Puerto Rico’s Attempts to Address a Public Health Crisis Struck Down by the United States Court of Appeals for the First Circuit

Abstract

This RCD discusses a recent decision by the United States Court of Appeals for the First Circuit that struck down Puerto Rico's Act 90-2019, which aimed to regulate pay structures for Medicare Advantage insurers in Puerto Rico. The court found that the provision in Act 90, known as the "Mandated Price Provision," is preempted by federal law. However, the author argues that the court's decision did not adequately consider the congressional intent of the Medicare Advantage Act in weighing the public health crisis in Puerto Rico. The RCD provides background on the Medicare Advantage program and Act 90 and explains how Act 90 aimed to eliminate insurers' practice of paying providers at rates below the CMS's minimum reimbursement rates under the traditional Medicare program. The article concludes that the court's decision inadequately considered the larger purpose of the Medicare Advantage Act and the relevant public health crisis in Puerto Rico.