Resolution 4B0/38195/2015, Of December 14, The Social Institute Of The Armed Forces, Which Are Published Concerts Signed With Entities Of Insurance For The Health Care Of Beneficiaries During 2016 And 2017.

Original Language Title: Resolución 4B0/38195/2015, de 14 de diciembre, del Instituto Social de las Fuerzas Armadas, por la que se publican los conciertos suscritos con entidades de seguro para la asistencia sanitaria de beneficiarios durante los años 2016 y 2017.

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In accordance with the provisions of articles 14 of the consolidated text of the law on Social security of the armed forces, approved by Royal Legislative Decree 1/2000, of 9 June, and 61 of its General Regulation, approved by Royal Decree 1726 / 2007, of 21 December, the ISFAS maintains a collaboration agreed with the military health system, regulated in the Ministerial order, 52/2004 18 March, having signed concert with the National Institute of Social Security and the General Treasury of the Social Security, dated December 30, 1986, in regime of successive annual extensions, so that members and other beneficiaries of the regime special of the Security Social of the armed forces can elect to receive health care for the military health services with the exceptions established in the Ministerial order hint, or through the health network of the Social Security, pursuant to the conditions in force for the General regime.

Also under the aegis of the abovementioned provisions, prior public announcement, the ISFAS subscribed concert with various entities of insurance, for health care for holders and beneficiaries during the year 2016 and 2017.

In order to facilitate the choice of the ISFAS holders and, in the case that opt for ascribed to an insurance institution, know the content and the provision regime, this management agrees: first.

Publish, as an annex to this resolution, the text of the agreement signed for the health care of the owners and beneficiaries of the ISFAS during 2016 and 2017, with the following insurance entities: ASISA, Interprovincial health care insurance, joint-stock company.

Company SEGURCAIXA ADESLAS, Sociedad Anónima de Seguros y Reaseguros.

Second.

Make public equally special care modalities detailed in annex 6 of the concert have been assigned to the above-mentioned insurance entities.

Third party.

Determine that, during the month of January of the year 2016, holders affiliated to the ISFAS wishing to do so could change healthcare modality, the timely repairs, so that, throughout the month of January, they may be ascribed to one of the insurance entities listed in paragraph first, welcome to the concert with the INSS and TGSS when you choose to receive assistance through public health services or exclusively in the provinces of Madrid and Zaragoza, ascribed to military health services, with the limitations laid down in the 52/2004 Ministerial order of 18 March.

Change that is referenced will be requested by the holder or person duly authorized accrediting the representation in the delegation or sub-delegation of the ISFAS to which belong or, in the case of Madrid, in any of the offices of delegates, Dante, join the application document of affiliation for replacement. You can also be done through the electronic Office of this Institute.

The deadline for changes of regular status, which may be made only once a year, is limited to the month of January, without prejudice to extraordinary changes laid down in clause 1.6 of the concerts and the corresponding specific regulation.

Madrid, 14 December 2015.-the Secretary General Manager of the Institute Social of the armed forces, María Soledad Álvarez Delgado Miranda.

Annex concert of the Social Institute of the armed forces with entities of insurance for the health care of holders and beneficiaries of the ISFAS during 2016 and 2017 contents chapter 1. Object of the agreement and scope of protective action.

1.1 subject to the concert.

1.2. contingencies covered. Scope of protective action.

1.3 territorial scope.

1.4 protected collective. Beneficiary of the concert.

1.5 birth and extinction of rights of beneficiaries.

1.6 change of entity.

1.7 health cards.

1.7.1 emission. Temporary health insurance card.

1.7.2 specifications.

1.7.3. access to services.

1.8. the entity actions related to its range of services.

Chapter 2. Portfolio of services 2.1 General considerations.

2.1.1 contents of the portfolio of services.

2.1.2 incorporating new means of diagnosis and treatment.

2.2. portfolio of primary care services.

2.2.1. contents.

2.2.2 homecare.

2.3. portfolio of specialty care services.

2.3.1 assistance in consultations.

2.3.2 specialized assistance in day hospital.

2.3.3 hospitalization in internment regime.

2.3.4 home hospitalization.

2.3.5. diagnostic and therapeutic procedures.

2.3.6. rehabilitation and physiotherapy.

2.3.7 reproduction assisted human (RHA).

2.3.8. Mental health.

2.3.9. other complementary specifications.

2.4 urgent care services portfolio.

2.4.1 content.

2.4.2 conditions of access.

2.4.3 emergency health transport.

2.4.4. hospital emergency services.

2.5 palliative care.

2.5.1 contents.

2.5.2 susceptible to palliative care patients.

2.5.3 structure and organization.

2.5.4. home-based palliative care.

2.5.5. palliative care in regime of hospitalization.

2.6. oral health.

2.6.1 contents.

2.6.2 exclusions.

2.6.3 specifications and requirements for certain treatments.

2.7 transport for health care.

2.7.1 General considerations.

2.7.2. non-urgent health transport.

2.7.3. transportation in ordinary means.

2.8 performance pharmaceutical and dietetic products.

2.8.1. General rules.

2.8.2 content.

2.8.3. medicines for outpatient treatments carried out by the entity.

2.8.4. dispensation for services of hospital pharmacy in special cases.

2.8.5. rational use of medication.

2.8.6. procedure for the impact of costs of medicines.

2.9 sanitary products.

2.10 provision prosthetics.

2.10.1 surgical implants.

2.10.2 products event of outpatient dispensing.

2.11. other benefits.

2.11.1 oxygen and other respiratory therapies.

2.11.2. preventive programmes.

2.11.3 podiatry.

2.11.4. assistance in the framework of monitoring studies.

Chapter 3. Means of the entity.

3.1. General rules.

3.2. availability of means and services criteria.

3.2.1. availability of means for primary care.

3.2.2 availability of specialized care services.

3.2.3 reference services.

3.3 special conditions for the islands of the Canary and Balearic archipelagos.

3.4. guarantee of accessibility to the media.

3.5 standards and requirements for the use of the means of the entity.

3.5.1. general rule.

3.5.2 identification.

3.5.3 additional requirements.

3.5.4 non-agreed private hospitals.

3.6. catalogue of the entity services.

3.6.1. General criteria.

3.6.2 structure and content.

3.6.3. responsibility in the edition of the catalogs of services and information on the web.

3.6.4 invariability of the catalogs of services.

3.6.5. principle of continuity of care.

3.6.6 information relating to the means available.

3.7. freedom of choice of physician and Center.

3.8 military hospitals.

Chapter 4. Use of non-agreed.

4.1. general rule.

4.2. unjustified refusal of assistance.

4.2.1 cases of unjustified refusal of assistance.

4.2.2. obligations of the entity.

4.2.3 claims.

4.2.4. other effects.

4.3. emergency care of vital character.

4.3.1 concept and requirements.

4.3.2. assistance by accident in Act of service and other special situations of urgency.

4.3.3. range.

4.3.4 communication to the entity.

4.3.5. obligations of the entity.

4.3.6 claims.

4.4 transport in foreign media for health care in cases of unjustified refusal of assistance and of vital urgency.

4.5 cross-border assistance.

Chapter 5. Information and health documentation and quality objectives.

5.1 information and documentation.

5.1.1. General rules.

5.1.2 general information activity.

5.1.3 economic information.

5.1.4. information about hospital care.

5.1.5 information about sanitary means.

5.1.6 documentation clinic.

5.1.7. other sanitary documentation.

5.2 digital medical records and electronic prescriptions.

5.3. quality of health care.

5.3.1 General considerations.

5.3.2 adaptation strategies of the national health system.

5.3.3. preparation of protocols.

5.3.4 quality pharmaceutical delivery.

5.3.5. quality of information.

5.3.6. evaluation of the quality of care processes and health centres.

Chapter 6. Legal regime of the concert.

6.1 nature and status of the concert.

6.2 nature and system of health care relationships.

6.3. joint committees.

6.3.1 types and operating regime.

6.3.2 composition.

6.3.3 functions.

6.3.4 operation.

6.4 procedure for claims.

6.5. execution of estimated claims procedure.

6.6 discounts pharmacy costs.

6.7. financial compensation for breach of obligations.

6.7.1. compensation for breach of obligations.

6.7.2. the procedure for the imposition of economic compensation.

Chapter 7. Duration, economic regime and the concert price.

7.1. duration of the concert.

7.2 economic regime of the concert.

7.2.1. the economic effects of the highs and lows of beneficiaries.

7.2.2. periodicity of payments.

7.2.3 payments scheme.

7.2.4 discounts and deductions.

7.2.5. claims for difference.

7.2.6 taxes.

7.2.7. subrogation in collection rights and actions.

7.3 price concert. Quotas.

7.4 incentives associated with objectives.

7.4.1 limits and objectives.
7.4.2. assistance to persons with special care needs.

7.4.3 guarantee coverage of emergency services.

7.4.4. improvement of quality in the provision of palliative care.

7.4.5. monthly incentive for improvement in the quality of the pharmaceutical prescription.

7.4.6. annual incentive for the breadth of the range of hospital services.

Annex 1. Media assistance in rural areas.

Annex 2. Services that require prior authorization from the entity.

Annex 3. With life-threatening diseases.

Annex 4. Health care information system. Registration of actividad-coste.

Annex 5. Medical record.

Annex 6. Complementary modality of primary care and emergency room.

Annex 7. Cross-border health care.

Annex 8. List of municipalities of level I of specialized care.

Annex 9. List of municipalities of level II of specialized care.

Chapter 1 subject of the concert and the protective action 1.1 scope object of the concert.

1.1.1. the purpose of the concert is to ensure access to health care benefits included in the portfolio of services to owners and beneficiaries of the ISFAS who choose to receive it through the State, throughout the national territory, with the exception in clause 4.5. This assistance will be provided in accordance with the text revised the law on Social security of the armed forces, approved by Royal Legislative Decree 1/2000, Act 14/1986, General health and law 16/2003, 28 of may, cohesion and quality of the national health system, and in its implementing rules.

1.1.2. the health care will be provided in accordance with the portfolio of services established in the present agreement with the reference, in terms of content, to the common portfolio of services of the national system of health, in accordance with the aforementioned law 16/2003 of 28 may, and its standards of development, in particular the Royal Decree 1030 / 2006 , 15 September, which establishes the portfolio of common services of the national health system and the procedure for its updating.

1.1.3. to give effect to the provision of comprehensive health care and quality, according to the portfolio of services, the signing entity of the concert (hereinafter entity) will provide owners and beneficiaries attached to it (hereinafter beneficiaries), all own or concerted media precise (hereinafter media entity).

If exceptionally the entity not available such means, will take care directly of spending caused by the use of means not approved in accordance with the provisions laid down in this concert.

1.1.4. in addition, the entity undertakes to coverage of cross-border healthcare of their collective protected, in accordance with provisions in the Real Decree 81/2014, on 7 February, which lays down rules to ensure cross-border healthcare, and amending the Royal Decree of 1718 / 2010 of 17 December, on prescription and dispensing orders , and in clause 4.5 of the concert.

1.1.5. for its part, and to the same end, the ISFAS undertakes to pay to the entity per month / person provided in clause 7.3, subject to the specifications and procedure contained in clause 7.2 and, where appropriate, economic incentives set out in clause 7.4.

1.2. contingencies covered. scope of protective action. The contingencies covered by this concert are those derived from common or professional disease, injuries resulting from accident, either that is the cause, even if it's an act of terrorism, and for pregnancy, childbirth and puerperium as well as preventive actions contained therein.

1.3 territorial scope. The right to the use of the means of the entity may exercise in all the national territory, regardless of which they are themselves, concluded or subconcertados.

Thus, in accordance with the provisions of clause 1.1.1, the entitlement to benefits that are the subject of the concert is confined to this territory, with the exception in clause 4.5.

1.4 protected collective: beneficiaries of the concert.

1.4.1. for the purposes of the present agreement, the collective protected by the same is composed of holders and beneficiaries who ISFAS, pursuant to the applicable legislation, has recognized this condition and have attached them to the entity.

They may also be included in the group protected by the concert, and shall be regarded as beneficiaries of it, foreign military students, subject to cooperation programmes with other countries in the field of education, which are ascribed to the entity by the ISFAS.

Any case, the recognition of the condition of holder or beneficiary and the right to the allegiance to the authority, for the purposes of the concert, corresponds to the ISFAS.

1.4.2. for certain management purposes beneficiaries of the concert can be called holders or simply beneficiaries, when they appear as such in the document of affiliation of a holder, or when they possess a document to the membership.

The condition of holder or beneficiary is credited by the document of affiliation, health card or certification issued by the ISFAS.

1.4.3 will be attached to the entity-holders and beneficiaries which, in his case, it would be December 31, 2015 and no change of entity, as provided for in clause 1.6 or according to the rules of affiliation to the Social security health network, and that choice in accordance with the rules of that clause or when there is discharge in the ISFAS and choose it.

1.5 birth and extinction of rights of beneficiaries.

1.5.1. without prejudice to the provisions of the following paragraph, the rights of the beneficiaries start on current date that have been assigned to the entity by the ISFAS services, where there is no lack for assistance any time.

1.5.2. for the aforementioned purposes, it is presumed in any case that the newborn is attached to the entity that meets the mother, from the moment of birth until after a month. From then on, cited law is conditioned to the formalization of the affiliation with the consequent economic effects.

1.5.3. the rights of the beneficiaries are extinguished, in any case, on the date in which the ISFAS services agree to the same low or the end of their secondment to the entity for failure to attend the requirements or alleged fact that allowed in each case be protected by this concert.

1.5.4. the ISFAS shall discharge from the beneficiaries to the entity daily form telematics.

Also and by the same procedure, shall communicate to the entity casualties and variations in the data of the beneficiaries.

1.6 change of entity.

1.6.1. without prejudice to the possibility to choose to receive health care through the health public, in accordance with the provisions of article 14 of the revised text of the law on Social security of the armed forces, approved by Royal Decree legislative 1/2000, article 61 of the rules of procedure General of the Security Social of the armed forces approved by the Royal Decree 1726 / 2007, of 21 December, and the seventh additional provision of the Royal Decree 1192 / 2012, of 3 August, which regulates the status of insured and beneficiary for purposes of health care in Spain, financed by public funds, through the national health system, the holders attached to the entity may elect to receive health care for themselves and their beneficiaries through another of (the arranged in the following cases: to) with regular and general character, only once, during the month of January, in the way that is established by the ISFAS.

((B) with extraordinary character: to) when there is a change of destination of the owner that involves transfer from province or island of residence or when an incumbent by secondary legislation or a holder by its own right, in situation of reserve or retirement, move its domicile to another province or island.

(b) when the person concerned agrees expressed in writing by the two entities concerned.

(c) when, because circumstances objective to justify the change from a plurality of holders affected by the same problem of health care, management of the ISFAS agreed the opening special term of choice of entity.

(d) in particular cases in which, in view of the Secretary General Manager the ISFAS, there are exceptional circumstances justifying the change of entity.

1.6.2. the fusion of the entity with one or other of the concerted by the ISFAS does not imply the opening of special period of change, being automatically assigned to the absorbent or resulting entity of the merger the beneficiaries which, at the time of the merger, were attached to the / extinct entity s s / s or to each of the merged entities forcing the absorbing entity resulting, from that moment, to guarantee all their rights in the terms provided for in the present agreement.

1.7 health cards.

1.7.1 emission. Temporary health insurance card. Upon becoming the entity, by any runway, aware of the high of a beneficiary, it will give you a temporary card or any document that will make possible the use of the media concluded from the time of discharge.

Subsequently, the corresponding definitive health insurance card, which will be sent to the domicile of the beneficiary within a maximum period of seven calendar days from the effective communication will be issued.
When at the express request of a holder, which would have been discharged as the beneficiary attached to the entity, it was not provided card provisional or document that will make possible the use of the media agreed, by the delegate of the ISFAS will dictate resolution in which shall be recorded all the expenses caused by the assistance of the holder and their beneficiaries through the optional services and centres included in the catalogue of services of the entity may be billed directly to the ISFAS, for a maximum period of thirty days, from the date of discharge for the realization of the corresponding payment. The amount of these expenses will be deducted from the monthly fees that will be paid to the entity, in accordance with the procedure laid down in section 6.5.4. the concert, without prejudice to the financial compensation that could be agreed.

1.7.2 specifications. Identification of holders and beneficiaries to medical devices is carried out through the health card so, to facilitate its recognition safe and univocal, as well as to facilitate the interoperability of different systems of clinical information and management, it is necessary to determine the technical specifications that conform the health cards, as well as the basic information that should be included and its format.

If the card was issued by a subconcertada entity, you must always wear the logo of the Organization agreed with the ISFAS, to facilitate the use of means outside of the provinces where the subconcertada entity is established.

In addition, cards that are issued shall appear in prominent permanent urgent care free phone.

Shall be determined by resolution of the management of the ISFAS and may changed the specifications of cards and their storage systems, as well as structure, format and content of the data which, apart from which the entity required for its own management, should be included.

1.7.3. access to services. The beneficiary must submit the corresponding health insurance card when you go to the media entity.

In any case, the non-submission of the cited health insurance card at the time of attendance, when the entity had not delivered it or in emergency situations, does not prevent or conditions the right of the beneficiary to make use of the means of the entity.

The entity undertakes to inform and implement the necessary mechanisms for compliance with provisions in the clauses above by professionals and its catalog of services centres.

1.8. the entity actions related to its range of services.

1.8.1. the entity can advertise on its range of services throughout the year and during the period of regular change, provided that is not carried out within the premises of institutions or agencies and of general nature, without contact with specific socio-demographic profiles or groups or professional specific. In advertising campaigns that make the entity shall not use the logo or any other sign of the ISFAS or the General Administration of the State.

1.8.2. in no case may offer gifts to the holders, directly or indirectly via third parties, especially during their regular exchange and processes of high-specific professional groups. However, the entity may offer health additional services, such as value-added and differentiated from other vendors offerings.

1.8.3. the entity is responsible for compliance with these obligations by both staff and other corporations, consortiums, associations, foundations, social partners or other entities of any type, with or without profit, to maintain any legal, business, group or other collaborative relationship and agree to act, or on behalf of the entity. Failure to comply with these obligations will lead to the economic compensation provided for in clause 6.7.

Chapter 2 2.1 General considerations service portfolio.

2.1.1 contents of the portfolio of services. The portfolio of services is the set of techniques, technologies and procedures, understanding as such each of the methods, activities and resources based on knowledge and scientific experimentation, by which health benefits must be paid.

The portfolio of services which is the subject of the concert, is structured in the following features: 1. primary care.

2. specialized care.

3. urgent care.

4. palliative care.

5. oral health.

6. sanitary transport.

7 providing pharmaceutical and dietetic products.

8. other features: oxygen and other respiratory therapies.

Providing prosthetics.

Preventive programs.

Podiatry.

The benefits included in the portfolio of services are guaranteed through the provision of health care resources by levels and geographic areas and population set out in Chapter 3 of this concert, with the procedures and conditions that are determined in Chapter 4.

The entity will drive aimed to enhance coordination between the services of primary care, specialized care emergency, to ensure the continuity of care and comprehensive care of patients.

2.1.2 incorporating new means of diagnosis and treatment. The services included in the portfolio of services is set to the provisions, at any time, for the rest of the national system of health.

Any technique of diagnosis or treatment that appears after the signing of the agreement will be medium required for the entity when it is applied to patients within the national health system in some of their own or concerted centers of the health services of the autonomous communities. If in doubt, be taken as reference provisions in law 16/2003, 28 of may, cohesion and quality of the national health system and its regulatory development in this area.

In this way, the portfolio of services, which is determined in this chapter will be updated automatically for updates of the common portfolio of services of the national health system.

2.2. portfolio of primary care services.

2.2.1. contents. Primary care is the basic level and initial health care and will be given by specialists in family and community medicine or practitioners, pediatric specialists and nurses, without prejudice to the collaboration of other professionals and includes: a) health care demand, scheduled and urgent consultation both at the home of the patient.

(b) the indication or prescription and carrying out, where appropriate, diagnostic and therapeutic procedures.

(c) attention and specific services for women, including the detection and treatment of situations of gender violence, childhood and adolescence.

(d) attention to adult, risk groups, immobilized and chronic sick, which includes the assessment of the State of health and risk factors, tips on healthy lifestyles, the detection of problems of health and evaluation of the clinical status, care and follow-up of persons polimedicadas and with pluripathology and information and Health Council about their illness and the precise care to the patient and caregiver , in your case. Shall in particular be provided: health care protocol for patients with chronic health problems and prevalent.

Care of people with HIV and sexually transmitted diseases in order to contribute to the clinical monitoring and improvement of their quality of life and prevent unsafe.

Attention to people with risky behaviors: attention to smoking and tobacco cessation support.

Attention to the excessive consumer of alcohol. It includes detection, assessment of dependence, the limitation or elimination of Consumer Council, the valuation of pathologies caused by the consumption and supply of health care for abandonment if necessary.

Attention to other addictive behaviors. It includes detection, the offer of specialized health support, if required, for abandonment of the dependence and the prevention of illnesses.

(e) palliative care to terminally ill patients.

2.2.2 homecare. Home health care will be provided by primary care professionals to patients who can not move, by reason of his illness chronic immobilized patients requiring assistance of another person to the basic activities of daily living and terminally ill patients, in line with the provisions in section 2.5.4.

The home care comprises: to) access to tests and diagnostic procedures not realizable in the patient's home, including the extractions and/or collection at home that are accurate.

(b) preparation and follow-up of treatments or therapeutic procedures requiring the patient, including parenteral treatments, cures, and drilling.

(c) information and advice to persons related to the patient, especially to the caregiver/main.

2.3. portfolio of specialty care services. Specialized care includes health care, diagnostic, therapeutic and rehabilitation and care activities, as well as those of prevention, whose nature requires the intervention of medical specialists.

The specialized care includes: 1. specialized assistance in consultations.

2. assistance in medical or surgical day hospital.
3 hospitalization in internment regime.

4. domiciliary hospitalization.

5. diagnostic and therapeutic procedures.

6. rehabilitation in patients with recoverable functional deficit.

7 assisted human reproduction.

8. Mental health.

2.3.1 assistance in consultations. The beneficiary can access consultation of specialized care directly, without prerequisites, with the exceptions provided for in clause 3.5.3.

This care includes activities, preventive care, diagnostic, therapeutic and rehabilitation, provided in the field of specialised outpatient, care including: 1. initial assessment of the patient, 2. indication and realization of tests and diagnostic procedures.

3 indication, realization and follow-up of treatments or therapeutic procedures that the patient needs.

4. indication of medication, parenteral or enteral nutrition, priests, consumables and other health products that are accurate.

5 implants.

6. indication of external prostheses, chairs casters, brace and special orthoprosthesis and its timely renewal.

7. information containing the procedures and diagnostic information to facilitate the correct patient follow-up and continuity and safety of care and care.

2.3.2 specialized assistance in day hospital.

A) content. Day Hospital assistance is an alternative regimen to hospitalization for the care of patients who require a lower intensity in his convalescence care and/or need of terapeuticos-rehabilitadores procedures that don't require hospitalization.

It includes health care, diagnostic, therapeutic and rehabilitation activities to patients requiring care specialized continued, including the major outpatient surgery, which do not require that the patient spend the night in the hospital. In particular comprises: 1. indication and realization of tests and diagnostic procedures.

2 indication, realization and follow-up treatments or therapeutic procedures or rehabilitation required by the patient, including outpatient surgery and chemotherapy treatments to cancer patients which includes the provision of precise medication.

3. nursing care needed for the proper care of the patient.

4 implants.

5 indication of external prostheses, wheelchairs, orthotics and special orthoprosthesis and its timely renewal chairs.

6 medication, medicinal gases, transfusions, cures, consumables and other health products that are accurate.

7. postoperative resuscitation and, if appropriate, after invasive diagnostic procedures.

8. parenteral or enteral nutrition.

9. if applicable, power, according to the prescribed diet.

10 discharge information with instructions for proper follow-up treatment and establishment of mechanisms that will ensure the continuity and safety of care and care.

For the purposes of the concert is considered of hemodialysis and chemotherapy treatments oncology outpatient are always performed in day Hospital regime.

(B) requirements. Access to assistance in day Hospital regime requires the indication of the medical specialist responsible for the patient assistance and authorization of the entity.

2.3.3 hospitalization in internment regime.

A) content. Hospital care in detention regime will be given when the patient likely need care special and continued, not likely to be provided on an outpatient basis or at home.

Includes medical, surgical, obstetric and pediatric care or carrying out treatments or diagnostic procedures, patients who require continued care requiring its detention, including: 1. indication and realization of tests and diagnostic procedures, including the neonatal review.

2 indication, realization and follow-up of treatments or therapeutic procedures or surgical interventions required by the patient, regardless of whether their need to come or not caused by the reason for their detention.

3 medication, medicinal gases, transfusions, cures, consumables and other health products that are accurate.

4. nursing care needed for the proper care of the patient.

5 implants and other orthoprosthesis and its timely renewal.

6. resuscitation or intensive care as appropriate.

7. treatment of possible complications that may occur during the care process.

8 treatments of rehabilitation and haemodialysis, where appropriate.

9. parenteral or enteral nutrition.

10 power, according to the prescribed diet.

11. directly related to own hospitalization basic hotel services with stay in a single room.

12 discharge information with instructions for proper follow-up treatment and establishment of mechanisms that will ensure the continuity and safety of care and care.

(B) requirements. Specializing in regime of hospitalization assistance will assist in the centers of the State, own or concerted.

Urgent admission will be made through hospital emergency services or by indication of the responsible physician, without further requirements.

Income scheduled in a Hospital shall specify the same prescription by physician of the entity, with an indication of the Center, and the prior authorization of the institution.

Moreover, the entity will put in knowledge of the Center the authorization of internment, in a way telematics or by fax, within 24 hours.

In cases of income made through emergency and inpatient services by maternity, the Centre will carry out the precise procedures before the entity.

In the case that the owner or the beneficiary is admitted to a hospital outside the entity by a situation of urgency, can apply for the continuity of care in a hospital of the same without the prescription of a physician of the entity, being necessary contributing with your request the medical report of the process that is being taken care of.

(C) duration of hospitalization. The entity will cover hospitalization coverage until the physician responsible for assisting the sick sounds discharge, considering that no longer exists the need for assistance in hospital regime. From that moment, the continuity of the stay would understand that it is due to social reasons.

(D) type of room. Hospitalization shall be carried out in a single room with bath or shower and bed companion, and must provide the institution of higher level when there were no available of the designated type. Rooms that are part of the accommodation capacity of the Centre may be excluded in any case.

The ISFAS may authorize that the entity have hospitals that do not comply with the requirement of the previous paragraph in its catalog of services of centres.

In the cases of psychiatric hospitalization is not required companion bed.

(E) hospitalization for maternity leave. At the time of entry, shall be sought authorization from the entity directly by the relevant hospital.

For the purposes of the assistance to the newly born will be taken into account as provided in section 1.5.2.

If the practice of tubal ligation is decided at the time of delivery without have indicated on the prescription of the income, the expenses caused by this concept will also be in charge of the institution.

(F) hospitalization in centers or units of medium and long stay. This type of hospitalization is intended especially to patients with functional impairment or suffering from chronic conditions or diseases associated with aging that, once the acute phase of disease, require continuous medical care medical surgical, rehabilitation and nursing, to its stabilization.

2.3.4 home hospitalization.

(a) it includes the set of treatments and health care provided in the home of the patient, a complexity, intensity and duration comparable to that same patient would receive in the conventional hospital, and for those reasons can not be assumed by the primary health care level.

(b) the home hospitalization may carry out in those cases in which the State of the patient allows it.

(c) during this hospitalization, the responsibility for the follow-up of the patient corresponds to the inpatient unit to home (UHD) and will be provided by specialists (family physicians or internists) and the nursing staff that makes up this UHD, which must be coordinated with the unit of medical or surgical hospitalisation corresponding to the pathology of the patient and the hospital emergency department , with the purpose of guaranteeing the continuity of care.

(d) membership of the UHD will be made from a hospital by the report of bypass service and primary care or specialized ambulatory. In these last two cases, the UHD shall assess whether the patient meets the criteria for admission in that unit.

(e) the income on the UHD will be subject to the same requirements as admission to a hospital, receiving the same attention it had received to be admitted to a hospital. The clinical documentation for such attention shall be completed with the same criteria as in conventional hospitalization.
f) La UHD shall report in writing to the patient and his family about how to contact the unit at any time of the day, in order to respond to any incidents. When there is discharge, doctor of the UHD will issue the corresponding medical part of high in the terms provided for by law.

