Foreword.
With Circular No 1/2010/DFP/DDI
11 March 2010 was provided operational guidance regarding
boot of the electronic communication of
certificates and medical certificates for the justification of
sick leave for employees of public authorities under Article
. 55-f of the Decree Law No
165 of 2001, introduced by art. 69 of Legislative Decree
October 27, 2009, No 150. In the said circular
clarifications were given regarding the operation
General system, the parties responsible for
electronic communication, charges and benefits for workers
and timing of implementation and sanctions for failure to comply
reporting requirements under the new rules.
In particular, in paragraph 6 ('Time
implementation and penalties for failure to comply with reporting requirements
by computer of a medical certificate) was
made as follows.
'To ensure uniform application of legislation,
is considered appropriate to clarify when and how
implementing the new system, taking into account
the need for a uniform and gradual introduction
country.
From the fifteenth day of the publication
the decree of the Ministry of Health, in consultation with
the Ministry of Labour and Social Policy and the
Ministry of Economy and Finance February 26, 2010 in the Official
Journal of the Italian Republic, the doctor treating
shall, on line, operations
preparation and data submission of certificates of illness,
operations correction and cancellation of certificates
already sent in the manner referred to in paragraph No. 2.
For the three three months after the publication of the Ministerial Decree
in the preceding sentence shall be recognized
still possible for the doctor to proceed
to issue paper certificates in the manner currently
force.
At the end of that period, or
of 3 months from the aforesaid publication in the Official Journal,
transmission is carried out solely by
telematics.
To verify the correct functionality of the system and may operate
development of interventions
same in the month following the expiration of the transitional period,
for the duration of one month, testing will be initiated
overall system, in a manner determined in consultation
with the Ministry of Health and the Ministry of Economy
and Finance and with the participation of all stakeholders
.
The responsibility for failure of electronic communication
certificate with the imposition of penalties related
you configure only the outcome of the transitional periods
and testing (for a total period of 4 months
). They are subject to any exceptional case,
limited in time and refer to specific geographical areas,
exceptional in nature, identified
Decree of the Minister of Public Administration and Innovation,
agreement with the Minister of Health and
Minister of Economy and Finance, for which continues to
not be operating the system of penalties for the period
indicated in the Decree.. "
In the same paragraph it was provided explanations
the sanctions regime with reference to the provisions of Article
. 55-f mentioned. In order
di procedere al collaudo generale, in linea con
quanto comunicato nella circolare, con decreto del Capo
del Dipartimento per la digitalizzazione della pubblica
amministrazione e l’innovazione tecnologica del 1° luglio
2010 è stata costituita apposita commissione i cui
componenti rappresentano le amministrazioni e i soggetti
coinvolti dall’applicazione del nuovo sistema. I lavori
della commissione si sono svolti nel periodo luglio - settembre
2010. Allo scadere del primo mese successivo alcommissione
ha riscontrato l’esistenza di « a) ritardi registrati
nella procedura di messa a provision of doctors
credentials to access the system, b) the unavailability of
telephone channel for sending by the medical certificates of
c) the need for tuning the performance of the system in relation
the progressive increase in
users.. " Accordingly, the Board decided not to
"consider positively the outcome of the test 'and
having further discussion
general operations of the system.
The second phase of testing was completed on September 15 last
. During the session, "the Board took act
the results of investigations of the system, in relation to
services made available to doctors, workers and governments,
and the provision of medical
and employers access credentials necessary for
its use, as concluded testing as
occurred functionality of the platforms and systems.
It shows signs of difficulty in the application
organizational perspective, both in hospital and territorial
for which solutions are provided to put in
act quickly accomplished in the process of optimization,
al fi ne di realizzare la finalità di un sistema che richiede
il complessivo allineamento di tutte le responsabilità. In
funzione di ciò, la commissione stabilisce di avviare un
monitoraggio continuo con il concerto di tutte le amministrazioni
interessate, della regolarità del servizio, al fine
di certificare eventuali situazioni di oggettiva difficoltà
di adempiere alla trasmissione di quanto previsto dalla
norma.».
