According to the provisions of Articles 14 of the recast 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 Real Decree 1726/2007 of 21 December, the ISFAS maintains a system of concerted collaboration with the Military Health, regulated in the Ministerial Order 52/2004, of March 18, having undersigned Concerto with the National Institute of Social Security and The General Treasury of Social Security, dated 30 December 1986, on a carry-over basis (a) the members and other beneficiaries of the Special Social Security System of the Armed Forces may choose to receive health care for the services of the Military Health, with the provisos established in the the mentioned Ministerial Order, or through the Health Network of Social Security, in accordance with the conditions in force for the General Regime.

In addition, under the aforementioned precepts, prior to public notice, the ISFAS has concluded Concerto with various Insurance Entities, for the health care of holders and beneficiaries during the years 2016 and 2017.

In order to facilitate the choice of the holders of the ISFAS and in order that, in the event that they choose to be assigned to an Entity of Insurance, they know the content and the regime of the benefit, this Management agrees:

First.

Publish, as an annex to this Resolution, the text of the undersigned Concert for the health care of the holders and beneficiaries of the ISFAS during the years 2016 and 2017, with the following Insurance Entities:

ASISA, Interprovincial Health Insurance Assistance, Limited Company.

INSURANCE Company ADESLAS, Insurance and Reinsurance Company.

Second.

Also make public that the special care arrangements detailed in Annex 6 to the Concert have been assigned to the aforementioned Insurance Entities.

Third.

To determine that, during the month of January 2016, the holders affiliated to the ISFAS who so wish may change the Attending Mode, through the appropriate application, so that, during the month of January, they may be assigned to one of the Insurance Entities related to the first paragraph, to the Concional with the INSS and the TGSS when it is chosen to receive the assistance through the Public Health Services or, exclusively in the provinces of Madrid and Zaragoza, attached to the Military Health Services, with the limitations established in the Ministerial Order 52/2004, dated March 18.

The change referred to shall be requested by the holder, or duly authorized person certifying the representation, in the Delegation or Subdelegation of the ISFAS to whose area it belongs or, in the case of Madrid, in any of the Delegated Offices, owing, joining the application the membership document for replacement. It may also be done through the Electronic Headquarters of this Institute.

The time limit for changes of ordinary character, which may be made only once a year, is limited to January, without prejudice to the extraordinary changes provided for in clause 1.6 of the Concerts and in the corresponding specific regulation.

Madrid, December 14, 2015. -General Secretary of the Social Institute of the Armed Forces, Maria Soledad Alvarez de Miranda Delgado.

ANNEX

Social Institute of the Armed Forces Concert with insurance entities for health care of holders and beneficiaries of ISFAS during the years 2016 and 2017

INDEX

Chapter 1. Object of the Concert and scope of the protective action.

1.1 Object of the Concert.

1.2 Contingencies covered. Scope of the protective action.

1.3 Territorial scope.

1.4 Protected Collective. Beneficiaries of the Concert.

1.5 Birth and extinction of beneficiaries ' rights.

1.6 Entity change.

1.7 Healthcare cards.

1.7.1 Issue. Provisional health card.

1.7.2 Specifications.

1.7.3 Access to services.

1.8 Entity actuations relative to your service offering.

Chapter 2. Service Portfolio

2.1 General considerations.

2.1.1 Content in the service portfolio.

2.1.2 Incorporation of new means of diagnosis and treatment.

2.2 Primary Care Services Portfolio.

2.2.1 Content.

2.2.2 Home Assistance.

2.3 Specialist care services portfolio.

2.3.1 Specialist assistance in queries.

2.3.2 Specialist day hospital assistance.

2.3.3 Hospitalization in detention.

2.3.4 Home Hospitalization.

2.3.5 Diagnostic and therapeutic procedures.

2.3.6 Rehabilitation and Physiotherapy.

2.3.7 Assisted Human Reproduction (RHA).

2.3.8 Mental Health.

2.3.9 Other Supplementary Specifications.

2.4 Emergency Care Services Portfolio.

2.4.1 Content.

2.4.2 Access conditions.

2.4.3 Urgent health transportation.

2.4.4 Hospital emergency services.

2.5 Palliative Care.

2.5.1 Content.

2.5.2 Patients susceptible to palliative care.

2.5.3 Structure and organization.

2.5.4 Home Palliative Care.

2.5.5 Palliative care under hospitalization.

2.6 Dental health.

2.6.1 Content.

2.6.2 Exclusions.

2.6.3 Specifications and requirements for certain treatments.

2.7 Transportation for healthcare.

2.7.1 General considerations.

2.7.2 Non-urgent sanitary transport.

2.7.3 Transport in ordinary media.

2.8 Pharmaceutical and dietary products.

2.8.1 General rules.

2.8.2 Content.

2.8.3 Medicines for outpatient treatments in charge of the Entity.

2.8.4 Hospital Pharmacy Services Dispensation in Special Assumptions.

2.8.5 Rational use of the medication.

2.8.6 Procedure for the Impact of Drug Costs.

2.9 Healthcare products.

2.10 Orthoprosthetic Prstation.

2.10.1 Surgical Implants.

2.10.2 Outpatient Dispensing Orthoprosthetic Products.

2.11 Other capabilities.

2.11.1 Oxygenotherapy and other respiratory therapies.

2.11.2 Preventive Programs.

2.11.3 Podology.

2.11.4 Assistance in the framework of monitoring studies.

Chapter 3. Means of the Entity.

3.1 General rules.

3.2 Media availability criteria and care services.

3.2.1 Media availability 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 Balearic and Canary Islands.

3.4 Media accessibility assurance.

3.5 Rules and Requirements for the Use of Entity Media.

3.5.1 General Rule.

3.5.2 Identification.

3.5.3 Additional requirements.

3.5.4 Non-concerted private hospitals.

3.6 Service Catalog of the Entity.

3.6.1 General criteria.

3.6.2 Structure and content.

3.6.3 Responsibility for editing the web services and information catalogs.

3.6.4 Invariability of service catalogs.

3.6.5 Principle of continuity of care.

3.6.6 Information regarding the available media.

3.7 Freedom of choice of optional and center.

3.8 Military hospitals.

Chapter 4. Use of non-concerted media.

4.1 General rule.

4.2 Unjustified denial of assistance.

4.2.1 Unjustified denial of assistance.

4.2.2 Entity Obligations.

4.2.3 Claims.

4.2.4 Other effects.

4.3 Vital character urgent assistance.

4.3.1 Concept and Requirements.

4.3.2 Service accident assistance and other special emergency situations.

4.3.3 Scope.

4.3.4 Communication to the Entity.

4.3.5 Entity Obligations.

4.3.6 Claims.

4.4 Transport in foreign media for health care in cases of unjustified denial of assistance and vital urgency.

4.5 Cross-border assistance.

Chapter 5. Health information and documentation and quality objectives.

5.1 Information and documentation.

5.1.1 General rules.

5.1.2 General activity information.

5.1.3 Economic information.

5.1.4 Information about hospital care.

5.1.5 Healthcare media information.

5.1.6 Clinical documentation.

5.1.7 Other health documentation.

5.2 Digital clinical history and electronic prescription.

5.3 Healthcare quality.

5.3.1 General considerations.

5.3.2 Adaptation to the strategies of the National Health System.

5.3.3 Elaboration of care protocols.

5.3.4 Quality of pharmaceutical delivery.

5.3.5 Quality of information.

5.3.6 Evaluation of the quality of healthcare and healthcare facilities.

Chapter 6. Legal status of the Concert.

6.1 Nature and legal status of the Concert.

6.2 Nature and regimen of care relationships.

6.3 Mixed Commissions.

6.3.1 Types and operating system.

6.3.2 Composition.

6.3.3 Functions.

6.3.4 Operation.

6.4 Procedure for claims.

6.5 Estimated claims execution procedure.

6.6 Discounts for pharmacy expenses.

6.7 Economic compensation for non-compliance with obligations.

6.7.1 Obligations for non-compliance with obligations.

6.7.2 Procedure for imposing economic compensation.

Chapter 7. Duration, economic regime and price of the Concert.

7.1 Duration of the Concert.

7.2 Economic Regime of the Concert.

7.2.1 Economic effects of beneficiaries ' ups and downs.

7.2.2 Periods of payments.

7.2.3 Payment Regime.

7.2.4 Discounts and deductions.

7.2.5 Differences Claims.

7.2.6 Taxes.

7.2.7 Subrogation on receivables and shares.

7.3 Concert Price. Quotas.

7.4 Incentive-associated incentives.

7.4.1 Limits and Objectives.

7.4.2 Assistance to people with special needs for care.

7.4.3 Guarantee in the coverage of emergency services.

7.4.4 Improvement of Quality in Palliative Care Delivery.

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

7.4.6 Annual Incentive for the breadth of hospital service offerings.

Annex 1. Means of assistance in rural areas.

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

Annex 3. Pathologies with vital risk.

Annex 4. Care information system. Asset-cost record.

Annex 5. Health Media Registration.

Annex 6. Additional primary care and emergency mode.

Annex 7. Cross-border healthcare.

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

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

CHAPTER 1

Object and Scope of the Protective Action

1.1 Object of the Concert.

1.1.1 The object of the Concerto is to ensure access to health care benefits included in the Portfolio of Services to holders and beneficiaries of ISFAS who choose to receive them through the Entity, throughout the national territory, with the exception set out in clause 4.5. This assistance will be provided in accordance with the consolidated text of the Law on Social Security of the Armed Forces, approved by Royal Legislative Decree 1/2000, in Law 14/1986, General of Health and Law 16/2003, of 28 May, of the cohesion and quality of the National Health System, and its standards of development.

1.1.2 Healthcare will be provided in accordance with the Services Portfolio established in this Agreement with the reference, in terms of its content, of the Common Portfolio of Services of the National Health System, according to with the provisions of Law 16/2003 of 28 May, and in its implementing rules, in particular Royal Decree 1030/2006 of 15 September, establishing the portfolio of common services of the National Health System and the procedure for your upgrade.

1.1.3 To make the provision of comprehensive and quality health care effective, in accordance with the service portfolio, the undersigned Entity of the Concert (hereinafter the Entity) shall make available to the holders and beneficiaries attached to it (hereinafter referred to as beneficiaries), all means of their own or concerted action (hereinafter referred to as the means of the Entity).

If exceptionally the Entity does not have such means, it shall be directly responsible for the expense caused by the use of non-agreed means in accordance with the clauses established in this Concert.

1.1.4 Furthermore, the Entity is obliged to cover the cross-border healthcare of its protected collective, in accordance with the provisions of Royal Decree 81/2014 of 7 February, laying down rules for to ensure cross-border healthcare, and amending Royal Decree 1718/2010 of 17 December 2010 on medical 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 is obliged to pay the Entity the amount per month and person provided for in clause 7.3, subject to the specifications and procedure contained in clause 7.2 and, if applicable, the economic incentives set out in clause 7.4.

1.2 Contingencies covered. scope of the protective action. The contingencies covered by this Concert are those arising from common or professional illness, injuries resulting from accidents, whatever the cause, even if it is an act of terrorism, and by pregnancy, childbirth and puerperium, as well as the preventive actions taken in the same.

1.3 Territorial scope. The right to the use of the means of the Entity may be exercised throughout the national territory, regardless of whether they are themselves, agreed or subconcerted.

In this way, in line with the provisions of clause 1.1.1, the right to benefits that are the object of the Concert is limited to this territorial scope, with the exception of clause 4.5.

1.4 Protected Collective: recipients of the concert.

1.4.1 For the purposes of this Concerto, the collective protected by it is composed of the holders and beneficiaries to whom the ISFAS, in accordance with the applicable rules, has recognised that condition and the attached to the Entity.

They will also be able to be included in the collective protected by the Concert, and will have the consideration of beneficiaries of it, the foreign military students, welcomed to programs of cooperation with other countries in the field of teaching, that they are assigned to the Entity by the ISFAS.

In any case, the recognition of the status of the owner or beneficiary and of the right to the assignment to the Entity, for the purposes of the Concert, corresponds to the ISFAS.

1.4.2 To certain management purposes the beneficiaries of the Concert may be called holders or simply beneficiaries, when they appear as such in the affiliation document of a holder or when they have an assimilated document to membership.

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

1.4.3 The holders and beneficiaries who, if any, are assigned to the Entity, will be assigned to the Entity by 31 December 2015 and do not change their Entity, as provided for in clause 1.6 or according to the rules of membership of the Network. Health of the Social Security, and those who choose it according to the rules of that clause or when their discharge occurs in the ISFAS and opt for it.

1.5 Birth and extinction of beneficiaries ' rights.

1.5.1 Without prejudice to the following paragraph, the rights of the beneficiaries begin on the date on which they are assigned to the Entity by the Services of the ISFAS, without the existence of a lack of time for no type of assistance.

1.5.2 For the aforementioned purposes, it is presumed in any case that the newborn is attached to the Entity that caters to the mother, from the moment of delivery until one month after the birth. From then on, this right is conditional on the formalisation of the membership with the consequent economic effects.

1.5.3 The rights of the beneficiaries shall be extinguished, in any event, on the date when the Services of the ISFAS agree to their discharge in the same or the purpose of their attachment to the Entity for ceasing to meet the requirements or assumptions in fact that they allowed in each case to be protected by this Concert.

1.5.4 The ISFAS will communicate the discharge of beneficiaries to the Entity on a daily basis.

Likewise, and by the same procedure, the Entity will be notified of the casualties and variations in the data of the beneficiaries.

1.6 Entity change.

1.6.1 Without prejudice to the possibility of receiving healthcare through the public health network, as provided for in Article 14 of the recast of the Law on the Social Security of Forces Armed, approved by Royal Decree Legislative 1/2000, Article 61 of the General Regulation of the Social Security of the Armed Forces, approved by Royal Decree 1726/2007 of 21 December, and the additional provision seventh of the Royal Decree Regulation (EEC) No 1192/2012 of 3 August 2012 regulating the condition of insured persons and beneficiaries for the purposes of health care in Spain, from public funds, through the National Health System, the holders attached to the Entity may choose to receive healthcare for themselves and their beneficiaries through another of the agreements in the following assumptions:

A) On an ordinary and general basis, once, during the month of January, in the form established by the ISFAS.

B) With extraordinary character:

(a) When a change of destination occurs for the holder involving a transfer of the province or island of residence or when a holder in his or her own right, in a reserve or retirement situation, or a holder of secondary law transfers his or her home to another province or island.

b) When the data subject obtains the written agreement of the two Entities concerned.

(c) Where, in the light of objective circumstances justifying the change of a plurality of holders affected by the same health care problem, the management of the ISFAS agrees to the opening of a special period of choice of Entity.

d) In particular cases where, in the judgment of the General Secretariat of the ISFAS, exceptional circumstances warrant the change of Entity.

1.6.2 The merger of the Entity with another or other of those agreed by the ISFAS will not result in the opening of a special period of change, being automatically attached to the acquiring Entity or resulting from the merger. beneficiaries who, at the time of the merger, will be assigned to the Entity/is extinguished/s or to each of the merged Entities, obliging the resulting absorbing Entity, from that moment, to guarantee all their rights in the terms provided for in this Concert.

1.7 Healthcare cards.

1.7.1 Issue. Provisional health card. At the time the Entity, by any means, becomes aware of the discharge of a beneficiary, it will give you an interim card or any document that makes it possible to use the means agreed upon from the moment of discharge.

Later, the corresponding final health card will be issued, which will be sent to the beneficiary's home within the maximum period of seven calendar days from the effective communication.

When, in response to the express request of a holder, who has been discharged as a beneficiary assigned to the Entity, the provisional card or document that makes possible the use of the media is not provided (a) a decision shall be made by the ISFAS delegate to the effect that all expenditure arising from the assistance of the holder and its beneficiaries through the optional, services and centres included in the Catalogue of Services of the Entity may be invoiced directly to the ISFAS, for a maximum period of thirty days, from the date of discharge for the materialization of the corresponding credit. The amount of these expenses shall be deducted from the monthly instalments to be paid to the Entity, in accordance with the procedure provided for in clause 6.5.4. of the Concert, without prejudice to any economic compensation that may be agreed.

1.7.2 Specifications. The identification of the holders and beneficiaries to the health devices is carried out through the Health Insurance Card and, in order to facilitate their safe and univocal recognition, as well as to facilitate the interoperability of the different Clinical and management information systems, it is necessary to determine the technical specifications to which the health cards will be adjusted, as well as the basic information to be included and their format.

If the card is issued by a subconcerted entity, it must always bear the logo of the Entity agreed with the ISFAS, for the purpose of facilitating the use of means outside the provinces where the Subconcerted entity.

In addition, the cards to be issued should feature prominently the free permanent attention phone of Urgency.

The ISFAS Management Resolution will determine and modify the specifications of the cards and their information storage systems, as well as the structure, format and content of the data that, The scope of which the Entity requires for its own management must be included.

1.7.3 Access to services. The beneficiary must present the relevant health card when it comes to the means of the Entity.

In any event, the failure to submit the health card at the time of the assistance, when the Entity has not issued it or in urgent situations, does not prevent or condition the right of the beneficiary to make use of the means of the Entity.

The Entity is required to report and implement the necessary mechanisms for compliance with the provisions of the above clauses by the professionals and the centers of its Service Catalog.

1.8 Entity actuations relative to your service offering.

1.8.1 The Entity may advertise on its offer of services throughout the year and during the period of ordinary change, provided that it is not carried out within the institutions or public bodies and has general character, without addressing specific groups or professionals or with specific socio-demographic profiles. In the advertising campaigns carried out by the Entity, you may not use the logo or any other identification of the ISFAS or the General Administration of the State.

1.8.2 In no case may you offer gifts to the holders, directly or indirectly through third parties, in particular during the period of ordinary change and in the processes of high specific professional collectives. However, the Entity may provide additional health services, such as added value and differentiated offer from other providers.

1.8.3 The Entity is responsible for the fulfilment of these obligations by both its staff and other corporations, consortia, associations, foundations, social agents or other entities of any kind, with or without for profit, which maintain any relationship of legal, commercial, group or other nature and act in agreement or in the name of the Entity. Failure to comply with these obligations will result in the economic compensation provided for in clause 6.7.

CHAPTER 2

Service Portfolio

2.1 General considerations.

2.1.1 Services Portfolio Content. The Services Portfolio is the set of techniques, technologies or procedures, understanding each of the methods, activities and resources based on scientific knowledge and experimentation, through which they will be effective. health benefits.

The Services Portfolio that is the object of the Concert is structured into the following capabilities:

1. Primary Care.

2. Specialized Care.

3. Emergency Care.

4. Palliative Care.

5. Oral health.

6. Sanitary transport.

7. Pharmaceutical and dietetic products.

8. Other capabilities:

Oxygenotherapy and other respiratory therapies.

orthoprosthetic delivery.

Preventive programs.

Podology.

The benefits included in the Portfolio of Servants are guaranteed by the provision of the necessary care resources by levels and geographical and population areas established in Chapter 3 of this Concert, with the procedures and conditions set out in Chapter 4.

The entity will promote actions aimed at strengthening the coordination between primary care, specialized care and emergency services, in order to guarantee the continuity of care and the integral care of the patients.

2.1.2 Incorporation of new means of diagnosis and treatment. The content of the services included in the Services Portfolio will be adjusted to the established, at each moment, for the rest of the National Health System.

Any diagnostic or treatment technique that appears after the signing of the Concert will be a mandatory means for the Entity when it is applied to patients within the National Health System in some of the own or concerted centres of the Health Services of the Autonomous Communities. In case of doubt, the provisions of Law 16/2003, of 28 May, of the cohesion and quality of the National Health System and its regulatory development in this field will be referred to.

In this way, the Service Portfolio that is determined in this Chapter will be automatically updated by updates to the Common Health System Services Common Portfolio.

2.2 Primary Care Services Portfolio.

2.2.1 Content. Primary care is the basic and initial level of health care and will be provided by specialists in family and community medicine or general practitioners, pediatric specialists and nursing professionals, without prejudice to the collaboration of other professionals and understand:

a) Healthcare on demand, scheduled and urgent in both the consultation and home of the patient.

(b) the indication or prescription and, where appropriate, the performance of diagnostic and therapeutic procedures.

c) Special attention and services for women, including the detection and treatment of situations of gender, childhood and adolescent violence.

d) Adult care, risk groups, chronically ill and immobilized, comprising the assessment of health status and risk factors, advice on healthy lifestyles, the detection of health problems and assessment of the clinical status, care and monitoring of polymedicated and multi-pathology persons and the information and health advice on their disease and the precise care of the patient and caregiver, if any. In particular it shall be provided:

Protocolized healthcare for patients with chronic and prevalent health problems.

Care for people with HIV + and sexually transmitted diseases in order to contribute to clinical monitoring and improvement of their quality of life and to avoid risk practices.

Care for people with risky behaviors: Attention to smokers and support for tobacco cessation.

Attention to the excessive alcohol consumer. It includes the detection, assessment of the dependency, the advice of limitation or elimination of consumption, the assessment of pathologies caused by the consumption and the offer of healthcare for abandonment if necessary.

Attention to other addictive behaviors. It includes screening, the provision of specialized healthcare support, if accurate, for abandonment of dependency and prevention of associated diseases.

e) palliative care for terminally ill patients.

2.2.2 Home Assistance. Home health care will be provided by primary care professionals to patients who, due to their illness, cannot move, patients who are chronically ill who need help from another person for basic activities. of daily life and terminal patients, in line with the provisions of clause 2.5.4.

Home Care comprises:

a) Access to tests and diagnostic procedures that are not feasible at the patient's home, including the extractions and/or collection of home samples that are accurate.

b) Realization and follow-up of therapeutic treatments or procedures that the patient needs, including parenteral treatments, cures, and sondages.

c) Information and advice to people linked to the patient, especially the caregiver/principal.

2.3 Portfolio of specialized care services. Specialized care includes care, diagnostic, therapeutic and rehabilitation activities, as well as prevention activities, the nature of which requires the intervention of medical specialists.

The Specialized Care comprises:

1. Specialist assistance in consultation.

2. Medical or surgical day hospital specialized assistance.

3. Hospitalization in detention.

4. Home hospitalization.

5. Diagnostic and therapeutic procedures.

6. Rehabilitation in patients with recoverable functional deficit.

7. Assisted human reproduction.

8. Mental Health.

2.3.1 Specialist assistance in consultation. The beneficiary may access the specialised care consultations directly, without prior requirements, with the provisos provided for in clause 3.5.3.

This attention includes the preventive, care, diagnostic, therapeutic and rehabilitation activities, which are provided in the field of specialized care in outpatient care, including:

1. Initial patient assessment,

2. Indication and conduct of diagnostic examinations and procedures.

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

4. Indication of medication, parenteral or enteral nutrition, cures, fungible material, and other medical devices that are accurate.

5. Implants.

6. Indication of external prostheses, wheelchairs, orthotheses and special orthoprostheses and their appropriate renovation.

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

2.3.2 Specialist day hospital assistance.

A) Content. The attendance at Hospital de Dia is an alternative to hospitalization for the care of patients who need less intense health care in their convalescence and/or need of therapeutic procedures-rehabilitators that do not require hospitalization.

Comprises care, diagnostic, therapeutic and rehabilitation activities, intended for patients who require continued specialized care, including outpatient surgery, who do not need to be patient. overnight in the hospital. In particular it comprises:

1. Indication and conduct of diagnostic examinations and procedures.

2. Indication, performance and follow-up of therapeutic or rehabilitation treatments or procedures required by the patient, including ambulatory surgery and chemotherapy treatments for oncology patients who will understand of the precise medication.

3. Nursing care needed for proper patient care.

4. Implants.

5. Indication of external prostheses, wheelchairs, orthotheses and special orthoprostheses and their appropriate renovation.

6. Medication, medicinal gases, transfusions, cures, fungible material, and other medical devices that are accurate.

7. Post-surgical resuscitation and, if appropriate, after invasive diagnostic procedures.

8. Parenteral or enteral nutrition.

9. If appropriate, diet, as prescribed.

10. High-level information with instructions for proper monitoring of the treatment and establishment of mechanisms to ensure continuity and safety of care and care.

The effects of the Concert are considered to be the treatments of Hemodialysis and Outpatient Oncology Chemotherapy, always performed in the Day Hospital regimen.

B) Requirements. Access to the Day Hospital assistance requires the indication of the optional specialist responsible for patient care and authorization of the Entity.

2.3.3 Hospitalization in detention.

A) Content. Hospital care in detention shall be provided where the patient is in need of special and continuous care, not likely to be provided on an outpatient basis or at home.

Comprises medical, surgical, obstetric and pediatric care or the performance of diagnostic treatments or procedures, to patients who require continued care that require their internment, including:

1. Indication and conduct of diagnostic examinations and procedures, including neonatal examination.

2. Indication, performance and follow-up of therapeutic treatments or procedures or surgical interventions required by the patient, regardless of whether or not their need is caused by the reason for their detention.

3. Medication, medicinal gases, transfusions, cures, fungible material, and other medical devices that are accurate.

4. Nursing care needed for proper patient care.

5. Implants and other orthoprostheses and their appropriate renovation.

6. Intensive care or resuscitation, as appropriate.

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

8. Rehabilitation and haemodialysis treatments, where appropriate.

9. Parenteral or enteral nutrition.

10. Diet, according to the prescribed diet.

11. Basic hotel services directly related to the hospitalization itself with stay in a single room.

12. High-level information with instructions for proper monitoring of the treatment and establishment of mechanisms to ensure continuity and safety of care and care.

B) Requirements. Assistance in the form of inpatient treatment will be provided at the institution's own or concerted centres.

Urgent income will be made through hospital emergency services or by indication of the optional officer, without further requirements.

The scheduled admission to a Hospital will require the prescription of the same by the Entity's physician, with the Center's indication, and the prior authorization of the Entity.

For your part, the Entity will inform the center of the authorization of the internment, telematic or fax, within the first 24 hours.

In the cases of income made through the emergency services and maternity hospitalization, the institution itself will carry out the necessary procedures before the Entity.

In the event that the owner or the beneficiary is admitted to a hospital outside the Entity for an emergency situation, he/she can request the continuity of the assistance in a hospital center without the prescription of a physician of the Entity is necessary, with your request the medical report of the process by which you are being treated.

C) Duration of hospitalization. The institution will address the coverage of the hospitalization until the physician responsible for the patient's care issues discharge, considering that there is no longer the need for hospital care. From that moment on, the continuity of the stay would be understood to be due to social reasons.

D) Type of room. The hospitalization shall be carried out in a single room with bath or shower and a companion bed, and must be provided by the higher level entity when it has not been available of the type indicated. In no case shall rooms which are part of the accommodation capacity of the Centre be excluded.

The ISFAS may authorize the Entity to have hospital facilities that do not meet the requirement of the previous paragraph in its Service Catalog of Centers.

In the case of psychiatric hospitalization, no companion bed is required.

E) Maternity hospitalization. At the time of entry, the authorization of the Entity will be obtained directly by the corresponding hospital center.

For the purpose of newborn care, the provisions of clause 1.5.2 shall be taken into account.

If the practice of the tubal ligation is decided at the same time of delivery without having indicated on the prescription of the income, the expenses caused by this concept will also be borne by the Entity.

F) Hospitalization in middle and long-stay centers or units. This type of hospitalization is especially intended for patients with functional impairment or chronic process affections and/or diseases associated with aging, which, once the acute phase of the disease has been overcome, require health care. continuous surgical, rehabilitation and nursing care, up to its stabilization.

2.3.4 Home Hospitalization.

(a) Comprises the set of treatments and health care provided at the patient's home, of a complexity, intensity and duration comparable to those of the same patient in the conventional hospital; and that for these reasons cannot be assumed by the Primary Care level.

b) Home hospitalization may be carried out in cases where the condition of the patient permits.

c) During this hospitalization, the responsibility for the patient's follow-up corresponds to the Home Hospitalization Unit (UHD) and will be provided by the specialists (family physicians or internists) and the staff of nursing that makes up the UHD, which must be coordinated with the medical or surgical hospitalization unit corresponding to the patient's pathology and the emergency area of the hospital, in order to ensure continuity assistance.

d) Entry into the UHD may be performed from a hospital service through the appropriate referral report and from Primary Care or Outpatient Care. In these last two cases, it will be up to the UHD to assess whether the patient meets the criteria for entry into that unit.

e) The income in the UHD will be subject to the same requirements as the admission to a hospital, receiving the same care that would have received from being admitted to a hospital. The clinical documentation for such care will be completed with the same criteria as in conventional hospitalization.

f) The UHD will inform the patient and his/her family in writing about how to contact the unit at any time of the day, in order to respond to any incidents. When the discharge occurs, the UHD physician will issue the relevant medical part of discharge in the terms provided for by law.

g) As long as the patient remains admitted to the UHD, they will be charged with the Entity and cannot be charged either to the beneficiary or to the ISFAS, all the care and products that the patient requires, in addition to all the medication, cures, non-common nutrition, complementary tests, interconsultations, absorbents, probes, home hemodialysis and oxygen therapy. In any case, the ordinary household envelopes, the common nutrition and the services of clinical auxiliaries are excluded.