(g) while the patient is admitted to the UHD, they shall be borne by the entity and may not be charged to the beneficiary or to the ISFAS, all the attention and products requiring the patient, in addition to all the medication, material cures, not common nutritions, complementary tests, consultations, absorbent, probes, home hemodialysis and oxygen therapy. They are excluded, in any case, ordinary domestic allocations, common nutrition and auxiliary of clinic services.

2.3.5. diagnostic and therapeutic procedures. The beneficiaries will have access to techniques and diagnostic or therapeutic procedures included in the portfolio of services established in this concert, whenever you set the corresponding indication by a physician of the catalogue of services, to the margin available or not of the technique or procedure in the geographical area in which they reside.

Without prejudice to the provision contained in clause 2.1.2, coverage of the following diagnostic and therapeutic procedures, will attend whenever you set your display by the assigned services physician responsible for the patient's care, taking into account the exceptions provided for in clauses 4.2 and 4.3.

1. in groups at risk prenatal diagnosis.

2. Imaging: A. simple Radiology: chest, Abdomen, radiology, bone densitometry.

B. mother: Mammogram, breast interventionism.

C. x-rays with contrast.

D. Ultrasound: Ultrasound, ultrasound doppler.

E. computerized tomography (CT).

F. magnetic resonance imaging (MRI).

3. diagnostic and therapeutic Interventional Radiology.

4. diagnostic and therapeutic hemodynamics.

5. diagnostic and therapeutic nuclear medicine.

Including tomography (PET) positron emission, and combined with the TC (PET-CT), in oncological indications in accordance with the specifications of the authorized technical sheet of the corresponding radiopharmaceutical.

6 neurophysiology.

7 endoscopies.

The capsuloendoscopia is included only in dark origin gastrointestinal bleeding that persists or recurs after a study initial negative endoscopy (upper endoscopy and/or colonoscopy) and is located in the small intestine.

8. functional tests.

9. Laboratory: A. pathology.

B. biochemistry.

C. genetics.

D. hematology.

E Immunology.

F microbiology and parasitology.

10 biopsies and punctures.

11. radiotherapy.

12. radiosurgery.

13. renal lithotripsy.

14 dialysis.

15 transplants of organs, tissues and cells of human origin.

16 intensive care, including the neonatal.

17 haemotherapy.

18. family planning, which includes: A. Council genetically at risk groups.

B. information, display and monitoring of contraception, including intrauterine devices.

C. realization of vasectomies and tubal ligature, excluding the reversal of both.

2.3.6. rehabilitation and physiotherapy.

A) includes procedures of diagnosis, evaluation and treatment of patients with functional deficits, designed to facilitate, maintain or return the highest degree of functional capacity and independence as possible to the patient, in order to reintegrate in their usual environment.

(B) includes the rehabilitation of disorders of the musculoskeletal system, nervous system, cardiovascular system and respiratory system, through physiotherapy, occupational therapy, speech therapy and adaptation of technical methods (orthoprosthesis).

In terms of speech therapy for language development disorders treatments, is will not serve coverage of proceedings for the recovery of the so-called learning disorders whose care is the responsibility of the educational system.

(C) rehabilitation and physiotherapy treatments may be required to the entity by the medical rehabilitation or medical specialists responsible for pathologies susceptible to such treatments.

The evolution of patient tracking and determination of discharge will be the responsibility of the medical rehabilitation or, where appropriate, of the medical specialist that requested such treatment. Your application may be performed by Physiatrist, physiotherapist, speech therapist and occupational therapist, as appropriate.

(D) the number of sessions is dependent on the optional criteria and to the situation of the patient, being indicative tables of duration of sessions recommended by the Spanish society of physical medicine and rehabilitation or other scientific societies.

The obligation of the institution will end when he has been fully achieved functional recovery / as possible is by having entered a State of stabilization intractable, it is attention to patients with functional deficits recoverable, the process taking in any case rehabilitation indicated by flare-ups of the process.

2.3.7 reproduction assisted human (RHA).

A) General considerations. Assisted reproduction techniques will be borne by the entity when the woman that will make has the status of beneficiary, as provided for in clause 1.4, and must also meet coverage tests and procedures included in the portfolio of services that are to be made to other Member of the couple is in the course of treatment. Excludes the financing of drug treatments that there must be the other Member of the couple.

However, when it was in progress a cycle of treatment, under cover of collected forecasts in previous concerts, the entity will maintain their coverage until the completion, for the same services, with application of the criteria and limits in force at the time of its inception, provided that you do not perform a change of entity.

Assisted reproduction treatments will have help to achieve pregnancy in those people with inability to do it naturally, not likely to exclusively drug treatments, or following the failure of the same. Also you can use these procedures to prevent diseases or serious genetic disorders in the offspring and when required from an embryo with immunologic characteristics identical to those of a fond brother of a process pathologically serious, is not susceptible of other therapeutic resource.

Reproduction treatments will be handled assisted included in the portfolio of basic services of the national health system, pursuant to the Act 14/2006, 26 May, on techniques of human assisted reproduction, to be carried out for therapeutic, preventative purpose and in certain special situations, when a diagnosis of infertility or a clinical indication established, with the general criteria listed in paragraph B) and , where appropriate, the specific criteria for each technique, applied in the rest of the national system of health, differentiating the following situations: 1. human reproduction assisted therapeutic treatments. Apply to people with a disorder of the reproductive capacity noted, not liable to medical treatment or after the apparent ineffectiveness of the same and absence of pregnancy, after twelve months of sex with vaginal intercourse without the use of contraceptive methods.

2 treatments of human reproduction assisted with preventive purpose. Aimed at preventing the transmission of diseases or serious disturbances of genetic basis, or the transmission or generation of other serious diseases, early onset, not susceptible to post-natal cure according to scientific knowledge current, and are preventable through the application of these techniques.

Shall apply to persons who meet the general criteria for access to treatments of RHA, collected in the section B) next, and according to the specific criteria for access defined in each technique.

3 treatments of human reproduction assisted in particular situations. Besides the treatments referred to in the preceding paragraphs, it will serve coverage of treatments of human reproduction assisted with the following purposes: to) embryo selection, bound for treatment of third parties.

b) preservation of gametes or preembryo for autologous deferred medical indication, use to preserve fertility in situations associated with pathological processes special, with the criteria and conditions applied in the rest of the national health system.

(B) General conditions of coverage.

1. the entity shall bear the costs arising from actions and precise studies for the diagnosis of sterility. The studies will be extended, where appropriate, both members of the couple.

2 treatments of assisted human reproduction will be subject to coverage, when there is a diagnosis of sterility or an established clinical indication and they met meet the following general criteria or situations of inclusion, without prejudice to the specific criteria provided for each technique: to) at the time of the beginning of the study of sterility, the beneficiary will be older than 18 and younger than 40 years , and will not have any type of pathology that could present you pregnancy severe and uncontrollable risk, both for their health and for their possible offspring. In the case of couples, also the male must be over 18 and under 55 years of age.
(b) the woman will not have any prior and healthy son. In the case of couples, without any common, prior and healthy son.

(Coverage of assisted human reproduction will attend 3 not when some Member of the couple sterility has been voluntarily or occurrence as a result of the natural physiological process of the completion of the reproductive cycle of the person or documented medical contraindication exists C) limits the maximum number of treatment cycles. Treatments of assisted human reproduction will be subject to limits in terms of the number of cycles and age of the patient, taking account at the beginning of efficiency and security to ensure the greatest effectiveness with the lowest possible risk.

The maximum limit of treatment cycles that is will serve will be establishing for each technique or procedure.

For the correct interpretation and application of the limits laid down in each case, be taken into account the following criteria: 1. in General, for the computation of the number of cycles, will take into account the total number of cycles carried out regardless of the funder. Therefore, where a couple is welcome to coverage of this concert, after having previously a human assisted reproduction treatment, will take into account the number of cycles has been completed so far and will coverage which corresponds, until the maximum number of cycles set.

2. in order to consider that a patient has completed an IVF cycle, you must have reached at least the oocyte recovery phase.

3. when there are frozen pre-embryos remaining, coming from authorized IVF cycles, deemed that its transfer is part of the same cycle in which they were obtained, so that coverage of the transfer of these pre-embryos will serve until the previous day that women age 50, irrespective of the existence of previous healthy children.

4 shall be authorised a new IVF cycle when there is surplus pre-embryos Cryopreserved from previous cycles.

(D) RHA techniques included in the portfolio of services. Access criteria and specific conditions of application.

1. artificial insemination.

(a) artificial insemination with sperm from the couple. Access to this technique shall be taken into account the following specific criteria: i. existence of recognized therapeutic indication.

II. age of women at the time of treatment: less than 38 years.

III. maximum number of cycles that will be handled: four.

(b) artificial insemination with donor gametes.

Access to this technique shall be taken into account the following specific criteria: i. existence of therapeutic indication.

II. the woman's age at the time of the indication of the treatment: less than 40 years.

III. maximum number of cycles: six, boundary comprising the cycles of insemination had done with own gametes.

2. in vitro fertilization. Fertilization is considered vitro conventional or using micromanipulation techniques and techniques of processing and storage of gametes and pre-embryos resulting from them.

Specific criteria for access to these techniques are as follows: to) in vitro fertilization with own gametes.

i. age of women at the time of treatment: less than 40 years.

II. lack of evidence of poor ovarian reserve.

III. maximum limit of cycles of treatment: three cycles with ovarian stimulation. This limit may be reduced based on the prognosis and, in particular, of the result of the previous treatments.

(b) in vitro fertilization with donated sperm.

i. age of women at the time of treatment: less than 40 years.

II. lack of evidence of bad book ovarian and diagnosis of primary or secondary sterility without healthy son.

III. maximum limit of cycles of treatment: three cycles with ovarian stimulation, regardless of the cycles that have been made with other techniques. This limit may be reduced based on the prognosis and, in particular, of the result of the previous treatments.

(c) in vitro fertilization with donated oocytes.

i. age of women at the time of treatment: less than 40 years.

II. existence of medical indication for: failure ovarian premature clinically established before age 36 (spontaneous or iatrogenic), genetic disorder of women only preventable through substitution of oocytes, ovaries inaccessible or not available for the extraction of oocytes.

III. maximum limit of cycles of treatment: three cycles with receipt of donated oocytes. This limit may be reduced in function of the prognosis, and in particular of the results of previous treatments.

The cost of drugs requiring donors and other expenses shall be borne by the entity to form part of the cost of the technique used. In no case may impact on the patient receiving the donation.

3. Cryopreservation of pre-embryos and their transfer. The Cryopreserved pre-embryos may be transferred for their own use or can be donated. In the case of transfer of pre-embryos Cryopreserved for own use shall apply the specific criterion that women are under 50 years with primary or secondary sterility, so attend the cryopreservation and maintenance of embryos until the woman reaches that age.

4 Cryopreservation of gametes and preembryos for own use deferred to preserve fertility in situations associated with special pathological processes. It's the Cryopreservation of gametes or pre-embryos for own use deferred, by strict medical indication, to preserve fertility in patients with possible risk of loss of their reproductive capacity associated with exposure to treatment gametotoxicos or pathological processes with risk premature ovarian failure-accredited or accredited risk of primary testicular failure.

The use of the gametes or pre-embryos Cryopreserved be held in women under 50 years of age, provided they do not present any type of pathology that could present you pregnancy severe and uncontrollable risk, both for their health and for their possible offspring. In the case of men, the preservation will serve until the age of 55 years.

You will be made exclusively by medical indication, not tending their coverage when it would only raise the patient's own request for delayed use.

5. seminal washing techniques to prevent transmission of chronic viral diseases. The seminal washing may apply to HIV-positive men to hepatitis C virus or HIV assistance to infertile couples discordant with chronic viral infection, both in the prevention of the transmission of chronic viral infections in couples without diagnosis of sterility.

In the case of couples seroconcordantes, only need washing, not needing the subsequent study of the presence of viral particles.

The criteria for the application of treatments and assisted human reproduction techniques required in these cases will be described in the corresponding sections.

6. preimplantation genetic diagnosis (PGD). Diagnose genetic preimplantation may be required: to) PGD for purpose of preventing transmission of diseases or disorders of chromosomal or genetic origin severe early onset and not susceptible of curative treatment according to scientific knowledge current, in order to carry out the not affected pre-embryo transfer embryo selection.

Situations that may give rise to DGP preventive purposes are: i. susceptible preimplantation genetic diagnosis of monogenic diseases.

II. structural chromosomal abnormality maternal and paternal.

III. specific criteria to perform a PGD procedure for this purpose are: that there is high risk of recurrence of the disease in the family, the genetic disorder to generate serious health problems, i.e., that genetic disease compromised expectancy or quality of life by producing congenital anomalies, intellectual, sensory or motorial disability not subject to a curative treatment, according to current scientific knowledge.

Genetic diagnosis possible and reliable and include a genetic counselling report.

That it is possible to perform a procedure IVF-ICSI with an adequate after controlled ovarian stimulation response.

The specific criteria for IVF with own gametes.

It will be necessary, in addition to the above criteria, an administrative authorization when necessary, according to article 12 of the law 14/2006, 26 May, on assisted human reproduction techniques.

(b) PGD for therapeutic purposes to third parties. Diagnostic genetic preimplantation in combination with the determination of HLA histocompatibility antigens (human leukocyte antigen) of the in-vitro preembryos for the selection of compatible HLA embryo for a third treatment (PGD-HLA).

The specific criteria for access to this technique are: i. patients with age less than or equal to 40 years with one ovarian reserve sufficient for the purpose of treatment pursued.

II. existence of recognized indication, i.e., previous child affection disease requiring treatment with brother histocompatible from hematopoietic precursors.

III. authorization of the appropriate health authority, prior favourable report from the National Commission for assisted human reproduction (CNRHA), as set forth in article 12 of the Act 14/2006, 26 May, on assisted human reproduction techniques.
IV. maximum limit of cycles of treatment: three cycles with ovarian stimulation and three additional cycles after clinical assessment or for the CNRHA of the results obtained in the three power-ups. This limit may be reduced based on the prognosis and, in particular, of the result of the previous treatments.

2.3.8. mental health.

A) content. The mental health care includes diagnosis and clinical follow-up the psychopharmacotherapy, mental disorders, individual psychotherapy, group or family (excluding the psychoanalysis and hypnosis) and electroconvulsive therapy and facilitate in regime of outpatient, day hospital or hospitalization scheme.

Attention to mental health, which will ensure the necessary continuity of care, includes: 1. diagnosis and treatment of mental disorders, including outpatient treatment, individual or family intervention and hospitalization when required.

2 diagnosis and treatment of addictive behaviors, including alcoholism and compulsive gambling.

3 diagnosis and treatment of psychopathological disorders of childhood/adolescence, including attention to children with psychosis, autism with disorders of conduct in general and food in particular (anorexia/bulimia), outpatient treatment, psychotherapeutic interventions in day hospital, hospitalization where required and the reinforcement of healthy behaviors.

4. attention to mental health disorders arising from situations of risk or social exclusion.

5. information and advice to persons related to the patient, especially to the caregiver/main.

(B) psychiatric hospitalization. You will be provided for all processes both acute and chronic psychiatric assistance that they require hospitalization or day hospitalization.

Also includes the income of those psychiatric patients in centers or units of medium and long stay when, once overcome the acute phase of the process, the evolution is not satisfactory, require a higher degree of stabilization and recovery for integration into their family and/or social environment.

Therefore, hospitalization, including day, is valid for the time that the psychiatrist responsible for assistance to the patient deems necessary and, therefore, to discharge from hospital and will cover all processes both acute and chronic.

Entry must be in centers concluded by the Agency, without prejudice to the provisions in clauses 3.4 and paragraph B.3 of the clause 3.2.2.

However the provisions of the preceding paragraph, had income occurred prior to January 1, 2015, a Center has not arranged for clinical reasons justified without prior authorization from the entity, it be paid to affiliate costs of hospitalization, with the limit of 87 euros per day, until the time of hospital discharge. The refund must be made within 10 calendar days following the date in which the proof of these expenses arise before the entity.

Coverage of the internment of patients suffering from dementias such as Alzheimer's disease and other neurodegenerative is excluded even though, is will take care of the hospitalization of those patients who suffer from some form of dementia, neurodegenerative, require psychiatric hospitalization because of intercurrent processes or severe decompensation.

(C) psychotherapy. Includes individual, group or family psychotherapy, provided that it has been prescribed by psychiatrist of the entity, carried out in media agreed with it and that its purpose is the treatment of psychiatric diseases. The entity is required to provide a number maximum of 20 sessions per calendar year (brief psychotherapy or focal therapy), except in the eating disorders, which all the sessions that the psychiatrist responsible for assistance considered necessary for the correct evolution of the case will be passed.

Psychoanalysis, psychoanalytic psychotherapy, hypnosis and ambulatory narcolepsy are excluded.

2.3.9. other complementary specifications.

A) plastic, aesthetic and reconstructive surgery. Plastic, aesthetic and reconstructive surgery that bears no relationship with accident, disease or congenital malformation is excluded.

In the event of accident of service or occupational disease, shall be in all its scope, including, if necessary, plastic, aesthetic and reconstructive surgery in the cases in which, having even been healed lesions, to be distortions or mutilations that produce alterations in the physical aspect or hinder the total recovery of the patient.

(B) transplants. Included is coverage of all transplants: organs, tissues and cells of human origin, as well as bone grafts. Obtaining and organ transplant will take place in accordance with the health legislation in force, corresponding to the entity to assume all the costs of obtaining and transplantation of the organ or tissue, including compatibility studies.

In particular coverage of the following types of transplants are will assist: 1. organs: kidney, heart, lung, liver, pancreas, intestine, kidney-pancreas, heart-lung, and any combination of two or more of these organs for which there is an established clinical indication.

2. other transplants authorized by the national transplant organisation.

3 tissues and cells: cells hematopoietic progenitor from bone marrow, peripheral blood, and umbilical cord blood, in those processes where there is an established clinical indication; tissues of the eyeball (cornea, sclera and limbus corneal); amniotic membrane; valve homografts; Vascular homografts; tissue Musculoskeletal and skin; transplantation of autologous chondrocytes as treatment of second choice when he has failed a previous therapeutic option in chondral knee joint injuries and osteochondritis dissecans; cultivation of keratinocytes and cell cultures for which there is an established clinical indication.

2.4 urgent care services portfolio.

2.4.1 content. The urgent care is provided to the patient in cases in which their clinical situation requires immediate health care.

The urgent care is dispensed both in hospitals and outside of them, including the home of the patient and the care on-site, 24 hours a day every day of the year, using health care and nursing and with the collaboration of other professionals.

Emergency care also includes the phone service, through the Coordinating Center of urgencies and emergencies of the entity, provided for in clause 3.1.1. D), which includes information and allocation of own resources, or in coordination with emergency services from 112 to give the answer to the health care demand and urgent health transport under the conditions provided for in section 2.4.3.

The Coordinator Emergency Center, with free, will channel the demand for accident and emergency care, ensuring accessibility and coordination of accurate for this type of care resources, 24 hours every day of the year, throughout the national territory.

In addition, the entity must have services of emergency hospital and hospital that can go the beneficiaries at all times and will have accurate guard physicians and the personal media and materials necessary for its functioning, in accordance with the availability criteria set out in clause 3.2.

2.4.2 conditions of access. When the owner or beneficiary need urgent or emergency health care must request via the freephone emergency care entity contained in the health insurance card, in the catalogue of suppliers and on the web, which gives access to the Coordinating Center of urgencies and emergencies of the entity to ensure accessibility and coordination of all available means for this type of care 24 hours a day of every day of the year, throughout the national territory.

A_traves_de phone of urgency or the information of the entity, may request information on care emergency hospital, outpatient and primary care means available and, in general, any other matter associated with such care, as well as for the purposes of clause 4.2.1. E).

Emergency care also may require emergency services of primary care and specialty of the entity, or directly physicians of general medicine, Pediatrics and nursing of the entity in their times.

2.4.3 emergency health transport.

A) General considerations. The urgent care also includes health transport urgent, land, air or sea, assisted or not assisted, as required by the clinical status of patients, in cases where it is necessary for appropriate transfer to the health centre that can attend the emergency situation in the proper.

(B) modalities. This type of transportation includes the following modalities: 1. urgent primary transportation, from the location where there has been the emergency until the first Center or sanitary device with capacity to attend to the patient. It may require a first aid, in the same place where there has been the emergence, by qualified personnel.

2. sanitary transport requested by the Coordinator Emergency Center.
(C) direct use of the ambulance service. In cases of urgency which has not been possible to communicate with emergency services or ambulance of the entity and not be appropriate Alternatively, the beneficiary may request directly from the ambulance service in the town moving to the emergency service of the entity to which is attached and the entity must assume or refund the transfer costs.

2.4.4. hospital emergency services. They will be available in the municipalities included in levels II, III and IV of specialized care, with the availability criteria set out in clause 3.2.2.

On the other hand, the deployment of the centres and units where the professional activity of the group protected, develops conditions its peculiar geographical distribution and some specific needs.

That is why in all the municipalities of less than 30,000 inhabitants, where there is a dependent of the corresponding autonomous community health service hospital, assistance coverage is will assist its emergency service, beneficiaries suffering from clinical situations in other situated or acute that make a not demorable attention, whenever centers reached is not available in the municipality in which the recipient requiring assistance is less than 15 kilometres.

2.5 palliative care.

2.5.1 contents. It includes comprehensive care, individualized and continued, people with disease in advanced situation not susceptible to treatment with curative purpose and with a limited life, as well as people hope to them linked. Their therapeutic goal is the improvement of the quality of life, with respect to their system of beliefs, preferences and values.

Participate in the provision of palliative care professionals of primary care and specialty care responsible for the pathological process of the patient, with the support of specific devices that, if necessary, patients can be referred by their degree of complexity.

This care will be provided in the patient's home or in the hospital, if necessary, establishing the necessary mechanisms to ensure the continuity of care and the coordination with other resources.

2.5.2 susceptible to palliative care patients. Palliative care must be given to those patients with a terminal illness, regardless of the pathology that originate it.

They will be susceptible to attention: to) terminal cancer patients, with documented, progressive, advanced and incurable disease, multiple symptoms severe, continuous and changing and little or no response to specific treatment.

(b) terminal patients with chronic non-cancer in an advanced stage and with non-reversible severe functional limitation, with intense, complex and changing symptoms. Among others: 1. patients with AIDS.

2. patients with neurological, respiratory diseases, cardiovascular, liver and kidney of any etiology.

3. patients with diseases of the central nervous system of any etiology (degenerative, dementia, Parkinson's disease, accident acute stroke, etc).

2.5.3 structure and organization. The provision of palliative care involve practitioners in primary care and specialty care, under an explicit organizational model, adapted to the territorial distribution of health care resources, according to the demands of media set out in clause 3.2 which will be complemented with assistive devices to which, if necessary, patients can be referred by their degree of complexity.

Ensure the interconnection between the different assistive devices to facilitate coordination.

In municipalities where not met the criteria of availability referred to in clause 3.2, will facilitate patient access to specific devices of the health service of the corresponding autonomous community.

2.5.4. home-based palliative care. The best place to provide palliative care at any given time will be determined by the level of complexity of the sick, the availability of adequate family support and the choice of the patient and his family, among other variables, but in general, the patient's home is the place of choice.

The home care will be provided by doctors and nurses in primary care are responsible for the care and facilitate care and patient access to therapeutic resources and professionals diagnostic accurate at home, being able to refer complex patients to other medical devices or to seek the intervention of support in palliative care teams.

Continuity of care in slots in which ceases the activity of specific resources, will be facilitated through the Coordinator Emergency Center (toll-free emergency care), for which precise coordination and referral procedures are structured.

The derivation of the patient toward resources within the level of hospital care (domiciliary hospitalization unit or other hospital care services) will depend on that overcome the healthcare possibilities in the field of home care. Hospitalization in these units will continue until it is possible for the patient to return to the home.

Beneficiaries who require palliative care support team specific either admission to hospital palliative care units shall, except in cases of urgency, request prior authorization to the authority, in accordance with the procedure laid down in paragraph 2 of annex 2.

2.5.5. palliative care in regime of hospitalization. In-home care is the alternative of choice for the majority of the terminally ill. However, responsible care practitioners may order referral to hospital palliative care units or units of home hospitalization, is referred to in clause 2.3.4 of the present agreement, or the transfer and admission to the Hospital of reference, when the patient need not subject to be provided on an outpatient basis or at home continued and special care.

2.6. oral health. It includes health care, diagnostic and therapeutic activities, as well as those for the promotion of health, health and preventive education directed attention to oral health.

2.6.1 contents. Oral care has the following content: to) treatment of acute dental processes, understanding as such infectious or inflammatory processes that affect the area dental, bone-dental injuries, wounds and lesions in the oral mucosa, as well as the acute pathology of temporo-mandibular joint.

Includes Council oral, pharmacological treatment of oral pathology requiring it, extractions, surgical extractions, minor surgery in the oral cavity, oral revision for the early detection of premalignant lesions and, where appropriate, biopsy mucosal lesions and mouth cleaning Tartar once a year or more, if necessary, previous supporting statement of the medical specialist.

(B) preventive examination of the oral cavity to pregnant women: including health instructions on diet and oral health, accompanied by training in hygiene oral, and application of topical fluoride according to the individual needs of every pregnant woman.

(C) aimed at children under 15 years of age, oral health program consisting of periodic reviews, application of topical fluoride, sealants occlusal permanent parts, restorations, fillings or reconstructions in permanent, treatment (Endodontics) pulp in permanent, treatment and treatments of incisors and canines permanent in case of illness, malformations or trauma. In addition, this programme will be actions that are included in the Buco-Dental Health Plan for the whole of the national health system, with the same scope, content and pace of implementation.

(D) when any accident in service or occupational disease Act, they will be in charge of the entity all the treatments and performances, including dental prostheses and implants osseointegrated are needed, as well as its placement.

(E) also includes the entity manager dental implants for patients with congenital malformations which present with anodontia and patients with oncological processes that affect the oral cavity that involve loss of teeth is related directly to the disease or its treatment. In both cases required prior prescription of medical specialist of the entity, along with budget for approval by the same.

2.6.2 exclusions. With the exceptions provided for in paragraphs 2(c)), D) and E) clause 2.6.1, are excluded from the oral attention the following treatments: 1. repairing treatment of temporary teeth.

2. orthodontic treatment.

3. extraction of healthy parts.

4 exclusively cosmetic treatments.

5 prostheses or dental implants.

6. realization of complementary tests for assessment and follow-up of treatments excluded from the portfolio of services.

7 fillings or fillings and root canals, except in the area of oral health program.

8 Periodontics.

2.6.3 specifications and requirements for certain treatments.
A) for the cleaning of the mouth, as well as in case of accident of service or occupational disease for dental prostheses, it will be necessary prescription of medical specialist of the catalogue of services along with budget, if it's prosthesis, and authorization by the entity.

(B) in the case of people with disabilities which, because of its deficiency, are unable to maintain, without the help of sedatives treatments, the necessary self-control that allows an appropriate attention to your oral health, providing previous services will be remitted to health care areas where can assure its proper performance.

In these cases will be paid by the entity the hospitalization expenses necessary for the realisation of the dental treatments, even those excluded from the coverage of the concert, mentally disabled patients, operating room and anesthesia whenever treatments are carried out by means of the entity.

2.7 transport for health care.

2.7.1 General considerations. Transportation for the health care provided for in this concert includes the following modalities: to) emergency health transport, referred to in clause 2.4.3.

(b) non-urgent health transport.

(c) transport in ordinary means.

The entity must meet expenses incurred by displacement requiring the beneficiaries when they use the assigned services, with the exceptions laid down in clauses 4.2 and 4.3, in the cases and conditions provided for in this clause.

As a general rule, transfers shall be located within the municipality of habitual or temporary residence centres or service, or if there were no accurate means in this, until the next municipality in which the entity has the corresponding services or the Center this would have referred to that patient.

2.7.2. non-urgent health transport.

A) content. It will attend the coverage of non-urgent health transport, with the requirements, conditions and limits provided for in this clause.

Non-urgent health transport is the movement of sick or injured who are not in a situation of urgency or emergency, which exclusively clinical reasons are unable to navigate in the ordinary means of transportation to a health centre to receive health care or his home after receiving the corresponding health care, and that may require or no health care during the trip. Non-urgent health transport should be accessible to persons with disabilities.

