Law for the exercise of the professional staff of the Free Body medical and non-medical Health ISS SAN MARINO We the Captains Regent of the Most Serene Republic of San Marino Having regard to Article 4 of the Constitutional Law no.185 / 2005 and the article 6 of Qualified Law n.186 / 2005; Promulgate and publish the following ordinary law approved by the Great and General Council at its meeting on October 22, 2013: October 29, 2013 LAW N.150 LAW FOR THE EXERCISE OF FREE PROFESSIONAL STAFF OF THE BODY HEALTH MEDICAL AND NON-MEDICAL ISS TITLE I GENERAL rULES Art. 1 (Purpose) 1. this law governs the activity of free professional employees that are part of the Body Health medical doctor and not the Institute for Social Security (hereinafter ISS) and activity freelance professionals are not employees who, following a specific authorization of the Executive Committee, to be held at the ISS facilities. Art. 2 (General Principles) 1. The professional activity referred to in Article 1 must not conflict with the ISS institutional purposes nor be seen as competition to the same. 2. The free professional activity is organized in such a way as to ensure the full performance of the tasks and the full functionality of institutional services ISS in accordance with local regulations, as provided by the Health Plan and Social Health and the guidelines . 3. The professional activity aims to: a) improve the quality of services and the use of human resources by encouraging the expansion, enhancement and optimization of the structure of the ISS; b) to attract additional sources of funding also benefit the implementation of the ISS institutional purposes; c) encouraging higher vocational case studies and scientific improvement of medical and non-medical, than those resulting from the continuing education, enriching the capacity to respond to the patient's health needs. 4. The verification planning, of the professional free control wherever it took place, are of relevance of Directors Department provided ISS organizational Act with Law 165 of 30 November 2004 (hereinafter in this Act referred to simply as Director the Department). Art. 3 (Types of freelance activities) 1. The free professional activity is carried out in favor of free choice of subjects and are not entitled, under current legislation, health care ISS. 2. The free professional activities can be carried out also in favor and of free choice of subjects having ISS right to health care limited only to benefits which do not fall within the coverage provided by the Public Health System and will be declined with subsequent regulation. 3. The exercise of the profession Leisure takes place only in the following forms: a) free professional intramural activities: it means the activities carried out by medical health personnel and non-medical, requested by the patient of his own free choice, individually or in teams at the facilities of the ISS; b) professional activity intramural enlarged: means the advisory activities carried out by the medical and non-medical health personnel, individually or as a team in public or private structures authorized, not even San Marino. The exercise of that activity is subject to the prior signing of a special agreement between the ISS and the institution where the practitioner or, in the case of a team, the professionals of the Institute intending to pursue the professional activity. The Convention defines and establishes the procedures for the concrete development of the Professions with the forms referred to in Article 18; c) consulting activities: it means the clinical activities carried out on an occasional basis by the physician, individually or in teams, in public or private structures outside San Marino, which aims to contribute to the improvement of health or to curative therapy or rehabilitation. The exercise of that activity is subject to prior signing of a special agreement between the ISS and the institution where the practitioner or, in the case of a team, the professionals of the same ISS will carry out the professional activity. The Convention defines and establishes the procedures for the concrete development of the Professions with the forms referred to in Article 19. The consultation activities may also be requested by a public or private non-San Marino, even in the absence of a special agreement or at the direct request of the patient already bound by the fiduciary relationship professional. Art. 4 (Excluding Special Features)
1. They are not payable in self-employed professionals: a) the performance of which is not recognized therapeutic diagnostic validity on the basis of the latest scientific and technical knowledge from literature and guidelines of international health organizations; b) the benefits paid under the "emergency-urgency"; c) the obligations which, by objective conditions, structural or for organizing the necessary support, are not profitable, thus not guaranteeing revenues for the ISS; d) the performance which may affect the smooth running of services offered by the ISS; e) Free professional activities against natural or legal persons to the ISS performs supervisory and inspection activities; f) benefits awarded why not secured parties choose the ISS and its facilities through the conclusion of agreements between institutions and not directly to its professionals. Art. 5 (Staff admitted to the exercise of the profession) 1. The profession is allowed to surgical and medical area medical personnel as well as the medical staff doctor in Table 2.1.2 of the Decree of 5 May 2005 n. 70, also included veterinarians, in part or in charge or contract or agreement with the ISS in the form and manner prescribed by law. 2. The free professional activity is allowed to staff referred to in the preceding paragraph in relation to the achieved specializations. 3. Are excluded from the exercise of free professional Departmental Directors and members of the Executive Committee. 