Barroso calls for a public hearing to discuss the exhaustive role of the ANS

Minister Luís Roberto Barroso, of the Federal Supreme Court, convened a public hearing for the 26th and 27th of September to hear experts and representatives of public authorities and civil society on the breadth of health insurance coverage, the methodology for updating the list of procedures and events in supplementary health and its exhaustive nature.

Brazil AgencyBarroso calls for a public hearing to discuss the exhaustive role and breadth of coverage

He is the rapporteur of five lawsuits (ADIs 7088, 7183 and 7193 and ADPFs 986 and 990) against provisions of the Health Plans Law (Law 9961/2000), Law 9656/1998 and Normative Resolution ANS 465/2021, which establish the competence of the National Supplementary Health Agency (ANS) to define the breadth of health plan coverage, regulate the procedure for updating the list of procedures and events in supplementary health and affirm its exhaustive nature.

With the hearing, the minister intends that “an effective dialogue be established, open to the various points of view that the matter raises and that makes it possible to obtain subsidies for the settlement of the constitutional controversy”.

interdisciplinary knowledge
In an order, Barroso stressed that the matter dealt with in the lawsuits goes beyond the strictly legal limits and requires interdisciplinary knowledge to unveil technical, medical-scientific, actuarial and economic issues related to the subject and the financial impact of judicial convictions for the provision of non-incorporated therapies.

He pointed out that, over the years, jurisprudence has been established by the statement that the list of procedures and events in supplementary health would merely exemplify the benefits payable by health plan operators, who would also be obliged to pay for other treatments prescribed by the medical professionals, who would be responsible for defining the appropriate therapy.

However, the controversy gained a new chapter in a recent judgment of the 2nd Panel of the Superior Court of Justice, in which the orientation prevailed that, as a rule, the role of the ANS is exhaustive, that is, that the health plan operator is not obliged to pay for a procedure not provided for in the list.

In the minister’s assessment, on the one hand, there is a legitimate concern with the economic-financial balance of health plan contracts, demanding a prior definition of their coverage. Disregarding this aspect, in his view, has the potential to make the offer of health plans unfeasible, which, ultimately, would compromise consumer rights and constitutional health protection.

On the other side of the controversy, pointed out the minister, is the just concern of health plan users with the existing omissions in the list and the consequent lack of coverage of all the procedures necessary for the treatment of covered diseases, in particular, rare diseases.

In this sense, for the rapporteur, “it is necessary to give voice to civil society and economic agents, whose sphere of interests will be directly affected by the decision to be rendered in these facts”.

public hearing
Those interested in participating as exhibitors must express themselves by July 29 exclusively through the email address [email protected] The request for participation must contain the qualification of the body, entity or specialist, as the case may be; indication of the exhibitor, accompanied by a brief resume of up to one page; and a summary of the positions to be defended at the hearing.

Participants will be selected, among others, by the criteria of representativeness, technical specialization and expertise of the exhibitor, and guaranteeing the plurality of the composition of the audience and the parity of the different points of view to be defended. The list of registered candidates eligible to participate in the public hearing will be published on the STF’s electronic portal. With information from the STF Press Office.

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