P.R. Laws tit. 24, § 3561
For purposes of this chapter, the following terms shall have the meaning stated below:
(a) Autism.— Neurodevelopmental disorder, as defined in the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) TR or current edition, with a typical onset in the first three (3) years of life. Persons with autism show symptoms related to the qualitative impairment in social interactions or patterns, qualitative impairments in communication, and repetitive and stereotyped patterns of behavior. It causes severe and significant impairment in cognitive development, thought process, sensations, language, and the ability to develop social relationships, all of which continue to manifest and worsen throughout life. Persons who have this disorder have learning, attention, development and social interaction, sensorial, and emotional difficulties. Moreover, they have stereotyped and unusual ways to react to social interactions.
(b) Assessment.— Process designed to identify children who are at risk of developing or have a delay in their development or an impairment. Any person who has been so identified should undergo specific tests and evaluations leading to an accurate diagnosis of the disorder.
(c) Autism spectrum disorder.— Neurodevelopmental disorders that may have an onset in the first three (3) years of life and persists throughout life. Clinical patterns of these disorders vary according to the degree of severity. Autism Disorder, Rett’s Disorder, Childhood Disintegrative Disorder, Asperger’s Disorder, and Pervasive Developmental Disorder are included within Autism Spectrum Disorders, according to diagnostic criteria.
(d) Care coordination.— Assistance and/or support provided for persons with Autism Spectrum Disorders and their families, including planning, coordination, location, access availability, and monitoring of services and assistance as are necessary to improve the quality of life and achieve an optimum level of participation in the community.
(e) Coverage.— Services included in the healthcare insurance coverage.
(f) Ludic sports.— Movement and sensorial activities performed during free time, suitable for all persons, according to their physical condition and age, that are performed in accordance with his/her developmental stage.
(g) DSM (Diagnostic and Statistical Manual of Mental Disorders).— Diagnostic manual and guidelines used by healthcare professionals to diagnose autism spectrum disorders as defined in its latest edition.
(h) Asperger’s Disorder.— A disorder similar to Autistic Disorder. Persons with this disorder manifest a normal intelligence and show no significant delay in language and cognitive development; however, they have difficulty with social interactions, use idiosyncratic language, have difficulty understanding symbolic or abstract language, humor or jokes, and have eccentric behavior.
(i) Rett’s Disorder.— Genetic disorder that, after an apparently normal development, has an onset between age 5 and 48 months manifesting severely impaired expressive and receptive language development with severe psychomotor retardation, loss of social engagement early in the course of the disorder and pervasive developmental disorder, not otherwise specified. It is characterized by stereotyped movements.
(j) Childhood disintegrative disorder.— Disorder that manifests before age 10, after an apparently normal development. It is characterized by the loss of communication and social interaction skills, stereotyped movements, and compulsive behavior.
(k) Pervasive developmental disorder, not otherwise specified.— Disorder diagnosed when the symptomatology does not meet the minimum or specific criteria for autism spectrum disorder, but some typical traits or characteristics are present.
(l) Education.— Process geared toward facilitating and broadening the continuous and multidimensional development of human beings, for the purpose of improving the potential and capabilities of persons to the fullest, so that they are able to live in harmony within their environment. In terms of education, this public policy seeks to provide persons with autism spectrum disorder with the proper environment and quality of education that takes into account their strengths and works toward satisfying their needs as part of a process whereby the functional capabilities of such persons are developed according to their different learning levels and styles.
(m) Interdisciplinary team.— Group of service providers composed of three (3) or more health professionals from different fields including, but not limited to: one (1) psychiatrist, one (1) clinical psychologist, and one (1) physician, together with therapeutic service providers, to wit: occupational therapists, physical therapists, speech-language pathologists, case managers, and teachers, who provide broad healthcare services based on the best practices of diagnosis and treatment of the different functions and capabilities of human beings; and other professionals with jurisdiction over autism spectrum disorder, as well as the person with autism spectrum disorder and his/her family. The team stands out for its consensus work which is characterized, among other things, by the interaction of all professionals with respect to interventions and case discussion, promoting full knowledge of the contributions made by each profession or discipline, as well as the best practices of each field for the benefit of patients and their families. The constitution and leadership of this team shall be subject to the scenario or rendered service, as well as the clinical and social needs of the person.
(n) Medical home.— Team-based model of delivering healthcare services by forming partnerships between the primary physician and other professionals and the patient’s family in order to provide healthcare services. It is originated in a primary care facility and offers family-centered services characterized by continuous, comprehensive, coordinated, accessible, sensible, and culturally sensitive.
(o) Medically necessary.— Any care, treatment, intervention, service, or issue that shall or is reasonably expected to produce any of the following results: prevent the development of an illness, disease, injury, disorder, or disability; reduce or improve physical, mental, and developmental effects of an illness, disease, injury, disorder, or disability; manage a critical illness; help to achieve or maintain maximum functionality to perform daily activities.
(p) Healthcare insurance.— Any healthcare policy, contract, agreement, person, or company that provides healthcare coverage to third-parties, whether through an individual or group policy.
(q) Healthcare service provider.— Any physician, hospital, primary care centers, diagnostic and treatment centers, dentists, laboratories, pharmacies, emergency medical and pre-hospitalization services, medical equipment provider, or any other person authorized in Puerto Rico to provide healthcare services.
(r) Secretary.— The Secretary of the Department of Health of Puerto Rico.
(s) Transition.— Group of coordinated activities for a person with an autism spectrum disorder, which are geared to attaining goals, and promote the progress throughout each of the different stages. It begins from childhood at preschool age and carries on through after-school activities, including postsecondary education, vocational training, integrated employment (including sustained employment), adult education, independent life services, and community participation. This group of coordinated activities is based on the individual needs of persons with an autism spectrum disorder taking into account the strengths, preferences and interests, community resources, job-related development, and other objectives for after-school life and the development of new skills for everyday life.
History —Sep. 4, 2012, No. 220, § 3.