MPF recommends that ANS clarify health plans about mandatory coverage for autism treatment — Attorney General’s Office

MPF recommends ANS to clarify health plans about mandatory coverage for autism treatment

The statement must emphasize that, according to the agency’s own regulations, any limitation on the number of sessions with specialists is illegal

The Federal Public Ministry (MPF) sent the National Supplementary Health Agency (ANS) a recommendation that aims to ensure comprehensive treatment for beneficiaries of health plans diagnosed with Autism Spectrum Disorder (ASD). The document sets a period of ten days for the regulatory agency to provide wide dissemination and clarify health operators regarding the obligation to pay for an unlimited number of sessions with psychologists, occupational therapists, speech therapists or physical therapists, according to medical indication.

Also according to the recommendation, the ANS statement should emphasize that mandatory coverage includes therapies applied in the ABA (Applied Behavior Analysis). Also known as Applied Behavior Analysis, the treatment consists of intensive teaching of the skills necessary for the individual diagnosed with autism and other pervasive developmental disorders to become independent. The document was issued on Monday (20).

The MPF emphasizes that the inapplicability of limitations on the number of sessions with professionals specializing in the treatment of autism has already been regulated by the ANS itself, through Normative Resolution 469/2021 and Communiqué n.^O 92, both from July last year. It also points out that the Consumer Defense Code guarantees the right to clear, crystalline and adequate information about the services contracted, and it is the duty of health plans to clarify users about the treatments guaranteed to the autistic patient.

The performance of the MPF Consumer and Economic Order Chamber (3CCR) has as its backdrop a recent decision of the Second Section of the Superior Court of Justice (STJ), which defined the exhaustive list of ANS health procedures and events. Under this understanding, health plans are not required to cover medical treatments and services that are not on the agency’s mandatory list. In the assessment of the MPF, the context of collective disinformation promoted by the dissemination of erroneous interpretation of the meaning and scope of the judgment demands action by the regulatory agency.

Misinformation – The MPF clarifies that the decision of the Superior Court is not a mandatory precedent and points out that, when analyzing embargoes of divergence, the rapporteur of the case, Minister Luiz Felipe Salomão, highlighted that the judgment did not cover issues related to the treatment of people with autism. In addition, the recommendation recalls that the STJ’s decision itself provides for exceptions to the exhaustive list, provided that there is evidence of the effectiveness of the indicated treatment and recommendations from technical bodies.

In 2016, the National Commission for the Incorporation of Technologies in the Unified Health System (Conitec) of the Ministry of Health (MS) approved the clinical protocol and therapeutic guidelines for aggressive behavior in Autism Spectrum Disorder, which provides, among other interventions, the therapy TAB.

Historic – The MPF has been following the issue since 2019, when the first public civil action was proposed against the limitation of the number of therapy sessions for the treatment of autism, in Goiás. Subsequently, similar actions were filed in the states of Acre, Alagoas, Bahia, Ceará, Pará, Pernambuco and São Paulo, with numerous favorable decisions.

In April of last year, the Health and Consumer Plan Working Groups, both from 3CCR, issued a recommendation to the ANS demanding the unification of the understanding. In response, the agency edited Normative Resolution 469/2021, expanding the treatment of people with Autism Spectrum Disorder throughout the national territory.

Integrity of the Recommendation