Public Health

Begin to enforce new coverage of health plans

The change includes 37 medicines for home treatment for cancer, and 50 new procedures such as examinations, consultations and surgery

Comes into force on Thursday (2) expansion of mandatory coverage to beneficiaries of health plans, including 37 medicamentos orais para tratamento domiciliar de câncer, plus 50 new procedures and examinations, consultations and surgeries. The changes were announced in October by the National Health Agency (ANS).

It is the first time that health plans will have to cover the cost of oral drugs for the treatment of cancer at home. With this addition, medicines for the treatment of tumors of high prevalence in the population as stomach, liver, intestine, kidney, testis, breast, uterus and ovary are to be deployed. According to ANS, the form of distribution of these drugs will be the responsibility of each provider of health plan.

Among the additions to the coverage of the plans are 28 laparoscopic surgeries (which reduce the risk for the patient and length of stay), the mandatory provision of intestinal and urinary collection bags for ostomates patients, treatment of chronic back pain using radiofrequency and Treatment of neuroendocrine tumors in nuclear medicine.

The ANS also defined 22 criteria for the appropriate use of technology in screening and treatment of 29 genetic diseases. The measure expands mandatory coverage, with more complex tests.

The dental coverage has also expanded to include periodontal grafts identification test the acidity of saliva and gingival surgery to facilitate tooth cleaning.

In addition to the inclusions, the NSA has expanded the use of 44 procedures already offered. Among them, the PET scan (procedure used to early detection of tumors or new foci) examination, passing from three to eight nominations. The number of consultations and sessions with a speech therapist and nutritionist was also expanded to specific cases.

Every two years, the agency revises the minimum list of procedures covered by the operators. The current expansion benefits 42.5 million consumers with health plan medical care and more with only 18.7 million dental plans, according to ANS.

In the case of operators who do not comply with mandatory coverage, consumers should contact the Dial ANS on 0800 701 9656 to make complaints or attend one of the agency's 12 cores installed in all regions of the country. ANS reports that operators who do not comply coverage are subject to a fine of U.S. $ 80,000 per infraction.

In a statement, the National Federation of Health Insurance (FenaSaúde), an organization that brings together operators of health plans, said the revision of the list of procedures has an effect on costs, with estimates of expenditure growth of healthcare operators. The actual financial impact, however, can only be measured from next year, according to the federation.

The impacts of these developments can only be measured from after the start of the new mandatory coverage, with accompanying implementation year. But ideally, prior to the incorporation of these procedures, the NSAs to analyze the cost-effectiveness of new hires, ensuring care outcomes favorable to the plan beneficiaries and at the same time, preserving the balance of the system, "the statement said.

According to ANS, the inclusion of new roofing is evaluated for one year and, if the agency identifies financial impact, this adjustment will be evaluated in the following year, which is 2015. Under current rules, the NSA provides the only adjustment for individual and family plans and can only suggest resetting for group plans that meet most users.

Confira a lista completa de procedimentos incluidos no rol 2014