Non-urgent health transport services portfolio includes sanitary transportation attended, for the transportation of sick or injured requiring technical assistance on route, and not assisted medical transport, which is suited for special transportation of sick or injured that do not require technical assistance on route.

(B) types of transfer. Non-urgent health transport, according to the origin and destination of the transfer of the patient, as well as by the character of periodicity, comprises the following types of transfers: 1. periodic patient transfers from home to health centres and/or transfer from hospital to home.

2 timely transfer of the patient from his home to health centres and/or transfer from hospital to his home.

3. transfer of the patient from a hospital to his home, if necessary, after the discharge from hospital or care in an emergency department.

4. transfer of a patient to their municipality of residence, either home or to another hospital when he received urgent assistance in another municipality in which was found displaced temporarily, provided that their clinical situation makes necessary medical transport.

The place of habitual or temporary residence means the patient's home.

Health centers of origin and/or destination must be centres with the entity, or have been the subject of specific authorisation.

(C) criteria of indication. The need for medical transport be justified through the written prescription of the corresponding optional which must be carried out both health status and the degree of autonomy of the patient to be able to scroll in ordinary transportation means, between his home and a health centre, or vice versa, regardless of the health problem that is at the origin.

The prescription of the transport shall be deemed justified provided that the patient meets at least one of the two following criteria: 1. limitation for autonomous navigation and which requires the support of third parties.

2. clinical status of the patient which prevents him from using ordinary transportation means.

(D) situations in which the patient can be accompanied. Whenever the patient's clinical situation advise it may be accompanied for non-urgent health transport charge to the entity.

For the indication of passenger optional prescribers will assess if the age or clinical status of the patient requires it and shall especially take into account the following circumstances: 1. patients with cognitive, sensory or mental disability that limits you understanding and communication with the environment during its transfer.

2. patients who, by the evolution of his disease, in the time of the transfer in a situation of great physical or psychological deterioration.

(E) re-evaluation of the need for medical transportation. In the case of periodic sanitary transport, such as hemodialysis, radiotherapy, rehabilitation, or otherwise referred to in this concert. the entity may propose the periodic re-evaluation of the patient by the physician responsible for the assistance so determine if held medical causes or physical disability that would justify the need for medical transport or, otherwise, ordinary transports can be used already.

In this case, the entity may suspend the medical transport, regardless of the duration or type of assistance that is being carried out.

2.7.3. transportation in ordinary means.

A) types of regular transport. He is considered regular transport to the welfare purposes at the concert, which takes place in automobile, bus, railway or, if appropriate for being insular provinces or cities of Ceuta or Melilla, by boat or plane.

(B) assumptions subject to coverage. The beneficiary of the ISFAS is entitled to this type of transport in charge of the institution, in the following cases: 1. displacements caused by the unavailability of the means required by the corresponding municipality, depending on the level of care that is framed in accordance with clause 3.2, so that the beneficiary required to move from the municipality in which he resides , with temporary or permanent character to the nearest where those are available.

When there had been moved to a center located in a province other than the residence, by the unavailability of required media in the appropriate level of care, if not already required medical transport, costs arising from the displacement of return on ordinary means of transportation will be handled.

2. transport services of level IV and reference services, those referred to in clause 3.2.3, located in a municipality other than the residence, in the same when such services are not available.

3. travel to and from a municipality other than the residence to receive health care for accident in service or occupational disease Act.

(C) valuation of shipments. Shipments is always carried at its cost, in normal class or tourist, in regular transport by bus or railway lines or, if appropriate for being insular provinces or cities of Ceuta and Melilla, by boat or plane, to the nearest town in which the entity provide means to complete the required assistance. The provision includes the return transfer.

(D) passenger transport. It is entitled to the transport costs of a companion to the movements of the patient in the following cases: 1. displacement of beneficiaries under 15 years and in the case of the cities of Ceuta and Melilla and island provinces, under 18 years of age.

2. displacement of beneficiaries showing a degree of disability greater than 65%.

3 displacements of residents in the cities of Ceuta and Melilla and beneficiaries in the provinces of the island, as directed by your responsible doctor, circumstance which will be through the submission of the written prescription of the optional.

2.8 performance pharmaceutical and dietetic products.

2.8.1. General rules. The pharmaceutical provision includes drugs and health products, and the series of actions aimed that patients receiving them appropriately to your clinical needs, in precise dosages according to your individual requirements, during the period of time and at the lowest possible cost.

This provision shall be governed by the provisions of the revised text of the law of guarantees and rational use of medicines and health products, approved by Royal Legislative Decree 1/2015, of 24 July, and other applicable provisions.

For access to medicines in terms other than those authorized, given their exceptional character, shall apply the provisions of the Royal Decree 1015 / 2009, of 19 June, which regulates the availability of drugs in special situations.
The provision with dietary products comprises persons who suffer from certain congenital metabolic disorders dietoterapicos treatments and home enteral nutrition for patients who cannot meet their nutritional needs, because of their clinical situation, with regular consumption food.

2.8.2 content.

A) in the case of patients treated in non-hospital setting, the portfolio of services to facilitate the institution includes indication and prescribing of medicines and items in providing pharmaceutical and dietetic products of the national health system.

These activities must be done by professionals of the entity in official prescriptions of the ISFAS, identifying the active principle of the drug or the generic name of the health product, in accordance with the provisions in the current regulations.

The entity shall take the measures necessary to drive the Mutualism of electronic prescription system, through the participation of its optional in the implementation and development of the same. Until its implementation, and for manual prescriptions in paper format, will require its optional appearing on filling in these recipes by their mandatory minimum data: name and surname, number of College and province where exercise, with a stamp that allows its readability.

(B) in the case of patients treated in the hospital setting, the portfolio of services to facilitate the institution includes indication, prescription and dispensation in charge of pharmaceutical, health and dietary products which require patients who are being treated in this healthcare field (internment, hospital day, domiciliary hospitalization, emergency room, dialysis unit and other units dependent on hospital) , with the specifications established in clauses 2.8.3 and 2.8.4.

2.8.3. medicines for outpatient treatments carried out by the entity. The provision of precise medicaments for the treatment of outpatients will be borne by the entity in the following cases: to) medicaments qualified as of hospital use, whose delivery is carried out through hospital pharmacy services, according to the established the consolidated text of the law of guarantees and rational use of medicines and sanitary products anyone than its indications or conditions of use.

(b) medicinal products not authorized in Spain, but marketed in other countries, whose dispensation, in accordance with the applicable regulations, should be made through hospital pharmacy services, to be restricted its use to the hospital environment.

(c) medicaments and pharmaceutical products financed in the national health system, with or without coupon precinct which, as set out in its technical form, require the intervention of facultative specialists, without prejudice to its dispensation by pharmacies for Administration.

(d) the media, elements or precise pharmaceuticals to perform diagnostic or therapeutic, techniques such as contrast media, drastic laxative or others.

2.8.4. dispensation for services of hospital pharmacy in special cases. Pharmacy services from centres hospital concluded shall treat specific medicines for outpatient treatment in charge of the ISFAS, in the following cases: a) medicaments which, without having the qualification of hospital use, have established unique reservations in the scope of the national health system consisting in limiting its dispensation to patients not hospitalized in hospital pharmacy services so they are not equipped with cupon-precinto, and for his administration without requiring the express intervention of facultative specialists, they shall treat the beneficiary by the hospital pharmacy services, in accordance with article 102 of the revised text of the law of guarantees and rational use of medicines and sanitary products.

These medications are billed for their direct payment by the ISFAS, under the conditions laid down by the Ministry of health, social services and equal to the selling price of the laboratory (PVL), plus tax, funding for the national health system, which will be deducted the amount of the contribution of the beneficiary to be reflected on the invoice.

(b) medicaments of hospital diagnostic whose dispensation is expressly authorized by the delegation of the ISFAS for the treatment of a specific patient, before the existence of difficulties for its dispensation in pharmacies by shortages or other problems shall treat the beneficiary by the hospital pharmacy services against payment of the reduced contribution, in the same terms referred to in the preceding paragraph.

These medications are billed for their direct payment by the ISFAS, the selling price to the public (PVP), funding for the national health system, by deducting the amount of the contribution of the beneficiary to be reflected on the invoice.

(c) medicaments in charge of the ISFAS which are subject to locking of «expenditure maximum ceiling» by the Ministry of health, social services and equality, will be billed within the period of one month from the date of his dispensation.

The ISFAS shall refer to the entity the information about these drugs so moving it to own or concerted centers.

2.8.5. rational use of medication. The entity will promote the participation of its optional in all measures and activities established by the ISFAS for the improvement of the use of drugs and products whose delivery is done through official recipe, and will collaborate with the Institute in procedures which are initiated to verify the adequacy of individualized requirements and the corresponding measures of control.

In the case of medicinal products subject to special conditions, shall be taken into account the conditions and requirements laid down in the Royal Decree 1015 / 2009, of 19 June, regulating the availability of drugs in special situations, for the access and use of these drugs.

Pursuant to the provisions of law 16/2003, 28 of may, Cohesion and quality of the national health system, the entity will boost the set of actions to the requirements of its optional conform to precise doses, according to the individual requirements of patients, during the period of time appropriate and at the lowest possible cost to them and the community.

Also, the entity will promote the rational use of the medicinal product, promoting the use of generic drugs among its practitioners, as well as the prescription for active ingredient.

If as a result of the analysis by data for prescriptions ISFAS certain measures in relation to them, the management of the ISFAS, is considered appropriate following a report of the National Joint Committee, you may agree the appropriate for implementation and compliance by the entity, including low from a physician or service proposed in the catalogue of services of the entity for the ISFAS insured.

2.8.6. procedure for the impact of costs of medicines. If in the process of revision of the turnover of recipes that made the ISFAS, prescriptions of medicines and sanitary products performed exceptionally in official of the ISFAS recipes, though they should have been in charge of the entity, pursuant to this concert, are detected the ISFAS will proceed to do the corresponding discount in the monthly payment of assessed contributions should be payable to the same , in accordance with the provisions of clauses 7.2. and 7.3. of the present agreement, transferring to the entity a detailed communication from prescriptions detected with your unit amount.

On the other hand, the entity undertakes to repay beneficiaries who request it, in a period not exceeding fifteen days counting from the request for reimbursement, the amount that they had paid in the pharmacy Office for these drugs or medical devices, sufficing to these ends the presentation by the applicant of the corresponding invoice for the pharmacy.

2.9 sanitary products. Without prejudice to the obligations set out in other provisions of the present agreement, shall be borne by the entity, and supplied by its means beneficiaries, medical devices listed below: to) systems administration of home enteral nutrition, cannula tracheostomy and laryngectomy and special urinary catheters that are not dispensable by the ISFAS official recipe When such products have been so marked by a specialist of the entity.

(b) intrauterine devices (IUDS) that have been prescribed by a specialist of the entity, including the intrauterine delivery systems (hormonal IUD).

(c) test strips for the measurement in diabetic patients of blood glucose and glycosuria combined glucose/ketones, as well as the meter and the necessary lancets, in accordance with the criteria and standards set by health authorities and scientific societies. In any case, the entity must provide those products which, in the opinion of the professional responsible for the indication or prescription, is better adapted to the needs and abilities of the patient.

(d) infusion pumps local for parenteral administration of insulin and other drugs.
(e) the consumables, whether for parenteral administration of insulin or other antidiabetic drugs: insulin syringes and corresponding needles, needles for injectors and preloaded antidiabetic of parenteral administration systems that lack them, as well as the consumables of insulin infusion pumps, fundable in the national health system.

All these products will be provided according to criteria of diligence, proportionality and maximum attention to the situation of the patient.

In those cases in which, for reasons attributable to the entity, the supply does not conform to these criteria, will facilitate access to products reviewed by the procedure for reimbursement of expenses.

2.10 provision prosthetics.

2.10.1 surgical implants. They will be subject of coverage the entity manager surgical implants therapeutic or precise diagnoses, understanding as such medical devices designed to be implanted in whole or in part in the human body through surgical intervention, or any medical act that are included in the offer of products event of the centers and the national system of health services, in accordance with the indication of the assigned specialized services including those implants approved by the Ministry of health, social services and equality monitoring studies.

Likewise the renovation will serve of implants and any of its accessories, including external, and materials for osteosynthesis techniques, running the entity manager all the associated costs.

Excludes implants osseointegrated dental prosthetic, except in the following cases: to) patients with injuries resulting from accident service or occupational disease.

(b) patients with oncological processes that affect the oral cavity and involve loss of teeth is related directly to this disease or its treatment.

(c) patients with congenital malformations which present with anodontia.

2.10.2 products event of outpatient dispensing. Indication or prescription of external prostheses and other medical devices included in the prosthetics of the ISFAS, and its timely renewal provision, will be performed by corresponding specialists of the services allocated, leaving its supervised the adaptation of these products.

Also the adaptation of products will be under the supervision of the specialist which has made the indication and, in the case of products that require a specific adaptation to the patient of high complexity and custom made products, the specialist shall verify the suitability of the product supplied with prescription as well as the suitability of the adaptation, by proposing, where appropriate , the changes it deems appropriate, that they will be reflected in the corresponding document.

The entity will promote the participation of its optional in all measures and activities established by the ISFAS for the improvement of the utilization of the provision of prosthetics, and collaborate with this Institute in procedures which are initiated to verify the adequacy of individualized requirements and the corresponding measures of control.

2.11. other benefits.

2.11.1 oxygen and other respiratory therapies. It includes coverage of any of the home respiratory therapy techniques served by the national health system, when the circumstances of the patient required, including the use of bags of liquid oxygen or portable concentrators, oxygen, pulse oximetry, the aerosol therapy and the supply of suction of secretions.

They require the written prescription of a specialist of the entity and prior authorization of the same.

2.11.2. preventive programmes.

A) the entity will carry out the proceedings laid down health rules on prevention and health promotion and will facilitate will facilitate the development of the following activities of primary and secondary prevention, provided for in paragraph 3.1 of the annex II of the Royal Decree 1030 / 2006: 1. Vaccinations in all age groups and, where appropriate, risk groups, according to the immunization schedule of the national health system, in the terms established by the competent health authorities, as well as any other program or campaign of vaccination to health authorities determined.

2 indication and administration, in his case, from antibiotic chemoprophylaxis in contact with infectious patients for problems infectious that need it.

3. activities to prevent the onset of diseases, acting on the factors of risk (primary prevention) or to detect presymptomatic phase through screening or early diagnosis (secondary prevention), including: breast cancer: screening with mammography every two years in women 50 to 69 years.

Cervical cancer: PAP Pap smear in women aged 25-65 years. At the beginning, 2 PAP on an annual basis and after every 3-5 years, in accordance with the guidelines recommended by the scientific societies or the competent health authorities.

Colorectal cancer: screening every two years in men and women aged 50 to 69 years with determination of occult blood in stool.

In all cases ensure the individual risk assessment including in the case of the breast cancer and colorectal cancer, where applicable, the implementation of study and genetic counselling of people who meet criteria for familial or hereditary cancer risk and, if confirmed, its specific follow-up.

4. newborn screening of the following diseases: congenital hypothyroidism, phenylketonuria, cystic fibrosis, deficiency of acyl Coenzyme A deshidrogenada medium-chain (MCADD), deficiency of 3-Hydroxy acyl-CoA Dehydrogenase, long-chain (LCHADD), glutaric acidemia type I (GA-I) and sickle cell anemia.

(B) the entity will facilitate actions that apply and shall have the necessary means to implement the above-mentioned preventive programs included in the portfolio of services, ensuring information appropriate to the beneficiaries, as well as the calendar, addresses and schedules of the centers where vaccinations and prevention programs will take place.

The entity will send delegations of the ISFAS relationship detailed the vaccination centers in the respective province with addresses, phone numbers, schedules and preventive programs that are included in the same.

(C) in cases where the entity had not developed any of the specific programs outlined in this clause, you must meet the coverage of the actions carried out to the beneficiaries within the framework of a prevention program developed by the relevant health authorities.

(D) the ISFAS may specifically inform owners and beneficiaries and through the middle which in each case more appropriate on the desirability of certain preventive programmes included in the portfolio of services.

2.11.3 podiatry. It includes the care podiatric for insulin-requiring diabetic patients as well as patients diagnosed with foot other than diabetes etiology neuropathic.

Attention to the Podiatrist required prescription and authorization from the entity. The maximum number of sessions per patient will be six per year.

2.11.4. assistance in the framework of monitoring studies. The entity will provide access to techniques, technologies or procedures included in the portfolio of common services of the national health system, studies of monitoring, beneficiaries who meet the inclusion criteria established in the study protocol, as set out in the order SSI/1356/2015, 2 July, that amending annexes II , III and VI in the Royal Decree 1030 / 2006, of 15 September, which establishes the portfolio of common services of the national system of health and the procedure for its updating, and regulate the studies of monitoring techniques, technologies and procedures.

You can perform only a technique, technology or procedure subject to monitoring research centres that have the authorization of the corresponding autonomous community. When in the whole of the national territory the entity does not have a concerted Center enabled to this effect, you must authorize and facilitate the transportation of the insured to an authorized and assume the associated costs.

Chapter 3 means the entity 3.1 General rules.

3.1.1. for the purposes laid down in articles 14 text revised the law on Social security of the armed forces, approved by Royal Legislative Decree 1/2000, of 9 June, and 62 of its General Regulation, are considered that media entity services allocated for the health care of the beneficiaries attached to it.

Welfare purposes of this concert, the means of the entity are as follows: to) health workers dependent of the entity by a relationship work or linked to it through a civil relationship.

(B) centres and services of the institution's own or concerted by the same under any legal regime.

(C) media available to another entity and which is assigned, use subconcierto with the concerted entity, for the purposes of this concert.
D) the Center Coordinator of emergency entity accessible via a phone free and unique for the whole national, available 24 hours every day to the year, which will channel demand for emergency and health emergencies, ensuring accessibility and coordination of the resources available for this type of care.

(E) primary care services and emergency public health network concluded on behalf of the entity, as set out in annex 1, are assimilated to media entity.

3.1.2. the entity will coordinate their devices of health emergencies with other coordinators of urgencies and emergencies, including those dependent on other health administrations.

3.1.3. the entity should enable the necessary means (postal or electronic mail, telephone, fax, website, etc) so that the recipient can perform communications provided for in concert, in an irrefutable manner, 24 hours a day, every day of the year, and allow evidence of such communications.

3.1.4. the media entity must meet the requirements laid down generally by the sanitary laws, under the supervision which, with equal character, can proceed by the competent health authorities.

Centres Charter services and establishments will be duly authorised pursuant to the Royal Decree 1277 / 2003 of 10 October, which establish the General bases on authorization of centers, health services and facilities, current regional legislation and, where appropriate, in the specific regulations governing their activity.

Health professionals must be qualified in accordance with the regulation established in law 44/2003, of 21 November, management of the health professions, and be registered according to the rules laying down the corresponding College Organization for that purpose. The entity must have registered and updated the number of College of each professional included in his catalog of services.

If the ISFAS aware of possible non-compliance with these general requirements, it shall inform the competent health authority.

3.1.5. the entity shall ensure that all media that record in your catalog of services will have access to electronic media sufficient to integrate into the actions referred to in clause 5.2, as well as other programmes and actions conducive to the improvement of the quality of care and health.

3.1.6. the entity will facilitate access to facilities and services including services of catalogs, so the ISFAS to verify the adequacy of the means of the institution with respect to the supply of services carried out.

3.2. availability of means and services criteria.

3.2.1. availability of means for primary care.

A) in all municipalities of the country will be provided access to the primary health care services comprising assistance in outpatient, home regime and of urgency, taking into account the following: in the municipalities of up to 5,000 inhabitants, will be available from general practitioner or family and diploma or degree in nursing.

In the municipalities of more than 5,000 inhabitants, you will also have Pediatric.

In municipalities with more than 10,000 inhabitants will facilitate further access to dentistry and physiotherapy services, and will be, at least, two general practitioners or family.

In the municipalities of more than 20,000 inhabitants will be available Podiatrist and matron.

In the municipalities of more than 100,000 inhabitants will have primary health care services in all postal districts or, failing, other border. Beneficiaries access to home care by the appropriate optional shall be guaranteed in any case.

(B) primary emergency care will be provided continuously, 24 hours a day, using health care and nursing in outpatient and home regime.

If exceptionally the entity not available precise own or concerted media, you must ensure coverage of assistance by other private services that exist in the municipality, or absence of these, by the relevant public services.

(C) as a supplementary criterion as provided in this clause, it shall take into account that, in rural areas specifically provided for in the conventions referred to in annex 1 of the concert, and the scope and content stipulated in each of them, the level home, outpatient or emergency health care in charge of the general practitioner or family , Pediatrician, diploma or degree in nursing will provide primary care and public health network emergency services.

In any case, in accordance with the provision contained in clause 3.7, in the municipalities affected by the above-mentioned conventions holders and beneficiaries eligible by the means available to the entity in the next municipalities.

(D) in the municipalities of less than 20,000 inhabitants belonging to autonomous communities that do not have have formalized collaboration agreements referred to in the previous point or these only relate to health emergency care, and in which the entity does not have own or concerted, media and in which there are no private means, this will facilitate the access of members and beneficiaries to primary care services dependent on the corresponding community Autonomous, both for regular assistance and emergency, assuming the expenses that can be billed directly.

3.2.2 availability of specialized care services. The specialized care will dispense in the municipalities from 20,000 inhabitants and beneficiaries more than 70 residents, unless they be included in any group.

Specialized care services are structured on four levels defined according to general population criteria, number of beneficiaries residing in the relevant geographical area, existing health resources, as well as the distance and travel time to the urban centres where there is a greater availability of private health care resources.

To optimize the supply of services, are set up groupings of municipalities that are included at the appropriate level, depending on the number of beneficiaries residing in the grouping and the population of the greater municipality that conform it, not taking into account, to this end, the population of the whole of its municipalities.

Each level of specialized care includes all specialties and services corresponding to the lower levels, as well as the corresponding services of primary health care in accordance with clause 3.2.1.

A) level I of specialized care.

1 municipalities and groups of municipalities. The municipalities of 20,000 to 30,000 inhabitants are included in level I with a group protected by the ISFAS of over 70 beneficiaries, the municipalities of 30,000 to 70,000 inhabitants located to a distance equal to or less than 15 km from another level III, and all towns of more than 30,000 inhabitants, in which the collective of the ISFAS is less than 170 unless they are included in a grouping of municipalities.

The relationship between municipalities and groupings of level I is included in annex 8.

In order to optimize the availability of concerted private media, gather some next municipalities considering valid the offer of services required at this level in any of the municipalities included in any of the following groups: groups municipalities level I Alicante province.





Campello, El/Mutxamel.






Sant Joan d' Alacant/Sant Vicente de Raspeig.






Barcelona.





Asparagus/Martorell/Olessa Monserrat.






Sant Andreu of the Barca/Molins de Rei/Sant Vicenç dels Horts.






VIC/Manlleu.






Biscayan.





Basauri/Sestao.






Portugalete/Santurzi.






Castellón.





Benicarló/Vinarós.






Girona.





Blanes/Lloret de Mar.






Tarragona.





Salou Vila Seca.






Tortosa/Amposta.






Valencia.





Aldaia-Valencia/Xirivella.






Burjassot/Mislata/Paterna.






Lliria/Pobla de Valbona.






Manises/Quart de Poblet.





These municipalities will be available, at least the following services of specialized care for ambulatory care: service level I 02 Pediatrics.






04. clinical analysis (extraction centers).






31 obstetrics and Gynecology. It includes ultrasound.






32 ophthalmology.






40. orthopedic surgery and traumatology.






42 Stomatology/Odontology.





In addition, at this level will be available physiotherapist, Podiatrist and matron.

Emergency services support will be provided in accordance with the provisions set out in clause 2.4.

(B) level II of specialized care.

2 municipalities and groups of municipalities.
Municipalities of 30,000 to 70,000 inhabitants located closer than 15 km of a municipality of level III and the municipalities of more than 70,000 inhabitants with a collective of the equal to or greater than 170 and less than 1,300 ISFAS, unless it be included in any group are included in the II level of specialized care.

The relationship of level II municipalities is included in annex 9.

In order to optimize the availability of private media agreed, with the general criteria set out, some municipalities are grouped by geographical proximity and ease of transport, considering valid the offer of services required at this level in any of the municipalities included in any of the following groupings: groupings municipalities level II A Coruña province.





Santiago de Compostela / Ames.






Alicante.





Alcoy/Ibi.






Benidorm/Alfas of the Pi/Altea/Calpe/Villajoyosa.






Denia/Javea.






Petrer/Elda/Villena.






Elche/Aspe/Crevillent/Novelda/Santa Pola.






Almeria.





Roquetas de Mar/Vicar.






Asturias.





Langreo/Mieres.






Badajoz.





Almendralejo/Mérida.






Don Benito/Villanueva de la Serena.






Barcelona.





Badalona and Santa Coloma de Gramanet/Sant Adrià de Besòs.






Barbera del Valles / Cerdenyola of the Vallès/Ripollet.






Gavà-Castelldefels/Viladecans.






Granollers/Mollet de Vallès/Moncada i Reixac.






Hospitalet de Llobregat/Cornellà de Llobregat/Sant Boi de Llobregat.






Mataró/sea Villassar.






Sant Feliu de Llobregat/Sant Joan Despí / El Prat de Llobregat/Esplugues de Llobregat.






Sant Cugat de Vallès/Terrassa/Ruby.






Barcelona Tarragona.





Vilanova i la Geltrú / El Vendrell.






Bizkaia.





Getxo/Leioa.






Cadiz.





Chiclana from the actual border/port.






Cordoba.





Lucena/Puente Genil.






Gipuzkoa.





Irún/Errenterria.






Illes Balears.





(Island of Ibiza) - Ibiza/Santa Eulalia de Rio/Sant Josep de sa Talaia, Sant Antoni de Portmany.






Las Palmas.





(Island of Fuerteventura) - Puerto del Rosario / La Oliva.






(Gran Canaria Island) - San Bartolomé de Tirajana/Santa Lucia de Tirajana.






(Gran Canaria Island) - Telde/Dublin/Ingenio.






Madrid.





Alcobendas/San Sebastian the Kings/Algete.






Arganda of the Rey/Rivas Vaciamadrid/Mejorada del Campo.






Colmenar Viejo/three songs.






Collado Villalba/Galapagar/Torrelodones.






Coslada/San Fernando de Henares.






Getafe/Parla.






Pinto/Valdemoro.






Malaga.





Benalmadena/Torremolinos.






Marbella/Fuengirola/Mijas.






Corner of the Victoria/Vélez-Málaga.






Murcia.





Cieza/Molina de Segura / Las Torres de Cotillas.






Lorca/Totana.






San Javier/San Pedro del Pinatar/Torre-Pacheco.






Sevilla.





Alcalá de Guadaira/two sisters / Los Palacios y Villafranca.






Tarragona.





Cambrils/Reus.






Tenerife.





(In Tenerife) Adeje-Arona-Granadilla de Abona.






(In Tenerife) The Orotava/Puerto de la Cruz / Los Realejos.






Valencia.





Alzira/relocation.






Gandia/olive.





3 specialized outpatient services.

In municipalities and groups of municipalities of level II, as well as the corresponding to level I services, will be the following specialized ambulatory assistance care services: services level II 08 digestive.






09. cardiology.






11. general and digestive surgery.






17. Radiology.






 





Conventional Radiology.






 





Mammography.






 





TAC.






 





Ultrasound.






24. internal medicine.






35. ent.






37. physical medicine and rehabilitation.






 





Physiotherapy.






 





Speech therapy.






43. hospital pharmacy.






 





Psychology.





This level II must be available a minimum of two optional carefully in outpatient. In the area of clinical analysis will be available, at least two points of extractions and sampling.

4. Services for specialized hospital care non-urgent or scheduled. In all those municipalities or groups of municipalities where there are hospitals general private, will be enforceable the availability of specialized care services corresponding to this level for any regime of hospital care, in addition, will facilitate access to the services of Anesthesiology, resuscitation and intensive medicine (UCI), if they were accurate for the care of hospitalized patients.

However, the offer of the entity shall be considered valid when concerted Hospital is in another municipality at a distance less than 25 km from the city centre or the furthest municipality in the case of groupings of municipalities.

5. emergency services. Emergency assistance will be provided in accordance with the provisions contained in clause 2.4 for what in all of the municipalities included in this level access to continued emergency care services should be facilitated.

In municipalities or groups of municipalities of level II, will facilitate access to emergency services through concerted centers available.

