The Chamber approves a undertaking that forces well being plans to pay for remedy outdoors the checklist of ANS |  Coverage

The Chamber approves a undertaking that forces well being plans to pay for remedy outdoors the checklist of ANS | Coverage

The Chamber of Deputies permitted this Wednesday (3) a undertaking that forces well being plans to cowl remedies and procedures with out the function of the Nationwide Well being Company (ANS). The vote was symbolic (no particular person registration), and the textual content goes to the Senate.

The President of the Chamber, Arthur Lira (PP-AL), mentioned that there’s an obligation signed for the Senate to vote on this undertaking as quickly as subsequent Tuesday (9). “I used to be knowledgeable and I hope that it will likely be fulfilled, it’s the settlement of the Senate, to vote on this undertaking subsequent Tuesday”, he mentioned after the approval of the Home.

The results of the controversy within the working group, the undertaking overturns the restriction imposed by the choice of the Supreme Court docket of Justice (STJ), which was understood as the entire checklist of remedies that should be lined by well being plans.

With the choice of the STJ, the plans had been launched from the protection procedures outdoors the checklist – which at the moment consists of 3,368 objects. Discover out within the video beneath:

The role of taxes: understand what changes to health plan coverage

The function of taxes: perceive what modifications to well being plan protection

The proposal permitted Wednesday states that drivers should authorize well being plans to cowl remedies or procedures prescribed by a health care provider or dentist not on the ANS checklist, until one of many following situations is met:

  • assured efficiency;
  • the advice of the Nationwide Fee for the Integration of Expertise within the SUS or;
  • authorization from the Nationwide Well being Inspection Company (Anvisa) or;
  • The proposal of a single worldwide well being skilled analysis physique, until they’ve permitted the identical remedy for his or her residents.

Among the many well-known ones talked about on this undertaking: Meals and Drug Administration, European Well being Union, Scottish Medicines Consortium (SMC); Nationwide Heart for Well being and Care Excellence (Good); Canadian Drug and Well being Expertise Evaluation (CADTH); Drug Profit Scheme (PBS); and the Medical Companies Advisory Committee (MSAC).

“The authorized framework for well being plans has introduced authorized certainty to well being plan contractors. It’s attainable that, on the one hand, it began to offer further authorized situations for well being work, alternatively, discussions about taxation or the presentation of the checklist entered the authorized court docket “, says the coordination of the undertaking, licensed. by a number of deputies.

In June, the STJ modified its understanding of the checklist of packages listed by the ANS to take care of well being plans.

The Court docket acknowledged that the checklist defining what should be lined by well being plans is exhaustive, that’s, what will not be on the unique checklist of ANS doesn’t require protection by operators.

Previous to the choice, the ANS checklist was thought-about precedent by nearly all of the Court docket. Which means that sufferers who aren’t allowed procedures, examinations, surgical procedures and medicines that weren’t on the checklist can go to court docket and get this assist.

It is because the function was thought-about the minimal that the plan ought to present. Plans, subsequently, should cowl different remedies that aren’t on the checklist, however are prescribed by a health care provider, are acceptable and aren’t experimental.

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