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  • Writer's pictureThe San Juan Daily Star

New changes in Vital Plan expands benefits for doctors and beneficiaries

By John McPhaul

Governor Pedro Rafael Pierluisi Urrutia announced on Thursday that the beneficiaries and health service providers of the “Vital Plan” will obtain more benefits under the new changes in the contracting of the selected insurers.

According to the governor, the coverage that will come into force on January 1, 2023, under new guidelines and compliance measures, will provide better compensation to doctors and health providers, but above all will offer more services to patients, especially to the most vulnerable. The insurers selected in the new contract are; MMM Multihealth, First Medical, Mennonite Health Plan and Triple S.

“We have redefined this model focused on the retention of doctors in Puerto Rico and in order to guarantee the health of the people. I thank the work team for their performance and their commitment to my call to complete the award process in an agile and efficient manner. The health of our people is a priority component for my administration and that is why attending to these changes in the Vital Plan is part of my government program,” Pierluisi Urrutia said at a press conference, together with the Secretary of the Department of Health, Carlos Mellado López. , and the executive director of the Health Insurance Administration (ASES), Edna Marín.

Among the main changes in the model, an increase in fees for medical specialists and health professionals from 70% to 80% of the “Medicare Fee Schedule” stands out. While the Medicare rate will be increased to 100% for the following subspecialties: neonatologists, neurologists, psychiatrists, orthopedic surgeons, rheumatologists, otorhinolaryngologists, cardiovascular surgeons, among others.

On the other hand, an additional increase of 5% will be applied to the more than 70 hospitals in Puerto Rico. This increase represents approximately $102 million between the 5% increase retroactive to October 2021 plus an additional 5% to January 2023. Also, billing methods are simplified, reducing from 72 forms of payment to 11.

“The total premium increase for 2023 will be approximately 5% in order to address these increases. This increase in compensation is part of the programmatic commitment that we have been working with the medical class, providers and health professionals, since day one of this administration. These measures, without a doubt, will allow us to retain our medical services professionals and be more attractive to attract those who are outside of Puerto Rico, which will result in better benefits for the Vital Plan participants,” said the Health Secretary.

Other changes in coverage include the pediatric glucometer for ages 0 to 18, mandatory vaccination for adults over 19 years of age, and the elimination of closed insurance networks. The change also provides that those doctors who are contracted by medical groups or IPAs as “staff” receive the proportional adjustment for the provision of services to Vital Plan beneficiaries. Now these networks for doctors will be opened under the concept known as “any willing providers.” The new model maintains the increase that was extended to primary care physicians.

The increase that was extended to primary physicians, that is to say pediatricians, generalists, internists and family physicians, is maintained, which projects a minimum payment of $18 to the primary physician. This is a historical increase in rates.

“This historic rate increase allows doctors who are also contracted under a ‘staff model’ to have their compensation adjusted for the provision of services to vital plan beneficiaries. We recognize that Puerto Rico has a Coordinated Care model and that our primary care physicians are the pillar of service provision, but given the exodus of health professionals, we trust that insurers will be able to manage the services that our population needs with the assigned resources,” Marin said.

In turn, it was reported that MMM insurance company will be in charge of the virtual population made up of approximately 2,800 boys and girls in the custody of the Department of the Family.

“Health is a human right and we will continue working on initiatives that protect the lives of all of us who live on this Island. Therefore, for the benefit of the participants we have developed an application for your mobile phone that will allow you to process your access to the plan from the palm of your hand and have a virtual card,” added the official.

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