In case of absence of centres agreed upon in the municipality in which the recipient requiring assistance is or other less than 15 kilometers, will facilitate access to emergency services of private centers that exist in the municipality and the entity assumes, in his case, corresponding entries or rooms that may arise from these emergency admissions.

Only in the absence of the above criteria, if in the corresponding municipality there is a public hospital is will assist assistance coverage by its emergency service, while in case required hospital admission, the patient shall be transferred to a concerted Center, their clinical status permitting.

Concerted hospital emergency departments must have doctors of physical presence for the specialties of Anesthesiology and resuscitation, General Surgery and gastroenterology, orthopedic surgery and Traumatology, gynaecology and obstetrics, internal medicine and Pediatrics. Clinical and radiology services will also be available. However, if the guard was located, must ensure is the availability of them, once they are required by the emergency room doctor, in the shortest possible time according to the pathology and clinical status of the patient, a term which may not be in any case exceeding 30 minutes.

(C) level III of specialized care.

1 municipalities and groups of municipalities. All provincial capital cities, the cities of Ceuta and Melilla are included in level III. Also included at this level, municipalities of more than 70,000 people, with private hospital infrastructures and those who reside more than 1,300 beneficiaries of the ISFAS, irrespective of the modality to which they are attached.

In order to optimize the availability of private media agreed, some groupings of municipalities, conform by geographical proximity and ease of transportation, in which at least one of the municipalities fulfils the criteria referred to in the preceding paragraph, considering valid the offer of services required at this level in any of the municipalities included in the corresponding group.

Standards exposed, all provincial capital cities, the cities of Ceuta and Melilla and also, the following municipalities and groups of municipalities are included in level III: province municipalities and groups of municipalities of level III Asturias.





Gijón.






A Coruña.





Ferrol/Narón.






Cadiz.





Algeciras / La línea de la Concepción / Los Barrios.






Cadiz/San Fernando.






Sherry of the border/Puerto de Santa María (El).






Leon.





Leon/San Andrés del Rabanedo.






Madrid.





Alcalá de Henares/Torrejon de Ardoz.






Móstoles/Alcorcón, Fuenlabrada.






Mount/Majadahonda/Las Rozas Boadilla.






Pozuelo de Alarcón.






Murcia.





Cartagena.






Pontevedra.





Vigo.
2. services of specialized outpatient and hospital care. At this level, in addition to the services required in level II, you will have the following services for assistance in outpatient, day hospital, hospital internment regime and in domiciliary hospitalization units: level III 03 allergy services.






07 Angiology and vascular surgery.






08. digestive tract: endoscopy.






09. Cardiology: Electrophysiology, cardiac/pacemaker.






16. medical and surgical Dermatology and Venereology.






17. Radiology.






 





MML.






 





Densitometry.






18 Endocrinology and nutrition.






21 haematology and haemotherapy: Day Hospital.






23. intensive medicine. Pediatric intensive care.






25. nuclear medicine: scan and radioisotopes.






26. Nephrology. Hemodialysis. Peritoneal dialysis.






27. Pulmonology. Bronchoscopy.






29. clinical neurophysiology. EEG, EMG, sleep unit.






30. Neurology.






31 obstetrics and Gynecology.






 





Prenatal diagnosis.






 





IVE.






33 Oncology medical: Day Hospital.






36 psychiatry. Detox, unit eating disorders unit.






37. physical medicine and rehabilitation.






 





Physiotherapy.






 





Occupational therapy.






 





Early warning unit.






 





Speech therapy.






38. Rheumatology.






41. urology. Endoscopy. Lithotripsy. Vasectomy.






43. hospital pharmacy.






47. palliative care. Home support, hospital care. UHD.





At this level you will have a minimum of three physicians with outpatient care in the following specialties: cardiology, General Surgery and gastroenterology, obstetrics and Gynecology ophthalmology, medical oncology and Citugia orthopedic and traumatology. In the rest of the specialties will be available to the less than two optional.

In the area of clinical analysis you must have, at least, three points of extraction and collection of samples.

In case of hospitalization the institution offer shall be considered valid when offered hospital is located in another municipality, provided that the hospital is less than 20 km away from the town centre, or from the farthest in the case of groupings of municipalities and in this municipality was not enforceable, in turn, the availability of hospital.

3. Services for specialized hospital care non-urgent or scheduled. In all municipalities or groups of municipalities, will be due the availability of specialized care services corresponding to this level for any regime of hospital care. In addition, will facilitate access to services anatomia Patologica, Anesthesiology and resuscitation and intensive medicine (UCI), in the hospital setting.

4. emergency services. Emergency assistance will be provided in accordance with the provisions contained in clause 2.4, bearing in mind that, in all municipalities and groups of municipalities included in this level, in addition to continuing care services, must be provided access to hospital emergency services.

In municipalities or groups of municipalities of level III, will facilitate access to emergency services through concerted centers available.

In absence of centres agreed the municipality or group of municipalities which is the beneficiary who requires assistance will facilitate is access to the emergency services of the private centers that exist in the municipality and the entity assumes, in his case, corresponding entries or rooms that may arise from these emergency admissions.

Only in the absence of the above criteria, if there is a public hospital in the corresponding municipality assistance coverage is will attend to its emergency service, while in case required hospital admission, the patient shall be transferred to a facility concerted, whenever permitted by their clinical condition and the hospital offer is valid, taking into account the provisions of the preceding paragraph.

Hospital emergency departments will benefit from the specialties of Anesthesiology and resuscitation, cardiology, General Surgery and digestive, orthopedic surgery and Traumatology, Gynecology and obstetrics, haematology and haemotherapy, intensive medicine (UCI), internal medicine, ophthalmology, otolaryngology, Pediatrics, psychiatry and Urology with practitioners of physical presence. Clinical and radiology services will also be available. If the guard was located, shall ensure the availability of corresponding specialists, as required by the emergency room physician, in the shortest possible time according to the pathology and clinical status of the patient, a term which may not be in any case exceeding 30 minutes.

D) level IV of specialized care. Specialized services that are included at this level are as follows: level IV. Services and special complexity 10 cardiovascular surgery units.






12. oral and maxillofacial surgery.






13. paediatric surgery.






14. plastic, aesthetic and reconstructive surgery.






15 thoracic surgery.






17 Radiagnostico: Radiology Interventional nuclear medicine 25: diagnostic and therapeutic. PET. PET-CT.






28. neurosurgery.






29. neurophysiology: Evoked potentials.






31 obstetrics and Gynecology: units of assisted reproduction.






34. radiation oncology. Radiosurgery.






Other multidisciplinary services: complex cancer treatments: surgery with curative intent of esophageal cancer.

Surgery with curative intent of pancreatic cancer.

Surgery of liver metastases.

Combined oncological surgery of the pelvic organs.






Brain injury unit.






Unit of injured spinal cord.





The level of complexity of the techniques and procedures applied in these specialized services, require to optimize them according to criteria of quality and safety, the focus of patients in a small number of centres and units with the appropriate experience, in order to ensure health care quality, safety and efficiency.

The assistance will be provided in outpatient care regime, in day hospital or hospital internment regime or through hospital emergency departments in which the entity must have the specialties of Angiology and Vascular Surgery, Gastroenterology, Cardiovascular Surgery, maxillofacial surgery, Pediatric Surgery, Nephrology, neurosurgery, Neurology, in addition to those provided for level III. If the guard was located, shall ensure the availability of corresponding specialists, as required by the emergency room physician, in the shortest possible time according to the pathology and clinical status of the patient, a term which may not be in any case exceeding 30 minutes.

Services and units of level IV will be available in each autonomous community or, failing that, in an autonomous region bordering to that in which the beneficiary resides.

Taking into account the availability criteria indicated in the corresponding autonomous community services level IV provided will be located the following large municipalities in which, in any case, you will be available all the services corresponding to level III of specialized care: municipalities autonomous community Andalusia.





Cordoba.






Granada.






Malaga.






Sevilla.






Aragon.





Zaragoza.






Asturias.





Oviedo.






Illes Balears.





Palma de Mallorca.






Canary Islands.





Las Palmas GC.






Santa Cruz de Tenerife.






Cantabria.





Santander.






Castilla y León.





Valladolid.






Castilla La Mancha.





Albacete.






Catalonia.





Barcelona.






Comunidad Valenciana.





Alicante/Alacant.






Valencia.






Extremadura.





Badajoz.






Galicia.
A Coruña.






Vigo.






La Rioja.





Logroño.






Madrid.





Madrid.






Region of Murcia.





Murcia.






Navarre.





Pamplona.






Basque country.





Bilbao.





In the municipalities of Madrid and Barcelona will always ensure the availability of all the services of level IV and a Hospital with teaching accreditation for the specialized medical training.

The following table summarizes services and specialized care units framed at each level.

Criteria of availability of means and services services services and units level I level II level III level IV allergy.





Allergology.





 





 





 





 






Clinical analysis.





Clinical analysis.





 





 





 





 






Cytogenetics.





 





 





 





 






Immunology.





 





 





 





 






Pathological anatomy.





Pathology (Hospital).





 





 





 





 






Anesthesia and resuscitation/URPA.





Anaesthesia and reanimation URPA.





 





 





 





 






Angiology and Vascular surgery.





Angiology and Vascular surgery.





 





 





 





 






Digestive.





Digestive.





 





 





 





 






Endoscopy.





 





 





 





 






Capsule endoscopy.





 





 





 





 






Cardiology.





Cardiology.





 





 





 





 






Electrophysiology/pacemaker.





 





 





 





 






Implantable defibrillator.





 





 





 





 






Ablation/Cardioversion.





 





 





 





 






Hemodynamics.





 





 





 





 






Cardiovascular Surgery.





Cardiovascular Surgery.





 





 





 





 






General Surgery and the digestive AP.





Surgery. General and the Ap. digestive.





 





 





 





 






Oral and maxillofacial surgery.





Oral and maxillofacial surgery.





 





 





 





 






Orthopaedic surgery and traumatology.





Orthopaedic surgery and traumatology.





 





 





 





 






Pediatric Surgery.





Pediatric Surgery.





 





 





 





 






Plastic and reconstructive surgery.





Plastic and reconstructive surgery.





 





 





 





 






Thoracic surgery.





Thoracic surgery.





 





 





 





 






Medical and surgical Dermatology.





Medical and surgical Dermatology.





 





 





 





 






Endocrinology and nutrition.





Endocrinology and nutrition.





 





 





 





 






Gynecology and obstetrics.





Obstetrics and Gynecology.





 





 





 





 






Gynaecological ultrasound.





 





 





 





 






IVE.





 





 





 





 






Prenatal diagnosis.





 





 





 





 






High risk obstetrics.





 





 





 





 






Assisted human reproduction.





 





 





 





 






Haematology and haemotherapy.





Hematology/day Hospital.





 





 





 





 






Hemotherapy (Hospital).





 





 





 





 






Physical medicine and rehabilitation.





General physiotherapy.





 





 





 





 






Physical medicine and rehabilitation.





 





 





 





 






Speech therapy.





 





 





 





 






Cardiac rehabilitation.





 





 





 





 






Pelvic floor rehabilitation.





 





 





 





 






Occupational therapy.





 





 





 





 






Early care unit.





 





 





 





 






Medicine intensive/UCI.





Medicine intensive/UCI.





 





 





 





 






Internal medicine.





Internal medicine.





 





 





 





 






Nuclear Medicine.





Radioisotopes/scan.





 





 





 





 






PET - TAC.





 





 





 





 






Nephrology.





Nephrology.





 





 





 





 






Hemodialysis, peritoneal dialysis.





 





 





 





 






Pulmonology.





Pulmonology.





 





 





 





 






Neurosurgery.





Neurosurgery.





 





 





 





 






Clinical neurophysiology.





Clinical neurophysiology.





 





 





 





 






Evoked potentials.





 





 





 





 






Sleep unit.





 





 





 





 






Neurology.





Neurology.





 





 





 





 






Ophthalmology.





Ophthalmology.





 





 





 





 






Medical Oncology.





(Day's Hospital) Medical Oncology.





 





 





 





 






Radiation Oncology.





Radiation Oncology.





 





 





 





 






Radiosurgery.





 





 





 





 






Otolaryngology.





Otolaryngology.





 





 





 





 






Pediatrics.





Pediatrics.





 





 





 





 






Psychiatry.





Psychiatry.





 





 





 





 






Radiology.





Conventional Radiology.
 





 





 





 






Ultrasound.





 





 





 





 






Mammography.





 





 





 





 






TC.





 





 





 





 






MML.





 





 





 





 






Densitometry.





 





 





 





 






Interventional Radiology.





 





 





 





 






Rheumatology.





Rheumatology.





 





 





 





 






Urology.





Urology.





 





 





 





 






Lithotripsy.





 





 





 





 






Green laser.





 





 





 





 






Palliative care.





Home support teams.





 





 





 





 






Hospital palliative care unit.





 





 





 





 






Multidisciplinary units.





Pain unit.





 





 





 





 






Spinal injuries unit.





 





 





 





 






The brain injury unit.





 





 





 





 






Unit's great burned.





 





 





 





 






Early care unit.





 





 





 





 






Radioguided surgery.





 





 





 





 






Curative surgery of the esophageal Ca.





 





 





 





 






Curative surgery of pancreatic Ca.





 





 





 





 






Surgery of liver metastases.





 





 





 





 






Combined surgery of the pelvic organs.





 





 





 





 






Transplantation of organs, tissues and cells.





 





 





 





 





3.2.3 reference services. The assistance of rare diseases and illnesses requiring techniques, technologies and procedures, high level of specialization, for which experience is essential in operation, which can only be achieved and maintained through certain volumes of activity, advises the concentration of cases in certain centres, services or units of reference.

For this purpose, the entity will facilitate access to services and reference units designated by the Ministry of health, social services and equality, consent of the Interterritorial Council.

Subsequent patient monitoring will take place for the services included in the catalogue of services, in accordance with the guidelines of the corresponding service or unit of reference of the national health system.

3.3 special conditions for the islands of the Canary and Balearic archipelagos.

3.3.1. the entity will count in the islands of the archipelagos Balearic and Canary Islands with sufficient and stable means to provide health care.

For the purpose of rating requirements of availability of means for the provision of primary health care the population of each municipality, will be taken as reference while providing specialized care for the population of each island they shall refer.

No United States Islands shall be provided the beneficiaries access to hospital emergency services established for the 2nd level of specialized care.

3.3.2 the following tables each archipelago relate the level and form of each corresponding specialized care.

Illes Balears island level attention specialized outpatient hospitalization (*) emergency admissions Mallorca.





Nivel IV





X





X





X






Eivissa.





Nivel II





X





X





X






Menorca.





Nivel II





X





X





X






Formentera.





 





 





 





X Canary Islands island level attention specialized outpatient hospitalization (*) emergency admissions Gran Canaria.





Nivel IV





X





X





X






Lanzarote.





Level II X X X Fuerteventura.





Nivel II





X





X





X






Tenerife.





Nivel IV





X





X





X






La Palma.





Nivel II





X





X





X






La Gomera.





 





 





 





X iron.





 





 





 





X (*) specialties in regime of hospitalization in the II level of specialized care are the following: clinical, pathological anatomy, anesthesia resuscitation/URPA, digestive, cardiology, General Surgery and digestive, orthopedic surgery and Traumatology, pharmacy, Gynecology and obstetrics, haemotherapy, physical medicine and rehabilitation, internal medicine, ophthalmology, otolaryngology, Pediatrics and radiology.

3.3.3. without prejudice to the general criteria laid down in clause 2.7, the entity will assume in all cases travel expenses for assistance to the specialties of level III inter-island, unless you have media agreed to provide assistance required on the island where the beneficiary is. In the case of Formentera, La Gomera and El Hierro, will be also handled the costs of inter-island travel for assistance to specialties of level II.

3.3.4. in case of absence of the required media in each island, the entity will ensure assistance on the nearest island that has them, and must assume the travel costs.

3.3.5. the specialized care of level IV, if it is not available in the corresponding Autonomous Community, will be in that which is nearest in time of displacement, and must assume the entity the travel costs.

3.3.6 where the patient required companion, companion travel expenses will be paid by the entity. For this report in the optional where the need is justified it shall be furnished before the entity.

3.3.7. in the Islands corresponds to level II of specialized care, unless any of its municipalities figure related to the table of Annex 9, if the entity does not have concerted hospital, but there is a private hospital, undertakes to provide this Centre (including all specialties available therein) health care in regime of outpatient and hospitalization, as well as assistance in emergency admissions scheme.

3.4. guarantee of accessibility to the media. The entity must guarantee access to the media that at each level of care requires the services portfolio under the terms established in this chapter, except that there are no public or private media, in which case will facilitate in the municipality more next to where they are available.

If the means required by each level of care were not available, the entity undertakes to facilitate the access of beneficiaries to other private services that exist in the same municipality or absence of these, the relevant public services, assuming the expenses that could be billed directly.

3.5 standards and requirements for the use of the means of the entity.

3.5.1. general rule. Will receive the assistance they need through the media entity defined in clause 3.1.1, holders and beneficiaries can choose freely optional and Centre from among those listed in the catalogues of entity services throughout the national territory.
The beneficiary shall apply directly to the chosen primary and specialized care optional, to receive the assistance required, no further requirement to accredit their status and submit the corresponding health card, without prejudice to the provisions in clause 1.7.3.

The prescription of the optional of the catalogue of services will be required to carry out diagnostic and treatment procedures and techniques.

Chapter 2 sets out the requirements and general conditions of access to services and benefits included in the portfolio of services, and must take into account the additional requirements laid down in clause 3.5.3.

3.5.2 identification. The beneficiary must provide proof of their status and their right to assistance, through the presentation of the individual health card which can be obtained from the entity in accordance with clause 1.7, the corresponding document of affiliation to the ISFAS.

In cases where, for reasons of urgency, it is not possible provide in the event the above documentation, the owner or beneficiary must identify with their ID card or another document certifying your personality and submit that documentation within a maximum period of 48 hours.

3.5.3 additional requirements.

A) in the cases expressly provided for in the present agreement, the entity may require the additional requirements which may be applicable, such as the prescription or the prior authorization of the institution.

The entity, through physicians who prescribe or perform diagnostic tests or treatments that require authorization, shall inform duly of this requirement the beneficiary.

(B) may be carried out with charge to the beneficiary unauthorized tests if he has not informed before the need for such prior authorization or, in the case of medical or surgical acts performed at the time of the inquiry, when it has there been time to obtain approval by the entity.

(C) the application for authorisation of a certain average diagnostic or therapeutic derives from the need for order and channel performance by the entity, to facilitate the service and avoid delays, but can never be a restriction of access to the benefits recognized in the portfolio of services.

(D) Annex 2 contains a comprehensive relationship, with the relevant specifications of the assumptions of use of media that require prior authorization from the entity, as well as the procedure to obtain.

(E) in no event will be denied a request for a diagnostic or therapeutic means included in the portfolio of services established in this concert, indicated by a health professional of the entity.

(F) access to level IV and reference services, provided in clause 3.2.3 and medical consultants will require another medical specialist prescription and authorization of the entity.

3.5.4 non-agreed private hospitals. Access to services in non-agreed private schools, as provided for in clause 3.2.2. B. 3) will require prior authorization from the entity pursuant to clause 2.3.3. B).

3.6. catalogue of the entity services.

3.6.1. General criteria. The Agency's services catalogue contains the detailed list of the media of the entity and the necessary information for proper use by holders and beneficiaries.

In the catalogue of services without exclusions include all physicians and medical centers owned or arranged by the entity that have been offered and included in the database provided for the subscription of the concert, provided in annex 5.

The catalogue of services should include all means care own or concerted entity offers for assistance of other mutuals of officials to keep healthcare concerts, whereas all services assigned to assist the beneficiaries attached to the entity.

The entity may determine in its medical picture appearing as certain consultants optional for specific and complex areas of specialization, provided that, for that specialty available specialists not consultants.

When a holder or beneficiary is attended to by a professional who is part of the team of a physician or concerted service included in the catalogue of services, means that it is part of the means of the entity and should be included as soon as possible in the register of health professionals required in clauses 3.6.6 and 5.1.5 and annex 5 , as well as on the website of the entity.

The entity will publish the catalogue according to the instructions described in section 3.6.2 that will have, both on paper and in electronic format, a common format of binding, to ensure homogeneity between the catalogues of the various concerted entities.

Service catalogs can be directed, as well as the beneficiaries of the ISFAS, also to the groups belonging to MUFACE and MUGEJU. They shall not include advertising or advertising messages or information concerning other products or services of the company.

The Subdirectorate of benefits of the ISFAS will be handed out in electronic format catalogues and two copies in each provincial catalogue paper, and provincial services, in addition to the electronic format of the respective catalogue, will be given at least five copies on paper.

When it is detected that a catalog does not identify with the corporate image of the entity or in its elaboration has not addressed to the common format of binding established in section 3.6.2. the ISFAS inform the entity, which shall have a period of ten calendar days to correct the detected defects and deliver corresponding delegations and central services of the ISFAS the new edition of the catalog in the format and with the number of copies that is required you this breach.

3.6.2 structure and content. Catalogs of services will be province-wide. Its content will be equivalent to which is included in the medical record provided for in clauses 3.6.6 and 5.1.5 and in annex 5, provided by the entity.

The catalogues of each province, both on paper and in computer support will be structured in the following way: to) must bear the ISFAS logo (or each of the Mutualities of officials) and that of the entity, as well as free and unique phone from the Coordinating Center of urgencies and emergencies of the entity of prominently on the cover.

(B) on the first page shall include data relating to: 1. phone of the Coordinating Center of urgencies and emergencies of the entity.

2. the entity info phone.

3. fax number or other system for authorizations.

4. website of the entity.

5 address, phone numbers and hours of operation of the provincial delegation of the entity, as well as the existing office/s / s in the province for face-to-face care of beneficiaries.

(C) on the right side of the header of each page should be the phone of the Coordinating Center of urgencies and emergencies of the entity.

(D) starting from the second page must bear the addresses of centers of emergency admissions in the province, which in the case of the island provinces are listed for each island.

E) general index of our catalog.

(F) general information and rules of use set out in concert.

It will include a summary of rights and rules for use of greater relevance in concert, that in no case replace the content of this.

The minimum to include in this section information will be structured and ordered according to the following headings: 1. identification for access to the media Charter/health insurance card.

2. instructions for use of the means of the entity, including free choice of physician and concerted Center, and the relationship of services requiring prior authorization from the entity and form of obtaining.

3 specifications relating to certain services: home care. assistance in regime of hospitalization, including day hospitalization and home.

4. transportation to health care. Terms and conditions for use.

5. guarantee of accessibility to the media.

6. use of non-agreed.

7. urgent assistance from vital character.

8 precise instructions for the use of the services of primary attention of the public system in rural areas, in ambulatory, home regime and urgency, in the terms provided in the agreements signed with the health services of the autonomous communities or, in its case, when conventions have not been formalized.

Separate annex will include the detailed list of the municipalities affected by the agreement at the provincial level.

9 information about healthcare in an accident when there is a third party liable to pay (road traffic, sportspeople, etc.)

10. services that, in each municipality, provide the entity above the requirements established in the concert, which will constitute its offer differentiated services, as element to facilitate the choice of entity by holders.

(G) medical box.

1. practitioners and hospitals will interact by municipalities, starting with the capital of the province, which will follow the rest of the municipalities in alphabetical order.

2. all practitioners, centres and functional units must appear related to its identification data (name and surname), and must include, in addition, the address, telephone number and hours of operation.
3. for each municipality are interact first media available for urgent care, then the primary care and then those corresponding to the specialized care: 4. urgent care: is connect the available hospital and hospital services, as well as ambulance services.

5 primary care: in each municipality, available media interact in the following way: a) general medicine or family.

(b) Pediatrics.

(c) nursing.

(d) midwives.

(e) physical therapy.

(f) Odontologia-estomatologia.

(g) podiatry.

Municipalities of level IV, for each of the types or forms of assistance, the resources shall be entered grouped by zip codes, and, in all cases, listed in alphabetical order by the last name of the professional.

If there were no resource in primary care in some of the municipalities, shall be recorded, where applicable, their allegiance to the Convention of rural environment with the corresponding public system, with expression is only for emergencies or for the set of primary care, must include, in addition, the direction of the health centre or point of attention continuing (PAC) corresponding to the municipality.

6. specialized care: be first interact consultations external or outpatient specifying, where appropriate, the subspecialty or functional unit, following the alphabetical order of the official denomination specialty and then, if there were, those referred to the assistance contract of hospitalization. In all cases, listed in alphabetical order by the last name of the professional.

In the municipalities of level IV, health professionals in each specialty could, in turn, grouped by zip codes or, in their case, by the name of the hospital.

When in the territorial area of a province, the entity is not obligated to level IV of specialized care services, the corresponding catalogue shall set forth the means for this purpose available to the entity in the territory of the autonomous region, which belongs to the province.

In each provincial catalogue of services must relate, separately, the services of level IV.

In the insular provinces resources must appear on the catalogues differentiated by Islands, comprised the capital first. Within each island, will be placed first the town main and then the rest of the municipalities or towns by alphabetical order.

(H) relationship of the information, emergency services and ambulances available in the remaining provinces, in order to facilitate its use in case of displacement of the beneficiaries.

I) services portfolio of specialized care in inpatient care regime. It will include pictures with the media by levels of specialized care offered, differentiated regime of hospitalization and emergency admissions, indicating the name of the hospital and the municipality in which it is located.

J) optional alphabetical index and index of centers reached.

3.6.3. responsibility in the edition of the catalogues of the entity web information and services.

A) the entity will publish catalogs of services responsibility.

(B) before 20 December prior to the start of each year of the concert, the entity must deliver in the central services of the ISFAS catalogs of services corresponding to all the provinces and delegations of the ISFAS, of the corresponding province in the format and number of copies specified in clauses 3.6.1 and 3.6.2. Also on January 1, will provide to holders and beneficiaries so request the catalogue of services in the corresponding province in edition of paper or in electronic form, at the option of the payee, by delivery to the postal or electronic address indicated by the person concerned or making it available on the premises and delegations of the entity. Delivery must be made within a period of not more than seven calendar days from the request.

((C) the institution must have a specific section on its web site that inform the beneficiaries of the ISFAS on the contents of catalogs of services corresponding to all the provinces, included the phone number of the Coordinating Center of urgencies and emergencies of the entity, provided for in clause 3.1.1. D) clearly differentiating it from other information or services of the company phone numbers.

(D) to avoid confusion with the benefits offered to insured persons outside the present agreement, this information must appear in a section specific to the ISFAS, perfectly identifiable and accessible and include the contents that are specified in 3.6.2 clause for each province. The information on the website should update whenever there are changes, as set out in clause 3.6.4, stating the date of the last modification.

(E) in the case of the institution failed to comply the provisions of the preceding two paragraphs, it undertakes to assume the expenses arising from the use by the beneficiaries of the services provided the centers and practitioners including the last existing catalog or on its website.

3.6.4 invariability of the catalogs of services.

A) the catalogue of services of the entity will remain stable throughout the duration of the concert, in such a way that once published, the offering of the entity may only register high, without that can result in casualties, except those duly accredited to the ISFAS arising from the death or incapacity of the optional for the exercise of their profession , by cessation of activity or transfer to another municipality, at the request of the specialist or facility.

In these cases, the low must be communicated to the central services and the corresponding delegation of the ISFAS with 30 days prior to the date on which will be effectively produce, except that it is happening, justifying in writing the reason for the same. In addition, if low affects centers or hospital services, the entity should submit to corresponding delegations of the ISFAS relationship of holders and beneficiaries who are being treated in these centres or services.

The entity is obliged to replace in the shortest time possible to professional or facility, and must communicate to the Subdirectorate of benefits and the corresponding delegation of professional ISFAS or center that has replaced produced downward.

(B) the ISFAS may authorize downward of some means for other reasons, duly accredited by the entity that justify it, and provided that the medium is replaced.

When the entity requested permission to deregister any means and the ISFAS, once analyzed the course, not appreciated it as justified, it shall so inform the entity and will mean that said half follow being for all purposes as a means of the same during the term of the concert, and therefore continues to be usable by the owners and beneficiaries on behalf of the entity taking into account that, if no response within the period of 30 days means that there is compliance with the low.

In either of the cases referred to in the above clauses, the entity is obliged to send a communication to beneficiaries, with generalized character, on the high or low in the catalogues.

(C) if there is any lower on the supply of media, the beneficiaries with assistance in course will be entitled to continue using the media included in the catalogue of services until that time, during the period provided for in section 3.6.5, corresponding to the entity to assume the payment of costs that could be billed for the use of such services.

