The National Supplementary Health Agency (Agência Nacional de Saúde Suplementar — ANS) has opened Public Consultation No. 170/2026 to receive input on a draft normative resolution that unifies and updates the rules for entering into contracts between Health Plans and health care service providers, and that contemplates the full repeal of ANS RN No. 503/2022 and No. 512/2022.
The draft normative resolution simultaneously addresses the general features of written contracts between Health Plans and providers and the definition by ANS of the adjustment index in the cases provided by law, thereby repealing ANS RN No. 503/2022 and No. 512/2022 to consolidate the subject in a single act. The Regulatory Outcomes Assessment Report (RARR), published on April 1, 2026, on ANS RNs No. 503/2022 and No. 512/2022, finds that although contractual formalization has advanced, negotiation and operational challenges persist, and it recommends maintaining the framework with targeted adjustments to bring greater clarity to adjustment rules, to regulate denials, and to strengthen monitoring and oversight mechanisms.
Scope
The proposed rule covers contractual relationships between private Health Plans for health care services and health care service providers, including natural and legal persons, and allows for physical or electronic contracts with unequivocal electronic signatures, which modernizes procedures and provides the parties with documentary certainty. The rule will apply to contracts executed after the new RN takes effect, and it expressly excludes relationships with cooperative professionals of cooperative Health Plans, employment relationships, and situations without direct contracting with Health Plans or with benefit administrators. In addition, contracts executed before the rule takes effect but that have clauses amended after it takes effect must comply with the provisions of the new rule.
In practice, Health Plans will need to revise contract templates to reflect requirements for clarity on compensation, adjustment criteria, prior authorization, and audit routines, as well as to provide communication channels and consensual dispute-resolution methods, subject to administrative sanctions. Providers, in turn, will have greater predictability with respect to authorization deadlines, access to the documents underpinning denials, and explicit parameters for challenges, as well as quality-linked incentives through the Quality Factor applicable when the ANS index applies.
Key aspects
The draft reinforces that the exchange of care data between Health Plans and providers must comply with the current TISS Standard (Supplementary Health Information Exchange), with a view to interoperability and informational transparency.
In terms of compensation, contracts must clearly state amounts and billing and payment routines and may allow the composition and adjustment criteria to consider quality attributes, indicators, and outcomes, provided that they are agreed in advance and auditable by both parties. The denials section prohibits limiting the provider’s access to the information and audit documents that supported the denial and guarantees the right to challenge. It also prohibits the denial of procedures that were previously authorized and actually performed, except where an audit identifies a technical discrepancy, thereby mitigating operational asymmetries and uncertainties that are recurrent in sector disputes.
As for prior authorization, the contract must identify the acts and procedures subject to authorization, establish the operational routine, allocate responsibilities, and indicate the response period for granting or issuing a reasoned denial, thereby reinforcing predictability in care pathways. The adjustment periodicity remains annual, to be applied on the contract anniversary date, except as provided in ANS RN No. 508/2022, and the adjustment clause must be transparent, calculable, and subject to audit, a public index, percentage, nominal amount, or another agreed criterion is permitted, provided it is clear and objective.
ANS-defined adjustment index, free negotiation, and Quality Factor
The draft, as does ANS RN No. 512/2022, defines the IPCA as the ANS adjustment index, to apply when, cumulatively, the contract provides for free negotiation as the sole form of adjustment and there is no agreement at the end of the negotiation period, with the IPCA corresponding to the accumulated amount over the 12 months preceding the contract anniversary date. The text innovates by providing that if the adjustment clause fails to meet clarity and content requirements, the index defined by ANS will apply. A contract that adopts free negotiation must indicate the opening of negotiations up to 90 days before the contract anniversary date, the means of evidencing the negotiations, and the consequences if negotiations fail, which may be the automatic application of a specific index provided in the contract or the application of the ANS index on the anniversary date, thereby shifting the negotiation window, which today is counted from January 1, to a reference point tied to the contract anniversary.
