Rico › TITLE TWENTY-FOUR - Health and Sanitation (§§ 1 — 15010) › PART IX - Health Insurance (§§ 7001 — 7075) › Chapter 303 - Treatment of Morbid Obesity (§§ 7071 — 7075) › § 7074 - Exceptions

Surgeries for removing excess skin (commonly known as folds) shall not be covered, unless the physician certifies that it is necessary to remove the excess skin because it affects the functions of any part of the body.
History —Aug. 9, 2008, No. 212, § 4, eff. 90 days after Aug. 9, 2008.
2023 Laws of Puerto Rico › TITLE TWENTY-FOUR - Health and Sanitation (§§ 1 — 15010) › PART IX - Health Insurance (§§ 7001 — 7075) › Chapter 303 - Treatment of Morbid Obesity (§§ 7071 — 7075) › § 7075 - Applicability

This chapter shall apply to every public or private health insurance in the Commonwealth of Puerto Rico.
History —Aug. 9, 2008, No. 212, § 5, eff. 90 days after Aug. 9, 2008.
2023 Laws of Puerto Rico › TITLE TWENTY-FOUR - Health and Sanitation (§§ 1 — 15010) › PART X - Health Professionals (§§ 10001 — 12020) › Chapter 501 - Hospital Professionals Salary (§§ 10001 — 10004) › § 10001 - Salary scales

As of July 1, 1996, the salary of graduate nurses of the Department of Health, the Health Facilities and Services Administration (AFASS) and the Mental Health and Addiction Services Administration (ASSMCA) is hereby raised by one hundred and twenty-five dollars ($125) per month and the salary of practical nurses of those same institutions by one hundred dollars ($100) per month.
Salary schedules that shall govern the Nursing Personnel of the Department of Health as of July 1, 1996:
Minimum Maximum Category Salary Salary Nurse I $1,112 $1,435 Nurse II $1,237 $1,597 Nurse III $1,296 $1,636 Nurse IV $1,386 $1,757 Nurse V $1,483 $1,889 Nurse VI $1,590 $2,033 Nurse VII $1,706 $2,190 Nurse VIII $1,905 $2,453 Practical Nurse $ 974 $1,210
Salary schedules that shall govern the Nursing Personnel of the Health Facilities and Services Administration as of July 1, 1966:
Minimum Maximum Category Salary Salary Nurse I $1,115 $1,392 Nurse II $1,252 $1,576 Nurse III $1,331 $1,683 Nurse IV $1,421 $1,805 Nurse V $1,518 $1,935 Nurse VI $1,625 $2,080 Nurse VII $1,741 $2,237 Practical Nurse $ 974 $1,210
The salary schedules which shall govern the Nursing Personnel of the Mental Health and Addiction Services Administration as of July 1, 1996, shall be the salary schedules in effect as of July 1, 1993, pursuant to this chapter, for the nursing personnel of Mental Health; the salary schedules for the Nursing Personnel of the former Addiction Services Department shall be those that appear in the eighth (8th) appropriation of classes of June 4, 1983, revised as of April 1, 1984. The Classification and Compensation Plan of Mental Health and Addiction Services Administration must consider the raise of one hundred dollars ($100) and one hundred twenty-five dollars ($125) which is granted by this chapter for the nursing personnel of said agency upon the termination thereof.
The funds needed to defray the costs of the nursing personnel salary raises provided in Section 1 of this Act for fiscal year 1996-1997, shall be included in a special appropriation. For subsequent fiscal years they shall be consigned annually in the Operational Expenses Budget of the Department of Health, the Health Facilities and Services Administration (AFASS) and the Mental Health and Addiction Services Administration (ASSMCA).
History —July 23, 1993, No. 27, § 1; Apr. 3, 1995, No. 34, § 1, 2; Aug. 8, 1996, No. 107, §§ 1—4, retroactive to July 1, 1996.
2023 Laws of Puerto Rico › TITLE TWENTY-FOUR - Health and Sanitation (§§ 1 — 15010) › PART X - Health Professionals (§§ 10001 — 12020) › Chapter 501 - Hospital Professionals Salary (§§ 10001 — 10004) › § 10002 - Separation

