Qualifying Medical Treatment Rule

The medical treatment exemption allows days spent outside Puerto Rico (including in the US) for qualifying medical reasons to still count as days present in Puerto Rico. This includes time spent accompanying a close family member receiving care.

To qualify under this rule, the medical treatment must:

• Treatment must be supervised by a physician.
• Address an illness, injury, impairment, or physical/mental condition.
• Involves inpatient care, which includes an overnight stay in a hospital or similar facility.

Additional eligibility: Any period immediately before or after inpatient care in a hospital may also qualify, but only if it is medically necessary.

Documentation You Must Keep:

• Patient’s name and relationship to the taxpayer.
• Name and address of the medical institution where the treatment was provided.
• Physician’s name, address, and phone number who provided the medical treatment.
• Dates on which the medical treatment was provided.
• Receipts of payment for the treatment.
• Certification signed by the physician confirming:
  • Patient’s name.
  • A reasonably detailed description of the medical treatment provided by (or under the supervision of) the physician.
  • Dates care was received.
  • A reasonably detailed description of the medical treatment provided by (or under the supervision of) the physician.

Important Note: There are no IRS cases specifically addressing high-risk pregnancies with this exemption. Therefore, to claim that your stay during this period will not be treated as days spent in the US, the documents described above must be obtained and relied upon.

30-Day Constructive Presence Rule

This rule, issued under preliminary IRS regulations, allows up to 30 days of travel outside both Puerto Rico and the United States to be treated as days spent in Puerto Rico.

In summary:

• You will be considered physically present in PR for any day (up to 30 days per year) outside of both PR and the US for business or personal travel.
• This applies only if you are in PR for more days than in the US (without including these 30 days).
• Applies to tax years starting in 2015 and onward.

If your target is to meet the 183-day rule using the 30-day constructive presence rule, you must spend at least 153 days in Puerto Rico in 2025, and spend less than that amount of days in the US.

Physical Presence Tests: More Than Just the 183-Day Rule

The 183-day rule is not the only way to meet the physical presence requirement. Other ways you may qualify in 2025 include:

• Spending no more than 90 days in the US in the calendar year (with or without the medical exemption).
• Having no significant connections to the US in 2025, meaning:
  • No permanent home in the US.
  • Not registered to vote in the US.
  • No spouse or dependent child with a principal home in the US.

Bottom Line

These rules can significantly affect how your days are counted for Puerto Rico’s tax residency tests, but they require careful planning and complete documentation. Make sure you maintain the required records and understand which physical presence test you are relying on for each tax year.