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Tuesday, February 7, 2023
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Senate approves bill that forces plans to cover treatments outside the ANS list

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The Senate approved this Monday (29) the bill that obliges health plans to pay for procedures or treatments that are not on the basic reference list of the ANS (National Supplementary Health Agency), putting an end to the so-called taxing role. . The text goes to presidential sanction.

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

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The bill was approved in early August in the Chamber of Deputies in reaction to the decision of the STJ (Superior Court of Justice). In June, the court understood that health plan operators are required to pay only the 3,368 treatments that are on the ANS list.

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

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Romário stated that the STJ’s decision was “unfair” and that, since then, Congress has been looking for a solution to end the “legal uncertainty” caused.

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

In his opinion, Romário stated that the coverage of health plans must “prevent, recover, maintain and rehabilitate health, for all diseases listed” in the ICD (International Statistical Classification of Diseases and Related Health Problems).

“In this way, if the REPS [Rol de Procedimentos e Eventos em Saúde] does not fully contemplate these patient’s rights, beneficiaries may request coverage of the treatments prescribed to them, even if they are not included in that list”, he wrote in the report.

The bill also amends the law that deals with health plans — the Plans Law — to determine that operators are subject to the Consumer Protection Code, which does not happen 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. Romário and senators who defended the end of the tax role were applauded.

“The exhaustive list has a negative impact on the lives of 48 million health plan users. It affects, especially, people with disabilities, autistic people, people with rare diseases. “, said Senator Paulo Paim (PT-RS).

The project was approved symbolically. In the midst of the electoral campaign and pressure from the entities, even government senators came out in defense of the end of the tax role.

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

The director-president of ANS, Paulo Rebello, stated that the tax role is dynamic, that the deadlines for incorporation foreseen in the rule edited this year will accelerate the analysis of new treatments and that the change in the agency’s relationship would cause “imbalance” in the health sector.

What does the bill say

The bill states that the 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 the light of health sciences, based on scientific evidence and a therapeutic plan;
  • or there is a recommendation by Conitec (National Commission for the Incorporation of Technologies in the Unified Health System);
  • or there is a recommendation from at least one health technology assessment body that is internationally renowned, as long as they are also approved for their nationals.

During the process of the bill, senators close to the sector suggested that the legislation say that all conditions were necessary for coverage of treatment, not just one or the other. The proposal was rejected by the rapporteur.

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