The salary schedule shall be separated from that of the rest of the personnel of the Department of Health, and the Health Facilities and Services Administration (AFASS, in its Spanish Acronym).
History —July 23, 1993, No. 27, § 2, eff. Oct. 1, 1993.
2023 Laws of Puerto Rico › TITLE TWENTY-FOUR - Health and Sanitation (§§ 1 — 15010) › PART X - Health Professionals (§§ 10001 — 12020) › Chapter 501 - Hospital Professionals Salary (§§ 10001 — 10004) › § 10003 - Increase

All employees subject to application of this chapter shall receive a raise in salary of not less than one hundred dollars ($100) a month.
History —July 23, 1993, No. 27, § 3; Apr. 3, 1995, No. 34, § 2, retroactive to Jan. 1, 1995.
2023 Laws of Puerto Rico › TITLE TWENTY-FOUR - Health and Sanitation (§§ 1 — 15010) › PART X - Health Professionals (§§ 10001 — 12020) › Chapter 501 - Hospital Professionals Salary (§§ 10001 — 10004) › § 10004 - Funds

The funds needed to defray the cost of the salary increases for nursing personnel provided in § 10001 of this title, shall be consigned annually in the Budget of Operating Expense of the Department of Health, and of the Health Facilities and Services Administration (Spanish Acronym: AFASS).
History —July 23, 1993, No. 27, § 4; Apr. 3, 1995, No. 34, § 3, retroactive to Jan. 1, 1995.
2023 Laws of Puerto Rico › TITLE TWENTY-FOUR - Health and Sanitation (§§ 1 — 15010) › PART X - Health Professionals (§§ 10001 — 12020) › Chapter 502 - Regulation of the Work Shifts of Medical Interns and Residents in Puerto Rico (§§ 10005 — 10009) › § 10005 - Definitions

The following terms and words when used or referred to in this chapter, shall have the meaning indicated, unless it is otherwise clearly construed from the context:
(a) Direct or indirect contact with a patient. — Refers to work in a hospital institution; clinical conferences; learning sessions, and reviews of patient records, as well as any other task that is pertinent to the work of interns and residents.
(b) Department. — Means the Department of Health.
(c) Dual employment. — Refers to work activities that are external to the education program, whether within the same assigned facility or at any other.
(d) Fatigue. — Is a physical, emotional, or mental condition resulting from excess work and chronic or acute sleep deprivation, which may result in adverse effects for both the patient and the resident.
(e) Intern. — Means a person who obtains a provisional license from the Board of Medical Examiners of Puerto Rico, pursuant to the dispositions set forth in Act No. 22 of April 22, 1931, and the regulation adopted pursuant to same, who is working his freshman year in the Internship Program of a hospital institution in Puerto Rico.
(f) Hospital institution. — Means any health facility, as defined by §§ 331 et seq. of this title.
(g) Education program. — Means specialized education in which knowledge is acquired by means of a series of experiences learned in a residency program, which in turn are designed to comply with the requirements set forth therein.
(h) Resident. — Means a person who obtains a provisional license from the Board of Medical Examiners of Puerto Rico, pursuant to the dispositions set forth in Act No. 22 of April 22, 1931, and the regulation adopted pursuant to same, who is working in the residency program of a hospital institution in Puerto Rico.
(i) Secretary. — Means the Secretary of the Department of Health of the Commonwealth of Puerto Rico.
History —Jan. 4, 2003, No. 47, § 2.
2023 Laws of Puerto Rico › TITLE TWENTY-FOUR - Health and Sanitation (§§ 1 — 15010) › PART X - Health Professionals (§§ 10001 — 12020) › Chapter 502 - Regulation of the Work Shifts of Medical Interns and Residents in Puerto Rico (§§ 10005 — 10009) › § 10006 - Prohibition

The establishment in any public or private hospital institution in Puerto Rico of internship or residency programs that require interns or residents to work shifts that exceed twenty-four (24) hours of continuous and uninterrupted work in direct or indirect contact with the treatment of a patient.
History —Jan. 4, 2003, No. 47, § 3.
2023 Laws of Puerto Rico › TITLE TWENTY-FOUR - Health and Sanitation (§§ 1 — 15010) › PART X - Health Professionals (§§ 10001 — 12020) › Chapter 502 - Regulation of the Work Shifts of Medical Interns and Residents in Puerto Rico (§§ 10005 — 10009) › § 10007 - Requirements

