With this change, the Department of Health will be in charge of the administration of the Government Health Plan (PSG, Spanish acronym), now known as Vital. (GFR Media)

Health Secretary Rafael Rodríguez Mercado said yesterday that if the Legislature approves the elimination of the Health Insurance Administration (PRHIA), as requested by the U.S. government, this public corporation could close in just a few months.

With this change, the Department of Health will be in charge of the administration of the Government Health Plan (PSG, Spanish acronym), now known as Vital. This agency already manages Medicaid funds for Puerto Rico which finance much of the so-called health reform.

The official explained that this is not the only requirement for federal funds management that has been imposed on the island following a public corruption case that, in mid-June, led to the arrest of former PRHIA director Ángela Ávila, BDO consultant Alberto Velázquez Piñol and Fernando Scherrer Caillet, a former executive at BDO Puerto Rico. Since the arrests, Yolanda García is PRHIA´s current deputy director.

The elimination of this public corporation was proposed in Senate Bill 1437 by Senate President Thomas Rivera Schatz at the request of the Department of Health. The measure is expected to be discussed in public hearings where Rodríguez Mercado, who also chairs PRHIA's board of directors, will also speak. House Health Committee Chairman Juan Oscar Morales expressed reservations about the measure.

The Health Secretary explained that, in addition to the elimination of PRHIA, the U.S. government will be overseeing contracting processes associated with Vital, and will conduct a forensic audit on the use of federal funds and will also add new safeguards to the ones that already exist.

For the official, this change will not necessarily affect services to the system participants but will simply seek to eliminate some of the bureaucracy in the system.

"It was a suggestion, almost a requirement...They imposed many restrictions on the funds and one of the things they are asking us is to merge that corporation with Medicaid," Rodríguez Mercado said in a press conference at La Fortaleza, in which he announced - along with the Education Department and the Swiss food company Nestlé - an educational campaign to combat childhood obesity in Puerto Rico.

"Right now, we are conducting the study about what PRHIA has, what can be swiftly merged, and once we have that, CMS has to certify those processes as well... We already had a conversation and there will be people coming with CMS (the Centers for Medicare and Medicaid Services) and they are going to also participate in that process. We don't want to do something that CMS doesn't certify," said the Secretary of Health.

Before these changes, the U.S. government had demanded the creation of an anti-fraud unit to specifically handle cases associated with Medicare and Medicaid programs, an issue that arose by the end of 2018. Similarly, another change was to establish a Medicare Management Information System (MMIS) on the island to identify irregularities in the system.

This last requirement, Rodríguez Mercado said, allows the government to verify the services that medical service providers bill their patients.

Rodríguez Mercado explained that in 1993 when the health system began to change, it was decided to create a public corporation that would be in charge of hiring and overseeing those private medical plans that would be offering their services to medically indigent patients. According to Rodríguez Mercado, such a public corporation does not exist in other U.S. jurisdictions.


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