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PC 763

Para establecer la Política Pública del Gobierno de Puerto Rico en torno a las Enfermedades Intestinales Inflamatorias, disponiéndose que se establecerá el acceso directo a proveedores y médicos especialistas, así como aquellos medicamentos, tratamientos, terapias y pruebas validadas científicamente como eficaces y recomendadas para diagnosticar y tratar la condición, sin necesidad de referido, autorización o pre-autorización del plan; y para otros fines relacionados.

2025-2028 Session

Establish a public policy guaranteeing direct access to IBD care, treatments, and tests without referrals or plan pre-authorization in Puerto Rico.

Comisión no recomienda aprobación de la medida
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Bill Summary · PC 763

Summary of Bill PC 763

Overview

Bill PC 763 proposes to establish the Government of Puerto Rico’s public policy regarding inflammatory bowel diseases (IBD). It would mandate direct access to healthcare providers and to scientifically validated treatments, therapies, and diagnostic tests for diagnosing and treating IBD, eliminating the need for referrals or plan pre-authorization. The bill is currently in its early legislative stage.

Purpose and Intent

  • Create a formal Puerto Rico public policy framework for addressing IBD.
  • Ensure patients have direct access to care from providers and medical specialists (including gastroenterologists) without mandatory referrals.
  • Guarantee access to medications, treatments, therapies, and diagnostic tests that are scientifically validated as effective and recommended for diagnosing and treating IBD.
  • Remove the requirement for referrals, plan authorization, or pre-authorization by health plans for these services when pursuing IBD care.

Key Provisions (as indicated by the bill’s title)

  • Establish a formal public policy on IBD for the Puerto Rico government.
  • Provide direct access to:
    • Healthcare providers and medical specialists (notably gastroenterologists).
    • Medications and therapies proven scientifically effective for IBD.
    • Diagnostic tests validated as effective for IBD diagnosis.
  • Remove procedural barriers such as:
    • Referrals
    • Plan authorization
    • Pre-authorization requirements by health plans
  • Include other related purposes aligned with improving IBD diagnosis and treatment access.

Affected Parties

  • Individuals living with IBD in Puerto Rico.
  • Healthcare providers, especially gastroenterologists and IBD specialists.
  • Health plans and insurers (public and private) operating in Puerto Rico.
  • Public health agencies and policymakers responsible for implementing the policy.

Implementation and Timeline

  • The bill’s text indicates a policy framework would be established (details not provided in available material).
  • No specific implementation schedule or funding provisions are disclosed in the summary provided.
  • Implementation would likely require regulatory rules and coordination with health plans to ensure access without referral/pre-authorization, plus criteria defining what is “scientifically validated” and “effective/recommended.”

Procedural Status and Legislative Timeline

  • Introduced: August 7, 2025.
  • First Reading in the House: August 18, 2025.
  • Referred to Committee(s): August 18, 2025.
  • Status: Referido a Comisión(es) (in committee review).

Potential Impacts and Considerations

  • Access: Could improve patient access to IBD care, reducing delays caused by referral barriers.
  • Coverage Standards: Requires clear criteria for what qualifies as “scientifically validated” and “effective/recommended” tests and treatments.
  • Payer Implications: May necessitate adjustments by public and private insurers to remove pre-authorization requirements for IBD-related services.
  • Budgetary Considerations: Potential changes in costs associated with broader access to specialists and therapies; impact would depend on enacted rules and negotiated plan provisions.
  • Implementation: Would require regulatory implementation and alignment among healthcare providers, insurers, and public health authorities.

Next Steps

Monitor committee action for proposed amendments, definitions (e.g., “scientifically validated” and “effective/recommended”), funding, and implementation timelines.

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

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