In application of the provisions of Articles 17.1 of the recast of the Law on Social Security of Civil Servants of the State, approved by Royal Legislative Decree 4/2000 of 23 June, and 77 of the General Regulation of Administrative Mutualism, approved by Royal Decree 375/2003 of 28 March 2003, this General Mutuality of Civil Servants of the State (MUFACE), upon public notice, the notice of which was published in the Official Gazette of the State and in the Platform of Contracting of the State on October 29, 2015, has signed on December 15, 2015 with Various Insurance Entities Concert for the assurance of access to the provision of health care in national territory to the beneficiaries of the same during the years 2016-2017.

In order to give public knowledge of the full content of the concert and of the insurance entities that have subscribed to it, as well as of the regulation of the change of the payment institution of the health care in territory national,

This General Address resolves:

First.

Publish, as an annex to this Resolution, the text of the "Concerto de la Mutualidad General de Civil Servants of the State with insurance entities for the insurance of access to health care in national territory" beneficiaries of the same, during the years 2016-2017 ".

Second.

Make public that the Concert has been subscribed to with the following health care insurance entities:

ASISA, Insurance Interprovincial Health Care, S.A.U.

DKV, Insurance and Reinsurance, Spanish Company.

Medical-Surgical Equalization, S. A of Insurance.

SECURE ADESLAS, Insurance and Reinsurance Company.

Third.

To determine that during the month of January of each year of validity of the Concert, the holders affiliated to MUFACE who so wish may change for once of the Entity, by the appropriate request, to be attached to some of the Entities that have subscribed to Concerto for the years 2016-2017 and that are related in the second paragraph of this Resolution, or to the National Institute of Social Security (Public Health System). The holders who do not apply for change shall continue to be assigned to the same Entity as they are at 31 December of each year of validity of the Concert.

This time limit is unique for the ordinary changes of Entity, and extraordinary changes can be made only in the specific assumptions foreseen in the corresponding concert.

Fourth.

Arrange that in the Provincial Services and Delegated Offices of MUFACE be exposed, at the disposal of the holders who wish to consult them, the Catalogues of Suppliers of the respective province corresponding to the entities of Concerted insurance. This information will also be accessible through the Mutual's website: www.muface.es

Madrid, December 16, 2015.-The Director General of the General Mutuality of Civil Servants of the State, P. S. (Royal Decree 577/1997, of April 18), the General Secretariat of the General Mutuality of Civil Servants of the State, Maria Dolores Lopez of Rica.

ANNEX

Concerto de la Mutualidad General de Civil Servicios Civil del Estado con Entities de seguro para el seguro del accesso a la esúde sanitaria en territorio Nacional a los beneficios de la misma, durante los años 2016-2017

INDEX

Chapter 1. Object of the concert, scope of the protective action and scope of application.

1.1 Object of the Concert and Scope of the Protective Action.

1.2 Protected Collective.

1.3 Birth and extinction of the right to receive healthcare from the Entity.

1.4 Healthcare provider changes.

1.5 Entity Health Card.

1.6 Entity actuations regarding your service offering.

Chapter 2. Service portfolio.

2.1 General rules.

2.2 Primary Care Services Portfolio.

2.3 Specialized Care Services Portfolio.

2.4 Emergency and Emergency Care Services Portfolio.

2.5 Preventive Programs.

2.6 Palliative Care.

2.7 Rehabilitation.

2.8 Dental health.

2.9 Pharmaceutical and dietary products.

2.10 Transportation for Healthcare.

2.11 Other capabilities.

2.12 Incorporation of new means of diagnosis and treatment. Procedure for updating the Concert Services Portfolio.

Chapter 3. Means of the entity.

3.1 General rules.

3.2 Media availability criteria.

3.3 Vendor Catalog.

3.4 Issue and delivery responsibility for the Supplier Catalog and information on the Entity's web page.

3.5 Invariability of the Entity Providers Catalogs.

3.6 Principle of continuity of care.

Chapter 4. Rules for the use of the means of the entity.

4.1 General rule.

4.2 Identification.

4.3 Mutualists not attached to Entity and its beneficiaries.

4.4 Access procedure and provision of assistance in consultation.

4.5 Access procedure and provision in home care.

4.6 Access and delivery procedures in emergency and emergency assistance.

4.7 Procedure for access and provision of assistance under hospitalization.

4.8 Additional requirements for media usage.

4.9 Private hospitals not agreed.

Chapter 5. Use of non-concerted media.

5.1 General Rule.

5.2 Unjustified denial of assistance.

5.3 Vital character urgent assistance in non-concerted media.

Chapter 6. Information, health documentation and quality objectives.

6.1 Healthcare documentation and information

6.2 Digital clinical history and electronic prescription

6.3 Quality of Healthcare

Chapter 7. Legal status of the concert.

7.1 Nature and regime of the Concert and relationships in it based.

7.2 Nature and regimen of care relationships.

7.3 Mixed Commissions.

7.4 Procedure for substantiating claims.

7.5 Estimated claims execution procedure.

7.6 Special procedure for substantiating claims with the same object.

7.7 Discounts for pharmacy expenses.

7.8 Economic compensations for partial default of obligations defined in the Concert.

Chapter 8. Duration, economic regime and concert price.

8.1 Duration of the Concert.

8.2 Economic Regime of the Concert.

8.3 Price of Concert and incentives to quality.

8.4 Deductions for availability failures.

8.5 Payment Terms.

Annex 1. Cross-border healthcare.

1. General rules.

2. Health benefits subject to prior authorisation and procedure for obtaining them.

3. Procedure for the reimbursement of expenses for cross-border healthcare.

Annex 2. Means of assistance in rural areas.

1. General rules.

2. Enable MUFACE.

3. Object.

4. Content.

Annex 3. Media availability criteria by care levels.

1. General criterion.

2. Availability of Primary Care Media.

3. Definition of the levels of Specialized Care and Portfolio of Services.

4. Availability of Specialized Care in External or Ambulatory Consultations.

5. Additional conditions for the island territory.

Annex 4. Instructions for the elaboration and dissemination of the supplier catalog.

Annex 5. Relationship of services that require prior authorization of the entity and procedure for obtaining it.

1. Services that require prior authorization of the Entity.

2. Procedure for obtaining prior authorization

Annex 6. Care information system.

1. Activity/Cost Record.

2. Information on cross-border healthcare.

3. CMBD record.

4. Health Media Registration.

Annex 7. Financial compensation for partial non-compliance with obligations defined at the concert. Procedure for their imposition.

1. General criteria, infringements and economic compensation.

2. Procedure for the imposition of financial compensation.

Annex 8. System of allocation of incentives to quality of assistance and deductions for failures of availability.

1. Allocation of the quality incentive.

2. Criteria for the allocation of economic incentives linked to quality objectives.

3. Deductions for availability failures.

Annex 9. Reports, scans or tests prescribed by the disability assessment bodies and other bodies of MUFACE.

Annex 10. Test reintegra's scale prescribed for the assessment of disabilities.

Annex 11. Fees for reimbursement of expenses for cross-border healthcare.

CHAPTER 1

Object of the concert, scope of the protective action and scope of application

1.1 Object of the Concert and Scope of the Protective Action.

1.1.1 Pursuant to Article 17 of the recast of the Law on Social Security of Civil Servants of the State, approved by Royal Decree-Law 4/2000 of 23 June (hereinafter LSSFCE) and in Article 77 of the General Regulation of Administrative Mutualism (hereinafter RGMA), approved by Royal Decree 375/2003 of 28 March 2003, the object of the Concerto between the General Mutuality of Civil Servants of the State (hereinafter MUFACE) and the signatory Entity (hereinafter, Entity) is to ensure access to the provision of assistance In the case of a health insurance scheme,

health insurance scheme is not intended to cover the costs of the aid.

1.1.2 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 included in it.

1.1.3 Healthcare will be provided under the Services Portfolio set out in this Concert which will include at least the Common Portfolio of National Health System Services (hereinafter SNS), according to established in the LSSFCE, Law 14/1986, of 25 April, General of Health and Law 16/2003, of 28 May, of cohesion and quality of the National Health System and their respective standards of development.

1.1.4 To this effect, the Entity shall make available to the protected collective all of its own or agreed means (hereinafter the means of the Entity) in accordance with the provisions of Chapter 3 of this Concert. 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 set out in this Concert.

1.1.5 Likewise, the Entity is obliged to cover the cross-border healthcare of its protected collective, in accordance with Royal Decree 81/2014 of 7 February, establishing rules to guarantee assistance This is the case for a number of amendments to the Royal Decree 1718/2010 of 17 December 2010 on medical prescriptions and dispensing orders. 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 Annex 1.

1.1.6 For its part, MUFACE is obliged to pay the Entity the amount per person and month that is provided for in clause 8.3, subject to the specifications and procedure contained in clauses 8.2 and 8.5.

1.2 Protected Collective.

1.2.1 For the purposes of this Convention, all mutualists and other health care recipients to whom MUFACE, in accordance with the applicable rules, have recognised that condition and the following are beneficiaries. assigned to the Entity for the purpose of their health care.

For certain management purposes and provided that this is derived from the text of the clauses itself, the beneficiaries of the Concert may be called holders, if they have a document of affiliation to MUFACE, or simply beneficiaries, when they appear as such in the affiliation document of a holder.

The beneficiaries will be assigned to the Entity while the owner is dependent.

1.2.2 The condition of mutualist or beneficiary is credited by the affiliation document issued by MUFACE.

1.2.3 MUFACE will communicate daily to the Entity the ups, downs and variations in the data of the beneficiaries assigned to it. The communication will be done in a telematic way, depositing the information in a secure directory with access by the Entity. MUFACE makes available to the Entities an on-line connection to their database so that they can know the real situation of membership of a certain mutual or beneficiary.

1.3 Birth and extinction of the right to receive healthcare from the Entity.

1.3.1 The right to receive healthcare by the Entity begins on the date the beneficiary has been assigned to it by the MUFACE Services, without there being any time limit for any kind of assistance.

1.3.2 To the above mentioned effects, it is presumed, in any case, that the newborn is attached to the Entity that caters to the mother during the first fifteen days from the moment of delivery. From then on, this right is conditional on the formalisation of the newborn's membership with the consequent economic effects.

1.3.3 The official or official who at the time of the provision of health care for himself or his beneficiaries has not yet formalised his affiliation to MUFACE (and consequently would not have exercised his right of option to one of the Concerted Entities) may require such assistance from the Entity and shall be entitled to receive it, or to be provided to its beneficiaries, in the terms provided for in clause 4.3.

1.3.4 The right of the beneficiaries to be extinguished, in any case, on the date when the services of MUFACE agree to their absence in the Mutuality or the end of their membership to the Entity for the purpose of the requirement or In fact, they would in each case be allowed to be protected by this Concert.

1.4 Change of healthcare provider entity.

1.4.1 Without prejudice to the possibility of opting for healthcare through the public health network, as provided for in Article 17 of the LSSFCE and Article 77 of the RGMA and the additional provision seventh of Royal Decree 1192/2012 of 3 August, governing 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 Member States may choose to receive health care for themselves and their beneficiaries through another institution. of the entities that are signatories to this Concert in the following assumptions:

(a) On an ordinary basis, during the month of January of each year of validity of the Concert. This right may be exercised only once.

b) On an extraordinary basis, throughout the entire term of the Concert when any of the following circumstances arise:

1) When a change of destination occurs for the mutualist that involves moving it to another province or island.

2) In the margin of the previous assumption, when keeping your destination location the mutualist changes your address to another province or island.

3) When there is a change of domicile, with change of province or island of residence of the holder, and this is a retired mutualist or beneficiary who has this condition for death, separation, divorce or invalidity of the marriage of the mutualist and has a document assimilated to that of affiliation issued by MUFACE. This right may be exercised only once every year of the Concert.

4) When the mutualist obtains the written agreement of the two entities concerned. This assumption also includes the change to the Entity from the public health network.

5) When the mutualist becomes understood in the collective protected by the Concert in national territory when his right to be protected by the Health Care Concert to the intended mutualists and/or resident abroad, provided that such extinction is not due to the loss of the status of a mutualist.

6) When, in the light of objective circumstances justifying the change of a plurality of holders affected by the same health care problem, the MUFACE Directorate-General agrees to the opening of a special deadline for choice of Entity.

The merger of the Entity with another or other of those agreed by MUFACE will not lead to the opening of an extraordinary period of change, automatically being 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, and obliging the resulting absorbing Entity, from that moment, to guarantee all their rights in the terms provided for in this Concert.

1.4.2 The holders who are at 31 December 2015 shall continue to be assigned to the Entity and who do not choose to be assigned to the public health network or to the change to another of the entities that have signed this Agreement, as provided for in Article 77 of the RGMA and in the above clause.

1.5 Entity Health Card.

1.5.1 At the time the Entity is aware of the discharge of a mutualist or beneficiary, it shall provide it with a provisional health card, or any other document that makes it possible to use the means agreed from the moment of discharge.

Later, you will issue the corresponding health card, which will be sent to the home of the mutualist or beneficiary within the maximum period of seven calendar days from the effective communication.