Come si evince dal verbale della commissione, il
collaudo delle funzionalità è stato ormai concluso e, in
considerazione delle criticità organization emerged and
emerge, it will open a monitoring phase of the system,
to be carried out in collaboration between the various actors
institutional stakeholders. The duration of monitoring is
estimated at about four months.
Given the development of the system, it is considered necessary to introduce additional
procedural elements for
best use of the service by users, and
at the same time, provide guidance to governments and operators on the implementation of
legislation also
the light of requests for clarification received.
remains stationary the integral referring to the contents of that circular No.
1.
1. By using these features by the different
stakeholders (doctors, workers, public administrations
).
As known, the system offers a range of services to physicians,
to workers and employers have already set out in Circular No
1.
Please note that to use the telephone channel
by the physician is on the toll free number 800 013 577,
reached from landline or mobile. This channel allows
to overcome any temporary difficulties due, for example
, alla mancanza di un personal computer o di
una connessione a internet.
Per quanto riguarda l’utilizzo del sistema da parte del
lavoratore, si segnala inoltre che questi, dopo essersi registrato
al sito dell’INPS ( http://www.inps.it/ - home page),
può prendere visione di tutti i certificati a lui intestati.
Si rammenta che le amministrazioni possono ricevere
gli attestati di malattia relativi ai propri dipendenti sia accedendo
direttamente via web al sistema INPS, sia richiedendo
all’Istituto l’invio ad una propria casella di posta
elettronica certificata (PEC). L’accesso diretto al sistema
I.N.P.S. avviene tramite apposite credenziali, che devono
essere richieste secondo le modalità indicate nella circolare
I.N.P.S. n. 60 del 16 aprile 2010. Le istruzioni per
attivare l’invio alla casella PEC sono contenute nella circolare
I.N.P.S. n. 119 del 7 settembre 2010. Considerate
le richieste di chiarimento pervenute, è opportuno evidenziare
che l’Ente con il quale le amministrazioni pubbliche
debbono dialogare per la ricezione degli attestati di
malattia relativi ai propri dipendenti è l’INPS anche se gli
stessi sono iscritti al regime INPDAP contributory.
Further information on services available on site
www.innovazionepa.gov.it in the section on disease
certificates online.
2. Clarifications on the scope.
2.1. The civil servants
concerned.
A first clarification concerns the scope
discipline. In this regard, we note that the provision
reference - which, as mentioned, is art. 55-f
of Legislative Decree No 165 of 2001 - it deals with staff to sort
private, or staff person
the discipline of the Decree.
Therefore, the rule does not directly affect the staff
under public law in Article. 3 of that decree
(judges and lawyers of the State,
university professors, personnel of the armed forces and
to the police, national corps of firefighters, career diplomatic staff
and prefectural and
other categories that, under the aforementioned Article. 3,
are governed by their laws), for which remains in force
the traditional way on paper, provided
that the new system will
also be applied against these categories of staff as a result of
depth investigation and adoption of appropriate measures
. In conclusion, for the categories of staff to sort
public law, not subject to the regime of
Legislative Decree 165 of 2001, doctors draw
certificates and certificates of illness in print and
administrations accept documents in
same form, with the usual mode of production or transmission
by the employee concerned. 2.2. Doctors forced to use the transmission system
telematics.
Si precisa poi che il nuovo regime di trasmissione telematica
dei certificati riguarda i medici dipendenti del
servizio sanitario nazionale, i medici convenzionati con
il servizio (di medicina generale, specialisti e pediatri di
libera scelta), nonché i medici liberi professionisti. Riprendendo
quanto detto nella circolare n. 1, la violazione
dell’obbligo di trasmissione in via telematica è sanzionata
dalla legge e dagli accordi collettivi per i medici dipendenti
del servizio sanitario nazionale e i medici che lavorano
in convenzione. Il mancato utilizzo della modalità
telematica non è invece specificamente sanzionato per
i medici liberi professionisti. A fini di economicità e di
efficienza, è comunque auspicabile che l’intero sistema
delle certificazioni funzioni in maniera uniforme. Il Dipartimento
della digitalizzazione della pubblica amministrazione
e le altre Amministrazioni competenti si stanno
impegnando per la sua estensione generalizzata e il processo
di distribuzione delle credenziali di accesso al sistema
telematico ai medici privati è in corso. Nelle more,
i dipendenti pubblici che, in linea e nei limiti di quanto
previsto nel comma 1 dell’art. 55-f of the Legislative Decree No
165, 2001, are aimed at a private doctor
for certifying the need to ask your doctor
ol'attestato the certificate in paper form and will deliver
administration according to the traditional mode. So, until the complete set up of
system, governments are obliged to accept
certificates and medical certificates in paper form from
independent practitioners, provided they are
the conditions laid down in that Article . 55-f
paragraph 1. He stands, of course, that la giustificazione
dell’assenza avverrà invece mediante certificazione
telematica ogni qual volta i medici privati siano già in
possesso delle credenziali di accesso e degli altri strumenti
necessari per l’invio telematico.