The entity must inform in writing each of the affected patients, about its right to maintain treatment and the continuity of care at the Center or service, charged to the authority, as laid down in section 3.6.5 in a period not exceeding seven calendar days from the date of the drop in centre or service.

When the entity do not attend the payment of these expenses, directly to the corresponding specialists or services, the ISFAS may authorize your subscription by the procedure provided for in clause 6.5.4 of the concert, by agreement of the Deputy Director of benefits of the ISFAS which shall be notified to the authority, without prejudice to compensation which would assume, in accordance with the provisions set out in clause 6.7.

3.6.5. principle of continuity of care.

A) irrespective of the provisions of clause 3.6.4, if the decline in some professional of the catalogue of services, the entity will ensure the continuity of care with the same optional patients in treatment of severe pathological processes during the six months following the date down has occurred, provided that the physician could continue the exercise of his profession and had compliance for its part.

(B) if the low refers to a health centre or hospital service, the entity will ensure patients who are being treated of a process the continuity of the treatment in the facility or service, during all the time that maintained the need for the same or until discharge from the process has been obtained. This continuum of care will be extended in any case for a maximum period one year provided that the entity has a valid health care alternative to treat that disease process.
(C) the entity shall inform in writing each of the affected patients, about its right to maintain treatment and the continuity of care at the Center or service, charged to the authority, in accordance with the provisions of the preceding paragraph in a period not exceeding seven calendar days from the date of the drop in centre or service.

(((D) when the change of concert occur low of centers or hospital services in the fields of Oncology and Psychiatry regarding the catalogue of services in 2015, the maximum period provided for in paragraph B) shall be 24 months, under identical conditions which it entails, as well as those on the duty of information in subparagraph (C)).

(E) the entity will ensure patients are being treated the continuity of the treatment in the Center or service where are being treated, when they are being cared for in centers located in municipalities which, by the change in concert, is assigned them another level of care to discharge from hospital with a maximum period of three months of a pathologic process , or a month, in the course of outpatient assistance, computed from the beginning of the term of the concert.

After the period of time that corresponds, as specified in the preceding paragraphs, the entity should provide a valid health care alternative to treat that disease process.

((F) when at the end of this concert the entity subscribes the concert of healthcare that will replace it, should meet the obligations laid down in this section 3.6.5, except the willing in paragraph E) above.

3.6.6 information relating to the means available. The entity must provide the ISFAS information concerning the resources available to provide benefits that are the subject of the concert, in computer support. This information shall be provided in a database with the structure established in annex 5.

3.7. freedom of choice of physician and Center. Beneficiaries can choose freely optional and Centre from among those listed in the catalogues of entity services throughout the national territory.

At the request of the beneficiary, the entity will facilitate his referral to centres or services where can be lent you the assistance you need, without prejudice to the right to freedom of choice of Charter services.

3.8 military hospitals. At the request of the beneficiary, the entity shall authorize charge any treatment or detention in a Hospital of the defense.

Chapter 4 use of media not concerted 4.1 general rule. In accordance with the provisions of articles 14 of the consolidated text of the law on Social security of the armed forces, approved by the Royal Decree legislative 1/2000, of 9 June, and 62 of its General Regulation, in relation to clause 3.1. of the present agreement, when a beneficiary, by choice or their families, use means other than the entity, payable, without the right to reinstatement, costs that may arise, except in cases of unjustified refusal of assistance and urgent care of vital character.

4.2. unjustified refusal of assistance.

4.2.1 cases of unjustified refusal of assistance. For the purposes provided for in article 62 of the rules of procedure General of the Security Social of the armed forces, it shall be deemed that you produced unjustified refusal of assistance in the following cases: A) when the entity not authorized or does not provide a valid health care solution before the end of the fifth working day following the date of application for the beneficiary of any of the features or services contained in annex 2 at the level where appropriate, and which has been prescribed by a doctor agreed, or deny a benefit included in the portfolio of services covered by this concert. The response of the authority shall be in writing or by any other means that allows to record the same.

(B) when it is not satisfying the requirements of availability of means provided for in clause 3.2 of the present agreement.

In this case, the beneficiary can go to physicians or private facilities that exist in the corresponding level or absence of these, the relevant public services, in accordance with the provisions in clause 3.4, without having to notify the entity the beginning of the assistance received, is entitled to the entity to assume the expenses.

(C) when the beneficiary request authorization to the entity to go to a physician or facility not concluded (prior prescription in writing by a physician of the entity with exhibition of the medical reasons for the need for referral to the not concerted medium) and the entity does not authorize it or offer a valid health care alternative with its means before the end of the tenth working day following the submission of the application for authorisation.

If you own or concerted media, offer must specify expressly the optional, service or centre you go to take care and that can carry out prescribed diagnostic or therapeutic technique.

If the entity authorized by referral to a physician or facility not concerted, you should assume the costs of the care process, without exclusions. However, after six months from the start of the assistance, the beneficiary shall require the entity renewal of the provision or the continuity of assistance, so that, before the end of the tenth working day following the date of application, the entity authorized by the renewal either offer a valid health care alternative with its means.

(D) when a beneficiary has come or is admitted to a center of the entity to receive assistance and discretion of the physician who treats you do not exist or are not available health care resources. In this case it is presumed that a situation of unjustified refusal of assistance when from the middle of the entity has sent the patient to not concerted Central.

(E) when the beneficiary is admitted to a facility not concluded because of a medical situation that requires immediate attention of urgency, and this (or relatives or responsible third parties) notify the entity within 48 hours to the entry and does not offer a valid health care solution before they are completed the 48 hours following the communication undertakes to assume the expenses resulting, well managing their transfer to a center of the entity, own or concerted, always moving either medically possible.

The request to the entity held by a means that allows to record it (preferably through its Center, emergency Coordinator) and the same shall contain a brief description of the facts and circumstances in which income has been.

4.2.2. obligations of the entity.

A) in any of the cases mentioned in the previous clause the entity shall pay expenses incurred by the attendance of the beneficiary directly to corresponding services, within the ten calendar days following the date on which the beneficiary submitted before the entity timely claim in writing.

When the beneficiary would have made the payment, the entity must proceed to the corresponding reimbursement within the same period.

In the case referred to in paragraph E) clause 4.2.1, the owner or beneficiary will be responsible for expenses incurred for attendance until his transfer to the Centre itself or concerted if the entity had proceeded to this by the deadline.

(B) where the institution provides own or concerted media, the offer must be managed by the entity, specifying the name of the optional, service or Center will assume the assistance and that it can carry out prescribed diagnostic or therapeutic technique.

(C) when the beneficiary has come not concerted media as a result of a refusal of assistance caused because the entity had not offered a valid health care alternative in the terms stated in the previous clause 4.2.1, or because it had authorized its referral to a physician or not concerted Center, the entity must assume, without exclusions, expenses incurred for the care process to discharge it. However, after six months from the refusal of assistance or the date of the last authorization of assistance, the beneficiary must request the entity the renewal of the continuity of care, so that, before the end of the tenth working day following the presentation, you authorize it or provide a valid medical alternative with its media , in accordance with the specifications provided for in clause 4.2.1.

(D) when the entity receives the holder or beneficiary communication of the assistance provided foreign media by any of the circumstances provided for in clause 4.2.1, it will be appropriate to the supplier negotiations issue the corresponding invoice in the name of the entity and be responsible for the costs of such assistance.

4.2.3 claims. The beneficiary can claim the corresponding ISFAS delegation, when the entity incurs in any of the cases of unjustified refusal of assistance provided for in clause 4.2.1. or when had not effected the reimbursement or direct payment of expenses incurred in designated deadlines in clause 4.2.2.
4.2.4. other effects. Acceptance by the entity or, where appropriate, the Declaration by the ISFAS that there is a case of unjustified refusal of assistance, does not imply the acceptance or declaration, respectively, of that ever denial of assistance to other civil or criminal purposes, which, in his case, the beneficiary must be attend the corresponding ordinary courts.

4.3. emergency care of vital character.

4.3.1 concept and requirements. Purposes equally provided for in article 62 of the rules of procedure General of the Security Social of the armed forces, is considered vital character emergency situation in which a pathology whose nature and symptoms to make predictable a vital risk imminent or very close or irreparable damage to the physical integrity of the person, not to immediately obtain a therapeutic action has occurred. To appreciate the concurrence of this circumstance be taken into account the provisions of annex 3.

Holder or beneficiary to be entitled to the coverage of any cost resulting from use of means other than the entity in vital emergency situation, must go to the optional or centre to which direct or transferred the patient reasonably chosen, taking into account the circumstances of place and time in which the pathology has occurred as well as the decision of the patient capacity and, where appropriate, of the people who have given first aid.

4.3.2. assistance by accident, Act of service and other special situations of urgency. Is considered provided that it brings together consideration of vital urgency and that the assistance received, have been used means other, also has the requirement provided for in the second paragraph of the preceding clause, the following special situations: to) assistance requiring the holders of the ISFAS on the occasion of accident in service in the exercise of the functions of its activity as a consequence or occasion of acts committed by people in bands or organized and armed groups.

(B) when the recipient is on the road or public places, and public health emergencies teams (112, 061, etc.) are activated by person other one or their families should be accompanied.

(C) when is the activation of the public health emergency teams carried out by State security bodies or other structures not health emergencies (fire, etc.).

D) when the insured suffers a traffic accident or accident of service and be attended by public health emergency teams in the place where it will be.

(E) when the beneficiary resides in an assisted Senior Center or at a Center for chronic and public health emergency teams are activated by the staff of the Centre, or when that reside in their home and these teams are activated by a tele-assistance service for public funding, in both cases if he or his family have communicated to the Centre or service their allegiance to the entity for the purpose of their health care.

4.3.3. range. The situation of urgency of vital character extends from admission to discharge from hospital of the patient (including possible transfers to other non-agreed welfare causes unavoidable), except in the following two cases: to) when the entity, with the agreement of the physician was providing assistance, offer a healthcare alternative that enables the transfer of the patient to appropriate its own centre and the patient or responsible relatives refuse to do so.

B) when the patient is transferred to a second alien facility and there are causes that prevent his transfer to a center of the entity.

4.3.4 communication to the entity. The beneficiary or other person on his behalf shall inform the entity assistance received with outside media by any means allowing to leave a record of communication, providing the corresponding medical report emergency within 48 hours at the beginning of the assistance, unless there are exceptional, duly justified, circumstances that have prevented to communicate the assistance received with means other Notwithstanding that the use of such means is always covered in case of vital urgency.

4.3.5. obligations of the entity. When the entity receives assistance of a beneficiary means non-agreed planned communication in the previous clause, you must answer, within 48 hours following the receipt of the communication, and by any means that allows to record the same, if it recognizes the existence of the situation of vital urgency and therefore accepts the payment of costs produced or if , on the other hand, is not obliged to pay because they understand that there has been a situation of urgency of vital character.

On the assumption that the entity recognises the existence of the situation of vital urgency he shall inform the supplier that is responsible directly incurred costs, so by this issue the corresponding invoice to the entity. If the holder or beneficiary had paid the expenses, the entity must be reinstated within ten calendar days following the date in which it sought reinstatement to presenting proof of expenses.

On the assumption that the entity is not considered obliged to payment by understanding that it has not been the situation of vital urgency, issue, within a maximum period of seven calendar days, report arguing and basing that fact and will transfer thereof to the beneficiary and the delegation of the ISFAS.

When the beneficiary has not carried out communication on time, the State reimbursed the amount of the assistance within the ten calendar days following the date on which submitted the corresponding invoice and, where applicable, the proof of payment. If the entity has not made provisions in this clause, it shall be obliged to direct payment the supplier health, if requested by the beneficiary.

On the assumption that the entity is not considered obliged to understand payment that has not been the situation of vital urgency, will report arguing and basing such circumstance, and will transfer it to the beneficiary.

4.3.6 claims. The beneficiary may claim in the corresponding delegation of the ISFAS when the entity fails to comply with the obligations laid down in clause 4.3.5, in case of discrepancy with the criterion of the entity, or in the absence of a response within the time limit set to the effect.

4.4 transport in foreign media for health care in cases of unjustified refusal of assistance and of vital urgency.

When the use of other means of transport is required in cases of unjustified refusal of assistance and of vital urgency, both health and ordinary, conditions and requirements shall be those set out in clauses 2.4.3 and 2.7.

The beneficiary is entitled to the entity to pay expenses incurred by such transfer. Payment must be made within the period of the ten calendar days following the date on which the beneficiary submitted before the entity timely claim in writing, accompanying proof of these expenses.

4.5 cross-border assistance. In the limits and conditions established in Royal Decree 81/2014, February 7, which lays down rules to ensure cross-border healthcare, and amending the Royal Decree of 1718 / 2010, of 17 December, on prescription and dispensing orders, and in the specific regulations for the ISFAS, notably resolution 38026-4B0-2014 19 February, which regulates health care outside the national territory, beneficiaries may apply for reimbursement of costs for cross-border healthcare through the ISFAS delegations.

The procedure for requesting and providing recognition are established in annex 7.

When it recognizes the right to reimbursement of costs for cross-border healthcare to a beneficiary attached to the entity, the ISFAS will affect the amount of the expenses that apply to benefits that are the subject of the concert, by the procedure laid down in section 6.5.4 to it.

In no event will affect the entity costs corresponding to outpatient dispensing of dietetic products, material CPO, medications and other health products which are the subject of benefits with dietetic products, prosthetics and pharmaceuticals, for outpatient treatment.

Chapter 5 information and health documentation and quality 5.1 objectives information and documentation.

5.1.1. General rules. So the ISFAS available the information necessary for the evaluation of health benefits that must be covered by this concert, its planning and decision-making, the entity will provide all data on services provided to holders and beneficiaries that are specified in this chapter. It will also do so upon those not specified that, during the term of the agreement, could be sued by the Ministry of health, social services and equality in the context of development of the information system of the national health system or by any other competent body in compliance with the regulations in force.

The entity is obliged to require of its professionals the completion of many documents are specified in this chapter.
Also, the entity is obliged to comply and enforce all the requirements established in the organic law 15/1999, of 13 December, of protection of data of a Personal nature and its implementing regulations, in relation to information and health documentation of holders and beneficiaries of the ISFAS practitioners and hospitals included in his catalogue of services as well as to safeguard the exercise of the rights of patients collected at article 10 of Act 14/1986 of 25 April, General health and in law 41/2002, of 14 November, regulating the patient autonomy and rights and obligations in terms of information and documentation clinic, paying special attention to informed consent and respect for previous instructions , pursuant to articles 10 and 11 of the aforementioned law 41/2002.

5.1.2 general information activity.

A) activity/cost information. The entity will have an information system that allows to know the number, type and cost of the services provided to the beneficiaries of the ISFAS with own or concerted media.

The entity shall provide the ISFAS, computer or telematic procedures, data on health care activity, with the structure and format that appears collected in annex 4.

Data shall be submitted with the periodicity provided for in the said annex, within the three months following the end of the relevant period.

(B) information about non-urgent health transport. The entity will have an information system that allows to know the number of patients who made use of non-urgent health transport regulated in section 2.7.2.

Such data should refer to the ISFAS periodicity with the characteristics set out in annex 4.

5.1.3 economic information. The entity shall provide, at the request of the ISFAS, statistical data legally established accounts satellites of the expenditure health public the Plan statistical national, as well as those of other data requested by the Ministry of health, social services and equality for the health of the system national health information system. All in the format and with the frequency determined by the ISFAS, for subsequent transfer to the mentioned Ministry.

5.1.4. information about hospital care.

A) the entity shall require their centers own or concerted, detailed in their catalogues of services, which completed the discharge report, at the end of stay in a hospital institution, assistance by major outpatient surgery or other assistance, as provided for in Royal Decree 1093 / 2010 of 3 September, which approves the minimum set of data in the national health system clinical reports.

(B) in the authorizations of admission to hospital or major outpatient surgery issued, the entity will be responsible for informing the beneficiaries of this concert that their health data can be treated by the ISFAS for the purposes set out, always with recommendations and precautions established by the organic law 15/1999, of 13 December Protection of Personal data and its implementing regulations.

5.1.5 information about sanitary means. In the years of the concert, the entity shall forward to the ISFAS in electronic format the up-to-date information of own and concerted media has offered for the subscription of the same. Such referral will take place in accordance with the instructions issued by the ISFAS and pursuant to the provisions of annex 5.

5.1.6 documentation clinic.

A) the information referred to in clause 5.1.4 must be kept for as long as regulations set on paper and/or support. In any case it must comply with the legal requirements already referred to in clause 5.1.1.

(B) the report of high, in any type of health care modality, will be delivered in hand to the patient or, by indication of the responsible physician, to the family member or legal guardian at the time thereof discharge the health centre or the process that is being treated in outpatient. Also will be provided a copy for delivery to the doctor responsible for the follow-up of the patient in the delivered field, while another copy of the report of high will be filed in the medical record.

Together with the report of high, the patient will receive instructions for the correct monitoring of treatment and establishment of mechanisms that will ensure the continuity and safety of care and care.

(C) a copy of your medical history will be, at the request of the person concerned, or certain data contained therein, without prejudice to the obligation of conservation in the health centre, leaving a written record of the entire process and, in any case, guaranteeing the confidentiality of the information related to the process and the stay of patient in health institutions , according to the law 41/2002, of 14 November, regulating the autonomy of the patient and of rights and obligations in terms of information and clinical documentation.

The indicated documentation is included in the clinic history Digital, interoperable with the rest of the national health system, as it unfolds.

5.1.7. other sanitary documentation. The entity will actively deal with professionals and health centres included in their catalog of services to comply with the following obligations: to) complete precise medical reports established by the ISFAS for low initial assessment by disease, accident or risk during pregnancy and maternity leave and its continuity and, where appropriate, the corresponding licensing officials. These reports diagnosis must be encoded, following the international disease ICD-9-cm classification, unless the ISFAS expressly determine another coding system.

(b) assist in the procedures aimed at checking the pathology that originated a disability or sick leave and their extensions.

(c) provide the background and medical records provided for in the fifth paragraph of the resolution of the Secretary of State for public administration from December 29, 1995, and other concordant regulations, the handling of procedures for the retirement of regular civil servants permanent disability for the service.

(d) Edit and issue orders of hospital dispensation, in accordance with the specifications and criteria established by legislation ensuring that the professional prescribing such orders and prescriptions have identifying stamps that allow its readability.

(e) to issue medical reports required by the ISFAS beneficiaries for certain medical, social or complementary benefits of these.

(f) to issue enforceable by law or regulatory documentation or medical certification of birth, death and other extreme for Civil registration, and other reports or certificates on the State of health.

(g) make the requirements of material CPO in standard document established, stating the product code CPO which are prescribed, being reproduced in the catalogue of the ISFAS on Material CPO.

5.2 digital medical records and electronic prescriptions.

5.2.1 data on health assistance to holders and beneficiaries will be adapted to the provisions of the Royal Decree 1093 / 2010 of 3 September, which approves the minimum data set of clinical reports in the national health system. In addition, prescription and dispensing through electronic prescription pursuant to the Royal Decree 1718 will be implemented / December 17, 2010.

5.2.2. the entity will promote the implementation of the system of history clinic Digital and electronic prescriptions of interoperable Mutualism with the rest of the national system of health and its use by all professionals and centres included in the media of the entity, so that relevant information is accessible from any point of health care, whether public or private, with the appropriate measures for security and protection of personal data.

5.2.3. Additionally, information of the pharmacotherapy record which can have access patient will be available via the Internet through the technological platform of electronic Headquartes of the ISFAS.

5.2.4. by resolution of the General Secretariat the ISFAS Manager shall be determined objectives on the stages to be covered in this project, as well as the necessary requirements for its development and implementation.

5.3. quality of health care.

5.3.1 General considerations. The ISFAS, as an integral part of the national health system in its condition of entity manager from the regime special of the Security Social of the armed forces, promoting a global quality policy for the improvement of health care to their collective protected, within the General guidelines established by law 16/2003, 28 May. To guarantee the implementation of the policies of the national health system quality, during the term of the concert are established the lines of action that are designated in the following clauses.

These lines of action set out specific objectives of quality that are linked some economic incentives in accordance with the provisions of clause 7.4. The entity will promote the involvement of its professionals, to take measures it considers most effective to stimulate and ensure the achievement of these objectives.
5.3.2 adaptation of the national health system strategies. The Ministry of health, social services and equality has promoted, in collaboration with the autonomous communities, scientific societies and experts, plans and strategies in relation to different diseases or health problems, and must promote the incorporation of the principles underlying these strategies in the field of the concerted assistance, so that should guide the activity that is the subject of the concert.

Assistance of the ISFAS will adapt to these strategies, following the same guidelines and goals for the assistance provided to groups of other mutualities of officials to keep healthcare concert.

5.3.3. preparation of protocols. For the development of strategies for improvement of quality, the entity must promote, in collaboration with its professionals, the development and implementation of clinical guidelines, protocols and guidelines, of accredited and proven effectiveness, related pathologies more prevalent in the population, with the purpose that they serve as an instrument of aid in clinical decision-making with the aim of contributing to the improvement of the quality of care and efficiency in the use of resources promoting its effective implementation in the health care practice of policyholders of the ISFAS.

5.3.4 quality pharmaceutical delivery.

A) in compliance with the provisions of the health law, the entity will promote the rational use of the medicinal product, developing precise actions professionals indicated or prescribed active principles and health products adapted to the clinical situation of the patient, doses and dosage forms in accordance with their individual requirements, for the period of time and at the lowest possible cost for the patients and for the ISFAS.

To such effect, and with the aim of improving the quality and efficiency of the pharmaceutical benefit which is paid to the beneficiaries, the entity will promote selection by professionals of active principles considered within its therapeutic subgroup in protocols and guides the NHS pharmaceutical, collaborating in the process of revision and control of the requirements in certain situations. In particular, the entity will promote between concerted physicians prescription drugs of first choice in certain pathologies considered more prevalent.

Therefore we have selected four indicators focusing on therapeutic subgroup of special relevance: Antiulcerosos, antihypertensive and lipid-lowering and nonsteroidal anti-inflammatory drugs. For the construction of the indicators have been taken into account, mainly three criteria: safety, efficiency and experience in its use.

(B) the clause 7.4.5 establishes targets and indicators that are set for the monitoring of the quality of the pharmaceutical provision during the term of this concert.

(C) in the hospital environment, the entity will ensure that hospitals themselves and concerted have tools and standard operating procedures (commissions, pharmaceutical guides and protocols) with comparable methodology than the rest of the national system of health, effects such as the evaluation and selection of drugs, the reconciliation of medication between levels of care or the use of drugs in different conditions than those authorized in your datasheet.

In the case of patients not admitted, the entity will ensure that hospital dispensing is performed in the same hospital where treatment orders may be laid down, except when medication must be dispensed in hospitals in the locality or province of residence of the patient to enable compliance or those other exceptional circumstances that may be authorized by the ISFAS Depending on the nature of the drug and in view of the circumstances and procedures before has been made that reference.

(D) in relation to the prescription pharmaceutical, the entity will promote the participation of its optional in all measures and activities established by the ISFAS for improving the use of medicines and sanitary products and collaborate in procedures which are initiated to verify the adequacy of individualized requirements and the corresponding measures of control.

5.3.5. quality of information. The entity shall ensure that the optional properly inform patients of everything related to your illness and care process, ensuring compliance with all the principles set out in law 41/2002, of 14 November, regulating the autonomy of the patient and of rights and obligations in terms of information and documentation clinic. In particular it shall ensure that informed consent in many procedures require it is carry out as well as compliance with the advance directive when the patient has concluded his living will.

5.3.6. evaluation of the quality of care processes and health centres. Within the framework of a process of continuous improvement of the quality of care is drive evaluation systems, by introducing in the centres own or concerted by the entity of accreditation and/or certification systems established in the autonomous communities or through ISO certification, hospital of the Joint Commission accreditation criteria or the evaluation of the EFQM model (European Foundation for quality management).

Chapter 6 status of the concert 6.1 nature and status of the concert.

6.1.1. the present agreement has administrative nature of public services management contract, in accordance with the available additional twenty of the revised text of the Public Sector Contracts Act, approved by Royal Legislative Decree 3/2011, of 14 November, and their legal status is laid down in the revised text of the law on Social security of the armed forces and the General Regulation of the Social security of the forces Armed, being its procurement regime provided for in article 119 of that regulation.

Por_lo_tanto, the present agreement is governed by: a) the revised text of the law on Social security of the armed forces, approved by Royal Legislative Decree 1/2000, of June 9, especially the forecasts contained in its article 5.2 which States that the regime of the concerts for the provision of health care and pharmaceutical services shall be established by this law and its implementing rules , by budgetary General Law in matters that may apply and, Additionally, by the law on organization and functioning of the General Administration of the State.

b) the regulation of the Security Social of the armed forces, approved by Royal Decree 1726 / 2006, of 21 December, with special reference to the provision contained in its article 119, on the status of the recruitment of the Social Institute of the armed forces.

(c) the resolution that meets the submission of applications for the formalization of the concert of the ISFAS for healthcare in national territory, holders and other beneficiaries who do not opt to receive it through the public health system.

(d) the own concert.

For matters not provided for in the aforementioned provisions, the concert will be governed by the Basic Law of the State in the field of public contracts, i.e., by the consolidated text of the law of contracts in the Public Sector, approved by Royal Legislative Decree 3/2011, 14 November and by the General Regulation of the law of contracts of the administrations public approved by Royal Decree 1098 / 2001 of 12 October, (RGLCAP). Addition, the remaining rules of administrative law and, failing that, shall apply the rules of private law.

(6.1.2 are relations based on the concert: to) relations between the ISFAS and the entity, on the occasion of the fulfilment of the rights and obligations established in the present agreement.

(B) relations between the beneficiaries and the entity, at the time of fulfilment of the obligations set out in the present agreement.

6.1.3. the issues that arise in the field of relationships listed in paragraph B) of the previous clause shall have administrative nature and they will be resolved by the organ of the ISFAS having attributed the competition, in accordance with the procedure which is determined in this chapter. Appeal before the holder person of the Minister of defence may be against any agreements that are handed down. The competent jurisdictional order, if necessary, will always be the contentious.

6.1.4 refers to the management of the ISFAS faculty interpret concert, resolve the doubts to offer compliance, modify it for reasons of public interest, remember its resolution for breach of the entity and determine the effects of this.

Also corresponds to the ISFAS management set the financial compensation provided for in clause 6.7 of the present agreement by partial breaches of obligations of the entity and rating quality incentives set out in clause 7.4.

6.2 nature and system of health care relationships.

6.2.1. the present agreement does not imply nor raises no relationship between the ISFAS physicians and centers of the entity providing the assistance. Relations between the entity and the optional or centres are in any case unrelated to the concert.
(6.2.2 as a result, are also unrelated to the set of rights and obligations that determine the end of the concert and are configured as autonomous relations between the parties: to) relations with physicians of the entity because that affects or relates to the scope of the professional exercise of such optional beneficiaries.

(B) the relationship of beneficiaries with the centers of the entity, because of the care activity of media or the operation of its facilities or why that affects or relates to the scope of professional practice of physicians which, under any title, develop activities in these centres.

The relationships referred to in paragraphs A) and B) record will remain beyond the end of the concert even though, under the existing links between physicians and centers and the entity, they can generate direct or subsidiary effects on these.

6.2.3. the relationships mentioned in the preceding clause nature which, pursuant to law, corresponds to its content, and knowledge and decision of questions that may arise in the same be competence of the ordinary civil courts or, where appropriate, the criminal.

6.3. joint committees.

6.3.1 types and operating regime. There will be mixed provincial commissions and a National Joint Commission.

Its operating regime shall be regulated in the following clauses, and in matters not provided for therein, shall apply the provisions contained in the law of legal regime of public administrations and common administrative procedure on the functioning of colleges.

6.3.2 composition.

To) the provincial mixed commissions will be composed, by the ISFAS, by the corresponding territorial delegate, who will preside over them, and by an official of the delegation which will act as Secretary; and, by the entity, by one or two representatives with sufficient decision-making powers. You can attend the medical adviser of the delegation of the ISFAS meetings.

(B) they will integrate the National Joint Committee of one to three representatives of the ISFAS and one to three representatives of the entity. The President will be the Deputy Director of benefits or the official delegated and as Secretary will act an official of ISFAS, with voice but without vote.

6.3.3 functions.

A) provincial joint committees and the National Joint Committee, with parity composition, in its respective territory are committed: the monitoring, analysis and evaluation of the implementation of the present agreement.

