Alerj established a collegiate body on Thursday (May 23) after a request from state deputy Fred Pacheco
Alerj (Legislative Assembly of Rio de Janeiro) established on Thursday (May 23, 2024) a CPI (Parliamentary Commission of Inquiry) to investigate non-compliance with health plan contracts for people with disabilities.
“This is a victory for the people of Rio, but it is mainly a victory for the mothers and fathers of PCDs, who fight so bravely. Since last year, we have been trying to find a solution so that treatments are not interrupted. It didn’t work, so let’s institute the CPI and resolve this”said state deputy Fred Pacheco (PMN), which requested the CPI.
According to physiotherapist Fabiane Alexandre Simão, 45 years old, who presides over the Associação Não Direito a Menos, the establishment of the CPI will be a relief for mothers and fathers of people with disabilities. She is the mother of Daniel, 9 years old, who suffers from cerebral palsy and autism spectrum disorder.
“The CPI for health plans is extremely important, as it will remove the curtain that hides what is behind the measures that operators are putting into practice. The plans are denying the right to health and, consequently, to the lives of our children, and leave them at risk of death, without the possibility of medical treatment.”said the physiotherapist.
On May 15, a group of mothers protested in front of the Guanabara Palace, headquarters of the state government, against the unilateral cancellation of the Amil health plan for people with autism spectrum disorder. According to the protesters, this has been happening in other states and involves other health insurance companies.
Fabiane Simão, who participated in this event, said that the problem is already affecting people in home care (home medical care), who depend on total life support, on a respirator. “And they want to cancel these plans, they want to remove home care”, he stated.
The specialist in consumer law and health and member of the Civil Law commission of the OAB (Brazilian Bar Association) of Campinas Stefano Ribeiro said that unilateral cancellation, in cases of health treatment, such as those involving autistic people, is illegal, and the user can demand their rights.
“The beneficiary can indeed go to court, with the obligation to make payment for the plan, so that this contract can be maintained, so that it is not terminated until the treatment is completed. This is also without prejudice to requesting compensation for moral damages, depending on the inconvenience and embarrassment that this beneficiary was forced to endure.”said Stefano Ribeiro.
ANS EXPANDS RULES
In June 2022, the ANS (National Health Agency) expanded the coverage rules for cases of global developmental disorders, such as, for example, autism spectrum disorder. The decision was taken at a meeting of the agency’s collegiate board. Therefore, coverage for any method or technique recommended by the doctor for the treatment of a patient who has one of the pervasive developmental disorders is mandatory.
Pervasive developmental disorders are characterized by a set of conditions that create communication and behavioral difficulties, impairing patients’ interaction with other people and coping with everyday situations. They include autism spectrum disorder/Asperger’s, childhood disintegrative disorder (psychosis), Rett syndrome and hyperkinesia disorder associated with mental retardation and stereotyped movements.
The approved regulations also adjusted Annex 2 of the List so that unlimited sessions with speech therapists, psychologists, occupational therapists and physiotherapists cover all global developmental disorders.
According to the CEO of ANS, Paulo Rebello, the agency was already discussing therapies for treating the autism spectrum in a working group created in 2021. “Based on these discussions and considering the principle of equality, we decided to establish mandatory coverage of different methods or therapies not only for patients with autism spectrum disorder, but for health plan users diagnosed with any disorder classified as pervasive developmental disorder. ”he said.
With information from Brazil Agency.
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