P.R. Laws tit. 26, § 3103
Providers, within the area of service of a health care plan, or provider representatives, may voluntarily assemble into groups according to specialty or geographical area. Groups or corporations authorized to engage in collective bargaining are not to exceed twenty percent (20%) of providers for such a specialty or service in said geographical area, which areas shall be defined by the Department of Health, with the advice of the Antitrust Affairs Office of the Department of Justice. Provided, however, That hospitals may only negotiate as individual corporations. These groups or corporations shall be authorized to engage in collective bargaining for the following terms and conditions in their contracts with third-party administrators and health services organizations:
(1) Fees and rates for health care services;
(2) guidelines on clinical practice and coverage criteria;
(3) administrative procedures, including methods and time of service for the payment of providers’ fees;
(4) proceedings for the resolution of controversies relative to disputes between health services organizations and providers concerning health care plans;
(5) subscriber referral procedures;
(6) establishment and application of methods to reimburse providers;
(7) quality assurance programs;
(8) reviewing procedures for the use of health care services;
(9) selection of providers in terms of health care plans and the criteria for terminating a contract, and
(10) the inclusion or alteration of the terms and conditions, to the extent these are subject to the regulations of the Government of Puerto Rico, prohibiting or requiring the particular term or condition in question; provided, however, that the aforementioned condition does not abridge the rights of providers to jointly petition that the Government of Puerto Rico modify regulations.
History —Ins. Code, added as § 31.030 on Aug. 8, 2008, No. 203, § 1, eff. 90 days after Aug. 8, 2008.