Knowledge of claims that could be made by the beneficiaries or, where appropriate, ex officio by the ISFAS, pursuant to the provisions of the present agreement.

The knowledge and evaluation of the initiatives of the ISFAS on the economic compensation for partial breaches of the concert.

(B) in addition, corresponds to the National Joint Commission: analysis of the initiatives on the economic compensation for partial breaches of the concert, in the terms set out in clause 6.7.

Knowledge of incidents or complaints about cross-border health care deductions.

For the purposes of the tasks set out in paragraphs A.2, B.1 and B.2 above, means that with the intervention of the entity takes place for the compliance with the procedure laid down in article 84 of the law 30/1992, of 26 November, legal regime of public administrations and common administrative procedure.

The indicated functions play by the provincial mixed commissions when they relate to the provincial level and the National Joint Committee when they affect the whole country.

Knowledge of complaints about health care cross-border that could be made by holders or, where appropriate, ex officio by the ISFAS is reserved to the National Joint Committee.

If it claims the distribution of functions be accommodated as provided in clause 6.4.

6.3.4 operation. The operation of the provincial mixed commissions shall conform to the following standards: to) whenever there were issues to be treated, the Committee will be meeting on a regular basis within the first ten days of each month. With extraordinary character, will gather at the request of one of the component parts.

B) if representatives of the entity do not attend the meeting on the date designated in the call, while mediate cause duly substantiated, means that default judgment of its representatives, that accepts the agreements adopted the ISFAS in relation to the matters included in the agenda of the meeting.

In the case that the lack of assistance of the representatives of the entity is due to properly justified, the meeting will be held within the period of two working days of the date referred.

(C) of each session shall be record by the Secretary, whose project, with its signature, shall immediately be sent to the entity for its understanding, compliance and return. Such return, signed by the representative of the entity must be made within a maximum period of ten calendar days. Once signed by a representative of the same, it means approved. Any disagreements on the content of the Act, they etiquette through appropriate negotiations between the parties and, in any case, at the next meeting.

The operation of the National Joint Committee shall be subject to the same norms indicated in for the provincial commissions, even though regular meetings may be convened throughout the entire month.

In matters not provided for, shall apply the rules of law 30/1992, of 26 November, legal regime of public administrations and common administrative procedure on the functioning of the colleges 6.4 procedure for claims.

(6.4.1 holders and beneficiaries may claim the ISFAS that, pursuant to the provisions in clause 6.1.3, you remember the origin of any action by the authority, in the following cases: to) when the entity denied any of the authorizations specifically referred to in the concert or when no answer to the request of the same and, in addition, it is not intended a positive effect for the absence of reply.

(B) when the entity is obliged to assume any expenditure directly or reimburse their amount and, upon request of the beneficiary, do it as well.

(C) if the entity fails to comply with any of the obligations that are incumbent on it under the terms of the agreement.

This administrative complaints on issues relating to the relationship referred to in clause 6.2 shall not be usable. In case of arise, will be answered to the interested party that, by reason of incompetence of the ISFAS, is not possible to resolve on the merits of the claim, indicating that may be formulated, if it considers appropriate, against physicians, centers or, if applicable, to the entity in the ordinary courts that corresponds according to the nature of the facts.

In those exceptional cases in which the beneficiary can not claim and occurred a billing on your behalf for assistance that the entity could be forced to assume, the ISFAS may initiate ex officio the claim before the Mixed Commission deems appropriate.

6.4.2. complaints will be formulated in writing before the corresponding provincial delegation of the ISFAS, accompanying documents to substantiate it.

6.4.3 received any claim, the ISFAS delegation, if you believe initially that there are reasons for their estimation, will immediately the necessary steps before the entity to get satisfaction to it, in which case will be filed without further formalities with annotation of the solution adopted.

6.4.4 where these efforts do not thrive, the ISFAS delegation will formalize the right record, will include it in the agenda of the immediate meeting of the Mixed Commission and studied it, will rise the corresponding act which shall necessarily include the ISFAS and positions of the entity on the complaint raised.

6.4.5 in all cases that the positions of the parties that make up the Provincial Joint Commission were consistent, the claim shall be resolved by the delegate from the corresponding ISFAS.

6.4.6. in the event that there are discrepancies in the bosom of the Provincial Joint Commission, record raise for consideration by the National Joint Committee and will be included in the agenda of the first meeting to be held. Studied by it, it will solve the ISFAS management, and must apply the resulting criterion by the entity in the management of performance requiring the beneficiaries.

6.4.7 when claims are subject to the National Joint Committee for similar issues that have already been previously resolved favourably, with the agreement of the entity, will be followed the same criterion agreed previously, by stating this circumstance on the Act, for the purposes specified in clause 6.7 of the concert.

6.4.8. the resolutions of the claims referred to in the above clauses must be handed down within a maximum period of six months, as envisaged in article 3.2. the Royal Decree 1728 / 1994, of 29 June, in relation to the provisions of the first transitional provision, 2, of law 4/1999 of 13 January.
6.4.9. decisions rendered by the delegates and by the management of the ISFAS shall be notified to the entity and to interested parties. Against them may bring appeal, to the Minister of defence, in accordance with the provisions of articles 107 to 115 of the law legal regime of public administrations and common administrative procedure and 31.1 of the revised text of the law on Social security of the armed forces, approved by Royal Legislative Decree 1/2000 of 9 June.

6.4.10 when concert change occur centers or hospital services low and for that reason there is a plurality of claims, in the application of the clause 3.6.5, the Secretary General Manager, prior resolution effect, may agree to the accumulation of all of them so they are substantiated through a special procedure whose resolution will correspond to the delegate of the ISFAS when parts of the corresponding Provincial Mixed Commission position is consistent and , if not to the Deputy Director of benefits.

For the execution of the estimatorias resolutions adopted through this special procedure, applies the provisions in section 6.5.4.

6.4.11. the provisions in the previous clause may be equally applied in claims whose object is the application of clause 7.1.2.

6.5. execution of estimated claims procedure.

(6.5.1 claims resolved positively by the delegates of the ISFAS, the enforcement procedure shall be as follows: to) when the claim is intended authorizing a particular healthcare, the entity shall issue the authorization within the period of five days from the notification of the decision.

(B) when the claim is intended the entity to assume any expenditure directly, the entity will proceed to do the corresponding health service subscription, being carried out in all case the entity's possible charges or interest on arrears that had been generated.

(C) when the claim is intended the reimbursement of the expenses claimed, the entity shall proceed to reimbursement, within the period of one month from notification of the decision, upon presentation, where appropriate, timely proof of expenditure, which will be returned to the claimant if you requested them.

(6.5.2 inside mentioned deadlines, the entity shall communicate to the delegation of the ISFAS, depending on the case: to) that has proceeded to issue the authorization, to make direct payment to the corresponding health service or to reimburse the expenses.

(b) that it has not proceeded to perform some actions earlier because beyond his control, especially because the person concerned has not filed, not to have been provided by the appropriate supporting documents or for not being accepted payment for this.

6.5.3 If the ISFAS had not received this communication within the deadline or if passed this time, had knowledge that had refused the payment to the person concerned, for any reason, the delegate of the ISFAS issued certification of the agreement or resolution adopted and the subsequent events and shall forward it to the Subdirectorate of benefits of the ISFAS which, without further requirements It will dictate the appropriate agreement and shall be deducted from the immediate monthly payment that you must subscribe to the entity and will be paid directly to the healthcare provider or the person concerned, on behalf of the same, the amount included in the certification.

6.5.4. in the case of refund claims resolved positively by the ISFAS management, payment of the amount which corresponds in each case will be made directly by the ISFAS to the person concerned on behalf of the entity, by deducting the amount of the monthly installments to pay to it and providing the document attesting to this having made payment on your own.

If claimed attendance had been invoiced to the applicant and this still hadn't made cash payment, the ISFAS can make direct payment to the creditor, the date of the estimate resolution, provided the applicant authorizes expressly direct payment on your behalf.

6.5.5 will be in charge of the entity, as well as billed by assistance charges, costs of possible enforcement charges or interest on arrears, when the delay was attributable to it. In the case of breach of terms of resolution indicated in clause 6.4.8 these surcharges would be borne by the ISFAS.

6.5.6. the administrative resolutions or decisions that resolve appeals against acts of the ISFAS regarding reimbursement of expenses subject to the present agreement, shall be implemented, where appropriate, in accordance with the procedure laid down in the preceding clause 6.5.4.

6.6 discounts pharmacy costs.

6.6.1 when in the process of revision of the turnover of recipes that made the ISFAS detected prescriptions of medicines and sanitary products made in their official recipes, that should have been in charge of the institution, as set out in this concert, the ISFAS will proceed to do the corresponding discount in the monthly payment of quotas that has paid to it , in accordance with the provisions of Chapter 7.

The entity undertakes to reimburse to the holders, in a period not exceeding fifteen days starting from the request for reimbursement, the amount that they would have paid at the office of pharmacy, with the only requirement of the presentation of proof of this circumstance and the corresponding invoice or proof of payment of the pharmacy.

(In those cases of dispensations of drugs and pharmaceutical products which, being financed by the national health system, are not equipped with coupon seal and are subject to unique reserves consist of limiting its dispensation to hospitals pharmacy services, is billed to the ISFAS at a higher price or conditions other than those indicated in clause 6.6.2 2.8.4. to) the ISFAS will proceed to the payment of invoices and, subsequently, will affect the differences about the limits to the entity, in the monthly payment of fees, in accordance with the provisions of Chapter 7.

6.7. financial compensation for breach of obligations. procedure for its imposition.

6.7.1. compensation for breach of obligations. Failure to comply with certain obligations contained in the concert, without prejudice to other intended effects in it, may give rise to the imposition of economic compensacionas.

As a general rule, for the qualification of the breach and the determination of the amount of the financial compensation will be considered, among others, the following factors: to) damage caused.

(b) the number of owners and beneficiaries affected.

(c) repetition of non-compliance.

Attention to these and other factors, sets the classification and rating of susceptible of being punished breaches and the amount of the compensation for each one of them according to their graduation.

A) compensation for minor breaches: 1,000 to 5,000 euros.

Delay in delivery of a temporary card or replacement document for the beneficiary access to services from the time of discharge.

Cards not adjusted to specifications: detection of issued cards that do not conform to the format that had been established by resolution of the management of the ISFAS, according to provisions of clause 1.7.2 of the concert, once completed the period designated for that purpose.

Delivery and availability of catalogs of services a province, once the time limit set for this purpose, less than 20 days late.

Defects in the content and format in the catalogue of services in a province that has not had rectified after the timely communication of the ISFAS, once the period referred to in clause 3.6.4.

Improper advertising: services of an entity performed, without authorization, within the precincts of any public body that negatively affects the operation of the.

Low in the catalogs of services: unsubscribe from dialysis or psychiatry services in the catalogue of services a province, in the period established for the ordinary entity change or in the month before or after that period and low in those media that do not obey to the exceptional circumstances provided for in clause 3.6.4 or when it has not guaranteed the principle of continuity of care for patients in the terms set out in clause 3.6.5. breach of obligations provided for in clause 4.3.5 in cases of vital emergency.

Denial of a benefit which, appearing in the portfolio of services established in the concert, has been indicated by a physician of the catalogue of services, when it corresponds to a matter which had already been addressed in national Joint Committee repeatedly (on more than two occasions), giving rise to a positive decision by the management of the ISFAS.

Delays in the delivery of information on activity, referred to in clause 5.1.2.

(B) compensation for serious breaches: 5,001 to 25,000 euros.

Deficiencies in the cards: persistence of deficiencies that had resulted in the imposition of remedies for mild breach, three months after it had notified the resolution by which the abovementioned compensation had imposed.

Delivery and availability of catalogs of services a province, once the time limit set for this purpose, with a delay of more than 20 days.
Defects in the content and format in the catalogue of services a province, which had resulted in the imposition of compensation for minor non-compliance, and had not corrected three months after it had notified the resolution by which the abovementioned compensation had imposed.

Improper advertising: services of an entity aimed at specific professional groups and for advertising gifts offer holders, held directly or indirectly through third parties.

Low in the catalogs of services: unsubscribe from hematology services (related to oncological processes) or of medical oncology in the catalogue of services a province, or level IV, in the period established for the ordinary entity change or services in the month before or after that period.

Failure in the delivery of health care information, three months since have had reported the resolution by which financial compensation for delay had imposed in the delivery.

(C) compensation for very serious breaches: 25.001 to 50,000 euros.

Undue publicity: offer for advertising of gifts to the holders, held directly or indirectly through third parties when this is done during the regular shift or in processes of high-specific professional groups.

Low in the catalogs of services: unsubscribe from hospitals in the catalogue of services in the period established for the ordinary entity change or the month after that period.

Breach of the agreements of the National Joint Commission.

6.7.2. the procedure for the imposition of economic compensation.

(A) in cases in which a breach of the obligations set out in clause 1.8 is detected. concert (improper advertising), the delegation of the corresponding ISFAS shall report in writing to the representation of the entity on the same and will include the issue in the agenda of the immediate meeting of the Joint Commission so that the entity can present the corresponding allegations. Studied the topic, are included in the corresponding act of the Committee positions held by the ISFAS and entity. When the positions were consistent and the result was that such breach is considered as failed, just that this end is collected in the agreed minute to end the matter.

Should remain the disagreements on the issue or there is no agreement on the existence of a breach, the record will rise for consideration by the National Joint Committee and will be included in the agenda of the first meeting to be held. Thereafter, follow the procedure in the following section.

(B) in cases in which any breach is detected, the Subdirectorate of benefits of the ISFAS shall report in writing to the representation of the entity on the same and include the matter on the agenda of the immediate meeting of the National Joint Committee so that the entity can present the corresponding allegations. Studied the topic, are included in the corresponding act of the Committee positions held by the ISFAS and entity. If positions were consistent, and the result was that such breach is considered as failed, this end will be reflected in the minutes and will proceed to the file of the file without any further formality.

In case of agreement with the existence of a violation or disagreement of the parties to the National Joint Committee, will meet the Secretary General Manager and, in accordance with the terms set out in the corresponding resolution, will proceed to deduct the cost of compensation in the next monthly payment to the entity. The resolution shall be notified to the entity that appeal may be brought before the head person of the Ministry of defence, in accordance with the provisions of articles 107 to 115 of the law legal regime of public administrations and common administrative procedure and 31.1 of the revised text of the law on Social security of the armed forces approved by Royal Legislative Decree 1/2000.

Chapter 7 duration, economic regime and the concert 7.1 price duration of the concert.

7.1.1. the purposes of the present agreement will start at zero hours on one of January of the year 2016 and will extend up to twenty-four hours of the thirty and one of December of the year 2017.

7.1.2. If the entity does not sign a new concert by 2018, it will continue to bound by the content of the present agreement, up to the thirty and first of January of the year 2018, for the collective that had attached to 31 December 2017. In addition, if to 31 January 2018 regime of hospitalization assistance or assistance was paying for maternity leave, with date for delivery in the following the month of February, the entity will be obliged to continue to provide the assistance until the day in which occurs the high or completion assistance for maternity, respectively. In the case that the need for hospitalization is prolonged, the entity will assume their coverage until the end of the month of March of 2018, date from which the new entity of assignment will assume the coverage.

The entity is entitled to receive, for the month of January of the year 2018 and by the collective assigned to thirty-one from December of the previous year, the price per person per month established for entities that are concerted with the ISFAS. However, the amount payable for that month, the ISFAS will retain ten percent up to thirty and one January 2019, with the sole purpose to deal, on behalf of the entity, to reimbursement of expenses that are agreed this year under cover of the present agreement. If the estimated amount is depleted or rebates agreed subsequently to the thirty and one January 2019, the entity is obliged to meet them directly and immediately.

7.1.3. the group affected by the non-subscription by the entity of the concert for 2018, should choose new entity for the period that set the ISFAS and election will have effects at the zero hour of the day, one February 2018, without prejudice, for hospitalizations and maternity in the previous clause.

7.2 economic regime of concert 7.2.1 the economic effects of the highs and lows of beneficiaries. Without prejudice to birth and extinction for the beneficiaries of rights arising from the concert in the terms provided in the corresponding clauses, the high will cause economic effects at zero hours of each day of the month following that which occur and casualties at twenty-four hours of the last day of the month that had taken place.

Consequently, each monthly payment shall take into account the existing holders and beneficiaries number zero o'clock on day one of the month the ISFAS concerned, whose purpose, will issue timely certification, communicating the number of owners and beneficiaries attached to the entity, differentiated by age, according to the parameters set out in clause 7.3.1, the number of owners and beneficiaries with special care needs in accordance with the provisions of clause 7.4.2 and the number of owners and beneficiaries who do not reside in municipalities of level III, pursuant to clause 7.4.3.

7.2.2. periodicity of payments. The fertilizer by the ISFAS to the entity of the amounts resulting from the application of clauses 7.3 and 7.4. ((will be included in the following way and with the following frequency: A) monthly the quantities provided for in clauses 7.3, 7.4.2 and 7.4.3 7.4.5, minoradas in the amount resulting from the reimbursement of expenses, discounts and financial compensation for breach of obligations that are agreed on the basis of the present agreement: B) every year the amount of the incentives associated with achieving objectives provided for in clauses 7.4.4. and 7.4.6.

7.2.3 payments scheme. Payment, except for eventualities of exceptional character, shall be made by ISFAS, by bank transfer, within fifteen days natural of the month following, previous retentions or discounts that apply in accordance with resolution of call and the concert with its annexes. The monthly payment corresponding to December you can anticipate, totally or partially, the last ten days of this month.

Quantities will be fulfilled with charge to the concept 14.113. 312E. 251, within the budgetary availabilities of the organism.

7.2.4 discounts and deductions. Provided that there is judicial judgment in the ISFAS which order the payment of compensation for direct or subsidiary responsibility for care proceedings included in the object of the concert, ISFAS, without prejudice to execute the sentence, it will affect the amount paid to the respondent agreed, in accordance with the procedure laid down in clause 6.5 of the present agreement.

In addition, the amount that each month, is payable to the entity, in concept of quotas and other concepts, be deducted: the economic compensation to be applied, as provided for in section 6.7.2.

The amount of the payments that are due be on behalf of the entity, according to established forecasts 1.7.1, 3.6.4, 4.5, 6.5.3, 6.5.4, 6.5.6 clauses. and in annex I.

Expenses assumed by the ISFAS, but that they should have been attended by the entity, according to the forecasts contained in the concert, especially in its clause 6.6.
7.2.5. claims for difference. THE ISFAS shall make available to the entity, in the first ten days of each month, a file with the complete relationship with all the data of the collective, including high, low, and variations produced during the previous month, relating to the twenty-four hours of the last day of that month.

The relationship of the group included in the file can be verified by the entity, so that, if it considers that there are differences, you can formulate the following claims: to) those relating to the holders, including which affect your beneficiaries, if they exist.

(b) those relating to beneficiaries only.

The entity shall submit claims separately, in accordance with the previous classification, and accompany them from file with the same technical characteristics as the one supplied by the ISFAS, containing the information in which the claim is founded. Claims must be submitted within a maximum period of three months from the monthly communication of the State of the collective and relation of incidents, after which while it had made representation means that there is compliance by the entity, acquiring firmness the payment made on the basis of collective said. Submitted claims will be resolved by the ISFAS, within the three months following the date of submission thereof.

Consolidation of the firmness of the payment referred to in the preceding paragraph, he is understood notwithstanding that under no circumstances can arise equity attribution without cause for the ISFAS or the entity.

7.2.6 taxes. All taxes, taxes, taxes and levies that imposed this concert or acts arising from it will be the entity account.

7.2.7. subrogation in collection rights and actions. In the case of health care caused injury or disease derived or aggravated by accidents covered by any form of insurance or when the cost of the health assistance should be fulfilled legal or regulations other than the ISFAS agencies or by private entities, the entity, subject to cover in any case assistance, may subrogate the rights and actions of the owners and beneficiaries relative to the amount of the costs of such health care, performing the necessary steps to return the cost of the same charge. Holders and beneficiaries, meanwhile, will be required to facilitate the necessary data for this entity.

7.3 price concert. quotas. The composition of the population protected by this concert has undergone important changes, by which, in order to balance inequalities produced, mainly derived from the evolution of the ISFAS collective age pyramid, during the term of the present agreement, the payment is made according to the following parameters: to) in 2016 and 2017 the ISFAS shall be paid to the entity the amount of 90,55 EUR per month , for each protected beneficiary who had 70 or more years of age to the twenty-four hours of the last day of the month preceding the applicable payment, according to the criteria of highs and lows that for economic purposes set out in clause 7.2.1.

((b) in 2016 and 2017 the ISFAS shall be paid to the entity the amount of 72,68 euros per month, for each protected beneficiary who was under 70 years of age and older than 60 years of age to the twenty-four hours of the last day of the month preceding the applicable payment, according to the criteria of highs and lows that for economic purposes set out in clause 7.2.1 c) also in 2016 and 2017 the ISFAS be paid to the entity the amount of 61,52 euros per month, for each protected beneficiary who was under 60 years of age twenty-four hours of the last day of the month preceding the applicable payment, according to the criteria of highs and lows that for economic purposes set out in clause 7.2.1.

7.4 incentives associated with objectives.

7.4.1 limits and objectives.

A) maximum amount. The continuous improvement of the health care services that holders and beneficiaries of the ISFAS receive through concerted entities is a central axis of the concert, which establishes economic incentives associated with the attainment of certain objectives (IAO).

The limit or maximum amount of economic incentives that can achieve the concerted entities will be determined by the following formula: LAIO (i) = Pm × C (t) × Q × 12 where: LAIO = annual limit of incentives associated with objectives.

PM = monthly average fee paid by the assistance of the ISFAS, affiliated entities of insurance with complete assistance mode, by 31 December of the previous year.

C (t) = group assigned to insurance entities in the form of complete assistance, to February 1, the corresponding year.

Q = modulator coefficient which is 0.035.

(B) objectives associated with incentives. The objectives which are linked to the payment of incentives are: objective 1: assistance from people with special care needs. Weighting ρ1 = 0.25.

Objective 2: Guarantee on the supply of emergency services. Weighting ρ2 = 0.15.

Objective 3: Improve the quality in palliative care. Weighting ρ3 = 0.15.

Goal 4: Improve the quality of pharmaceutical prescription. Weights ρ4 = 0.30.

Goal 5: Extent of hospital services. Weights ρ5 = 0.15.

The payment of the incentive associated with achieving the goals 3 and 5 shall be annual and will be included along with the quotas corresponding to the month of December of each year of the concert.

The payment of the incentive associated with the fulfillment of objectives 1, 2 and 4 will be made monthly.

The payment of the incentive associated to the goal in providing pharmaceutical (objective 4) will be included each month, the second month after that apply the indicators established for their evaluation. I.e., incentives from the indicators of the month n credited the quotas of the month n + 2.

If the entity had signed the existing concert in 2015, the months of January and February 2016 will receive incentives provided at that concert, corresponidentes November and December 2015, respectively.

7.4.2. assistance to persons with special care needs. The intensity of the attention and care that require persons in situations of absolute invalidity and severe disability and, therefore, the use of health services is greater than in the general population.

To modulate the tensions arising from this increased need for services, the ISFAS will pay a monthly incentive by each holder or beneficiary attached to the entity, with a disability that has resulted in the recognition of AIDS for child with severe disabilities or disability in need of third party (DS), and an incentive for each holder with absolute invalidity (IA).

A) incentive for persons with severe disabilities (IPDS). The monthly amount that will perceive the entity for each person with disabilities that has resulted in the recognition of AIDS for child with severe disability or major disability in need of third party (DS) is obtained by applying the following formula, expressing the result to two decimal places: IPDS (i) = Pm × C (t) × Q × CDS (i) x 0.20 CDS (t) where : IPDS (i) = incentive per person with disabilities severe, corresponding to the entity (i).

PM = monthly average fee paid by the assistance of the ISFAS, affiliated entities of insurance with complete assistance mode, by 31 December of the previous year.

C (t) = total collective attached to insurance entities arranged in the form of complete assistance, to February 1, the corresponding year.

CDS (i) = number of holders and beneficiaries with disabilities that has given rise to recognition supports by son in charge with severe disability or severe disability in need of third-party, affiliated to the entity (i) assistance mode complete, referred to the one day of the month that corresponds.

CDS (t) = number of holders and beneficiaries with disabilities who has given rise to recognition of aid by son in charge with severe disability or severe disability in need of third-party, ascribed to entities of insurance in the form of complete assistance, referred to the one day of the month that corresponds.

Q = modulator coefficient which is 0.035.

(B) incentive per person with absolute invalidity (IPIA).

The monthly amount that will perceive the entity by each holder with disabilities that has given rise to the recognition of absolute invalidity (IA) is obtained by applying the following formula: IPIA (i) = Pm × C (t) × Q × CIA (i) x 0.05 CIA (t) where: IPIA (i) = incentive per person with corresponding to the entity absolute invalidity (i).

CIA (i) = number of holders with disabilities that has resulted in the recognition of absolute and permanent disability, ascribed to the entity (i) assistance mode complete, referred to the one day of the month that corresponds.

CIA (t) = number of holders with disabilities that has resulted in the recognition of absolute and permanent disability, affiliated entities of insurance in the form of complete assistance, referred to the one day of the month that corresponds.

7.4.3 guarantee coverage of emergency services. The location of the centers in which develops the professional activity of the group protected by the ISFAS conditions its peculiar geographical distribution and the need for resources for emergency assistance in small municipalities, in which only can be facilitated through non-agreed services.
To compensate for the higher costs associated with the coverage of emergency assistance in certain areas, with low population concentration, the ISFAS will pay an incentive or monthly compensation (IMPSU) by each holder or beneficiary attached to the entity, which has fixed his residence in municipalities that are not included in level III of specialized care, the amount of which shall be obtained by applying the following formula : IMPSU (i) = Pm × C (t) × Q × Cd (i) x 0.15 Cd (t) where: IMPSU (i) = monthly incentive per person attached to the entity (i) for guarantee coverage of emergency services.

PM = monthly average fee paid by the assistance of the ISFAS, affiliated entities of insurance with complete assistance mode, by 31 December of the previous year.

C (t) = total collective attached to insurance entities arranged in the form of complete assistance, to February 1, the corresponding year.

Q = modulator coefficient which is 0.035.

CD (i) = number of holders and beneficiaries attached to the entity (i) in the form of complete assistance, who have their habitual residence in areas with lower population density, consideration which will have all the municipalities that are not included in the III level of specialized care, referred to the one day of the month that corresponds.

CD (t) = number of holders and beneficiaries attached to insurance entities arranged in the form of complete assistance who have their habitual residence in areas with lower population density, consideration which will have all the municipalities that are not included in the III level of specialized care, referred to the one day of the month that corresponds.

7.4.4. improvement of quality in the provision of palliative care.

A) documentation for the evaluation. The guidelines that inspire the strategy on palliative care in the national health system should guide the provision of palliative care in the field of the concerted assistance of the ISFAS.

To apply for the corresponding incentive before 31 October of the year concerned, the entity must present the Subdirectorate of benefits of the ISFAS following information in computer support: palliative care Plan developed by the entity for the corresponding year, whereby its objectives, procedures for case management (identification of patients, referral, information and coordination services will be detailed (, etc.) and protocols of care that include periodic evaluation with monitoring of pain and other symptoms and functional assessment.

Information system in excel format, with the ratio of beneficiaries who have received care parliativos for the previous 12 months.

In the case of entities agreed with the ISFAS in 2015, the table corresponding to 2016 will include a record (row) for each beneficiary assisted by specific palliative care services in the 12 months prior to September 30, including its identification number (num of beneficiary) and the code that corresponds to the type of services that have attended it.

The codes to be used are as follows: support or home-based support team: 11.

Unit or hospital services: 12.

Others: 19.

For institutions not subscribing to the concert by 2015. as an exception, the file corresponding to the 2016 will only include the information of the beneficiaries attended between January and September 2016. In this case, the data relating to the number of beneficiaries served in the last 12 months is estimated from the resulting monthly average.

The table will have the following structure and format: ID_BENEF COD_SERV 11 287099999999 in the time allocated services for palliative care, inform patients that their data can be treated by the ISFAS for purposes of management, always with the guarantees and precautions established by the organic law 15/1999, of 13 December, of protection of data of a Personal nature and its implementing regulations.

(B) indicators for the evaluation and allocation of the incentive. The indicators that will be obtained and used for evaluation are: 1. map of specific resources for palliative care, provinces and device type, in excel format.

Only devices support home and hospital, own or concerted, units for the media support of primary care in complex situations will be included.