1.5.2 On the card, the telephone number 900 .../800 ... of free emergency care of the Entity, provided for in clause 3.1.1 (c), must be included in the card to which the beneficiary can call in case of emergency or health emergency. In any case on the front of the card the membership number of the card holder and the MUFACE logo will be entered.

1.5.3 By Resolution of the Director-General of MUFACE, the content of the data which, apart from the data required by the entity for its own management, must appear in the data storage system of the data storage system, may be determined. Card for the purpose of identification of the mutualist or beneficiary which also allows access to the interoperable systems of digital medical history, prescription and pharmaceutical dispensing and the preparation of parts of temporary incapacity (IT), risk during pregnancy (RE) and risk during natural lactation (RLN).

1.5.4 In case a holder has chosen to be assigned to the Entity and has not received, for himself or his beneficiaries, the provisional card or the document that makes possible the use of the means agreed Having expressly requested it, the person responsible for the corresponding MUFACE Provincial Service shall issue a certificate stating that all the costs incurred for the assistance to that holder and its beneficiaries for the Optional, services and centres included in the Supplier's Catalog of the Entity may be invoiced directly to MUFACE for the materialization of the corresponding credit. Subsequently, the amount of these expenses shall be deducted from the monthly instalments to be paid to the Entity, without prejudice to the financial compensation provided for in clause 7.8.

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

1.5.6 Once they are assigned to the Entity, the mutualists must give in MUFACE the health cards (their own and their beneficiaries) of the other Entity or Public Health Service of the Autonomous Community the status of their health care in national territory or, where applicable, abroad.

1.6 Entity actuations regarding your service offering.

1.6.1 The Entity may advertise on its offer of services throughout the validity of the Concert and during the period of ordinary change, provided that such advertising is not carried out within institutions or institutions. bodies of a public nature and are carried out in a general manner without addressing specific professional groups. In the advertising campaigns carried out by the Entity, you may not use the logo or any other identification of MUFACE or the General Administration of the State.

1.6.2 In no case can you offer gifts to the mutualists, directly or indirectly through third parties, especially during the period of ordinary change and in the processes of high specific professional collectives.

1.6.3 Failure to comply with these obligations will result in the economic compensation provided for in clause 7.8.

CHAPTER 2

Service Portfolio

2.1 General rules.

2.1.1 Healthcare to the beneficiaries of MUFACE attached to the Entity will be provided in accordance with the Services Portfolio established in this Concert.

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

2.1.2 The Services Portfolio under the Concert comprises at least all the benefits that make up the Common Portfolio of SNS Services, with the content that, at any time, determines the health regulations of the application in this Chapter, which also includes the specificities of each of them.

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

a) Primary Care.

b) Specialized Attention.

c) Emergency and Emergency Care.

d) Preventive Programs.

e) Palliative Care.

f) Rehabilitation.

g) Dental Health.

h) Pharmaceutical and dietary products.

i) Transportation for healthcare.

j) Other benefits (Podology, Respiratory Therapies and Orthopreprosthetic Prstation).

2.1.4 The benefits included in the Portfolio of Services are guaranteed by the provision of care resources required by levels and geographical and population areas set out in Chapter 3 of this Concert and in Annex 3, with the procedures and rules for the use of these means as described in Chapter 4. Annex 5 lists the services that require prior authorization of the Entity and establishes the procedure for processing and obtaining, where appropriate.

2.1.5 The Entity will promote actions aimed at strengthening coordination between the levels of Primary Care, Specialized Care and Emergency and Emergency Services, in order to guarantee the continuity of care and comprehensive patient care.

2.2 Primary Care Services Portfolio.

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 impairment of the collaboration of other professionals, including:

a) Health care on demand, scheduled and urgent, both at the consultation and at the patient's home.

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

c) palliative care for terminally ill patients.

2.3 Specialized Care Services Portfolio.

2.3.1 The Specialized Care includes the care, diagnostic, therapeutic and rehabilitation activities and palliative care, as well as those of prevention whose nature makes necessary the intervention of doctors specialists, and understands:

a) Specialist assistance in queries.

b) Medical or surgical day hospital specialized assistance.

c) Hospitalization in detention.

d) Home hospitalization.

e) Diagnostic and therapeutic procedures.

2.3.2 Specifications to the Specialized Care Services Portfolio.

A) Mental health.

1. It includes the diagnosis and clinical follow-up of mental disorders, including pharmacological treatment and individual, group or family psychotherapy. Mental health care will be carried out in hospitalization, external consultations and emergency services, guaranteeing in any case the necessary continuity of care.

2. Individual, group or family psychotherapy is included, provided that it has been prescribed by a psychiatrist of the Entity, carried out in a concerted manner with the same 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 cases of eating disorders, in which all sessions will be provided which the psychiatrist responsible for Consider necessary for the correct evolution of the case.

3. Psychoanalysis, psychoanalytic psychotherapy, hypnosis, ambulatory narcolepsy, and social internment are excluded.

B) Plastic, aesthetic and restorative surgery. The entity shall address the coverage of plastic, cosmetic and restorative surgery when it is related to accident, disease or congenital malformation.

In the event of an accident in an act of service or professional illness 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

C) Diagnosis and treatment of sterility. Assisted reproductive treatments are intended to help achieve pregnancy in those who are unable to achieve it naturally, not susceptible to exclusively pharmacological treatments, or after the failure of the " 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, according to the rules in force at any time.

1. General considerations.

(a) The Entity is obliged to assume the necessary expenses to obtain the diagnosis of sterility, which shall be extended, where appropriate, to the couple.

(b) At the time of the start of the sterility study, the beneficiary must be over 18 years of age and under 40 years of age, and not suffer from 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 aged 18 and under 55.

(c) The assisted reproduction techniques shall be carried out by the entity when the woman on whom the technique is to be performed is a holder or beneficiary of MUFACE and has no child, prior and healthy. In case of couples, without any common, prior and healthy children.

(d) They shall include all the techniques included in the common portfolio of services of the National Health System, in accordance with Law 14 /2006, of May 26 on Assisted Human Reproduction Techniques, and Order SSI/2065/2014, of 31 October amending Annexes I, II and III to Royal Decree 1030/2006 of 15 September establishing the portfolio of common services of the National Health System and the procedure for updating them, with the conditions and requirements set out in the same.

(e) Not included, among the benefits funded by assisted reproduction techniques, which are performed when the sterility of any member of the couple has been produced voluntarily or over- the natural physiological process proper to the completion of the person's reproductive cycle, or documented medical contraindication.

f) In assisted reproduction treatments, the tests to be performed in the field of the treatment of the other member of the couple shall be provided by the entity of the woman's attachment to which the Assisted Human Reproduction technique. The funding of the pharmacological treatments associated with the Assisted Human Reproduction Technique to which the other member of the couple is to be submitted is excluded.

g) In the case of assisted human reproduction techniques with the donation of gametes and preembryos, the costs resulting from the actions and, where appropriate, the medicinal products required by the donors, shall be borne by the institution. be part of the cost of the technique used. In no case may the recipient recipient of the donation be passed on.

h) The coverage of the cryopreservation and maintenance of gametes and ovarian tissue for the deferred use of beneficiaries who are to undergo medical and/or surgical treatments that may be subject to medical and/or surgical treatment. significantly affect your fertility. The coverage period in the case of the woman will be up to the day before the 50-year-old compliance and in the case of the man until the day before the 55-year-old compliance.

(i) It shall be in charge of the Entity for the cryopreservation and maintenance of the excess preembryos of IVF cycles authorized up to the previous day in which the woman is 50 years of age.

j) The coverage of assisted human reproduction techniques in women in which there is a diagnosis of sterility by gynecological pathology that prevents the achievement of a pregnancy, regardless of whether or not there is existence. pair.

2. Limits on the maximum number of treatment cycles and the age of the woman.

In any case assisted human reproduction treatments will be subject to limits in terms of the number of cycles and age of the patient, based on principles of efficiency and safety to ensure the greatest effectiveness. with the lowest possible risk.

The limits for the maximum number of treatment cycles and the age of the beneficiary for each technique are:

	Artificial Insemination		Fecundation in vitro *
	Semen pair	Semen donor	Own Gametos	Donated Gameos
	6		3	4	3	4
woman age	< 38	< 40	< 40
< 40

* Including complementary techniques. In cases of the use of cryopreserved ovocytes and ovarian tissue, the age limit will be the one established for the IVF technique with donation of gametes/preembryos. The ages are computed until the day before the woman is 38 or 40 years old, as the case may be.

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

(a) The prescription of the treatment of Assisted Human Reproduction must have been performed prior to the day when the woman has fulfilled the years established as the age limit to be entitled to the funding in each one of the techniques.

b) For computation purposes, the number of cycles is independent for each technique, although the total number of cycles performed independently of the funder will be taken into account. 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.

c) To consider that a patient has performed a IVF cycle must have reached at least the egg recovery phase.

(d) When there are leftover frozen preembryos from authorised IVF cycles, the transfer of the same forms part of the same IVF cycle in which the preembryos were obtained, the transfer of the preembryos until the day before the woman is 50 years old, regardless of the existence of previous and healthy children.

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

f) In any case, the completion of the initiated cycle that was covered by application of the criteria and limits in force at the time of its commencement is guaranteed.

g) If after the performance of a technique of assisted human reproduction and obtained a pregnancy the abortion patient may repeat a new cycle with the technique for which the pregnancy occurred, once the number has been completed maximum of established cycles and provided that the age limit is not exceeded in order to be eligible for funding in each of the techniques.

2.4 Emergency and Emergency Care Services Portfolio. It is the one that lends itself to the patient in cases where his clinical situation requires immediate health care. It 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 nursing care and with the collaboration of others. professionals, further comprises:

2.4.1 Telephone attention, through the Emergency and Emergency Coordinating Center of the Entity, provided for in clause 3.1.1 (c), which includes the information and allocation of own resources or in coordination with the 112 emergency services to provide the most appropriate response to the demand for care.

2.4.2 The urgent sanitary transport regulated in clause 2.10.1.

2.5 Preventive Programs.

2.5.1 The Entity will perform the actions established by the health regulations on prevention and health promotion that include:

(a) Vacations in all age groups and, where appropriate, risk groups, in accordance with the vaccination schedule of the SNS, 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.

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

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

Having regard to the above, as well as the development of the preventive programs of gynecological cancer included in the Cancer Plan of the Entity, the following activities will be carried out among others: the cribates of:

1. Breast cancer: Population screening with mammography every two years in women aged 50 to 69 years.

2. Cervical cancer (cervix): 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.

3. Colorectal cancer: Population 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, should be ensured, 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.

2.5.2 The Entity shall have the necessary means to carry out the preventive programmes included in the Portfolio of Services, guaranteeing the appropriate information to the beneficiaries, as well as the calendar, addresses and schedules of the centres where the vaccinations and prevention programmes will be carried out.

The Entity will transmit to the Provincial Services of MUFACE detailed relationship of the vaccination centers of the respective province with addresses, telephones, schedules and preventive programs that are included in the same.

In cases where the Entity has not developed any of the specific programmes mentioned above, it must cover the coverage of the actions undertaken to the beneficiaries under the prevention programme. developed by the relevant health administration.

2.5.3 The Directorate-General of MUFACE may specifically inform the beneficiaries and through the means that in each case it considers more appropriate on the appropriateness of the implementation of certain preventive programmes included in the Services Portfolio.

2.6 Palliative Care.

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

2.6.2 For care in palliative care, the Entity will have an explicit organizational model according to the requirements of the means listed in Annex 3 and to the requirements of the Plan in Palliative Care. In the provision of palliative care, the Primary Care and Specialized Care professionals responsible for the pathological process of the patient will participate with the support and support of devices to which, if necessary, patients can be derived based on their degree of complexity.

2.6.3 The level of complexity of the patient will determine the most appropriate place to provide palliative care to be provided at the patient's home or in the healthcare facility, by care professionals. Primary, and if necessary, in hospitalization by the professionals of the specialized care, establishing the necessary mechanisms to guarantee the continuity of care and coordination with other resources. In case of complexity, this care will be complemented by the intervention of support teams in palliative care that will be able to intervene both in the home and hospital settings or with the referral and entry of these patients in Hospital Palliative Care Units.

The continuity of the attendance in the slots in which the resources in palliative care in home care cease their activity, will be provided through the Emergency and Emergency Coordinating Center of the Entity, for which precise coordination and referral procedures will be articulated.

2.6.4 The beneficiaries who require palliative care by specific support teams or the entry into Hospital Palliative Care Units must, except in cases of urgency, request prior authorization from the Entity, in accordance with the procedure set out in point 2 of Annex 5.

2.7 Rehabilitation.

2.7.1 Understands the procedures for the diagnosis, evaluation, prevention and treatment of patients with a recoverable functional deficit, performed, as appropriate, through rehabilitation physician, physiotherapist, therapist occupational and logopeda.

2.7.2 Includes the rehabilitation of the conditions of the musculoskeletal system, the nervous system, the cardiovascular system and the respiratory system, through physical therapy, adaptation of technical methods (orthoprostheses), occupational therapy, and logopedia that has a direct relationship with pathological processes of those who are already being treated for being included in the Services Portfolio. The so-called Learning Disorders whose attention is the competence of the education system are not considered.

