ASES gets OK from CMS for contracts with ‘MI Salud’ health insurers
The Health Insurance Services Administration, or ASES, which runs the Health Reform program for the medically indigent, announced it has received the approval from the Centers for Medicare and Medicaid Services for contracts with insurers that manage the government’s health plan and corresponding policies for the current fiscal year.
The validity of the contracts signed is extended retroactively from July 1, 2017 to June 30, 2018 and are independent of the process of implementation of the new ‘MI Salud’ that was recently model announced, ASES Executive Director Ángela Ávila said.
“After almost a year of an arduous negotiation process, we received the authorization to legally award the contracts with the ‘MI Salud’ insurers, complying fully with the standards established by the federal government and the financial projections of the current fiscal year,” said Ávila.
Avila was emphatic in explaining that “this contract approved by CMS is for the current fiscal year and that it does not interfere in the process of requesting proposals of the new ‘MI Salud’ model.”
The official attributed the delay in receiving CMS’ approval of the financial information to the federal government’s increased rigor in the review processes and the devastating impact of the passage of Hurricanes Irma and María. The signing of contracts with insurers took place last December.
Among the achievements of the new contract, Ávila highlighted that ASES managed to include for the first time, a language in the contract with insurers that establishes a mechanism to mitigate the impact in ‘MI Salud’ of changes in the beneficiary population as a result of the migration to other jurisdictions in the United States.
ASES created the new mechanism with the objective of ensuring that the premium payment negotiated with insurers reflects more accurately the number of beneficiaries residing in Puerto Rico.