HHS: Consumer, insurance provisions cover P.R.

HHS reached its decision following months of intense efforts by the resident commissioner and Gov. Luis Fortuño to ensure that the territories received “state-like” treatment under that section of the national healthcare legislation creating the consumer protections and instituting the insurance market reforms.

“Since the healthcare bill was enacted into law in March, we have been working side-by-side with the governor and his office in Washington to make certain that these important protections would apply to Puerto Rico,” Pierluisi said.

“I am grateful to HHS for having responded to our efforts in such a just and appropriate manner. When it comes to the health of the people of this nation, we should not treat American citizens living in Puerto Rico and the other territories differently than their fellow citizens residing in the states,” the resident commissioner added.

Pursuant to the decision announced by HHS this week, insurance companies in Puerto Rico will be prohibited from denying coverage based on an individual’s preexisting condition; prohibited from establishing lifetime or annual limits on an individual’s benefits; prohibited from rescinding coverage except in the case of fraud; and required to make dependent coverage available to adult children until age 26.

In addition, insurance companies in Puerto Rico will be required to implement an effective process so that patients can appeal decisions by the insurance company, such as a decision not to cover a claim. Insurers will also be required to provide coverage for certain preventive health services, like vaccinations, and prohibited from charging co-payments for these services. Moreover, insurance companies will be required to provide justification for any increase in premiums.

In addition, Puerto Rico will benefit from multiple federal grant programs to implement the consumer protections created in PPACA. For example, Sebelius reiterated HHS’ announcement from last week that Puerto Rico and the other territories will be able to participate in a $30 million program designed to help consumers understand their insurance options and legal rights. Likewise, Puerto Rico will be eligible to obtain federal grants to ensure that insurance companies do not unreasonably increase premiums.

“The healthcare reform bill, spearheaded by President Obama, is of critical importance for Puerto Rico. Pursuant to this legislation, Puerto Rico will receive three times as much federal funding for its Medicaid program as it would have received in the absence of this bill,” Pierluisi said.

“The island will also be eligible to establish a health insurance exchange, a new market for private insurance plans regulated and subsidized by the federal government that will begin operation in 2014, the resident commissioner said.

“But our hard work on this legislation would have been incomplete if the bill did not provide individuals in Puerto Rico with these important consumer protections that, in the final analysis, are the centerpiece of the entire reform effort,” he concluded.