2.7.3 The treatments may be required by the physician or by the medical specialists responsible for the pathologies susceptible to these treatments.

Patient monitoring and determination of discharge will be the responsibility of the rehabilitating physician, except in cardiac and vestibular rehabilitation treatments that will be the responsibility of the physician. requested such treatment.

2.7.4 The number of sessions is subject to the optional criterion and the patient situation, for which the recommendations of the scientific societies will be taken into account.

As it is addressed to patients with a recoverable functional deficit, the obligation of the Entity will be terminated when the functional recovery has been fully achieved, or the maximum possible recovery from having entered the process in an insuperable stabilization state, according to the report of the rehabilitator physician or the optional specialist who applied for the treatment. In any case, the rehabilitation indicated by the process of resharpening of the process will be affected.

2.8 Dental health.

2.8.1 Comprises the care, diagnostic and therapeutic activities, as well as those of health promotion, health education and preventive care directed to the attention of the dental health.

2.8.2 The Dental Health Care Portfolio includes the treatment of stomatological conditions in general, all kinds of extractions and cleaning of the mouth once a year, or more if necessary, prior to Evidence of the optional specialist.

Also includes the oral health program for children under 15 years of age, consisting of periodic reviews, application of topical fluoride, and permanent parts: occlusal sealants, obturations, fillings, or reconstructions, pulparian treatments (endodontics), tartrectomies and treatments of incisors and canines in case of disease, malformations or trauma. In addition, this program will incorporate the actions that are included in the Child Dental Health Plan for the set of SNS, with the same content, scope and rhythm of implantation.

Pregnant beneficiaries will be given preventive follow-up to the oral cavity with topical fluoride application according to individual needs.

It will also be in charge of the Entity the expenses of hospitalization, operating room and anaesthetist necessary for the performance of the treatments and dental services excluded from the coverage of the Concert to patients mentally disabled, provided that the treatments are carried out with means of the Entity.

2.8.3 Dental implants are included in charge of the Entity for patients with congenital malformations with anodontics and for patients with oncological processes affecting the oral cavity involving the 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.

2.8.4 When an accident is measured in service or occupational disease, all treatments and performances, including dental prostheses and osteointegrated implants, as well as placement, shall be carried out by the Entity. For dental prostheses, it will be necessary to prescribe an optional specialist of the Entity, together with a budget for authorization by the same.

2.8.5 Excluded, with the provisos provided in the above clauses, the fillings, the endodontics, the periodontics, the dental prostheses, the osteointegrated implants, the orthodontics, both in terms of its cost and to their placement, as well as the treatments for exclusively aesthetic purposes and the carrying out of complementary tests for the assessment and monitoring of treatments excluded from the Portfolio of Services.

2.9 Pharmaceutical and dietary products.

2.9.1 The pharmaceutical supply includes medicines and medical devices, and the set of actions aimed at ensuring that patients receive them in an appropriate manner to their clinical needs, at the precise doses according to their individual requirements, during the appropriate period of time 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 2015, and other applicable provisions.

In the case of access to medicinal products under conditions other than those authorised, and given their exceptional character, the provisions of Royal Decree 1015/2009 of 19 June, governing the availability of medicines in 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.

2.9.2 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 with SNS dietetic products.

Such activities must be carried out by the professionals of the Entity in the official prescriptions and orders for the supply of MUFACE, identifying the active substance of the product or the generic name of the product health, in accordance with the provisions of the rules in force.

The entity will take all necessary measures to promote the Electronic Recipe System of MUFACE, through the participation of its faculty in the implementation and development of the same. Until it has been put in place, and for manual requirements in paper form, it shall require the power of its powers to include, by means of a stamp enabling its readability, its mandatory minimum particulars: name and two surname, number of colegate and province where you exercise.

2.9.3 In the case of patients treated in the hospital, the Portfolio of Services to be provided by the Entity includes the indication, prescription and dispensing of all pharmaceutical products. and dietetic patients who need to be cared for in this care setting (internment, day hospital, home hospitalization, emergency room, dialysis unit and other hospital-dependent units), with the following specifications:

a) Outpatient treatments in the hospital setting that will be in charge of the Entity and provided by the means of the Entity in the following assumptions:

1. Medicinal products marketed as a Hospital Use, the supply of which is carried out through hospital pharmacy services, in accordance with the law on guarantees and the rational use of medicinal products and medical devices, any of its indications and/or conditions of use.

2. Medicinal products 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 is restricted to the medium hospital.

3. Medicinal products and pharmaceutical products financed in the SNS, whether or not they have a seal, which, as laid down in the technical information sheet, require the participation of specialists in their administration, without prejudice to their supply through the pharmacy office.

4. Precise means, elements or pharmaceutical products for performing diagnostic techniques, such as contrast media, drastic or other laxatives.

(b) Outpatient treatments in the hospital setting in charge of MUFACE and which will be dispensed by the pharmacy services of the hospital centres arranged in the following cases:

1. The drugs that, without the qualification of hospital use, have established singular reserves in the field of the National Health System consisting in limiting their dispensation to the non-hospitalized patients in the services of pharmacy of the hospitals, so they are not equipped with a seal, and that for their administration they do not require the participation of specialists, they will be dispensed to the beneficiary by the services of the hospital pharmacy previous payment of the reduced contribution in accordance with the provisions of Article 102 of the Law on guarantees and use rational use of medicinal products and medical devices.

These medicines will be invoiced for credit by MUFACE to the laboratory selling price (PVL), plus taxes, funding for the National Health System, which will be deducted the amount of the beneficiary's contribution. will be reflected in the invoice.

2. The Hospital Diagnostic medications, which will be authorized by MUFACE for treatment of certain patients, in the face of difficulties for dispensing through pharmacy offices. These medicinal products shall be dispensed by the hospital pharmacy services after payment of the reduced contribution by the beneficiary, in the same terms as in the previous paragraph.

For billing, MUFACE will pay them to the public selling price (PVP) for SNS, by deducting the amount of the beneficiary's contribution that will be reflected in the bill.

3. The medicinal products in charge of MUFACE which are subject to the fixing of "maximum expenditure ceiling" by the Ministry of Health, Social Services and Equality shall be invoiced within one month from the date of their dispensation.

MUFACE will forward the relevant and updated information on these medicines to the Entity to move them to their own or concerted centres.

In those cases in which, after communication from the Ministry of Health, Social Services and Equality, according to the provisions of Articles 92 and 94 of the Royal Legislative Decree 1/2015, of 24 July, approves the recast text of the Law on the guarantees and rational use of the medicinal product and medical devices, the maximum expenditure ceiling for the medicinal products charged by MUFACE shall be reached, the Mutuality shall inform the entities of the date from which it is not will take care of your credit, so that you can communicate it to the hospitals that dispense these medications. In any case, the Entity must ensure the continuity necessary in the treatments established to the beneficiaries and previously authorized by MUFACE without assuming any cost for this.

4. In the case of medicinal products borne by MUFACE, which in the authorization of financing by the Ministry of Health, Social Services and Equality, in accordance with the rules referred to in the preceding paragraph, are subject to 'maximum cost per treatment-patient' shall not exceed the corresponding funding limits.

In such cases, the Entity must ensure, at all times, the necessary continuity in the treatments established to the beneficiaries and previously authorized by MUFACE without assuming any cost for this.

2.9.4 You will be in charge of the Entity and provided by your means to the beneficiaries the medical devices listed below:

(a) Home enteral nutrition administration systems, tracheotomy cannulas and laringuectomy as well as special bladder accessories and probes that are not available through MUFACE prescription, when such products would have been properly 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 adapted to the needs and abilities of the patient.

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

e) Fungible material, either for parenteral administration of insulin or other antidiabetic drugs.

All of these products will be provided on the basis of diligence, proportionality and maximum attention to the patient's situation. In those cases where, for reasons attributable to the Entity, the supply will not conform to these criteria, the beneficiary will be able to directly acquire the product and request the refund to the Entity.

2.10 Transportation for Healthcare.

The transport for healthcare provided in this Concert includes the following modes:

a) Urgent health transportation.

b) Non-urgent sanitary transport.

c) Transport in ordinary media.

2.10.1 Urgent health transportation. Health transport is considered to be the transport of land, air or sea, assisted or non-assisted, as required by the clinical situation of the patient, in cases where it is necessary for the appropriate transfer to the health centre which may attend The emergency situation is optimal.

2.10.2 Non-urgent sanitary transport. It is considered as non-urgent health transport that consists of the displacement of sick or injured persons who are not in a situation of emergency or emergency, and that for exclusively clinical causes they are unable to move 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, which is indicated for the transfer of sick or injured persons requiring technical-health assistance en route, and transport Non-assisted health care, which is indicated for the special transfer of sick or injured persons who do not require technical-health assistance en route.

A) 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. Transfer from a health centre to your home, if necessary, after discharge or after care in an emergency department.

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

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

4. Transfer of the displaced patient to a municipality other than that of their habitual residence that would have received urgent assistance, with or without hospital admission, and decide to transfer them to the municipality of habitual residence, or to their address or to another healthcare facility.

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

B) Clinical criteria for indication of non-urgent sanitary transport. The need for sanitary transport will be justified by the written prescription of the corresponding physician who will assess both the state of health and the degree of autonomy of the patient in order to be able to move in the means of transport ordinary.

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.

When physical incapacity or other medical causes disappear as criteria for indication of health transport and patients may use the means of ordinary transport, in accordance with the criterion of the optional in writing, the health transport shall be suspended, irrespective of the duration or type of assistance being carried out.

c) User input. For these purposes, the regulations established by the Ministry of Health, Social Services and Equality for the entire National Health System will apply.

Where appropriate, the Entity shall develop the necessary procedures for the proper management of the contribution to be paid by the beneficiaries, in accordance with the aforementioned regulations, and shall provide the relevant information with the periodicity and in the format to be determined by the Mutuality.

2.10.3 Transport in ordinary media.

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

B) Coverage criteria. This type of transport shall be entitled in the following cases:

1. Where the required means do not exist, so that the beneficiary is obliged to move from the locality in which he resides, on a temporary or permanent basis, to the nearest locality where those are available.

2. To Level IV services and Reference Services located in a province other than that of residence.

3. In the case of transfers necessary to another locality other than that of residence for health care resulting 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, rail, boat or aircraft transport lines.

D) Transportation of the companion. They shall be entitled to travel expenses for accompanying movements, in accordance with the preceding paragraphs, by patients:

1. Under fifteen years of age, and in the case of the cities of Ceuta and Melilla and island provinces, those under the age of eighteen.

2. Those who credit a degree of disability equal to or greater than 65%.

3. Residents in the cities of Ceuta and Melilla and the island provinces when prescribed by their responsible doctor, in which case they shall provide written prescription of the optional.

2.11 Other capabilities.

2.11.1 Podology. 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.

2.11.2 Respiratory Therapies. Includes the coverage of any of the home respiratory therapy techniques served in the SNS, when the circumstances of the patient so require, including the use of the liquid oxygen backpacks, the pulsioximetry and the aerosoltherapy.

2.11.3 Orthopreprosthetic Prstation. Surgical, therapeutic or diagnostic implants are included in the coverage of this Concert. These medical devices designed to be implanted in whole or in part in the human body by means of a a given medical act or surgical intervention, which are included in the supply of orthopaedic products from SNS centres and services. Also included are the renovation of any of its accessories, including the external ones and the materials used to perform osteosynthesis techniques.

The monitoring studies are also included in accordance with the provisions of Order SSI/1356/2015 of 2 July, amending Annexes II, III and IV to Royal Decree 1030/2006, of 15 September, for which the establishes the common services portfolio of the National Health System and the procedure for updating it.

Oosteintegrated implants for dental prostheses are excluded, except when the implants themselves result from an accident in the act of service or occupational disease and in the cases covered by clause 2.8.3.

The prescription and adaptation of external prostheses and other orthoprostheses that are the subject of benefits in charge of MUFACE will be performed under the indication and supervision of the corresponding specialist.

2.12 Update of the Concert Services Portfolio.

2.12.1 The Service Portfolio that is determined in this Chapter will be automatically updated by the SNS Common Service Portfolio update.

2.12.2 The incorporation of new services, techniques or procedures into the Services Portfolio or the exclusion of existing ones that do not correspond to the Common Portfolio of SNS Services, and that have a relevant character, shall be carried out by a Resolution of the General Directorate of Mutual, after hearing of the entities that have signed the Agreement, and shall, where appropriate, be carried out in accordance with the provisions on the modification of contracts laid down in the rules in force on public sector procurement.

The provisions of the preceding paragraph shall not apply to the pharmaceutical provision, which shall be governed by its own rules. It shall also not apply to services, techniques or procedures involving a minor change in existing or incorporating devices or products with minor technical modifications, except for scientific evidence and/or the impact of such changes. bioethical and social, the Directorate-General of MUFACE considers it appropriate to limit its incorporation to the Portfolio of Services for specific indications, drawing up the corresponding protocol.

CHAPTER 3

Entity Media

3.1 General rules.

3.1.1 To the effects of the application of this Concert, it is considered that the means of the Entity are the services, own or concerted, assigned for the health care of the beneficiaries of the same. 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 system, as well as non-concerted private centres and services, as provided for in Annex 3 (paragraph 3.6.3), which remain assimilated to the means of the Entity.

c) The Entity's Emergency and Emergency Coordinating Center 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.