2. the presentation of the map of resources in the format established, updated to October 1, the corresponding year will result in a score (P1) of 0.10 points.

The percentage of municipalities of level III in which the entity has concerted support home (ESD) equipment.

Formula: a/b x 100, where a = number of municipalities offering ESD.

b = total number of municipalities and groups of municipalities of level III (i.e. 64).

Minimum 40%.

Maximum 0.40 points.

Value for the maximum score: 80%.

The assigned score will be proportional to the level of attainment, obtained from the following formula: P2 (i) = (Vi - Vm) Pmax x /(VM-Vm) where: P2 (i) = the indicator score for the entity (i).

Vi = value of the indicator of the entity i.

Pmax = maximum score allocated to the indicator.

VM = value of the indicator for the highest score.

VM = minimum allowable value for the indicator.

3. percentage of beneficiaries served by equipment support, and home-based support (ESD).

Formula: a/b x 100, where a = number of beneficiaries served by ESD in the period that corresponds (corrected to a year).

b = estimated number of subsidiary beneficiaries of palliative care. The estimate will be made by applying the following formula, which allows to obtain a rate estimated from epidemiological studies, with a correction by infraregistro: b = C (i) × 175 × 0.15 per 100,000 minimum 15%.

Maximum score 0.50 points.

Value for the maximum score of 40%.

The assigned score will be proportional to the level of attainment, obtained from the following formula: P3 (i) = (Vi - Vm) x Pmax /(VM-Vm) C) amount of the incentive. Then the global score (Pcp) shall be obtained from the institution (i) which will be given by the sum of the assigned scores, according to the indicators obtained.

PCP (i) = P1 (i) + P2 (i) + P3 (i) the amount of the annual incentive associated with the objective of palliative care (IACP) is obtained, taking into account the achieved score and the weights given to the objective, applying the following formula: IACP (i) = Pm × C (i) × Q × 12 × Pcp (i) 0.15 × where: IACP (i) = annual incentive associated with the objective of palliative care.

PM = monthly average fee paid by the assistance of the ISFAS, affiliated entities of insurance with complete assistance mode, by 31 December of the previous year.

C (i) = group assigned to the entity (i) in the form of complete assistance, to February 1, the corresponding year.

Q = modulator coefficient which is 0.035.

PCP (i) = overall score (Pcp) of the entity (i) which will be given by the sum of the assigned scores, according to the indicators obtained.

7.4.5. monthly incentive for improvement in the quality of the pharmaceutical prescription.

A) quality in the pharmaceutical prescription. The quality and efficiency of the pharmaceutical benefit is a central aim of the concert, so it is established a monthly incentive associated with improvement in the quality of pharmaceutical prescribing (IMPF).

For the evaluation of the quality of pharmaceutical prescription, are established four indicators of selection, focusing on therapeutic groups of special relevance, such as ulcer, hipolipidemiantes, antihypertensive and anti-inflammatory not steroidal, setting for each indicator a value for reference objective, tending to the historical values and the estimated opportunity to advance in the direction of the improvement of the quality of prescription.

Indicators and the criteria for their evaluation may be amended by resolution of the Secretary General Manager the ISFAS.

(B) indicators for evaluation. The prescription-drug of first choice in certain pathologies prevalent, will be evaluated through indicators of consumption of DDDs (defined daily doses) listed below.

1 use of anti-ulcer drugs: % of DDDs dispensed of omeprazole, on the total number of DDDs of Proton pump inhibitors.

Formula: a/b x 100, where a = number of DDDs dispensed of omeprazole (A02BC01).

b = number of DDDs dispensed from all (A02BC) Proton pump inhibitors.

Minimum value: 50%.

Value for the maximum score: 75%.

Maximum score: 0.25 points.

2 use of lipid-lowering drugs: % of DDDs dispensed from simvastatin on the total DDDs dispensed of inhibitors of HMG CoA reductase and associations.

Formula: a/b x 100, where a = number of DDDs dispensed of simvastatin (C10AA01).

b = number of DDDs dispensed from all inhibitors of HMG CoA reductase (C10AA) and associations (C10BX03, C10AX09 and C10BA02).

Minimum value: 10%.

Value for the maximum score: 25%.

Maximum score: 0.25 points.

3 use of drugs acting on the Renin-angiotensin system: % of DDDs dispensed drugs ACE Inhibitors, on the total number of dispensations of the Renin angiotensin system inhibitors medications.

Formula: a/b x 100, where a = number of DDDs dispensed of Aceis and associations (C09AA, C09BA and C09BB).

b = number of DDDs dispensed from all drugs inhibitors of the Renin-angiotensin system associations (C09AA, C09BA, C09BB, C09CA, C09DA, C09DB and C09XA).

Minimum value: 20%.
Value for the maximum score: 45%.

Maximum score: 0.25 points.

4 use of analgesics nonsteroidal anti-inflammatory drugs (NSAIDs): % of DDDs dispensed from NSAIDs of first choice (diclofenac, ibuprofen, and naproxen) over the total DDDs dispensed of all NSAIDs.

Formula: a/b x 100, where a = number of DDDs dispensed of diclofenac, ibuprofen and naproxen (M01AB05, M01AE01 and M01AE02).

b = number of DDDs dispensed of all NSAIDs (M01AA, M01AB, M01AC, M01AE, M01AG, M01AH, M01AX01, M01AX02 and M01AX17).

Minimum value: 40%.

Value for the maximum score: 70%.

Maximum score: 0.25 points.

The source of information for the calculation of the indicators will be the system of management of pharmaceutical turnover and checkbooks of the ISFAS recipes.

(C) allocation of the incentive. The score assigned to the entity for each of the indicators will be proportional to the level of attainment, obtained from the following formula: Pi = (Vi - Vm) Pmax x /(VM-Vm) where: Pi = the indicator score for the entity (i).

Vi = value of the indicator of the entity (i).

VM = minimum allowable value for the indicator.

Pmax = maximum score allocated to the indicator.

VM = optimal value of the indicator that will result in the maximum score set for the indicator.

Then the global score (Ppf) shall be obtained from the institution (i), which will be given by the sum of the assigned scores, according to the indicators obtained.

PPF (i) = P1 (i) + P2 (i) + P3 (i) + P4 (i) the amount of the monthly incentive associated with the goal of prescription pharmaceutical (IMOPF) will be obtained, taking into account the achieved score and the weights given to the objective, applying the following formula: IMOPF (i) = Pm × C (i) × Q × Ppf (i) × 0.30 7.4.6 incentive yearly by the breadth of the range of hospital services. Concerted services offer looks conditioned by the volume of existing hospital infrastructure, so that the objective of improving the extent of the supply of hospital services has focused on provincial capitals with more than three hospitals with General or medical internment of privately owned, with more than 30 beds, according to the data collected in the national catalogue of hospitals referring to December 2014, situation in which Barcelona, Bilbao, Las Palmas de Gran Canaria, Madrid, Málaga, Palma de Mallorca, Santa Cruz de Tenerife, Seville, Valencia and Zaragoza.

To encourage a wide range of hospital services, the ISFAS will pay an incentive when in the mentioned capitals met the availability criteria laid down in General and, in addition, the entity offering exceeds the established minimum levels.

The amount of the annual incentive for the breadth of the range of hospital services is obtained by applying the following formula: IAOSH (i) = Pm × C (i) × Q × 12 x PT (i) 0.15 × where: IAOSH (i) = annual incentive for breadth of hospital services of the entity.

PM = monthly average fee paid by the assistance of the ISFAS, affiliated entities of insurance with complete assistance mode, by 31 December of the previous year.

C (i) = total collective ascribed to the entity (i) in the form of complete assistance, to February 1, the corresponding year.

Q = modulator coefficient which is 0.035.

PT (i) = final score assigned to each entity by the breadth of the range of hospital services in the capital included in the evaluation.

PT (i) = ∑ pn (i) = p1 (i) + p2 (i) +... + p13 (i), where p score each of the capitals where the offer is evaluated.

A) requirements for the evaluation of the offer. So that it can be subject to assessment, offering services in the corresponding capital shall meet the following requirements: 1. the catalogue of services shall contain, at least 50% of hospitals with internment or packaging of privately owned with more than 30 beds, existing in the corresponding capital, based on data collected in the national catalogue of hospitals , to December 31, 2014.

In Madrid, the offer will include at least 60% of hospitals with General or medical internment of privately owned existing.

2. the hospitals included in the catalogue of services must provide comprehensive care that will reach all the specialities of the corresponding level of care that is available, including the services of clinical analysis, diagnostic imaging and other central services.

(C) score. By offering services of the institution of each of the cities included in the evaluation, where the requirements are met, you will be assigned a score that will be the result of applying a factor of proportionality (F) coefficient of the corresponding capital: pn = µn x F where: pn (i) = score assigned to the entity (i) for the supply of hospital services in the corresponding capital n.

µn = coefficient attributed to the corresponding province, pondering its population, the collective of the ISFAS and breadth of their private hospital infrastructures.

F = B (i) / b (t) is a proportionality factor, being B (i) = collective entity in the corresponding capital province to February 1.

B (t) = collective in the province of the set of entities that meet the requirements, to February 1.

The following table lists the coefficients allocated to each capital included in the evaluation: capitals Coef. (µ)






Barcelona.





0.16 Bilbao.





0.04 las Palmas.





0.06 Madrid.





0.33 malaga.





0.07 palma de Mallorca.





0.05 santa Cruz de Tenerife.





0.05 Seville.





0.09 valencia.





0.09 Zaragoza.





0.06 relationship of annexes: 1. media support in rural areas.

2. services requiring prior authorization from the entity.

3. with life-threatening diseases.

4. health care information system.

5. registration of sanitary means.

6. complementary modality of primary care and emergency room.

7. cross-border health care.

8. relationship of municipalities of level I of specialized care.

9. list of municipalities and groupings of level II of specialized care.

Annex 1 means assistance in rural areas 1. General rules. To enable the delivery of health services in rural areas beneficiaries attached to the entity, the ISFAS may agree with the health services of the autonomous communities the provision of the same, according to the possibility provided for in the legislation in force.

2 habilitation to the ISFAS. Through the signing of this concert the entity grants the ISFAS express and total permission to agree such services, which also covers the authorisation for the extension of the agreements signed for the same purpose prior to January 1, 2015.

The authorization will not prevent that institutions can subscribe Meanwhile agreements with identical purpose and scope with the competent administrations, when its provisions is not contrary to the provisions of this annex.

3. object. Services to be included in these conventions are: health care services in primary care in municipalities of up to 20,000 inhabitants in which the entity does not have their own means or sufficient agreed.

Emergency services in towns of up to 20,000 inhabitants, provided through the primary health care services.

4. content.

4.1. each Convention will be common for all the signing entities of the concert. Healthcare content, the economic compensation and the relationship of municipalities agreed with the respective autonomous communities will be communicated to each of them.

(4.2 economic consideration established in each agreement may stipulate: a) depending on the group affected, through a monthly price by person and type of service.

(b) by a medical Act, through the application of the public prices or fees applied by the corresponding autonomous community for the provision of health services.

(4.3 the final amount of each Convention, as provided for in point 4.2 to), you will be satisfied with charge to the price that once earned and delivered, the ISFAS payable to each entity by the present agreement, understanding made the payment on behalf of the same.

The ISFAS held each monthly payment to the amount of the same month that payable to the authority by the concert, moving him corresponding justification.

(4.4 in those agreements in which the economic consideration, according to provisions of section 4.2 b), are required by medical Act, the entity shall be the direct payment to the respective autonomous community in the terms stipulated in the corresponding agreement.

In the case of existing outstanding economic obligations with any autonomous community as result of direct payment or payment by the entity, the ISFAS commitment to proceed to the payment of these, on the terms of the previous point, understanding made the payment for the account of the same, moving him corresponding justification.
5. media for assistance in municipalities of the autonomous communities with which is has not concluded Convention. In the municipalities of less than 20,000 inhabitants belonging to the autonomous communities that not collaboration agreements have been formalized or these only relate to emergency health care, and that the entity does not have own or concerted media and there are no private means, this will facilitate the access of beneficiaries to primary care services dependent on the corresponding Autonomous Community both for ordinary and emergency assistance, assuming the entity directly costs that can be billed.

Annex 2 services that require prior authorization from the entity 1. Relationship of services requiring authorised prior authorization of the institution. In accordance with provisions in clause 3.5.3 of the concert, the provision of services that precise prior authorization from the entity listed below: 1.1 hospitalizations.

A) hospitalization.

(B) day hospitalization.

(C) domiciliary hospitalization.

D) palliative care at home by support teams.

1.2 diagnostic techniques, treatments and surgical techniques.

(E) outpatient surgery.

((F) Odontostomatology: Tartar - cleaning of mouth-dental prostheses and implants osseointegrated in accident in service or occupational disease Act and in the cases provided for in clause 2.6.1. E).

(G) rehabilitation, physiotherapy and speech therapy.

(H) home respiratory therapies: aerosol therapy, respiration, and oxygen therapy.

I) peritoneal dialysis and hemodialysis treatments.

(J) Oncology: Immunotherapy and chemotherapy, cobalt therapy, Radiumterapia and radioactive isotopes, brachytherapy and linear accelerator.

(K) diagnostic imaging: computed tomography, magnetic resonance, panoramic radiography, mammography, interventional radiology, PET-CT, scan, Doppler and bone densitometry.

(L) neurophysiological studies.

(M) tests and neuropsychological studies.

(N) study and endoscopic treatment.

(O) Cardiology: Studies and hemodynamic treatments.

(P) Obstetrics: Amniocentesis.

(Q) Ophthalmology: Retinography and laser treatment. Optical coherence tomography. Scan optics with Laser Confocal (HTR - Heidelberg Retina Tomograph). Polarimetry. Laser GDX. Treatment of macular age (AMD) by Intravitreal injection of anti-angiogenics or Photodynamic therapy.

(R) treatment in pain unit.

(S) study and treatment on sleep unit.

(T) renal lithotripsy.

1.3 psychotherapy.

1.4. assistance to medical consultants.

1.5 podiatry.

1.6 services corresponding to level IV (except outpatient specialists) and referral services.

1.7. the non-agreed private hospitals for services referred to in clause 3.5.4.

2. procedure for obtaining prior authorization.

2.1. the prior authorization of the services listed in point 1 of this annex is derived from the need for order and channel performance by the entity, to facilitate attendance and avoid delays, but you can never assume a restriction to access to benefits recognized in the portfolio of services.

In no case will be denied a request for a diagnostic or therapeutic means included in the portfolio of services established in this concert, indicated by a physician of the entity.

For the purposes of the preceding paragraph, when not met the requirements of availability of means provided for in the present agreement at the appropriate level, the prescription of not concerted optional, which will be always accompanied by reasoned report's indication of the requested provision will be valid.

2.2. the State, through physicians who prescribe or perform services requiring prior authorization, shall inform duly of this requirement the beneficiary.

In no event may be carried out with charge to the beneficiary unauthorized tests if he has not informed prior to the need of such prior authorization or, in the case of medical or surgical acts performed at the time of the inquiry, due to lack of time to get it.

2.3. the entity shall have the organizational resources to facilitate holders and beneficiaries of the ISFAS requiring it to obtain prior authorization for provision of the services referred to in point 1 of this annex, by any of the following means: a. in person at any of its offices.

B. by telephone.

C. by fax.

D. through the web page of the entity.

E. other telematic procedures.

2.4. the owners or beneficiaries who require it can arrange authorization prior to sending it to the entity by any available means.

2.5 applications for authorisation shall contain the following information, either that is the medium used to be sent to the entity: a. applicant's personal data:-name and surname.

-Health card number.

-Phone contact, email, or fax.

B. data service for which authorization is requested:-province in which the provision will be held.

-Identification of the requested service.

-Date of prescription.

-Identification of the physician making the prescription, with the same signature.

-Date for the realization of the benefit, if any.

-Health Centre which will be prescription, in his case.

(In case of accident of service or occupational disease and in the cases provided for in clause 2.6.1 2.6. E) for dental prostheses, it will be necessary prescription of medical specialist of the entity, along with budget for approval by the entity.

2.7. in the case referred to in paragraph 1.7. of this annex, the entity, once received the request, may confirm the professional or health centre chosen by the applicant either, if so deemed appropriate, assign a different, provided that it constitutes a valid health care alternative for the realisation of the requested provision.

2.8. the authorization issued by the entity will have an identification number, which will be unique and specific to the requested provision and will detail professional or health center where it has carried out. The entity may refer it to the holder or beneficiary for any of the following means: a. in hand, when the request has been submitted in person at any of the delegations of the entity, and it is possible.

(B) by mail, phone or fax, when the application was lodged by fax or when, having been presented in person, is not possible their processing in the Act.

C. email, when the application has been filed through the web page of the entity.

2.9. the shipping of the authorization to the holder or beneficiary by the entity will be held as soon as possible, in order to avoid any delays in access to the requested provision. If not possible the immediate processing, the entity will have a maximum of seven calendar days for shipment, except in the case referred to in point C of clause 4.2.1 of the concert, which will have ten calendar days.

2.10. the entity may only refuse authorization if the request: a. lacks the necessary information, in which case you must immediately contact with the applicant in order to complete the missing.

B. refers to a provision not included in the portfolio of services, in which case shall inform the owner or beneficiary of this circumstance.

C. it isn't supported by the prescription of a physician entered into or not concluded under the terms of section 2.1, in which case also shall inform the owner or beneficiary of this circumstance.

Denial of benefits occur always in writing and reasoned way, through a means that allows record of its receipt.

2.11. with the aim of facilitating access to benefits, the entity will provide advice to beneficiaries who request it.

2.12. the entity included in his catalogue of services, web site and, where appropriate, other means of information holders and beneficiaries, the information of the procedure for obtaining prior authorization necessary to facilitate its processing.

Annex 3 pathologies with A life-threatening title purely indicative and not exhaustive, the following assumptions means that there is a risk of imminent or very close not to obtain a therapeutic action immediately, so that, if the requirements pursuant to clause 4.3.2 concur, will result from the reimbursement of costs in the event of use of means other than the entity : 1. acute haemorrhage intracranial or intracerebral, genital, digestive, respiratory, renal or rupture of blood vessels in general, with considerable loss of blood or internal bleeding.

2. complete or incomplete abortions. The complication of extrauterine pregnancy or uterine rupture. Pregnancy toxicosis.

3 shocks heart, kidney, liver, circulatory, traumatic, toxic, metabolic, or bacterial. Commas. Allergic reactions with impairment of general condition.

4. acute respiratory, kidney, or heart failure.

5. acute abdomen, formulated as a prior diagnosis or presumption.

6 lesions with external tears with involvement of internal organs.

7. the head of the femur or hip fractures.

8. cerebral vascular accident.

9. Acute poisonings. Acute sepsis.

10 anuria. Acute urinary retention.
11. diphtheria. Botulism. Meningitis. Meningoencephalitis. Acute form of ulcerative colitis. Acute gastroenteritis with impairment of general condition.

12. obstruction of the upper respiratory tract. Pulmonary embolism. Pleural effusion. Spontaneous pneumothorax. Acute Lung edema. Bronchial asthma crisis.

13. myocardial infarction. Hypertensive crisis. Peripheral arterial embolism. Asystole. Paroxysmal tachycardia.

14 diabetic coma. Hypoglycemia.

15 seizures. Seizures of childhood. Infant toxicosis.

16. acute adrenal failure. Acute failure of the peripheral circulation. Severe alterations of electrolyte metabolism.

Annex 4 health care information system. Actividad-coste registry includes information on ambulatory activity, hospital activity, activity of emergency, surgical and other procedures diagnostic and therapeutic activity.

1. out-patient activity information.

On a quarterly basis the entity shall notify the ISFAS accumulated data disaggregated by: table 1. Activity of medical consultation specialty number of queries * cost General family medicine.





 





 






Pediatrics.





 





 






Allergology.





 





 






Anesthesiology and resuscitation.





 





 






Angiology and Vascular surgery.





 





 






Digestive.





 





 






Cardiology.





 





 






Cardiovascular Surgery.





 





 






General Surgery and digestive.





 





 






Oral and maxillofacial surgery.





 





 






Orthopaedic surgery and traumatology.





 





 






Pediatric Surgery.





 





 






Plastic, aesthetic and reconstructive surgery.





 





 






Thoracic surgery.





 





 






Medical and surgical Dermatology and Venereology.





 





 






Endocrinology and nutrition.





 





 






Stomatology/Odontology.





 





 






Geriatrics.





 





 






Haematology and haemotherapy.





 





 






Immunology.





 





 






Intensive medicine.





 





 






Internal medicine.





 





 






Nuclear Medicine.





 





 






Nephrology.





 





 






Pulmonology.





 





 






Neurosurgery.





 





 






Neurology.





 





 






Obstetrics and Gynecology.





 





 






Ophthalmology.





 





 






Medical Oncology.





 





 






Radiation Oncology.





 





 






Otolaryngology.





 





 






Psychiatry.





 





 






Rehabilitation.





 





 






Rheumatology.





 





 






Treatment of pain.





 





 






Urology.





 





 






Entered into a fixed price service / pay capitation.





 





 






Other *.





 





 





* Includes all queries (first, revisions and home).

* This section will be used when there is some concept that has no place in the preceding paragraphs; in that case, you must specify each concept included.

Table 2. Other ambulatory activity activity no. consultations/meetings/services cost contribution user D.U.E. patients no.





 





 





 





 






Matron.





 





 





 





 






Physiotherapy.





 





 





 





 






Speech therapy/speech therapy.





 





 





 





 






Psychotherapy.





 





 





 





 






Oxygen therapy/respiratory therapies.





 





 





 





 






Medical transports.





 





 





 





 






Non-urgent health transport.





 





 





 





 






Urgent.





 





 





 





 






Other benefits: test strips for glucose, insulin syringes, pharmacy (V04, hospital use...).





 





 





 





 






Compensation: Direct payments to insured persons by use of non-agreed media, CMP, CMN, conventions of rural area,...





 





 





 





 






Dialysis.





 





 





 





 






Hemodialysis.





 





 





 





 






Home dialysis.





 





 





 





 






Still ambulatory peritoneal dialysis (CAPD).





 





 





 





 





Table 3. Diagnostic tests diagnostic imaging studies cost Simple Radiology (head, trunk, Member, dental radiology) No..





 





 






Special Radiology (Radiology contrast, mammography...).





 





 






Interventional Radiology.





 





 






Ultrasound/Doppler (does not include Gynecologic ultrasonography or echocardiography).





 





 






Tomography (CT).





 





 






Nuclear magnetic resonance.





 





 






Bone densitometry.





 





 






Other techniques.





 





 






Clinical analysis no. cost biochemistry determinations.





 





 






Endocrinology (hormonal determinations).





 





 






Genetics.





 





 






Hematology.





 





 






Immunology.





 





 






Microbiology.





 





 






Parasitology.





 





 






Other determinations.





 





 






No. pathology of studies cost biopsies.





 





 






Pap smears.





 





 






FNAB.





 





 






Others.





 





 






No. studies cost scans nuclear medicine.





 





 






PET.





 





 






Others.





 





 






Other diagnostic studies cost allergy tests no..





 





 






Allergic test.





 





 






Cardiology.





 





 






ECG.





 





 
Echocardiography/doppler echo.





 





 






Ergometry.





 





 






Holter.





 





 






Other (excludes hemodynamic and Electrophysiology).





 





 






Digestive.





 





 






Gastroscopias.





 





 






Colonoscopies.





 





 






Others.





 





 






Gynecology.





 





 






Ultrasound.





 





 






Colposcopies.





 





 






Others.





 





 






Pulmonology.





 





 






Bronchoscopies.





 





 






Spirometry.





 





 






Others.





 





 






Neurology/Neurophysiology.





 





 






Electroencephalography.





 





 






Electromyography.





 





 






Polygraphy dream.





 





 






Others.





 





 






O.R.L.





 





 






Otoacoustic emissions.





 





 






Brain stem auditory evoked potentials.





 





 






Hearing tests.





 





 






Others.





 





 






Urology.





 





 






Endoscopy.





 





 






Urodynamic studies.





 





 






Others.





 





 





2. information on hospital activity.

Table 4. Conventional hospitalization hospitalization conventional income stays No. * cost center concluded public Center Center concluded public Centre Centre concerted public medical center.





 





 





 





 





 





 






Surgical.





 





 





 





 





 





 






Obstetric.





 





 





 





 





 





 






Births.





 





 





 





 





 





 






C-sections.





 





 





 





 





 





 






Pediatric.





 





 





 





 





 





 






Mental health.





 





 





 





 





 





 






Intensive care.





 





 





 





 





 





 






Neonatology.





 





 





 





 





 





 






Palliative care unit.





 





 





 





 





 





 





* Number of rooms accumulated on a quarterly basis by line of business.

Table 5. Home Day Hospital and day hospitalization * number of patients number of sessions / days * cost Oncohematologico.





 





 





 






Psychiatry.





 





 





 






Others.





 





 





 






Hospitalización a domicilio.





 





 





 






Home support in palliative care teams.





 





 





 





* Excludes surgical day hospital * number of sessions accumulated on a quarterly basis by line of business.

3. activity of emergency information.

With quarterly the entity shall notify the ISFAS accumulated activity of emergency data disaggregated by: table 6. Information about activity of emergency emergency hospital cost type number *.





 





 






Outpatient *.





 





 






Home emergency *.





 





 






Center/emergency fixed price service.





 





 






Others.





 





 





* Emergency admissions: are all those that have been treated in emergency departments of a hospital, including those emergencies that have ended up in hospital.

* Emergency outpatient: are all those that have been attended by emergency services of non-hospital health centers (polyclinics, external emergency services, etc.)

Home emergency: are all those urgent assistance served in the patient's home by emergency services.

4. surgical activity information.

On a quarterly basis the entity shall notify the ISFAS surgical activity accumulated data disaggregated by: table 7. Group description No. cost major surgery surgical activity.





Planned inpatient surgeries.





 





 






Urgent surgery with hospitalization.





 





 






Outpatient surgical procedures in the operating room (CMA).





 





 






Urgent surgical interventions outpatient (CMA).





 





 






Minor surgery.





Minor surgical interventions.





 





 





5. other diagnostic and therapeutic procedures.

On a quarterly basis the entity shall notify the ISFAS accumulated other therapeutic procedures-disaggregated activity data: table 8. Other diagnostic and therapeutic procedures procedures cost implant intracranial neurostimulators description #.





 





 






Simple radiosurgery.





 





 






Fractional radiosurgery.





 





 






Litotricias.





 





 






Cochlear implants.





 





 






Radiation therapy.





 





 






Diagnostic cardiac hemodynamics.





 





 






Therapeutic cardiac hemodynamics.





 





 






Total number of stents.





 





 






Electrophysiological diagnostic studies.





 





 






Therapeutic electrophysiological studies.





 





 






Ablation.





 





 






Implant / defibrillator replacement.





 





 






Others.





 





 






Cycles of assisted human reproduction.





 





 





Annex 5 1 health media registration. The media information themselves and agreed that the entity's bid to provide healthcare services to their beneficiaries in the national territory will be sent to the ISFAS in electronic format. In addition to the data entity's generals, issue the data contained in the following tables with the specified format.
The data sent must match all contained in the catalogues of published services. The ISFAS will establish the periodicity of updating data and provide a simple mechanism of load telematics thereof. Professional identification data must adapt to those established by the various colleges and professional associations.

The structure of all tables location data corresponds to the official structure of the INE for possible exploitation by means of a geographical information system.

2. table of health professionals: contains the information of all the professional sanitary agreements of the entity. One row for each professional shall be completed.




Name type length description of the alphanumeric CIF_NIF, 9 CIF or NIF of the professional fields.






50 alphanumeric Apellido1_profesional surname of the professional.






50 alphanumeric Apellido2_profesional maiden name of the professional.






Name alphanumeric professional 50 name of the professional.






IDcolegiado numeric 9 number of Chartered required only if occupational activity is 1 (medical).






2 numeric IDProv code province INE.






IDMun numeric 5 code municipality INE where the professional activity.






3 numerical IDEspec (1) code according to CMDB/SIFCO specialties. Mandatory if professional activity is 1 (medical).






Specialist text 75 specialty designation. Required only when the specialty code is equal to ZZZ.






Alphanumeric Actividad_profesional 1 1. Doctor.

2 professional nursing.

3. dentist.

4. physical therapist.

5. psychologist.

6 speech therapist.

7 Podiatrist.

8 others.






Alphanumeric CIF_Centro, 9 CIF of the health centre where exercises the activity.






