P.R. Laws tit. 24, § 7073
In order to comply with the provisions of this chapter and the payment of services, the following shall be required:
(a) The insurance policy, whether public or private, shall only cover one (1) surgery for life in Puerto Rico, if the services are available.
(b) The treatment plan shall be approved by a physician specialized in bariatric medicine or bariatric surgery. The treatment plan shall include the written consent of the patient to comply with the treatment, including the psychological protocol and specify the risk, complications, and benefits of bariatric surgery, as well as long-term changes in lifestyle to be made by the patient.
(c) In order to obtain preauthorization by the insurance company, health services organization or health maintenance organization, as defined in subsection (x) of Section 1 of Act No. 101 of June 26, 1965, as amended [sic], the first treatment for morbid obesity shall be dieting and a change in lifestyle. The physician shall document the previous diet plan and the causes for failure thereof. In addition, the physician shall specify whether the patient has conditions that worsen due to morbid obesity, such as cardiovascular or cardiopulmonary diseases, severe diabetes, arthritis, and sleep apnea.
(d) As to the health facility in which the surgery shall be performed:
(1) It must be accredited by the Joint Commission and one (1) of the following: the American College of Surgeons or the American Society for Metabolic and Bariatric Surgery.
(2) It must have a bariatric program [which has been] operating consecutively [sic] during the preceding (12) twelve months.
(3) It must count on an institutional medical team available [twenty-four hours a day, seven days a week] (24/7) to respond to clinical events, which shall be composed of, without being limited to: a bariatric surgeon, intensivists, physicians specialized in critical care, anesthesiologists, nephrologists, and emergency physicians, in addition to nursing staff for outpatients and inpatients, who are trained in the management of morbidly obese and bariatric patients.
(4) It must have the equipment and tools for the care of morbidly obese patients, including: adapted beds, wheelchairs, operating room table, radiological facilities (CT scanner >350 lbs.; lift equipment with capacity for >450 lbs.) and surgical instruments.
(5) It must have an in-house ambulance service or a service contract with a company having ambulances equipped to serve the bariatric population.
(6) It must have written protocols for all cases involving bariatric patients, selection criteria of the patients for the program and the Committee in charge of administering said criteria, post-surgery rehabilitation services, support groups, follow-up plans, and patient education.
Automated quality programs to compile, analyze and keep data related to the Bariatric Program. — The Department of Health shall establish by regulations the information and indices that are to be compiled, which shall include patient satisfaction surveys; mortality rates; number and rate of patients who require a second surgery within thirty (30) days after the first bariatric surgery is performed; the number and rate of patients who are readmitted within thirty (30) days of the bariatric surgery; average hospital stay after the initial bariatric surgery; complications arisen within thirty (30) days as of the bariatric surgery; patients [maintain] more than fifty percent (50%) of their weight loss for two (2) or more years after the surgery.
History —Aug. 9, 2008, No. 212, § 3, eff. 90 days after Aug. 9, 2008.