In order to have working conditions and work schedules for the medical interns and residents that promote the quality of the medical services, all hospital institutions must establish the following limits in the work shifts of such physicians:
(a) In hospital institutions with more than fifteen thousand (15,000) unscheduled visits to the emergency room per year, the assignment of a medical intern or resident shall be limited to not more than twelve (12) consecutive hours of work in emergency room services. The Secretary may approve alternate work plans limited to fifteen (15) hours for residents in emergency room services as long as:
(1) The alternate work plan contributes toward having the hospital institution satisfy the needs of the community regarding such emergency services;
(2) the volume of patients examined and treated during the extended period is substantially less than that of another daily schedule, and
(3) an adequate rest time of not less than ten (10) hours is provided between scheduled work periods to prevent tiring out the physician.
(b) Training programs must comply with the following criteria:
(1) The weekly work schedule shall not exceed an average of eighty (80) hours per week.
(2) The medical intern or resident shall not work more than twenty-four (24) consecutive hours in any schedule.
(3) Such duties are programmed for each resident for not more than every three (3) nights.
(c) The Director of the internship or residency program of a hospital institution must develop and implement policies pertaining to the medical interns or residents that establish limits to the duties assigned to said physicians, including, but not limited to: the assignment of new patients and the duration of their daily guard.
(d) When establishing the limits of work hours for a medical intern or resident, as set forth in subsections (a) and (b) of this section, the Director of the program must require that the guard schedule be separated by not less than eight (8) free hours. At least one twenty-four (24) free hour period shall be established per week.
(e) All hospital institutions that employ an intern or resident must adopt and implement specific policies that regulate dual employment of same. Such rules must at least require each intern or resident to notify the hospital institution of any other employment different from the one practiced in the hospital, and the schedule dedicated to same. [All interns or residents who would have worked the maximum hours established in this chapter, shall be prohibited from working extra hours and providing health care services to patients in any hospital institution.]
History —Jan. 4, 2003, No. 47, § 4.
2023 Laws of Puerto Rico › TITLE TWENTY-FOUR - Health and Sanitation (§§ 1 — 15010) › PART X - Health Professionals (§§ 10001 — 12020) › Chapter 502 - Regulation of the Work Shifts of Medical Interns and Residents in Puerto Rico (§§ 10005 — 10009) › § 10008 - Implementation Committee

(a) An Implementation Committee, adjoined to the Department of Health, is hereby created for the regulation of work shifts.
(b) The Secretary of Health shall set forth by means of regulation those procedures to be used by the Committee to address in the first instance those claims submitted to the Committee after the promulgation of this chapter. These decisions shall be reviewable by the Circuit Court of Appeals of Puerto Rico, pursuant to the dispositions of §§ 2101 et seq. of Title 3, known as the “Uniform Administrative Procedures Act”.
(c) The Committee shall be comprised by the Secretary or his representative, the Dean of the Schools of Medicine of Puerto Rico or his representative, one (1) representative intern and resident per each school of medicine, and two (2) community physicians, selected in consensus by the members to create imparity.
(d) The Committee shall be responsible for observing the dispositions set forth in this chapter and the regulation approved pursuant to same.
History —Jan. 4, 2003, No. 47, § 5.
2023 Laws of Puerto Rico › TITLE TWENTY-FOUR - Health and Sanitation (§§ 1 — 15010) › PART X - Health Professionals (§§ 10001 — 12020) › Chapter 502 - Regulation of the Work Shifts of Medical Interns and Residents in Puerto Rico (§§ 10005 — 10009) › § 10009 - Penal sanctions

All hospital institutions that violate any of the dispositions set forth in this chapter shall incur in a misdemeanor, and if convicted, shall be sanctioned with the penalty of a fine that shall not exceed five thousand dollars ($5,000) per violation. All medical interns and residents who violate any of the dispositions set forth in this chapter shall be sanctioned with a fine that shall not exceed two hundred dollars ($200).
History —Jan. 4, 2003, No. 47, § 6.
2023 Laws of Puerto Rico › TITLE TWENTY-FOUR - Health and Sanitation (§§ 1 — 15010) › PART X - Health Professionals (§§ 10001 — 12020) › Chapter 503 - Advanced Studies Center for Medical Emergency Personnel in the Public Sector (§§ 10011 — 10021) › § 10011 - Creation

The Center for Advanced Studies for the Training and Retraining of the Medical Emergencies Personnel of the Government of Puerto Rico, hereinafter referred to as the Center, is hereby established as an entity attached to the College of Health Related Professions.
History —Aug. 31, 2004, No. 235, § 1, eff. 60 days after Aug. 31, 2004.
2023 Laws of Puerto Rico › TITLE TWENTY-FOUR - Health and Sanitation (§§ 1 — 15010) › PART X - Health Professionals (§§ 10001 — 12020) › Chapter 503 - Advanced Studies Center for Medical Emergency Personnel in the Public Sector (§§ 10011 — 10021) › § 10012 - Interpretation