(d) The Primary Care and Emergency Services of the Public Health Network, which are taken on behalf of the Entity, as provided for in Annex 2, 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, website, etc.) to enable the beneficiary to carry out the communications provided for in Chapter 5, during the 24 hours of the day, every day of the year, and to permit the constancy of such communications.

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

The centres, establishments and services will 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 Supplier Catalog.

If MUFACE is aware of the potential 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 means which it records in its Supplier Catalogue have access to sufficient electronic means to be integrated into the actions referred to in clause 6.2, as well as in other programmes and actions leading to the improvement of health and care quality.

3.1.6 The Entity will provide access to the centres and services that are included in its Supplier Catalogue, so that MUFACE can check the adequacy of these facilities with respect to the offer of services.

3.2 Media availability criteria.

3.2.1 The services provided in the Portfolio of Services to be provided by the Entity will be structured territorially by care levels, determined by the population size (according to the latest figures). officers published by the National Statistics Institute) and by the resident protected group, among other criteria.

3.2.2 In accordance with clause 2.1 of this Concert, the following care levels are distinguished:

a. The level of Primary Care, whose geographical and population framework is the municipality.

b. The level of specialized care will be available in municipalities or groups with a population of 20,000 inhabitants and 500 resident beneficiaries.

The geographical and population framework of levels I and II is the municipality or group of municipalities, that of Level III is the province or clusters of municipalities and that of Level IV is the Autonomous Community.

c. The Reference Services, whose geographical and population framework is the national territory.

3.2.3 Each level of care includes all services from the lower levels. The criteria for the availability of means by care levels are set out in Annex 3.

3.2.4 Media accessibility guarantee. The Entity must guarantee access to the means that the Services Portfolio requires in each level of care in the terms set out in Annex 3, unless there are no private or public means, in which case it will facilitate it in the municipality more next 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.

3.3 Vendor Catalog.

3.3.1 The Supplier Catalog contains the detailed relationship of the means of the Entity and the information necessary to enable the beneficiaries to use those means.

3.3.2 In the Catalogue, all the optional and own assistance centres or centres agreed by the Entity that have been registered in the database provided for the subscription of this Concert must be included without exclusions, with the format and in the terms set out in point 5 of Annex 6.

3.3.3 The Entity may determine that, in its medical picture, specific and complex areas of its specialty will appear as optional consultants, provided that the specialty has no specialists. consultants.

3.3.4 Where a beneficiary is cared for by a professional who is part of the team of an optional or concluded service included in the Catalogue, it shall be understood as part of the means of the Entity and shall be included with as soon as possible in the table of health professionals provided for in Annex 6 and on the website of the Entity.

3.3.5 The Entity will edit the Catalogue according to the instructions detailed in Annex 4, which will have, both on paper and in electronic support, a common format of mandatory compliance, in order to be processed Uniform among the various concerted entities.

3.3.6 The Catalogue will be specific to MUFACE, will have provincial scope and will be adapted to the levels of care established in the Concert. It shall not include advertising, or information relating to other products or services of the Entity.

3.3.7 When it is detected that some Catalogue 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 Annex 4, MUFACE will communicate this non-compliance with the Entity, which will have a period of ten calendar days to correct the defects detected and to deliver in the Provincial Service or Services and in the Central Services of MUFACE the new edition of the Catalogue in the format and number of copies required for you.

3.4 Issue and delivery responsibility for the Supplier Catalog and information on the Entity's web page.

3.4.1 Before 20 December of the year prior to the beginning of the validity of the Concert, the Entity must deliver in the Central Services and Provincial Services of MUFACE the catalogues of suppliers of the Entity for all the provinces in the format and number of copies set out in Annex 4. It shall also, as from 1 January 2016, provide the beneficiaries with attached and request the Catalogue of Suppliers of the relevant province in paper edition or, at the choice of the beneficiary, in electronic format, by means of their submission to the postal or electronic address indicated by the data subject 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.

3.4.2 The Entity on its website must have a specific section that informs the beneficiaries of MUFACE about the contents of the catalogues corresponding to all the provinces, including the telephone number of the Centre Emergency and Emergency Coordinator of the Entity, provided in clause 3.1.1 (c), clearly differentiating it from other telephone numbers of information or services of the Entity.

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 MUFACE that is perfectly identifiable and accessible and will include Province of the contents specified in Annex 4. The information on the website should be updated whenever there are modifications, as set out in clause 3.5.1, by stating the date of the last amendment.

3.4.3 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.

3.4.4 Before December 20, 2015, when the change of Concert results in casualties of hospital centers or services in the Catalogs, the Entity must deliver in the Central Services and in each Provincial Service. a document containing the details at the provincial level of the hospital centres and services which have ceased to be concluded.

In the event that the entity does not proceed to make the referred delivery or make it do not include a particular center or service, the same shall be understood to be the same.

3.5 Invariability of the Entity Providers Catalogs.

3.5.1 The Entity's Supplier Catalog will remain stable throughout the validity of the Concert, so that once published, the Entity's offer of means will only be able to register high, without any there are casualties, except those duly accredited to MUFACE 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 must be communicated to the Central Services and the corresponding MUFACE Provincial Service 30 days in advance of the fact that it will be produced, unless it is overcome, justifying in writing the reason for the same. In addition, if the discharge affects hospital facilities or services, the Entity must refer to the corresponding Provincial Services the relationship of beneficiaries who are being cared for in such centers or services.

the entity is obliged to replace the professional or the centre in the shortest possible time, and must inform the Central Services and the corresponding Provincial Services of MUFACE the professional or centre of the replace the produced low

3.5.2 MUFACE 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.

In the event that the Entity requests authorization to discharge any means and MUFACE, once the case has been analyzed, it does not appreciate it as justified, it will inform the Entity and will imply that the media continues to be considered all effects as a means of it during the validity of the Concert and, consequently, continue to be usable by the beneficiaries on behalf of the Entity.

3.5.3 In any of the assumptions provided for in the above clauses, the Entity must direct a communication, in general, to the beneficiaries on the high or low levels produced in the catalogues.

3.5.4 The lack of availability of means by the Entity shall result in the application of the deductions set out in Annex 8 in accordance with the terms established therein.

3.6 Principle of continuity of care.

3.6.1 Regardless of what is foreseen in clause 3.5.4, if the absence of any professional from the Catalogue occurs, the Entity will guarantee the continuity of care with the same optional to the patients in treatment serious pathological processes during the six months following the date on which the discharge occurred, provided that the practitioner is able to continue the exercise of his profession and that he has agreed on his part.

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

3.6.3 The Entity must inform each patient 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 plan in the above clause within a period not exceeding seven calendar days, from the date of the centre or service discharge.

3.6.4 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 Providers of 2015, the maximum period foreseen in the clause 3.6.2 it shall be 24 months, under the same conditions as laid down by it, as well as those established on the duty of information in clause 3.6.3.

3.6.5 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 the change of Concert has assigned another level of care, to the hospital discharge with a maximum period of three months, or one month in the case of 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.

3.6.6 When the Entity underwrite the Health Care Concert in the national territory that replaces it, it must meet the obligations laid down in this clause 3.6, except as provided for in the clause 3.6.5.

CHAPTER 4

Entity Media Utilization Rules

4.1 General Rule. The beneficiaries must receive the assistance through the means of the Entity defined in clause 3.1.1 and they will be able to choose freely optional and center from among those listed in the catalogues of providers of the Entity in all the national territory.

4.2 Identification. The beneficiary must prove his/her right to health care by presenting the individual health card to be provided by the Entity in accordance with the provisions of clause 1.5, or, where applicable, the membership document. MUFACE.

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

4.3 Mutualists not attached to Entity and its beneficiaries. In the case provided for in clause 1.3.3, the Entity shall provide assistance to the mutualists and their beneficiaries. Within the following five calendar days, the Entity shall notify the facts to MUFACE to proceed to the discharge of the mutualist in the Entity with the effect of the fifth of those days and to the payment of the costs of the assistance provided up to the date of effects of discharge.

4.4 Access procedure and provision of assistance in consultation. The beneficiary will be directly directed to the chosen primary care doctor and/or specialist to receive the care provided by the corresponding health card. In addition, in order to attend the consultations of the specialities which must be available from Level IV (described in Table 1 of point 3.9 of Annex 3) and for those of the consultant doctors, the prescription of another optional specialist and authorization of the Entity.

It will also be necessary to obtain prior authorisation from the Entity for access to the speciality consultations provided for in point 3.6.3 of Annex 3, as set out in Annex 5.

4.5 Access procedure and provision in home care.

4.5.1 Healthcare will be provided by Primary Care professionals at the patient's home, provided the clinical situation so requires, in the following cases:

(a) In the case of patients who are unable to travel because of their illness.

(b) In the case of chronic immobilized patients who need help from another person for the basic activities of daily life.

c) When dealing with terminally ill patients.

4.5.2 Home care for these patients includes the extractions and/or collection of home samples that are accurate, as well as all of the primary care procedures, including treatments. parenteral, cures and sondages.

4.6 Access and delivery procedures in emergency and emergency assistance.

4.6.1 When the beneficiary requires urgent care or health emergency, he/she must request it by dialling the phone 900 .../800 ... free of the Entity that consists in his health card, in the Catalogue of Suppliers and in the the website of the same, which gives you access to the Emergency and Emergency Coordinating Center of the Entity to ensure the accessibility and coordination of all available means for this type of care 24 hours a day from all days of the year, throughout the national territory.

4.6.2 Similarly, in the emergency and emergency care telephone or in the information provided by the Entity, the beneficiary may collect information about the hospital emergency, outpatient and care facilities. Primary that the Entity has in which they can be cared for, and in general on any other aspect related to this care modality.

4.6.3 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.

4.7 Procedure for access to and provision of assistance under hospitalization

4.7.1 Assistance under hospitalization includes medical-surgical assistance, including the treatment and diagnostic procedures required by patients requiring continued care in the hospital. Hospitalization arrangements, as well as the basic hotel services inherent in it.

4.7.2 The beneficiaries who require assistance under the hospitalization procedure must request prior authorization from the Entity, in accordance with the provisions of Annex 5, providing the prescriptive prescription of the physician of the Entity with indication of the hospital. Such processing shall be carried out within the shortest possible time in the revenue made through the emergency services.

4.7.3 In the event that a beneficiary is admitted to a hospital outside the Entity for an emergency situation, he/she can request his/her entry into a concerted center of the Entity for the continuity of the assistance without requiring the prescription of a physician from the Entity, for this in addition to the request must provide the medical report of the process by which it is being attended.

4.7.4 Hospitalization will persist while, in the opinion of the physician who is responsible for the care of the patient, the need arises, without the reasons of social type being the reason to prolong the stay.

4.7.5 The hospitalization will take place in a single room with bath or shower and a companion bed. In no case may rooms which are part of the accommodation capacity of the centre be excluded. MUFACE may authorise the Entity to have in its Catalogue of Providers of hospital centres that do not meet this requirement. In the case of psychiatric hospitalization, no accompanying bed is required.

4.7.6 The Entity covers all medical-surgical expenses during hospitalization of the patient from admission to hospital discharge, including the pharmacological treatment and diet of the patient according to diet prescribed.

4.7.7 Types of hospitalization.

A) Hospitalization of day.

a) Comprises care, diagnostic, therapeutic and rehabilitation activities, intended for patients who require continued specialized care, including the most outpatient surgery, but do not require that the patient stays in the hospital.

(b) The entity shall be entitled to all hospitalisation expenses that may be incurred in the healthcare facility during the stay in the healthcare facility for the performance of diagnostic and/or therapeutic procedures.

B) 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.

C) 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 borne by the Entity and cannot be charged either to the beneficiary or to MUFACE, 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.

D) Maternity hospitalization. At the time of admission, or in any case before discharge, the authorization of the Entity must be presented in the hospital. The provisions of clause 1.3.2 shall be taken into account for the purpose of assisting the newborn.

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.

E) Psychiatric hospitalization. It includes the psychiatric care of all the acute and chronic processes that require hospital admission or hospitalization of the day.

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

The entry must be made in centres arranged by the Entity, without prejudice to the provisions of clause 3.2.4 and 3.6.3 of Annex 3.

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 the person concerned the costs of hospitalization up to the hospital discharge, with the limit of 87 euros per day. The refund shall be made within 10 calendar days of the date on which the supporting documents are presented to the Entity.

4.8 Additional requirements for media usage.

4.8.1 In the cases expressly provided for in the Concert, the Entity may require additional requirements, such as medical prescription or prior authorization of the Entity. The institution, through healthcare professionals who prescribe or perform diagnostic tests or treatments that require authorisation, shall report the existence of this requirement to the beneficiary.

4.8.2 Non-authorised tests may not be carried out from the beneficiary if the beneficiary has not been informed of the need for such prior authorisation. The medical or surgical acts performed at the time of the consultation shall not be borne by the beneficiary either where there has been no time to obtain their authorisation by the Entity.

