ANS opens public consultation to update the rules governing contracts between healthcare plan operators and service providers

Brazil’s National Supplementary Health Agency has published Public Consultation No. 170/2026 to solicit contributions on a draft normative resolution that proposes consolidating and updating the rules governing contracts executed between healthcare plan operators and healthcare service providers.

The proposed regulation stems from the Regulatory Outcome Evaluation Report (“RARR”) drafted by ANS’s Innovation Incentives and Providers’ Quality Assessment Unit (“GEIQP”).
 The report found that, although the formal execution of contracts is no longer the sector’s main regulatory challenge, material asymmetries persist in the performance and enforcement of contractual clauses, particularly in regard to pricing, price increases, payment disallowance/denial (“glosa”), and default.

If its current wording is approved, the new resolution will repeal Normative Resolutions No. 503/2022 and No. 512/2022, consolidating the rules scattered across different provisions on contracting arrangements and the price increase index.

Key highlights of the proposed resolution

• Electronic signature: the draft sets out that contracts may be executed electronically, provided that both parties use an electronic signature with unequivocal authenticity and ensure access to the contract and its annexes in full.
• Remuneration models and risk allocation: where remuneration models other than fee-for-service are adopted, the contract must provide for the allocation of clinical, operational, and regulatory risks assumed by each party, according to the agreed-upon model.
• Sale in foreign currency: where materials, medicines, medical devices, or other inputs are sold in foreign currency, the contract must include a clause on the method of conversion into Brazilian currency.
• Rules on payment disallowances and payment of the undisputed amount:
  • Prohibition from disallowing/denying payment for procedures previously authorized by the operator, provided that they are effectively performed and billed in accordance with the contract, and that no technical discrepancy is indicated in an audit.
  • Mandatory payment of undisputed amounts, even if part of the bill is under review for potential disallowance.
• Consensual dispute resolution: an innovative provision requires contracts to set out communication channels provided by the operator for interaction with the provider. These channels will be used to address matters arising from the parties’ service relationship, including the referral of any disputes and the pursuit of consensual solutions.
• Effective term, renewal, and notice periods:

• In cases of automatic renewal, there must be a common notice period for prior expression of lack of interest in maintaining the agreement. A 60-day prior notice period applies if there is no contractual provision.
• Where renewal is conditional upon prior expression of interest by the parties, this must occur at least 30 days in advance; otherwise, the contract will be terminated upon the end of its term.

• Penalties: the draft requires that contracts contain specific penalties for all assumed obligations, and further requires that penalty clauses be proportionate, limited, and equivalent for both parties.

Current rules that were preserved:

The draft does not change rules on the:

• percentages and criteria of the Quality Factor;
• index and frequency of price increases; and
• irregular status continuation for operators that maintain relationships with service providers without executing a formal contract.

Applicability and transition

If approved, the proposed resolution will enter into force 180 days after its publication, establishing that the new rules will apply in full to contracts executed as of that date. Previously executed contracts do not need to comply with the new rules unless any clauses are amended. In this case, they will be subject to all applicable penalties.

The regulatory proposals introduced by Public Consultation No. 170/2026 reflect a shift in ANS’s regulatory approach, which will increasingly prioritize not only the formal existence of the contract but also the quality, clarity, and balance of its content. This stance aligns with the RARR’s findings, which identify “bargaining inequality” as one of the sector’s main current challenges.

Documentation related to Public Consultation No. 170/2026 is available on ANS’s official website.

Contributions may be submitted by May 16, 2026.

Demarest’s Insurance, Reinsurance, Health and Private Pension and Life Sciences and Healthcare teams will monitor the public consultation and remain available to provide further clarification.