4. And 'excluded from the exercise of free professional administrative staff ISS. Art. 6 (objective Limitations) 1. The free professional activity is carried out outside normal service and activity in different time bands from the normal ISS and advance certain activities. In the event that specific performance to organizational technical reasons, can not be performed outside normal service, the staff concerned is quantified par institutional activities to ensure the recovery of the hours devoted to professional services. 2. The professional activity may not involve a time commitment for each employee over 30% of the weekly required by the collective labor agreement. 3. The free professional activity higher than the rate indicated in the preceding paragraph may be authorized by the Executive Committee, after consultation mandatory and binding of the Department Director and the Director of Complex Organizational Unit, for a maximum period of six months, in exceptionally and unless it would jeopardize the conduct of the ISS ordinary. 4. The professional activity can not be exercised: - in shifts readily available or guard; - In case of absences from work for illness, accident, mandatory or optional maternity leave, lactation, ordinary and parental leave, permission to any recognized title, expectation of any kind, suspension of work due to precautionary measures, strike, weekly rest; - In the case of organization of their part-time service. Art. 7 (Authorization for the free exercise of the profession) 1. The medical staff or doctor who wishes to practice the free professional activity must submit a formal request to the Director of the Department to which pertains the Organizational Unit, the Functional Module or Functional Group Project which it is assigned. 2. The request made by the trader or by the team must indicate: - the framework in which they will exercise the profession; - The type of performance; - The times at which they will exercise the profession; - Any support staff (qualification and number) necessary for the performance of professional free; - The possible use of equipment and apparatuses. 3. The Director of the Department, within 5 days of receiving the request referred to in the preceding paragraph, expresses compulsory and binding opinion on whether to start the professional activity that is claimed. 4. For the purposes of prescribed opinion, the Director of Department: 1) acquires the opinion of the Director or the Head of Organisational Unit Complex from which the trader hierarchically; 2) estimates that the waiting time for assisted ISS are within the limits set by Health Plan and Social Health; 3) checks the compliance of procedures for conduct of free professional indicated by the trader or by the team requesting the requirements of this Act. 5. The Executive Committee, gained the consent of the Director of Department, authorizes
the start of the professional free. 6. The resolution authorizing the Executive Committee shall be communicated to the applicant following its adoption and sent to the Office of Personnel and Free Profession for the result of competence. Art. 8 (Insurance coverage) 1. The professional chosen by the user or the team composed of medical and non-medical health personnel, before starting the free professional activities in any form, must deliver a copy of the insurance contract signed by him to "serious and willful misconduct". The Administrative Legal Expert ISS, once analyzed the terms and conditions of the professional policy, it can accept it as valid or requires special extensions or contractual details. Such preventive control is intended necessary and binding to authorize the pursuit of free professional. 2. The liability insurance policy to third parties stipulated by the ISS covers the liability of the individual physician health personnel and non-medical as well as the support personnel involved in freelance only if falling in intramural activities, even enlarged, in all the forms provided for in this law, without recourse, except the case of fraud or gross negligence and in any case subject to all statutory provisions. 3. The advice and consultation, carried out on behalf and in the name of the ISS, in Article 3, paragraph 3, letters b) and c), in the context of specific and detailed agreements between institutions are included, when not otherwise specified, the ISS insurance coverage. TITLE II ACTIVITY 'FREE PROFESSIONAL intramural Art. 9 (Purpose and forms of exercise) 1. The professional activity intramural referred to in Article 3, paragraph 3, letter a) relates to visits and / or therapeutic services, diagnostic, laboratory and instrumental and can be exercised on an outpatient or inpatient basis, ordinary or day hospital, in the following ways: - individual: characterized by the specific choice for the professional user; - As a team: characterized by the request from the user of the only provision for a fee, without the professional. The performance is executed by the Organizational Unit staff, Form Functional and Functional Project Group has formally joined and is directly involved in the provision; - Individual with support staff: characterized by the performance by the user's request to a professional who is assisted in the performance of professional activity, according to mechanisms that ensure appropriate rotation, the support staff. Art. 10 (free outpatient professional activities intramural) 1. The health staff or the team performing outpatient intramural activities whether alone or with support staff defines, every six months, according to the Head of Unit to which the Organizational Complex hierarchically he assigned the personnel involved and the Department Directors, the schedule of activities in privately. 2. The schedule referred to in the preceding paragraph is approved by the Department Committee preventively startup intramural activity. 