2.3. I certificati rilasciati dalle strutture di pronto soccorso
e dagli ospedali in caso di ricovero e dimissione.
Nel corso dei lavori della commissione di collaudo
sono emerse alcune specifiche criticità legate ai certificati
e agli attestati rilasciati dalle strutture ospedaliere o
in sede di pronto soccorso o per attestare il ricovero del
paziente o prodotti al momento delle dimissioni. I documenti
rilasciati in tali occasioni presentano delle particolarità
che creano delle criticità nell’applicazione del
nuovo modello di trasmissione. Le particolarità sono rinvenibili
per i certificati rilasciati dal pronto soccorso nel
carattere dell’urgenza proprio della specifica attività, per
i certificati di ricovero nell’esigenza di attestare - oltre
alla diagnosi - il ricovero del paziente nella struttura e
per i certificati di dimissione nella necessità di produrre
una relazione al paziente al momento del rilascio dalla
struttura. La commissione ha preso atto dell’esistenza di
queste criticità per l’applicazione del sistema di trasmissione
telematica dei certificati, contestualmente ad altre
problematiche organizzative, ed ha segnalato la necessità
di individuare adeguate soluzioni e di attuare un monitoraggio
con il concerto delle amministrazioni coinvolte
per verificare la funzionalità del servizio. Si chiarisce
pertanto che, durante questo periodo di monitoraggio e
sino a quando non saranno decise le misure ad hoc da
seguire in queste situazioni, per i certificati di ricovero,
di dimissione e di pronto soccorso, physicians will continue to develop
certificates in paper form, employees
continue to deliver or deliver promptly
certificates and certificates of membership administration and administrations
accept them according to traditional methods
.
3. Situations where the administration needs to know
diagnosis.
According to the process of the electronic communication of
certificates currently being developed, and once formed
sent in electronic format by the certificate of
physician, the employer receives a certificate of illness.
Come chiarito nella circolare n. 1, l’attestato di malattia
consiste nel certificato privo dell’esplicitazione della
diagnosi. L’attestato è il documento che di regola viene
utilizzato dai lavoratori dei settori pubblico e privato per
la giustificazione dell’assenza e l’omissione della diagnosi
è finalizzata a tutelare la riservatezza del lavoratore.
Come noto, esistono però alcune situazioni particolari in
cui il datore ha necessità di conoscere la diagnosi. Per i
dipendenti contrattualizzati delle pubbliche amministrazioni
ciò accade nelle ipotesi di esenzione the curtailment
pay and the availability of the scheme
tax purposes of the visit. In these situations, the administration
is required to apply the general scheme unless
not have documentation allowing for derogations
and first interest of the employee who is absent
the administration has all acts necessary to properly apply
the reference standard.
Without going into detail on this point, we refer to the general guidelines
already provided by the Department of Public
circulars numbers 7 and 8 of 8 of 2008 and 2010, and in Opinion No.
