ANS ends coverage limit with psychologists and physiotherapists in plans

After expanding health plans coverage for users with global developmental disorders, such as TEA (autism spectrum disorder), the National Agency for Complementary Health (ANS) collegiate board on Monday (11) agreed to end limiting the number of consultations and sessions with psychologists, speech therapists and occupational therapists and physical therapists.

The measure, which was taken at an extraordinary meeting, applies to health plan users with any disease or health condition listed by the World Health Organization (WHO), such as cerebral palsy, Down syndrome and schizophrenia.

According to the entity’s statement, “The goal is to promote equal rights of complementary health users and standardize the form of procedures currently guaranteed, relating to these occupational groups. In this way, guidelines for use (conditions required for certain coverage) consultations and sessions with psychologists, speech therapists, occupational therapists and physical therapists, the department will now consider in the physician’s assistant’s prescription.”

This new rule becomes effective for patients with any diagnosis, according to the indication of the physician assisting them, as of August 1, after its publication in the Official Gazette of the Federation.

In a recent decision, on June 8, the Supreme Court of Justice (STJ) released operators from paying for actions not on the ANS coverage list. One of the most impacted treatments has been the treatment of children with autism spectrum disorder, as many of the treatments are not on the list.

With the decision, in favor of companies, an understanding was reached that the role of the ANS is comprehensive – not typical.

Called the list of health procedures and events, the list specifies the consultations, examinations, treatments and surgeries that constitute the mandatory coverage of organized health plans, that is, those contracted after January 2, 1999 or adapted to Law 9.656 / 98. According to the ANS, the list currently includes about 3,000 procedures. (Vulbras)