4.8.3 The application for authorization of a given diagnostic or therapeutic means derives from the need to order and channel the benefits on the part of the Entity, to facilitate the service and avoid delays, but never can assume a restriction on access to the services recognized in the Services Portfolio of this Concert.

4.8.4 Annex 5 contains an exhaustive list of the scenarios for the use of the means required by prior authorisation of the Entity, as well as the procedure for obtaining it.

4.8.5 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 and, in the case in question of a process for which a protocol has been specifically approved, in accordance with clause 2.12.2, that the indication is in conformity with the protocol.

4.9 Private hospitals not agreed. Access to services in non-concerted private centres as provided for in point 3.6.3 of Annex 3 shall require prior authorisation of the Entity in accordance with point 1.7 of Annex 5

CHAPTER 5

Using non-concerted media

5.1 General Rule. In accordance with Articles 17 of the LSSFCE and 78 of the RGMA, in relation to clause 3.1 of this Concert, where a beneficiary, by his own decision or his family members, uses means not agreed with the Entity, shall pay, without entitlement to reimbursement, any costs incurred, except in cases of unjustified refusal of assistance and in the case of emergency assistance of a vital nature.

5.2 Unjustified denial of assistance.

5.2.1 According to the provisions of Article 78.1 of the RGMA, there is an unjustified refusal of assistance 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 5, 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 Entity does not meet the requirements of the availability of means provided for in this Concert. In this case, the beneficiary may refer to the optional or private centres which exist at the appropriate level, or where these are not available, to the relevant public services, in accordance with the provisions of clause 3.2.4.

c) When the beneficiary requests authorization from the Entity to go to an optional or non-concerted center (prior written prescription of an optional Entity with an exposure of the medical causes of the the need for a referral to the non-concerted means) and the Entity neither authorizes nor offers a valid alternative care with its means before the end of the tenth working day following the submission of the application for authorisation.

d) When a beneficiary has come or is admitted to a center of the Entity to receive assistance and according to the criterion of the physician that serves him, the necessary 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 care, 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 a means that allows to be put on record (preferably through its Emergency and Emergency Coordinating Center) and will include a brief description of the facts and circumstances. in which the income has occurred.

5.2.2 Entity Obligations.

(a) In any of the alleged unjustified refusal of assistance described in clause 5.2.1, the Entity is obliged to assume the expenses arising from the assistance.

In the case referred to in point (e), if the Entity has offered a valid care solution within the prescribed period, the beneficiary shall bear the costs incurred for the assistance until it has been transferred to the institution. own or concerted.

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

(c) Where the beneficiary has gone to non-concerted means as a result of a refusal of assistance caused by the Entity not offering a valid alternative care within the time limits set out in the clause 5.2.1, or because it has 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, the beneficiary shall request the entity to renew the continuity of the assistance so that, before the end of the the tenth working day following the submission, the authorisation or offer a valid alternative to the media, in accordance with the specifications set out in point (b) above.

(d) When the Entity receives the communication of the assistance provided by the beneficiary in other than any of the circumstances provided for in clause 5.2.1, it shall make appropriate representations to the supplier to issue the corresponding invoice in the name of the Entity and take charge of the costs incurred for such assistance.

e) If the beneficiary has paid the expenses directly to the healthcare provider, the Entity shall make the refund within 10 calendar days of the date on which the person concerned submits the supporting documents to the expenses.

5.2.3 Acceptance by the Entity or, where appropriate, the statement by MUFACE that there is an unjustified refusal of assistance, does not imply acceptance or declaration, respectively, that there has been a refusal for assistance to other civil or criminal purposes, for which the person concerned shall, where appropriate, go to the appropriate ordinary course of action.

5.3 Vital character urgent assistance in non-concerted media.

5.3.1 For the purposes set out in Article 78.1 of the RGMA, it is considered a situation of urgency of a vital nature in that a pathology has been produced whose nature and symptoms make it foreseeable a vital risk imminent or very next, or irreparable damage to the physical integrity of the person from not obtaining a therapeutic action immediately.

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

5.3.2 Special situations of urgency.

It will be considered that they always meet the condition of emergency of a vital nature and that the assistance received in foreign media also has the requirement provided for in the second paragraph of the previous clause, in the following special situations:

(a) Where the beneficiary is on the public road or public health emergency equipment (112, 061, etc.) is activated by a person other than that or his or her family members in the event of their being accompanied.

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

(c) When the mutualist suffers an accident at the service and is treated by the public health emergency teams at the place where it is carried out.

(d) 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 home, and Such equipment shall be activated by a public financing teleassistance service, in both cases provided that the latter or his family has communicated to the centre or service his or her attachment to the Entity for the purpose of their health care.

5.3.3 The assistance required by the mutualists belonging to the National Police Corps, on the occasion of injuries or bodily harm suffered in the exercise of the functions proper to the activity of the Body or on the occasion of acts committed by persons integrated into organised and armed groups or groups, is considered to be always a matter of vital urgency and that the assistance received from having used other means has also the requirement laid down in the second paragraph of clause 5.3.1.

5.3.4 For the purposes of the coverage of the expenses incurred, the emergency situation of a vital nature extends from the entrance to the hospital discharge of the patient (including the possible transfers to other non-concerted centers). for health reasons), except in the following two cases:

a) When the Entity, with the compliance of the medical team that is providing the assistance, offers a care alternative that allows the patient to be transferred to a proper or appropriate center and the patient or his or her responsible family members refuse to do so.

b) When the patient is referred to a second foreign center and there are no causes to prevent the continuity of treatment at a center of the Entity.

5.3.5 The beneficiary, or other person on his behalf, shall communicate to the Entity the assistance received with other means by any means that permits the communication to be recorded, contributing to the corresponding medical report of emergency, within 48 hours of the start of the assistance, unless exceptional circumstances, duly justified, have prevented the communication of the assistance received with other means.

5.3.6 When the Entity receives the communication of the assistance of a beneficiary in a non-concerted means, it must reply within 48 hours after the receipt of the communication and by any means to allow the 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 other hand, it is not considered to be obliged to pay for the fact that there has not been a situation of urgency vital character.

In the event that the Entity recognizes the existence of the emergency situation, it must inform the health provider that it is directly responsible for the expenses incurred, in order to be issued by the entity. corresponding invoice to the Entity. If the beneficiary has paid the expenses, the Entity shall make the refund within 10 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. circumstance and will transfer the same to the beneficiary and the MUFACE Provincial Service.

When the beneficiary has not made the communication in time and form, the Entity will refund the amount within one month from the date on which the corresponding invoice is presented and, if applicable, the supporting document fertilizer. If the Entity has not made the provision in this clause, it shall be obliged to pay directly to the healthcare provider if the person concerned requests it.

CHAPTER 6

Information, health documentation, and quality objectives

6.1 Health information and documentation.

6.1.1 General rules:

(a) In order for MUFACE to have the information necessary 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 beneficiaries specified in this Chapter. It will also do so for those who, although not specified, 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 SNS Information System. or by any other competent body in compliance with the rules in force.

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

c) Likewise, the Entity is obliged to comply with and enforce the health professionals and centers included in its Supplier Catalogue all the requirements laid down in Organic Law 15/1999, of December 13, Protection of Personal Data and in its development regulations, in relation to the information and health documentation relating to the beneficiaries of MUFACE, as well as to safeguard the exercise of the rights of the patients collected in Article 10 of Law 14/1986 of 25 April, and Law 41/2002 of 14 November 2002, Patient autonomy and rights and obligations in the field of Clinical Information and Documentation. This safeguard of the rights of patients will be particularly careful with regard to informed consent and respect for the prior instructions, rights established by Articles 10 and 11 of Law 41/2002, 14 of November.

6.1.2 Activity information.

i. Information about activity/cost. The institution shall have an information system that allows the number, type and cost of the services provided to the beneficiaries of MUFACE with their own or agreed means to be known, in accordance with the format set out in Annex 6.

The Entity shall provide MUFACE, in computerised form, with data on care activity according to the summary tables and data structure provided for in point 1 of Annex 6.

Such data shall be submitted on the basis of the periodicity set out in Annex 6, within three months of the end of the corresponding period.

ii. Information on cross-border healthcare. The institution shall have a system of information to enable it to know the number of authorised patients, the type of benefits requested and the amount of reimbursement of expenses granted for cross-border healthcare.

Such data should be submitted to MUFACE with the characteristics and periodicity set out in Annex 6.

6.1.3 Economic information. The Entity shall provide 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 Ministry, at the request of MUFACE. Health, Social Services and Equality within the NHS Health Information System. All this in the format and with the periodicity required by MUFACE, for its subsequent transfer to it.

6.1.4 Information about hospital care. The Entity will require its own or concerted centers detailed in the supplier catalogs to fill in the high clinical reports at the end of the stay in a hospital institution, or the attendance by Ambulatory Major Surgery or other assists, 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. They shall also collect the Minimum Basic Data Set (hereinafter referred to as CMBD) of the discharge reports with the criteria set out for the purpose in the SNS, and the contents of which are set out in Annex 6.

The entity will provide MUFACE with the CMBD of beneficiaries who have had a hospital admission or who have undergone Major Ambulatory Surgery, within three months of the end of the period. corresponding.

The treatment of the information contained in this CMBD allows MUFACE to have the knowledge of the services provided and the processes taken care of its beneficiaries in the own and concerted centers of the Entity, which allow it to adequately develop the management functions, epidemiological studies and quality assessment of its health services which it is required to carry out as public health administration and for which it is legally empowered in accordance with its specific rules and Article 53 and the fourth additional provision of Law 16/2003 of 28 May.

In compliance with the provisions of the Organic Law 15/1999 of 13 December, and its implementing legislation, MUFACE is responsible for the processing of such information. Consequently, in the process of transmitting the information of the centers to the Entity and the Entity to MUFACE, the transmitted data may not be communicated to other persons, nor used or applied by the Entity for purposes other than the referred to in this Chapter, for which the relevant high level security measures shall be applied, ensuring the confidentiality of data relating to the health of the protected and avoiding any alteration, loss, treatment or access not authorized by them.

The data will be incorporated into the "CMBD Data File", whose structure and other relevant information is contained in Order HAP/2478/2013 of 20 December, which regulates the files of personal data existing in the the department and in certain public bodies attached to it.

In the authorization of admission to hospital or major outpatient surgery, the Entity will inform the beneficiaries that their health data can be treated by MUFACE for the purposes established, with the The use of the materials used in the Organic Law 15/1999 of 13 December and its implementing legislation.

6.1.5 Healthcare media information. The Entity shall transmit to MUFACE in electronic form the updated information of the own and concerted means that it has offered for the subscription of the Concert. Such remission shall be made in accordance with the instructions given by MUFACE as set out in Annex 6.

6.1.6 Clinical patient documentation. The information referred to in clause 6.1.4 shall be kept on paper and/or computer support for as long as the legislation establishes. In any case it must be met with the legal requirements already referred to in clause 6.1.1.

The discharge report, in any form of care modality, will be delivered to the patient or, at the indication of the responsible physician, to the family member or legal guardian, at the time the discharge of the health center or the process occurs. from which you are being cared for in external consultation. You will also be provided with a copy for delivery to the doctor responsible for monitoring the patient, 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.

Also, at the request of the data subject, a copy of his or her medical history or of certain data contained therein shall be made, without prejudice to the obligation of his or her conservation in the health center, written of the entire process and guaranteeing, in any case, the confidentiality of all information related to the process and the patient's stay in health institutions, as established by Law 41/2002 of 14 November.

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

6.1.7 Other health documentation. The Entity shall ensure that the healthcare professionals and healthcare facilities included in its Catalogs comply with the following obligations:

a) Compliment in official models the medical part for situations of temporary disability, risk during pregnancy and risk during natural lactation, as well as additional medical reports of ratification and part for the assessment and grant, where appropriate, of the corresponding licenses of the officials, as well as those reports that are necessary to accredit these situations, with strict compliance with the law in force.

In order to ensure the full validity of these parts, the diagnosis must be coded according to the international classification of diseases contained in the CIE code 9 MC, unless MUFACE expressly determines another encoding.

b) Collaborate with the practitioners in the procedures for the verification of the pathology that originated the sick leave and its extensions.

(c) Facilitate medical records and reports for the processing of procedures for the assessment, qualification, declaration or review of permanent disability of mutualists, in order for the recognition of retirement of mutualists for permanent incapacity for service or for a permanent disability pension.

d) Edit and issue orders for hospital supply, in accordance with the specifications and criteria established by the current regulations, guaranteeing that for the prescription, both in the orders of supply and in the Medical prescriptions, have identifying seals that allow their readability.

e) Issue the medical reports required by MUFACE to your mutualists or beneficiaries for any of the benefits managed by the Mutuality.

f) Make the reports, scans or diagnostic tests in accordance with Annex 9 to the mutualists.

g) 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.

h) To comply, in the prescriptions of orthoprosthetic material, the code of the orthoprosthetic product that they prescribe, as stated in the General Catalogue of Orthopedic Material of MUFACE.

6.2 Digital Clinical History and Electronic Recipe.

6.2.1 Continuing with the projects of Digital Clinical History and Electronic Recipe of MUFACE, the data on the healthcare provided to the beneficiaries will be adapted to what is foreseen in the Royal Decree 1093/2010, of 3 of September, approving the minimum set of data for clinical reports in the SNS and the common requirements for medical prescriptions, as provided for in Royal Decree 1718/2010 of 17 December 2010.

