Health

STF overturns PB law on assistance to people with disabilities through health plans

The Plenary of the Federal Supreme Court (STF) invalidated a law in Paraíba that obliges health plan operators to ensure comprehensive and adequate medical and hospital care for people with disabilities. Unanimously, in a vote by the Virtual Plenary, the ministers upheld the Direct Action of Unconstitutionality (ADI) 7,029, filed by the National Union of Health Self-Management Institutions (Unidas).

Among other points, State Law 11,782/2020 establishes that plans cannot impose restrictions on the care and treatment of people with disabilities and must offer the necessary coverage for multiprofessional care, respecting the terms of the attending physician, under penalty of being compelled to pay the costs. or fully reimburse expenses with non-accredited professionals. The obligation covers trained and specialized professionals in the prescribed areas, the quantity and duration of the sessions and the application of the technique indicated by the attending physician.

Competence

The Plenary followed the vote of the rapporteur, Minister Cármen Lúcia, who considered that the state law invaded the sphere of regulation reserved for the Union. She highlighted the relevance of the matter and the importance of adopting public policies to meet the needs of vulnerable groups. However, she considered that the Court cannot adopt a solution that does not strictly comply with the federative principle, which defines the division of constitutional powers of the federated entities.

In her vote, she highlighted the jurisprudence of the STF that medical and hospital care services are governed by contracts of a private nature, referring to civil law and insurance policy. Thus, it is the responsibility of the Union to legislate on the subject (items I and VII of article 22 of the Federal Constitution).

Cármen Lúcia explained that, in the exercise of this constitutional competence, the Union enacted Law 9,656/1998, which provides for private health care plans and insurance, regulated by Resolution 465/2021 of the National Supplementary Health Agency (ANS).

Procedure

The minister also informed that a bill is being processed in the Chamber of Deputies which, by proposing an amendment to Law 9,656/1998, aims to provide for comprehensive health care for people with disabilities and rare diseases, a matter conveyed in the Paraíba law.

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