3. The benefits in outpatient settings are programmed, having regard to the use of facilities and equipment, strictly observing the programming and the ongoing procedures for the routine activities. 4. For the diagnosis and treatment services, for which the professional activity can not be separated from the institutional, additional schedules ordinary ones must be identified at a flat rate based on the timing of the services provided, on a proposal from the competent Department Directors. The additional time will be made in flexible form in accordance with the directions and Organisational Unit Complex interested programming. 5. To facilitate the calculation of hours worked during the intramural activities, presence in the ISS structures must be detected by use of badges with differentiated code than ordinary activity. Art. 11 (free professional intramural activities during hospitalization, including day hospital) 1. The professional activities free in-patient treatment is allowed only in cases where it is compatible with the conduct of the ISS institutional. 2. The activities referred to in the preceding paragraph relates to specialist visits and medical-surgical treatments. 3. The Director of the Department, having consulted the relevant Complex Organizational Unit Director, ad hoc measure has, for professional activities free in-patient treatment, the allocation of the number of beds for each Organisational Unit
extent but never incompatible with the institutional activities. 4. The bed places identified for professional activities free in-patient treatment, are also used for the normal activities. 5. The Department Director may reduce or suspend on a temporary professional activities free in-patient treatment, motivated by the epidemiological or emergency order requirements or to other documented and justified needs of absolutely exceptional. Art. 12 (organization of professional activity intramural free in-patient treatment) 1. The professional activities free in-patient treatment is carried out in dedicated time slots, outside of working hours and service commitment. 2. Where the benefits can not be done outside of regular working hours, the practitioner must comprise through the means of detection of the presences in use at the Institute for Social Security, the number of hours dedicated free professional activity which is due time to be integrated within the year of expertise in performance and in any case in accordance with its own Director of Organisational Unit Complex and Department. Art. 13 (Support staff) 1. An supporting professional activities, supplementary or necessary or essential to support the conduct of free professional intramural, directly and / or indirectly connected to professional performance delivered, guaranteed by staff health. 2. Direct support activities that directly related to the provision of free professional services. 3. The activities referred to in the preceding paragraph is provided by health care professionals, other than the freelancer, belonging to the medical and non-medical health body, in the role or responsibility or contract or agreement with the ISS in accordance with current legislation, which He has expressed his willingness to play in the discipline of belonging an additional working hours. 4. The activities to support the profession may not exceed the overall limit of 30% of the hours worked per week. Where, for technical and organizational reasons, the support activities should be carried out during working hours, the Director of Department and the Director of the competent Complex Unit will proceed to quantify the debt in time to make further specific and detailed measurement. 5. The identification of support personnel indicated by the trader in the request for authorization to pursue the professional Free is made on a voluntary basis for accession of the employees concerned with the requirements deemed necessary by the professional who has requested it. 6. The Organizational Complex competent Unit Director, taking into account the criteria established for the selection of support staff, ensures that the same staff operates on the basis of the rotation policy, a priority considering the requirement of membership Organisational Unit that supplies performance or secondarily membership in related services. 7. The professional who carries out freelance activity provides to the Director of Organizing Complex the monthly report of the involved support staff units, indicating their names and the number of hours worked. 8. The direct support health personnel participating in the allocation of the proceeds of the professional free through specific quotas in the face of the recovery time for the activities carried out in the working timetable period. 9. In case of intramural performance in-patient treatment, the compensation of direct support staff is calculated on an hourly basis, established through specific agreement between the Executive Committee and trade unions. The cost of supporting the activity carried out in the additional time is calculated in the benefit rate. 10. Indirect support activities or collaboration that aimed at ensuring the free exercise of the profession, even if not directly connected to the output performance. Belong to the indirect support staff employees assigned to transversal services actually involved in the organization of professional free system. 11. To this staff distributed a share of the equalization fund referred to in Article 17. 12. The indirect support staff is required to guarantee patient access in private practice, within the limits of its time, the health care activity . Art. 14 (Information, booking and access to free professional services) 1. The Office Acceptance ISS makes available all relevant information with regard to benefits payable in private practice regime, the applied tariffs and exercising professionals.
