MPF determined that the ANS reinforces in 10 days for health plans that treatments are mandatory
The MPF (Federal Public Ministry) gave 10 days for the ANS (National Supplementary Health Agency) to clarify that health plan operators are still obliged to offer treatments for TEA (Autism Spectrum Disorder) despite the decision of the STJ (Superior Court of justice).
The MPF sent the recommendation on the subject to the agency on Monday (May 20, 2022). Recommendations are MPF documents sent to public bodies so that they comply with certain standards. Here is the entire document (7 MB).
The ANS will have a meeting on the subject later this week. O Power 360 found that, so far, all treatments for ASD available before the STJ’s decision are maintained, but there will still be analysis of the new scenario. There is a working group to discuss the services available for the disorder.
The MPF states that the purpose of the action is to ensure comprehensive treatment for beneficiaries of health plans diagnosed with the disorder.
The operators won the discussion on the coverage of the contracts in the STJ on June 8. The Court had a majority for the understanding that the plans should be obliged to pay only what appears on the ANS list. Medical patient organizations argued that the agency’s list should be the minimum and that other services should also be covered on prescription.
The MPF asks that the ANS carry out wide dissemination and clarify to operators that they are required to pay for an unlimited number of sessions with psychologists, occupational therapists, speech therapists or physical therapists for patients with ASD, as long as there is a medical indication. The body highlighted that the agency dropped the limit on therapeutic sessions in July 2021.
The agency also determined that the ANS should reinforce the mandatory coverage of therapies applied in the ABA (Applied Behavior Analysis, in Portuguese). Treatment focuses on intensive teaching of skills for the patient to become independent.
The recommendation is signed by the Deputy Attorney General of the Republic, Luiz Augusto Santos Lima, and by the Attorneys of the Republic Mariane Guimarães de Mello and Hilton Araújo De Melo.
The agency established 10 days for the agency to inform the measures adopted or the reasons for non-compliance with the measure. “Failure to comply with the recommendation may result in the appropriate legal measures”, said the organ.