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Medicare refund rates for P.R. hospitals to be increased

Resident Commissioner Pedro Pierluisi

Resident Commissioner Pedro Pierluisi

Puerto Rico hospitals will soon begin receiving the same basic reimbursement rate — known as the “base rate” — as hospitals in the U.S. mainland for treating Medicare patients, Resident Commissioner Pedro Pierluisi said Monday.

The action responds to the Consolidated Appropriations Act for Fiscal 2016, enacted in December 2015, included the language of H.R. 1417, or the “Puerto Rico Hospital Medicare Reimbursement Equity Act,” which Pierluisi introduced in March 2015.

“For the first time in the history of the Medicare program, which was established in 1965, Puerto Rico hospitals will essentially be treated the same as hospitals in the states with respect to how they are reimbursed for the services they provide,” he said in a statement.

The Congressional Budget Office estimates that, as a result of this legislative change, Puerto Rico hospitals will receive $618 million more in federal reimbursement payments between 2016 and 2025, an average of over $60 million per year.

The Consolidated Appropriations Act also included the language of H.R. 1225, the “Puerto Rico Hospital HITECH Amendments,” a bill that Pierluisi introduced to make Puerto Rico hospitals eligible for the same bonus payments as hospitals in the U.S. mainland for adopting use of electronic health records.

CBO estimates that this legislative fix will increase payments to Puerto Rico hospitals by $266 million over the next 10 years.

“On Thursday, CMS notified me it has informed Puerto Rico hospitals that increases in their reimbursement rates are forthcoming. Although it will take several months for CMS to fully implement these changes, which require updates to the agency’s computer systems, the changes will be made retroactive to Jan. 1, 2016 — so that Puerto Rico hospitals will receive the higher reimbursement rates for all Medicare patients who are admitted on or after that date,” said Pierluisi.

“Puerto Rico’s hospitals — and the patients they serve — deserve to be treated the same as hospitals in the states, and I am gratified that CMS is implementing the provisions of the Consolidated Appropriations Act that provide equitable treatment to our hospitals and our patients,” he said.

“There is still much work to be done to improve Puerto Rico’s treatment under Medicaid and Medicare, but it is important to acknowledge our accomplishments in this area when they do occur,” Pierluisi noted.

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This story was written by our staff based on a press release.

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