Health plans needed to cover autism treatment, says MPF

Health plans needed to cover autism treatment, says MPF

The National Complementary Health Agency (ANS) has 10 days to notify health plans of the obligation to provide comprehensive care for autism, as recommended by the Federal Public Prosecutor (MPF ) released this Monday (6/20).

Some plans had begun not to cover the value of sessions with psychologists, occupational therapists, speech therapists or physical therapists indicated for 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 treatment and services that are not on the agency’s mandatory list.

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The MPF recalls, however, that the decision of the STJ is not a binding precedent. Additionally, the decision does not cover the treatment of people with ASD.

The recommendation also points out that the STJ’s decision provides for exceptions to the exhaustive list, “subject to evidence of the effectiveness of the treatment indicated and the recommendations of the technical bodies”.

Prosecutors complain of “collective misinformation fostered by the dissemination of misinterpretation of the meaning and scope of the trial”, which must now be corrected by the ANS.

Limiting 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 have been brought in the states of Acre, Alagoas, Bahia, Ceará, Pará, Pernambuco and São Paulo.

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