2. The free professional activities as an outpatient or in-patient treatment is provided on a request made by the user to the Office Acceptance, which provides the full range of performance reservation service in privately. 3. The Office Acceptance, received the claim for service outpatient basis, informs the user on the amount due to the required performance, the venue where the same will be paid and the method of payment. 4. The performance required in-patient treatment is formulated, on a special form, the user Acceptance Office which handles forwarding to the relevant Department Director. 5. The Director of the Department, after receiving the request referred to in the preceding paragraph, make sure it complies with the provisions of this Act and, if so, authorizes the user's hospitalization. The authorization shall be submitted to the competent complex Organizational Unit Director and Management Control. 6. The Office Acceptance, gained the approval of the Director of the Department, prepares the form of quotation expenses related to the planned performance in which benefits payable are indicated, the fees in favor of the trader and the team involved and the portion of ISS relevance. 7. The estimate referred to in the preceding paragraph is signed for acceptance of the conditions set out therein by the user at the time of booking. Art. 15 (performance of payment) 1. In the case of benefits in outpatient settings, the user is required to pay the required performance in a single solution, in advance of the provision of the service, subject to any adjustments for additional activities not predictable to be regularized on the sidelines for granting the benefits itself. 2. In the case of in-patient system, the user is required to pay before his dismissal the amount shown in the budget form or the greater amount calculated in the face of unpredictable performance when budget definition. 3. The amount payable for the services provided is also paid by cash, check, or cashier's not transferable, headed to the ISS, or credit card, or bank transfer directly to the Office Acceptance user issuing the invoice or receipt . Art. 16 (Criteria for determining the rates and the distribution of income) 1. The rate is the amount that the user is required to pay ISS to receive assistance requested under the freedom intramural occupation regime. 2. The ISS prepares annually in consultation with professionals or with the team's charging all benefits payable in privately. 3. The rates for outpatient assets comprise: a) honorary professional or team agreed with the Executive Committee; b) staff share the cost of direct support, referred to in Article 13; c) quota to be allocated to the ISS calculated as a percentage of the rate shown in the tariff approved by the Executive Committee for outpatient diagnostic and specialist services; d) share for equalization fund referred to in Article 17. 4. The rates for freelance activities in-patient treatment, are defined: a) honorary professional or team agreed with the Executive Committee; b) compensation for direct support staff referred to in Article 13, which operates outside of normal working hours, specifically calculated based on the tariff established by specific agreement between the Executive Committee ISS and the trade unions; c) quota to be allocated to the ISS; d) share for equalization fund referred to in Article 17. 5. The support staff takes part in the distribution of the proceeds of the professional free through specific quotas, against recovery time for the activities carried out in the working timetable period. These shares will be distributed among the support staff in the manner determined by the operators involved and in any case in proportion to the degree of professional involvement. The quotas involved in the distributions are proposed to the Organizing Complex competent Unit Director who shall send them to the Director of the Department for the possible authorization. 6. The rates of benefits paid teams will be authorized by the Executive Committee with special tariff prepared in accordance with the health personnel involved. 7. The proportion allocated to the team is divided among its members in the manner determined by the actors involved, and still in proportion to the degree of professional involvement. 8. The Director Organisational Unit Complex to which the hierarchically pertains team