2.3.5 Diagnostic and therapeutic procedures. Beneficiaries shall have access to diagnostic or therapeutic techniques and procedures included in the service portfolio set out in this Concert, provided that the relevant indication is established by an optional Services, regardless of whether or not the technique or procedure is available in the geographical area in which they reside.

Without prejudice to the forecast contained in clause 2.1.2, the coverage of the following diagnostic and therapeutic procedures shall be considered, provided that their indication is established by the optional of the assigned services. responsible for patient care, taking into account the caveats provided for in clauses 4.2 and 4.3.

1. Prenatal diagnosis in risk groups.

2. Diagnostic by image:

A. Simple Radiology: Chest, Abdomen, Bone Radiology, Densitometry.

B. Mom: Mamography, Mom Interventionism.

C. Conventional radiology with contrast.

D. Ultrasounds: Ultrasound, Doppler Ultrasound.

E. Computed Tomography (CT).

F. Magnetic resonance imaging (MRI).

3. Diagnostic and therapeutic interventional radiology.

4. Diagnostic and therapeutic haemodynamics.

5. Diagnostic and therapeutic nuclear medicine.

Including positron emission tomography (PET), and combined with CT (PET-TC), in oncology indications according to the specifications of the authorised technical tab of the corresponding radiopharmaceutical.

6. Neurophysiology.

7. Endoscopies.

Capsuloendoscopy is included only in the dark-origin digestive hemorrhage that persists or recurs after an initial negative endoscopy study (colonoscopy and/or upper endoscopy) and is predictably localized in the small intestine.

8. Functional testing.

9. Laboratory:

A. Pathological anatomy.

B. Biochemistry.

C. Genetics.

D. Haematology.

E. Immunology.

F. Microbiology and parasitology.

10. Biopsies and punctures.

11. Radiation therapy.

12. Radiosurgery.

13. Renal litotricia.

14. Dialysis.

15. Organ, tissue and cell transplants of human origin.

16. Intensive care, including neonatal care.

17. Haemotherapy.

18. Family planning, which includes:

A. Genetic advice in risk groups.

B. Information, indication and follow-up of contraceptive methods, including intrauterine devices.

C. Tubal ligation and vasectomies, excluding the reversal of both.

2.3.6 Rehabilitation and Physiotherapy.

A) Comprises procedures for the diagnosis, evaluation and treatment of patients with functional deficits, aimed at facilitating, maintaining or returning the greatest degree of functional capacity and independence to the patient, with the purpose of reintegrating it into its usual environment.

B) Includes the rehabilitation of the conditions of the musculoskeletal system, the nervous system, the cardiovascular system and the respiratory system, through physical therapy, occupational therapy, speech therapy and adaptation of the technical methods (orthoprostheses).

As for the treatment of language development disorders, the coverage of the actions for the recovery of the so-called Learning Disorders whose attention is the responsibility of the Educational System.

C) Rehabilitation and physical therapy treatments may be required to the Entity by rehabilitating physicians or by the medical specialists responsible for the pathologies susceptible to such treatments.

The monitoring of the patient's evolution and the determination of discharge will be the responsibility of the rehabilitator physician or, as the case may be, of the optional specialist who requested such treatment. Your application may be performed by rehabilitator, physical therapist, logopeda, and occupational therapist, as appropriate.

D) The number of sessions is subject to the optional criterion and the situation of the patient, with the duration of the sessions recommended by the Spanish Society of Rehabilitation and Physical Medicine. other scientific societies.

The obligation of the Entity will terminate when the functional recovery has been achieved fully or as much as possible because it has entered the process into an insuperable stabilization state, since it is an attention directed to patients with a recoverable functional deficit, in any case the rehabilitation indicated by the process of resharpening.

2.3.7 Assisted Human Reproduction (RHA).

A) General considerations. The assisted reproduction techniques shall be carried out by the Entity when the woman on which they are to be performed has the status of beneficiary, as provided for in clause 1.4, and the coverage of the tests must also be met. procedures included in the portfolio of services to be performed on the other member of the partner in the course of the treatment. The financing of the pharmacological treatments to which the other member of the couple is to be submitted is excluded.

However, when a treatment cycle is in progress, under the guidance of previous Concerts, the Entity will maintain its coverage until the end, for the same services, with the application of the criteria and limits in force at the time of commencement, provided that no change of Entity is performed.

Assisted reproductive treatments will be aimed at helping to achieve pregnancy in those people who are unable to achieve it naturally, not susceptible to exclusively pharmacological treatments, or after the failure of the same. These procedures may also be used to prevent serious genetic diseases or disorders in the offspring and when an embryo with the same immunological characteristics as a sibling is required to affect a process. serious pathological condition, which is not susceptible to another therapeutic resource.

The assisted reproductive treatments included in the basic portfolio of services of the National Health System, according to Law 14/2006 of May 26, will be attended on techniques of Human Reproduction Assisted, which is carry out therapeutic, preventive and in certain special situations where there is a diagnosis of sterility or an established clinical indication, with the general criteria set out in paragraph B) and, where appropriate, the criteria specific to each technique, applied in the rest of the National Health System, differentiating the following situations:

1. Treatments for assisted human reproduction for therapeutic purposes. They shall apply to persons with a recorded reproductive capacity disorder, not susceptible to medical treatment or following the evident ineffectiveness of the reproductive capacity and absence of pregnancy, after 12 months of sexual intercourse with unemployable vaginal intercourse. of contraceptive methods.

2. Treatments for assisted human reproduction with a preventive purpose. Intended to prevent the transmission of serious genetic diseases or disorders, or the transmission or generation of diseases of other serious origin, of early onset, not susceptible to post-natal curative treatment according to the current scientific knowledge, and that they are avoidable through the application of these techniques.

They will apply to people who meet the general criteria for access to RHA treatments, listed in section B) below, and according to the specific access criteria defined in each technique.

3. Treatments for assisted human reproduction in particular situations. In addition to the treatments referred to in the above paragraphs, the coverage of assisted human reproduction treatments shall be addressed for the following purposes:

a) Embryonic Selection, with destination for third-party treatment.

b) Preservation of gametes or preembryo for deferred autologous use by medical indication, to preserve fertility in situations associated with special pathological processes, with the criteria and conditions applied in the rest of the National Health System.

B) General coverage conditions.

1. The institution shall bear the costs arising from the actions and studies required to obtain the diagnosis of sterility. The studies shall be extended, where appropriate, to both members of the couple.

2. Treatments for assisted human reproduction shall be covered, where there is a diagnosis of sterility or an established clinical indication and the following general criteria or situations of inclusion are met, without prejudice to the following: of the specific criteria laid down for each technique:

(a) At the time of the start of the sterility study, the beneficiary shall be over 18 years of age and under 40 years of age, and shall not present any type of pathology in which the pregnancy may present a serious and uncontrollable risk to her. for their health as for that of their possible offspring. In the case of couples, the male should be older than 18 years and under 55 years.

b) The woman will not have any previous and healthy children. In case of couples, without any common, prior and healthy children.

3. The coverage of assisted human reproduction treatments shall not be considered when sterility in any member of the partner has occurred voluntarily or over-come as a result of the natural physiological process of the end of the the person's reproductive cycle or documented medical contraindication

C) Limits relative to the maximum number of treatment cycles. Assisted human reproduction treatments shall be subject to limits in terms of the number of cycles and age of the patient, taking into account the principles of efficiency and safety to ensure the greatest effectiveness at the lowest possible risk.

The maximum limit of treatment cycles to be treated will be the one set for each technique or procedure.

For the correct interpretation and application of the limits established in each case, the following criteria will be taken into account:

1. In general, for the calculation of the number of cycles, account shall be taken of the total number of cycles carried out independently of the funder. Therefore, in the event that a couple is engaged in the coverage of this Concert, having previously undergone an assisted human reproduction treatment, account will be taken of the number of cycles that would have been performed up to that time and provide coverage to which it corresponds, until you complete the maximum number of cycles set.

2. To consider that a patient has performed a IVF cycle, it must have reached at least the egg recovery phase.

3. Where frozen pre-embryos are available from authorised IVF cycles, their transfer shall be deemed to be part of the same cycle in which they were obtained and the coverage of the transfer of such pre-embryos shall be considered. preembryos until the day before the woman is 50 years old, regardless of the existence of healthy previous children.

4. A new IVF cycle shall not be permitted where cryopretained leftover preembryos from previous cycles exist.

D) RHA techniques included in the Services Portfolio. Application-specific access criteria and conditions.

1. Artificial insemination.

a) Artificial insemination with semen of the couple. The following specific criteria shall be taken into account for access to this technique:

i. Existence of recognised therapeutic indication.

ii. Age of the woman at the time of treatment: less than 38 years.

iii. Maximum number of cycles to be attended: four.

b) Artificial insemination with donor gametes.

For access to this technique, the following specific criteria will be considered:

i. Existence of therapeutic indication.

ii. Age of the woman at the time of indication of treatment: less than 40 years.

iii. Maximum number of cycles: six, which shall comprise the insemination cycles which would have been carried out with own gametes.

2. In vitro fertilisation. Conventional in vitro fertilisation or micromanipulation techniques and the techniques for the treatment and preservation of gametes and preembryos derived therefrom are considered.

The specific access criteria for these techniques are as follows:

a) In vitro Fecundation with own gametes.

i. Age of the woman at the time of treatment: less than 40 years.

ii. Absence of evidence of poor ovarian reserve.

iii. Maximum limit of treatment cycles: Three cycles with ovarian stimulation. This limit may be reduced according to the prognosis and, in particular, the result of previous treatments.

b) In vitro Fecundation with donated sperm.

i. Age of the woman at the time of treatment: less than 40 years.

ii. Absence of evidence of poor ovarian reserve and diagnosis of primary or secondary sterility without a healthy child.

iii. Maximum limit of treatment cycles: Three cycles with ovarian stimulation, regardless of the cycles that would have been performed with other techniques. This limit may be reduced according to the prognosis and, in particular, the result of previous treatments.

c) In vitro Fecundation with donated oocytes.

i. Age of the woman at the time of treatment: less than 40 years.

ii. Existence of medical indication by: Preterm clinical ovarian failure established before 36 years (spontaneous or yatrogenic), female genetic disorder only avoidable by replacement of oocytes, Unreachable or non-broachable Omules for the oocyte extraction.

iii. Maximum limit of treatment cycles: Three cycles with receipt of donated oocytes. This limit may be reduced according to the prognosis, and in particular the result of the previous treatments.

The cost of the medicines required by donors and other related expenses will be borne by the Entity when it forms part of the cost of the technique used. In no case may the recipient of the donation be passed on.

3. Cryopreservation of preembryos and their transfer. Cryopreserved preembryos may be transferred for their own use or may be donated. In the case of the transfer of cryopreserved preembryos for own use, the specific criterion for women to be under 50 years of age with primary or secondary sterility shall be applied, so that the cryopreservation and maintenance of embryos until the woman meets that age.

4. Cryopreservation of gametes or preembryos for own deferred use to preserve fertility in situations associated with special pathological processes. This is the cryopreservation of gametes or preembryos 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 treatments. gametotoxic or pathological processes with an accredited risk of premature ovarian failure or accredited primary testicular failure risk.

The use of cryopreserved gametes or preembryos will be carried out in women under 50 years of age, provided that they do not present any type of pathology in which the pregnancy may present a serious and uncontrollable risk, both for their health as for that of their possible offspring. In the case of men, the preservation will be attended to the age of 55.

It will be performed exclusively by medical indication, not by attending to its coverage when it is raised only at the patient's own request for deferred use.

5. Seminal washing techniques to prevent the transmission of chronic viral diseases. Seminal washing of HIV-positive men to hepatitis C virus or HIV may be applied both in the care of serodiscordant sterile partners with chronic viral infection, and in the prevention of transmission of viral infections. chronic in pairs with no sterility diagnosis.

In the case of seroconcordant couples, only the washing is necessary, and the subsequent study of the presence of viral particles is not necessary.

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

6. Preimplantation genetic diagnosis (DGP). Pre-implantation genetic diagnosis may be required:

(a) DGP for the purpose of preventing the transmission of diseases or disorders of chromosomal or serious genetic origin of early onset and not susceptible to curative treatment in accordance with scientific knowledge in order to carry out the embryo selection of the non-affected preembryos for transfer.

The situations that can give place to DGP for preventive purposes are:

i. Monogenic diseases susceptible to preimplantation genetic diagnosis.

ii. Maternal or paternal structural chromosomal abnormality.

iii. The specific criteria for performing a DGP procedure for this purpose are:

That there is a high risk of recurrence of the disease present in the family,

That the genetic disorder generates serious health problems, that is, that the disease of genetic base compromises the hope and/or quality of life for producing congenital anomalies, intellectual, sensory or motor disability, not susceptible to curative treatment, according to current scientific knowledge.

That genetic diagnosis is possible and reliable and includes a report of genetic advice.

It is possible to perform a FIV-ICSI procedure with an appropriate response after controlled ovarian stimulation.

The specific criteria for IVF with own gametes.

It will be necessary, in addition to the above criteria, for an administrative authorisation where appropriate, on the basis of Article 12 of Law 14/2006 of 26 May on assisted human reproduction techniques.

b) DGP for therapeutic purposes to third parties. Pre-implantation genetic diagnosis in combination with the determination of HLA (human leukocyte antigen) histocompatibility antigens of in vitro preembryos for the selection of the HLA embryo compatible for the treatment of a third party (DGP-HLA).

The specific criteria for accessing this technique are:

i. Patients aged less than or equal to 40 years with an ovarian reserve sufficient for the purpose of the treatment being pursued.

ii. Existence of a recognised indication, i.e. the previous child of disease that requires treatment with haematopoietic precursors from a histocompatible sibling.

iii. Express authorisation of the corresponding health authority, after favourable report of the National Commission of Assisted Human Reproduction (CNRHA), as provided for in Article 12 of Law 14/2006 of 26 May on reproduction techniques assisted human.

iv. Maximum treatment cycle limit: Three cycles with ovarian stimulation and three additional cycles after clinical assessment or by CNRHA of the results obtained in the three initial cycles. This limit may be reduced according to the prognosis and, in particular, the result of previous treatments.

2.3.8 Mental health.

A) Content. Mental health care includes the diagnosis and clinical follow-up of mental disorders, psychopharmacotherapy, individual, group or family psychotherapies (excluding psychoanalysis and hypnosis) and therapy. electroconvulsive and will be provided on an outpatient basis, in hospital day or in hospital treatment.

Mental health care, which will ensure the necessary continuity of care, includes:

1. Diagnosis and treatment of mental disorders, including outpatient treatment, individual or family interventions, and hospitalization when required.

2. Diagnosis and treatment of addictive behaviors, including alcoholism and ludopathies.

3. Diagnosis and treatment of psychopathological disorders of infancia/adolescence, including care for children with psychosis, autism and with general and dietary disorders in particular (anorexia/bulimia), including outpatient treatment, psychotherapeutic interventions in hospital day, hospitalization when necessary 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 people linked to the patient, especially the caregiver/principal.

B) Psychiatric hospital. It will be facilitated for psychiatric care of all acute and chronic processes requiring hospital admission or day hospitalization.

Likewise, the entry of psychiatric patients into middle and long-stay centers or units is included when, once the acute phase of the process is overcome, the evolution is not satisfactory, they require a greater degree of stabilization and recovery for integration into your family and/or social environment.

Therefore, hospitalization, including day care, will be prolonged for as long as the psychiatrist responsible for patient care considers it necessary and, therefore, up to hospital discharge and will cover all processes. both acute and chronic.

The income must be made in the centers arranged by the Entity, without prejudice to the provisions of clauses 3.4 and B. 3 of clause 3.2.2.

By way of derogation from the preceding paragraph, if the entry had occurred prior to January 1, 2015, in a non-concerted center for justified clinical causes without prior authorization of the Entity, the same pay to the affiliate the costs of hospitalization, with the limit of 87 euros per day, until the moment of the hospital discharge. The refund shall be made within 10 calendar days of the date on which the supporting documents are presented to the Entity.

The coverage of the social internment of patients affected by neurodegenerative dementias such as Alzheimer's and others is excluded, although the hospitalization of those patients who suffer some type of illness will be treated. Neurodegenerative dementia, require psychiatric hospitalization due to ongoing processes or severe decompensation.

C) Psychotherapy. Psychotherapy, individual, group or family, is included, provided that it has been prescribed by a psychiatrist of the Entity, performed in means arranged with it and that its purpose is the treatment of psychiatric pathologies. The entity is required to provide a maximum number of 20 sessions per calendar year (short psychotherapy or focal therapy), except for eating disorders, in which all sessions will be provided which the psychiatrist responsible for assistance is considered necessary for the correct evolution of the case.

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

2.3.9 Other complementary specifications.

A) Plastic, aesthetic and restorative surgery. Plastic, aesthetic and restorative surgery that does not have a relationship with accident, disease or congenital malformation is excluded.

In the cases of accident of service or occupational disease, it will be practiced in all its amplitude, including, if necessary, the plastic, aesthetic and restorative surgery in cases where, even having been cured the injuries, deformations or mutilations that result in changes in the physical appearance or make the patient's total recovery difficult.

B) Transplants. The coverage of transplants of all types is included: organs, tissues and cells of human origin, as well as bone grafts. Organ procurement and transplantation will be performed in accordance with the current health legislation, corresponding to the Entity assuming all the expenses of obtaining and transplantation of the organ or tissue, including the studies of compatibility.

The coverage of the following types of transplants will be covered:

1. Organs: kidney, heart, lung, liver, pancreas, intestine, kidney-pancreas, heart-lung, and any other combination of two or more of these organs for which there is an established clinical indication.

2. Other transplants authorized by the National Transplant Organization.

3. Tissues and cells: haematopoietic progenitor cells 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 corneal limb); amniotic membrane; valvular homografts; vascular homografts; musculoskeletal and skin tissues; autologous chondrocyte transplantation as a second-choice treatment when a prior therapeutic option has failed Chondral lesions of the knee joint and in dissecting osteochondritis; keratinocyte cultures and cell cultures for which there is an established clinical indication.

2.4 Emergency Care Services Portfolio.

2.4.1 Content. The Urgency Care is one that is provided to the patient in cases where their clinical situation requires immediate health care.

Urgency care is dispensed both in health centers and outside of them, including the patient's home and in situ care, during the 24 hours of the day every day of the year, through medical and medical care. nursing and with the collaboration of other professionals.

Emergency care also includes telephone attention, through the Emergency and Emergency Coordinating Center of the Entity, provided for in clause 3.1.1.D), which includes information and allocation of resources. own or in coordination with the emergency services of 112 in order to provide the most appropriate response to the demand for care, and the urgent health transport, under the conditions set out in clause 2.4.3.

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

In addition, the Entity will have to have hospital and extra hospital emergency services to which the beneficiaries will be able to attend at all times and will have the necessary medical doctors and the personal means and materials necessary for their function, in accordance with the availability criteria set out in clause 3.2.

2.4.2 Access conditions. Where the holder or beneficiary requires urgent or emergency health care, he shall request it via the appropriate emergency care telephone of the entity listed in the health card, in the Supplier Catalogue and on the website and gives you access to the Emergency and Emergency Coordinating Center of the Entity to ensure the accessibility and coordination of all the available means for this type of care 24 hours a day every day of the year, in all national territory.

Information about the available hospital, outpatient, and primary care facilities may be collected through the emergency care or the entity's information telephone and, in general, any other aspect related to this type of care, as well as for the purposes of clause 4.2.1.E).

Urgent assistance may also be required in the Primary and Specialized Care Urgent Services of the Entity, or directly to the general medical, pediatric and nursing faculty of the Entity in their query schedules.

2.4.3 Urgent health transportation.

A) General considerations. The Emergency Care also includes the urgent, terrestrial, air or sea, assisted or unassisted sanitary transport, as required by the clinical situation of the patients, in cases where it is necessary for their proper transfer to the center health that can adequately address the situation of urgency.

B) Modes. This type of transport comprises the following modes:

1. Urgent primary transportation, from the place where the emergency has occurred to the first center or sanitary device with the capacity to care for the patient. It may require first assistance, in the same place where the emergency has occurred, by qualified personnel.

2. Sanitary transport requested by the Emergency Coordinator Center.

C) Direct use of the Ambulance Service. In cases of urgency where it has not been possible to communicate with the Emergency and/or Ambulance Services of the Entity and no other alternative is appropriate, the beneficiary may request directly from the existing Ambulance Service in the location of the transfer to the Emergency Service of the Entity to which it is assigned and the Entity shall assume or reintegrate the expenses of the shipment.

2.4.4 Hospital Emergency Services. They will be available in the municipalities included in Levels II, III and IV of the Specialized Attention, with the criteria of availability set out in clause 3.2.2.

On the other hand, the deployment of the centers and units where the professional activity of the protected collective develops, conditions its peculiar geographic distribution and some specific needs.

For all of this, in all the municipalities of less than 30,000 inhabitants, where there is a hospital-dependent hospital of the Health Service of the corresponding Autonomous Community, the coverage of the assistance will be attended Emergency service, to beneficiaries suffering from acute clinical situations requiring non-demorable care, provided that no concerted centres are available in the municipality in which the beneficiary is found to be in need of assistance. or in another situated less than 15 kilometres.

2.5 Palliative Care.

2.5.1 Content. It includes the integral, individualized and continuous care of people with advanced disease who are not susceptible to receiving treatments with a curative purpose and with a limited life expectancy, as well as the people linked to them. Your therapeutic goal is to improve the quality of life, with respect to your belief system, preferences and values.

In the provision of palliative care, primary care and specialized care professionals responsible for the pathological process of the patient will participate, with the support of specific devices to which, in case of Patients may be derived by their degree of complexity.

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

2.5.2 Patients susceptible to Palliative Care. Palliative Care will be provided to those patients with a terminal disease, regardless of the pathology that originates it.

They will be sensitive:

a) Terminal oncology patients, with documented, progressive, advanced and incurable disease, with multiple, continuous and changing symptoms, and poor or no response to specific treatment.

b) Terminal patients with chronic non-oncologic disease, at an advanced stage and with severe non-reversible functional limitation, with severe, complex and changing symptoms. Included among others:

1. AIDS patients.

2. Patients with neurological, respiratory, cardiocirculatory, hepatic and renal diseases of any etiology.

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

2.5.3 Structure and organization. In the provision of palliative care, primary care and specialized care professionals will participate, under an explicit organizational model, adapted to the territorial distribution of care resources, according to the requirements of means set out in clause 3.2 which shall be supplemented by support devices to which patients may be derived, if necessary, due to their degree of complexity.

The interconnection between the different care devices will be guaranteed to facilitate coordination.

In municipalities where the availability criteria provided for in clause 3.2 are not met, the patient's access to the specific Health Service devices of the corresponding Autonomous Community will be provided.

2.5.4 Palliative care homes. The most appropriate place to provide palliative care at any time will be determined by the level of complexity of the patient, the availability of adequate family support and the choice of the patient and his family, among other variables, Although usually the patient's home is the place of choice.

Domiciliary care will be provided by physicians and nursing professionals in Primary Care who will be responsible for care and facilitate care and patient access to therapeutic and diagnostic resources. accurate at home, which may result in complex patients being referred to other medical devices or the intervention of support teams in palliative care.

The continuity of assistance in slots in which the activity of the specific resources ceases, will be facilitated through the Emergency Coordinating Centre (free emergency care telephone), for which articulate the precise coordination and referral procedures.

The referral of the patient to the resources at the Hospital Care level (Home Hospitalization Unit or other hospital care services) will be based on the above possibilities. care in the field of home care. Hospitalization in these units will be prolonged until it is possible for the patient to reintegrate into the home.

The beneficiaries who require palliative care by specific support teams or the admission to Hospital Palliative Care Units must, except in cases of urgency, request prior authorization from the Entity, in accordance with the procedure provided for in paragraph 2 of Annex 2.

2.5.5 Palliative care in hospitalization. Care at home is the choice of choice for most terminally ill patients. However, the practitioners responsible for the assistance may order the referral to the Hospital Palliative Care Units or the Home Inpatient Units, referred to in clause 2.3.4 of this Concert, or the transfer and admission to the Reference Hospital, when the patient needs special and continued care not to be provided on an outpatient basis or at home.

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

2.6.1 Content. Oral care has the following content:

A) Treatment of acute dental processes, understanding of the infectious and/or inflammatory processes affecting the bucodental area, trauma-tooth trauma, wounds and lesions in the oral mucosa, as well as the acute pathology of the temporo-mandibular joint.

Includes oral dental advice, pharmacological treatment of oral pathology requiring it, exodontics, surgical exodontics, minor surgery of the oral cavity, oral review for early detection of premalignant lesions and, in its Case, biopsy of mucosal lesions and cleaning of mouth or tartrectomy once a year or more, if necessary, prior to the medical specialist's supporting report.

B) Preventive screening of the oral cavity to pregnant women: Includes health instructions for diet and oral health, accompanied by training in oral hygiene, and application of topical fluoride according to the individual needs of each pregnant woman.

C) Buco-dental health program aimed at children under 15 years of age, consisting of periodic reviews, application of topical fluoride, occlusal sealants in permanent parts, fillings, fillings or reconstructions in permanent pieces, pulparian treatments (endodontics) in permanent pieces, tartrectomies and treatments of incisors and permanent canines in case of disease, malformations or trauma. In addition, this program will incorporate the actions that are included in the Health Plan for the National Health System as a whole, with the same scope, content and rhythm of implementation.

(D) Where an accident is a service or occupational disease, all treatments and performances, including dental prostheses and osteo-integrated implants, as well as their own, shall be carried out by the Entity. placement.

E) Also included in charge of the Entity are dental implants for patients with congenital malformations that are in anodontics and for patients with cancer processes that affect the oral cavity that involve loss of teeth directly related to the pathology or its treatment. In both cases, prior prescription of an optional specialist of the Entity is required, together with a budget for authorization by the entity.

2.6.2 Exclusions. With the provisos set out in paragraphs C), D) and E) of clause 2.6.1, the following treatments are excluded from oral care:

1. Temporary teething repair treatment.

2. Orthodontic treatments.

3. Exodontics of healthy pieces.

4. Treatments for exclusively aesthetic purposes.

5. Dentures or dental implants.

6. Carrying out complementary tests for the assessment and monitoring of treatments excluded from the Services Portfolio.

7. Fillings or obturations and endodontics, except in the area of the dental health program.

8. Periodoncia.

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 the dental prostheses, it will be necessary prescription of optional specialist of the Service Catalog together with budget, if it is a prosthesis, and authorization by the Entity.

B) In the case of persons with disabilities who, because of their deficiency, are not able to maintain, without the help of sedative treatments, the necessary self-control that allows adequate attention to their dental health, for Provide them with the above services to those areas where they can be guaranteed to be successful.

In these cases, the expenses of hospitalization, operating room and anaesthetist necessary for the conduct of dental treatments, even those excluded from the coverage of the Concert, will be charged to the entity. mental disabled patients, provided that the treatments are carried out with means of the Entity.

2.7 Transportation for healthcare.

2.7.1 General considerations. The transport for healthcare provided for in this Concert includes the following modalities:

(a) Urgent health transport, provided for in clause 2.4.3.

b) Non-urgent sanitary transport.

c) Transport in ordinary media.

the entity shall be responsible for the costs incurred for the displacements required by the beneficiaries when using the assigned services, with the provisos set out in clauses 4.2 and 4.3, in the cases and the conditions set out in this clause.

In general, the transfers will be made to centers or services located within the municipality of habitual or temporary residence or, if in this one does not exist the precise means, to the nearest municipality in which the Entity have the corresponding services or even the centre to which the patient has referred.

