Para enmendar el inciso (3) de la Sección 18 del Artículo VI de la Ley Núm. 72 de 7 de septiembre de 1993, según enmendada, conocida como “Ley de la Administración de Seguros de Salud de Puerto Rico” a fin de prohibir que algún proveedor participante o su agente establezca segregación de beneficiarios mediante la implantación de un protocolo de itinerarios y fechas para citas o consultas distinto para asegurados bajo planes privados, que limiten o reduzcan la prestación de servicios contratados a los beneficiarios del Plan de Salud del Estado Libre Asociado de Puerto Rico y para otros fines

2025-2028 Session

PC 780 — Summary OverviewPC 780 proposes to amend a provision of the Puerto Rico Health Insurance Administration Law (Law No. 72, Sept. 7, 1993, as amended). The goal is to prevent

Referido a Comisión(es)

Overview

PC 780 proposes to amend a provision of the Puerto Rico Health Insurance Administration Law (Law No. 72, Sept. 7, 1993, as amended). The goal is to prevent any participating health care provider or the provider’s agent from creating a segregation of beneficiaries by using a protocol that sets different itineraries and appointment/consultation dates for insured individuals under private plans, if such practices would limit or reduce the contracted services available to beneficiaries of the Puerto Rico State Health Plan.

Status and legislative actions:
- Introduced: August 18, 2025
- Legislative actions:
- August 18, 2025: Filed (Radicado)
- August 21, 2025: Appears in First Reading
- August 21, 2025: Referred to Commission(s)

Purpose

To prohibit discriminatory scheduling practices by health care providers or their agents that would treat beneficiaries differently based on whether they are enrolled in private plans versus the State Health Plan.

Specifically targets protocols that create different itineraries or dates for appointments/consultations in a way that would limit or reduce contracted services for State Health Plan beneficiaries.

Key Provisions (based on the bill’s description)

Amendment to inciso (3) de la Sección 18 del Artículo VI de Law No. 72 (Health Insurance Administration Law).

Prohibits any participating provider or their agent from establishing or enforcing a scheduling protocol that segregates beneficiaries by plan type (private vs. State Health Plan).

Aims to prevent limiting or reducing access to contracted services for State Health Plan beneficiaries through differential appointment scheduling.

Contains a general “para otros fines” clause, indicating potential additional purposes or clarifications might be added during the legislative process.

Affected Parties

Participating health care providers and their agents in Puerto Rico.

Beneficiaries of the Puerto Rico State Health Plan (beneficiaries who are part of the government health program).

Potentially, private plan insureds, insofar as the prohibition prevents discriminatory scheduling that adverse affects State Plan beneficiaries relative to private-plan beneficiaries.

Procedural and Timeline Considerations

Currently in early stages of the legislative process.

After First Reading and committee referral, the bill would be subject to committee review, potential amendments, and subsequent readings before a full vote.

No specific enforcement mechanisms or penalties are described in the provided information; those details would typically be addressed in committee deliberations or final language.

Potential Impact

If enacted, the bill would bolster parity in access to contracted health services between State Health Plan beneficiaries and private-plan beneficiaries by outlawing discriminatory appointment scheduling practices.

Could affect provider scheduling policies, referral practices, and patient access workflows.

May influence oversight, compliance requirements, and possible enforcement actions if discriminatory practices are identified.

If you’d like, I can tailor this summary for a specific audience (general public, policymakers, healthcare providers) or add a comparison to related existing provisions in Law No. 72.