P.R. Laws tit. 24, § 6164
The treatment of persons with substance-related disorders, including comorbid conditions diagnosed, who suffer from substance or alcohol dependency, shall require the intervention of an interdisciplinary team constituted by mental healthcare professionals, as determined by the study of the individual case conducted initially by the primary-care physician and the psychologist, in consultation with the psychiatrist, if the diagnosis so indicates. All interdisciplinary team physicians and clinicians shall have completed a specialty or continuing education in addiction issues. The therapeutic value of the intra-hospital detoxification process shall be assessed by the psychiatrist and the interdisciplinary team, vis-à-vis the first intoxication episodes, the physical condition, and the mental state of the person at the time of requesting such service.
Such treatment may include, but is not limited to the following:
(1) The adequate matching of the level of treatment with the patient’s individual needs.
(2) Such treatment shall be readily accessible, assure integration and continuity as to the various levels of treatment, and be reasonably located in each municipality of the Island.
(3) Such treatment shall accord flexibility and be based on ongoing assessments of the patients’ needs, which might change during the course of treatment.
(4) Treatment shall be integrated into one (1) or more levels, and may last no less than six (6) months of treatment, after a follow-up and lastly, an indefinite maintenance. Premature abandonment of the treatment shall be avoided.
(5) The multiple kinds of individual, family and group psychotherapy may be combined with pharmacotherapy, strategies to prevent relapses, and spiritual guidance, among others.
(6) Treatment shall have scientific foundations and shall include periodic evaluations of its effectiveness. The adequate use of medications prescribed by a psychiatrist shall not be limited.
(7) The rule-rather than the exception-shall be that persons who present two (2) or more psychiatric diagnoses, including substance and/or alcohol dependency, shall have all of their conditions treated concurrently.
(8) Detoxification shall be seen as the first stage in the treatment for the disease and shall be followed by an intensive treatment to avoid relapses.
(9) Drug use shall be monitored on an ongoing and periodical basis, including the use of alcohol and other controlled substances, as per the clinical history of the person.
(10) The pharmacological treatment modality, whether or not with agonist medications, shall be understood to be only one among various therapeutic interventions integrated into the treatment of substance- and alcohol-related disorders. Such modality shall not preclude the use of other treatment modalities, such as psychotherapy (whether cognitive, behavioral modification, introspective, or group or family therapy) and other community sustenance interventions, such as spiritual counseling, motivational counseling, vocational counseling, peer supervision, and support groups.
(11) Coordination and referral shall be provided for the evaluation and treatment of related diseases, such as HIV/AIDS, hepatitis, and tuberculosis, and guidance shall be offered to patients so as to prevent their physical deterioration and to prevent other persons from becoming infected.
(12) As pertains to long-term rehabilitation treatment, patients with controlled substance- or alcohol-related disorders shall be separated from other patients who suffer only from psychiatric disorders. Groups shall also be separated according to age and gender, as set forth in this chapter. Persons who present comorbid disorders relative to controlled substance and/or alcohol abuse or dependency, as well as any other psychiatric diagnoses, shall have all their conditions treated concurrently.
(13) As to for-profit or nonprofit community-based organizations that provide treatment to persons with substance- and/or alcohol-related disorders, spiritual-pastoral guides and/or counselors, among others, may be constituents of the inter- or multidisciplinary team.
(14) The cases of children and adolescents with substance- and/or alcohol-related disorders shall be evaluated and treated by a child and adolescent psychiatrist with up-to-date continuing medical education or a psychiatric specialty in addiction issues, in consultation with an interdisciplinary team, whose members shall also keep abreast of the continuing education pertaining to their professions. In the absence of these professionals, a psychiatrist or a physician may carry on to conduct the evaluation and treatment until consultation with a sub-specialist is practicable.
(15) Care for pregnant women with substance- or alcohol-related disorders shall include special measures as their condition dictates, taking into account the welfare of the unborn baby and the foreseeable medical needs in relation to the birthing.
(16) Care for persons under placement (whether in correctional institutions of any level, hospitals, service or treatment or live-in centers, for-profit or nonprofit community-based organizations, or through any other restrictive treatment or confinement) shall take into account the planning and coordination of ongoing services to be offered in the community in the course of deinstitutionalization or in the discharge plan.
Provided, That cases strictly about controlled substance and/r alcohol dependency or abuse, the indirect mental healthcare service provider shall be under the obligation to cover the following benefits, insofar as medically warranted:
(1) Hospitalization for thirty (30) days during the policy year.
(2) A maximum of fifteen (15) visits to the psychiatrist.
(3) A maximum of fifteen (15) therapy sessions facilitated by a psychologist.
Health plans shall cover live-in treatments at a rate of ninety (90) days per policy year, insofar as medically warranted and as the services are available in Puerto Rico.
History —Oct. 2, 2000, No. 408, § 13.01; Aug. 6, 2008, No. 183, § 63.