The training, retraining and continuing education courses administered by the Center shall be deemed to be instruments complementary to the requirements set forth in §§ 3451 et seq. of Title 20, known as the “Act to Create the Board of Examiners of Medical Emergency Technicians”. It shall in no way be understood that the provisions of this chapter divert from the purpose and objectives established in §§ 3451 et seq. of Title 20, since the provisions set forth herein constitute a complementary mechanism, not a substitute to the provisions established in the aforementioned §§ 3451 et seq. of Title 20.
History —Aug. 31, 2004, No. 235, § 3, eff. 60 days after Aug. 31, 2004.
2023 Laws of Puerto Rico › TITLE TWENTY-FOUR - Health and Sanitation (§§ 1 — 15010) › PART X - Health Professionals (§§ 10001 — 12020) › Chapter 503 - Advanced Studies Center for Medical Emergency Personnel in the Public Sector (§§ 10011 — 10021) › § 10013 - Duties and functions

The primary institutional responsibility entrusted to the Center shall be to provide a broad and diverse assortment of training, retraining and continuing education courses, advanced level academic programs and other academic offerings, all geared toward verifying, validating and allowing public medical emergencies personnel to acquire advanced skills and knowledge in the areas of trauma, cardiopulmonary resuscitation, neonatal care, cardiology, obstetrics and all other areas that, as determined by the Center, are necessary for the optimal development of the government medical emergencies personnel, and for their services and intervention to be supported and imbued in advanced skills, criteria and knowledge in medical emergency management.
For such purposes, it is hereby provided that all government medical emergencies personnel shall comply in a mandatory and exclusive manner with the legal and administrative requirements in the areas of training and retraining in the Center created by this legislation. On the other hand, the Center shall be one of the alternatives available within our jurisdiction to the government medical emergencies personnel regarding the administration of continuing education activities and the offering of advanced level academic programs.
History —Aug. 31, 2004, No. 235, § 4, eff. 60 days after Aug. 31, 2004.
2023 Laws of Puerto Rico › TITLE TWENTY-FOUR - Health and Sanitation (§§ 1 — 15010) › PART X - Health Professionals (§§ 10001 — 12020) › Chapter 503 - Advanced Studies Center for Medical Emergency Personnel in the Public Sector (§§ 10011 — 10021) › § 10014 - Operational and practical autonomy

The Center shall have full practical and operational autonomy in matters pertaining to the design of courses, strategies and educational approach, organization of educational areas, the contracting of faculty and non-faculty personnel, the evaluation of the beneficiaries of its programs and the certification stating that a person has complied with the demands and requirements established by the Center and which serve the purposes of this chapter.
History —Aug. 31, 2004, No. 235, § 5, eff. 60 days after Aug. 31, 2004.
2023 Laws of Puerto Rico › TITLE TWENTY-FOUR - Health and Sanitation (§§ 1 — 15010) › PART X - Health Professionals (§§ 10001 — 12020) › Chapter 503 - Advanced Studies Center for Medical Emergency Personnel in the Public Sector (§§ 10011 — 10021) › § 10015 - Differentiation

The training, retraining and continuing education courses administered by the Center shall be configured according to the categories established in §§ 3451 et seq. of Title 20 for the various medical emergencies professionals.
History —Aug. 31, 2004, No. 235, § 6, eff. 60 days after Aug. 31, 2004.
2023 Laws of Puerto Rico › TITLE TWENTY-FOUR - Health and Sanitation (§§ 1 — 15010) › PART X - Health Professionals (§§ 10001 — 12020) › Chapter 503 - Advanced Studies Center for Medical Emergency Personnel in the Public Sector (§§ 10011 — 10021) › § 10016 - Reports

The Center, through its officers, shall evaluate the effectiveness of its offerings and programs annually, and shall submit the corresponding reports to the Legislature and the Office of Management and Budget. Concurrently, the Center shall annually remit to said entities complete and detailed reports on its operations and financial statements for each fiscal year within sixty (60) days after the closing of the corresponding fiscal year.
History —Aug. 31, 2004, No. 235, § 7, eff. 60 days after Aug. 31, 2004.