Extinction of the Health Regional Administrations

The new Decree-Law No. 54/2024, of 6 September, has formalized the long-announced extinction of the five Health Regional Administrations (the “ARS”), transferring their powers and tasks to different public entities.

This new Decree-Law aims to conclude a previously initiated process of reorganization of the Portuguese health system, proceeding with the extinction of the ARS and the restructuring of the Central Administration of the Health System (the “ACSS”), the Executive Directorate of the National Health Service (the “DE-SNS”), and the Directorate-General of Health.

In this sense, we highlight some of the domains targeted by the distribution of powers and tasks of the ARS resulting from the Decree-Law

Contracting the provision of healthcare

The new Decree-Law establishes that the ACSS succeeds the ARS in contracting the provision of healthcare at national and regional levels, without prejudice to the powers of the Local Health Unions (the “ULS”) to contract the provision of healthcare in their respective geographical areas. Furthermore, the Decree-Law determines that the ULS succeed the ARS in the legal regimes of conventions, without prejudice to the possibility of intervention of the ACSS in contracting the provision of healthcare at the regional level.

In this domain, the changes arising from the Decree-Law are not evident, because the power for entering into agreements with the private and social sectors was legally transferred from the ARS to the ACSS, in 2023. Moreover, the Decree-Law does not specify how the ULS will assume the powers and tasks of the ARS in relation to conventions, especially given the differences in the territorial scope of intervention of the ARS and the ULS.

Coordinating the integrated continuous care and palliative care

The Decree-Law determines that the DE-SNS will succeed the ARS in its powers and tasks on integrated continuous care and palliative care.

Since 2023, the DE-SNS has been responsible for the management and national coordination, in the health domain, of the National Network of Integrated Continuous Care (the “RNCCI”), as well as the management of the National Network of Palliative Care (the “RNCP”).

In this context, the transfer of the regional powers and tasks on integrated continuous care and palliative care from the ARS to the DE-SNS appears to be aimed at consolidating both national and regional levels of coordination in the areas of integrated continuous care and palliative care.

However, the Decree-Law does not clarify whether the regional procedures for healthcare providers to adhere to the RNCP will be maintained, or if there will be any changes, considering that national and regional levels of coordination of the RNCCI and the RNCP, in the health domain, will be carried out by a single entity.

Allocating the financial resources from the Recovery and Resilience Plan

The Decree-Law establishes that the powers and tasks of the ARS in relation to the Recovery and Resilience Plan (the “RRP”) are transferred to different public entities depending on their domain. RRP investments in primary care are transferred to the ULS (except for aggregated procurement procedures), and the remaining investments are transferred to the ACSS.

Notwithstanding, the Decree-Law does not amend the established rules and procedures for the allocation of financial resources from the RRP (e.g., to private companies and Institutions of the Solidarity and Social Economy, in the domains of integrated continuous care and palliative care), thereby leaving some doubts about the future of the processes that were followed by the ARS.

Processing the requests to open medically assisted procreation centers

The Decree-Law does not explicitly mention the entity that will succeed the ARS specifically in processing the requests to open medically assisted procreation (“MAP”) centers. It merely states that all remaining competences not listed in the Decree-Law that were held by the ARS, as provided for in other legislation, have been transferred to the ACSS.

As such, to anticipate any changes in the field of MAP (and others), the Decree-Law requires the knowledge of the powers and tasks of the ARS provided for in special legislation.

Even though the Decree-Law comes into force on October 1, 2024, the merger and restructuring processes may last 60 working days but can eventually be extended if, after this period, the necessary conditions for their completion have not yet been met.