Clinical Labs ask that some insurers be excluded from gov’t health plan bidding due

By John McPhaul

jpmcphaul@gmail.com

Clinical Laboratories Association (ALC by its Spanish initials) President Laura Trujillo requested on Wednesday that the insurers Medicare and Much More, First Medical, MCS Health Care Holdings and Triple-S be ruled out as bidders to become “contracted insurers” in relation to the government health plan.

“Under the provisions of Section 2 of Article VI of the ‘ASES Organic Law’ it is provided that ‘The Administration shall contract … insurers and/or health service organizations authorized to do health insurance business in Puerto Rico … [and] will be responsible for supervising and ensuring the compliance capacity and effectiveness of these organizations …’” Trujillo said, referring to the organic law of the Health Insurance Administration of Puerto Rico (ASES by its Spanish initials). “In light of the aforementioned, it is a non-delegable ministerial function of ASES and therefore the members of its board of directors (in favor of public health), to scrutinize the character, integrity, performance history and commitment of the insurers (aspiring to contract) for public health in Puerto Rico.”

“The insurers aspiring to be contracted by ASES, all of them, maintain a history of gross violations of the ‘Prompt Payment Law’ and the Insurance Code, as well as non-compliance with the regulations that govern them, issued by the Centers for Medicare and Medicaid Services (CMS),” Trujillo added in her appeal to ASES. “The ALC has been a historical denouncer of these extremes.”

On July 15, the term expired for health insurers in Puerto Rico to submit to ASES the documents and elements related to their bidding, to appear as contracted insurers for the government health plan.