2.7.2 Non-urgent sanitary transport.

A) Content. The coverage of non-urgent health transport, with the requirements, conditions and limits set out in this clause, shall be addressed.

The non-urgent health transport consists of the displacement of sick or injured people who are not in urgent or emergency situations, and who, for exclusively clinical reasons, are unable to travel in the ordinary means of transport to a health centre for health care or at home after receiving the relevant health care, and which may or may not require health care during the journey. Non-urgent healthcare should be accessible to people with disabilities.

The portfolio of non-urgent sanitary transport services includes assisted health care, for the transfer of sick or injured persons requiring technical-health assistance en route, and for the non-assisted health transport, which is indicated for the special transfer of sick or injured persons who do not require technical-health assistance en route.

B) Move types. The non-urgent health transport, according to the origin and destination of the patient's transfer, as well as the frequency nature, includes the following types of transfers:

1. Periodic transfers of the patient from his home to health centres and/or transfer from the health centre to his home.

2. Timely transfer of the patient from home to health centres and/or transfer from a health centre to his home.

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

4. Transfer of a patient to his/her municipality of residence, either to his or her home or to another health centre, when he/she would have received urgent assistance in another municipality where he/she will be temporarily displaced, provided that his/her clinical situation does The use of health transport is required.

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

Health centers of origin and/or destination must be centers arranged with the Entity, or have been subject to specific authorization.

C) Indication criteria. The need for sanitary transport shall be justified by the written prescription of the appropriate practitioner who must assess both the health status and the degree of autonomy of the patient in order to be able to move in the means of transport ordinary, between your home and a healthcare facility, or vice versa, regardless of the health problem at the source.

The prescription of transport shall be considered justified provided that the patient meets at least one of the following two criteria:

1. Limitation for autonomous displacement and requiring third-party support.

2. Clinical situation of the patient preventing the use of ordinary means of transport.

D) Situations in which the patient may be accompanied. Whenever the clinical situation of the patient advises, it may be accompanied by the non-urgent health transport from the Entity.

For the indication of the companion the optional prescriber will assess whether the age or clinical situation of the patient requires it and will take particular account of the following circumstances:

1. Patients with a cognitive, sensory or psychic disability that limits their understanding and communication with the media during their transfer.

2. Patients who, due to the evolution of their disease, are at the time of the transfer in a situation of great physical or mental deterioration.

E) Reassessment of the need for health transport. In cases of periodic health care, such as hemodialysis, radiation therapy, rehabilitation, or others referred to in this Concert. the Entity may propose periodic reassessment of the patient by the physician responsible for the care to determine whether the medical causes or physical incapacity to justify the need for health transport are maintained or, otherwise, the means of ordinary transport may be used.

In this case, the Entity may suspend the health transportation, regardless of the duration or type of assistance being provided.

2.7.3 Transport in ordinary media.

A) Common transport types. It is considered as a means of ordinary transport, for the purposes of assistance provided for in the Concert, which is carried out by car, bus, railway or, if it comes from the island provinces or the cities of Ceuta or Melilla, by boat or aircraft.

B) Subpositions covered by the coverage. The beneficiary of the ISFAS shall be entitled to this type of transport in charge of the Entity, in the following cases:

1. Displacements motivated by the unavailability of the means required in the corresponding municipality, depending on the level of care in which it is framed, in accordance with the provisions of clause 3.2, so that the beneficiary is obliged to to move from the municipality in which it resides, on a temporary or permanent basis, to the nearest one where those are available.

When the transfer to a center located in a province other than that of residence would have occurred, due to the unavailability of means required in the corresponding care level, if no longer needed health transportation, shall address the costs arising from the movement of return in ordinary means of transport.

2. Travel to Level IV Services and Reference Services, referred to in clause 3.2.3, located in a municipality other than that of residence, where such services are not available in the municipality.

3. Travel to a municipality other than the municipality of residence for health care arising from an accident in service or occupational disease.

C) Valuation of shipments. Transfers shall always be valued at their cost, in normal or tourist class, on regular bus or rail transport lines or, if they are the island provinces or the cities of Ceuta and Melilla, by boat or plane, up to the the nearest municipality in which the Entity has the means to complete the required assistance. The benefit shall include the return transfer.

D) Transportation of the companion. The transport costs of an accompanying person shall be entitled to travel for the patient in the following cases:

1. Displacements of beneficiaries under the age of 15 years and in the case of the cities of Ceuta and Melilla and island provinces, under the age of 18.

2. Displacements of beneficiaries who credit a disability degree of more than 65%.

3. Movements of beneficiaries resident in the cities of Ceuta and Melilla and in the island provinces, when indicated by their responsible doctor, which will be demonstrated by the presentation of the written prescription of the optional.

2.8 Pharmaceutical and dietary products.

2.8.1 General Rules. The pharmaceutical supply comprises the medicines and medical devices, and the set of actions aimed at the patients receiving them in an appropriate manner to their clinical needs, in the precise doses according to their requirements individual, during the appropriate time period and at the lowest possible cost.

This benefit will be governed by the provisions of the recast text of the Law on the guarantees and rational use of medicines and medical devices, approved by Royal Legislative Decree 1/2015 of 24 July, and other provisions applicable.

For access to medicines under conditions other than those authorised, given their exceptional character, the provisions of Royal Decree 1015/2009 of 19 June, regulating the availability of medicinal products in the special situations.

The provision of dietetic products includes dietoterapic treatments for people suffering from certain congenital metabolic disorders and home enteral nutrition for patients who are not possible cover their nutritional needs, due to their clinical situation, with food for ordinary consumption.

2.8.2 Content.

A) In the case of patients treated in the non-hospital setting, the portfolio of services to be provided by the Entity includes the indication and prescription of the medicinal products and products included in the pharmaceutical supply and with National Health System dietetic products.

Such activities should be carried out by the professionals of the Entity in the official prescriptions of the ISFAS, identifying the active substance of the medicinal product or the generic name of the medical device, in accordance with the provided in the current regulations.

The entity will take all necessary measures to promote the Electronic Recipe System of Mutualism, through the participation of its faculty in the implementation and development of the same. Until they are put in place, and for manual prescriptions in paper format, they will require their doctors to include their mandatory minimum data in the completion of these prescriptions: name and two surnames, number of collegiate and province where exercise, by means of a seal to allow readability.

B) In the case of patients treated in hospital, the Portfolio of Services to be provided by the Entity includes the indication, prescription and dispensing of all pharmaceutical, sanitary and pharmaceutical products. Dietary requirements for patients who are being treated in this care setting (internment, day hospital, home hospitalization, emergency room, dialysis unit and other hospital-dependent units), with the specifications which are set out in clauses 2.8.3 and 2.8.4.

2.8.3 Medicines for outpatient treatments in charge of the Entity. The provision of the necessary medicinal products for the treatment of outpatients shall be provided by the Entity in the following cases:

(a) Qualified medicines such as Hospital Use, the supply of which is carried out through the Services of Hospital Pharmacy, as established in the Recast Text of the Law on Guarantees and the Rational Use of the medicines and medical devices, whatever their indications and/or conditions of use.

(b) Medicines not authorised in Spain, but marketed in other countries, the supply of which, in accordance with the applicable rules, must be carried out through Hospital Pharmacy Services, when their use of the hospital environment.

c) Drugs and pharmaceutical products financed in the National Health System, whether or not they have a seal, which, as established in the technical information sheet, require the intervention of medical practitioners. specialists, without prejudice to their dispensing through pharmacy offices.

d) The precise means, elements or pharmaceutical products for performing diagnostic and/or therapeutic techniques, such as contrast media, drastic or other laxatives.

2.8.4 Hospital Pharmacy Services in special cases. For the Pharmacy Services of the agreed hospital centers, the necessary medications for outpatient treatment of the ISFAS will be dispensed, in the following cases:

(a) Medicines which, without the qualification of hospital use, have established unique reserves in the field of the National Health System, consisting of limiting their supply to non-hospitalized patients in the the pharmacy services of the hospitals, so they are not equipped with a seal, and that for their administration do not require the express intervention of specialists, they will be dispensed to the beneficiary by the services of pharmacy -hospital, in accordance with the provisions of Article 102 of the recast of the Law of guarantees and rational use of medicinal products and medical devices.

These medicines will be invoiced for direct payment by the ISFAS, under the conditions laid down by the Ministry of Health Services and Equality, at the cost of selling the laboratory (PVL), plus taxes, financing for the National Health System, to which the amount of the beneficiary's contribution to be reflected in the invoice shall be deducted.

(b) The Hospital Diagnostic Medicines whose dispensation is expressly authorized by the ISFAS Delegation for the treatment of a particular patient, in view of the existence of difficulties for their dispensing in offices In the case of a pharmacy due to problems of supply or other problems, the beneficiary shall be exempted from the hospital pharmacy services after payment of the reduced contribution, in the same terms as in the previous paragraph.

These medicines will be invoiced for direct payment by the ISFAS, the public selling price (PVP), financing for the National Health System, deducting the amount of the beneficiary's contribution reflect on the invoice.

(c) Medicines under the responsibility of ISFAS which are subject to the "ceiling of expenditure" fixing by the Ministry of Health, Social Services and Equality shall be invoiced within one month from the date of their dispensing.

The ISFAS will refer to the Entity the information on these medications to move it to the own or concerted centers.

2.8.5 Rational use of the medicinal product. The entity shall encourage the participation of its faculty in all measures and activities established by the ISFAS for the improvement of the use of medicines and products whose dispensing is made through an official prescription, and will collaborate with This Institute shall be in the process of verifying the adequacy of individual prescriptions and the adoption of the corresponding control measures.

In the case of medicinal products subject to special conditions, the conditions and requirements laid down in Royal Decree 1015/2009 of 19 June, governing the availability of medicinal products in the special situations, for the access and use of these medicinal products.

In compliance with the provisions of Law 16/2003, of 28 May, of Cohesion and Quality of the National Health System, the Entity will promote the set of actions aimed at ensuring that the prescriptions of its physicians are at the precise doses, according to the individual requirements of the patients, during the appropriate period of time and at the lowest possible cost to them and the community.

Likewise, the Entity will encourage the rational use of the Drug, promoting the use of generic drugs among its physicians, as well as the prescription for active substance.

If, as a result of the analysis by the ISFAS of the data corresponding to the requirements, certain measures were considered appropriate in relation to the same, the Management of the ISFAS, prior to the report of the Joint Commission National, you may agree to do so for execution and compliance with the Entity, including the proposal for a reduction of an optional or service in the Service Catalog of the Entity for insured of the ISFAS.

2.8.6 Procedure for the impact of drug costs. If in the process of reviewing the billing of prescriptions issued by the ISFAS, prescriptions for medicinal products and medical devices made exceptionally in official ISFAS prescriptions will be detected, although they should have been in charge of the Entity, as provided for in this Agreement, the ISFAS shall carry out the corresponding discount on the monthly payment of the fees it has to pay to it, as provided for in clauses 7.2. and 7.3. of this Agreement, by transferring to the Entity a detailed communication of the requirements identified with the amount unit.

On the other hand, the Entity undertakes to reintegrate the beneficiaries who so request, within a period of not more than fifteen days from the request for reimbursement, the amount that they would have paid in the Office of Pharmacy for these medicinal products or medical devices, the presentation by the person concerned of the corresponding bill of the Pharmacy is sufficient for these purposes.

2.9 Healthcare products. Without prejudice to the obligations set out in other clauses of this Concert, they shall be responsible for the Entity, and provided by their means to the beneficiaries, the following medical devices:

(a) Home enteral nutrition administration systems, tracheotomy cannulas and laringuectomy and special vesical probes that are not available through the official ISFAS prescription, when such products have been duly indicated by an Entity specialist.

(b) Intrauterine devices (IUD) that have been prescribed by an Entity specialist, including intrauterine release systems (hormonal DIUs).

c) Reactive strips for the measurement in diabetic patients of glucose, glucosuria and combined glucose/ketone bodies, as well as the glucometro and the necessary lancets, according to the established criteria and standards for health administrations and scientific societies. In any case, the Entity shall provide those products which, in the opinion of the professional responsible for the indication or prescription, are best suited to the needs and abilities of the patient.

d) Local infusion pumps for parenteral administration of insulin and other drugs.

e) Fungible material, whether for parenteral administration of insulin or other antidiabetic drugs: insulin syringes and corresponding needles, needles for injectors, and preloaded systems Parenteral administration diabetics that lack them, as well as the fungible material of the insulin infusion pumps, bankable in the National Health System.

All of these products will be provided on the basis of diligence, proportionality and maximum care criteria for the patient.

In cases where, for reasons attributable to the Entity, the supply does not conform to these criteria, access to the products is provided through the reimbursement procedure.

2.10 Orthoprosthetic Prstation.

2.10.1 Surgical implants. Therapeutic surgical implants or accurate diagnoses shall be covered by the Entity, with such medical devices designed to be implanted in whole or in part in the human body by means of a a particular medical act or surgical intervention, which is included in the supply of orthopaedic products from the centres and services of the National Health System, in accordance with the indication of the assigned specialized services, including those implants submitted to monitoring studies approved by the Ministry of Health Services and Equality.

The renovation of the implants and any of its accessories, including the external ones, and the materials used to perform osteosynthesis techniques, will also be attended, running in charge of all the costs. associates.

OsteXX_ENCODE_CASE_CAPS_LOCK_Off-Integrated Implants For Dental Prostheses Are Excluded, Except For The Following Assumptions:

a) Patients with injuries resulting from an accident of service or professional illness.

b) Patients with cancer processes that affect the oral cavity and involve loss of teeth directly related to this pathology or its treatment.

c) Patients with congenital malformations who are in anodontic disease.

2.10.2 Outpatient Dispensing Orthoprosthetic Products. The indication or prescription of external prostheses and other medical devices included in the orthoprosthetic provision of the ISFAS, and of its timely renewal, shall be carried out by the corresponding specialists of the assigned services. under their supervision the adaptation of these products.

The adaptation of the products will also remain under the supervision of the specialist who has formulated the indication and, in the case of products requiring a specific adaptation to the patient of high complexity and of products The specialist must verify the adequacy of the product supplied with the prescription as well as the suitability of the adaptation, proposing, where appropriate, any modifications which it considers appropriate, which will be reflected in the document.

The entity will encourage the participation of its faculty in all measures and activities established by the ISFAS for the improvement of the use of the orthoprosthetic provision, and will collaborate with this Institute in the procedures to be initiated to verify the adequacy of individual prescriptions and the adoption of the corresponding control measures.

2.11 Other capabilities.

2.11.1 Oxygenotherapy and other respiratory therapies. Includes the coverage of any of the home respiratory therapy techniques served by the National Health System, when the circumstances of the patient so require, including the use of the liquid oxygen backpacks or Portable oxygen concentrators, pulsioximetry, aerosoltherapy and the supply of secretions vacuum cleaners.

Require the written prescription of an Entity specialist and prior authorization of the Entity.

2.11.2 Preventive Programs.

A) The Entity shall perform the actions established by the health regulations in the field of health prevention and promotion and facilitate the development of the following prevention actions, primary and secondary, as provided for in point 3.1 of Annex II to Royal Decree 1030/2006:

1. Vaccinations in all age groups and, where appropriate, risk groups, in accordance with the vaccination schedule of the National Health System, in the terms established by the competent health authorities, as well as any other programme or vaccination campaign to be determined by the health authorities.

2. Indication and administration, if any, of antibiotic chemoprophylaxis in contacts with infectious patients for infectious diseases that require them.

3. Activities to prevent the occurrence of diseases, acting on risk factors (primary prevention) or to detect them in presymptomatic phase by screening or early diagnosis (secondary prevention), including:

From breast cancer: screening with mammography every two years in women aged 50 to 69 years.

Cervical cancer: Pap smear in women aged 25-65 years. At the beginning, 2 cytologies with an annual frequency and then every 3-5 years, in accordance with the guidelines recommended by the Scientific Societies or the competent health authorities.

Colorectal cancer: Screening with blood-based determination in stool every two years in men and women aged 50 to 69 years.

In all cases, the assessment of individual risk including in the case of breast cancer and colorectal cancer, if appropriate, the conduct of study and genetic advice of persons who meet criteria of risk of family or hereditary cancer and, if confirmed, specific monitoring.

4. Neonatal screening of the following diseases: congenital hypothyroidism, phenylketonuria, cystic fibrosis, acyl coenzyme deficiency A dehydrogenated medium chain (MCADD), 3-hydroxy acyl-CoA long-chain dehydrogenase deficiency (LCHADD), type I glutaric acidaemia (GA-I) and sickle cell disease.

B) The Entity will facilitate the actions that correspond and will have the means necessary to carry out the aforementioned preventive programs included in the Portfolio of Services, guaranteeing the appropriate information to the beneficiaries, as well as the timetable, addresses and schedules of the centres where the vaccinations and prevention programmes will be carried out.

The entity shall send to the ISFAS Delegations the detailed relationship of the vaccination centers of the respective province with addresses, telephones, schedules and preventive programs that are included in them.

C) In cases where the Entity has not developed any of the specific programmes outlined in this clause, it must address the coverage of the actions undertaken to the beneficiaries under a programme of prevention developed by the relevant health administrations.

(D) The ISFAS may specifically inform its holders and beneficiaries and through the means that in each case it considers more appropriate on the desirability of carrying out certain preventive programs included in the Portfolio of Services.

2.11.3 Podestology. It comprises podiological care for insulin-dependent diabetic patients as well as for diagnosed patients with neuropathic foot of etiology other than diabetes.

The attention of the podiatrist requires medical prescription and prior authorization of 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 institution shall provide access to the techniques, technologies or procedures included in the common portfolio of services of the National Health System, subject to monitoring studies, of beneficiaries meeting the inclusion criteria established in the study protocol, as provided for in Order SSI/1356/2015 of 2 July 2015 amending Annexes II, III and VI to Royal Decree 1030/2006 of 15 September establishing the service portfolio National Health System common to the National Health System and the procedure for its updating, and the monitoring of techniques, technologies and procedures.

Only a technique, technology or procedure submitted to the monitoring study can be performed in the centers that have the authorization of the corresponding Autonomous Community. Where in the whole of the national territory the Entity does not have a concerted centre enabled for that purpose, it shall authorise and facilitate the transfer of the beneficiary to an approved centre and assume the associated costs.

CHAPTER 3

Entity Media

3.1 General rules.

3.1.1 To the effects provided for in Articles 14 of the recast of 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, it is considered that the means of the Entity are the services assigned to the health care of the beneficiaries assigned to it.

For the purposes of this Concert, the means of the Entity are as follows:

A) Healthcare personnel dependent on the Entity through a relationship of a working nature or linked to it by a civil relationship.

B) Centers and Services of the Entity or concerted by it under any legal regime.

C) Means that another Entity is available and that they are assigned, by subconcert with the Concerted Entity, to the ends of this Concert.

D) The Emergency Coordinator Center of the Entity accessible through a free and unique telephone for the entire national territory, available 24 hours every day a year, which will channel the demand for emergency and health emergencies, ensuring the accessibility and coordination of the resources available for this type of care.

E) Primary care and emergency services of the Public Health Network, which are taken on behalf of the Entity, as provided for in Annex 1, are assimilated to the means of the Entity.

3.1.2 The Entity will be able to coordinate its health emergency devices with other emergency and emergency coordinators, including those dependent on other health administrations.

3.1.3 The Entity must provide the necessary means (postal or electronic mail, telephone, fax, web page, etc.) so that the beneficiary can carry out the communications provided for in the Concert, in a feisty manner, during 24 hours of the day, every day of the year, and which permit the constancy of such communications.

3.1.4 The means of the Entity must comply with the requirements established in general by the health regulations in force, under the supervision that, with the same character, can proceed by the Health Administration competent.

The establishments and services shall be duly authorised in accordance with the provisions of Royal Decree 1277/2003 of 10 October 2003 laying down the general bases for the approval of centres, health services and establishments, in the existing regional regulations and, where appropriate, in the specific rules governing their activity.

Healthcare professionals should be entitled to the regulations laid down in Law 44/2003 of 21 November, of management of the health professions, and be collegial according to the rules to this effect. establish the corresponding Collegial Organization. The Entity must have registered and updated the number of collegias of each professional included in its service catalogue.

If the ISFAS is aware of the possible non-compliance with these general requirements, it will be brought to the attention of the competent health authority.

3.1.5 The Entity shall ensure that all the means which it records in its catalogue of services shall have access to electronic means sufficient to be integrated into the actions referred to in clause 5.2, as well as in other programmes and actions leading to the improvement of health and care quality.

3.1.6 The Entity will facilitate access to the centers and services included in the Services Catalogues, so that the ISFAS can check the adequacy of the institution's means regarding the offer of services performed.

3.2 Media availability criteria and care services.

3.2.1 Media availability for Primary Care.

A) In all municipalities of the national territory, access to Primary Care services shall be provided, comprising assistance on an outpatient, home and emergency basis, taking into account the following:

In the municipalities of up to 5,000 inhabitants, there will be a general or family doctor and a graduate or graduate in nursing.

In the municipalities of more than 5,000 inhabitants, pediatrics will also be available.

In the municipalities of more than 10,000 inhabitants, access to dental and physical therapy services will also be provided and at least two general or family doctors will be available.

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

In the municipalities of more than 100,000 inhabitants, primary care services will be available in all the postal districts or, failing that, in another border. In any case, the beneficiaries ' access to the home care shall be guaranteed by the relevant medical practitioners.

B) Primary Emergency Care will be provided on an ongoing basis, 24 hours a day, through medical and nursing care on an outpatient and home basis.

If, exceptionally, the Entity does not have its own or concerted means, it must guarantee the coverage of the assistance by other private services that exist in the same municipality or, if not, by the corresponding public services.

C) As a criterion for the provision of this clause, it shall be taken into account that, in the rural areas expressly provided for in the Conventions referred to in Annex 1 to the Convention, and with the scope and content of the the health care at the outpatient, home or emergency level in charge of the general practitioner or the family, order, diploma or graduate in nursing will be provided by the primary and secondary care services. urgencies of the Public Health Network.

In any case, according to the forecast contained in clause 3.7, in the municipalities affected by the aforementioned Conventions, the holders and beneficiaries will be able to choose the means available to the Entity in the municipalities. next.

(D) In the municipalities of less than 20,000 inhabitants belonging to Autonomous Communities with which no cooperation agreements provided for in the previous point have been formalised or are only intended for assistance (a) health emergency, and where the entity does not have its own or concerted means, and where there is no private means, it shall facilitate the access of the mutualists and beneficiaries to the primary care services dependent on the corresponding Autonomous Community, both for ordinary and urgent assistance, assuming directly the expenses that can be billed.

3.2.2 Availability of Specialized Care Services. The Specialized Care will be dispensed in the municipalities from 20,000 inhabitants and with more than 70 resident beneficiaries, unless they are included in some group.

The Services of Specialized Care are structured in four levels that are defined according to general population criteria, number of beneficiaries resident in the corresponding geographical area, health resources existing, as well as the distance and time of travel to the urban centres where there is a greater availability of private health resources.

To optimize the supply of services, we set up clusters of municipalities that meet at the corresponding level, depending on the number of beneficiaries residing in the group and the population of the largest municipality of the population of the whole of their municipalities, not taking into account these effects, the population of all their municipalities.

Each Level of Specialized Care includes all the specialties and services corresponding to the lower levels, in addition to the corresponding Primary Care Services according to the clause 3.2.1.

A) Level I of Specialized Care.

1. Municipalities and groups of municipalities. Included in Level I are the municipalities of 20,000 to 30,000 inhabitants with a collective protected by the ISFAS of more than 70 beneficiaries, the municipalities of 30,000 to 70,000 inhabitants located at a distance equal to or less than 15 km from another of the III, and all municipalities with more than 30,000 inhabitants, where the ISFAS collective is less than 170, unless they are included in a cluster of municipalities.

Annex 8 includes the relationship of municipalities and Level I clusters.

For the purpose of optimizing the availability of private means, some municipalities are grouped, considering the offer of the services required at this level in any of the municipalities included in some of the following pools:

	Level I municipality
Alicante.	Campello, El/Mutxamel.
	Sant Joan d' Alacant/Sant Vicente de Raspeig.
Barcelona.	Stud/Martorell/Olessa de Monserrat.
	Andreu de la Barca/Molins de Rei/Sant Vicenc dels Horts.
	Vic/Manlleu.
Bizcay.	Basauri/Sestao.
	Portugalete/Santurzi.
Benicar/Vinar_body.
Girona.	Blanes/Lloret de Mar.
Tarragona.	Salou/Vila Dry.
	Tortosa/Amposta.
	Valencia.	Alaquas/Aldaia/Xirivella.
		Burjassot/Mislata/Paterna.
		Lliria/Pobla de Valbona.
		Manises/Quart de Poblet.

In these municipalities, at least the following specialized services for outpatient care will be available:

Level I

02	Pediatrics.
04	Clinical analysis (extraction centers).
31	Obstetrics and Gynecology. Includes ultrasound.
32	Ophthalmology.
40	Orthopaedic and trauma surgery.
42	Stomatology/dentistry.

In addition, this Level will be available as a Physiotherapist, Podologo, and Matron.

Urgency services assistance will be provided in accordance with the forecasts contained in clause 2.4.

B) Level II specialized care.

2. Municipalities and clusters of municipalities.

The municipalities of 30,000 to 70,000 inhabitants located at a distance greater than 15 km from a municipality of Level III and the municipalities of more than 70,000 inhabitants with a collective are included in the Level II of Specialized Care. of ISFAS equal to or greater than 170 and less than 1,300, unless they are included in any grouping.

In Annex 9, the ratio of Tier II municipalities is included.

For the purpose of optimizing the availability of private means, with the general criteria indicated, some municipalities are grouped by geographical proximity and ease of transport, considering the offer of the services required at this level in any of the municipalities included in any of the following groupings:

Elche/Aspe/Crevilent/Novelda/Santa Pola.

	Level II Municipalities
A Coruña.	Santiago de Compostela/Ames.
Alicante.	Alcoy/Ibi.
	Benidorm/Alfas del Pi/Altea/Calp/Villajoyosa.
	Elda/Petrer/Village.
Almeria.	Mar/Vicar Roquettes.
Asturias.	Badajoz.
Badajoz.		.
	Barcelona.		Barcelona.	Barcelona.	Badalona/Santa Coloma de Gramanet/Sant Adria de Besos.
Barbera del Valles/Cerdenyola del Valles/Ripollet.
Castelldefels/Gava/Viladecans.
Granollers/Mollet del Valles/Moncada i Reixac.
Hospitalet de Llobregat/Cornella de Llobregat/Sant Boi de Llobregat.
		Feliu de Llobregat/Sant Joan Despi/El Prat de Llobregat/Esplugues de Llobregat.
Sant Cugat del Valles/Terrassa/Rubi.
Barcelona Tarragona.	Vilanova i la Geltru/El Vendrell.
Bizkaia.	.
	Cadiz.
Córdoba.	Lucena/Genil Bridge.
Illes Balears.
	(Ibiza Island)- Eivissa/Santa Eulalia de Rio/Sant Josep de sa Talaia/Sant Antoni de Portmany.
Palmas.	(Isla de Fuerteventura)-Puerto del Rosario/La Oliva.
	(Isla de Gran Canaria)-San Bartolomé Tirajana/Santa Lucia de Tirajana.
(Isla de Gran Canaria)-Telde/Aguimes/Ingenio.
Madrid.	Alcobendas/San Sebastian de los Reyes/Algete.
	Arganda del Rey/Rivas Vaciamadrid/Enhanced Field
	Colmenar Old/Three Cantos.
	Colside Villalba/Galagagar/Torrelodones.
	Coslada/San Fernando de Henares.
Getafe/Parla.
Malaga.
	Benalmadena/Torremolinos
Marbella/Fuengirol/Mijas.
Rincon Victoria/Velez-Malaga.
	Murcia.	Cieza/Molina de Segura/Las Torres de Cotillas.
		.
.
Seville.	Seville.	Seville. Guadaira/Dos Sisters/Los Palacios and Villafranca.
Tarragona.	Cambrils/Reus.
Tenerife.	(Tenerife Island) Arona/Adeje/Granadilla de Abona.
	(Isla de Tenerife) La Orotava/Puerto de la Cruz/Los Realejos.
	Valencia.	Alzira/Carcaixent.
		Ganday/Oliva.

