P.R. Laws tit. 26, § 9358
(a) As specified below, every health insurance organization or issuer shall document and communicate information about its quality assessment program and quality improvement program, if it has one, and shall:
(1) Include a summary of its quality assessment and quality improvement programs in marketing materials;
(2) include a description of its quality assessment and quality improvement programs and a statement of patient rights and responsibilities with respect to those programs in the certificate of coverage or handbook provided to newly enrolled covered persons or enrollees, and
(3) make available once (1) every year to providers and covered persons or enrollees the findings from its quality assessment and quality improvement programs and information about its progress in meeting internal goals and external standards, where available. The reports shall include a description of the methods used to assess each specific area.
(b)
(1) A health insurance organization or issuer shall certify to the Commissioner annually that its quality assessment program and quality improvement program, along with the materials provided to providers and consumers in accordance with subsection (a) of this section, meet the requirements of this chapter.
(2) A health insurance organization or issuer shall make available for review by the public upon request, subject to a reasonable fee, the materials certified in clause (1) of this subsection, except for the materials subject to the confidentiality requirements of § 9359 of this title, and materials that are proprietary to the health plan. A health insurance organization or issuer shall retain all certified materials for at least three (3) years from the date the material has been used or until the material has been examined as part of a market conduct examination, whichever comes first.
History —Aug. 29, 2011, No. 194, added as § 20.080 on Aug. 23, 2012, No. 203, § 4, eff. 90 days after Aug. 23, 2012.