Published on November 28, 2018, by the National Supplementary Health Agency (ANS), the resolution amends RN nº 363 of December 11, 2014, which provides for the rules for entering into written contracts signed between health plan operators health care and health care service providers, and RN No. 364 of December 11, 2014, which provides for the definition of the readjustment index by the ANS applied by operators of private health care plans to their providers of health care service.
In practice, the ANS, through RN 436, is forcing health operators to consider quality criteria in the readjustments of providers, which is very positive for the Accreditation Program in Diagnostic Imaging (Padi). However, according to CBR's economic advisory, this can bring risks to the use of quality criteria that do not reflect real quality, that is, that health operators create their own quality criteria.
Below are the various changes that had an impact:
– There is no longer a limit for adjustment up to the IPCA value. It only mentions that the IPCA is the ANS reference (Article 3);
– All Art. 7 on the rules and percentages of adjustment according to quality criteria were directed to a specific annex in RN 436;
– Improved the percentages suggested by the ANS and included new criteria;
– IPCA 115% for quality factor level A providers (Accreditation Certificate – maximum level, Patient Safety Center registered with ANVISA and having made at least one notification via NOTIVISA every quarter in the last year, as well as having 75% of the guides in the current version of the TISS Standard);
– IPCA 110% for Quality Factor Level B providers (Accreditation Certificate – Certification covering the entire scope of care, Patient Safety Center registered with ANVISA and having made at least one notification via NOTIVISA every quarter in the last year and have 75% of the guides in the current version of the TISS Standard);
– IPCA 105% for Quality Factor Level C providers (Patient Safety Center registered with ANVISA and having made at least one notification via NOTIVISA every quarter in the last year and having 75% of the guides in the current version of the TISS Standard or Participation in one of the DIDES/ANS quality induction projects when applicable);
– IPCA 100% for other providers that do not comply with the provisions of items I, II and III