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PC 348

Para enmendar el inciso (s) del Artículo 26.060 de la Ley Núm. 194-2011, según enmendada, mejor conocida como “Código de Seguros de Salud de Puerto Rico”, a los fines de establecer que la responsabilidad de la coordinación de beneficios es una mancomunadamente compartida de las organizaciones de seguros de salud o aseguradores, de sus intermediarios y de los proveedores participantes y cuáles serán los parámetros para tramitar la coordinación de beneficios de servicios de salud de los pacientes; añadir los sub-incisos 14 y 15 al inciso (a) del Artículo 17 de la Ley 194-2000, según enmendada, conocida como “Carta de Derechos y Responsabilidades del Paciente”, a los fines de proveer alternativas para que el paciente, asegurado o consumidor pueda presentar querellas administrativas; requerir la redacción de un Reglamento conforme a los parámetros de esta Ley y establecer campaña educativa; y para otros fines relacionados.

2025-2028 Session

COB duties are now jointly shared by insurers, intermediaries, and participating providers, clarifying who pays and coordinates health benefits for patients.

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Bill Summary · PC 348

Summary of Bill PC 348

Overview

Bill PC 348 proposes amendments to Puerto Rico’s health and patient rights laws to modify how coordination of benefits (COB) is handled, create new avenues for patient complaints, and require a regulatory framework and an accompanying educational campaign. The bill aims to clarify that COB responsibility is jointly shared among health insurers/carriers, their intermediaries, and participating providers, and to provide additional administrative complaint options for patients, insureds, or consumers.

  • Bill Number: PC 348
  • Primary references:
    • Amends Article 26.060 of Law No. 194-2011 (Health Insurance Code of Puerto Rico)
    • Adds sub-incisos 14 and 15 to Article 17(a) of Law No. 194-2000 (Patient Rights and Responsibilities)
  • Status: Remitted to the House Committee on Calendars
  • Introduction: February 24, 2025

What the Bill Would Change

1) Coordination of Benefits (COB) Responsibility
- Establishes that COB is a jointly shared responsibility among:
- Health insurance organizations or insurers
- Their intermediaries
- Participating providers
- Sets the parameters for how COB for health services should be processed, including the responsibilities and interactions among the involved parties.

2) Administrative Complaints Pathways
- Adds two new sub-incisos (14 and 15) to Article 17(a) of the Patient Rights and Responsibilities Law (Law 194-2000).
- Purpose: provide alternative avenues for patients, insured individuals, or consumers to file administrative complaints.

3) Regulatory Framework and Public Education
- Requires the drafting of a Regulation that aligns with the new COB parameters and complaint processes.
- Requires an educational campaign to inform stakeholders about the changes.

4) Other Related Purposes
- The bill also includes miscellaneous provisions to support implementation and related activities.

Who Is Affected

  • Health insurers/carriers and their intermediaries
  • Participating healthcare providers and hospitals
  • Patients, insured individuals, and healthcare consumers
  • State regulatory and administrative bodies responsible for health insurance and patient rights enforcement

Implementation and Timeline

  • The bill requires the issuance of a Regulation and an educational campaign, but no specific dates are provided in the text available.
  • Legislative history to date:
    • 2025-02-24: Filed (Radicado)
    • 2025-02-25: First Reading; Referred to Committees
    • 2025-11-13: First Committee Report issued, no amendments
    • 2025-11-13: Remitted to Committee on Calendars

Potential Impacts (Contextual)

  • Clarifies accountability for COB, potentially reducing disputes over who pays or coordinates benefits.
  • Creates formal complaint mechanisms that could streamline consumer protections and administrative remedies.
  • Requires regulatory action and an educational campaign, which may necessitate agency resources and outreach efforts.

Next Steps for Readers

  • Monitor for Committee deliberations and any proposed amendments.
  • Await the Regulation(s) implementing the COB framework and the details of the educational campaign.
  • Assess how the new complaint pathways interact with existing patient rights processes.

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

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