P.R. Laws tit. 26, § 9355
Any health insurance organization or issuer that provides managed care plans shall develop and maintain the infrastructure and disclosure systems necessary to measure the quality of healthcare services provided to covered person or enrollees or enrollees on a regular basis and appropriate to the types of plans offered by it. For such purposes, a health insurance organization or issuer shall:
(a) Establish a system designed to assess the quality of healthcare services provided to covered person or enrollees or enrollees. Such system shall be appropriate to the types of plans offered by the health insurance organization or issuer.
(b) Communicate the findings of the quality assessment and improvement program in a timely manner to applicable regulatory agencies, including the Commissioner, providers and consumers, as provided in § 9358 of this title.
(c) Report to the applicable regulatory agencies, including the Commissioner, any persistent pattern of problematic care provided by a provider that is sufficient to cause the health insurance organization or issuer to terminate or suspend contractual arrangements with such provider. A health insurance organization or issuer shall not be held liable, for complying with the duties imposed onto it by this provision.
(d) File with the Commissioner in the prescribed format a description of the quality assessment program, which shall include a signed certification by a corporate officer of the health insurance organization or issuer that the filing meets the requirements of this chapter.
History —Aug. 29, 2011, No. 194, added as § 20.050 on Aug. 23, 2012, No. 203, § 4, eff. 90 days after Aug. 23, 2012.