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PS 867

Para crear la “Ley de la Reforma Médica para la Eficiencia, Salud y Agilidad”, a los fines de crear eficiencia, transparencia y agilidad en la operación del sistema de salud de Puerto Rico mediante la regulación del proceso de reclamaciones sometidas por los proveedores de servicios de salud a las aseguradoras o planes médicos, tanto en la esfera privada como bajo el Plan Vital; para crear el Fondo REMESA; y para otros fines relacionados.

2025-2028 Session

Puerto Rico bill creates claims processing standards and REMESA Fund to accelerate healthcare provider reimbursement from insurers and improve system transparency.

Referido a Comisión(es)
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Bill Summary · PS 867

Legislative bill overview

Bill PS 867 proposes Puerto Rico's "Medical Reform Law for Efficiency, Health and Agility" to streamline the health claims process between healthcare providers and insurers (both private plans and Plan Vital). The bill aims to create a dedicated REMESA Fund and establish regulatory mechanisms to improve transparency and operational efficiency in the island's healthcare system.

Why is this important

Healthcare claims processing directly affects provider cash flow and patient access to care. Delays in claim reimbursement force providers to reduce services or close facilities, while inefficient systems increase administrative costs passed to consumers. Puerto Rico's fragmented healthcare system—combining private insurers with the public Plan Vital—particularly needs standardized claims procedures given the island's economic constraints and health infrastructure challenges.

Potential points of contention

  • REMESA Fund structure and financing: Unclear how the fund will be capitalized, whether through provider contributions, insurer fees, or government allocation—raising concerns about cost distribution and fiscal sustainability
  • Claims processing timelines: Establishing enforceable deadlines for insurers to process claims may increase insurer compliance costs, potentially affecting premium prices or coverage availability
  • Plan Vital integration: Determining whether public plan claims follow identical private sector rules could conflict with government budget constraints or create administrative complexity
  • Enforcement mechanisms: The bill's authority to penalize non-compliant insurers and remedies available to providers remain undefined, affecting real-world leverage and compliance

Compiled from official sources — confirm details with the bill’s official record.

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