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PS 435

“Para enmendar el Artículo 6 de la Ley Núm. 194 de 25 de agosto de 2000, según enmendada, conocida como “Carta de Derechos y Responsabilidades del Paciente”; enmendar la Sección 8, del Artículo VI, de la Ley Núm. 72 de 7 de septiembre de 1993, según enmendada, conocida como “Ley de Administración de Seguros de Salud de Puerto Rico”; enmendar los Artículos 30.020, 31.020 y 31.031 de la Ley Núm. 77 de 19 de junio de 1957, según enmendada, conocida como “Código de Seguros de Puerto Rico”; a los fines de garantizar el derecho de toda mujer a seleccionar y recibir atención directa de un ginecólogo-obstetra, en adición a su médico primario, bajo el plan de cuidado de salud al que esté acogida, hasta un (1) año después del parto; para disponer que las aseguradoras autoricen al obstetra a diagnosticar, manejar y tratar las condiciones de las pacientes durante el embarazo y el posparto, sin requerir un referido o autorización previa del médico primario; atemperar las disposiciones legales pertinentes; y para otros fines relacionados.”

2025-2028 Session

Guarantees direct access to OB-GYN care under health plans during pregnancy and up to 1 year postpartum, without referrals or prior authorizations from primary physicians.

Comisión no recomienda aprobación de la medida
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Bill Summary · PS 435

Summary of PS 435

Overview

PS 435 is a Puerto Rico Senate bill introduced on March 19, 2025. The measure seeks to amend several statutes to guarantee that every woman has the right to select and receive direct care from a gynecologist-obstetrician (OB-GYN) in addition to her primary care physician, under her health plan, up to one year after delivery. It would also authorize OB-GYNs to diagnose, manage, and treat pregnancy- and postpartum-related conditions without requiring a referral or prior authorization from the patient’s primary physician. The purpose is to align patient rights and health plan operations to facilitate direct OB-GYN access during pregnancy and the postpartum period.

Key Provisions (Proposed Amendments)

  • Patient Rights (Law 194, Article 6)
    Amend to guarantee the right of every woman to select and receive direct OB-GYN care in addition to her primary physician, under her health plan.

  • Health Insurance Administration (Law 72, Article VI, Section 8)
    Amend to support or implement the above direct access framework within the health insurance administration framework.

  • Puerto Rico Insurance Code (Law 77, Articles 30.020, 31.020, 31.031)
    Amend to:

    • authorize obstetricians to diagnose, manage, and treat pregnancy- and postpartum-related conditions.
    • remove or reduce barriers such as referrals or prior authorization from a primary physician for OB-GYN services during pregnancy and up to one year postpartum.

  • General Purpose
    Aligns existing laws to ensure direct access to OB-GYN care, and coupling this access with a postpartum coverage window of up to one year after delivery.

Who Would Be Affected

  • Patients (Women): Benefit from expanded access to direct OB-GYN care within their health plans, especially during pregnancy and the first year after birth.
  • Obstetricians/Gynecologists: Authorized to diagnose and treat maternity-related conditions directly under health plans, without needing prior referrals or approvals from primary care physicians.
  • Primary Care Physicians: May see changes in referral dynamics and coordination of care when patients choose OB-GYN direct access.
  • Health Insurers and Plans: Required to accommodate direct OB-GYN access and revised authorization processes as specified by the amendments.
  • Healthcare Providers and Hospitals: Implications for coding, billing, and network agreements to reflect direct OB-GYN access.

Procedural and Timeline Aspects

  • Introduced: March 19, 2025
  • First Reading: March 31, 2025 (Senate)
  • Referral: March 31, 2025 (to committees)
  • Committee Action: May 1, 2025 — Commission “no recomienda aprobación” (Committee does not recommend approval)

Current status indicates the bill did not receive committee approval to advance, limiting its chances of passage in its current form unless reintroduced or revised.

Potential Implications and Considerations

  • Access and Autonomy: Could significantly increase patient choice and direct access to OB-GYN care during pregnancy and the first year postpartum.
  • Cost and Utilization: Insurance authorization practices and potential impact on costs and utilization patterns for obstetric services.
  • System Coordination: Requires alignment across patient rights, insurance administration, and insurer networks; potential implications for primary care coordination.
  • Legislative Fate: With a committee recommendation against passage, the bill may require amendments, renegotiation, or reintroduction to advance.

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

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