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The National Supplementary Health Agency (ANS) has up to 10 days to notify health plans about the obligation to pay full autism treatment, as recommended by the Federal Public Ministry (MPF) issued this Monday (20/6).
Some plans had started not to cover the value of sessions with psychologists, occupational therapists, speech therapists or physical therapists indicated to patients diagnosed with Autism Spectrum Disorder (ASD).
The recommendation is based on the decision of the Superior Court of Justice (STJ), which approved the taxation of the list of ANS health procedures – in practice, the Court decided, health plans do not need to cover medical treatments and services that are not on the agency’s mandatory list.
ANS-health-plans-26-mar-2020 (1)The National Supplementary Health Agency (ANS) is the entity responsible for regulating the readjustments applied by health plan operatorsBrazil Agency
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The MPF points out, however, that the STJ’s decision is not a mandatory precedent. In addition, the decision does not cover the treatment of people with ASD.
The recommendation also highlights that the STJ’s decision provides for exceptions to the exhaustive list, “provided there is evidence of the effectiveness of the indicated treatment and recommendations from technical bodies”.
Prosecutors complain of “collective misinformation promoted by the dissemination of erroneous interpretation of the meaning and scope of the trial”, something that must now be corrected by the ANS.
The limitation of the number of therapy sessions for people with autism has been debated in court since 2019, when the first public civil action against it was proposed. Similar actions were filed in the states of Acre, Alagoas, Bahia, Ceará, Pará, Pernambuco and São Paulo.
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