May 31, 2023

Procon-JP warns that health plans should cover treatment for global disorders, including autism

The Municipal Secretariat for Consumer Protection and Defense warns users of health plans that Normative Decision 539/2022, edited by the National Agency for Complementary Health (ANS), has been in force since July 1 last year, which expands the coverage of Rules help for users with pervasive developmental disorders , including autism spectrum disorder (ASD).

Therefore, since that date, coverage for any method or technique, prescribed by a physician, to treat a patient with a disorder classified in ICD 84, the International Classification of Disease, has become mandatory.

Procon-JP Secretary Rougger Guerra ensures that the decision establishes mandatory coverage for health plans for different methods or therapies, not only for patients diagnosed with autism, but also for those with a pervasive developmental disorder. “Consumers using health plans who need treatment and are refused by the operator should immediately request Procon-JP so that we can take the necessary measures,” he explained.

Regulation ANS 539 amended Appendix II of Normative Resolution 465/2021, which provides for a list of procedures, which provides for unlimited sessions with speech therapists, psychologists, occupational therapists and physical therapists for all global developmental disorders, which are characterized by a group of conditions that generate difficulties in Communication and behaviour, impairing patients’ interaction with others and coping with everyday situations.

global unrest – According to the International Classification of Diseases (ICD-10), the following are considered universal developmental disorders: childhood autism; Atypical autism, Rett syndrome, childhood disintegrative disorder. disorder with hyperkinesis associated with mental retardation and stereotyped movements; Asperger’s syndrome; other pervasive developmental disorders; and pervasive growth disorders unspecified.

Approaches to pervasive developmental disorders are varied and depend on individual procedures performed by professionals trained in a specific field or consist of multidisciplinary care. The most appropriate method should be chosen by health professionals with the patient’s family.

under and cerebral palsy – According to the ANS, health plan operators cannot refuse to provide care for people with conditions such as cerebral palsy and Down syndrome and those with a global developmental disorder.

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