Change in rule should reduce amount required for reserves in bankruptcy; operators should save BRL 11.8 billion
The ANS (National Health Agency) approved, on Monday (19.Sep.2022), a measure that changes the rules for requests for bankruptcy of health plan operators. With the new rule, these companies will have to comply with fewer requirements to file for bankruptcy. The main one is the decrease in the value of cash reserves.
According to the agency, the measure “eliminates any disproportionalities in financial guarantees”. Also according to ANS, the positive impact for operators should be R$ 11.8 billion.
The measure was presented by DIOPE (Standards and Qualification of Operators) and did not need to be evaluated at a public hearing as it did not require a change in the standard. Other measures proposed by the ANS, however, need to be discussed at a hearing. Are they:
- Automatic granting of annual prior authorization to enable the movement of assets for regular operators, in addition to the shorter period for resumption of authorization, in case it is cancelled;
- Extension to up to 60 months for terms of economic adequacy procedures available to irregular operators;
- Measures to simplify guarantor assets, such as the release of asset requirements for all benefit administrators and dental operators, in addition to enabling the reduction of guarantor asset requirements for health plans with post-established prices and reimbursement to the SUS (Sistema Único of health).
The measures that aim to help health plan operators occur in the face of the overthrow of the so-called taxing role of the ANS. Sanctioned on Wednesday (September 21) by the president Jair Bolsonaro (PL), the text determines that health plans offer certain treatments even if they are not on the mandatory coverage list.
According to the agency, the purpose of the changes is to “reduce bureaucracy” and help in the financial planning of operators and avoid damage to the service provided by companies.
The project to simplify the rules for health plan operators has been underway since 2021. In communiquéthe agency’s CEO, Paulo Rebello, stated that the actions discussed will be aligned with other measures already approved previously.
“ANS looks at the supplementary health market as a whole, while taking into account the heterogeneity of the companies that make up the sector. We are attentive to all market niches, seeking to reduce the administrative burden and bureaucracy as a way of keeping the market economically sustainable and safe for the beneficiaries. The permanent monitoring carried out by the Agency will continue to be carried out”declared.
taxing list
O PL 2033 of 2022 was approved in August by Congress. Determines that health plans must cover treatments prescribed by a doctor or dentist, even if they are not on the list of procedures defined by the ANS, as long as they meet at least one of the following requirements:
- be proven effective, according to scientific evidence and therapeutic plan; or
- be recommended by Conitec (National Commission for the Incorporation of Technologies in the Unified Health System) or by another internationally renowned health technology assessment body.
In June, health plan operators won a discussion on the mandatory coverage of contracts in the STJ (Superior Court of Justice). The Court established the understanding that the plans should be obliged to pay only what appears on the ANS list, that is, that the agency’s role is “tax”.
With the new law enacted, the interpretation that the ANS list is “exemplary” – expanding the range of treatments that plans must cover, if the requirements of the text are met.
To the STF (Supreme Federal Court), the ANS stated, in July, that any change in the coverage of mandatory treatments by the private health sector could cause an increase in the prices of health plans. According to the agency, a “unrestricted coverage” of procedures would affect the calculation of health companies to maintain their operations, which would lead to an increase in the amount paid by consumers.
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