Island Health Insurance Administration finalizes transition deal with Molina Healthcare

By John McPhaul

Puerto Rico Health Insurance Administration (ASES by its Spanish acronym) Executive Director Jorge Galva announced this past weekend that the signing of the transition contract with Molina Healthcare was finally achieved to protect the continuity of services to the approximately 100,000 subscribers of the Puerto Rico government health plan, known as “Plan Vital.”

“The agreement makes the Molina corporation at the central level headquartered in the United States an unlimited guarantor of the contracted commitments,” Galva said in a written statement. “It is established that by September 15, a restricted reserve equivalent to 125% of pending claims will be established to protect suppliers. Furthermore, ASES reserves the right to audit the reserve and demand additional capital if the settlement of claims requires it.”

On May 14, Molina reported that it would be leaving the Vital Plan on Oct. 31, 2020.

Galva announced that none of the Molina Healthcare subscribers would have interruptions or changes in their benefits and health coverage services, including their previously coordinated medications and clinical procedures.

In addition, by Sept. 14, ASES will assign an insurer where the primary doctor is hired, so that beneficiaries will keep the same primary doctor and medical group.

“Now with the signatures by both parties for this transition contract, which was reviewed and has the approval of the Centers for Medicare & Medicaid, we increase our guarantees of continuity of care for beneficiaries of [Plan] Vital, and as chairman of the ASES Board of Directors, I thank the board members for their support, and the Molina executives and the ASES team for this achievement,” said island Health Secretary Lorenzo González Feliciano.

Regarding the pending invoices to service providers, Galva showed where in the agreement it says that “Molina is committed to maintaining the personnel and resources for the draw out period” that ends on August 31, 2021 in order to reconcile and pay pending claims.

“We also achieved that 70 percent of all clean claims -- as defined in Article 16 of the Contract -- will be paid before October 31, 2020,” Galva said.

“We must also remember that the selection and change of insurer is a right of the beneficiary, which should not be directed in any way by a provider or an insurer,” added the ASES chief added.

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