Senate approves bill mandating plans to cover treatments off ANS . list

Senate approves bill mandating plans to cover treatments off ANS . list

On Monday (29) the Senate approved a bill requiring health plans to pay for procedures or treatments not on the National Supplemental Health Agency (ANS) basic checklist, putting an end to the so-called tax role. The text goes to a presidential sanction.

The proposal rescues the model list and establishes that the ANS procedure list serves only as a “basic reference” for health plans. This way, beneficiaries will be able to request coverage for treatments not on the list, as long as they are identified by other agencies or there is scientific evidence.

The bill was approved in early August in the House of Representatives in response to the Supreme Court of Justice (STJ) decision. In June, the court ruled that health plan operators are only obligated to pay 3,368 treatments on the ANS list.

Despite being part of Jair Bolsonaro’s (PL) government base – which was against the proposal – the text’s rapporteur, Senator Romario (PL-RJ), defended the overthrow of the blanket role and maintained the changes approved by MPs.

Romario stated that Sores for Truth and Justice’s decision was “unfair,” and that Congress has, since then, been looking for a solution to end the “legal uncertainty” that resulted.

“Today is a historic day. Unforgettable. A day when Brazilian society mobilizes and defeats the powerful lobby for health plans. A day when the right to life and health will prevail over greed and usury,” the senator said.

In his view, Romario stated that coverage of health plans should “prevent, recover, preserve and rehabilitate health for all diseases included” in the International Statistical Classification of Diseases and related health problems.

“This way, if REPS [Rol de Procedimentos e Eventos em Saúde] It does not fully consider the rights of these patients, and beneficiaries can request coverage for treatments prescribed to them, even if they are not on that list,” he wrote in the report.

The bill also amends the law dealing with health plans – the Plans Act – to specify that operators are subject to consumer protection law, which is not the case today.

Representatives of associations and families of people with disabilities, autism and rare diseases followed the vote on the Senate floor and celebrated the decision. Romeo and the senators who advocated ending the tax role were welcomed.

“The comprehensive list negatively impacts the lives of 48 million health plan users. It particularly affects people with disabilities, autism, and people with rare diseases. We cannot make it impossible for residents to access checks, treatments, and surgeries,” said Senator Paulo Baim (PT-RS). ).

The project was nominally approved. In the midst of the election campaign and the pressure of entities, even senators have come out to advocate ending the tax role.

Last week, during a session of thematic debates in the Senate, the Minister of Health, Marcelo Quiroga, criticized the proposal. He said health plans would have more costs, and that the bill would be passed on to consumers.

The director of the ANS President, Paulo Rebelo, stated that the tax role is dynamic, that the expected incorporation deadlines in the revised rule this year will speed up analysis of new treatments and that a change in the agency’s relationship could cause an “unbalance” in the health sector.

What does the bill say?

The bill states that a treatment or procedure prescribed by a doctor or dentist that is not included in the ANS list must be authorized by the operator provided that:

  • There is evidence of efficacy, in light of the health sciences, based on scientific evidence and a treatment plan;
  • Or there is a recommendation from Conitec (National Committee for the Integration of Technologies in the Unified Health System);
  • Or there is a recommendation from at least one health technology assessment body that is internationally famous, as long as it is also accredited to its own citizens.

During the bill process, senators close to the sector suggested that the legislation stipulate that all conditions are necessary to cover a treatment, not just one or the other. The proposed rapporteur was rejected.

What do health plans say?

Abramge (the Brazilian Association of Health Plans) says the project approved in the Senate “could lead the Brazilian health sector, both private and public, to a systemic collapse” and that it would bring patient safety risks.

The association says there has been “no further technical discussion on this subject”.

On a note, Abramge also says that the process of updating the health plan coverage list is on an ongoing basis and based on health technology assessment studies, “with reduced deadlines, making Brazil a global reference in terms of speed of incorporation, with safety and immediate coverage, of new health technologies into plans “.

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