6.2.2 The Entity will promote the use and implementation of the MUFACE Electronic Recipe System (SIREM), which must be interoperable with the rest of the SNS, and its use by all professionals and centers included in the the Entity, so that the relevant information is accessible from any point of health care, public or private, with the appropriate security and data protection measures of a personal nature.

6.2.3 Additionally, depending on the development of SIREM, the information of the Pharmacotherapeutic History to which the patient may have access will be made available through the Internet through the technology platform. Electronic Headquarters of MUFACE.

6.2.4 By Resolution of the Directorate-General of MUFACE, the objectives on the steps to be covered in this project will be set, the fulfillment of which will entail the perception of the economic compensation provided for in clause 8.3.3. The Joint Working Group shall develop the scope, content and specific characteristics of each phase, as well as the requirements for its development and implementation.

6.2.5 In those cases where the fulfillment of the aforementioned objectives results in products that must pass for their subsequent control and maintenance to be owned and owned by MUFACE, the cession will be improved of these in the terms set out in clauses 8.3.3 and 8.5.2.

6.3 Quality of healthcare.

6.3.1 MUFACE, as an integral part of the SNS in its status as Gestora of the Special Regime of Social Security of Civil Servants of the State, promotes a comprehensive policy of quality for the improvement of the assistance health to its 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 SNS, the lines of action set out in the following clauses are established during the term of the Concert.

In these lines of action, specific objectives of quality are set for which economic incentives are linked, which are perceived by the entities in accordance with clause 8.3.2 and Annex 8. 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.

6.3.2 Evaluation of the plans to adapt to the strategies of the National Health System. The Ministry of Health, Social Services and Equality has published, in collaboration with the Autonomous Communities, scientific societies and experts, plans and strategies regarding various diseases or health problems.

During the validity of previous concerts, the signatory entities developed the adaptation plans related to the strategies in Cancer, Palliative Care, Stroke and Ischemic Heart Disease, and since 2012 MUFACE is evaluating the development of these plans.

To this end, a series of indicators have been selected for each plan and an evaluation methodology has been established, linking their results to the allocation of an economic incentive of quality.

With the same methodology, during the duration of this Concert, MUFACE will analyze the development achieved by the plans in Cancer, Palliative Care, Istroke and Ischemic Heart Disease.

In Annex 8, the economic incentive linked in this exercise to this objective and the allocation criteria is established.

In the event that the Entity has not subscribed to the previous Concert, it must prepare the plans in Cancer, Palliative Care, Stroke and Ischemic Heart Disease, according to the Framework Document that will be provided by MUFACE to the signature of this Concert. The deadline for delivery to the Mutuality of the referred plans will be March 3, 2016.

6.3.3 Elaboration of clinical care protocols.

(a) The Entity must promote, in collaboration with its professionals, the development and application of clinical guidelines, protocols and guidelines of action, of accredited and proven efficacy, related to the more prevalent in the population in order to serve as instruments of aid in clinical decision-making and with the objective of contributing to the improvement of quality of care and efficiency in the use of resources.

b) The MUFACE Directorate-General will be able to promote, prior to obtaining the opinion of the concerted entities, the elaboration of the protocols of attention to diseases or processes that because of its high incidence or prevalence among the the beneficiaries of MUFACE, for generating high consumption of resources, for being related to emerging technologies or forms of care whose high impact is foreseeable, or for the possibility of introducing improvements in the quality and efficiency, and are considered to be of priority interest.

c) During the validity of previous concerts, the concerted entities developed a Protocol of Attention to the Urgency. MUFACE since the 2015 Concert is evaluating the development and implementation of this protocol, establishing objectives that will be linked to economic incentives, according to the criteria defined in Annex 8.

In the event that the Entity has not subscribed to the previous Concert, it will have to draft its Protocol of Attention to the Urgency, according to the Framework Document that will be provided by MUFACE to the signature of this Concert. The deadline for delivery to Mutuality will be March 3, 2016.

6.3.4 Quality of the pharmaceutical delivery.

(a) In compliance with the provisions of the health legislation, the Entity shall promote the rational use of the medicinal product by developing the necessary actions to enable its professionals to indicate or prescribe those active substances, medicines 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 Mutuality.

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 Annex 8, the objectives and indicators that are set for the monitoring of the quality of the pharmaceutical supply for the validity of this Concert with the corresponding economic incentive are established.

c) In the hospital field, the Entity will ensure that the hospital's own and concerted hospitals have standard working tools and procedures (commissions, pharmacotherapeutic guides, protocols) with a methodology that is homologous to that of the rest of the SNS, for purposes such as the evaluation and selection of medicinal products, the reconciliation of medication between care levels or the use of medicinal products under conditions other than those authorised in its Technical tab.

d) In the case of patients not admitted, the Entity shall ensure that the hospital dispensation is performed in the same hospitals where the treatment orders have been prescribed, except where the medicinal product is 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 MUFACE, depending on the nature of the medicinal product and in the light of the circumstances and procedures referred to above.

6.3.5 Quality of information. The relevant and reliable information on the care provided is a fundamental aspect for the continuous improvement of the benefit, considering therefore the availability and quality of the information provided in this Chapter one of the dimensions of the quality of the assistance that the Entity provides to the beneficiaries of MUFACE.

To be able to make the relevant analysis of the characteristics of the hospital assists, it is necessary to have a minimum volume with the CMBD records of the high-hospital reports coded correctly The method of operating the system is to be used by the Diagnostic-Related Groups System (GRD, s). For this purpose, the objective is to extend and improve the information in the CMBD.

In Annex 8, the economic incentives linked to this objective and the criteria for their allocation are established.

6.3.6 Evaluation of the quality of health 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 (European Foundation for Quality Management) Model.

CHAPTER 7

Legal framework of the concert

7.1 Nature and regime of the Concert and relationships in it based.

7.1.1 This Concert is governed by:

(a) The LSSFCE, in particular the forecasts contained in Article 5.2 (which states that the arrangements for the provision of health and pharmaceutical services are laid down by the same Law and Article 16 (which lays down the content of the health care which MUFACE must provide to its protected beneficiaries) and Article 17 (1) (which provides that health care may be provided by Concert with a view to the public or private entities).

(b) The RGMA, in particular the forecasts contained in Articles 77 and 151.3 of the RGMA, on the arrangements for procurement by Concert and its basic contents for the provision of medical care services by MUFACE.

c) The Royal Legislative Decree 3/2011 of 14 November, approving the recast of the Law on Public Sector Contracts, and its regulatory development.

7.1.2 They are relationships based on the Concert:

(a) The relations between MUFACE and the Entity, in order to comply with the rights and obligations established in this Concert.

(b) The relationship between the beneficiaries and the Entity, in order to comply with the obligations set out in this Concert.

7.1.3 Issues arising in the field of the relations listed in point (b) of the above clause shall be of an administrative nature and shall be resolved by the body of MUFACE which has the jurisdiction conferred upon it. the procedure that is determined in this chapter. Against any of the agreements thus issued, the person who holds the Ministry of Finance and Public Administrations shall be entitled to appeal. The competent court shall, where appropriate, always be the administrative dispute.

7.1.4 It is up to the Directorate-General of MUFACE to interpret the Concerto, to resolve any doubts 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 the entity. It is also up to the MUFACE Directorate-General to agree on compensation for partial breaches of obligations, incentives for quality and deductions for failures of availability, as provided for in the terms of the clauses. 7.8, 8.3.2, and 8.4.

7.2 Nature and regimen of care relationships.

7.2.1 This Concert does not imply or cause any relationship to arise between MUFACE 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.

7.2.2 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 the purpose of affecting or referring to the scope of the professional exercise of such powers.

(b) the relations of the beneficiaries with the institutions of the Entity themselves or concerted, because of the care activity of those means or of the operation of their facilities or for reasons affecting or referring to the field of the professional exercise of the faculty who, under any title, develop activity in such centers.

The relations referred to in points (a) and (b) of this clause shall continue to be alien to the ends of the Concert even if, by virtue of the links between the faculty and the institutions and the Entity, they may generate direct or subsidiary effects on these.

7.2.3 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, of the criminal jurisdiction.

7.3 Mixed Commissions.

7.3.1 There will be Joint Provincial Commissions and a National Joint Commission, all of them with joint membership.

7.3.2 Composition.

(a) The Provincial Mixed Commissions shall be composed of MUFACE by the Director of the Provincial Service, who shall preside over them, and by an official of that Service who shall act, in addition, as secretary; and, by the Entity, by one or two representatives of the entity with sufficient decision-making powers. The Medical Advisor of the Provincial Service may attend the meetings.

b) The National Joint Commission shall be composed of three representatives of MUFACE and three of the Entity, with sufficient powers and representation. The Chair shall be the Director of the Department of Health Benefits or the official to whom he delegates and as Secretary an official of MUFACE shall act, with a voice but without a vote.

7.3.3 Functions.

(a) The National Mixed Commission and the Provincial Mixed Commissions are committed in their respective territorial scope:

1. Monitoring, analysis and assessment of compliance with the Concert.

2. The knowledge of complaints that may be made by the holders or, where appropriate, of trade by MUFACE, as provided for in this Agreement.

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

1. The analysis of MUFACE's initiatives on economic compensation for partial non-compliances of the Concerto, in the terms stipulated in clause 7.8 and in Annex 7, deductions for availability failures and incentives to the quality, in accordance with the provisions of Annex 8.

2. Knowledge of claims on cross-border healthcare that may be made by the holders or, where appropriate, of trade by MUFACE, as provided for in Annex 1.

For the purposes of the tasks referred to in point 2 of point (a) and in both points of (b) it is understood that with the intervention of the Entity it takes place for the same the fulfillment of the procedure established in the article 84 of Law 30/1992, of 26 November.

7.3.4 Operating Rules. The operation of the Provincial and National Mixed Commissions will be in accordance with the following rules:

(a) Whenever there are matters to be dealt with, the Commission shall hold an ordinary meeting within the first 10 days of each month. An extraordinary meeting shall be held 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 shall be understood that, due to the appearance of their representatives, the accepts the agreements that will be adopted by MUFACE in relation to the 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 recorded 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 carried out within the maximum period of seven calendar days. Once signed by the representative of the same, it shall be deemed to have been approved, as if it had not been received within the prescribed period. 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 rules of Law 30/1992, of 26 November, of the Legal Regime of Public Administrations and of the Common Administrative Procedure, in particular the provisions on the functioning of the the collegiate bodies.

7.4 Procedure for substantiating claims.

7.4.1 The holders will be able to claim from MUFACE that, as provided for in clause 7.1, 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 for the same and, in addition, there is no positive effect on that absence of response.

b) When the Entity is required to directly assume some expense or to reintegrate its amount and, upon request of the data subject, 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 about the relationships mentioned in clause 7.2. In the event of a question, the person concerned will be replied that, due to the incompetence of MUFACE, it is not possible to resolve the merits of the complaint, with the indication that it can be acted upon, if deemed appropriate, in the face of the facultative, centres or, where appropriate, before the Entity itself, in the ordinary court which corresponds according to the nature of the facts.

In those exceptional circumstances in which the holder is unable to lodge a claim and a billing has occurred in his or her name, or to any of its beneficiaries, for an assistance that the Entity may be obliged to reintegrate, MUFACE will be able to automatically initiate the complaint to the Joint Commission that it considers appropriate, motivating the cause of this initiation of trade.

7.4.2 The complaint shall be made in writing before the Provincial Service of the holder, accompanying as many documents as possible.

7.4.3 Any claim, if the Provincial Service initially considers that there are reasons for its estimation, will immediately take the necessary steps before the Entity to obtain satisfaction to the itself, in which case it will be archived without further processing with annotation of the adopted solution.

7.4.4 In case the aforementioned steps do not prosper, the Provincial Service will formalize the timely file, will include it on the agenda of the immediate meeting of the Provincial Joint Commission, and studied the same, (a) the corresponding minutes shall be drawn up in which the positions of MUFACE and the Entity on the complaint raised shall necessarily be established.

7.4.5 In all cases where the positions of the parties that make up the Provincial Joint Committee are consistent, the complaint shall be settled by the Director of the Provincial Service concerned.

7.4.6 In case there are discrepancies within the Provincial Joint Commission, and before the deadline set in clause 7.4.8 to pass resolution by the Provincial Directorate, the file will be raised. for their study by the National Joint Commission and will be included on the agenda of the next meeting to be convened. Once studied at the National Joint Commission, it will resolve the MUFACE General Directorate.

7.4.7 No complaints may be filed in the National Joint Commission for similar issues that have already been previously resolved, in a favorable manner and in agreement with the Entity, by the Directorate General of MUFACE, the criterion resulting from the corresponding National Joint Commission in the management of the entities with the beneficiaries. If the Entity does not apply the criterion, the Director of the corresponding Provincial Service shall decide, in accordance with the criterion, without the agreement between the parts of the Provincial Joint Commission being necessary.

7.4.8 The decisions of the Directors of the Provincial Services referred to in clauses 7.4.5 and 7.4.7 shall be issued within the maximum period of three months. If the resolution corresponds to the MUFACE General Directorate, according to clause 7.4.6, that maximum period shall be six months.