3. Services for specialized outpatient care.

In the municipalities and clusters of municipalities of Level II, in addition to the services corresponding to Level I, the following specialized care services will be available for outpatient care:

Level II

08	Aparate digestive.
09	Cardiology.
11	General and digestive system body.
17
Conventional Radiology
	Mamography.
	TAC.
	Ecography.
24	Internal Medicine.
35	Otorhinolaryngology.
37	Physical medicine and rehabilitation.
				43
Hospital Pharmacy.
		Psychology.

At this Level II, a minimum of two physicians should be available with care in outpatient consultation. In the field of Clinical Analysis, at least two points of extraction and sampling shall be available.

4. Services for non-urgent or scheduled hospital specialized care. In all those municipalities or clusters of municipalities where there are private general hospital facilities, the availability of specialized care services corresponding to this level will be required for any care system. In addition, access to the services of Anesthesiology and Resuscitation and Intensive Medicine (ICU) will be facilitated if they are accurate for the care of hospitalized patients.

However, the offer of the Entity will be considered valid when the Hospital concluded is located in another municipality at a distance of less than 25 kilometers from the urban core or from the most distant municipality in the case of cluster of municipalities.

5. Emergency services. Emergency service assistance shall be provided in accordance with the provisions set out in clause 2.4, so that access to emergency care services should be provided in all the municipalities under this Level.

In municipalities or clusters of level II municipalities, access to hospital emergency services will be facilitated through the available centres.

If there are no agreed centres in the municipality in which the beneficiary is found to require assistance or in another located less than 15 kilometres, access to the emergency services of the centres will be facilitated. private persons in the same municipality and the Entity shall assume, where appropriate, the corresponding income or stays that may be derived from such hospital emergencies.

Only in default of the above criteria, if in the corresponding municipality there exists a public hospital center will be attended the coverage of the assistance for its emergency service, although, in case of need of income hospital, the patient must be transferred to a concerted center, provided his or her clinical status permits.

The hospital emergency services will have to have physicians of physical presence for the specialties of Anesthesiology and Resuscitation, General Surgery and the Digestive System, Orthopedic Surgery and Traumatology, Gynecology and Obstetrics, Internal Medicine and Pediatrics. In addition, Clinical Analysis and Radiodiagnostic services will be available. However, if the guard is located, the availability of the same should be ensured, once they are required by the Emergency Doctor, as soon as possible according to the patient's pathology and clinical condition, which will not be possible. may be in no case greater than 30 minutes.

C) Level III of Specialized Care.

1. Municipalities and groups of municipalities. Included in Level III are all provincial capitals, the cities of Ceuta and Melilla. In addition, more than 70,000 inhabitants are included in this level, with private hospital infrastructures and in which more than 1,300 ISFAS beneficiaries reside, regardless of the modality they are assigned to.

For the purpose of optimizing the availability of private means, some groups of municipalities are formed, due to geographical proximity and ease of transport, in which at least one of the municipalities complies with the criteria mentioned in the previous paragraph, considering that the offer of the services required at this level in any of the municipalities included in the corresponding pool is valid.

According to the above criteria, all the provincial capitals, the cities of Ceuta and Melilla are included in Level III and, in addition, the following municipalities and groups of municipalities:

Province	Level III municipalities and
Asturias.
A Coruña.	Ferrol/Naron.
Cadiz.	Algeciras/The Line Conception/Los Barrios.
	Cadiz/San Fernando.
	de la Frontera/Puerto de Santa Maria (El).
Leon.	Leon/San Andres del Rabanedo.
Madrid.	Alcala de Henares/Torrejon de Ardoz.
	Boadilla of Mount/Majadahonda/Las Rozas.
Murcia.	Cartagena.
Pontevedra.	Vigo.

2. Outpatient and inpatient services. At this level, in addition to the services required in Level II, the following services will be available for outpatient care, in hospital day, in hospital detention system and in Hospitalization Units. Home:

III
03	Alergology.
	Angiology and vascular surgery.
08	Digestial Apparatus: Copy.
09	Cardiology: Cardiac Electrophysiology/Pacemaker.
	16	Medical-surgical Dermatology and Venereology.
17	Diagnostics.
	RNM.
	18	Endocrinology and nutrition
Hematology and haemotherapy: Hospital of the day
23	Intensive medicine. Pediatric intensive care
25	Nuclear medicine: Gammagrafia and Radioisotopes.
26	Nephrology. Hemodialysis. Peritoneal dialysis
	Pneumonia. Bronchoscopy.
29	Clinical Neurophysiology. EEG, EMG, Sleep Unit.
30	Neurology.
31
prenatal diagnosis
	33
Medical Oncology: Hospital of Day
36	Psychiatry. Detox Unit, Power Disorders Unit.
37	Physical medicine and rehabilitation
	Physical Therapy.
	Occupational Therapy.
	Attention Unit early
	Logopedia.
38		41
Urology. Endoscopy. Lithotricia. Vasectomy
	43	Hospital Pharmacy
47	Palliative Care. Home support, hospital care. UHD

At this level there will be a minimum of three physicians with care in outpatient consultation in the following specialties: Cardiology, General Surgery and the Digestive System, Obstetrics and Gynecology Ophthalmology, Medical Oncology and Orthopaedic Citugia and Traumatology. In the rest of the specialties, at least two optional facilities shall be available.

In the area of Clinical Analysis, at least three points of extraction and collection of samples must be available.

In case of hospitalization the offer of the Entity will be considered valid when the hospital offered is located in another municipality, provided that the hospital is at a distance of less than 20 kilometers from the urban core, or from the in the case of clusters of municipalities and in that municipality, the availability of a hospital is not to be required.

3. Services for non-urgent or scheduled hospital specialized care. In all municipalities or groups of municipalities, the availability of specialized care services corresponding to this level will be required for any hospital care system. In addition, access to the services of Pathology, Anesthesiology and Resuscitation and Intensive Medicine (ICU), in the hospital environment, will be facilitated.

4. Emergency services. Assistance for emergency services shall be provided in accordance with the provisions set out in clause 2.4, taking into account that, in all municipalities and groups of municipalities located at this level, in addition to the services provided for Access to hospital emergency services should be provided.

In the municipalities or clusters of Level III municipalities, access to hospital emergency services will be facilitated through the available centres.

In case of no concerted centres in the municipality or group of municipalities in which the beneficiary is located, access to the emergency services of the private centres will be facilitated. exist in the same municipality and the Entity shall assume, where appropriate, the corresponding income or stays that may be derived from such hospital emergencies.

Only in default of the above criteria, if in the corresponding municipality there exists a public hospital center will be attended the coverage of the assistance for its emergency service, although, in case of need of income The patient must be transferred to a concerted centre, provided that his clinical condition permits and the hospital offer is valid, taking into account the provisions of the previous paragraph.

Hospital emergency services will have the specialties of Anesthesiology and Resuscitation, Cardiology, General and Digestive System Surgery, Orthopedic Surgery and Traumatology, Gynecology and Obstetrics, Hematology and Hemotherapy, Intensive Care Medicine (ICU), Internal Medicine, Ophthalmology, Otorhinolaryngology, Pediatrics, Psychiatry and Urology with physical presence. In addition, Clinical Analysis and Radiodiagnostic services will be available. If the guard is located, the availability of the appropriate specialists must be guaranteed, once they are required by the Emergency Doctor, as soon as possible according to the patient's pathology and clinical condition, the time limit which may not be more than 30 minutes.

D) Level IV specialized care. The specialized care services included in this Level are the following:

Level IV. Services and units of special complexity

10	Cardiovascular surgery.
12	Oral and maxillofacial surgery.
13	Paediatric surgery.
14	Plastic, aesthetic, and repairer.
15	thoracic surgery.
17
Nuclear Medicine: Diagnostics and Therapeutics. PET. PET-TAC.
28	Neurosurgery.
29	Neurophysiology: Evoked Potentials
31	Obstetrics and Gynecology: Assisted Reproduction Units.
34	Radioterapic Oncology. Radiosurgery

Other multidisciplinary services:

complex treatments: Surgery with curative intent of pancreatic cancer. Surgery of liver metastases. Combined Cancer Surgery of the pelvic organs.

Brain Damage Unit.

spinal injury unit

The level of complexity of the techniques and procedures applied in these specialized services, they require to optimize them under quality and safety criteria, concentrating the attention of patients in a reduced number of centres and units with due experience, in order to ensure quality, safety and efficiency of care.

Assistance will be provided for care in outpatient care, in hospital day or in hospital detention or through the hospital emergency services in which the entity will have to dispose of the specialties of Angiology and Vascular Surgery, Digestive System, Cardiovascular Surgery, Maxillofacial Surgery, Pediatric Surgery, Nephrology, Neurosurgery, Neurology, in addition to those foreseen for Level III. If the guard is located, the availability of the appropriate specialists must be guaranteed, once they are required by the Emergency Doctor, as soon as possible according to the patient's pathology and clinical condition, the time limit which may not be more than 30 minutes.

Level IV services and units shall be available in each Autonomous Community or, failing that, in an Autonomous Community bordering on that in which the beneficiary resides.

Taking into account the availability criteria identified, in the corresponding Autonomous Community Level IV services to be offered will be located the following large municipalities in which, in any case, will be available of all the services corresponding to Level III of Specialized Care:

Asturias.

Extremadura.

Autonomous Community	Municipalities
Andalusia.	Córdoba.
	Granada.
	Malaga.
	Seville.
	Aragon.	Asturias.
Illes Balears.	Palma de Mallorca.
Canary.	The Palms GC.
	Santa Cruz de Tenerife.
	Cantabria.	Santander.
Castilla y Leon.	Valladolid.
Castilla La Mancha.	Albacete.
Catalonia.	Barcelona.
Valencian Community.	Valencia.
Badajoz.
Galicia.	A Coruña.
	.
La Rioja.	Logon.
Madrid.
Region of Murcia.	Murcia.
.	Pamplona.
Basque Country.	Bilbao.

In the municipalities of Madrid and Barcelona, the availability of all Level IV Services and a Hospital with teaching accreditation for the Specialized Medical Training will always be guaranteed.

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

Media and service availability criteria

Services

Otorhinolaryngology.

Ecography.

pancreatic ac healing surgery.

Services and units	Level I	Level II	Level III	Level IV
Alergology.	Alergology.
Clinical Analysis.	Clinical Analysis.
	Cytogenetics.
Pathology Anatomy.	Anatomy Pathological (Hospital).
Anesthesia and Resuscitation/URPA.	Anesthesia and Resuscitation URPA.
Angiology and Vascular Surgery.	Angiology and Vascular Surgery.
Digestive Appliance.	Digestive System.
	.
Cardiology.	Cardiology.
	Electrophysiology/Pacemaker.
		implantable defibrillator.
	Abblation/Cardioversion.
		Hemodynamic.
Cardiovascular Surgery.	Cardiovascular Surgery.
General and Digestive Ap.	Surgery. General and Digestive Ap.
	and Maxillofacial Surgery.	Oral and Maxillofacial Surgery.
Orthopaedic and Traumatology Surgery.	Orthopaedic and Traumatology Surgery.
Surgery.	Pediatric Surgery.
and Repairing Surgery	Plastic and Repairing Surgery.
Toracic Surgery.	Toracic Surgery.
-Surgical Dermatology.	Medical-Surgical Dermatology.
Endocrinology and Nutrition.	Endocrinology and Nutrition.
Gynecology and Obstetrics.	Obstetrics and Gynecology.
	Gynecological Ecography.
		IVE.
	prenatal diagnosis.
Hematology and Hemotherapy.	Hematology/Hospital Day.
	Hemotherapy (Hospital).
Medicine and Rehabilitation.	General physical therapy.
	Medicine and Rehabilitation.
	Logopedia.
	Cardiac Rehabilitation.
	Pelvic Floor Rehabilitation.
Therapy.
Intensive Medicine/ICU.	Intensive Medicine/ICU.
Medicine.	Internal Medicine.
Nuclear Medicine.	Radioisotopes/Gammagrafia.
	PET-TAC.
Nephrology.	Nephrology.
	Hemodialysis, peritoneal Dialysis.
Neumology.
Neurosurgery.	Neurosurgery.
Neurophysiology.	Clinical Neurophysiology.
	evoked Potentials.
	Unit.
Neurology.	Neurology.
ophthalmology.	Ophthalmology.
Oncology.	Medical Oncology (Day Hospital).
Radioterapica.	Radioterapic Oncology.
.	Pediatrics.
Psychiatry.
.	Conventional Radiology.
	Mamography.
		RNM.
	Densitometry.
Interventional Radiology.
Rheumatology.	Rheumatology.
Urology.	Urology.
	Litotricia.
	Laser.
Palliative Care.	Home Support Teams.
	palliative care unit Hospitals.
Multidisciplinary Units.
	Unit of Injured Medulars.
	Brain Damage Unit.
	Unit of Burns.
	Esophageal Ca's healing surgery.
pelvic organ surgery.
Organ, tissue, and cell transplantation.

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

To do this, the Entity will facilitate access to the Servants and Reference Units designated by the Ministry of Health, Social Services and Equality, with the agreement of the Interterritorial Council.

The follow-up of the patient will be carried out by the services included in the Service Catalog, in accordance with the guidelines of the corresponding service or reference unit of the National Health System.

3.3 Special conditions for the islands of the Balearic and Canary Islands.

3.3.1 The Entity will count on the islands of the Balearic and Canary Islands with sufficient and stable means to provide health care.

For the purpose of assessing the requirements of availability of means for the provision of Primary Care, the population of each municipality will be taken as a reference, while for the provision of specialized care it will be taken as reference to the population of each island.

In the non-capitol islands the access of the beneficiaries to the hospital emergency services established for the Level II of the Specialized Care must be provided.

3.3.2 In the following tables, the islands of each archipelago are related to the level and modality of Specialized Care that each correspond.

Illes Balears

Island	Specialized Attention Level	External Queries	Hospitalization (*)	Hospital
Mallorca.	Level IV	X	X	X
Eivissa.	Level II	X	X	X
Menorca.	Level II	X	X	X	X
Formentera.				X

Canary Islands

The Palm.

Island	Specialized Attention Level	External Queries	Hospitalization (*)	Hospital
Gran Canaria.	Level IV	X	X	X
.	Level II	X	X	X
Fuerteventura.	Level II	X	X	X	X
Tenerife.	Level IV	X	X	X
Level II	X	X	X
The Gomera.				X
The Iron.				X

(*) The specialties in hospitalization in the Level II of the Specialized Care are the following: Clinical Analysis, Pathological Anatomy, Anesthesia Resuscitation/UrPA, Digestive System, Cardiology, General Surgery and Digestive System, Orthopedic Surgery and Traumatology, Pharmacy, Gynecology and Obstetrics, Hemotherapy, Physical Medicine and Rehabilitation, Internal Medicine, Ophthalmology, Otorhinolaryngology, Pediatrics and Radiodiagnosis.

3.3.3 Without prejudice to the general criteria set out in clause 2.7, the Entity shall in all cases assume the costs of interisland travel for assistance to Level III specialties, unless it has the means agreed to provide the assistance required on the island where the beneficiary is located. In the case of Formentera, La Gomera and El Hierro, the costs of inter-island displacement for assistance to Level II specialties will also be considered.

3.3.4 In case of non-existence of the means required on each island, the Entity shall guarantee the assistance on the nearest island which has the same, and must assume the travel expenses.

3.3.5 Level IV, if it is not available in the corresponding Autonomous Community, will be given in the one that is closest to the time of travel, and the entity must assume the offset.

3.3.6 In case the patient requires accompanying, the travel expenses of the companion will be borne by the Entity. To this end, the report of the optional on which the need is justified shall be provided to the Entity.

3.3.7 In the islands to which the Level II of the Specialized Attention corresponds, unless one of its municipalities is listed in the table in Annex 9, if the Entity does not have a concerted hospital, but there is a private hospital, is obliged to provide in this center (including all the specialties available in the same) the health care, in the regime of external consultations and hospitalization, as well as the assistance in hospital emergencies.

3.4 Media accessibility guarantee. The Entity must ensure access to the means that the Services Portfolio requires in each level of care in the terms set forth in this Chapter, unless there are no private or public means, in which case it shall facilitate them in the nearest municipality where they are available.

If the means required at each level of care are not available, the Entity is obliged to facilitate the access of the beneficiaries to other private services that exist in the same municipality or, in the absence of these, to the corresponding public services, directly assuming the expenses that could be invoiced.

3.5 Rules and Requirements for the Use of Entity Media.

3.5.1 General Rule. The holders and beneficiaries will receive the assistance they require through the means of the Entity defined in clause 3.1.1 and they will be able to freely choose optional and center from among those listed in the Catalogues of Services of the Entity in the entire national territory.

The beneficiary will be directly directed to the optional Primary and Specialized Care, to receive the assistance that he needs, without further requirement to prove his/her condition and to present the corresponding card health, without prejudice to the provisions of clause 1.7.3.

For the performance of diagnostic and treatment techniques and procedures, the prescription of the optional Service Catalog will be required.

Chapter 2 lays down the general conditions and conditions for access to services and services included in the service portfolio, and the additional requirements provided for in the clause must be taken into account. 3.5.3.

3.5.2 Identification. The beneficiary must prove his/her condition and his/her right to assistance, by presenting the individual health card that will be provided by the Entity in accordance with the provisions of clause 1.7, the corresponding Affiliate Document to ISFAS.

In cases where, for reasons of urgency, it is not possible to provide in the act the above documentation, the holder or beneficiary must identify with his identity card or other document that accredits his personality and present the document. documentation within the maximum period of 48 hours.

3.5.3 Additional requirements.

A) In the cases expressly provided for in this Concert, the Entity may require additional requirements, such as medical prescription or prior authorization of the Entity.

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

B) Unauthorised tests may not be carried out from the beneficiary if he has not been informed prior to the need for such prior authorisation or, in the case of medical or surgical acts carried out at the time of the query, when there is no time to obtain your authorization by the Entity.

C) The request for authorization of a given diagnostic or therapeutic means derives from the need to order and channel the benefits by the Entity, to facilitate the service and avoid delays, but never can assume a restriction on access to the recognized capabilities in the Services Portfolio.

(D) Annex 2 contains a comprehensive relationship, with the relevant specifications, of the assumptions of use of the means which require prior authorisation of the Entity, as well as the procedure for obtaining it.

E) In no case shall a request for a diagnostic or therapeutic means included in the Portfolio of Services established in this Concert be refused, indicated by a healthcare professional of the Entity.

F) For access to Level IV services and reference services, provided for in clause 3.2.3 and to medical consultants, the prescription of another optional specialist and the authorization of the Entity will be required.

3.5.4 Non-concerted private hospitals. Access to services in non-concerted private centres as provided for in clause 3.2.2.B. 3) shall require prior authorisation of the Entity in accordance with clause 2.3.3.B).

3.6 Service Catalog of the entity.

3.6.1 General criteria. The Entity's Services Catalog contains the detailed relationship of the Entity's means and the information necessary for its proper use by the holders and beneficiaries.

In the Service Catalogue, all the optional and/or own assistance centres and centres provided by the Entity which have been offered and are in the database provided for the subscription of the service will be included without exclusions. Concert, as set out in Annex 5.

In the Service Catalog, all the appropriate or concerted assistance means must be included that the Entity offers for the assistance of the collective of other Mutualities of officials with whom it maintains Health Care, considering all the assigned services effects for the assistance of the beneficiaries assigned to the Entity.

The entity may determine that in its medical picture, certain optional consultants appear as consultants for specific and complex areas of its specialty, provided that, for that specialty, it has no specialists. consultants.

When a holder or beneficiary is cared for by a professional who is part of the team of an optional or concluded service included in the Service Catalog, it shall be understood as part of the means of the Entity and it shall be included as soon as possible in the register of health professionals provided for in clauses 3.6.6 and 5.1.5 and in Annex 5, as well as on the website of the Entity.

The Entity will edit the catalog according to the instructions detailed in clause 3.6.2 that will have, both on paper and in electronic support, a common format of mandatory compliance, to ensure homogeneity between the catalogues of the various concerted entities.

The Services Catalogues may be directed, in addition to the beneficiaries of the ISFAS, also to the collectives belonging to MUFACE and MUGEJU. They shall not include advertising or advertising messages or information relating to other products or services of the Entity.

In the Subdirection of Pristations of the ISFAS will be delivered the catalogues in electronic format and two copies in paper of each provincial catalogue, and in the Provincial Services, in addition to the electronic format of the respective catalogue, at least five paper copies will be delivered.

When it is detected that any Catalog is not identified with the corporate image of the Entity or in its elaboration it has not been addressed to the common format of mandatory compliance set out in clause 3.6.2. the ISFAS will communicate this non-compliance with the Entity, which shall have a period of ten calendar days to remedy the defects detected and to deliver in the relevant Delegations and the ISFAS Central Services the new edition of the Catalogue in the format and with the number of copies required for you.

3.6.2 Structure and content. The Services Catalogues will be of provincial scope. Its content shall be equivalent to that included in the health media register provided for in clauses 3.6.6 and 5.1.5 and in Annex 5, provided by the Entity.

The catalogs of each province, both in paper format and in computer support, will be structured as follows:

A) The cover must include the logo of the ISFAS (or the one of each of the Mutualities of Officials) and the one of the Entity, as well as the free and unique telephone of the Center for Emergency and Emergency of the Entity prominently.

B) On the first page the data relating to:

1. Telephone of the Emergency and Emergency Coordinating Center of the Entity.

2. Entity Information Phone.

3. Fax number or other system for authorizations.

4. Web page of the Entity.

5. Address, telephones and operating hours of the provincial delegation of the Entity, as well as the existing office/s in the province for the in-person care of the beneficiaries.

C) In the right margin of the header of each page, the telephone of the Emergency and Emergency Coordinator Center of the Entity must appear.

D) From the second page, the addresses of the hospital emergency centers throughout the province must be included, which in the case of the island provinces will be detailed for each island.

E) General Index of the Catalog.

F) General information and rules of use established in the Concert.

A summary of the most relevant usage rights and rules collected in the Concert will be included, which in no case replace the content of this one.

The minimum information to be included in this section will be structured and ordered according to the following headings:

1. Identification for access to the agreed media/health card.

2. Rules for the use of the means of the Entity, including the free choice of optional and concerted centre, and the relation of services that require prior authorization of the Entity and method of obtaining.

3. Specifications for certain services: home care. assistance in the treatment of hospitalisation, including day and home hospitalisation.

4. Transport for health care. Modalities and requirements for their use.

5. Guarantee of accessibility to the media.

6. Use of non-concerted media.

7. Vital urgent assistance.

8. Precise instructions for the use of the Primary Care Services of the Public System in the Rural Environment, in outpatient, home and emergency conditions, in the terms provided for in the Conventions signed with the Health Services of the Autonomous Communities or, where applicable, where no Conventions have been formalised.

The detailed list of the municipalities affected by this Convention at the provincial level shall be included in the Annex.

9. Information on health care in the event of an accident when there is a third party liable for payment (traffic accidents, federated sportsmen, etc.)

10. Services which, in each municipality, offer the Entity above the requirements established in the Concert, which will constitute its differentiated offer of services, as an element to facilitate the choice of Entity by the holders.

G) Medical table.

1. Health professionals and centres will be linked by municipalities, starting with the provincial capital, which will be followed by the rest of the municipalities in alphabetical order.

2. All professionals, centres and functional units must appear in relation to their identification data (first and last names), and the address, telephone and working hours must also be included.

3. For each municipality, the resources available for the Emergency Care, after the Primary Care, and then those corresponding to the Specialized Care, will be related first:

4. Urgent attention: the available hospital and hospital services, as well as the ambulance services, will be related.

5. Primary Care: In each municipality, the available means will be related as follows:

a) General or family medicine.

b) Pediatrics.

c) Nursing.

d) Matrons.

e) Physical Therapy.

f) Odontology-Stomatology.

g) Podology.

In the case of municipalities of Level IV, for each of the types or modalities of assistance, the resources shall be grouped by postal codes, and, in all cases, sorted alphabetically by the first surname of the professional.

If in any of the municipalities there is no concerted resource in Primary Care, it will be stated, if necessary, its attachment to the agreement of rural environment with the corresponding public system, with expression of if only for In addition, the address of the Health Center or the Point of Continuing Care (PAC) corresponding to the municipality must also be included.

6. Specialised attention: first, external or outpatient consultations shall be related, specifying, where appropriate, the subspecialty or functional unit, in accordance with the alphabetical order of the official name of the specialty and then, if they exist, those referred to in the case of specialist assistance under hospitalisation. In all cases, sorted alphabetically by the first name of the professional.

In the municipalities of Level IV, the healthcare professionals in each specialty could, in turn, be grouped by postal codes or, where appropriate, by the name of the hospital.

When in the territorial area of a province, the Entity is not obliged to have services of Level IV of Specialized Attention, in the corresponding Catalogue the means of that to this end will be indicated Entity in the territorial scope of the Autonomous Community to which the province belongs.

In each Provincial Service Catalog, Level IV Services must be separately related.

In the Island Provinces, the resources will have to be included in the Catalogues differentiated by the Islands, with the capital in the first place. Within each island, the main urban core will be placed first and then the rest of the municipalities or localities in alphabetical order.

H) Relation of information services, emergencies and ambulances available in the other provinces, in order to facilitate their use in the event of the displacement of the beneficiaries.

I) Portfolio of Care Services Specialized in hospital care. It will include the tables with the means by levels of specialized care offered, broken down by hospitalization and hospital emergency, indicating the name of the hospital and the municipality in which it is located.

J) Index of facultative in alphabetical order and index of concerted centers.

3.6.3 Responsibility for editing the Services Catalogs and the Entity's web information.

A) The Entity will edit the Services Catalogues under its responsibility.

B) Before 20 December preceding the beginning of each year of validity of the Concert, the Entity shall provide in the Central Services of the ISFAS the service catalogues corresponding to all the provinces and, in the Delegations from the ISFAS, the corresponding province in the format and number of copies set out in clauses 3.6.1 and 3.6.2. It shall also, as from 1 January, provide the holders and beneficiaries who request it with the Service Catalogue of the relevant province in paper edition or in electronic form, at the choice of the beneficiary, by sending them to the the postal or electronic address indicated by the person concerned or by making it available to the premises and delegations of the Entity. Delivery shall be made within a period not exceeding seven calendar days from the application.

C) The Entity must have a specific section on its website that informs the beneficiaries of the ISFAS about the content of the Services Catalogues for all the provinces, including the telephone number of the Emergency and Emergency Coordinating Center of the Entity, provided for in clause 3.1.1.D), clearly differentiating it from other information or services telephone numbers of the Entity.

D) In order to avoid confusion with the benefits offered to insured persons other than this Concert, this information must appear in a specific section of the ISFAS, perfectly identifiable and accessible, and include for each province the contents specified in clause 3.6.2. The information on the website should be updated whenever there are modifications, as set out in clause 3.6.4, by stating the date of the last amendment.

E) In the event that the Entity does not comply with the above two paragraphs, it is required to assume the costs arising from the use by the beneficiaries of the services provided by the institutions and optional items included in the latest Catalog in force or on your website.

3.6.4 Invariability of Service Catalogs.

A) The Service Catalog of the Entity will remain stable throughout the validity of the Concert, so that once published, the offer of means of the Entity will only be able to register high, without that they can be produced leave, except those duly accredited to the ISFAS which are due to 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 centre.

In these cases, the discharge shall be communicated to the Central Services and the corresponding ISFAS Delegation 30 days in advance of the date on which it is actually to be produced, unless it is exceeded, justifying in writing the reason for the same. In addition, if the discharge affects hospital facilities or services, the Entity should refer to the corresponding ISFAS delegations the list of holders and beneficiaries who are being cared for in such centres or services.

The entity is obliged to replace the professional or centre in the shortest possible time, and must inform the Subdirectorate of Prstations and the corresponding ISFAS delegation the professional or centre to replace the institution. low produced.

B) The ISFAS may authorize the discharge of any means by other causes, duly accredited by the Entity that justify the same, and, provided that the medium is replaced.

When the Entity requests the authorization to discharge any means and the ISFAS, after the analysis of the case, does not appreciate it as justified, it will inform the Entity and will imply that this means continues to be considered effects as a means of it during the validity of the Concert and, consequently, continue to be usable by the holders and beneficiaries on behalf of the Entity, taking into account that, if no reply was given within 30 days, understand that there is compliance with the low.

In any of the assumptions provided for in the above clauses, the Entity is obliged to direct a communication to the beneficiaries, on a general basis, on the high or low produced in the Catalogs.

