ACA and State Insurance Fund outline faster payments, online claims and major premium proposals ahead of transition

Noé Marcano Rivera, director ejecutivo de la Administración de Compensación por Accidentes (ACA), told Puerto Rico’s transition committee that the agency has moved to single‑payment settlements for eligible claimants and modernized billing, cutting provider payment times to about nine to 12 days.

“Our mission is to reduce the devastating effects of traffic accidents on Puerto Rican families, ensuring injured people and their dependents have medical care and the economic backing they need,” Marcano said, describing a shift from a weekly stipend system to one‑time settlement payments for qualified beneficiaries.

Marcano and the administrator of the Corporación del Fondo del Seguro del Estado reported several operational changes they said improved access and provider relations: an online claims filing platform implemented with PRix that allows citizens to submit a claim remotely; prompt electronic payment for providers; and an expanded ambulance network now counting more than 70 providers across the island, including municipal units.

The ACA also introduced optional premium tiers for vehicle registration: a mandatory base ACA charge of $35 remains, while customers can choose $50 or $70 tiers for higher coverage. Marcano said the new voluntary tiers generated roughly $5 million in additional annual revenue and increase lump‑sum compensation to families in fatal or severe injury cases (examples cited: a $50 tier yields up to $70,000; the $70 tier up to $92,000 plus a $8,000 funeral benefit).

At the Corporación del Fondo del Seguro del Estado, officials highlighted employer incentives and digitalization: a temporary 50% incentive for small and medium employers to reduce the premium burden, online wage and payroll filings for employers, and a proposed project before the Fiscal Oversight Board to reclassify nearly 190 job classifications. If the classification plan proceeds as presented, Marcano said roughly 150 classifications could receive reductions between 0% and 40% and that the projected cost of those premium reductions could be “casi cien millones de dólares” in foregone premium revenue.

Committee members pressed agency officials on outstanding accounts receivable and audit risks. Marcano acknowledged “veintinueve millones y pico” in accounts receivable tied to statutory exclusions and said the agency expects to recover nearly $3 million by June 30 under the new collection program that uses liens on vehicle registrations and driver’s licenses.

Lawmakers also asked about backlogs of unpaid provider invoices and service interruptions. The fund’s representative said the agency addressed a large share of legacy arrears (estimating they had paid about 60–70% of certain outstanding medical supplier debts) and plans to replace recurring payment agreements with formal contracts where appropriate.

The committee queried the fund about COFARMA, the cooperative network contracted to manage pharmacy supply and dispensing. Officials said the COFARMA contract—approved by the Fiscal Oversight Board for $14 million—had used about $4 million to date and was extended one year to avoid service disruption while a competitive procurement and possible segregation of PMB and pharmacy operations are carried out. The administrator confirmed a cyberattack affected the company that supplies the pharmacy application and that for a period billing was processed manually while the vendor restored systems.

On infrastructure, officials said structural assessments showed the fund’s former San Francisco site is unsuitable for reconstruction because of ground instability; demolition and rebuild there were estimated at roughly $80 million and five to six years of work, so the fund pursued acquiring another property for a central office instead.

The agencies provided a series of follow‑up items and promised written materials requested by committee members, including listings of outstanding audits, a breakdown of receivables and documentation on contracts with COFARMA and other major suppliers. The transition committee scheduled further executive‑level follow‑ups to clarify points raised in written communications to the panel.

What’s next: officials said some proposals (notably the premium‑reclassification project) require approval from the Fiscal Oversight Board before taking effect; the committee requested data and legal workpapers to evaluate fiscal impacts and operational continuity for the incoming administration.