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PC 572

Para establecer como mandatorio que todo contrato de seguro médico en Puerto Rico incluya en su cubierta la evaluación de procesamiento auditivo y terapias educativas para estudiantes con necesidades de educación especial mayores de veintiún (21) años, con el fin de garantizar la continuidad de estos servicios esenciales una vez culminen la escuela secundaria y accedan a la educación postsecundaria; disponer para que el Comisionado de Seguros de Puerto Rico adopte, enmiende o derogue reglamentación para el cumplimiento de esta Ley.

2025-2028 Session

Requires Puerto Rico medical plans to cover auditory processing evaluations and educational therapies for students with special needs over 21, ensuring postsecondary continuity.

Referido a Comisión(es)
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Bill Summary · PC 572

PC 572 — Summary

Purpose and intent

PC 572 proposes a statutory mandate requiring all medical insurance contracts in Puerto Rico to include coverage for:
- Evaluación de procesamiento auditivo (auditory processing assessment)
- Terapias educativas (educational therapies)

targeted to students with needs in educación especial who are mayores de veintiún (21) años. The aim is to guarantee continuity of these essential services after high school as students transition to postsecondary education.

Key provisions

  • Coverage mandate:

    • All medical insurance contracts issued or regulated in Puerto Rico must cover auditory processing evaluations.
    • All medical insurance contracts must cover educational therapies.
    • Coverage applies to students with special education needs who are older than 21 years.

  • Purpose of coverage:

    • Ensure continuity of services beyond the completion of high school.
    • Support access to education postsecondary, helping students maintain necessary supports during transition and enrollment.

  • Regulatory authority:

    • The Comisión de Seguros de Puerto Rico (Insurance Commissioner) is empowered to adopt, amend, or repeal regulations to implement and enforce this law.

  • Regulatory timeline and implementation:

    • Specific effective dates and regulatory timelines are not provided in the available text; the bill gives the Insurance Commissioner authority to regulate compliance.

Affected parties

  • Beneficiaries:

    • Individuals in Puerto Rico who are insured under medical plans and are over 21 with special education needs.

  • Insurers:

    • Health/medical insurance carriers operating in Puerto Rico, which would need to modify contracts and benefits to include the mandated coverage.

  • Providers:

    • Providers of auditory processing evaluations and educational therapies, who may experience increased demand for services.

Procedural status and timeline

  • Introduced: May 1, 2025
  • First Reading: May 5, 2025
  • Referenced to Commissions: May 5, 2025
  • Status: Referred to commissions (as of the latest available actions)

Potential impact and considerations

  • Access and continuity: If enacted, the bill could improve access to essential services for students with special needs transitioning from high school to postsecondary education.
  • Costs and coverage changes: Insurers may incur higher costs due to mandated coverage; policies may require revisions, network considerations, and potential rate impacts.
  • Regulatory pathway: The Insurance Commissioner would need to develop or amend regulations to specify definitions, scope, reimbursement terms, and any exemptions or limitations.

Note: As a bill in early procedural stages, many implementation details (definitions, scope, effectiveness date, enforcement mechanisms) will be clarified through committee work and regulatory rulemaking.

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

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