7.4.9 Resolutions issued by the Directors of the Provincial Services and the Directorate General of MUFACE shall be notified to the Entity and to the interested parties. Against them, an appeal may be brought before the person who holds the Ministry of Finance and Public Administration, in accordance with Articles 107 to 115 of Law No 30/1992 of 26 November 1992, and in relation to the 37.1 of the LSSFCE.

7.5 Estimated claims execution procedure.

7.5.1 The decisions of the Directors of the Provincial Services which estimate the complaints submitted, as set out in clauses 7.4.5 and 7.4.7, shall follow the implementing procedure laid down in continuation, depending on the object of the claim:

(a) Where the claim is intended to allow for a particular health care, the Entity shall issue the appropriate authorization within five working 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 health provider, being in charge in any case the possible surcharges or interest of delay that could have been generated since the meeting of the Provincial Joint Committee.

(c) Where the claim relates to the reimbursement of the costs claimed, the entity shall carry out the claim within one month of the notification of the decision, subject to the submission of the relevant information, if appropriate. evidence of expenditure, which shall be returned to the claimant if requested.

7.5.2 Within the deadlines mentioned in the above clause, the Entity must inform the Provincial Service of MUFACE, as the case may be:

(a) You have issued the authorization, direct credit to the healthcare provider, 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.

7.5.3 If MUFACE had not received this communication within the indicated time limit or if, after this deadline, it was aware that the payment to the person concerned would have been refused for any reason, the Director of the Service Provincial shall issue certification of the adopted agreement or resolution and subsequent events, and forward it to the Economic and Financial Management Department of MUFACE.

This, without further requirements, will propose the appropriate agreement to the General Directorate of MUFACE and will deduct from the immediate monthly payment to the Entity and will pay, on behalf of it, the amount included in the certification directly to the healthcare provider, subject to the express authorisation of the person concerned, or to the person concerned himself.

7.5.4 In the case of complaints positively resolved by the Directorate General of MUFACE, the following procedure will be followed:

(a) The payment of the amount in each case shall be made directly by MUFACE to the person concerned on behalf of the Entity, deducting the amount of the monthly fees to be paid to the entity and facilitating the document 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, MUFACE may make the direct payment to the creditor as of the date of the judgment, provided that the You expressly authorize such direct credit to your name.

(b) Where the claim is intended to allow a particular health care to be authorised, the Entity shall issue the appropriate authorisation within five working days of the notification of the decision.

If the Entity does not do so and the person concerned is obliged to pay the costs of such assistance, it shall be paid in accordance with the procedure set out in point (a) above.

7.5.5 The costs of potential late fees or interest charges will be borne by the Entity when the cause of delay is attributable to it.

7.5.6 Administrative decisions or judgments that resolve actions brought against the acts of MUFACE in respect of expenses subject to this Concert shall be executed, if appropriate, in accordance with the procedure set in clause 7.5.4.

7.6 Special procedure for substantiating claims with the same object.

7.6.1 When by the change of Concert there are casualties of hospital centres or services and for that reason there is a plurality of complaints, in application of clause 3.6, the Director General, after resolution to the (a) the Commission may agree to the cumulation of all or part of those which refer to the same centre or service to be substantiated by means of a special procedure, the decision of which shall be the responsibility of the Director of the Provincial Service where That, even if the position of the parties to the relevant Joint Committee is not consistent, and the maximum time limit for resolution shall be one month.

7.6.2 For the execution of the orders of order adopted through this special procedure, it may be applied, if so agreed by the Director General, the direct payment by MUFACE to the Center or service, on behalf of the Entity by discount from the amount of the monthly fees to be paid to it.

7.6.3 The provisions of the above clause may also be applied in the claims for which the application of clause 8.1.2 is applied.

7.7 Discounts for pharmacy expenses.

7.7.1 When in the process of reviewing the billing of prescriptions that MUFACE makes, prescriptions of medicines and medical devices made in their official prescriptions will be detected, both in paper format, and, if necessary, electronic, that they should have been in charge of the Entity as established in this Concert, or when for other exceptional and justified circumstances MUFACE would have been forced to assume expenses of pharmacy or sanitary products corresponding to the Entity, MUFACE will proceed, after communication to the Entity, to carry out the the corresponding discount on the monthly payment of the fees to be paid to it, as provided for in Chapter 8.

The entity undertakes to reintegrate the beneficiaries, 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, which MUFACE will provide to them for these purposes, or the corresponding pharmacy invoice.

7.7.2 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, MUFACE is invoiced at a higher price than the one indicated in clause 2.9.3.b.1, the maximum expenditure ceiling is exceeded as indicated in clause 2.9.3.3 or subject to "Maximum cost per treatment-patient" arrangements have been exceeded, and may exist difficulty in the access of patients to these treatments, MUFACE will pay for the bills issued by the hospital or centre and subsequently, will affect the differences on the limits set to the Entity in the monthly payment of the quotas.

7.8 Economic compensations for partial default of obligations defined in the Concert.

7.8.1 The failure to comply with the expected obligations and deadlines set out in clauses 1.5, 1.6, 3.4.1, 3.6, 4.7.3, 4.8, 5.2.1 e), 5.3.6, 6.1.2 and 6.1.4 of this Concert will result in the imposition of the corresponding compensation economic.

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

a) Perjudgment occasioned.

b) Number of affected beneficiaries.

c) Reiteration of the default.

In consideration of these and other factors, in Annex 7 to this Agreement, the classification and qualification of a minor, serious or very serious of the non-compliances liable to be sanctioned and the amount of the economic compensation for each of them according to their graduation. The procedure for their taxation is also set out in that Annex.

CHAPTER 8

Duration, economic regime and concert price

8.1 Duration of the Concert.

8.1.1 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.

8.1.2 If the Entity does not subscribe with MUFACE a new Concert for the year 2018, it will continue to be bound by the content of this Concert until thirty-one of January 2018, for the collective that has attached to thirty and one of December 2017. In addition, if on 31 January 2018 continued to provide assistance under hospitalisation or maternity care (with a planned date of birth for the month of February), the Entity will be obliged to continue to provide assistance to the the day when the hospital discharge occurs or the maternity care is completed, respectively. However, if the need for hospitalization is prolonged, the Entity will only assume its coverage until the end of the month of March 2018, from which the new entity will have to assume it.

The entity shall be entitled to receive, for the month of January 2018, the fixed premium per person/month to be established for entities that are agreed with MUFACE that year, by the collective that has been assigned to thirty-one of December 2017. However, the amount to be paid for that month, MUFACE will retain ten per cent 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 course of the year. 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.

8.1.3 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 will set MUFACE and the election will have effects at zero hours of the day one of February 2018 without prejudice to the provisions for hospitalizations and maternity in the first subparagraph of the previous clause.

8.2 Economic Regime of the Concert.

8.2.1 Without prejudice to the birth and extinction for beneficiaries of rights derived from the Concert in the terms provided for in the corresponding clauses, the high ones will cause economic effects at zero hours of the day one of the month following the month in which they occur and the casualties within 24 hours of the last day of the month in which they took place.

8.2.2 Accordingly, each monthly payment shall take into account the number of holders and beneficiaries existing in the census of the month concerned, for which the appropriate certification shall be issued by MUFACE, holders and beneficiaries assigned to the Entity, differentiated by age, according to the parameters set out in clause 8.3.1. The payment, except for exceptional eventualities, shall be made by MUFACE, by bank transfer, within the first ten working days of the following month, prior to any withholding or discounts arising under the Resolution. of Convocation and the Concert with its Annexes. 50% of the monthly payment corresponding to the month of December may be anticipated and made from the 16th of that month.

8.2.3 MUFACE will make available to the Entity, in the first week of each month, in electronic file, the complete relation with all the data of the collective, including the high, low and variations produced during the month referred to at the end of the day of that month.

8.2.4 The electronic file with the relationship of the collective can 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.

8.2.5 The Entity will file the claims separately, and will accompany them with electronic file with the same technical characteristics as the one provided by MUFACE, containing the information on which the claim is based. 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 MUFACE within three months of the date of submission of the complaints.

The consolidation of the finality of the payment referred to in the preceding paragraph is without prejudice to the fact that in no case can an estate be attributed without cause to MUFACE or to the Entity.

8.2.6 All taxes, arbitrations, fees and charges that are taxed in this Concert or the acts that will be derived from it shall be on behalf of the Entity.

8.2.7 In the case of health care for injuries caused or a disease caused by or aggravated by accidents covered by any form of compulsory insurance or when the cost of the healthcare provided must be satisfied by law or regulation by public bodies other than MUFACE 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 beneficiaries relating to the (a) the amount of expenditure arising from such health care, taking into account the necessary steps to be reintegrated into the cost of the project. The beneficiaries, for their part, shall be obliged to provide the Entity with the data necessary for this purpose.

8.2.8 Whenever there is a firm court judgment in which MUFACE is ordered to pay compensation, arising from direct or subsidiary liability for assistance actions included in the object of the Concert, MUFACE, without prejudice to the execution of the judgment, the amount paid to the relevant agreed entity shall be passed in accordance with the procedure laid down in the 7.5 clause.

8.3 Price of Concert and incentives to quality.

8.3.1 The price of the Concert is established by a fixed premium that will be paid per person monthly and that varies according to your age. The amount of fixed premiums in euro (exempt from VAT), per person per month, for the years 2016 and 2017, shall be distributed as follows:

Groups

Prima €/person and month years 2016 and 2017
0-4	63.81
	5-14	53.17
15-44	60.27
45-54	63.81
	55-64	70.91
65-74	85.09
than 74	92.17

The amount of the fixed premium to be paid shall be the amount corresponding to the age group for the age of the beneficiary at zero hours of day 1 January of each calendar year and for each new beneficiary shall be that corresponding to the age group in which you are included in the date of membership by MUFACE.

In no case will the amount of the fixed premium of a beneficiary suffer any alteration within each calendar year of the Concito, although over the course of the year, for age, change the age group.

8.3.2 An annual quality incentive (IAC) is established, the maximum amount of which will be calculated using the formula:

(IAC)_i = Pm × 12 × C _i × Q

Where:

Pm = Weighted monthly premium for the protected collective in the Concert at 1 February of each year.

C_i = Collective attached to the Entity i to one of February of the respective year

Q = Coefficient 0.035

8.3.3 In the margin of the IAC, the monthly amount of EUR 0,010 per mutual and beneficiary is established as the maximum economic compensation for the development and implementation of the actions referred to in clause 6.2, which will be paid to the Entity on the express agreement of MUFACE. The payment to the Entity shall be made in accordance with clause 8.5.2 (B) (d), and the transfer of ownership and ownership of the final products resulting from each stage and action at the time of the payment shall be further refined.

8.4 Deductions for availability failures.

8.4.1 The Entity is obliged to comply with the expected obligations and deadlines fixed in relation to the availability criteria set out in the Concert and its Annexes. Annex 8 sets out criteria for measuring the degree of availability of care provided by the Entity.

8.4.2 After carrying out the monitoring, control and evaluation of the management of the health care service provided by the Entity, the Directorate-General of MUFACE shall, if necessary, apply the deductions. the economic performance of the availability failures listed in Annex 8.

8.4.3 The maximum annual amount of deductions for availability failures shall not exceed the maximum amount of the quality incentive to be fixed in accordance with clause 8.3.2.

8.4.4 The deductions for availability failures referred to in the above clause are independent of the economic compensation for partial non-compliance with obligations under clause 7.8 of this Concert.

8.5 Payment Terms.

8.5.1 Payment shall be made in accordance with the terms set out in Article 216 of the TRLCSP, in firm and in favour of the entity (s), in the form that is regulated in the following headings, on presentation of the invoice electronic through the Electronic Invoice Entry Point (FACE) and the certificate of conformity execution of the contract's proposing unit.

The additional provision of the HAP/492/2014 Ministerial Order of 27 March 2014 governing the functional and technical requirements of the accounting records of entities in the scope of the law 25/2013, of December 27, of impulse of the electronic invoice and creation of the accounting record of invoices in the Public Sector, determines that the invoices are issued by collecting the codes established in the directory DIR3, therefore the codification of administrative bodies in this contract is:

	dir3 Code
	E00106104	General State Civil Officials Mutuality (MUFACE)
Accounting Office (PO)	EA0003306	Accounting Service (MUFACE).
Unit processing unit (UT)	EA0003307	Hiring Service (MUFACE).
Proposer Unit (UP)	E02660204	Health services department.

8.5.2 The payment by MUFACE to the Entity of the amounts resulting from the application of clauses 8.3. and 8.4 and Annexes 7, 8, 9 and 10 shall be made effective as follows:

A) Monthly:

amount resulting from the application of clause 8.3.1.

1. The amount resulting from reimbursement of expenses, discounts and financial compensation for non-compliance with obligations that are agreed under this Concert.

2. The amount resulting from the application of the system of deductions for failures of availability as set out in clause 8.4 and point 3 of Annex 8 to this Agreement.

B) Quarterly:

(a) The amount resulting from the implementation of the system of incentives for improvements in the quality set out in point 2.3 of Annex 8.

