Approved legislation that obligates plans to cover treatment outside the ANS list

President Jair Bolsonaro authorized this Wednesday, 21, a invoice that ends the limits of procedures lined by well being plans, the so-called taxing function of the ANS chargeable for regulating personal sector operators. Law 14.454/22 was revealed in DOU and is already in pressure.

According to the ANS, the full list is a list of well being procedures, authorized by the company’s decision and periodically up to date, together with examinations and coverings with obligatory protection by well being plans, in accordance to the help division of the plan.

The textual content was unanimously authorized at the finish of August by the Federal Senate, coming from the Chamber of Deputies. The subject got here earlier than the National Congress after a choice by the STJ in June, which exempted well being plans from paying for treatment, examinations and medicines supplied by the ANS. Before that, circumstances outside the list have been disposed of in court docket.

According to the federal authorities, the passage of the regulation seeks to stop the withholding of medical treatment, notably for these affected by uncommon ailments.

According to the textual content, for a well being plan to be obligated to cover a specific treatment, it’s needed that its effectiveness be confirmed; Conitech – Recommended by the National Commission for the Incorporation of Technologies in the SUS or a specialised entity of worldwide reputation.

Another change caused by the regulation is a provision that now stipulates that authorized entities ruled by personal regulation that function well being care plans are additionally topic to the provisions of the Consumer Protection Code.

Enacted legislation that obligates plans to cover treatment outside the ANS list.(Image: Freepik)

Brazil in the wrong way

The FenaSaúde Regretted approval of PL 2033/22.

“This change places Brazil in opposition to the world’s finest practices for evaluating the inclusion of medication and well being procedures, makes it troublesome to correctly worth plans and compromises the predictability of care prices, which might lead to excessive month-to-month charges and mass displacement of beneficiaries of complementary well being. “

The entity additionally warned that such a transfer might additional have an effect on the sector’s funds. Finally, he mentioned he plans to resort to the judiciary.

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Law No. 14,454, dated September 21, 2022

Amends Law No. 9,656 of June 3, 1998, which gives for personal well being care plans, to set up standards that enable protection of well being examinations or therapies that are usually not included in the list of complementary well being procedures and occasions.

President of the Republic

I declare that the National Congress decrees and I approve the following legislation:

Art. 1 This regulation of June 3, 1998, Law no. Amends 9,656, which offers with personal well being care plans, to set up standards that enable protection of well being examinations or therapies that are usually not included in the list of complementary well being procedures and occasions.

Art. Second Law No. 9,656 of June 3, 1998, turns into efficient with the following modifications:

“Art. 1º Legal entities ruled by personal regulation that handle well being care plans are topic to the provisions of this regulation, with out prejudice to compliance with particular legal guidelines governing their exercise and, as nicely, to the provisions of Law No. 8,078, 11 September 1990 (Consumer Defense Code), by adopting, for functions of implementing the guidelines established herein, the following definitions:

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

“Section 10……………………………………… .. ………………………………………… ….. ……………………………..

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

§ 4 The breadth of protection in the scope of complementary well being, together with transplants and extremely complicated procedures, can be established in a rule edited by the ANS, which can publish a list of procedures and occasions in complementary well being, which can be up to date with every establishment.

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

§ 12. The List of Complementary Health Procedures and Events, up to date by the ANS with every new incorporation, constitutes the fundamental reference and units well being care pointers for personal well being care plans contracted on January 1, 1999 and contracts pursuant to this regulation. .

§ 13. In the occasion of a treatment or process prescribed by a doctor or dental assistant that shouldn’t be included in the list laid out in § 12 of this text, the protection should be approved by the well being care plan operator, supplied that:

I – in the mild of well being science, there may be proof of effectiveness based mostly on scientific proof and therapeutic plan; Or

II – Have suggestions from the National Commission for Incorporation of Technology into the Unified Health System (CONITEC) or at the least 1 (one) advice from a Health Technology Assessment Body of worldwide reputation, supplied they’re additionally recognised. for his or her residents.” (NR)

Art. 3 This Act comes into pressure from the date of its promulgation.

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

Jair Messiah Bolsonaro

MARCELLO ANTONIO CARTAXO QUIROGA LOPEZ

Tatiana Barbosa de Alvarenga

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