2 of 2010 (all found at www.
funzionepubblica.it). In such cases, the doctor certifying
should proceed to draw up the certificate in electronic form, the computer model
entering all the data and information needed
as specified by the ministerial decree
December 18, 2009, No 206, and circulars
mentioned, using, where appropriate, the notes window
which is a free field. The certificate will be sent by
medical practices using electronic channels and the administration
electronically receive the certificate. In this particular case
physicians should also ensure
printed and handed to the employee
paper copy of the certificate that the employee has the burden to send
timely administration according to the traditional mode
(PEC, fax, mail, hand delivery
). Therefore, according to this process, the absence from
service of the employee will still justified by
the transmission of electronic documents, while
the legal regime will be influenced by the absence
receipt of the copy of the document by 's administration. The correspondence between
paper document and electronic certificate can be verified by
affected by browsing the site
INPS. 4. The specific responsibility for violation of
rules for electronic communication of
certificates.
With Circular No Information has been provided a relatively
penalties for failure to comply
transmission by electronic certificates (
par. 6). Referring to the contents of that circular
helps only to recall that the law has introduced specific
penalties for violation of the rules on transfer
telematics. In fact, art. 55-f, paragraph 4, of Legislative Decree No
165 of 2001 provides that
"4. Failure to comply with reporting requirements by
electronically on the medical certification for absences of workers
disease referred to in paragraph 2 is
disciplinary offense and in case of recurrence,
involves the application of the penalty of dismissal or,
for doctors in a contractual relationship with the local health agencies
, the decline in the Convention, so the overriding
contracts or collective agreements.. " In addition,
paragraph 6 of that provision constitutes the
tort hypothesis for the manager
in which the employee works and the Director of General Affairs
and staff in relation to their skills,
omit the observance of legislation on
absences from work for illness. The penalties
for this hypothesis to other documents are identified with reference to Articles
21:55 e
paragraph 3 of that decree. Even
contracts and collective agreements recently concluded
intervened on specific matters. In fact, the National Collective Bargaining Agreement for the area
IV, medical management and veterinary
signed May 6, 2010 provides for the sanction of suspension from service
without pay from a minimum of three days up to a maximum of
six months for the case of 'non-compliance, ascribed to him,
on the medical certification on
absences due to illness of workers' (Article 8, paragraph 8) and retrieves the contents of Article
. 55-f between the quoted paragraph 4
case involving the illegal dismissal with
notice.
Furthermore, collective agreements concluded pursuant to art. 8
of Legislative Decree No 502 of 1992 for the regulation of relations with
panel doctors in general medicine,
the paediatricians and medical specialists
have provided specific penalties for cases of non
fulfillment of obligations related to the transmission
electronic certificates (Article 59-ter ACN
23 March 2005, introduced May 27, 2009 by adult
for doctors in general medicine, art. 58-b of the ACN
15 December 2005, introduced May 27, 2009 by adult
for pediatricians to free choice, art. 28-b 23 March ACN
2005, introduced by adult on 27 May 2009
medical specialists, veterinarians and other health professionals).
Accordingly, as mentioned above (see: Introduction),
outcome of testing on the functionality of the system
The committee pointed out the need to monitor
the process of electronic data transmission, since during
work have emerged of the critical organizational
especially for certain sectors and geographical areas. The existence of such
critical for the elimination of which the government
interested to work in the coming months
even with evidence of monitoring, make
state problem the emergence and detection of
any liability for the violation of specific
regulations and, therefore, the conduct of proceedings
for the imposition of the ensuing penalties. In fact, the full application of the sanctions
requires the definition of conditions of action and a clear operational framework
certain in the absence of which could not be found
the element of guilt of the offense.
therefore subject to the requirement of medical
continue to send certificates electronically in
presence of organizational and technical
make it possible for the transitional period, until January 31, 2011
during which the most important critical
need to be addressed, should the government refrain from competent
dispute of charges specifically related to compliance.
will be the responsibility of the Departments of Public Service, for
digitization and technological innovation and
other government authorities, hereinafter
communicate more information with a view to making full
regime of the system.
Final Recommendations.
for monitoring purposes, it is recommended to general
that, as employers,
receive certificates in paper form of the disease outside of the situations mentioned in this circular
to report the fault within
48 hours from receipt thereof,
sending an e-mail communication to the certified reference
Company doctor.
are invited government target
of this circular to want to inform the content
the same for their employees.
also asked the Ministry of Health, the Regions and Autonomous Provinces
, the Health Trusts and Orders
professional reference to wanting to spread
operators at the medical profession.