(b) The invoice for the reports, explorations and tests carried out by the Inabilities Assessment Teams within the MUFACE application field in accordance with the terms set out in Annex 9 and under the Baremo set out in Annex 10.

c) The invoice for the reports, scans and tests prescribed for the performance of certain medical examinations for the management and monitoring of the temporary incapacity within the field of application of MUFACE in the terms as set out in Annex 9 and under the Baremo set out in Annex 10.

d) The compensation set out in clause 8.3.3, in accordance with the level of compliance with the objectives set by MUFACE for the actions referred to in clause 6.2.

C) Years:aThe amount to be applied to the system of incentives for improvements in the quality set out in points 2.1, 2.2 and 2.4 of Annex 8.

8.5.3 The quantities shall be satisfied by application 15.106.312E.251 with the exception of those corresponding to compliance with clause 8.5.2 (B) (c) which shall be satisfied by application 15.106.222M.227.06, all within the Agency's budgetary availabilities.

ANNEX 1

Cross-border healthcare

In accordance with clause 1.1.5, the Entity is obliged to cover the cross-border healthcare of its protected collective, in accordance with Royal Decree 81/2014 of 7 February, for which it is establish rules for ensuring cross-border healthcare, and amending Royal Decree 1718/2010 of 17 December 2010 on medical prescriptions and dispensing orders. 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 EU Member State. Therefore, it does not include the temporary stay cases where, for over-sold medical reasons, the beneficiary has received health care, the coverage of which, in general, corresponds to MUFACE directly or through the mechanisms of coordination with the institutions of the other member states.

Cross-border healthcare does not include expenses related to healthcare provision.

1. General rules.

1.1 Content. The cross-border healthcare in charge of the Entity comprises the health benefits that form the Common Portfolio of SNS Services and the coverage of which corresponds to the Entity in accordance with the provisions of Chapter 2 of the Concert.

When in the cross-border care process expenses are incurred for the outpatient supply of medicines, dietetic products, and other sanitary products covered by the pharmaceutical provision of the SNS, as well as material The reimbursement of the same shall be borne by MUFACE in accordance with the terms laid down in the specific rules of the mutual benefit governing these benefits.

Those benefits expressly mentioned by Royal Decree 81/2014 of 7 February 2014 laying down rules to ensure cross-border healthcare are excluded, such as:

(a) 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.

b) The allocation of organs and access to organs for transplantation purposes.

(c) Public vaccination programmes against infectious diseases, which have the sole purpose of protecting the health of the population in the Spanish territory and which are subject to specific planning and implementation, without prejudice to those relating to cooperation between Spain and the other Member States in the field of the European Union.

In no case will the expenses arising from healthcare provided on national territory be reimbursed by means other than those allocated by MUFACE to the beneficiary through this Concert.

In the case of treatments listed in paragraph 2.1 of this Annex, prior authorisation shall be required in accordance with the procedure laid down in point 2.2.

1.2 Mode. The coverage mode shall be through the reimbursement of expenses by the application of the tariffs included in Annex 11, without exceeding the actual cost of the assistance actually provided, and with the limits, terms, conditions and requirements that are specified in this Annex.

1.3 Subjective scope. The expenditure covered by the institution shall be the expenditure incurred by the cross-border health care provided by the mutualists and the family members or assimilated persons who are recognised as beneficiaries and the newborn in question. the terms of clause 1.3.2.

1.4 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 following benefits will be subject to prior authorization of the Entity:

a) Any type of health care that involves the patient having to stay in the hospital at least one night.

b) Those techniques, technologies or procedures included in the common portfolio of SNS services that have been selected on the basis of the requirement for the use of highly specialised medical procedures or equipment, to the need for care for patients with complex problems, or at high economic cost:

− positron emission tomography (PET), and combined with CT (PET-TC) and SPECT.

− Assisted human reproduction.

− Dialysis.

− Outpatient surgery requiring the use of a surgical implant.

− Treatment with radiotherapy.

− Drug treatments or with biological products, the monthly amount of which is greater than 1,500 €.

− Radiosurgery.

− Genetic analyses, oriented to the diagnosis of complex cases, including prenatal and pre-implantation diagnosis, presymptomatic and carrier genetic analysis, pharmacogenetic and pharmacogenomic analysis.

− Treatment of disabilities that require for correction or improvement: Electric wheel sils, upper limb prosthesis except partial hand prostheses, lower limb prosthesis except partial prostheses standing, hearing aids and bitutors.

− Attention to pathologies and performing procedures listed in Annex 3 as Reference Services.

This relationship should be adjusted, where appropriate, to the common criteria that the SNS Interterritorial Council will establish.

2.2 The application for authorisation shall be submitted to the Entity which, within a maximum of seven working days, must authorise the benefit requested or, if not appropriate, indicate the motive and, where appropriate, the means allocated to the provide it on national territory, in the terms stipulated in the Concert.

The response of the Entity must be made in writing or by any other means that permits to be placed on the record and with an indication of the right of the person concerned to lodge a complaint with the Mutuality.

In the event that the authorization is denied, on the same date of communication to the data subject, the Entity must submit the complete file to the Department of Health Services with a supporting report.

When the Entity has issued the appropriate authorization, and immediate complications are produced that require other assistance that is included within those requiring prior authorization, they will be understood All care benefits derived from the same process are authorized.

2.3 The authorization may be refused in the cases and for the reasons expressly mentioned in Article 17 of Royal Decree 81/2014, cited above, including when health care can be provided on national territory, in the terms stipulated in the Concert, within a period that is medically justifiable.

If the refusal is not made to include the assigned means, or if the reply does not occur within the time limit set out in point 2.2, it is understood that the assistance of the beneficiary cannot be carried out within a period of time. justifiable.

2.4 In the event of a complaint by the person concerned to MUFACE, because the Entity has refused the authorization, it will be resolved by the MUFACE General Directorate, on a proposal from the Department of Health Services, within the maximum period of Forty-five working days, from the date of entry of the application into the Entity, suspending the calculation of the period from the day following the date of refusal of the Entity until the day when the claim of the person concerned has The entry into the Mutuality is inclusive.

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. However, it may be initiated on its own initiative by MUFACE, where the person concerned has submitted a request for reimbursement of expenditure abroad and in the case of the case, which is considered to be the subject of cross-border health care. If the Entity considers this to be a benefit received due to the need for temporary stays, it will send to the corresponding MUFACE Provincial Service the complete file for study and resolution as appropriate.

3.2 The request for reimbursement shall be submitted by the person concerned to the Entity, within a maximum period of three months from the date of payment of the assistance received, accompanied by the original invoice, in which they appear in a form details of the various care concepts carried out, and of the accreditation of their credit, as well as a copy of the medical prescription or clinical report showing the health care provided, indicating the diagnostic procedures and primary and secondary therapeutics performed.

In the treatments listed in point 2.1 of this Annex, reference to the existence of prior authorisation shall be required.

3.3 The application and other documentation, once the necessary checks have been carried out, including if the default of the application or lack of the documentation is necessary, the Entity will proceed to the reimbursement of the costs to the person concerned in accordance with the tariffs in Annex 11, within a maximum of one month.

Within that same period, if the Entity considers that the reimbursement, in whole or in part, does not proceed, it shall inform the person concerned in writing or by any other means which permits to be put on record, indicating the reason for refusal and the the right to claim for mutual benefit.

In the event of a refusal, on the same date of communication to the data subject, the Entity shall forward the complete file to the Department of Health Services with a supporting report.

3.4 The person concerned may make the corresponding complaint to MUFACE in case the Entity does not proceed within the time limit laid down in the point before the reimbursement of the expenses or is refused, as well as in the case of disconformity with the application of the tariffs. For the processing and resolution of the complaint, the procedure provided for in clauses 7.4 and 7.5 will be followed, corresponding to the knowledge and study of the complaint, as stipulated in clause 7.3.3, to the National Joint Commission. This complaint will be resolved by the MUFACE Directorate-General within the maximum period of three months.

ANNEX 2

Support for rural areas

1. General rules. In order to enable the provision of health services in rural areas to beneficiaries assigned to the Entity, MUFACE may agree with the Health Services of the Autonomous Communities to provide them, according to the possibility provided for in Article 6 of Law 30/1992 of 26 November.

2. Enablement to MUFACE. By the signature of this Concert the Entity grants its express and total authorization to MUFACE to agree to such services, which also protects the authorization for the extension of the agreements signed to the same end prior to January 1, 2016.

The authorisation shall not prevent entities from being able to subscribe to 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:

(a) Primary care health services in municipalities up to 20,000 inhabitants where the Entity does not have sufficient or sufficient means of its own.

b) Emergency services in municipalities of up to 20,000 inhabitants, which are provided through Primary Care Services.

4. Content.

4.1 Each convention will be common for all entities that are signatories to the Concert. The health care content, the economic consideration and the relationship of municipalities agreed with the respective autonomous communities will 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 freed, MUFACE must pay to each Entity for this Concert, understood made the payment on behalf of the same.

MUFACE will make every monthly payment charged to the amount of the same month that you must pay to the Entity for the Concert, moving 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, MUFACE will pay the payment of these obligations, in the terms of the previous point, The payment on behalf of the same is made, with the corresponding justification being transferred to it.

ANNEX 3

Media availability criteria by care levels

1. General criterion. The Entity must ensure access to the means that at each level requires the Services Portfolio of this Concert in the terms specified below, unless there are no private or public means.

2. Availability of Primary Care Media.

2.1 All the municipalities will have Primary Care, which will include health care at the outpatient, home and emergency level in charge of the general practitioner or family, pediatrician, nursing graduate, matron, physiotherapist, dentist and podiatrist, according to the following criteria:

(a) The municipalities of less than 10,000 inhabitants will always have a general or family doctor and a diploma in nursing. In addition, the municipalities from 5,000 inhabitants will have a paediatrician.

b) The municipalities of more than 10,000 inhabitants will also have physiotherapists and odontostomatologists.

(c) The municipalities of more than 20,000 inhabitants, in which more than 500 MUFACE beneficiaries reside, will also have a podiatrist and a midwife, increasing the number of professionals according to the number of beneficiaries. as follows:

1) A general or family physician and a nursing graduate will be increased for each increase of 500 resident beneficiaries.

2) A pediatrician, odontostomatologist, and physical therapist will be increased for each increase of 1,000 resident beneficiaries.

3) A podiatrist and a midwife will be increased, for each increase of 2,000 resident beneficiaries.

d) The municipalities of more than 100,000 inhabitants will have Primary Care services in all postal districts or, failing that, in a border district.

2.2 Primary Emergency Care will be provided, on an ongoing basis, during the twenty-four hours of the day, through medical and nursing care on an outpatient and home basis.

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

2.4 As an additional criterion, it will be taken into account that, in the rural areas expressly provided for in the conventions referred to in Annex 2 to this Agreement, and with the scope and content stipulated in each of them, the Health care at the outpatient, home or emergency level, in charge of the general practitioner or family, pediatrician, nursing graduate and matron may be provided by the Primary Care and Emergency Services of the Public Health Network. In any case, the beneficiaries resident in the municipalities included in the respective rural agreements, may choose to be cared for in the means available to the Entity in the nearby municipalities.

In any case, and for the assistance of this Concert, the services of Primary Care and Emergency Services of the Public Health Services are assimilated to the means of the Entity, in accordance with the provisions of the rural conventions referred to in Annex 2 to this Agreement.

2.5 In the municipalities of less than 20,000 inhabitants belonging to autonomous communities with which the collaboration agreements provided for in the previous point have not been formalized, or these only have as their object the assistance In the case of emergency health, and where the Entity does not have its own or concerted means, and there is no private means, it shall facilitate the access of the beneficiaries to the Primary Care services dependent on the relevant Community Autonomous, both for ordinary and urgent assistance, directly assuming the expenses that can be billed.

3. Definition of the Specialized Care and Service Portfolio Levels.

3.1 Specialized attention will be provided in municipalities or groups with a population of 20,000 inhabitants and 500 resident beneficiaries.

The various benefits included in the Portfolio of Care Services to facilitate by the Entity are structured in four levels in increasing order, in which definition is addressed to general population criteria, number of resident beneficiaries, as well as distance and time of travel to urban centres where there is a greater availability of private health resources.

3.2 Furthermore, and taking into account the above, in order to optimise the availability of private means, some municipalities are grouped by geographical proximity and ease of transport, as well as by concentrating a higher number of beneficiaries, in such a way that the supply of the required means at that level in any of the municipalities listed in the corresponding listings by level of Specialized Care will be considered valid.

3.3 Each Level of Specialized Care includes the means required at the lower level of care, in addition to the Primary Care services that correspond, according to the provisions of point 2 of this section. Annex.

3.4 The following descriptive tables are included in point 3.9 of this annex:

a) In tables 1, 2 and 3, the required specialties are related to each level of specialized care in outpatient or outpatient settings, hospital and hospital emergency.

b) In Table 4, the units and multidisciplinary teams are related to levels of care.

c) In Table 5, the specifications corresponding to the contents of the different specialties are related.

3.5 Level I Care.

3.5.1 The territorial framework of the Level I of the Specialized Care is that of the municipalities and groupings that with the criteria defined above are related in the following table:

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