Sanctioned law that obliges the plan to cover treatment outside the ANS list

Sanctioned law that obliges the plan to cover treatment outside the ANS list
Sanctioned law that obliges the plan to cover treatment outside the ANS list

President Jair Bolsonaro sanctioned this Wednesday, 21, the bill that ends the limitation of procedures covered by health plans, the so-called taxing role of the ANS, responsible for the regulation of private sector operators. Law 14.454/22 was published in the DOU and is already in force.

According to the ANS, the exhaustive list is a list of health procedures, approved by means of an agency resolution and periodically updated, which includes exams and treatments with mandatory coverage by health plans, according to the plan’s assistance segmentation.

The text had been unanimously approved at the end of August by the Federal Senate, coming from the Chamber of Deputies. The issue came to the National Congress after a decision by the STJ, in June, which released health plans from paying for treatments, exams and medicines not provided for by the ANS. Before that, cases outside the list used to be resolved in court.

According to the Federal government, the sanction of the law seeks to prevent the discontinuation of medical treatments, especially for those who suffer from rare diseases.

According to the text, for the health plan to be obliged to cover a certain treatment, it is necessary that it has proven effectiveness; be recommended by Conitec – National Commission for the Incorporation of Technologies in the SUS or by a specialized entity of international renown.

Another change brought by the law is the provision that now determines that legal entities governed by Private Law that operate health care plans are also subject to the provisions of the Consumer Defense Code.

Enacted law that obliges the plan to cover treatment outside the ANS list.(Image: Freepik)

Brazil in the opposite direction

THE FenaSaúde regretted the sanction of PL 2033/22.

“The change puts Brazil against the world’s best practices for evaluating the incorporation of medicines and health procedures, makes it difficult to properly price plans and compromises the predictability of care expenses, which can lead to high monthly fees and mass expulsion of beneficiaries of supplementary health.”

The entity also warned that such a measure could further impact the financial situation of the sector. Finally, he said that he considers resorting to the Judiciary.

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LAW No. 14,454, OF SEPTEMBER 21, 2022

Amends Law No. 9,656, of June 3, 1998, which provides for private health care plans, to establish criteria that allow the coverage of health exams or treatments that are not included in the list of procedures and events in supplementary health .

THE PRESIDENT OF THE REPUBLIC

I make it known that the National Congress decrees and I sanction the following Law:

Art. 1 This Law amends Law No. 9,656, of June 3, 1998, which provides for private health care plans, to establish criteria that allow the coverage of health exams or treatments that are not included in the list of procedures and events in supplementary health.

Art. 2nd Law No. 9,656, of June 3, 1998, becomes effective with the following changes:

“Art. 1º Legal entities governed by private law that operate health care plans are subject to the provisions of this Law, without prejudice to compliance with the specific legislation that governs their activity and, simultaneously, with the provisions of Law No. 8,078, of 11 of September 1990 (Consumer Defense Code), adopting, for the purposes of applying the rules established herein, the following definitions:

………………………………………………………. ………………………………………………………. ………………….” (NR)

“Article 10. …………………………………………… ………………………………………………………. ……….

………………………………………………………. ………………………………………………………. ………………………………………

§ 4 The breadth of coverage in the scope of supplementary health, including transplants and highly complex procedures, will be established in a rule edited by the ANS, which will publish a list of procedures and events in supplementary health, updated with each incorporation.

………………………………………………………. ………………………………………………………. ………………………………………

§ 12. The list of procedures and events in supplementary health, updated by the ANS with each new incorporation, constitutes the basic reference for private health care plans contracted as of January 1, 1999 and for contracts adapted to this Law and sets health care guidelines.

§ 13. In the event of a treatment or procedure prescribed by a physician or dental assistant that is not included in the list referred to in § 12 of this article, coverage must be authorized by the health care plan operator, provided that:

I – there is evidence of effectiveness, in the light of health sciences, based on scientific evidence and a therapeutic plan; or

II – there are recommendations from the National Commission for the Incorporation of Technologies in the Unified Health System (Conitec), or there is a recommendation from at least 1 (one) health technology assessment body that is internationally renowned, provided that they are also approved for their nationals.” (NR)

Art. 3 This Law enters into force on the date of its publication.

Brasilia, September 21, 2022; 201st of Independence and 134th of the Republic.

JAIR MESSIAH BOLSONARO

Marcelo Antonio Cartaxo Queiroga Lopes

Tatiana Barbosa de Alvarenga

The article is in Portuguese

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