STJ to decide if health plans must cover music therapy for autism

The Superior Tribunal de Justiça (STJ) has designated the issue of whether health insurance providers must cover music therapy for individuals with Autism Spectrum Disorder (ASD) for judgment under the repetitive appeals rite.

Minister Raul Araújo, the rapporteur, affected Special Appeals 2.242.804 and 2.129.469 to establish a binding precedent. The central controversy involves determining if coverage is mandatory under Law 9.656/1998 when a treatment is not explicitly listed in the National Supplementary Health Agency (ANS) list or fails to meet specific extra-list requirements.

As a result of this decision, the processing of similar special appeals and interlocutory appeals in second-instance courts and the STJ has been suspended. The goal is to ensure legal certainty and uniformity in judicial decisions regarding medical procedures prescribed by doctors that fall outside the standard ANS regulatory list.