Rising costs and the increase in population make the Federal ceiling unrealis tic. The $17 per capita appropriation authorized since 1966, should be readjuste accordingly. The cost of health insurance in Puerto Rico has followed a trend similar t that in the U.S. mainland. A Blue-Shield type health insurance plan in Puert Rico (triple S) offered a policy for $15.00 per month for a family of five in 1964 Such a policy, for a low middle class family will cost twice as much now. One o the most important factors for the increase is the application to Puerto Ric in recent years, of Federal minimum wages for hospital employees. The Department of Health has some limited experience in the purchase hospital services from private hospitals under the crippled children's program Table I shows the rise in hospital rates under such program in Puerto Rico du ing the last six years. The 1967 amendments to Law 89-97 make it mandatory for Puerto Rico to pr vide free choice of physicians, hospitals, dental and pharmaceutical services all those (1.2 million) beneficiaries under the title XIX program by 1972. Puer Rico is anxious to implement the free choice provision. This will be another ste in our goal for equality of service, in private and public medicine. We cannot achieve this objective, however, without additional Federal su port. With $17 per capita annual Federal share we cannot purchase health i surance for title XIX beneficiaries. The cost of an insurance policy is about $10 per person per year. We have been trying to keep all our commitments with the Federal Gover ment as stated in our medical assistance plan under title XIX. It is interestin to note that through the implementation of Puerto Rican law 56 of 1969, (appe dix A), we will have complied with practically all the recommendations of t evaluation team of the title XIX program which visited Puerto Rico in 196 Its recommendations were forwarded to Dr. Ellen Winston, ex-Commissioner Welfare. We have not been able to comply with the free choice provision, and we ha serious doubts that we might be able to do so by 1972 so long as a ceiling of $ per person in Federal aid continues in force. We respectfully request, that as first step in tackling this problem, the Federal Government, in recognition the real needs of Puerto Rico and of the real effort we are making to achie the national goal, eliminate the ceiling so that we obtain a 50-50% matching the monies that we can contribute to our program. The national Governors Co ference has approved a resolution, requesting that the 20,000,000 ceiling f Puerto Rico be removed. (See table II) Puerto Rico needs Federal aid to continue developing its health services on experimental basis and to continue to explore ways of integrating public a private medical care, while retaining the best of the structure and values both systems. It is conceivable that experimentation in the organization and delivery health services in Puerto Rico could be of value to agencies concerned w medical care organization in the mainland. TABLE 1.-INCREASE IN COSTS OF HOSPITAL SERVICE CONTRACTS BETWEEN DEPARTMENT OF HEALTH AND PRIVATE HOSPITALS-CRIPPLED CHILDREN'S PROGRAM TABLE 2.-DEPARTMENT OF HEALTH OF PUERTO RICO APPROPRIATIONS FOR HEALTH SERVICES AND AMOUNTS SUBJECT TO FEDERAL MATCHING UNDER TITLE XIX Proportion of expenditures applicable to eligible persons under title XIX (70 percent). 19, 373, 659 78,087,941 1,561,759 2, 342, 638 3,904, 397 20,000,000 101, 992, 338 71, 394, 636 35,697, 318 AN ACT To establish an integrated system of medical-hospital assistance in the Commonwealth of Puerto Rico, within which all persons, independent of their economic conditions, race, color, origin, religion or political creed, may request and receive medical-hospital assistance from any person, agency, organization and institution authorized by law to render such services within the system STATEMENT OF MOTIVES Puerto Rico, in proportion to its territorial extension, has public and private resources for the developing, maintenance and conservation of the health of the Puerto Ricans, equivalent in its quantity, variety and quality to similar existing resources in the most advanced countries of the world. In spite of all this, these resources are not integrated into a system capable of offering to every Puerto Rican, comprehensive and adequate health services in quantity, quality, variety and duration. Meanwhile, these resources, continue developing and multiplying through separate roads, in need of a common philosophy of service and in an atmosphere teeming with competition and lacking order and efficiency. The moment has arrived of offering a formula which will permit our private and public health resources to become a part of a system capable of absorbing and using the skill and techniques of modern medicine to produce and to plac at the disposal of every Puerto Rican its product, comprehensive health service The integration of these health services resources into only one system be comes a matter of vital urgency since from and after July 1, 1972, and in a cordance with the provision of Section 1902 (a) (23) of the Social Security A of the United States, the Puerto Ricans who are beneficiaries of the healt service under Title XIX of this act, must be guaranteed their rights of reques ing these services from any person or institution authorized by law to rende such services within and without the Commonwealth of Puerto Rico. In orde to comply with this provision of law, it is necessary to modify the public polic in regard to the health of the people and to carry out gradually reorganizatio of the financing, operation and administration of all health resources in Puer Rico. BE IT ENACTED BY THE LEGISLATURE OF PUERTO RICO: Section 1-The Secretary of Health is hereby authorized to use the hospital medical centers, health centers, nursing homes, dispensaries, clinics and oth health institutions, the property of the Commonwealth and its municipalitie to offer medical-hospital assistance in the same quantity, variety and quality every person, independent of his economic condition, race, color, origin, religio or political creed. The Secretary of Health shall establish, with the advice of the Director the Bureau of the Budget and of the medical, dental and paramedical class Puerto Rico, the administrative procedures and systems necessary for: (A) Determining and fixing the reasonable cost of the services of medica hospital assistance in all health institutions, the property of the Commonweal of Puerto Rico and its municipalities. (B) The partial or total payment, as required by each case, of the reaso able cost, as fixed for each health institution, for the services of medical-hospit assistance offered to each person or family whose annual income and oth resources results greater than the one established by the Secretaries of Heal and Social Services, to determine whether persons or families are eligible request and receive these services chargeable to public funds, or that they ha some kind of health insurance. Section 2-The Secretary of Health, with the advice of the Secretary Social Services, shall establish similar standards of application for every pers or family, to determine and promulgate the grade of annual income and oth economic resources under which a person or family will be certified as eligi to request and receive medical-hospital assistance within and without the heal institutions of the Commonwealth and its municipalities, chargeable to pub funds. This eligibility certificate shall be transacted through swift and simp administrative procedures, which might best protect the interest of the reque ing person or family. An annual review shall be made of the resources und which every person or family obtains the certificate. Section 3 The Secretary of Health shall establish, with the advice of t Commonwealth Board of Health, a system of medical audit which will pern to evaluate annually, the quantity, variety, utilization and quality of the se ices of the medical-hospital assistance offered to the public in each heal institution. Section 4 The Secretary of Health, in consultation with the Director of t Bureau of the Budget, shall introduce the administrative procedures for t accounting, deposit and use of the funds collected in each health institution, t property of the Commonwealth and its municipalities, through the charge of t reasonable cost of services offered to persons or families classified under Secti 2 of this Act, as not eligible to receive these services chargeable to public fun The funds collected under this section shall be used, subject to priorities th the Secretary of Health may establish, for the improvement of the salaries of t personnel and of the health services and facilities. The Secretary may contract with the municipalities their contribution for payments of the services given to the residents of the municipality in the Co monwealth hospitals as well as in private hospitals. There shall be accredited contribution of the municipality a proportional fraction of the sums collec within their territorial limits for services given in hospitals, the property of Commonwealth, to the users who were able to pay all or part of the service. Section 5-The medical-hospital services insurance plans and insurance co panies engaged in the sale of medical-hospital insurance in the Commonwea of Puerto Rico, shall be bound to pay to the Commonwealth and to its municip |