Committee reviews bill to set minimum provider fees for Plan Vital; agencies urge financial study

San Juan — Lawmakers on the House Health Committee heard testimony March 11 on Proyecto de la Cámara No. 2, a proposal to require the Administración de Seguros de Salud (ASES, also referred to in testimony as CES) to set a uniform system of minimum compensation for providers participating in the government health plan known as Plan Vital, including a pharmacy dispensing fee.

The measure would direct ASES/CES to establish minimum payment levels for services such as drug dispensing, laboratory tests and medical devices, require annual statistical reports from insurers to ASES/CES within 90 days of fiscal year close, and authorize the agency to adopt regulations and audits of compensation agreements.

Why it matters: Committee members and agency witnesses said a statutory floor for provider payments could help retain providers and improve access for beneficiaries, but they repeatedly emphasized that any change must comply with federal Medicaid rules and be supported by actuarial and financial studies so the plan remains fiscally sustainable.

Department of Health representative Elisa Muñoz told the committee: "El PDC dos propone modificaciones a la ley ... con el objetivo de mejorar la equidad en la compensación de los proveedores dentro del plan de salud gubernamental." She and other health witnesses said they support the policy aim but that "el éxito de esta medida depende de su viabilidad dentro del marco legal y financiero de Medicaid" and recommended an impact study…