CMS moves to shield Puerto Rico from Medicare regulatory requirements

Gov. Jenniffer González Colón (Facebook via Jenniffer González Colón)

By THE STAR STAFF

Gov. Jenniffer González Colón has announced a major victory for more than 300,000 dual-eligible beneficiaries on the island after the Centers for Medicare & Medicaid Services (CMS) released its proposed rule on Dual Eligible Special Needs Plans (D-SNP) earlier this week, explicitly excluding Puerto Rico from regulatory requirements that could have severely limited plan options for this vulnerable population.

The exemption follows an official letter sent by the governor on Oct. 7 to CMS Administrator Dr. Mehmet Oz, warning that the previously drafted policy would impose a one-size-fits-all national model, reducing the variety of benefit packages and undermining the integrated system Puerto Rico has successfully maintained for over two decades.

“Today we see concrete results from our efforts,” González Colón said. “Since October, we have been warning about the impact this rule would have on our dual-eligible beneficiaries. Thanks to that advocacy, along with the continued work of PRFAA [the Puerto Rico Federal Affairs Administration] in Washington, D.C., Puerto Rico has been preliminarily excluded from requirements that would restrict plan offerings on the island. This is a major win for our seniors, people with disabilities, and the stability of our healthcare system.”

The proposed CMS rule now includes a specific exception for territories without a Medicare Savings Program (MSP), including Puerto Rico, meaning the island is fully shielded from the change.

While CMS has opened a public comment period, the determination marks a significant step toward preserving Puerto Rico’s integrated D-SNP model, which has been a cornerstone for delivering coordinated, high-quality care.

The governor reaffirmed her commitment to working with the healthcare industry, PRFAA, and CMS throughout the comment period to ensure the exemption remains in the final rule.