communicate the arrangements for the allocation of quotas defined by the team to the Director of the Department for approval and subsequently to the competent administrative offices for the activation of procedures for future liquidation. Art. 17 (Equalisation Fund) 1. The equalization fund is established for the provision of 5% calculated on the proceeds of the staff involved directly derived from professional services, excluding the share in favor of the ISS; 70% of the total annual amount accrued Equalisation Fund is reserved: a) to staff working with the Housing Health and medical doctor who does not, by virtue of their functions or membership discipline, has a limited ability to direct exercise of free intramural profession; b) the modernization and improvement of facilities and equipment ISS and to projects relating to training activities of the ISS staff. The remaining 30%, the Equalisation Fund is: c) to staff working with the Medical Corps physician and not ISS doctor who carries out indirect support activities. The allocation of the equalization fund is effected, in one solution to all those eligible, at year end, once the total quantified the proceeds from the profession. 2. The equalization fund distributes the proceeds of the professional free through specific quotas that are set of Regulations drawn up by the Executive Committee, in consultation with trade union representatives, in proportion to the degree of professional involvement of the staff concerned. 3. Alternatively, the allocation among the beneficiaries, the Equalisation Fund can be used for the definition of specific training projects shared between the Executive Committee ISS and union representatives. TITLE III FREE PROFESSIONAL ACTIVITIES intramural EXTENDED AND ACTIVITIES 'OF CONSULTING Art. 18 (free professional activities intramural enlarged) 1. The professional activity intramural enlarged in Article 3, paragraph 3, letter b) is allowed to Medical Corps doctor and not ISS doctor for conducting professional activities in public and private health facilities authorized, not even San Marino. 2. The free exercise of the profession referred to in this Article, as approved by the Executive Committee following mandatory consultation with the Director of Department from which the professional hierarchy depends, must ensure compliance with the fungibility and the rotation of staff providing the performance and compatibility of the same consulting with institutional goals of the ISS. 3. This activity is regulated by a special agreement between the ISS and the entity or interested structure that defines: a) the nature of the benefits; b) the minimum and maximum limits of the professional commitment compatible with the organization of their working at the ISS; c) the amount of compensation due and the possible reimbursement of costs incurred; d) the rules for granting the compensation and reimbursement of expenses. 4. The fee for the consulting business in outdoor facilities is forfeited by the Institute for Social Security, which shall retain a stake of between 15% and 30% of the total, depending on the type of service and attribute the remaining share the same professional within two months with the effective collection of the amount. Art. 19 (consulting activities) 1. The consulting activities under Article 3, paragraph 3, letter. c) relates to the clinical activity with occasional character, required by public bodies or private external also not affiliated or directly from the patient not attend ISS or its family. 2. The consultation is made by ISS professionals, even in the contract or agreement, exclusively in the specialist disciplines and, in any case, outside working hours. 3. The consulting activity is allowed only if previously authorized by the Executive Committee. 4. The request, specifying the day and time, has to be addressed from time to time to the Executive Committee, after consultation with the Director of the Department to which the professional, releases to consent in writing. 5. The fee of the consultation, set by the ISS in agreement with the manager concerned should be collected, through the Office Acceptance, ISS, in advance of the performance. Art. 20 (control and verification functions) 1. The control activities referred to in this article is promoted automatically by the Office or on the recommendation of users, ISS or other private practitioners. 2. The Executive Committee, in connection with the inspection activities relies Expert
Legal Administrative Office of General Affairs and Department Directors of the Institute for Social Security. 3. The Director of the Department, following the appropriate investigations, reports any irregularities to the Executive Committee which assesses the appropriate consequent actions. 4. The Department Directors shall verify that the freelance activities are planned so as to ensure the complete fulfillment of institutional activities and to ensure the full functionality of the ISS services. 5. This test is carried out with the cooperation of the Director of the IT Complex. 6. In particular the Directors of Complex Organizational Unit: a) monitor the hourly volumes dedicated to the exercise of the profession and verify that that professional activity does not involve a time commitment for each employee over 30% of the weekly provisions of the employment contract the individual practitioner; b) monitor the wait times for access to health services; c) verify that the conditions for the booking and payment of benefits. 7. The Organizational Unit Director Complex that, in exercising the powers referred to in the preceding paragraph, behavior occurs not in line with the authorization granted to the professional and the provisions of this Act, shall challenge them to the person concerned, notifying the Director of the Department concerned. 