New Prices and Co-Payment Rules for Home Respiratory Care

Two ordinances published today in the Official Journal change the co-payment rules and set a new price table for home respiratory care (CRD) provided to beneficiaries of the Regional Health Service of the Autonomous Region of Madeira (SRS-Madeira). The changes take effect on 1 October 2026, meaning they already cover care provided since that date, and Ordinance No. 625/2026 creates new exceptions to payment by the user.

What changes#

Ordinance No. 625/2026 amends clause 3 and Annex I of the standard agreement on billing approved by Ordinance No. 40/2023, of 12 January. This agreement is the model that providers join to bill care directly to SRS-Madeira. Among the main changes:

• When the total monthly co-payment is less than EUR 3.00, the provider may charge the remaining amount.
• The provider may not charge the beneficiary any payment beyond those provided for in the agreement, whether as moderating fees or similar charges that are not expressly provided for.
• VAT at the legal rate in force in the Autonomous Region of Madeira (RAM) is added to the table price.
• The contribution of IASAÚDE, IP-RAM (the regional institute that funds this care) may be combined with that of health insurance, provided the base contribution does not exceed the total value set out in Annex I. In this case, IASAÚDE does not cover the deductibles paid by the beneficiary.

Ordinance No. 626/2026 updates the price table in Annex I of Ordinance No. 46/2023, of 13 January, which approves the agreement for the same care area. The agreement is the equivalent instrument to the billing agreement, applicable to a different contractual framework. According to the text itself, the update seeks to keep pace with the values currently in force nationally, with the adaptations needed for the reality of Madeira.

Who is exempt from co-payment#

The general rule is that the beneficiary pays a share of each service. The document does, however, define three situations in which that share does not apply:

• Beneficiaries holding a valid special reimbursement card, who are not covered by the co-payment.
• SRS-Madeira beneficiaries admitted to psychiatric health clinics with cooperation agreements concluded within the health sector.
• Beneficiaries admitted to Private Institutions of Social Solidarity (IPSS) with health activity and registered with IASAÚDE, IP-RAM, upon declaration by the institution concerned.

In the last two situations, beneficiaries admitted to the Integrated Continuing Care Network of the RAM (REDE) and those institutionalised in Residential Structures for Elderly People (ERPI) are excluded. In exempt cases, IASAÚDE, IP-RAM assumes the full cost, with no charge to the beneficiary.

Table prices#

Annex I of Ordinance No. 625/2026 lists 18 treatments, each with a code, total price, beneficiary co-payment and IASAÚDE contribution. The values are as follows:

• Aerosol therapy A1117 (pneumatic nebulisation): EUR 1.12 total, EUR 0.22 co-payment and EUR 0.90 contribution.
• Aerosol therapy A1119 (ultrasonic nebulisation): EUR 1.12 total, EUR 0.22 and EUR 0.90.
• Aerosol therapy A1120 (electronic nebulisation with oscillating membrane): EUR 2.52 total, EUR 0.50 and EUR 2.02.
• Aerosol therapy A1121 (electronic nebulisation with oscillating membrane and "smart"): EUR 4.79 total, EUR 0.96 and EUR 3.83.
• Oxygen therapy O901 (gaseous oxygen): EUR 2.51 total, EUR 0.50 and EUR 2.01.
• Oxygen therapy O902 (liquid oxygen): EUR 5.44 total, EUR 1.09 and EUR 4.35.
• Oxygen therapy O903 (oxygen by conventional concentrator): EUR 2.45 total, EUR 0.49 and EUR 1.96.
• Oxygen therapy O914 (oxygen by portable concentrator): EUR 3.06 total, EUR 0.61 and EUR 2.45.
• Ventilation therapy V129 (ventilators with auto-adaptive servo ventilation): EUR 5.02 total, EUR 1.00 and EUR 4.01.
• Ventilation therapy V957 (continuous positive airway pressure generators, CPAP): EUR 1.46 total, EUR 0.29 and EUR 1.17.
• Ventilation therapy V958 (automatic CPAP, Auto CPAP): EUR 1.73 total, EUR 0.35 and EUR 1.38.
• Ventilation therapy V962 (bi-level positive pressure ventilators in spontaneous or automatic mode): EUR 2.46 total, EUR 0.49 and EUR 1.96.
• Ventilation therapy V963 (auto bi-level positive pressure ventilators ST and AVAPS): EUR 4.62 total, EUR 0.92 and EUR 3.70.
• Ventilation therapy V912 (volumetric ventilators): EUR 13.86 total, EUR 2.77 and EUR 11.09.
• Ventilation therapy V951 (hybrid ventilators): EUR 13.86 total, EUR 2.77 and EUR 11.09.
• Other treatments A904 (secretion aspirator): EUR 2.06 total, EUR 0.41 and EUR 1.65.
• Other treatments I901 (in-exsufflator): EUR 7.81 total, EUR 1.56 and EUR 6.25.
• Other treatments M901 (cardio-respiratory monitor with integrated capnography and oximetry): EUR 2.77 total, EUR 0.55 and EUR 2.21.

Ordinance No. 626/2026 presents the same 18 codes with identical total prices, without the split between co-payment and contribution. The values are as stated, before VAT. The text does not indicate the prices previously in force, so it is not possible to measure from it the exact size of the increase or decrease for each treatment.

Background#

An ordinance is a government instrument, in this case signed by the Regional Secretaries for Health and Civil Protection, Micaela Cristina Fonseca de Freitas, and for Finance, Duarte Nuno Nunes de Freitas. Both ordinances are based on Regional Regulatory Decree No. 8/2018/M, of 26 June, which regulates billing agreements and the situations in which costs are fully borne by IASAÚDE, IP-RAM.

Ordinance No. 40/2023 has already been amended several times, and Ordinance No. 625/2026 is its eighth amendment. Ordinance No. 46/2023 has had three amendments to its Annex, and this is the third. The instrument also repeals paragraphs c) and j) of point 2 of clause 8, points 2 and 4 of clause 11, and Annexes IV, V and VI of the clauses of Ordinance No. 40/2023. The same applies to Ordinance No. 46/2023, with the repeal of the same paragraphs, points and annexes of its respective Annex.

The preamble of Ordinance No. 625/2026 also refers to the digitalisation of procedures associated with the prescription of these treatments, which reduces paper use and strengthens traceability of information. The document does not, however, detail how this digitalisation works in practice for the user.