Health plans: MPF recommends treatment coverage for people diagnosed with autism

O Federal Public Ministry (MPF) sent, on Monday, the 20th, to the National Supplementary Health Agency (ANS) recommendation for private health plans to offer comprehensive treatment for people diagnosed with Autism Spectrum Disorder (ASD).

Insured persons must have, according to the MPF, coverage of therapies applied in ABA (Applied Behavior Analysis), a method used by health professionals to promote greater independence to patients with autism and other pervasive developmental disorders, through multidisciplinary care.

The document also states that health operators must pay for an unlimited number of sessions with psychologists, occupational therapists, speech therapists or physical therapists, when treatment is requested by medical indication. The ANS has 10 days to inform companies about the Federal Public Ministry’s recommendation.

On June 8, the Second Section of the Superior Court of Justice (STJ) defined the establishment of an exhaustive list, a measure that, in practice, exempts health plans from covering and paying for medical treatments and services that are not included in the list. determined by the National Supplementary Health Agency. According to the health insurance sector, around 49 million Brazilians are covered by a health care plan.

Family members of people with autism fear that the public will be left without treatments. One of the most critical of the measure was presenter Marcos Mion, father of a teenager diagnosed with ASD. In an interview with Estadão on the 13th, the director-president of ANS, Paulo Rebello, was questioned about the matter, and stated that no autistic patient is not being treated.

“We are not neglecting any autistic patient, no one can say that. Do you have a service technique that is not being paid for by the role? Okay, but was she ever submitted to the ANS? Other times they are very specific situations. For example, horse riding. Obviously you can’t put everything, there are choices. We have to analyze scientific evidence, cost-effectiveness”, declared Rebello.

The MPF also points out that the non-limitation of the number of sessions with health professionals specializing in the treatment of autism was already regulated by the National Agency last year. And remember that several lawsuits filed by the ministry in different states of Brazil, against the establishment of a limit of sessions of attendance, had favorable decisions.

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