8. Violations detected regarding free professional activity intramural enlarged, found in the performance of their respective competence on the part of the Executive Committee and Health and Socio-Sanitary Authority, notify each other in the relevant formalities. 9. The Management Control and run the offices in charge, quarterly investigations and surveys freelance on its activities and on income received by the ISS in order to realize an analysis of the average cost of benefits paid in the reference year . 10. The Executive Committee, the results of surveys and investigations occurred under the previous paragraph, verifying the adequacy of the rates established for the professional activity. These surveys shall also be sent to the Consulta Health and Socio-Sanitary. TITLE IV VIOLATIONS AND PENALTIES Art. 21 (Sanctions) 1. In case of violations being committed in independent practice, under and for the purposes of this Act, the Director of Organisational Unit Complex proceed, advance, to challenge them to the person concerned and to inform the Director of the Department concerned. 2. The violations and breaches of the rules of this law shall be punished with the penalties and procedures of Law 106 of July 31, 2009. 3. In any event, if the freelance activity being paid at the time of service or in the cases provided for in Article 3 of this law, the fees for the services performed will be confiscated ex officio by the ISS. Art. 22 (offenses subject to suspension from work) 1. The suspension of the service, in addition to the assumptions set out in Article 11 of Law 106 of July 31, 2009, is imposed for the following offenses: a) exercise of freedom profession in a situation of waiting times than those indicated by the current health plan; b) exercise of professional activity on the ISS to offer activities also assisted by the public health system; c) unauthorized exercise of professional services during working hours; d) exercise of the intramural enlarged unauthorized at facilities not in agreement. Art. 23 (Suspension and revocation) 1. In the event that the professional has been contested an infringement leading to the suspension or dismissal from service, taking into account the mode and severity of the conduct and the extent of the material damage or morals went Administration, applies the suspension of the exercise of the profession. 2. The suspension of exercise of the professional free is taken in respect of the professional also as additional sanction of suspension from service. 3. In the event that the trader has committed a relapse in the space of fifteen years applies the definitive withdrawal of the authorization to the exercise of the profession. TITLE V FINAL PROVISIONS Art. 24 (with the allowance payment) 1. The fees of the professionals for the professional activity intramural are cleared within the next quarter of the Administration ISS. 2. Fees for intramural activities enlarged breakthrough in the form of advice and consulting
They will be settled in favor of the employees concerned within two months following the month of the settlement received after the payment made by the external structure, with which specific agreement has been concluded according to the sessions or hours performed for counseling or consulting by the latter notified. Art. 25 (Repeals) 1. The following are repealed Articles 3 and 14 of Law 16 December 1991 n. 153 "Consolidated provisions for the healthcare employees of the Institute for Social Security." Art. 26 (Final Provisions) 1. The tariff of the benefits paid in the manner provided by this Act shall be approved by the Executive Committee and confirmed or modified each year with a specific resolution. 2. The free professional fees of the professionals, as well as salaries for institutional activity, will be announced through the website ISS and updated annually. 3. It is the obligation of the staff of the Medical Corps physician and non-physician who wishes to pursue professional activity deposited with the Executive Committee ISS, together with the request for authorization to conduct business, self refers to any existing holdings directly or indirectly in limited liability companies or joint stock companies that have as their core business than health. Art. 27 (Entry into force) 1. This law comes into force on the fifteenth day following that of its legal publication. 2. With delegated decree may be adopted any changes to the present law. 3. Regulation for the Equalisation Fund under Article 17 shall be adopted within thirty days after the entry into force of this Act. 4. It identifies in ninety days after the entry into force of this law the transition period for professionals to regularize their professional free positions and not the penalties provided for in Title IV. Our Residence, this day of 29 October 2013/1713 THE CAPTAINS REGENT Gian Carlo Capicchioni - Anna Maria Muccioli p.IL SECRETARY OF STATE FOR INTERNAL AFFAIRS SECRETARY OF STATE Pasquale Valentini