The index applies to the prices of contracted services, except for orthotics, prosthetics, supplies, and medicines billed separately, and it will be adjusted by the Quality Factor, with percentages of 115%, 110%, 105%, and 100% of the IPCA, according to the level attained by the provider. The annex to the draft details objective criteria for classification by provider type, including accreditation recognized under QUALISS, the existence of a Patient Safety Center (Núcleo de Segurança do Paciente) with reports via Notivisa, and adoption of the TISS Standard for a minimum percentage of claim forms, among others, thereby reinforcing verifiability by the Health Plan.
Consensual dispute resolution, term, and sanctions
The proposal requires that contracts specify a communication channel to handle relationship matters and to pursue amicable settlement, identifying mediation and conciliation as possible methods, without prejudice to the filing of matters with ANS channels, thereby institutionalizing swift pathways to prevent and resolve available monetary disputes.
The text also governs term, extension, renewal, and termination, including a default rule of 60 days for a response in cases of automatic renewal, and it prohibits adjustment criteria tied to care delivery expenses or to the Health Plan’s revenues, reducing potentially controversial linkages.
Current rule vs. proposal — key changes
The principal structural change is to consolidate, in a single RN, the subjects that are currently separated between ANS RN No. 503/2022 (contracts) and ANS RN No. 512/2022 (adjustment index and Quality Factor), with updated operational and transition provisions. Other points include:
| Theme | ANS RNs No. 503/2022 and No. 512/2022 | Public Consultation proposal |
| Electronic contract and signature | No explicit provision for an unequivocal electronic signature. | Admits electronic contracts and unequivocal electronic signatures. |
| Adjustment | Negotiation window counted from January 1. ANS index (IPCA) applies only when, despite free negotiation, there is no agreement between the parties at the end of the negotiation window. No express prohibition on adjustment criteria tied to the Health Plan’s expenses or revenues. | Negotiation window starts up to 90 days before the contract anniversary. The ANS index (IPCA) also applies when the adjustment clause is missing or inadequate. The contract must set out the consequence of failed negotiations (e.g., use of a specific index or application of the ANS index). Prohibits tying the adjustment to care delivery expenses or to the Health Plan’s revenues. |
| ANS index | IPCA applies when free negotiation (as the sole form) yields no agreement. | Keeps IPCA and the same application triggers. |
| Quality Factor | Percentages of 115%, 110%, 105%, and 100% of the IPCA, verification by the Health Plan. | Keeps the percentages, with criteria detailed in the Annex (QUALISS, Patient Safety Center, TISS, training). |
| Denials | Requires an audit routine and deadlines and does not detail a specific prohibition on denial of an authorized procedure. | Prohibits denial of a previously authorized and actually performed procedure, absent a technical discrepancy, and guarantees access to documents. |
| Consensual solution | No obligation to provide a specific channel. | Requires a communication channel for amicable settlement and recognizes mediation/conciliation. |
Open questions and next steps
Some issues merit attention during the consultation, such as how to operationalize verification of the Quality Factor criteria across different provider profiles and how to align negotiation deadlines tied to the contract anniversary with the parties’ budget cycles, issues that can be improved with evidence and specific proposals. It is also relevant to discuss applying the ANS index when there is no adequate adjustment clause, an innovation that changes the regime currently set out in ANS RN No. 512/2022, weighing the impact on incentives for formalization and for contractual clarity.
Deadlines and how to participate
Public Consultation No. 170 is open until May 16, 2026, during which time interested parties may submit substantiated contributions.
For regulated entities and representative organizations, participation is strategically relevant to calibrate negotiation criteria and the evidencing of negotiations, parameters for denials and authorization deadlines, quality incentives, and transition rules, elements that directly affect contract governance, transaction costs, and predictability in finance and care delivery.
The Life Sciences & Healthcare practice is available to provide further information on the topic.