C) If any drop in the media offer occurs, beneficiaries with ongoing assistance will be entitled to continue using the means included in the Services Catalog in force up to that time, during the period provided for in clause 3.6.5, corresponding to the Entity assuming the payment of expenses that may be invoiced for the use of such services.

The Entity must inform each patient in writing about its right to maintain the treatment and continuity of care in the said center or service, with charge to the Entity, according to the provisions of the clause 3.6.5 within a period not exceeding seven calendar days, from the date of the centre or service discharge.

When the Entity does not pay for the payment of these expenses, directly to the corresponding specialists or services, the ISFAS may authorize its credit for the procedure provided in clause 6.5.4 of the Concert, by means of Agreement of the Sub-Director of ISFAS to notify the Entity, without prejudice to any compensation to be paid, in accordance with the provisions of clause 6.7.

3.6.5 Principle of continuity of care.

A) Regardless of what is foreseen in clause 3.6.4, if the absence of any professional of the Service Catalog occurs, the Entity will guarantee the continuity of care with the same optional to the patients in treatment of serious pathological processes during the six months following the date on which the discharge occurred, provided that the practitioner can continue the exercise of his/her profession and that he/she has agreed on his/her part.

B) If the discharge refers to a health center or hospital service, the Entity will guarantee to the patients that the continuity of treatment of the same in that center or service is being treated in a certain process, for as long as the need for the same or until the discharge of the process has been obtained. Such continuity of care shall be extended in any case for a maximum period of one year provided that the Entity has a valid care alternative to treat that pathological process.

C) The Entity must inform each of the affected patients in writing about their right to maintain the treatment and the continuity of care in that center or service, with charge to the Entity, according to the provisions of the the previous paragraph within a period of not more than seven calendar days from the date of the centre or service discharge.

D) When by the change of Concert there are casualties of hospital centers or services in the specialties of Oncology and Psychiatry with respect to the Catalog of Services of 2015, the maximum period provided for in paragraph B) shall be 24 months, under the same conditions as laid down by it, as well as those established on the duty of information in paragraph C).

E) The Entity will guarantee patients who are being treated for a certain pathological process the continuity of treatment of the same in the center or service where they are being treated, when they are being treated in centers located in municipalities to which, by the change of Concert, they have been assigned another level of care, to the hospital discharge with a maximum period of three months, or one month, in the event of assistance in external consultations, computed from the beginning of the validity of the Concert.

Ended the appropriate time period, as specified in the above paragraphs, the Entity must provide a valid alternative care to treat that pathological process.

F) When the Entity subscribes to the completion of this Concert of Health Care that replaces it, it shall meet the obligations laid down in this clause 3.6.5, except as provided for in paragraph E) previous.

3.6.6 Information on the available means. The entity shall provide the ISFAS with the information concerning the means available to facilitate the performance that is the object of the Concert, in computerised form. This information shall be provided in a database with the structure set out in Annex 5.

3.7 Freedom of choice of optional and center. Beneficiaries will be able to choose freely optional and centre from among those listed in the Entity Services Catalogues throughout the national territory.

At the request of the beneficiary, the Entity shall facilitate its referral to the centers or services where the assistance it requires may be provided, without prejudice to the right to freedom of choice of services.

3.8 Military hospitals. At the request of the beneficiary, the Entity shall authorize any treatment or detention in a Defense Hospital.

CHAPTER 4

Using non-concerted media

4.1 General Rule. In accordance with the provisions of Articles 14 of the recast of 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, in relation to the 3.1. of this Concert, where a beneficiary, by his own decision or his family members, uses means other than the Entity, he or she shall pay, without the right to reimbursement, the costs which may be incurred, except in cases of unjustified refusal of assistance and in those of emergency assistance of a vital nature.

4.2 Unjustified denial of assistance.

4.2.1 Unjustified refusal of assistance. For the purposes set out in Article 62 of the General Regulation of the Social Security of the Armed Forces, an unjustified refusal of assistance shall be deemed to occur in the following cases:

(A) Where the Entity does not authorize or does not provide a valid care solution before the end of the fifth working day following the date of application of the beneficiary of any of the benefits or services collected in the Annex 2, at the appropriate level, and which has been prescribed by a medical practitioner, or denies a benefit included in the Services Portfolio covered by this Concert. The response of the Entity shall be made in writing or by any other means that permit to be recorded.

B) When the media availability requirements specified in clause 3.2 of this Concert are not met.

In this case, the beneficiary may refer to the optional or private centres which exist at the appropriate level, or if they do not exist, to the corresponding public services, in accordance with the provisions of the clause 3.4 and, without the need to communicate to the Entity the commencement of the assistance received, it shall be entitled to the Entity to assume the costs incurred.

C) When the beneficiary requests authorization from the Entity to go to an optional or non-concerted center (prior written prescription of an optional of the Entity with exposure of the medical reasons justifying the the need for referral to the non-concerted means) and the Entity does not authorise or offer a valid alternative to the media before the end of the tenth working day following the submission of the application for authorisation.

If you offer your own or concerted means, the offer must expressly specify the optional, service or center to assume the assistance and which may carry out the prescribed diagnostic or therapeutic technique.

If the Entity authorizes the referral to a non-agreed optional or center, it must assume the expenses incurred by the care process, without exclusions. However, six months after the start of the assistance, the beneficiary shall ask the Entity to renew the benefit or the continuity of the assistance, so that, before the end of the tenth working day following the date of application, the Entity authorizes the renewal or offers a valid alternative to the media.

D) When a beneficiary has come or is in a center of the Entity to receive assistance and according to the criterion of the optional one, the necessary care resources are not available or not available. In this case, it is presumed that an unjustified denial of assistance situation occurs when the patient has been referred to a non-concerted centre from the entity's environment.

E) When the beneficiary is admitted to a non-concerted centre because of a medical situation requiring immediate emergency attention, and this (or the family members or third parties responsible) informs the Entity within the the 48 hours after admission and does not offer a valid care solution before the end of the 48 hours following the communication, either committing to the costs incurred, or managing the transfer to a centre of the the Entity, itself or concerted, provided that the shipment is medically possible.

The application to the Entity will be made by means of a means that allows to be put on record (preferably through its Emergency Coordinator Center) and in the same one will be given a brief description of the facts and circumstances in which the income occurred.

4.2.2 Entity Obligations.

A) In any of the cases mentioned in the above clause, the Entity will pay the expenses incurred for the assistance of the beneficiary directly to the corresponding services, within the ten calendar days following the date on which the payee submits the timely written claim to the Entity.

When the payee has made the payment, the Entity must proceed to the corresponding refund within the same period.

In the case referred to in paragraph (E) of clause 4.2.1, the owner or beneficiary shall bear the costs incurred by the assistance until his transfer to the centre itself or arranged if the Entity has proceeded to it within the time limit set.

B) When the Entity offers its own or concerted means, the offer must be managed by the Entity, specifying the name of the optional, service or center that will assume the assistance and that may carry out the technique prescribed diagnostic or therapeutic.

C) When the beneficiary has come to non-concerted means as a result of a refusal of assistance caused by the Entity not having offered a valid alternative care within the time limits set out in the previous one clause 4.2.1, or because it would have authorized the referral to an optional or non-concerted center, the Entity must assume, without exclusions, the expenses incurred by the care process until the discharge of the same. However, after six months from the refusal of assistance or from the date of the last authorisation of the assistance, the beneficiary shall request the entity to renew the continuity of the assistance so that, before which concludes on the tenth working day following the submission, authorizes or offers a valid alternative to the media, in accordance with the specifications set out in clause 4.2.1.

D) When the Entity receives from the holder or beneficiary the communication of the assistance provided in other means than any of the circumstances provided for in clause 4.2.1, it shall make appropriate representations to the supplier for issue the corresponding invoice in the name of the Entity and shall bear the costs incurred for such assistance.

4.2.3 Claims. The beneficiary may lodge a complaint with the relevant ISFAS delegation, where the Entity incurs any of the alleged unjustified refusal of assistance provided for in clause 4.2.1. or where it has not carried out the drawback or direct payment of the costs incurred within the time limits set out in clause 4.2.2.

4.2.4 Other effects. The acceptance by the Entity or, where appropriate, the statement by the ISFAS that there is an unjustified refusal of assistance, does not imply acceptance or declaration, respectively, that there has been a refusal of assistance to others. civil or criminal purposes, for which, where appropriate, the beneficiary will have to go to the appropriate ordinary court.

4.3 Vital character urgent assistance.

4.3.1 Concept and requirements. For the purposes also provided for in Article 62 of the General Regulation of the Social Security of the Armed Forces, it is considered a situation of urgency of a vital nature when a pathology has occurred whose nature and symptoms do the foreseeable or very imminent vital risk or irreparable damage to the physical integrity of the person, if there is no immediate therapeutic action. To assess the concurrency of this circumstance, account shall be taken of the provisions set out in Annex 3.

In order for the holder or beneficiary to be entitled to cover the costs incurred through the use of means other than the Entity in a situation of vital urgency, it must be provided that the optional or foreign institution to which it is directed or the patient is reasonably chosen, taking into account the circumstances of the place and the time when the disease has occurred, as well as the decision-making capacity of the patient and, where appropriate, the persons who have provided the first aid.

4.3.2 Accident Assistance in Service Act and other special emergency situations. It is always considered that it brings together the consideration of vital urgency and that the assistance received, if not used, has also the requirement laid down in the second paragraph of the above clause, the following situations special:

(A) The assistance specified by the holders of the ISFAS in the event of an accident as a service or in the exercise of the functions of the ISFAS or as a result of or in the event of acts committed by integrated persons in organised and armed bands or groups.

B) When the beneficiary is on the public road or public health emergency teams (112, 061, etc.) are activated by a person other than that or his or her family members in case he/she is accompanied.

C) When the activation of public health emergency equipment is performed by the state security bodies or other non-sanitary emergency structures (firefighters, etc.).

D) When the beneficiary suffers a road accident or accident of service and is treated by public health emergency teams at the place where it occurs.

(E) Where the beneficiary resides in an assisted senior centre or in a chronic centre and public health emergency teams are activated by the staff of the centre, or where the person resides at his or her private address and these teams are activated by a Public Financing Teleassistance Service, in both cases as long as the person or his/her family has communicated to the center or service their attachment to the Entity for the purpose of their health care.

4.3.3 Scope. The emergency situation of a vital nature extends from the entrance to the patient's hospital discharge (including possible transfers to other non-concerted centers, for unavoidable care causes), except in the two cases. following:

A) When the Entity, with the agreement of the physician who is providing the assistance, offers a care alternative that will enable the patient to be transferred to an appropriate own Center and the patient or his or her family members. They are not responsible.

B) When the patient is transferred to a second foreign center and there are no causes to prevent their transfer to a center of the Entity.

4.3.4 Communication to the Entity. The beneficiary or other person on his behalf shall communicate to the Entity the assistance received with other means by any means which allows the communication to be recorded, with the corresponding emergency medical report, within 48 hours. hours following the start of the assistance, unless exceptional circumstances, duly justified, have prevented the communication of the assistance received with other means, without prejudice to the use of those means always in case of vital urgency.

4.3.5 Entity Obligations. Where the Entity receives the communication of the assistance of a beneficiary in non-concerted means provided for in the above clause, it shall reply within 48 hours of receipt of the communication and by any means which The Commission is aware of the existence of the situation of vital urgency and therefore accepts the payment of the costs incurred or if, on the contrary, it is not considered to be obliged to pay for the fact that there has not been a situation of vital urgency.

In the event that the Entity recognises the existence of the emergency situation, it must inform the supplier that it is directly responsible for the costs incurred, in order for it to be issued by the entity. corresponding invoice to the Entity. If the holder or beneficiary has paid the expenses, the Entity shall make the refund within ten calendar days of the date on which it applies for reimbursement by submitting the supporting documents for the expenses.

In the event that the Entity is not considered obligated to pay for understanding that the situation of vital urgency has not existed, it will issue, within a maximum period of seven calendar days, a report arguing and substantiating such a situation. This shall be the case and shall be transferred to the beneficiary and to the ISFAS Delegation.

When the beneficiary has not made the communication in time and form, the Entity will refund the amount of the assistance within ten calendar days following the date on which the corresponding invoice is presented and, in their case, the proof of payment. If the Entity has not performed as set out in this clause, it shall be required to pay directly to the healthcare provider, if requested by the beneficiary.

In the event that the Entity is not considered obligated to pay for understanding that the situation of vital urgency has not existed, it will issue a report arguing and substantiating such a circumstance, and will give the same to the beneficiary.

4.3.6 Claims. The beneficiary may lodge a complaint in the relevant ISFAS Delegation where the Entity fails to comply with the obligations under clause 4.3.5, in case of discrepancy with the Entity's criterion or in the absence of a response in the deadline set for effect.

4.4 Transport in foreign media for health care in cases of unjustified denial of assistance and vital urgency.

Where in the case of unjustified refusal of assistance and vital urgency the use of non-transport means, both sanitary and ordinary, is necessary, the conditions and requirements shall be those laid down in clauses 2.4.3 and 2.7.

The beneficiary will have the right to have the Entity pay the expenses incurred for such a shipment. Payment shall be made within ten calendar days following the date on which the beneficiary submits the appropriate written complaint to the Entity, accompanying the supporting documents for such expenses.

4.5 Cross-border assistance. In the limits and conditions laid down in Royal Decree 81/2014 of 7 February 2014 laying down rules for the guarantee of cross-border healthcare, and amending Royal Decree 1718/2010 of 17 December 2010, on medical prescription and dispensing orders, and in the specific legislation of the ISFAS, especially in Resolution 4B0/38026/2014 of 19 February, which regulates health care outside the national territory, the beneficiaries may request the reimbursement of costs for cross-border healthcare through the Delegations from ISFAS.

The procedure for the application and recognition of the benefit is set out in Annex 7.

When the right to reimbursement of expenses for cross-border healthcare to a beneficiary assigned to the Entity is recognized, the ISFAS will have an impact on the amount of the expenses that correspond to benefits that are object of the Concert, by the procedure set out in clause 6.5.4.

In no case shall the expenses corresponding to the outpatient supply of dietetic products, orthopaedic material, medicinal products and other medical devices which are the subject of the services be passed on to the Entity Dietary, orthoprosthetic and pharmaceutical products for outpatient treatment.

CHAPTER 5

Health information and documentation and quality objectives

5.1 Information and documentation.

5.1.1 General rules. In order for the ISFAS to have the necessary information for the assessment of the health benefits to be covered by this Concert, its planning and decision-making, the Entity will provide all the data on the services provided to the holders and beneficiaries specified in this Chapter. It will also do so on those not specified that, during the validity of the Concert, could be sued by the Ministry of Health, Social Services and Equality in the context of the development of the Information System of the National System of Health or any other competent body in compliance with current regulations.

The Entity is required to require its professionals to complete how many documents are specified in this chapter.

Likewise, the Entity is obliged to comply with and enforce the health professionals and centers included in its Service Catalogue all the requirements laid down in the Organic Law 15/1999 of 13 December, of Protection of Personal data and in its development regulations, in relation to the health information and documentation concerning the holders and beneficiaries of the ISFAS, as well as to safeguard the exercise of the rights of the patients collected in the Article 10 of Law 14/1986, of 25 April, General of Health and Law 41/2002, of 14 November, regulating the Autonomy of the Patient and of rights and obligations in the field of Information and Clinical Documentation, paying special attention to the informed consent and to the respect of the previous instructions, as to the provisions of Articles 10 and 11 of that Law 41/2002.

5.1.2 General activity information.

A) Activity/cost information. The entity shall have an information system that allows the number, type and cost of the services provided to the ISFAS beneficiaries to be known with their own or concerted means.

The entity shall provide ISFAS, in IT support or with telematic procedures, with the data on care activity, with the structure and format shown in Annex 4.

The data shall be submitted with the periodicity provided for in that Annex within three months of the end of the corresponding period.

B) Non-urgent health transportation information. The Entity shall have an information system in place that allows the number of patients who have made use of the non-urgent health transport regulated in clause 2.7.2 to be known.

Such data should be submitted to ISFAS with the characteristics and periodicity set out in Annex 4.

5.1.3 Economic Information. The entity shall provide, at the request of the ISFAS, the legally established statistical data of the Public Health Expenditure Satellite Accounts of the National Statistical Plan, as well as other data requested by the institution. Ministry of Health, Social Services and Equality for the Health Information System of the National Health System. All this in the format and with the periodicity to be determined by the ISFAS, for subsequent transfer to the Ministry.

5.1.4 Information about hospital care.

A) The Entity will require its own or concerted centers, detailed in its Services Catalogues, to fill in the discharge report, at the end of the stay in a hospital institution, the assistance for Major Surgery Outpatient or other assistance, as provided for in Royal Decree 1093/2010 of 3 September, approving the minimum set of data for clinical reports in the National Health System.

B) In the authorization of admission to hospital or major outpatient surgery, the Entity will be responsible for informing the beneficiaries of this Concert that their health data may be processed by the ISFAS for the purposes established, always with the recommendations and channels established by the Organic Law 15/1999, of December 13, of Protection of Personal Data and its regulations of development.

5.1.5 Healthcare media information. In the years of validity of the Concert, the Entity will transmit to the ISFAS in electronic format the updated information of the own and concerted means that it has offered for the subscription of the same. Such remission shall be carried out in accordance with the instructions given by the ISFAS and as provided for in Annex 5.

5.1.6 Clinical documentation.

A) The information referred to in clause 5.1.4 must be maintained for as long as the legislation establishes paper and/or computer support. In any case it must be met with the legal requirements already referred to in clause 5.1.1.

B) The discharge report, in any form of care modality, shall be delivered to the patient or, at the time of the discharge of the health centre, by the responsible doctor, the family member or legal guardian. of the process being attended to in external consultation. You will also be provided with a copy for delivery to the physician responsible for monitoring the patient in the outpatient setting, while another copy of the discharge report will be archived in the medical history.

Along with the discharge report, the patient will be instructed to follow up the treatment and establish mechanisms to ensure continuity and safety of care and care.

C) A copy of his or her clinical history or certain data contained therein shall also be delivered, at the request of the data subject, without prejudice to the obligation of his/her conservation in the health centre, leaving a written record of the entire process and guaranteeing, in any case, the confidentiality of the information related to the process and the patient's stay in health institutions, as established by Law 41/2002 of 14 November, regulating the autonomy of the patient and rights and obligations in terms of information and clinical documentation.

The indicated documentation will be included in the Digital Clinical History, interoperable with the rest of the National Health System, as it develops.

5.1.7 Other health documentation. The Entity shall actively take care that the healthcare professionals and healthcare facilities included in its Services Catalogues meet the following obligations:

(a) Meet the precise medical reports established by the ISFAS for the assessment of the initial discharge due to illness, accident or risk during pregnancy and maternity and its continuity and, where appropriate, the granting of the corresponding licences of the officials. In such reports, the diagnosis must be coded, following the international classification of diseases CIE-9-MC, unless the ISFAS expressly determines another coding system.

b) Collaborate in procedures for the verification of the pathology that caused an incapacity or sick leave and their extensions.

c) Facilitate the medical records and reports provided for in the fifth paragraph of the Resolution of the Secretariat of State for Public Administration of 29 December 1995, and other concordant rules, for the processing of the retirement procedures for civil servants for permanent incapacity for service.

d) Edit and issue the orders for hospital supply, in accordance with the specifications and criteria established by the current regulations, guaranteeing that the professionals prescriber such orders and prescriptions They have identifying seals that allow their readability.

e) Issue the medical reports required by the ISFAS to its beneficiaries for certain health, social or complementary health benefits.

f) Issue the medical documentation or certification of birth, death and other ends for the Civil Registry, and other reports or certificates on the health status required by law or regulation.

g) Make the prescriptions for ortho-prosthetic material in the standard document to be established, stating the code of the ortho-prosthetic product prescribed in the ISFAS Catalogue on Material Orthoprosthetic.

5.2 Digital clinical history and electronic prescription.

5.2.1 Data on health care provided to the holders and beneficiaries will be adapted to the provisions of Royal Decree 1093/2010 of 3 September, approving the minimum set of data in the reports. Clinical trials in the National Health System. The prescription and dispensing by electronic prescription as provided for in Royal Decree 1718/2010 of 17 December 2010 will also be implemented.

5.2.2 The Entity will promote the implementation of the System of Digital Clinical History and electronic prescription of Interoperable Mutualism with the rest of the National Health System and its use by all professionals and centers included in the means of the Entity, so that the relevant information is accessible from any point of health care, public or private, with the appropriate security and personal data protection measures.

5.2.3. In addition, the information of the Drug History History to which the patient may have access will be made available through the Internet through the technological platform of the Electronic Headquarters of the ISFAS.

5.2.4 By Resolution of the General Secretariat of the ISFAS, the objectives on the steps to be covered in this project will be set, as well as the necessary requirements for its development and implementation.

5.3 Healthcare quality.

5.3.1 General considerations. The ISFAS, as an integral part of the National Health System in its capacity as the Gestora of the Special Regime of the Social Security of the Armed Forces, promotes a comprehensive quality policy for the improvement of health care to its citizens. protected collective within the general guidelines established by Law 16/2003 of 28 May. In order to ensure the implementation of the quality policies of the National Health System, the lines of action set out in the following clauses are established during the validity of the Concert.

In these lines of action, specific quality objectives are set for which economic incentives are linked in accordance with the provisions of clause 7.4. The Entity shall promote the involvement of its professionals by taking the measures it considers to be most effective in stimulating and ensuring the achievement of these objectives.

5.3.2 Adaptation to the Strategies of the National Health System. The Ministry of Health, Social Services and Equality has, in collaboration with the Autonomous Communities, Scientific Societies and experts, plans and strategies in relation to different diseases or health problems, should be promoted the incorporation of the principles that inspire these strategies in the field of concerted assistance, so they must guide the activity that is the object of the Concert.

The assistance of the ISFAS collective will be adapted to these strategies, following the same guidelines and objectives set for the assistance provided to collectives of other mutual societies of officials with whom Health care concert.

5.3.3 Elaboration of care protocols. For the development of quality improvement strategies, the Entity must promote, in collaboration with its professionals, the development and application of clinical guidelines, protocols and guidelines for action, accredited and proven effective, related to the most prevalent pathologies in the population, in order to serve as an aid instrument in clinical decision-making, with the objective of contributing to the improvement of the quality of care and to the efficiency in the use of resources promoting their effective implementation in the care practice of ISFAS policyholders.

5.3.4 Quality of pharmaceutical delivery.

(A) In compliance with the provisions of health legislation, the Entity shall promote the rational use of the medicinal product, developing the necessary actions for its professionals to indicate or prescribe those active substances. and medical devices appropriate to the clinical situation of the patient, in the dosage and pharmaceutical forms in accordance with their individual requirements, during the period of time required and at the lowest possible cost to patients and to ISFAS.

To this end, and with the aim of improving the quality and efficiency of the pharmaceutical supply provided to the beneficiaries, the Entity will encourage the selection by its professionals of those active principles considered within its therapeutic subgroup in the protocols and pharmacotherapeutic guides of the SNS, collaborating in the processes of review and control of the prescriptions in certain situations. In particular, the Entity will promote the prescription of first-choice drugs among the medical practitioners in certain pathologies considered to be more prevalent.

For this purpose, four indicators focused on therapeutic subgroups of special relevance have been selected: Antiulcerative, Hipolipemiants, Antihypertensives and Non-steroidal Antiinflammatory. The construction of the indicators has mainly taken into account three criteria: safety, effectiveness and experience in their use.

B) In clause 7.4.5 the objectives and indicators that are set for the monitoring of the quality of the pharmaceutical supply during the validity of this Concert are set.

C) In the hospital environment, the Entity will ensure that the hospital's own and concerted hospitals have standard working tools and procedures (commissions, pharmacotherapeutic guides, protocols) with methodology that is homologable to that of the rest of the National Health System, for such purposes as the evaluation and selection of medications, the reconciliation of medication between care levels or the use of medications under different conditions those authorised on their technical tab.

In the case of patients not admitted, the Entity will ensure that the hospital dispensation is performed in the same hospitals where the treatment orders would have been prescribed, except when the medication is required. be dispensed in hospitals in the patient's locality or province of residence to enable therapeutic compliance or in those other exceptional cases which may be authorised by the ISFAS, depending on the nature of the medicinal product and in the light of the circumstances and procedures referred to above.

D) In relation to the pharmaceutical prescription, the Entity will encourage the participation of its physicians in all measures and activities established by the ISFAS for the improvement of the use of medicines and products health and cooperation in procedures to be initiated to verify the adequacy of individual prescriptions and the adoption of the corresponding control measures.

5.3.5 Quality of information. The entity will ensure that the physicians correctly inform the patients of everything related to their illness and care process, guaranteeing the fulfillment of all the principles contained in Law 41/2002, of November 14, regulatory of the Autonomy of the Patient and of rights and obligations in the field of Information and Clinical Documentation. In particular, it will ensure that informed consent is carried out on how many procedures are required and that the previous instructions are met when the patient has formalised his living will.

5.3.6 Evaluation of the quality of care and healthcare facilities. In the framework of a process of continuous improvement of the quality of care, evaluation systems will be promoted, through the implementation in the own centers or concerted by the Entity of the systems of accreditation and/or certification established in the Autonomous Communities or through the ISO certification, the hospital accreditation criteria of the Joint Commission or the external evaluation of the EFQM Model (European Foundation for Quality Management).

CHAPTER 6

Legal Regime of the Concert

6.1 Nature and legal status of the Concert.

6.1.1 This Concert has the administrative nature of the public service management contract, as provided for in the additional 20th of the recast of the Law on Public Sector Contracts, approved by the Royal Legislative Decree 3/2011 of 14 November, and its legal regime is established in the Recast Text of the Law on Social Security of the Armed Forces and the General Regulation of the Social Security of the Forces Armed, the contracting regime being the one provided for in Article 119 of that Regulation.

Therefore, this Concert is governed by:

(a) The Recast Text of the Law on Social Security of the Armed Forces, approved by Royal Legislative Decree 1/2000, of 9 June, especially the provisions contained in its article 5.2, which states that the In order to provide the services of health and pharmaceutical services, it will be established by this Law and its implementing rules, by the General Budget Law in matters that are applicable and, in an additional way, by the Law of Organization and Operation of the General Administration of the State.

(b) The General Regulation of the Social Security of the Armed Forces, approved by Royal Decree 1726/2006 of 21 December, with special reference to the forecast contained in Article 119, on the arrangements for the of the Social Institute of the Armed Forces.

c) The Resolution calling for the submission of applications for the formalisation of the ISFAS Concert for health care in, national territory, holders and other beneficiaries who do not choose to receive it through the public health system.

d) The Concert itself.

For what is not foreseen in the provisions mentioned, the Concerto will be governed by the basic legislation of the State in the field of public contracts, that is, by the recast of the Law on Public Sector Contracts, approved by The Royal Decree of Law 3/2011 of 14 November and the General Regulations of the Law of Contracts of Public Administrations, approved by Royal Decree 1098/2001 of 12 October (RGLCAP). The other rules of administrative law and, failing that, the rules of private law shall apply.

6.1.2 They are relationships based on the Concert:

A) The relations between the ISFAS and the Entity, in order to comply with the rights and obligations established in this Concert.

B) The relations between the beneficiaries and the Entity, in order to comply with the obligations set out in this Concert.

6.1.3 Issues arising in the field of the relations listed in paragraph B) of the above clause shall be of an administrative nature and shall be resolved by the ISFAS body which has the jurisdiction conferred, in accordance with the procedure laid down in this Chapter. Against any of the agreements that will be given to the person of the Minister of Defense, he will appeal to the Minister of Defense. The competent court shall, where appropriate, always be the administrative dispute.

6.1.4 It is for the management of the ISFAS to interpret the Concert, to resolve the doubts that it offers, to modify it for reasons of public interest, to agree its resolution for non-compliance with the Entity and determine the effects of this.

It is also for the management of the ISFAS to fix the economic compensation provided for in clause 6.7 of this Concert for partial non-compliances of the obligations of the Entity and to assess the incentives to the quality set in clause 7.4.

6.2 Nature and Regime of Care Relations.

6.2.1 This Concert does not imply or cause any relationship to arise between the ISFAS and the institutions of the Entity that provide the assistance. The relationships between the Entity and the faculty or centers are in any case alien to the Concert.

