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) › § 7025 - Selection of health plans

The Administration shall negotiate health plans for one (1) or more geographic areas upon determining that such geographic areas meet the necessary conditions to ensure access to quality health services within a cost effective scheme. To such purposes, we may consider that the territorial delimitation of Puerto Rico as a whole, constitutes one (1) single area, as well as the grouping of one (1) or more municipalities, may constitute one (1) independent and separate area or region. Among the criteria that the Administration shall use to determine the territorial boundary by areas or regions, shall be the participation of a minimum number of insurers that the Administration has previously qualified to guarantee competition in the cost of the premiums and quality of services. Prior to determining that Puerto Rico as a whole is one (1) single area, the Administration shall carry out a study to determine the viability of establishing one single area, as well as the advantages and disadvantages for the stability and strengthening of the health plan, so that it may truly support free selection and access to quality services for the beneficiaries. The Administration shall take into consideration the solvency, and administrative and operational resources when evaluating the insurers. The Department, through the Medical Assistance Office (PAM, Spanish acronym), shall identify and certify the persons that are eligible for the services pursuant to their level of income and their eligibility to receive state and federal health benefits, in harmony with the provisions of § 7029 of this title. Provided, That when determining eligibility, beneficiaries shall be notified in a timely manner of the adoption of new standards of eligibility within a term of not less than six (6) months before the same take effect, except in the case of a federal regulation requiring immediate compliance.
Among the rules of eligibility, regarding rustic farms, when assessing real property under the process for determining beneficiary’s eligibility, the value per cuerda shall be one thousand dollars ($1,000); provided, that such farm is not producing or generating any income whatsoever. There shall be determined that this assessment designation shall be exclusively for the purposes of this section. In such case, the beneficiary shall be required to show the beneficiary’s proof of ownership and a sworn statement, which shall attest to the fact that the farm is not generating any income whatsoever. If after extending the benefit, it is determined that such person furnished false information, he/she shall be bound to reimburse twice the amount paid as a result of using the Health Plan of the Government of Puerto Rico, without prejudice of any other penal sanctions that may apply as provided in the laws in effect on presenting false information or documents or illegally obtaining government services.
The health plans provided by this chapter shall be subject to evaluation by the Administration, in order to determine their success and the need to modify the same in order to achieve the purposes of this chapter.
History —Sept. 7, 1993, No. 72, Art. VI, § 1; Dec. 29, 2000, No. 463, § 2; July 19, 2002, No. 105, § 4; Aug. 13, 2008, No. 267, § 1; Oct. 7, 2009, No. 120, § 1.