Il Regional Administrative Court (Tar) of Lazio ha the decree is suspended issued last November by the Ministry of Health, which updated the rates for the new treatments and services guaranteed by the National Health Service (SSN). This decree, which came into force on December 30, concerned the new Essential Levels of Care (Lea), expected for eight years (since 2017), and introduced Updates for over 3.000 features, including innovative therapies and advanced prosthetics. In particular, the provision updated 1.113 tariffs associated with outpatient specialist services (visits and tests) and prosthetics, out of the 3.171 total that make up the nomenclature.
The TAR has The appeal presented by hundreds of accredited facilities and laboratories was accepted, together with the main trade associations. This is, therefore, a new brake on the application of the price list, which has been frozen respectively at 1996 for outpatient specialists and 1999 for prosthetics.
The reasons for the appeal
The decree has been contested by hundreds of private facilities and accredited laboratories, supported by organizations such as FederAnisap, Uap and Aiop. updated rates were deemed insufficient, with cuts that would come up to 70% refunds compared to the real costs. The lawyers of the appellants, Giuseppe Barone and Antonella Blasi, have denounced a violation of constitutional principles of efficiency and good performance of the public administration, highlighting how the investigation underlying the decree was incomplete and not representative of real operating costs, aggravated by the pandemic and the economic crisis.
The TAR justified the suspension with the lack of urgency in adopting the decree, which occurred more than 20 years after the last update of the nomenclature. A new hearing is set for January 28, while the Ministry of Health is evaluating a urgent appeal to the Council of State to temporarily unblock the situation. Also because there would already be 300-400 thousand prescriptions issued yesterday through Sogei with the codes provided for in the new price list.
New performances blocked
The decision of the Lazio TAR thus postpones theentry into force of the new Essential Levels of Assistance, waiting to start in 2017. These services, financed with an overall impact of approximately 549,9 million euros, included important news for citizens: from medically assisted procreation to new aids and prostheses (such as digital hearing aids and home automation equipment), from new neonatal screening to the diagnosis and monitoring of pathologies such as celiac disease, endometriosis and various rare diseases.
Among innovative diagnostic technologies include computerized optical tomography, useful for detecting serious eye diseases such as retinopathy, glaucoma and maculopathy, and enteroscopy with ingestible videocapsules to diagnose intestinal pathologies. For the treatment of tumors, advanced technologies are planned such as stereotactic radiotherapy, hadrontherapy for inoperable tumors and radiotherapy with a robotic arm.
Administrative and IT chaos
In addition to the blocking of new services, the ASL computer system, already updated with the new tariff codes, is in chaos. Some doctors have reported the impossibility of provide services due to unrecognized codes. Restoring the old price lists will take time and risks worsening the inconvenience for patients and healthcare facilities.
Luana Zanella, leader of Avs in the Chamber, defined the situation a “mess”, inviting the Minister of Health to intervene to ensure the application of the new tariffs. Philip Rings, president of the National Federation of Medical Associations (Fnomceo), underlined how the problem is rooted in chronic lack of resources for public health. “With inadequate reimbursement, it is inevitable that many operators will seek alternatives to the NHS, putting access to care at risk,” Anelli said.
The Ministry of Health is working to unblock the suspended decree, but the situation remains uncertain until the next hearing on January 28. In the meantime, some Regions could continue to finance yourself blocked services. Without, however, a structural intervention and an increase in resources, the risk is that citizens will find themselves having to pay out of their own pockets or give up essential care.
This latest chaos in healthcare represents the sign of a deep crisis for the Italian health system, which urgently needs structural reform and adequate funding to ensure the efficiency and equity of the National Health Service.
After the chaos, the TAR revokes the halt to the decree
After a day of chaos, the Lazio TAR backtracks e revokes the suspension of the decree on the new tariffs. The request for revision came from the Ministry of Health, which underlined, through the State Attorney's Office, the severity of the consequences of the suspension. This would have in fact led to the blocking of the booking and service delivery system, with negative impacts on patients' health.
“Having taken note of the declared severity of the consequences of the suspension of the decree, which would have led to the blocking of the booking and service delivery system with an impact on the health of patients,” the TAR has decided to revoke the provision issued yesterday with an urgent procedure. The final hearing remains set for January 28.
The revocation had also been requested by the same appellant parties, following serious disruptions recorded, as in Campania, where overcrowding occurred in medical offices.
“Yesterday in Campania there were major disruptions with queues and overcrowding in doctors' offices, following the decision of the Lazio Regional Administrative Court to suspend the decree with the new rates for outpatient specialist care. This situation, it should be reiterated, does not depend on the prescribing doctors” he explained John Siena, regional secretary of Campania for the Smi doctors' union. "In this way, until January 28, 2025, the date of the new review of the provision, there is a risk of chaos for the care of Campania patients."
“The Regions, throughout Italy, had already adjusted the nomenclature with the new performance codes and now, in light of what the TAR provides, the Ministry of Health will have to implement the suspension (and therefore define the return to the old codes pending the new ruling)”, reiterates Senese, inviting to “avoid that the Government-Regions ballet falls on the health of citizens”.
Along the same lines, too Smi Lazio, which urges "the regional and national government to immediately clarify the continuation of the implementation criteria, in light of the subsequent ruling by the Lazio Regional Administrative Court" stated Andrea Figà Talamanca, regional president of Smi Lazio.
Last update 15,59am