6.2.2 Consequently, they are also alien to the set of rights and obligations that determine the ends of the Concert and are configured as autonomous relationships between the parties:

A) The relations of the beneficiaries with the powers of the Entity for cause that affects or relates to the scope of the professional exercise of such facultative.

B) The relations of the beneficiaries with the Centers of the Entity, because of the care activity of those means or the functioning of their facilities or for reason that affects or relates to the own scope of the exercise professional of the facultative who, under any title, develop activity in such centres.

The relationships mentioned in paragraphs (A) and (B) above will continue to be alien to the ends of the Concert even if, by virtue of the links between the faculty and the Centers and the Entity, they can generate direct or subsidiary effects on these.

6.2.3 The relationships mentioned in the preceding clause will have the nature that, according to the law, corresponds to its content, and the knowledge and decision of the questions that may arise in the same will be competition of the ordinary civil jurisdiction or, where appropriate, the criminal jurisdiction.

6.3 Mixed Commissions.

6.3.1 Types and operating system. There will be Joint Provincial Commissions and a National Joint Commission.

Its operating system will be regulated in the following clauses and, as not provided for in them, the provisions of the Law on the Legal Regime of Public Administrations and the Procedure will apply. Common Administrative Board on the functioning of collegiate bodies.

6.3.2 Composition.

(a) The Provincial Joint Committees shall be composed, on the part of the ISFAS, by the corresponding territorial delegate, who shall preside over them, and by an official of the Delegation who shall act, in addition, as Secretary; and, of the Entity, by one or two representatives of the Entity with sufficient decision-making powers. The Medical Advisor to the ISFAS Delegation may attend the meetings.

B) The National Joint Commission will integrate it with one to three representatives of the ISFAS and one to three representatives of the Entity. The President shall be the Deputy Director of Prstations or the official in whom he delegates and as Secretary an ISFAS official shall act, with a voice but without a vote.

6.3.3 Functions.

(a) The Provincial Joint Committees and the Joint National Commission, with a joint composition, in their respective territorial scope are committed:

The monitoring, analysis and assessment of compliance with this Concert.

The knowledge of the claims that may be made by the beneficiaries or, where appropriate, of their trade by the ISFAS, as provided for in this Agreement.

The knowledge and assessment of the ISFAS initiatives on economic compensation for partial non-compliances of the Concert.

B) In addition, it corresponds to the National Joint Commission:

The analysis of the initiatives on economic compensation for partial non-compliances of the Concerto, in the terms stipulated in clause 6.7.

Knowledge of incidents or claims on deductions for cross-border healthcare.

For the purposes of the tasks set out in paragraphs A. 2, B. 1 and B. 2 above, it is understood that with the intervention of the Entity it takes place for the same the fulfillment of the procedure laid down in article 84 of the Law 30/1992, of 26 November, of the Legal Regime of Public Administrations and of the Common Administrative Procedure.

The functions identified will be performed by the Provincial Mixed Commissions when they refer to the provincial level and the National Joint Commission when they affect the entire national territory.

The knowledge of claims on cross-border healthcare that may be made by the holders or, where appropriate, of trade by the ISFAS is reserved for the National Joint Commission.

If this is claims the distribution of functions will be accommodated as provided in clause 6.4.

6.3.4 Operation. The operation of the Provincial Mixed Commissions shall be in accordance with the following rules:

A) Whenever there are issues to be dealt with, the Commission will hold regular meetings within the first ten days of each month. On an extraordinary basis, they shall meet at the request of one of the parties.

B) If the representatives of the Entity do not attend the meeting on the date indicated in the call, without due cause due due cause, it will be understood that, due to the appearance of their representatives, the one accepts the arrangements to be made by the ISFAS in relation to matters on the agenda of the meeting.

If the lack of assistance from the representatives of the Entity is duly justified, the meeting shall be held within two working days of the date referred to.

C) Each session shall be lifted by the Secretary, whose project, with his signature, shall be sent immediately to the Entity for knowledge, conformity and return. This refund signed by the representative of the Entity must be made within the maximum period of ten calendar days. Once signed by the representative of the same, it will be understood as approved. If there are discrepancies in the content of the minutes, they shall be settled by means of appropriate arrangements between the two parties and, in any case, at the following meeting.

The operation of the National Joint Commission will be in accordance with the same rules as for the Provincial Commissions, although ordinary meetings may be convened throughout the month.

The rules of Law 30/1992, of November 26, of the Legal Regime of Public Administrations and of the Common Administrative Procedure on the functioning of the collegiate bodies shall apply.

6.4 Procedure for claims.

6.4.1 The holders and beneficiaries will be able to claim from the ISFAS that, as provided for in clause 6.1.3, it agrees the origin of any action by the Entity, in the following cases:

(A) When the Entity refuses any of the authorisations specifically referred to in the Concert or when it does not answer the request of the same and, in addition, there is no positive effect for such absence of response.

B) When the Entity is required to directly assume some expense or to reintegrate its amount and, upon request of the beneficiary, do not do so.

C) When the Entity fails to comply with any other obligations under the terms of the Concert.

This administrative route will not be used for complaints on issues relating to the relationships mentioned in clause 6.2. In the event of a question, the person concerned will be replied that, due to the lack of competence of the ISFAS, it is not possible to resolve the merits of the complaint, with the indication that it can be made, if appropriate, in relation to the doctors. or, if applicable, before the Entity itself, in the ordinary court that corresponds according to the nature of the facts.

In those exceptional cases where the beneficiary is unable to lodge a claim and a billing has occurred in his name for an assistance that the Entity may be required to assume, the ISFAS may initiate The complaint to the Joint Committee that it considers appropriate.

6.4.2 Claims will be made in writing to the relevant ISFAS Territorial Delegation, accompanying how many documents can be substantiated.

6.4.3 Any claim, the ISFAS Delegation, if you initially consider that there are reasons for your estimation, will immediately take the necessary steps to the Entity to obtain satisfaction with the itself, in which case it will be archived without further processing with annotation of the adopted solution.

6.4.4 In case the aforementioned démarches do not prosper, the ISFAS Delegation will formalize the timely file, will include it in the Order of the day of the immediate meeting of the Provincial Joint Commission and, studied the same, (a) raise the relevant Act in which the positions of the ISFAS and the Entity on the complaint raised will necessarily be established.

6.4.5 In all cases where the positions of the parties that make up the Provincial Joint Committee are consistent, the claim will be settled by the corresponding ISFAS Delegate.

6.4.6 In case there are discrepancies within the Provincial Joint Commission, the file will be raised for study by the National Joint Commission and will be included in the agenda of the first meeting to be held. Studied by it, it will solve the management of the ISFAS, and the criterion resulting from the Entity in the management of the benefits that the beneficiaries need be applied.

6.4.7 When submitting to the Joint Committee National Claims for similar issues that have already been previously resolved in a favorable manner, with the agreement of the Entity, the same criteria agreed with prior to that, by stating that in the minutes, for the purposes set out in clause 6.7 of the Concerto.

6.4.8 The resolutions of the complaints referred to in the above clauses must be given within a maximum period of six months, as provided for in Article 3.2 of Royal Decree 1728/1994 of 29 June 1994, in relationship to the provisions of the First Transitional Disposition, 2, of Law 4/1999, of January 13.

6.4.9 The resolutions issued by the Delegates and the Management of the ISFAS will be notified to the Entity and to the interested parties. They may be brought against the Minister of Defence in accordance with the provisions of Articles 107 to 115 of the Law on the Legal Regime of Public Administrations and the Common Administrative Procedure and 31.1 of the text. Recast of the Law on Social Security of the Armed Forces, approved by Royal Legislative Decree 1/2000, of June 9.

6.4.10 When by the change of Concert there are casualties of hospital centers or services and for that reason there is a plurality of complaints, in application of clause 3.6.5, the General Secretary General, previous (a) a resolution to this effect may be agreed upon to the cumulation of all of them to be substantiated by a special procedure, the resolution of which shall be the responsibility of the ISFAS delegate when the position of the Parties of the relevant Joint Committee Provincial is concordant and, if not the Subdirector of Prstations.

For the execution of the judgment-style resolutions adopted through this special procedure, the provisions of clause 6.5.4 shall apply.

6.4.11 The provisions of the above clause may also be applied in the case of complaints, the object of which is the application of clause 7.1.2.

6.5 Estimated claims execution procedure.

6.5.1 In the complaints positively resolved by the ISFAS Delegates, the execution procedure will be as follows:

A) Where the claim is intended to allow for a particular health care, the Entity shall issue the appropriate authorization within five days of the notification of the decision.

B) When the claim has as its object that the Entity directly assumes some expense, the Entity will proceed to make the payment to the corresponding sanitary service, being in charge in any case of the Entity the possible surcharges or interest on late payment that could have been generated.

(C) Where the claim is for reimbursement of the costs claimed, the Entity shall, within one month of the notification of the decision, make a refund on the basis of the relevant information. evidence of expenditure, which shall be returned to the claimant if requested.

6.5.2 Within the above deadlines, the Entity must communicate to the ISFAS Delegation, as the case may be:

(a) You have issued the authorization, direct credit to the corresponding health service, or reimbursement of expenses.

(b) That it has not carried out any of the above actions for reasons other than its will, in particular because the person concerned has not submitted, because the appropriate supporting documents have not been provided for the same reasons; have been accepted for payment by this.

6.5.3 If the ISFAS had not received this communication within the indicated period or if, after this deadline, it was aware that the payment to the interested party would have been denied, for any reason, the ISFAS Delegate will issue certification of the agreement or resolution adopted and the subsequent facts and shall forward it to the Subdirectorate of ISFAS Benefits which, without further requirements, shall give the appropriate agreement and shall be deducted from the immediate monthly payment to the ISFAS Entity and shall 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 reimbursement claims positively resolved by the Management of the ISFAS, the payment of the amount that in each case corresponds will be made directly by the ISFAS to the interested person on behalf of the Entity, by deducting the amount of the monthly fees to be paid to the same and making it easier for the document to prove that you have made the payment on your own account.

If the claimed assistance had been invoiced to the person concerned and the person concerned had not yet made the payment effective, the ISFAS may make the direct payment to the creditor as of the date of the estimated resolution, provided that the Explicitly authorize direct payment to your name.

6.5.5 It will be in charge of the Entity, in addition to the charges invoiced for the assistance provided, the costs of possible surcharges of aprize or interest of delay, when the delay is imputable to the same. In the event of non-compliance with the resolution deadlines set out in clause 6.4.8, these surcharges would be on behalf of the ISFAS.

6.5.6 Administrative Resolutions or Sentences that resolve actions brought against ISFAS acts in respect of reimbursement of expenses subject to this Concert shall be executed, if appropriate, in accordance with the procedure set in clause 6.5.4.

6.6 Discounts for pharmacy expenses.

6.6.1 When in the process of reviewing the billing of prescriptions issued by the ISFAS, prescriptions of medicines and medical devices made in their official prescriptions, which should have been carried out by the Entity, as established in this Concert, the ISFAS will proceed to effect the corresponding discount on the monthly payment of the fees to be paid to it, as provided for in Chapter 7.

The entity undertakes to reintegrate the holders, within a period of not more than fifteen days from the request for reimbursement, the amount that they would have paid in the pharmacy office, with the sole requirement of the presentation of the evidence of this circumstance or of the corresponding invoice or proof of payment of the pharmacy.

6.6.2 In those cases of dispensations of medicinal products and pharmaceutical products that, being financed by the National Health System, are not equipped with a seal and are subject to consistent singular reserves In order to limit their supply to the pharmacy services of hospitals, the ISFAS will be invoiced at a higher price or under conditions other than those indicated in clause 2.8.4.a), the ISFAS will proceed to the payment of the invoices and subsequently, it will affect the differences in the limits set for the Entity, in the monthly payment of the quotas, agreement with the provisions of Chapter 7.

6.7 Economic compensations for non-compliance with obligations. procedure for their imposition.

6.7.1 Compensation for non-compliance with obligations. Failure to comply with certain obligations contained in the Convention, without prejudice to other effects provided for therein, may lead to the imposition of economic compensation.

In general, for the rating of non-compliance and the determination of the amount of the economic compensation, the following factors shall be taken into account, inter alia:

a) Perjudgment occasioned.

b) Number of affected holders and beneficiaries.

c) Reiteration of the default.

In consideration of these and other factors, the classification and qualification of the non-compliances liable to be sanctioned and the amount of the financial compensation for each of them according to their graduation are established.

A) Compensation for minor defaults: 1,000 to 5,000 euros.

Delay in the delivery of an interim card or replacement document for the beneficiary's access to services from the time of discharge.

Non-spec cards: Card detection issued with the non-conforming to the format that would have been established by ISFAS Management Resolution, as provided for in clause 1.7.2 of the Concert, after the end of the period indicated to the effect.

Delivery and availability of the Services Catalogues of a province, after the deadline set for the effect, with delay of less than 20 days.

Defects in the content and format in the Service Catalog of a province, which would not have been remedied after the timely communication of the ISFAS, after the deadline stated in clause 3.6.4.

Improper advertising: Offering of services of an Entity carried out, without authorization, within the premises of any public body that has a negative impact on the operation of the entity.

Low in the Services Catalogues: Low of psychiatry or dialysis services in the Service Catalog of a Province, in the period established for the ordinary change of Entity or in the month before or after that period and Bajas in those means which do not obey the exceptional circumstances provided for in clause 3.6.4 and/or where the principle of patient care continuity has not been guaranteed in the terms set out in the clause 3.6.5.

Non-compliance with obligations under clause 4.3.5 in cases of vital urgency.

Denial of a benefit which, appearing in the Services Portfolio established in the Concert, has been indicated by an optional Service Catalog, where it corresponds to a subject that has already been addressed in the National Mixed Commission (more than two times), giving rise to the resolution of the management of the ISFAS.

Delays in the delivery of the activity information, as provided for in clause 5.1.2.

B) Compensation for serious non-compliances: 5,001 to 25,000 euros.

Deficiencies on the cards: Persistence of deficiencies that would have resulted in the imposition of compensation for minor non-compliance, three months after the resolution had been notified The above compensation is imposed.

Delivery and availability of the Services Catalogues of a province, after the deadline set for the effect, with delay exceeding 20 days.

Defects in the content and format in the Service Catalog of a province, which would have resulted in the imposition of compensation for minor non-compliance, and would not have been remedied three months after it had been notified of the decision on which the said compensation would have been imposed.

Improper advertising: The offer of services of an Entity directed to specific professional collectives and the offer for advertising purposes of gifts to the holders, carried out directly or indirectly through third parties.

Low in Services Catalogues: Low hematology services (related to oncology processes) or medical oncology in the Service Catalog of a province, or Level IV services, in the established period for the ordinary change of Entity or in the month before or after that period.

Failure to deliver care information, three months after the resolution was notified that an economic compensation was imposed for late delivery.

C) Compensation for very serious defaults: From 25,001 to 50,000 euros.

Improper advertising: The offer for advertising purposes of gifts to the holders, carried out directly or indirectly through third parties when it is carried out during the period of ordinary change or in the process of high specific professional collectives.

Low in the Services Catalogues: Low of hospital centers in the Service Catalog in the period set for the ordinary change of Entity or in the month after that period.

Non-compliance with National Joint Commission Agreements.

6.7.2 Procedure for imposing economic compensation.

(A) In cases where a breach of the obligations set out in clause 1.8. of the Concert (undue publicity) has been detected, the relevant ISFAS Delegation shall inform the Commission in writing. representation of the Entity on the same and will include the matter in the order of the day of the immediate meeting of the Provincial Joint Commission for the Entity to present the corresponding allegations. In the case of the case, the Commission's minutes will include the positions held by the ISFAS and the Entity. If the positions are consistent and the result of the positions is that such non-compliance is considered as unproduced, it will be sufficient for this to be included in the approved minutes to end the case.

In case the discrepancies in the case remain or there is no agreement on the existence of a breach, the file will be raised for study by the National Joint Commission and will be included on the agenda the first meeting to be held. Thereafter, the procedure provided for in the following paragraph shall be followed.

B) In cases where any other non-compliance has been detected, the Subdirection of Pristations of the ISFAS shall inform the representation of the Entity on the same and shall include the matter on the agenda of the immediate meeting of the National Joint Commission for the Entity to present the corresponding allegations. In the case of the case, the Commission's minutes will include the positions held by the ISFAS and the Entity. In case the positions are consistent and the result of the same is that such non-compliance is considered to be unproduced, this end will be reflected in the record and the file will proceed to the file without further processing.

In case of agreement with the existence of a breach or disagreement of the parties in the National Joint Commission, the General Secretariat shall be resolved and, in accordance with the terms set out in the relevant resolution, will proceed to discount the cost of the compensation in the following monthly payment to the Entity. The decision shall be notified to the Entity which may bring an appeal to the holder of the Ministry of Defence, as provided for in Articles 107 to 115 of the Law on the Legal Regime of Public Administrations and of the Common Administrative Procedure and 31.1 of the Recast Text of the Law on Social Security of the Armed Forces, approved by Royal Legislative Decree 1/2000.

CHAPTER 7

Duration, economic regime and price of the Concert

7.1 Duration of the Concert.

7.1.1 The effects of this Concert shall be initiated at zero hours of the day one January 2016 and shall be extended to 24 hours on the thirtieth day of December 2017.

7.1.2 If the Entity does not subscribe to a new concert for 2018, it will continue to be bound by the content of this Concert, until the thirtieth day of January 2018, for the collective that I have assigned to 31 December of 2017. In addition, if, by 31 January 2018, an inpatient or maternity care assistance was provided, with a planned date of birth in the month of February, the Entity will be obliged to continue to provide the assistance until the day of the discharge or the termination of the maternity care, respectively. In the event that the need for hospitalization is extended, the Entity will assume its coverage until the end of the month of March 2018, from which the new entity will assume the coverage.

The entity shall be entitled to receive, for the month of January 2018 and for the collective assigned to thirty-one December of the previous year, the price per person/month to be established for the Entities that are the ISFAS. However, from the amount to be paid for that month, the ISFAS will retain ten percent until thirty-one January 2019, with the sole purpose of dealing, on behalf of the Entity, with the reimbursements of expenses that are agreed upon during the This year is covered by this Concert. If the estimated amount is exhausted or the reimbursements will be agreed after thirty-one January 2019, the Entity is required to satisfy them directly and immediately.

7.1.3 The collective affected by the non-subscription by the Entity of the Concert for 2018, will have to choose new Entity during the deadline that the ISFAS will establish and the election will have effects to the zero hours of the day one of February 2018, without prejudice, of what is intended for hospitalizations and maternity in the above clause.

7.2 Economic Regime of the Concert

7.2.1 Economic effects of the high and low beneficiaries. Without prejudice to the birth and extinction of the beneficiaries of the rights deriving from the Concert in the terms provided for in the relevant clauses, the High shall cause economic effects at zero hours of the day one of the following month the one in which they occur and the casualties within 24 hours of the last day of the month in which they took place.

Accordingly, each monthly payment shall take into account the number of holders and beneficiaries existing at zero hours of the day one of the month in question, for which the ISFAS shall issue the appropriate certification, communicating the number of holders and beneficiaries assigned to the Entity, differentiated by age, according to the parameters set out in clause 7.3.1, the number of holders and beneficiaries with special needs for care, as provided for in the clause 7.4.2 and the number of holders and beneficiaries who do not reside in municipalities of Level III, having regard to the provisions of clause 7.4.3.

7.2.2 Periods of payments. The payment by the ISFAS to the Entity of the amounts resulting from the application of clauses 7.3 and 7.4. shall be made effective as follows:

A) Monthly the amounts provided for in clauses 7.3, 7.4.2, 7.4.3 and 7.4.5, which are reduced by the amount resulting from reimbursement of costs, discounts and financial compensation for non-compliance with obligations which are agreed under this Concert:

B) Annually the amount of the incentives associated with the achievement of objectives set out in clauses 7.4.4 and 7.4.6.

7.2.3 Payment Scheme. The payment, except for exceptional eventualities, shall be made by the ISFAS, by bank transfer, within the first 15 calendar days of the following month, prior to the withholding tax or the discounts that come under the Notice of convocation and of the Concional with its annexes. The monthly payment for December may be anticipated, in whole or in part, in the last ten days of that month.

The amounts will be met by concept 14.113.312E.251, within the Agency's budgetary availabilities.

7.2.4 Discounts and deductions. Provided that there is a firm judicial judgment in which the ISFAS is ordered to pay compensation, arising from direct or subsidiary liability for assistance actions included in the object of the Concert, the ISFAS, without prejudice to execute the judgment, it shall have an impact on the amount paid to the corresponding agreed entity, in accordance with the procedure laid down in clause 6.5 of this Concert.

Also, of the amount that, each month, must be paid to the Entity, in terms of quotas and other concepts, will be deducted:

The economic compensation to be applied, as provided for in clause 6.7.2.

The amount of payments that have to be made on behalf of the Entity, taking into account the provisions of clauses 1.7.1, 3.6.4, 4.5, 6.5.3, 6.5.4, 6.5.6. and Annex I.

The expenses incurred by the ISFAS, but which should have been addressed by the Entity, in accordance with the forecasts contained in the Concert, especially in its clause 6.6.

7.2.5 Differences Claims. The ISFAS will make available to the Entity, in the first ten days of each month, a file with the complete relation with all the data of the collective, including the high, low and variations produced during the previous month, referring to the Twenty-four hours on the last day of that month.

The relationship of the collective included in the file may be checked by the Entity, so that, if you estimate that there are differences, you can make the following claims:

a) Those relating to the holders, including those affecting their beneficiaries, if they exist.

b) Those relating to beneficiaries exclusively.

The entity will present the claims separately, in accordance with the above classification, and will accompany them with the same technical characteristics as the one provided by the ISFAS, containing the information in which the cover the claim. Complaints must be submitted within three months of the monthly communication of the status of the collective and the relationship of incidents, after which no claim has been made conformity by the Entity, acquiring firmness the payment made according to that collective. The complaints submitted shall be resolved by the ISFAS within three months of the date of submission of the complaints.

The consolidation of the finality of the payment, as referred to in the preceding paragraph, is without prejudice to the fact that in no case may an uncausable attribution be originated for the ISFAS or for the Entity.

7.2.6 Taxes. All taxes, arbitrations, fees and charges that are taxed in this Concert or the acts that derive from it shall be of account of the Entity.

7.2.7 Subrogation on receivables and shares. In the case of health care for injuries caused or a disease arising or aggravated by accidents covered by any form of compulsory insurance or where the cost of the health care provided must be legal or by public bodies other than ISFAS or by private entities, the Entity, without prejudice to the provision of assistance in any event, may be subrogated to the rights and actions of the holders and beneficiaries relating to the amount of the costs arising from such health care, taking the steps to be taken necessary to reintegrate with the cost of the same. The holders and beneficiaries, for their part, shall be obliged to provide the Entity with the data necessary for this purpose.

7.3 Concert Price. quotas. The composition of the population protected by this Concerto has undergone significant variations, so that, in order to balance the inequalities produced, derived fundamentally from the evolution of the age pyramid of the collective of the ISFAS, for the duration of this Concert, the payment is made based on the following parameters:

(a) In 2016 and 2017 the ISFAS shall pay the Entity the amount of EUR 90.55 per month, for each protected beneficiary who was 70 or more years of age at 24 hours on the last day of the month preceding the date of the payment, according to the high and low criteria which for economic purposes are set out in clause 7.2.1.

(b) In 2016 and 2017 ISFAS shall pay the Entity the amount of EUR 72.68 per month for each protected beneficiary who is under 70 years of age and over 60 years of age at the end of the month preceding the month preceding the month preceding the date of corresponds to the payment, according to the high and low criteria which for economic purposes are set out in clause 7.2.1.

(c) In 2016 and 2017, the ISFAS shall also pay the Entity the amount of EUR 61,52 per month for each protected beneficiary who is less than 60 years of age at twenty-four hours on the last day of the month preceding the date of corresponds to the payment, according to the high and low criteria which for economic purposes are set out in clause 7.2.1.

7.4 Incentive-associated incentives.

7.4.1 Limits and Objectives.

A) Maximum amount. The continuous improvement of the health care services that the holders and beneficiaries of the ISFAS receive through the Concerted Entities is a central axis of the Concerto, thus establishing economic incentives associated to the achievement of certain objectives (IAO).

The limit or maximum amount of economic incentives to be reached by the Concerted Entities shall be determined by the following formula:

LAIO (i) = Pm × C (t) × Q × 12

Where:

LAIO = Annual Incentive Limit associated with targets.

Pm = Average monthly fee paid for the assistance of the ISFAS collective, attached to insurance entities with full assistance mode, at December 31 of the previous year.

C (t) = Collective attached to Insurance Entities in full assistance mode, at 1 February of the corresponding year.

Q = Coefficient modulator to be 0.035.

B) Objectives associated with incentives. The objectives that are linked to the payment of incentives are:

Objective 1: Assistance for people with special needs for care. Weight ρ₁= 0.25.

Objective 2: Guarantee in the offer of Emergency Services. Weight ρ₂= 0.15.

Goal 3: Improvement of quality in palliative care. Weight ρ₃ = 0.15.

Objective 4: Improvement in the quality of the pharmaceutical prescription. Weight ρ₄= 0.30.

Objective 5: Amplitude of the supply of hospital services. Weight ρ₅= 0.15.

The payment of the incentive associated with the fulfilment of Objectives 3 and 5 shall be annual and shall be made effective in conjunction with that of the quotas corresponding to the month of December of each year of validity of the Concert.

The payment of the incentive associated with the fulfilment of Objectives 1, 2 and 4 shall be carried out on a monthly basis.

The payment of the incentive associated with the objective in the pharmaceutical supply (objective 4) shall be made cash monthly, the second month after which the indicators established for its evaluation correspond. In other words, the incentives obtained from the month n indicators will be paid with the month n + 2. quotas.

If the Entity had subscribed to the Concert in force in 2015, the months of January and February 2016 will receive the incentives provided for in that Concert, which will be in November and December 2015, respectively.

7.4.2 Assistance to people with special needs for care. The intensity of care and care required by persons in the situation of absolute invalidity and great invalidity 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 for each holder or beneficiary assigned to the Entity, with a disability that has resulted in the recognition of child support in charge of severe disability or disability with the need for third person (DS), and an incentive for each holder with absolute invalidity (IA).

A) Incentives for a person with severe disability (IPDS). The monthly amount that the Entity will receive for each person with disabilities that has resulted in the recognition of child support in charge of severe or severe disability Invalidity with the need for third person (DS) will be obtained by applying the following formula, expressing the result with two decimal places:

IPDS (i) =

Pm × C (t) × Q × CDS (i) x

CDS (t)

Where:

IPDS (i) = Person with severe disability incentive, corresponding to Entity (i).

Pm = Average monthly fee paid for the assistance of the ISFAS collective, attached to insurance entities with full assistance mode, at December 31 of the previous year.

C (t) = Total Collective attached to Concerted Insurance Entities in full attendance mode, as of February 1 of the corresponding year.

CDS (i) = Number of holders and beneficiaries with disabilities that have resulted in the recognition of child support in charge of severe disability or disability with a third person's need, attached to the Entity (i) in the full attendance mode, referred to as the appropriate day of the month.

CDS (t) = Number of holders and beneficiaries with disabilities that has resulted in the recognition of child support in charge of severe disability or disability with the need for a third person, attached to insurance in full assistance mode, referred to as the appropriate day of the month.

Q = Coefficient modulator to be 0.035.

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

The monthly amount that the Entity will receive for each disability holder that has resulted in the absolute invalidity (IA) recognition will be obtained by applying the following formula:

IPIA (i) =

Pm × C (t) × Q × CIA (i) x 0.05

Where:

IPIA (i) = Incentive per person with absolute invalidity corresponding to Entity (i).

CIA (i) = Number of holders with disabilities that have resulted in the recognition of absolute and permanent invalidity, attached to the Entity (i) in the form of complete assistance, referred to the day one of the corresponding month.

CIA (t) = Number of holders with disabilities that have resulted in the recognition of absolute and permanent invalidity, attached to insurance entities in the form of complete assistance, referred to the day one of the month corresponds.

7.4.3 Guarantee in the coverage of Urgent Services. The location of the centers where the professional activity of the collective protected by the ISFAS is developed conditions its peculiar geographical distribution and the need of means for the emergency assistance in small municipalities, in which can only be provided through non-concerted 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) for each holder or beneficiary assigned to the Entity, who has fixed his residence in municipalities that are not included in Level III of specialized care, the amount of which will 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 assigned to the Entity (i) by warranty in the coverage of Urgent Services.