Clinica_centro text, 150 clinic or Center where the professional performs its activity (where identical description than in the national catalogue of hospitals).






Alphanumeric Direccion_tipovia, 5 type of path of the domicile (INE codes).






150 alphanumeric Direccion_Nombrevia name of the track.






20 alphanumeric Direccion_Numero address of the route number.






IDMun numeric 5 code municipality INE where the centroional is located.






5 alphanumeric Postal Code Postal code.






60 alphanumeric Correo_electronico professional email address.






Alphanumeric phone 15 professional contact telephone.






Boolean Equipo_informatico: s/n 1 availability of computer equipment.






Boolean Firma_electronica: s/n 1 availability of electronic signature.

S = Yes; N = NOT.






Boolean Lector_dni: s/n 1 indicates availability of ID reader.

S = Yes; N = NOT.






Boolean prescripcion_receta: s/n 1 indicates if you can prescribe prescription or not.

S = Yes; N = NOT.






(1) code of MBDS/SIFCO ALG allergy specialty care services.

ACL clinical analysis.

APA pathology.

ANR anesthesia and resuscitation.

ACV Angiology and vascular surgery.

DIG digestive system.

CAR cardiology.

CCA cardiac surgery.

ICC child cardiac surgery.

CGD general surgery and digestive tract.

CMF maxillofacial surgery.

CPE Pediatric Surgery.

CPL plastic and reconstructive surgery.

CTO thoracic surgery.

DER medical and surgical Dermatology and Venereology.

RAD Radiology.

END Endocrinology and nutrition.

EST Stomatology.

FAR pharmacy.

Gene genetics.

GRT geriatrics.

GIN Gynecology.

HEM haematology and haemotherapy.

HAD Hospitalización a domicilio.

INM Immunology.

MFC Medicina Familiar y Comunitaria MIV intensive medicine.

MIN internal medicine.

MNU nuclear medicine.

MPR preventive medicine.

NEF Nephrology.

NML pneumology.

NRC neurosurgery.

NFC clinical neurophysiology.

NRL Neurology.

OBG OB / GYN.

OFT ophthalmology.

ONC medical oncology.

ONR radiation oncology.

Otolaryngology Ent.

PED Pediatrics.

PSC psychology.

PSQ psychiatry.

REH rehabilitation.

REU Rheumatology.

TRA Traumatology and orthopedic surgery.

URO urology.

UDO pain unit.

URG urgent.

OTR others.

ZZZ unknown 3. Table of clinics and hospitals.

It contains information of all the hospitals and clinics (with internment) own or concerted by the entity. A row shall be completed by each hospital or clinic.




Format/type length description of the 6 alphanumeric IDHosp fields names code of the Hospital, collected in the national catalogue of hospitals.






Clinica_hospital text, 150 name of clinic or hospital.






2 numeric IDProv code province INE.






3 numerical IDMun code municipality INE where the professional activity.






Alphanumeric Lista_atencionEsp - ready portfolio services of specialized care at the clinic.






5 alphanumeric Postal Code Postal code.






60 alphanumeric Correo_electronico Center e-mail address.





4. table of health centres without internment.

It contains information of all the centers of assistance without internment, own or concerted by the entity. A row shall be completed by each centre.




Names format/type length description of the CIF_NIF clinica_centro text, 150 name fields.






2 numeric IDProv code province INE.






3 numerical IDMun code municipality INE where the professional activity.






5 alphanumeric Tipo_Centro code laid down in the annex 1 of the Royal Decree 1277 / 2003 of 10 October. (1). Direccion_TipoVia alphanumeric, 5 type of path of the domicile (INE codes).






150 alphanumeric Direccion_Nombrevia name of the track.






20 alphanumeric Direccion_Numero address of the route number.






40 alphanumeric OTRDIR further details of the address.






5 alphanumeric Postal Code Postal code.






60 alphanumeric Correo_electronico Center e-mail address.






Alphanumeric phone 15 phone center.






Alphanumeric fax Fax from the Center.






5 alphanumeric Tipo_Centro code laid down in the annex 1 of the Royal Decree 1277 / 2003 of 10 October. (1). Ofserv_medicos alphanumeric 5 offer of medical services.

Code specialties WTO.
Alphanumeric OFTECDCO will include codes of the techniques that are carried out in the Centre between separators. (2). (1) type of facility: C.2.1 medical consultations.

C.2.2 consultations of other health professionals.

C.2.4 multi-purpose centres.

C.2.5 specialized centres.

C.2.5.1 dental clinics.

C.2.5.2 assisted human reproduction centers.

C.2.5.3 voluntary interruption of pregnancy centers.

C.2.5.4 major outpatient surgery centers.

C.2.5.5 dialysis centers.

C.2.5.6 diagnostic centers.

C.2.5.7 mobile health care centers.

C.2.5.8 establishments.

C.2.5.9 tissue banks.

C.2.5.11 mental health centres.

C.2.5.90 other specialized centers.

C.2.90 other providers of health care without internment.

(2) supply of techniques: laboratory: 100 sample extraction/collection point.

101. hematology.

102. biochemistry.

103 microbiology and parasitology.

104. Immunology.

105 genetics.

106. hormone levels.

107. levels of drugs.

Radiology: 121 X-rays (simple and contrast).

122. mammography.

123. CT.

124. ultrasound.

125 Densitrometria.

126. digital angiography.

127. Interventional Radiology.

Other diagnostic techniques.

141 endoscopy.

151. scan.

161. EEG.

162. EMG.

163. evoked potentials.

170 PET-CT.

Services medical specialties.

The MBDS/SIFCO code EST inscrit.

5. table of provincial offices of the entity.

It contains general information of each provincial delegation of the insurance entity data. A row shall be completed by each of the provincial delegations of the entity.




Field data length 2 numeric IDProv fields Description type code province INE.






3 numerical IDMun municipality code INE.






Own Boolean 1 indicate if it is own.: S = Yes; N = NOT.






50 alphanumeric Nombre_responsable name contact person in the delegation.






50 alphanumeric Apellido1_responsable first name person of contact in the delegation.






50 alphanumeric Apellido2_responsable maiden name contact person.






Alphanumeric Direccion_TipoVia, 5 type of path of the domicile (INE codes).






150 alphanumeric Direccion_Nombrevia name of the track.






20 alphanumeric Direccion_Numero address of the route number.






5 alphanumeric Postal Code Postal code.






60 alphanumeric Correo_electronico Center e-mail address.






Alphanumeric phone 15 phone of the Provincial delegation.






Alphanumeric fax Fax of the Provincial delegation.






Telephone emergency alphanumeric, 9 toll free emergency and coordination.






9 alphanumeric Telefono_ambulancias phone of the ambulance service.





Annex 6 complementary modality of primary care and emergency room in accordance with the provisions of article 61 of the rules of procedure General of the Security Social of the armed forces, the ISFAS maintains a regime of collaboration with the military health, which provides coverage of specialized assistance and hospitalization through the military hospitals of Zaragoza and Madrid as indicated in the order Ministerial 52/2004, of March 18, leaving aside from that scheme corresponding to the primary tier assistance and of emergency assistance that can therefore be provided by entities that enter into concert with this Institute, provided that so choose what headlines.

With this object, a complementary health care modality is defined: the form of primary care and emergency (mode C), which may be ascribed determined members and beneficiaries according to the conditions that then are designated.

The first.

They may be ascribed to the entity, for exclusive coverage of primary care and emergency (mode C), holders and beneficiaries of the regime special of the Security Social of the armed forces who, having set their residence in any of the municipalities mentioned in the fifth paragraph, receive the specialized care and hospitalization through the defense of hospitals , according to the regime of collaboration between the ISFAS and the existing military health at all times.

The aforementioned relationship of municipalities may be amended by resolution of the management ISFAS.

Second.

(A) health services that will provide the entity to the affiliated group for primary care and emergency room will include the following:-General Medicine or family, Pediatrics and nursing, outpatient, home regime or emergency.

-Health services emergency (without hospitalization), 24 hours a day, under the same conditions as the beneficiaries with complete assistance carried out by the entity.

(B) in General, be taken into account that a beneficiary receive emergency assistance in any of the municipalities of the autonomous community of Madrid and the province of Zaragoza, if your initial valuation is infers the necessity of internment, emergency service shall refer the patient to the corresponding military Hospital, managing if necessary ambulance transportation. In the rest of the national territory the beneficiary must enter in hospitals of the services of health of the autonomous communities.

(C) only the income of the beneficiary in the Center with the entity that would have provided emergency assistance, when their clinical status does not permit the transfer to hospital centres designated, not running costs arising from this detention carried out by the entity can be managed.

(D) in addition, all optional of the entity, because of urgent and immediate assistance that shall be paid by him, may prescribe the income of the beneficiary in a military Hospital.

(E) the corresponding optional of the entity shall make the prescription of medicines and other pharmaceutical products in the ISFAS official recipes, formalize the reports for the proposal of low or temporary disability (I.T.) in the official models and the prescription of tests or Diagnostics in the corresponding flyers. The books of recipes and I.T. Informes-Propuestas will be presented to physicians of the entity by the beneficiaries of the ISFAS when necessary.

(F) in no event shall coverage the pharmaceutical provision or transfers in medical transport that, aside from the emergency assistance, could be clarified.

Third party.

Health services referred to in the preceding paragraph shall be provided throughout the country with the same extent and under the same conditions established in the present agreement to the members and beneficiaries with full support by the entity, whereas application clauses to such services.

As exception, will take into account the basic diagnostic techniques in the field of primary health care are considered as part of General Medicine, family services and Pediatrics that alluded to in the subheading to) previous second paragraph, so the entity will take care of your coverage, provided that the prescription had formulated by the corresponding optional of the catalogue of services. For these purposes, diagnostic studies shall be regarded as basic techniques of diagnosis by image via simple x-rays, without contrasts, as well as the analytical determinations included in the basic catalogue of evidence collected in the sixth paragraph.

Room.

The price payable by the welfare services corresponding to the mode of primary care and emergency (mode C) in 2016 and 2017 shall be as follows: to) El ISFAS be paid to the entity the amount of 16,23 EUR per month, for each beneficiary attached to C mode that had 70 or more years old to twenty-four hours of the last day of the preceding month to the appropriate payment According to the criteria of highs and lows that for economic purposes set out in clause 7.2.1.

(b) the ISFAS be paid to the entity the amount of 13,21 Euro per month, for each beneficiary attached to mode C under 70 years of age and older from 60 years old to twenty-four hours of the last day of the month preceding the applicable payment, according to the criteria of highs and lows that for economic purposes set out in clause 7.2.1.
(c) also the ISFAS paid entity the amount of 11,33 euros per month, per beneficiary attached to C mode that was less than 60 years of age to the twenty-four hours of the last day of the month preceding the applicable payment, according to the criteria of highs and lows that for economic purposes set out in clause 7.2.1.

Fifth.

Be entitled to primary care and emergency mode policyholders and beneficiaries who have set their habitual residence in some of the following municipalities: Madrid.

Alcalá de Henares.

Alcobendas.

Alcorcón.

Aranjuez.

Arganda.

Boadilla del Monte.

Colmenar Viejo.

Collado Villalba.

Coslada.

Fuenlabrada.

Galapagar.

Getafe.

Leganés.

Madrid (including Aravaca and El Pardo).

Majadahonda.

Móstoles.

Pozuelo de Alarcón.

Rivas Vaciamadrid Rozas (Las).

San Fernando de Henares.

San Sebastián de los Reyes.

Torrejón de Ardoz.

Tres Cantos.

Valdemoro.

Villanueva de la Cañada.

Villaviciosa de Odón.

Zaragoza.

Calatayud.

Egea de los Caballeros.

Zaragoza.

Sixth.

The analytical determinations referred to in the third paragraph are those included in the following basic catalogue of analytical tests: 00 hematology.

Blood count/Coulter.

V. sedimentation.

00 Hematology Bank.

Blood group.

Direct Coombs.

Indirect Coombs.

Reticulocytes.

00 clotting I.

Prothrombin time.

APTT.

Fibrinogen.

00-biochemistry blood I.

Glucose.

Adult glucose curve.

Pregnant glucose curve.

Test of O sullivans.

Urea.

Creatinine.

Uric acid.

Total cholesterol.

Triglycerides.

HDL-cholesterol.

LDL-cholesterol.

Total Bllirrubina.

Direct Bllirrubina.

Indirect Bllirrubina.

GOT/AST.

GPT/ALT.

GGT.

Amllasa.

Alkaline phosphatase.

CPK.

LDH.

Calcium.

Phosphorus.

Iron.

Ferritin.

Transferrin.

I S. transferrin.

Sodium.

Potassium.

Total protein.

Cholinesterase.

Rheumatoid factor.

C-reactive protein.

ASLO.

Albumin.

Proteinogram.

01 Special biochemistry.

Hemoglobin glicosllada.

01-serology.

Hepatitis A, IgM.

Hepatitis B (markers).

Hepat. B, anti-HBs (post-vacunacion).

Hepatitis C, anti-HCV.

Rubella Ig G.

Rubella Ig M.

Sifllis, RPR.

Sifllis, Phat.

Toxoplasmosis, AC Ig G.

Toxoplasmosis, AC Ig M.

HIV, antibodies.

01 microbiology.

Urine culture.

Stool culture.

02. urine.

Systematic urine.

Pregnancy test.

Microalbuminuria.

02. biochemistry. 24-hour urine.

Glucose (urine).

Creatinine (urine).

Urea (urine).

Uric acid (urine).

Calcium (urine).

Alpha amllasa (urine).

Inorganic phosphate.

Sodium (urine).

Potassium (urine).

Protein (urine).

Number 03.

Fecal occult blood.

Annex 7 cross-border health care in accordance with the provisions of clause 4.5, the entity is obligated to coverage of cross-border healthcare of their collective protected, as provided for in Royal Decree 81/2014, on 7 February, which lays down rules to ensure cross-border healthcare, and amending the Royal Decree of 1718 / 2010 of 17 December, on prescription and dispensing orders, with regard to the benefits included in the portfolio of services which is the subject of the concert. The exercise of the right by the beneficiaries, their scope, conditions, requirements and procedure for the reimbursement of costs for such assistance are established in this annex.

Cross-border healthcare is that which is received when the beneficiary decides to go to health services located in another Member State of the European Union. Therefore, excluding the cases of temporary stay that, for medical reasons, which have arisen, the beneficiary has received health care coverage, General, corresponds to the ISFAS directly or through mechanisms of coordination with the institutions of other Member States.

Cross-border healthcare does not include related costs or ancillary or supplementary benefits.

1. General rules.

1.1 content.

Cross-border healthcare in charge of the institution includes the health benefits that make up the common portfolio of services of the national health system, whose coverage corresponds to the entity in accordance with the provisions of Chapter 2 of the concert.

When in cross-border healthcare process expenses generated by the outpatient dispensing of drugs, diet products, and other health products subject to the pharmaceutical service of the national system of health, as well as material CPO, in his case, the reimbursement of the same will be paid by the ISFAS in the terms provided in the specific legislation governing these benefits.

Excluded benefits which expressly mentions the aforementioned Royal Decree 1718 / 2010 of 17 December, such as:.

-Services in the field of the long-term care, whose purpose is to help those who require assistance when performing daily and routine tasks.

-The allocation of organs and the access to them for the purpose of transplantation.

-Programs of public vaccination against infectious diseases, which have as their sole purpose the protection of the health of the population and that are subject to specific measures for planning and implementation, without prejudice to those relating to the cooperation between Spain and the other States members in the field of the European Union.

In no event shall refund the costs of health care provided in national territory by means other than those allocated by the ISFAS recipient through this concert.

In the case of the treatments included in section 2.1 of this annex, it will be necessary to have obtained prior authorization, in accordance with the procedure laid down in paragraph 2.2.

1.2 mode.

The coverage will be through reimbursement of costs through the application of the rates approved by the ISFAS, without exceeding the actual cost of the assistance actually received, and with the limits, terms, conditions and requirements.

1.3. other obligations of the entity.

The media entity will facilitate access by beneficiaries seeking cross-border health care your medical history or, at least, a copy of the same.

Regardless of the right to reimbursement of cross-border healthcare expenses, whenever necessary, the entity will facilitate monitoring of the beneficiary, through corresponding concerted services, under the same conditions as if the assistance had been conducted by means of the entity.

2. health benefits subject to prior authorization and procedure to obtain.

2.1. the prior authorization of the ISFAS is essential so get the refund of costs in the case of allowances for which is established the requirement of prior authorization in the Real Decree 81/2014, on 7 February, which lays down rules to ensure cross-border healthcare, and amending the Royal Decree of 1718 / 2010 on medical prescription and orders of dispensation, in line with the provisions in the directive 2011-EU/24, the European Parliament and of the Council of 9 March, 17 December.

(2.2 authorization will be presented to the ISFAS which, where appropriate, will place the entity so that, within a maximum period of ten calendar days, issued a report that gets revealed: to) if the required assistance for the beneficiary can carry out in national territory, on the terms stipulated in the concert, in this case specifying the means or services assigned to the effect.

(b) the period in which assistance could start.

2.3. in view of the report issued by the entity, or passed within ten days unless it received, the ISFAS shall dictate reasoned ruling on the request of the beneficiary, authorizing or denying care, within a maximum period of one month from the date of receipt of the request, which shall be notified to the person concerned and appeal may be brought against that , before the head person of the Ministry of defence, as laid down in article 107 of the law 30/1992, of 26 November.

The authorization may be refused in cases and by the causes set forth in Royal Decree 81/2014, February 7, including when the health care be provided in national territory, on the terms stipulated in the concert, in a time limit which is medically justifiable, in which resolution should contain the resources allocated for the provision of the assistance sought.

3. procedure for the reimbursement of costs for cross-border healthcare.

3.1. the procedure will begin at the request of the person concerned. However, you can start ex officio by the ISFAS, when the interested party has submitted a request for reimbursement of expenses abroad and in the examination of the case, deemed that it is subject to cross-border health care.

3.2 the refund request will be presented by the person concerned to the ISFAS, within a maximum period of three months from the date of payment of the assistance received, accompanied by the required documentation, in accordance with the procedure laid down in the specific regulation.

In the case of the treatments included in section 2.1 of this annex, it will be necessary to make reference to the existence of prior authorization.
3.3 received the application and other required documentation, after having made the necessary checks, including if necessary, remedying default application or lack of documentation, the ISFAS issue resolution, which shall be notified to the person concerned and the institution, and against which appeal of appeal, may be brought before the titular person of the Ministry of defence , in accordance with article 107 of the law 30/1992, of 26 November.

3.4 provided that it recognizes the right to reimbursement, the ISFAS will proceed to the payment to the person concerned and will affect your amount to the authority, in accordance with the procedure laid down in section 6.5.4.

Annex 8 list of municipalities of level I to level I A Coruña province municipalities specialized care.





Arteixo.






A Coruña.





Cambre.






A Coruña.





Carballo.






A Coruña.





Culleredo.






A Coruña.





Ribeira.






Albacete.





Almansa.






Albacete.





Villarrobledo.






Alicante.





Campello/Muxamel.






Alicante.





Sant Joan d' Alacant/Sant Vicente de Raspeig.






Alicante.





Pilar de la Horadada.






Almeria.





ADRA.






Almeria.





Níjar.






Asturias.





Castrillon.






Barcelona.





Asparagus/Martorell/Olessa Monserrat.






Barcelona.





Igualada.






Barcelona.





Molins de the Rei/Sant Andreu of the Barca/Sant Vicenç dels Horts.






Barcelona.





Premià de Mar.






Barcelona.





Villafranca del Penedés.






Barcelona.





Sitges.






Barcelona.





VIC/Manlleu.






Bizkaia.





Baracaldo.






Bizkaia.





Basauri/Sestao.






Bizkaia.





Portugalete/Santurzi.






Burgos.





Miranda de Ebro.






Cadiz.





Arcos de la Frontera.






Cadiz.





Barbate.






Cadiz.





Conil de la Frontera.






Cadiz.





Broken.






Cadiz.





San Roque.






Cantabria.





Camargo.






Cantabria.





Castro Urdiales.






Cantabria.





Pielagos.






Castellón.





Benicarló/Vinarós.






Castellón.





Burriana.






Castellón.





Wave.






Castellón.





Vall d' Uxó (La).






Castellón.





Villa Real.






Cordoba.





Baena.






Cordoba.





Goat.






Cordoba.





Montilla.






Cordoba.





Palma del Río.






Cordoba.





PRIEGO de Córdoba.






Girona.





Blanes/Lloret de Mar.






Girona.





Olot.






Granada.





Almuñecar.






Granada.





Armilla.






Granada.





Baza.






Granada.





Loja.






Granada.





Maracena.






Guadalajara.





Azuqueca de Henares.






Huelva.





Almonte.






Huelva.





Ayamonte.






Huelva.





Lepe.






Illes Balears.





(Mallorca Island) - Marratxí.






Illes Balears.





(Minorca) - Ciutadella de Menorca.






IllesBalears.





(Minorca) - Mahon.






Jaén.





Alcalá la Real.






Jaén.





Martos.






Las Palmas.





(Gran Canaria Island) - Agüimes.






Las Palmas.





(Gran Canaria Island) - Arucas.






Las Palmas.





(Gran Canaria Island) - Gáldar.






Las Palmas.





(Island of Lanzarote) - Teguise.






Madrid.





Arroyomolinos.






Madrid.





Ciempozuelos.






Madrid.





Navalcarnero.






Madrid.





Paracuellos de Jarama.






Madrid.





Villaviciosa de Odón.






Malaga.





Coin.






Malaga.





Nerja.






Murcia.





Sewer.






Murcia.





Alhama de Murcia.






Murcia.





Caravaca de la Cruz.






Murcia.





Jumilla.






Murcia.





Mazarron.






Murcia.





Yecla.






Navarre.





Barañáin.






Pontevedra.





Estrada.






Pontevedra.





Cangas.






Pontevedra.





Lalín.






Pontevedra.





Marin.






Pontevedra.





Ponteareas.






Pontevedra.





Redondela.






Rioja, the.





Calahorra.






Sevilla.





Bormujos.






Sevilla.





Beds.






Sevilla.





Carmona.






Sevilla.





Coria's River.






Sevilla.





Lebrija.






Sevilla.





Mairena de Alcor.






Sevilla.





Mairena de Aljarafe.






Sevilla.





Morón de la Frontera.






Sevilla.





La Rinconada.






Sevilla.





San Juan de Aznalfarache.






Sevilla.





Tomares.






Tarragona.





Tortosa/Amposta.






Tarragona.





Salou Vila Seca.






Tarragona.





Vendrell (El).






Tenerife.





(Tenerife Island) - Candelaria.






Tenerife.





(Tenerife Island) - Icod de los Vinos.






Tenerife.





(Tenerife Island) - Tacoronte.






Tenerife.





(Palm Island) - Llanos de Aridane.






Toledo.





Illescas.






Valencia.





Aldaia-Valencia/Xirivella.






Valencia.





Alboraya.






Valencia.





Alfafar.






Valencia.





Algemesí.






Valencia.





Betera.






Valencia.





Burjassot/Mislata/Paterna.






Valencia.





Catarroja.






Valencia.





Cullera.






Valencia.





Moncada.






Valencia.





St Albans.






Valencia.





Lliria/Pobla de Valbona.






Valencia.





Manises/Quart de Poblet.






Valencia.





Ontinyent.






Valencia.





Requena.






Valencia.





RIBA-Roja de Turia.






Valencia.





Swedish.






Valencia.





Torrent.






Valencia.





Xàtiva.






Valladolid.





Laguna de Duero.






Valladolid.





Medina del Campo.






Zaragoza.





Calatayud.





Annex 9-list of municipalities of II level of specialized care province municipalities and groups level II A Coruña.





Oleiros.






A Coruña.





Santiago de Compostela / Ames.






Albacete.





Hellín.






Alicante.





Alcoy/Ibi.






Alicante.





Alfas of the Pi/Altea/Benidorm/Calp/Villajoyosa.






Alicante.





Denia/Javea.






Alicante.





Elche/Aspe/Crevillent/Novelda/Santa Pola.






Alicante.





Petrer/Elda/Villena.






Alicante.





Orihuela.






Alicante.





Torrevieja.






Almeria.





The Ejido.






Almeria.





Roquetas de Mar/Vicar.






Asturias.





Avilés.






Asturias.





Langreo/Mieres.






Asturias.





SIERO.






Badajoz.





Almendralejo/Mérida.






Badajoz.





Don Benito/Villanueva de la Serena.






Barcelona.





Badalona and Santa Coloma de Gramanet/Sant Adrià de Besòs.






Barcelona.





Barberà del Vallès/Ripollet/Cerdenyola of the Vallès.
Barcelona.





Gavà-Castelldefels/Viladecans.






Barcelona.





Granollers/Mollet de Vallès/Moncada i Reixac.






Barcelona.





Hospitalet de Llobregat/Cornellà de Llobregat/Sant Boi de Llobregat.






Barcelona.





Manresa.






Barcelona.





Mataró/Vilassar de Mar.






Barcelona.





Ruby/Sant Cugat of the Vallès/Terrassa.






Barcelona.





Sabadell.






Barcelona.





Sant Feliu de Llobregat/Sant Joan Despí / El Prat de Llobregat/Esplugues de Llobregat.






Barcelona.

Tarragona.





Vilanova i la Geltrú / El Vendrell.






Bizkaia.





Leioa/Getxo.






Burgos.





Aranda de Duero.






Cáceres.





Plasencia.






Cadiz.





Chiclana from the actual border/port.






Cadiz.





Sanlúcar de Barrameda.






Cantabria.





Torrelavega.






Ciudad Real.





Alcazar de San Juan.






Ciudad Real.





Puertollano.






Ciudad Real.





Tomelloso.






Ciudad Real.





Valdepeñas.






Cordoba.





Lucena/Puente Genil.






Girona.





Figueres.






Granada.





Motril.






Gipuzkoa.





Irun/Errenteria.






Illes Balears.





(Island of ibiza) - Ibiza/Santa Eulalia de Rio/Sant Josep de sa Talaia, Sant Antoni de Portmany.






Illes Balears.





(Mallorca Island) - Calvià.






Illes Balears.





(Mallorca Island) - Inca.






Illes Balears.





(Mallorca Island) - Llucmajor.






Illes Balears.





(Mallorca Island) - Manacor.






Jaén.





Andujar.






Jaén.





Linares.






Jaén.





Ubeda.






Las Palmas.





(Island of Fuerteventura) - Puerto del Rosario / La Oliva.






Las Palmas.





(Gran Canaria Island) - Santa Lucia de Tirajana/San Bartolomé de Tirajana.






Las Palmas.





(Gran Canaria Island) - Telde/Dublin/Ingenio.






Las Palmas.





(Island of Lanzarote) - reef.






Leon.





Ponferrada.






Madrid.





Aranjuez.






Madrid.





Arganda del Rey/Rivas-Vaciamadrid/Mejorada del Campo.






Madrid.





Colmenar Viejo/three songs.






Madrid.





Coslada/San Fernando de Henares.






Madrid.





Collado Villalba/Galapagar/Torrelodones.






Madrid.





Leganés.






Madrid.





Getafe/Parla.






Madrid.





Pinto/Valdemoro.






Madrid.





Algete-Alcobendas-San Sebastián de los Reyes.






Malaga.





Alhaurín de la Torre.






Malaga.





Antequera.






Malaga.





Benalmadena/Torremolinos.






Malaga.





Estepona.






Malaga.





Marbella/Fuengirola/Mijas.






Malaga.





Corner of the Victoria/Vélez-Málaga.






Malaga.





Round.






Murcia.





Eagles.






Murcia.





Cieza/Molina de Segura / Las Torres de Cotillas.






Murcia.





Lorca/Totana.






Murcia.





San Javier/San Pedro del Pinatar/Torre-Pacheco.






Navarre.





Tudela.






Pontevedra.





Vilagarcía de Arousa.






Sevilla.





Two sisters/Alcala de Guadaira / Los Palacios y Villafranca.






Sevilla.





Ecija.






Sevilla.





Utrera.






Tarragona.





Cambrils/Reus.






Tenerife.





(Tenerife Island) - Adeje-Arona-Granadilla de Abona.






Tenerife.





(Tenerife Island) - La Orotava/Puerto de la Cruz / Los Realejos.






Tenerife.





(Tenerife Island) - San Cristóbal de la Laguna.






Toledo.





Talavera de la Reina.






Valencia.





Alzira/relocation.






Valencia.





Gandia/olive.






Valencia.





Sagunto.

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