Senate hearing on Proyecto 1314: psychologists urge law to break APS’s grip on mental‑health contracting

The Senate Commission on Community Initiatives, Mental Health and Addiction heard testimony Feb. 21 on Proyecto del Senado 1314, a proposal to amend Section 1 of Article 9 of Ley 72 (1993) to end what witnesses called a monopoly in mental‑health contracting and require insurers to contract directly with a range of providers.

The presiding senator opened the session saying the bill aims to “terminar de acabar con el monopolio en la salud mental” and to require insurers to contract directly with different mental‑health providers and institutions under equal conditions. Testimony that followed described longstanding access problems, structural barriers tied to private plans and a perceived concentration of control in APS (an administrative organization referenced in testimony as APS Health Puerto Rico).

Gerardo López Sánchez, director ejecutivo of the Asociación de Psicólogos de Puerto Rico, and Dra. Malvali Santana of the association told the commission their members face restricted networks, long waits and narrow hiring criteria. Santana said the project’s supporting materials cite an ASEX report as delivered in May, but the association only saw the report in December 2022 after a journalist published it online. “Nunca nos enteramos” that the report had been available earlier, she said, and the timing, the association argued, affects the factual basis for some claims in the bill.

Speakers described three practical pathways patients face depending on their insurer: participants in the government Plan Vital may be held 24 hours in observation before admission to an acute hospital bed; other plans require additional days for approval of partial hospitalizations; and a third class of coverage allows immediate admission. Santana said those differences produce unequal access for people with the same clinical needs.

A recurrent concern was that some plans limit contracting to psychologists with doctoral degrees, excluding clinicians with master’s‑level training (school psychologists, counseling psychologists) and shrinking available networks. Santana and López Sánchez cited a membership survey — reportedly between 500 and 722 respondents — that found a very high share of psychologists were considering emigration for better conditions; the association agreed to provide the commission the survey document for the record.

Witnesses supported the bill in principle but urged lawmakers to clarify how APS would be treated if the law requires insurers to contract directly. “No nos quedó tan claro… cuál va a ser el rol de APS en este proceso,” Santana said, asking the commission to specify whether APS would be allowed to act as a provider while also administering networks and to define the fiscalization mechanisms that would prevent concentration of control.

Commission members pressed for specific, actionable changes to the draft: define contracting terms that prevent closed networks; forbid educational‑level discrimination that would exclude competent master’s‑level practitioners; and establish clear oversight and sanctioning authority to prevent a new monopoly from forming under a different label. The association also pointed lawmakers to related legislation, including Proyecto 967 (mentioned as a draft to raise revalidation to the doctoral level), and recommended a broader review of Ley 96.

The hearing closed with the presiding senator asking the association to submit the cited survey promptly and with an assurance the discussion would continue beyond the single hearing. No vote or formal action on the bill was recorded during the session.

The commission indicated it will consider the association’s written recommendations and requested documentation (survey and related reports) to inform any revisions to Proyecto 1314. The next formal step — scheduling additional hearings or committee markup — was not set on the record at the close of the session.