Pm = Average monthly fee paid for the assistance of the ISFAS collective, attached to insurance entities with full assistance mode, at December 31 of the previous year.

C (t) = Total Collective attached to Concerted Insurance Entities in full attendance mode, as of February 1 of the corresponding year.

Q = Coefficient modulator to be 0.035.

Cd (i) = Number of holders and beneficiaries assigned to the Entity (i) in the form of full assistance, who have their habitual residence in areas with lower population density, consideration that will have all the municipalities which are not included in the specialised care level III referred to in the relevant day of the month.

Cd (t) = Number of holders and beneficiaries assigned to insurance entities concerted in the form of complete assistance with their habitual residence in areas with lower population density, consideration that they will have all municipalities which are not included in Level III of specialised care referred to in the relevant day one of the month.

7.4.4 Quality Improvement in Palliative Care Delivery.

A) Documentation for evaluation. Guidelines that inspire the National Health System's Palliative Care Strategy should guide the provision of palliative care in the field of concerted assistance from ISFAS.

In order to qualify for the corresponding incentive, before 31 October of the corresponding year, the Entity must submit the following information to the ISFAS Information Support:

Palliative Care Plan developed by the Entity for the corresponding year, in which its objectives, case management procedures (patient identification, referral, information services and information services) will be detailed. coordination, etc.) and care protocols that include periodic evaluation with pain monitoring and other symptoms and functional assessment.

Information system in excel format, with the relationship of beneficiaries who have received palliative care in the previous twelve months.

In the case of Concerted Entities with the ISFAS in 2015, the table for 2016 will include a record (row) for each beneficiary attended by specific Palliative Care services in the 12 months preceding the year. September 30, including their identifying number (beneficiary number) and the code corresponding to the type of services that have been attended to.

The tags that will be used are the following:

Support or home support equipment: 11.

Hospital unit or services: 12.

Other: 19.

For the Entities that did not subscribe to the 2015 Concert. As an exception, the file for 2016 will only include the information of the beneficiaries served between January and September 2016. In this case, the data relating to the number of beneficiaries served in the last 12 months shall be estimated from the resulting monthly average.

The table will have the following structure and format:

ID_BENEF

COD_SERV
287099999999	11

At the time of the allocation of palliative care services, patients will be informed that their data may be processed by the ISFAS for management purposes, always with the guarantees and channels established by the law. Organic 15/1999, dated December 13, Personal Data Protection and its development regulations.

B) Indicators for the assessment and allocation of the incentive. The indicators that will be obtained and used for evaluation are:

1. Map of specific palliative care resources, by provinces and type of device, in excel format.

Only home-support devices and hospital units, either own or arranged, will be included for primary care media support in situations of complexity.

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

Percentage of Tier III municipalities in which the Entity has concerted home support (ESD) teams.

Formula: a/b x 100, where

a = n. municipalities with ESD offering.

b = n. total number of municipalities and clusters of Tier III municipalities (i.e. 64).

Minimum value 40%.

Maximum score 0.40 points.

Value for maximum score: 80%.

The assigned score will be proportional to the attainment level, resulting from the following formula:

P2 (i) = (Vi-Vm) x Pmax/(VM-Vm)

Where:

P2 (i) = Indicator score for Entity (i).

Vi = The value of the Entity i indicator.

Pmax = Maximum score assigned to the indicator.

VM = Indicator value for maximum score.

Vm = The minimum allowed value for the indicator.

3. Percentage of beneficiaries served by support or home support (ESD) teams.

Formula: a/b x 100, where

a = n. number of beneficiaries served by ESD in the corresponding period (corrected to one year).

b = n. estimated number of palliative care subsidiary beneficiaries. The estimation shall be carried out using the following formula, which allows an estimated rate from epidemiological studies to be obtained, with a correction for under-registration:

b =

C (i) × 175 × 0.15

100,000

Minimum value 15%.

Maximum score 0.50 points.

Value for maximum score 40%.

The assigned score will be proportional to the attainment level, resulting from the following formula:

P3 (i) = (Vi-Vm) x Pmax/(VM-Vm)

C) Amount of incentive. The overall score (Pcp) of the Entity (i) that will be given by the sum of the assigned scores will then be obtained, depending on the indicators obtained.

Pcp (i) = P1 (i) + P2 (i) + P3 (i)

The amount of the annual incentive associated with the palliative care goal (IACP) will be obtained, taking into account the score reached and the weight assigned 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 palliative care goal.

Pm = Average monthly fee paid for the assistance of the ISFAS collective, attached to insurance entities with full assistance mode, at December 31 of the previous year.

C (i) = Collective attached to the Entity (i) in full attendance mode, at 1 February of the corresponding year.

Q = Coefficient modulator to be 0.035.

Pcp (i) = Overall Score (Pcp) of the Entity (i) to be given by the sum of the assigned scores, based on 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 supply is a central objective of the Concerto, thus establishing a monthly incentive associated with the improvement in the quality of the pharmaceutical prescription (IMPF).

For the evaluation of the quality of the pharmaceutical prescription, four indicators of selection are established, focusing on therapeutic groups of special relevance, such as antiulcerative, lipid-lowering, antihypertensive, and Non-steroidal anti-inflammatory drugs, with each indicator setting a reference value as an objective, taking into account historical values and the estimated possibility of progress in the direction of improvement of the quality of prescription.

The indicators and criteria for their assessment may be modified by Resolution of the General Secretariat of the ISFAS.

B) Indicators for evaluation. The prescription of first-choice drugs will be evaluated in certain prevalent pathologies, through the indicators of consumption of DDDs (defined daily doses) that are indicated below.

1. Use of antiulcerative drugs:% of DDDs dispensed from omeprazole, on the total DDDs of proton pump inhibitors.

Formula: a/b x 100, where

a = n. º of dispensed DDDs of omeprazole (A02BC01).

b = n. º of DDDs dispensed from all proton pump inhibitors (A02BC).

Minimum value: 50%.

Value for maximum score: 75%.

Maximum score: 0.25 points.

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

Formula: a/b x 100, where

a = n. º of simvastatin dispensed DDDs (C10AA01).

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

Minimum value: 10%.

Value for maximum score: 25%.

Maximum score: 0.25 points.

3. Use of medicinal products acting on the renin angiotensin system:% of DDDs. dispensed with IECA drugs, on the total number of medicinal products that are inhibitors of the renin angiotensin system.

Formula: a/b x 100, where

a = n. º of DDDs dispensed from IECAs and associations (C09AA, C09BA, and C09BB).

b = n. º of DDDs dispensed from all renin-angiotensin system inhibitor drugs and associations (C09AA, C09BA, C09BB, C09CA, C09DA, C09DB, and C09XA).

Minimum value: 20%.

Value for maximum score: 45%.

Maximum score: 0.25 points.

4. Use of non-steroidal anti-inflammatory drugs (NSAIDs):% of DDs dispensed from first-choice NSAIDs (diclofenac, ibuprofen, and naproxen) on the total of DDDs dispensed from all NSAIDs.

Formula: a/b x 100, where

a = n. º of DDDs dispensed from diclofenac, ibuprofen, and naproxen (M01AB05, M01AE01, and M01AE02).

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

Minimum value: 40%.

Value for maximum score: 70%.

Maximum score: 0.25 points.

The source of information for the calculation of the indicators will be the system for managing the pharmaceutical and talonary billing of ISFAS recipes.

C) Incentive allocation. The score assigned to the Entity for each of the indicators shall be proportional to the level of achievement, resulting from the following formula:

Pi = (Vi-Vm) x Pmax/(VM-Vm)

Where:

Pi = Indicator score for Entity (i).

Vi = Entity indicator value (i).

Vm = The minimum allowed value for the indicator.

Pmax = Maximum score assigned to the indicator.

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

The overall score (Ppf) of the Entity (i) will then be obtained, which will be given by the sum of the assigned scores, depending on the indicators obtained.

ppf (i) = P1 (i) + P2 (i) + P3 (i) + P4 (i)

The amount of the monthly incentive associated with the pharmaceutical prescription target (IMOPF) will be obtained, taking into account the score reached and the weight assigned to the target, applying the following formula:

IMOPF (i) = Pm × C (i) × Q × Ppf (i) × 0.30

7.4.6 Annual incentive for the extent of the supply of hospital services. The offer of concerted hospital services is conditioned by the volume of existing hospital infrastructures, so the objective of improving the range of hospital services has been focused on capital cities. Province that has more than three hospital facilities with general or medical-surgical facilities of private ownership, of more than 30 beds, according to the data collected in the National Catalogue of Hospitals, referred to December 2014, situation in Barcelona, Bilbao, Las Palmas de Gran Canaria, Madrid, Malaga, Palma de Mallorca, Santa Cruz de Tenerife, Sevilla, Valencia and Zaragoza.

In order to promote a wide range of hospital services, the ISFAS will pay an incentive when the availability criteria are met in the capital cities and, in addition, the offer of means of the Entity exceeds the minimum levels set.

The amount of the annual incentive for the breadth of the hospital service offer will be obtained by applying the following formula:

IAOSH (i) = Pm × C (i) × Q × 12 x PT (i) × 0.15

Where:

IAOSH (i) = Annual Amplitude Incentive of the Entity's Hospital Services Offering.

Pm = Average monthly fee paid for the assistance of the ISFAS collective, attached to insurance entities with full assistance mode, at December 31 of the previous year.

C (i) = Total Collective attached to the Entity (i) in full attendance mode, at 1 February of the corresponding year.

Q = Coefficient modulator to be 0.035.

PT (i) = Final score assigned to each Entity by the breadth of the hospital service offering in the capitals included in the assessment.

PT (i) = p1 (i) = p1 (i) + p2 (i) + ... + p13 (i), with p being the score for each of the capitals where the offer is evaluated.

A) Requirements for the assessment of the offer. In order for it to be assessed, the offer of services in the relevant capital must meet the following requirements:

1. In the Service Catalogue, at least 50% of the hospital facilities with general or medical-surgical facilities of private ownership with more than 30 beds, existing in the corresponding capital, according to the data collected in the National Catalogue of Hospitals, as at 31 December 2014.

In Madrid, the offer will include at least 60% of the existing private or medical-surgical inpatient facilities.

2. The hospital facilities included in the Service Catalog must provide comprehensive care that will reach all the specialties of the corresponding level of care available, including the clinical analysis services, diagnostic imaging and other central services.

C) Score. For the offer of services of the Entity of each of the capitals included in the assessment, where the required requirements are met, a score that will be the result of applying a proportionality factor (F) to the coefficient of the corresponding capital:

p_n = µ_n x F

Where:

p_n (i) = Score assigned to the Entity (i) by the offering of hospital services in the corresponding capital n.

µ_n = Coefficient attributed to the corresponding province, weighting its population, the ISFAS collective and the breadth of its private hospital infrastructures.

F = B (i) /B (t) Is a proportionality factor, being

B (i) = Collective of the Entity in the province of the corresponding capital, on February 1.

B (t) = Collective in the province of the set of Entities that meet the required requirements, on February 1.

The following table details the coefficients attributed to each capital included in the assessment:

Capitals

Madrid.

Coef. (µ)
Barcelona.
Bilbao.	0.04
0.06
Malaga.
Palma de Mallorca.	0.05
	Santa Cruz Tenerife.	0.05
Seville.
Zaragoza.	0.06

Attachment relationship:

1. Means of assistance in rural areas.

2. Services that require prior authorization of the entity.

3. Pathologies with vital risk.

4. Care information system.

5. Health Media Registration.

6. Additional primary care and emergency mode.

7. Cross-border healthcare.

8. Relation of municipalities of level I of specialized care.

9. Relationship of municipalities and level II clusters of specialized care.

ANNEX 1

Support for rural areas

1. General rules. To enable the provision of health services in rural areas to beneficiaries assigned to the Entity, the ISFAS may agree with the Health Services of the Autonomous Communities to provide them, according to the possibility provided for in the legislation in force.

2. Enable the ISFAS. By the signature of this Concert the Entity grants its express and total authorization to the ISFAS to agree to such services, which also protects the authorization for the extension of the Conventions subscribed to the same end prior to January 1, 2015.

The authorization shall not prevent the Entities from entering into agreements with the same object and scope with the competent authorities, provided that their clauses do not object to the provisions of this Annex.

3. Object. The services that may be included in those conventions are:

Primary care health services in municipalities of up to 20,000 inhabitants where the Entity does not have sufficient or sufficient means of its own.

Emergency services in municipalities of up to 20,000 inhabitants, which are provided through Primary Care Services.

4. Content.

4.1 Each agreement will be common for all the Entities that are signatories to the Concert. The aid content, the economic consideration and the relationship of municipalities agreed with the respective Autonomous Communities shall be communicated to each of them.

4.2 The economic consideration to be established in each convention may be stated:

a) Depending on the affected collective, by fixing a monthly price per person and type of service.

(b) By medical act, by applying the public prices or tariffs that the corresponding Autonomous Community applies for the provision of health services.

4.3 The final amount of each agreement, as provided for in point 4.2 (a), will be satisfied by the price that, once accrued and released, the ISFAS must pay to each Entity for this Concert, understood made the payment on behalf of the same.

The ISFAS will make each monthly payment charged to the amount of the same month that you must pay to the Entity for the Concert, transferring the corresponding justification.

4.4 In those conventions in which the economic consideration, as provided for in point 4.2 (b), is provided by medical act, the Entity shall pay the respective Autonomous Community directly in the terms that are stipulated in the corresponding convention.

In the event of any outstanding economic obligations with any Autonomous Community as a result of direct payment or payment commitment by the Entity, the ISFAS will pay the payment of these, in the terms of the item above, the payment on behalf of the same being made, and the corresponding justification is transferred to it.

5. Means of assistance in municipalities of Autonomous Communities with which no Convention has been formalized. In the municipalities of less than 20,000 inhabitants belonging to Autonomous Communities with which no collaboration agreements have been formalized or these only have as their object the emergency health care, and in which the Entity does not have of own or concerted means and there are no private means, it shall facilitate the access of the beneficiaries to the Primary Care services dependent on the corresponding Autonomous Community, both for ordinary and emergency assistance, assuming the Entity directly the expenses that can be billed.

ANNEX 2

Services that require authorization from the Entity

1. Relationship of Services that require prior authorization of the Entity. In accordance with the provisions of clause 3.5.3 of the Concert, the provision of the services listed below requires prior authorization of the Entity:

1.1 Hospitalizations.

A) Hospitalization.

B) Day Hospitalization.

C) Home hospitalization.

D) Palliative care home by Support Teams.

1.2 Diagnostic techniques, treatments, and surgical techniques.

E) Outpatient surgery.

F) Odontostomatology: Tartrectomy-cleaning of the mouth-Dental protesis and osteo-integrated implants in an act of service or occupational disease and in the assumptions provided for in clause 2.6.1.E).

G) Rehabilitation, Physiotherapy, and Logopedia.

H) Home respiratory therapies: Oxygenotherapy, ventilation and aerosoltherapy.

I) Peritoneal dialysis and hemodialysis treatments.

J) Oncology: Immunotherapy and Chemotherapy, Cobaltotherapy, Radiumtherapy and Radioactive isotopes, Brachytherapy and Linear Accelerator.

K) Diagnosis by image: Computed Tomography, Magnetic Resonance Imaging, Orthoppantomography, Mammography, Interventional Radiology, PET-TC, Gammagrafi, Doppler, and Bone Densitometry.

L) Neurophysiological studies.

M) Test and neuropsychological studies.

N) Study and endoscopic treatment.

O) Cardiology: Hemodynamic studies and treatments.

P) Obstetrics: Amniocentesis.

Q) Ophthalmology: Retinography and laser treatment. Coherency Optical Tomography. Optical tomography with Confocal Laser (HTR-Heidelberg Retina Tomograph). Polarimetry. GDX Laser. Treatment of age-associated macular degeneration (AMD) by Photodynamic Therapy or Intravitreal injection of antiangiogenics.

R) Treatment in Pain Unit.

S) Study and treatment in Sleep Unit.

T) Renal Litotricia.

1.3 Psychotherapy.

1.4 Assistance to consultant physicians.

1.5 Podology.

1.6 Services from Level IV (except specialist outpatient consultations) and referral services.

1.7 The Services for the private non-concerted hospital centres 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 derives from the need to order and channel the benefits on the part of the Entity, in order to facilitate the assistance and avoid delays, but never before. You can assume a restriction on access to the recognized capabilities in the Services Portfolio.

In no case will a request for a diagnostic or therapeutic means included in the Services Portfolio be denied in this Concert, indicated by an Entity.

For the purposes of the preceding paragraph, where the requirements for the availability of means provided for in this Concert at the relevant level are not met, the prescription of non-concerted optional, which shall be always accompanied by a reasoned report of the requested benefit.

2.2 The Entity, through the facultives that prescribe or perform the services that require prior authorization, shall duly inform the beneficiary of this requirement.

In no case may the beneficiary be made out of the unauthorised evidence if he has not been informed prior to the need for such prior authorisation or, in the case of medical or surgical acts performed at the time of the query, for lack of time to obtain it.

2.3 The Entity will have the necessary organisational resources to make it easier for the holders and beneficiaries of ISFAS to obtain the prior authorisation for the provision of the services referred to in point 1 of this Article. this Annex, by any of the following means:

A. Presentially, in any of your delegations.

B. Telephonically.

C. By fax.

D. Through the Entity's web page.

E. Other telematics procedures.

2.4 The holders or beneficiaries who need it will be able to process the application for prior authorization by sending it to the Entity by any of the available means.

2.5 Prior authorization requests will contain the following information, regardless of the means used for sending them to the Entity:

A. Personal data of the applicant:

-Name and last name.

-Health card number.

-Contact phone, email, or fax.

B. Data for the service for which prior authorization is requested:

-Province in which the capability will be performed.

-Identification of the requested service.

-Prescription date.

-Identification of the prescription, with signature of the prescription.

-Expected date for the performance of the benefit, if any.

-The health center where the prescription will be performed, if any.

2.6 In the event of an accident of service or occupational disease and in the cases provided for in clause 2.6.1.E) for dental prostheses, it will be necessary to prescribe an optional specialist of the Entity, together with budget for authorization by the Entity.

2.7 In the case referred to in paragraph 1.7. of this Annex, the Entity, upon receipt of the application, may confirm the professional or health center chosen by the applicant or, if it deems appropriate, assign another different, provided that it constitutes a valid care alternative for the performance of the requested benefit.

2.8 The authorization issued by the Entity will have an identification number, which will be unique and specific to the benefit requested and will detail the health care professional or center where it is to be performed. The Entity may refer the entity to the holder or payee for any of the following means:

A. In hand, where the application has been submitted in person to any of the delegations of the Entity and, as such, is possible.

B. By mail, telephone or fax, when the application has been submitted by fax or when, having been presented in person, its processing is not possible in the event.

C. By email, when the request has been submitted through the Entity's web page.

2.9 The sending of the authorization to the holder or beneficiary by the Entity will be carried out as soon as possible, in order to avoid any delays in the access to the requested benefit. If the immediate processing is not possible, the Entity shall have a maximum of seven calendar days for its shipment, except in the case provided for in paragraph C of clause 4.2.1 of the Concert, in which it shall have ten calendar days.

2.10 The Entity may only deny prior authorization if the request:

A. It does not have the necessary information, in which case it must immediately contact the applicant with the object of completing the missing one.

B. It refers to a provision not included in the Services Portfolio, in which case it must inform the holder or beneficiary of this circumstance.

C. It is not supported by the prescription of a concerted or non-concerted optional in the terms of paragraph 2.1, in which case it shall also inform the holder or beneficiary of this circumstance.

Denial of benefits will always occur in writing and in a motivated manner, through a means that allows you to record your receipt.

2.11 In order to facilitate access to benefits, the Entity will provide advice to beneficiaries who so request.

2.12 The Entity shall include in its Services Catalogue, website and, where appropriate, other means of information to the holders and beneficiaries, all information in the procedure for obtaining prior authorizations resulting from the necessary to facilitate processing.

ANNEX 3

Life-threatening pathologies

A purely indicative and non-exhaustive title, in the following cases it will be understood that there is an imminent or very near risk of not obtaining an immediate therapeutic action, so that, if the Requirements under clause 4.3.2, shall result from the reimbursement of expenses in the event of the use of means other than the Entity:

1. Intracranial or intracerebral acute bleeding, genital, digestive, respiratory, renal or rupture of blood vessels in general, with significant loss of blood or internal bleeding.

2. Complete or incomplete abortions. Uterine rupture or the complication of extra-uterine pregnancy. Gravidic toxicosis.

3. Cardiac, renal, hepatic, circulatory, traumatic, toxic, metabolic or bacterial shocks. Commas. Allergic reactions with involvement of the general state.

4. Acute respiratory, renal or cardiac failure.

5. Acute abdomen, formulated as a diagnosis, prior or presumption.

6. Lesions with external tears with imputation of viscera.

7. Hip fractures or the head of the femur.

8. Cerebrovascular accidents.

9. Acute poisonings. Acute sepsis.

10. Anuria. Acute urine retention.

11. Diphtheria. Botulism. Meningitis. Meningoencephalitis. Acute form of ulcerative colitis. Acute gastroenteritis with involvement of the general state.

12. Obstruction of the upper respiratory tract. Pulmonary embolism. Pleural effusion. Spontaneous pneumothorax. Acute lung oedema. Bronchial asthma crisis.

13. Myocardial infarction. Hypertensive crisis. Peripheral arterial embolism. Asistolia. Paroxysmal tachycardia.

14. Diabetic coma. Hypoglycaemia.

15. Seizures. Childhood seizures. Toxicosis of the infant.

16. Acute adrenal insufficiency. Acute failure of peripheral circulation. Severe alterations of electrolyte metabolism.

ANNEX 4

Care information system. Asset-cost record

Includes information on outpatient activity, hospital activity, emergency activity, surgical activity, and other diagnostic and therapeutic procedures.

1. Information on outpatient activity.

On a quarterly basis, the Entity shall communicate to ISFAS the accumulated data broken down by:

Table 1. Medical consultation activity

Anesthesiology and Resuscitation.

Intensive Medicine.

Neurosurgery.

Oncology.

	Query # *	Cost
Family General Medicine.
Paediatrics.
Angiology and Vascular Surgery.
Digestive.
.
Surgery.
General and Digestive Apparatus.
and Maxillofacial Surgery.
Orthopaedic and Traumatology Surgery.
Surgery.
, Aesthetic, and Repairing Surgery.
Medical-Surgical and Venereology dermatology.
Endocrinology and Nutrition.
stomatology/dentistry.
Hematology and Hemotherapy.
Medicine.
Nuclear Medicine.
Nephrology.
Neumology.
Neurology.
Obstetrics and Gynecology.
Radioterapic Oncology.
Otorhinolaryngology.
Psychiatry.
Rehabilitation.
Rheumatology.
Treatment.
Urology.
concerted service at price fixed/capitative payment.
Other * *.

* All queries are included (first, check, and home).

** This section will be used when there is a concept that does not fit in the previous sections; in this case, each concept must be specified.

Table 2. Other outpatient activity

Oxygenotherapy/Respiratory Therapies.

Dialysis.

Dialysis continuous ambulatory peritoneal (CAPD).

Activity	# patients	N. queries/sessions/services	Cost	User
D. U. E.
Matron.
Therapy.
Foniatria/Logopedia.
Psychotherapy.
Healthcare Transport.
-urgent health transport
Urgent_table_body.
Other capabilities: Reactive glucose, insulin syringes, pharmacy (V04, Hospital Use ...).
: Direct Payments to Secured by Media Utilization unconcerted, CMP, CMN, Rural Zone Conventions, ....
Home Dialysis.

Table 3. Diagnostic tests

Tomography (TAC)

	by image	No. of studies	Cost
Simple Radiology (head, trunk, limbs, stomatological radiology).
Special Radiology (contrast radiology, mammography ...).
Interventional Radiology.
/Doppler (does not include echocardiography or gynecological ultrasound).
Nuclear Resonance.
Densitometry Osea.
Other techniques.

Clinical Analysis

Determinations	Cost
Biochemistry.
Endocrinology (determinations
Genetics.
		Immunology.
Immunology.
Microbiology.
Parasitology.
Other determinations.

Pathological Anatomy

No. of Studies	Cost
Biopsies.
Citologies.
Other.

Medicine	No. of Studies	Cost
PET.		PET.

Other diagnostic tests

Ecocardiography/Echo doppler

Gastrocopies.

Colposcopies.

Broncocopies.

Urology.

No. of studies	Cost
Allergy.
Allergic tests.
	.
Ergometry.
	Holter.
(excludes hemodynamics and electrophysiology).
Digits.
colonoscopies.
Other.
Ecopies.
Other.
Neumology.
Spirometries.
	.
		Electroencephalography
Other.
	. A. L.
Acoustic Otoemissions.
.
Auditries.
.
urodynamic studies.

2. Information on Hospital Activity.

Table 4. Conventional hospitalization

Partos.

Hospitalization	Revenue				Cost
		Center	Public Center	Concerted center	Public Center	The Public Center	Public
	Medical.
.
Obstetrics
Caesareas.
Care.
Neonatology.
Unit Palliatives.

* No. of stays accumulated quarterly by line of activity.

Table 5. Hospitalization by day and home

Hospital *	Patient No.	Session #/
Home Hospitalization.
palliative care home support teams.

* Excludes the surgical day hospital

** N. of sessions accumulated quarterly by line of activity.

3. Information on emergency activity.

On a quarterly basis, the Entity shall communicate to ISFAS the accumulated emergency activity data broken down by:

Table 6. Information on emergency activity

Type

Emergency Nº	Cost
Ambulatory * *.
Home Urgency * **.
Center/Emergency Service at fixed price.
Other.

* Hospital emergency: all those who have been treated in the emergency services of a hospital, including those who have finished in hospital admission.

** Outpatient emergencies: are all those that have been attended by the emergency services of the non-hospital health centers (polyclinics, external emergency services, etc.)

*** Home urgencies: These are all urgent assistance attended at the patient's home for emergency services.

4. Information about surgical activity.

On a quarterly basis, the Entity shall communicate to ISFAS the accumulated data of surgical activity broken down by:

Table 7. Surgical activity

	Description	N.	Cost
Major Surgery.	Scheduled Surgical Interventions with Hospitalization.
	Urgent Surgical Interventions with Hospitalization.
	Ambulatory Surgical Interventions in the operating room (CMA).
	Ambulatory Urgent Surgical Interventions (CMA)
minor surgery.	Minor surgery interventions.

5. Other diagnostic and therapeutic procedures.

On a quarterly basis, the Entity shall communicate to ISFAS the cumulative activity data of other therapeutic procedures broken down by:

Table 8. Other diagnostic and therapeutic procedures

Description

Procedures No.	Cost
Intracranial Neurostimulator Implant.
Simple Radiosurgery.
Fractious radiosurgery.
cardiac hemodynamics.
total stents.
electrophysiological studies.
electrophysiological studies:.
Implant/defibrillator replacement.
Other.
Reproduction Cycles Assisted.

ANNEX 5

Health Media Record

1. The information of the own and concerted means that the Entity offering to provide the health care service to its beneficiaries in the national territory will be sent to the ISFAS in electronic format. In addition to the general data of the Entity, the entity will transmit the data listed in the following tables in the format indicated.

The data sent must correspond to all the data that is contained in the edited service catalogs. The ISFAS shall establish the frequency of updating the data and provide a simple mechanism for the telematic load of the data. The professional identification data must be adapted to those established by the different professional associations and associations.

The location data structure in all tables corresponds to the official structure of the INE for possible exploitation through a geographic information system.

2. Table of Healthcare Professionals:

Contains the information of all the agreed healthcare professionals in the Entity. A row shall be completed for each professional.

