644th Ordinary Meeting of the ANS Board of Directors

Decisions and analysis

1. ITEM 1 PRESI – Approval of the draft minutes of the 643rd Ordinary Meeting of the Board of Directors and the 11th Extraordinary Meeting of the Board of Directors, held on Sep 18 and 25, respectively.

Votes: APPROVED

2. ITEM 2 DIPRO – Consideration of the proposed amendment to Normative Instruction ANS 31, which provides for the monitoring and assessment of health plan operators’ guarantee of care for beneficiaries (Care Guarantee Monitoring).

The matter returned for decision after its consideration was suspended at the 627th DICOL meeting, held on August 28, 2025. At this sitting, a proposed normative resolution was presented to amend Normative Instruction No. 31/2022, which provides for the monitoring and assessment of the guarantee of care. Currently, under the rule set out in Art. 15, §2 of the IN, an operator is “considered at risk if it remains, for the second consecutive period, in assessment band 3 and meets at least one of the following requirements: I – there has not been a reduction of at least ten percent in its IO compared with the immediately preceding period; or II – its IO, according to the box-plot method, represents an outlier value”. From what can be gathered from the presentation, ANS intends to amend item I, providing that only operators that “worsen their IO for two consecutive periods”, that is, that are “repeat offenders in deterioration”, will be considered at care risk.

Current flow:

Envisaged flow:

The second point of the proposed normative resolution concerns exclusively dental plans. ANS proposes that exclusively dental plans should still be covered by care guarantee monitoring but, given the low care risk involved in this coverage, should no longer be sanctioned with suspension of sales:

In summary:

In the end, DICOL approved the technical note waiving the AIR and ordered the opening of a public consultation for deliberation on the proposed normative resolution.

Votes: APPROVED

3. ITEM 3 OUT OF AGENDA DIPRO – Approval of the proposed update to the List of Health Procedures and Events (Rol).

Return from Public Consultation. Consideration of the Final Recommendation Technical Note (NTRF), concerning Technical Analysis Unit (UAT) 201. Approval of the proposed Normative Resolution. UAT 201 addresses bronchoscopy with cryobiopsy, indicated for patients with suspected Interstitial Lung Disease (ILD). The technology was the subject of deliberation at the 52nd and 55th technical meetings of COSAÚDE, as well as Public Consultation No. 174/2026. DICOL approved the proposed normative resolution updating the Rol.

Votes: APPROVED

4. ITEM 4 OUT OF AGENDA DIFIS – Approval of the proposal to enter into a Technical Cooperation Agreement between ANS and the Federal Regional Court of the 5th Region, under the Parceiros da Cidadania Program.

Votes: APPROVED

5. ITEM 5 OUT OF AGENDA DIPRO – Report on the NAT/Malaria test per blood component arising from Ordinance GM/MS 11,685 of the Ministry of Health, which redefined the technical regulation on hemotherapy procedures.

Director Lenise Secchin clarified that, with the publication of Ordinance GM/MS 11,685, which began to require malaria detection by the nucleic acid method – NAT, an amendment was published to the Unified Terminology of Supplementary Health – TUSS, including the item “NAT malaria per blood component” (code 40404587). ANS clarifies that the “NAT malaria per blood component” test has mandatory coverage and is not a new inclusion in the list of health procedures and events, being an offshoot of the “malaria testing” procedure that was already on that list. Finally, the director recalled that, in light of Art. 25 of RN 465/2021, “operators must comply with the provisions of the regulations issued by the competent government bodies with respect to the National Policy on Blood, Blood Components and Blood Derivatives”.