Program Description

Contracts and negotiates physical, mental, oral health and pharmacy benefit coverage, as established by law, with organizations that are governed by these laws and regulations; known as insurers (MCO's), Mental Health Organizations (MBHO's) and Pharmacy Administrators (PBM). Provides health insurance to qualified government employees, following the direct care model. Currently, the Island has been divided into 8 regions. The organizations that provide health insurance in these regions are: Humana Health Plans of PR (East, Southeast and Southwest), Medical Card System (MCS), (North, Metro-North, San Juan, Northeast and the Virtual Region), physical health care and APS Health Care PR, in mental health (all regions). To offer quality medical services to the population, the Government has developed a new integrated health care model called "Mi Salud." It can negotiate and contract on behalf of government employees.

Statistical Data	2011	2012	2013
Drug Stores	894	890	890
Eligible	1,686,913	1,836,913	1,836,913
Hospitals	31	53	53
Insured	1,583,423	1,633,423	1,633,423
Laboratories	737	540	540
Other	1,786	2,000	2,000
Primary doctors	2,767	2,040	2,040
Specialists	2,764	2,560	2,560

*Note: Primary physician includes: generalists, internists, family physicians, pediatricians and obstetricians /gynecologists. Others include: dentists, x-rays, psychiatric centers and hospitals.
The statistical data was provided by the Agency during the Fiscal Year 2012-2013 budget formulation process.

Customers

The general public

FISCAL YEAR 2012-2013 PROPOSED BUDGET

The proposed consolidated budget for Fiscal Year 2012-2013 is $2,256,874,000. This amount includes $5,660,000 from the Joint Resolution General Fund, $888,739,000 from Special Appropriations General Fund, $285,100,000 from Other Income and $1,077,375,000 in Federal Funds.

Operational expenses reflect a increase of $6,315,000 when compared to the funds assigned in fiscal year 2011-2012. The Administration expects an increase in revenues thanks to income generated from purchasing medication with discounts or rebates.

Resources from the Joint Resolution General Fund will allow the Administration to comply with the faculties and duties established by its Organic Law, specifically the implementation, administration and contract negotiation with suppliers to guarantee citizens access to medical services. An additional Special Appropriation is included for the payment of insurance premiums for the health and mental benefits of the "Mi Salud" program.

Other Income is generated with contributions from the Municipal Income Collection Centers, from rebates, bank interest and from employer contributions for public servants that participate of the "Mi Salud" program.

Contributing federal programs include: Medicaid Title XIX, State Children Health Insurance Program Title XXI and the Prescription Drug Program Payments. There is an increase of $143,348,000 in federal funding. This increment, changes to the eligibility parameters and access to the program via auto enrollment will allow the Administration to include additional 50,000 to 150,000 new participants to "Mi Salud". The auto enrollment process guarantees medical services to those under "Mi Salud" that have been qualified by the Medicare Office. Resources are also included for the payment of insurance premiums for the health and mental benefits of the "Mi Salud" program.