Names	Type	Length	Description of fields
CIF_NIF	alphanumeric,	9	CIF or NIF of the professional.
50	alphanumeric		50	First name of the professional.
	alphanumeric	50	Second name of the professional
Name professional	alphanumeric	50	Professional name.
numeric		9	numeric	number of collegiate Required only if the professional activity is 1 (doctor)
		numeric	2	INE Province Code.
numeric		5	5	INE Municipality Code where you perform the activity professional.
IDEspec	numeric	3	(1) Code Specialties according to CMB/SIFCO. Required if professional activity is 1 (medical)
	Specialist	text	75	The name of the craft. Required only when the craft code is equal to ZZZ.
Activity	alphanumeric	1	1. Doctor. 2. Nurse practitioner. 3. Dentist. 4. Physical therapist. 5. Psychologist. 6. Logopeda. 7. Podiatrist. 8. Others
ICF_Center	alphanumeric,	9	CIF health center where you exercise the activity.
Clinic_link	text,	150	Clinic or Center where the professional performs his/her activity (in his case description identical than in National Hospital Catalog)
alpha_type	alphanumeric,	5	Home path type (INE codes).
	alphanumeric	150	Path name
Number	alphanumeric	20	Number of the address of the path
IDMun	numeric	5	INE Township Code where the centroional is located.
Postal Code	alphanumeric	5	Postal Code.
E_box	alphanumeric	60	Professional email address
Phone	alphanumeric		15	Professional Contact Phone.
Equip	boleano: s/n	1	Availability of computer equipment
1	1	1	1	1	1	Electronic signature available_table_file. S = Yes; N = NO.
Lector_dni	boleano: s/n	1	Indicates e-DNI reader availability. S = Yes; N = NO.
Recipe	boleano: s/n	1	Indicates whether you can prescribe a prescription or not. S = Yes; N = NO.

(1) CMB/SIFCO specialized care

ALG Alergology. ACV pathology and resuscitation. ACV Angiology and Vascular Surgery. Zant_table_table_izq"> DIG Digits. CAR Cardiology. CCA Cardiac Surgery. CCI Children's cardiac surgery. CGD General surgery and digestive system. CPE Pediatric Surgery. CPL Plastic and Repair Surgery. CTO Thoracic Surgery. DER Medical Dermatology-Surgical and Venereology. RAD Radiodiagnosis. END Endocrinology and Nutrition. EST Stomatology. FAR Pharmacy. gene. Geriatrics GRT. GIN Gynecology. HEM Hematology and hemotherapy. HAD Home hospitalization. INM Immunology. MFC Family and Community Medicine

MIV Intensive Medicine. MIN Internal Medicine. MNU Nuclear Medicine. MPR Preventive Medicine. NEF Nephrology. NML Pneumology. NRC Neurosurgery. NFC Clinical neurophysiology. NRL Neurology. OBG Obstetrics and gynecology. OFT Ophthalmology. ONC Medical Oncology. ONR radioterapic Oncology. ORL Otorhinolaryngology. PED Paediatrics. PSC Psychology. PSQ Psychiatry. REH Rehabilitation. REU Rheumatology. TRA Traumatology and Orthopedic Surgery. URlogy URlogy. UDO Pain Unit. URG URGES. OTR Other. Unknown ZZZ

3. Table of Clinics and hospitals.

Contains the information of all hospitals and clinics (with internment) themselves or arranged by the Entity. One row shall be completed for each hospital or clinic.

Names

Format/Type	Length	Description of fields
alphanumerical	alphanumeric	6	Hospital Code, collected in the National Hospital Catalogue
150			150	150	150	Text,	Text,
IDProv	numeric	2	INE Province Code.
IDMun	numeric	3	The INE Municipality Code where you perform the professional activity
alphanumeric	alphanumeric	-	List Portfolio Services Clinic Specialist
Postal Code	alphanumeric	5	Postal Code.
E_box	alphanumeric	60	Center e-mail address

4. Table of health centers without internment.

Contains the information of all care centers without internment, own or agreed by the Entity. A row shall be completed for each centre.

Names

Format/Type	Length	Description of fields
CIF_NIF
center_Clinic			150
IDProv	numeric	2	INE Province Code.
IDMun	numeric	3	numeric The_table_table_izq"> INE Municipality Code where you perform the professional activity
	alphanumeric	5	Code set in Annex 1 to Royal Decree 1277/2003, October 10. (1)
alphanumeric		5	5	Home Path Type (INE Codes)
	alphanumeric	150	Path name.
Number	alphanumeric	20	Number of path address.
OTRDIR	alphanumeric	40	Other address data.
Postal Code	alphanumeric	5	Postal Code.
E_box	alphanumeric	60	Center e-mail address
Phone	alphanumeric	Table_table_izq"> 15	Center Phone.
Fax	alphanumeric		Fax from the center.
		5	Code set in Real Annex 1 Decree 1277/2003 of 10 October. (1)
	Alfico	5	Offering of medical services. WTO specialties code
OFTECDCO	Alfico		The techniques that you know will be included Make the center between separators. (2)

(1) Type of center:

C. 2.1 Medical Queries.

C. 2.2 Consultations from other healthcare professionals.

C. 2.4 Polivalent Centers.

C. 2.5 Specialized Centers.

C. 2.5.1 Dental clinics.

C. 2.5.2 Assisted human reproduction centers.

C. 2.5.3 Centers for voluntary termination of pregnancy.

C. 2.5.4 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 Transfusion centers.

C. 2.5.9 Fabric banks.

C. 2.5.11 Mental health centers.

C. 2.5.90 Other specialized centers.

C. 2.90 Other Non-Internal Healthcare Providers.

(2) Offering of techniques:

Lab:

100 Sample Extraction/Collection Point.

101 Hematology.

102 Biochemistry.

103 Microbiology and parasitology.

104 Immunology.

105 Genetics.

106 Hormone Levels.

107 Drug Levels.

Radiodiagnosis:

121 Conventional Radiology (simple and contrast).

122 Mammography.

123 TAC.

124 Ecography.

125 Densitrometry.

126 Digital Angiography.

127 Interventional Radiology.

Other diagnostic techniques.

141 Endoscopy.

151 Gammagrafia.

161 EEG.

162 EMG.

163 Potentials evoked.

170 PET-TAC.

Medical specialty services.

The CMBD/SIFCO code will be entered.

5. Table of Provincial Delegations of the Entity.

Contains the general information data for each provincial delegation of the Insurance Entity. A row shall be completed for each of the provincial delegations of the Entity.

Field

Data Type	Length	Description of fields
IDProv	numeric	2	IDMun
IDMun		numeric	3	NINE Code.
	Propia		1	Indicate if it is your own.: S = Yes; N = NO.
Name	alphanumeric	50	The Contact Person Name in the Delegation.
responsable Apellid1_	alphanumeric		First last name contact person in the Delegation.
responsable	alphanumeric	50	Second last name contact person.
	alphanumeric,	5	Home Path Type (INE Codes)
alphanumeric		150	alphanumeric	Name of the
	alphanumeric	20	Number of the address of the path
Postal Code	alphanumeric	5	Postal Code.
E_box	alphanumeric	60	Center e-mail address
Phone	alphanumeric		15	Phone from the Provincial Delegation
Fax	alphanumeric		Provincial Delegation Fax.
Urgences Phone	alphanumeric,	9	Free Urgences and Coordination Phone
alphanumerical	alphanumeric	9	Phone from the Ambulance Service

ANNEX 6

Primary and emergency care supplementary mode

In accordance with the provisions of Article 61 of the General Regulation of the Social Security of the Armed Forces, the ISFAS maintains a system of concerted collaboration with the Military Health, which includes the coverage of the Specialized Assistance and Hospitalization through the Military Hospitals of Madrid and Zaragoza, as stated in the Ministerial Order 52/2004, of March 18, leaving aside the corresponding assistance to the primary and the urgent step, assistance which can therefore be provided by the Entities that subscribe to the Concert with this Institute, as long as the holders choose it.

With this object, a complementary care modality is defined: the Primary Care and Emergency Mode (Mode C), to which certain affiliates and beneficiaries can be assigned according to the conditions that The following are indicated.

First.

May be assigned to the Entity, for the exclusive coverage of Primary Care and Emergency Care (Mode C), the holders and beneficiaries of the Special Regime of Social Security of the Armed Forces who, having set their residence in any of the municipalities mentioned in Paragraph 5, receive the Specialized Assistance and Hospitalization through the Defense Hospitals, in accordance with the system of concerted collaboration between the ISFAS and the Health Military in force at any time.

The aforementioned relationship of municipalities may be modified by Resolution of the ISFAS Management.

Second.

A) The health services to be provided by the Entity to the Primary Care and Emergency Care Collective will be as follows:

-General or Family Medicine, Pediatrics and Nursing, either on an outpatient, home or emergency basis.

-Emergency health services (without hospitalization), during the 24 hours of the day, under the same conditions as the beneficiaries with full assistance in charge of the Entity.

B) In general, it will be taken into account that, if a beneficiary receives emergency assistance in any of the municipalities of the Autonomous Community of Madrid or the province of Zaragoza, if the initial assessment is The need for detention should be reduced, the Emergency Service will refer the patient to the appropriate Military Hospital, managing if the transfer is necessary by ambulance. In the rest of the national territory, the beneficiary must enter the Health Services Hospitals of the Autonomous Communities.

C) Only the beneficiary's income may be managed in the agreed centre with the Entity which has provided emergency assistance, where the clinical status of the beneficiary does not permit the transfer to the designated hospital centres, not running in charge of the Entity the expenses arising from this internment.

D) In addition, any optional of the Entity, due to urgent and immediate assistance to be provided by the entity, may prescribe the beneficiary's income in a Military Hospital.

(E) The corresponding entitles of the Entity shall make the prescription of medicinal products and other pharmaceutical products in the official prescriptions of the ISFAS, formalize the reports for the proposal of discharge or Incapacity Temporary (I.T.) in the official models and the prescription of tests or means of diagnosis in the corresponding flyers. The recipe and information-proposals of I.T. will be presented to the faculty of the Entity by the beneficiaries of the ISFAS when they are needed.

F) In no case shall the pharmaceutical supply or shipments in health care be covered which, apart from the assistance for emergency services, may be specified.

Third.

The health services referred to in the preceding paragraph shall be provided throughout the national territory with the same extension and under the same conditions laid down in this Convention for the members and beneficiaries with Full assistance by the Entity, considering the application of the clauses relating to such services.

As a single exception, it will be taken into account that the basic diagnostic techniques in the field of Primary Care are considered as part of the services of General Medicine, Family and Pediatrics, which are referred to in the sub-heading (a) of the second paragraph, and therefore the Entity shall take charge of its coverage, provided that the prescription has been made by the corresponding optional of the Service Catalogue. For these purposes, diagnostic imaging studies by simple conventional radiology, without contrasts, as well as the analytical determinations included in the Basic Catalogue of the Analytical Tests collected in Section 6.

Fourth.

The price to be paid for the care services corresponding to the Primary and Emergency Care Mode (Mode C) in 2016 and 2017 will be as follows:

(a) The ISFAS shall pay the Entity the amount of EUR 16,23 per month, for each beneficiary under Mode C who is 70 or more years of age at twenty-four hours on the last day of the previous month to which the payment, according to the high and low criteria which for economic purposes are set out in clause 7.2.1.

(b) The ISFAS shall pay the Entity the amount of EUR 13,21 per month for each beneficiary assigned to Mode C under 70 years of age and over 60 years of age at 24 hours on the last day of the month preceding the date of corresponds to the payment, according to the high and low criteria which for economic purposes are set out in clause 7.2.1.

(c) The ISFAS shall also pay the Entity the amount of EUR 11.33 per month for each beneficiary under Mode C that is less than 60 years of age at 24 hours on the last day of the month preceding the date of corresponds to the payment, according to the high and low criteria that for economic purposes are set out in Clause 7.2.1.

Fifth.

May be eligible for Primary Care and Emergency Care for insured persons and beneficiaries who have their habitual residence in some of the following municipalities:

Madrid.

Alcala de Henares.

Alcobendas.

Alcorcon.

Aranjuez.

Arganda.

Boadilla del Monte.

Old Hive.

Villalba Collado.

Coslated.

Fuenlabada.

Galpower.

Getafe.

Leganes.

Madrid (including Aravaca and El Pardo).

Majadahonda.

Mostols.

Pose of Alarcón.

Rivas Vacamadrid

Rozas (Las).

San Fernando de Henares.

San Sebastian de los Reyes.

Torrejon de Ardoz.

Three Chants.

Valdemoro.

Villanueva de la Cañada.

Villaviciosa de Odon.

Zaragoza.

Calatayud.

Egea of the Knights.

Zaragoza.

Sixth.

The analytical determinations referred to in the third paragraph are those included in the following basic catalog of analytical tests:

00 Hematology.

Hemogram/Coulter.

V. Sedimentation.

00 Bank Hematology.

Blood group.

Direct Coombs.

Indirect Coombs.

Reticucytes.

00 Coagulation I.

Prothrombin time.

APTT.

Fibrinogen.

00 -Blood Biochemistry I.

Glucose.

Adult glucose curve.

Gestant glucose curve.

Test of O'sullivans.

Urea.

Creatinine.

Uric acid.

Total Cholesterol.

Triglycerides.

HDL-Colesterol.

LDL-Colesterol.

Total Bllyrubin.

Direct Bllyrubin.

Indirect Bllirubin.

GOT/AST.

GPT/ALT.

GGT.

Amllasa.

alkaline phosphatase.

CPK.

LDH.

Calcium.

Phosphorus.

Iron.

Ferritina.

Transferrin.

I. S. Transferrin.

Sodium.

Potassium.

Total proteins.

Colinesterase.

The Rheumatoid Factor.

C-reactive protein.

ASLO.

Albums.

Proteinogram.

01-Special Biochemistry.

Glycated hemoglobin.

01 -Serology.

Hepatitis A, IgM.

Hepatitis B (markers).

Hepat. B, anti-HBs (post-vaccination).

Hepatitis C, anti-HCV.

Rubella, Ig G.

Rubella, Ig M.

Sifllis, RPR.

Sifllis, TPHA.

Toxoplasmosis, AC Ig G.

Toxoplasmosis, CI Ig M.

HIV, Antibodies.

01 Microbiology.

Uroculture.

Coproculture.

02-Orin.

Systematic urine.

Pregnancy test.

Microalbuminuria.

02 Biochemistry. 24-hour urine.

Glucose (Urine).

Creatinine (Urine).

Urea (Urine).

Uric acid (Orina).

Calcium (Urine).

Alfa amllase (Orina).

Inorganic phosphate.

Sodium (Urine).

Potassium (Urine).

Proteins (Urine).

03 Miscellaneous.

Blood hidden in stool.

ANNEX 7

Cross-border healthcare

In accordance with the provisions of clause 4.5, the Entity is obliged to cover the cross-border healthcare of its protected collective, as provided for in Royal Decree 81/2014 of 7 February, by the that rules are laid down to ensure cross-border health care, and amending Royal Decree 1718/2010 of 17 December 2010 on medical prescription and supply orders in respect of the benefits included in the portfolio services that are the object of the Concert. The exercise of the right by the beneficiaries, their scope, the conditions, requirements and procedure for the reimbursement of expenses for such assistance are set out in this Annex.

cross-border healthcare is the one received when the beneficiary decides to go to health services located in another Member State of the European Union. Therefore, it does not include the temporary stay cases where, for oversold medical reasons, the beneficiary has received health care, the coverage of which, in general, corresponds to the ISFAS directly or through the mechanisms of coordination with the institutions of the other Member States.

Cross-border healthcare does not include ancillary or ancillary expenses or ancillary services.

1. General rules.

1.1 Content.

The cross-border healthcare in charge of the Entity includes the health benefits that make up the Common Portfolio of Services of the National Health System and whose coverage corresponds to the Entity according to the established in Chapter 2 of the Concert.

When in the cross-border care process expenses are incurred for the outpatient dispensing of drugs, dietetic products, and other medical devices that are the subject of the pharmaceutical provision of the National Health System, as well as of orthoprosthetic material, where appropriate, the reimbursement of the same shall be borne by the ISFAS in the terms laid down in the specific rules governing these benefits.

Those benefits that are expressly mentioned in Royal Decree 1718/2010, of December 17, are excluded, such as:.

-Services in the field of long-term care, the purpose of which is to help those who require assistance when performing routine and daily tasks.

-The allocation of organs and access to organs for transplantation purposes.

-Public vaccination programmes against infectious diseases, which are exclusively intended to protect the health of the population and which are subject to specific planning and enforcement measures, without prejudice of those relating to cooperation between Spain and the other Member States in the field of the European Union.

In no case shall the expenses arising from healthcare provided on national territory be reimbursed by means other than those allocated by the ISFAS to the beneficiary through this Concert.

In the case of treatments listed in section 2.1 of this Annex, prior authorisation shall be required in accordance with the procedure laid down in paragraph 2.2.

1.2 Mode.

The coverage mode will be through the reimbursement of expenses by applying the rates approved by the ISFAS, without exceeding the actual cost of the assistance effectively provided, and with the limits, terms, established conditions and requirements.

1.3 Other obligations of the Entity.

The means of the Entity shall facilitate the access of beneficiaries seeking cross-border healthcare to their medical records or, at least, to a copy thereof.

Regardless of the right to reimbursement of expenses arising from cross-border healthcare, where necessary, the Entity will facilitate the subsequent monitoring of the beneficiary through the corresponding services, under the same conditions as if the assistance had been carried out by means of the Entity.

2. Health benefits subject to prior authorisation and procedure for obtaining them.

2.1 The prior authorisation of the ISFAS will be essential for the reimbursement of the corresponding expenses, in the case of the benefits for which the requirement of prior authorisation is established in the Royal Decree 81/2014 of 7 February 2014 laying down rules for the guarantee of cross-border healthcare and amending Royal Decree 1718/2010 of 17 December 2010 on medical prescription and supply orders in in line with the provisions of Directive 2011 /EU/24 of the European Parliament and of the Council of 9 March.

2.2 The application for authorisation shall be submitted to the ISFAS, which shall, where appropriate, place the Entity so that, within a maximum period of ten calendar days, it shall issue a report showing:

(a) If the assistance required by the beneficiary can be carried out on national territory, in the terms stipulated in the Concert, specifying in this case the means or services assigned to the effect.

b) The period in which assistance might be initiated.

2.3 In the light of the report issued by the Entity, or after the period of ten days without the date of receipt of the report, the ISFAS shall issue a reasoned decision on the application of the beneficiary, authorizing or refusing assistance, within the maximum period of one month from the date of receipt of the request, which shall be notified to the person concerned and against which the person concerned may be brought before the holder of the Ministry of Defence, in accordance with the provided for in Article 107 of Law 30/1992 of 26 November.

The authorisation may be refused in the cases and for the reasons set out in Royal Decree 81/2014 of 7 February, including when health care can be provided on national territory, in the terms stipulated in the Concert, in a time that is medically justifiable, in which the resolution must state the means allocated for the provision of the assistance requested.

3. Procedure for the reimbursement of expenses for cross-border healthcare.

3.1 The procedure will be initiated at the request of the data subject. It may, however, be initiated on its own initiative by the ISFAS, where the person concerned has submitted a request for reimbursement of expenses abroad and in the case of the case, which is considered to be the subject of cross-border healthcare.

3.2 The request for reimbursement shall be submitted 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 set to the specific regulation.

In the case of treatments listed in section 2.1 of this Annex, reference to the existence of prior authorisation shall be required.

3.3 Received the request and other required documentation, once the necessary checks have been made, including if the default of the application or lack of documentation is necessary, the ISFAS will dictate a decision, which shall be notified to the person concerned and to the Entity, and against which the person of the Ministry of Defence may be brought before the Minister of Defence, in accordance with the provisions of Article 107 of Law No 30/1992, of 26 September 1992, November.

3.4 Provided that the right to reimbursement is recognised, the ISFAS shall pay the person concerned and, in accordance with the procedure laid down in clause 6.5.4, pass on the amount to the Entity.

ANNEX 8

Specialized Care Level I Municipalities Relationship

Almería.

.

Cadiz.

.

Castellon.

Pontevedra.

.

Valencia.

Province	Level I
A Coruña.	Artixo.
A Coruña.	Cambre.
A Coruña.	Carballo.
A Coruña.	Culleredo.
A Coruña.	Ribeira.
Almansa.	Albacete
Albacete.	Villarroledo.
Alicante.	Campello/Muxamel.
Alicante.	Sant Joan d' Alacant/Sant Vicente de Raspeig.
Alicante.	Almería.
		Almería.
Almería.
Almería.
Nijar.
Asturias.	Barcelona.
Barcelona.	Stud/Martorell/Olessa de Monserrat.
Barcelona.	Igualada
	Barcelona.	Molins del Rei/Sant Andreu de la Barca/Sant Vicenc dels Horts.
Barcelona.
	Barcelona.	Barcelona.
Barcelona.
Barcelona.	Vic/Manlleu
Bizkaia.	Baracaldo.
Bizkaia.	Basauri/Sestao.
	Bizkaia.	Portugalete/Santurzi.
.	Miranda de Ebro.
.	.
	Cadiz.
	Cadiz.
	Cadiz.
Rota.
.	San Roque.
Cantabria.	Camargo.
Castro Urdials.
Cantabria.	Pielagos.
Castellon.	Benicar/Vinos.
Castellon.	Castellon
Castellon.		Castellon.
	Vall d' Uxo (La).
Real Villa.
.	Baena.
Córdoba.	Open.
Montilla
.	Rio Palma.
.	Priego of Córdoba.
Girona.	Blanes/Lloret
	Girona	Granada.
	.
.
Grenada.	Armilla.
Granada.	Baza.
Granada.	Loja.
Granada.	Maracena.
Guadalajara.	Henar Azuqueca.
Huelva.	Almonte.
Huelva.	Ayamonte.
Huelva.	Lepe.
Illes Balears.	(Mallorca Island)-Marratxi.
Illes Balears.	(Island from Menorca)-Minorca Citadel
IllesBalears.	(Menorca Island)-Mahon.
Jaen.	Alcala the Real.
Jaen.	Martos.
Palmas.	(Gran Canaria Island)-Aguimes.
Palmas.	(Gran Canaria Island)-Arucas.
Palmas.	(Gran Canaria Island)-Galdar.
Palms.	(Lanzarote Island)-Teguise.
Madrid.	Arroyomolinos.
Madrid.	Ciemos.
Madrid.	carnero.
Madrid.	Paracoulos del Jarama.
Madrid.	Odon Villaviciosa
Malaga.	.
	Murcia.
	Murcia.			Murcia.
Murcia.	Murcia's table_table_izq"> Alhama.
Murcia.	Caravaca de la Cruz.
Murcia.
Murcia.	Mazarron.
Murcia.	Yecla.
Baranain.	Baranain.
	.	Estrada.
Pontevedra.	Cangas.
Pontevedra.	Lalin.
Pontevedra.	Marin.
Ponteareas.
Pontevedra.	Redondela.
Rioja, la.	Calahorra.
Seville.	Bormuds.
Seville.	Camas.
Seville.	Carmona.
Seville.	Coria de Rio.
Seville.	Lebrija.
Seville.	Mairena de Alcor.
Seville.	Mairena of Aljarafe.
Seville.	.
	Rinse.
	Zant_table_izq"> Seville.	San Juan of Aznalfarache.
Seville.	Tomares.
Tarragona.	Tortosa/Amposta.
.	Salou/Vila Seca.
.	Vendrell (The)
Tenerife.	(Tenerife Island)-Candelaria.
Tenerife.	(Tenerife Island)-Icod of the Wines.
Tenerife.	(Tenerife Island)-Tacoronte.
Tenerife.	(Island of the Palma)-Aridane Llanos
Toledo.	Valencia.
	Alaquas/Aldaia/Xirivella.
Valencia.	Alboraya
Valencia.	Alboraya.
Valencia.	Algemesi.
Valencia.	.
Valencia.	Burjassot/Mislata/Paterna.
Valencia.	Catsheds,.
Valencia.	Valencia.
	Valencia.		Valencia.
	Valencia.
Lliria/Pobla de Valbona.
Valencia.	Manises/Quart de Poblet.
Valencia.	Ontinyent.
Valencia.
.
Valencia.	Valencia.
Valencia.	Swedish.
Valencia.	Torrent.
Valencia.	.
	Valladolid.
	Valladolid.	Medina of the Field.
Zaragoza.	Calatayud.

ANNEX 9

Specialized Care Level II Municipalities Relationship

Tenerife Island)-Arona/Adeje/Granadilla de Abona

Orotava/Puerto de la Cruz/Los Realejos.

Province	Municipalities and Tier II
A Coruña.	Oleiros.
A Coruña.	Santiago de Compostela/Ames.
Hellin.	Hellin
Alicante.	Alcoa/Ibi.
	Alicante.	Alfas Pi/Altea/Benidorm/Calp/Villajoyosa.
	Alicante.	Denia/Javea.
Alicante.	Elche/Aspe/Crevilent/Novelda/Santa Pola.
Alicante.	Elda/Petrer/Villena
Alicante.	Orihuela.
Alicante.	Torrevieja.
Almeria.	The Ejido.
Almeria.
	Asturias.	Avils.
Asturias.
Asturias.
Siero.
Badajoz.	Almendralejo/Merida.
Barcelona.
Barcelona.		Barcelona.		Barcelona.	Barcelona. Badalona/Santa Coloma of Gramanet/Sant Adria de Besos.
	.	Barbera del Valles/Ripollet/Cerdenyola del Valleys.
Barcelona.	Castelldefels/Gava/Viladecans.
Barcelona.	Valles/Mollet del Valles/Moncada i Reixac.
Barcelona.	Hospitalet de Llobregat/Cornella de Llobregat/Sant Boi de Llobregat.
Barcelona.	Manresa.
Barcelona.	Barcelona
	Barcelona.	Rubi/Sant Cugat Valleys/Terrassa.
	Barcelona.	Sabadell.
Barcelona.	Sant Feliu de Llobregat/Sant Joan Despi/El Prat de Llobregat/Esplugues de Llobregat.
Barcelona. Tarragona.	Vilanova i la Geltru/El Vendrell.
Bizkaia.	Leioa/Getxo.
.	Duero Aranda.
Caceres.	Plasency.
.	Border/Royal Port Chiclana.
.	Sanlúcar of Barrameda
Cantabria.	Torrelavega.
City Real.	San Juan Alcazar
City.
Real City.
Tomellous.
Real City.	Valdepeñas.
.	Girona.
	Girona.
	Granada.
	Motril
	Gipuzkoa.	Irun/Errenteria.
Illes Balears.	(Ibiza Island)-Eivissa/Santa Eulalia de Rio/Sant Josep de sa Talaia/Sant Portmany Antoni.
Illes Balears.	(Mallorca Island)-Calvia.
Illes Balears.	(Mallorca Island)-Inca.
(Mallorca Island)-Llucmajor.
Illes Balears.	(Isla de Mallorca)-Manacor.
Jaen.	Jaen.
		Jaen.
	Jaen.		Jaen.	Ubeda.
Palmas.	(Isla de Fuerteventura)-Port of the Rosary/La Oliva.
Gran Canaria Island)	Lucia of Tirajana/San Bartolomé de Tirajana.
Palmas.	(Isla de Gran Canaria)-Telde/Aguimes/Ingenio.
Lanzarote Island)-Arrecife
.	Ponferrada.
Madrid.	.
		.
Arganda del Rey/Rivas-Vaciamadrid/Enhanced Field
Madrid.	Colmenar Viejo/Tres Cantos.
	Madrid.	Coslada/San Fernando de Henares.
Madrid.	Collated Villalba/Galagain/Torrewatch.
Madrid.	Leganes.
Madrid.	Getafe/Parla.
	Madrid.	Pinto/Valdemoro
Madrid.	Alcobendas/Alget/San Sebastian de los Reyes.
	Malaga.	Alhaurin de la Torre.
Malaga.	Antequera.
Malaga.	Benalmadena/Torremolinos.
Malaga.	Estepona.
Malaga.	Marbella/Fuengirol/Mijas.
Malaga.	Corner of the Victoria/Velez-Malaga.
	Malaga.	Ronda.
Murcia.	Eagles
Murcia.	Segura/Las Torres de Cotillas)
Murcia.	Lorca/Totana
Murcia.	San Javier/San Pedro del Pinatar/Torre-Pacheco.
Navarra.	Pontevedra.
	Arrousa's table_table_izq"> Vilagarcia
Seville.	Two Sisters/Alcala de Guadaira/Los Palacios and Villafranca.
Seville.	Ecija.
Seville.	Utrera.
.	Tenerife.
(Tenerife Island)
	Tenerife.	(Tenerife island)-San Cristobal de la Laguna.
Toledo.	Queen's Talavera.
	Valencia.	Alzira/Carcaixent.
Valencia.	Gandia/Oliva.
Valencia.	Sagunto.