Aids and prostheses for disabilities, appeal to the Lazio TAR against the ministry

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Published by Marta Strinati on 5 January 2024

LEA on aids and prostheses for disabilities, 25 years late

The LEAs and the tariff (or nomenclator) of aids and prostheses for disabilities covered by the National Health Service (NHS) were introduced 25 years ago, respectively, with the 'Bindi Reform' (Legislative Decree 229/99) and the decree of the Ministry of Health 332 /99. However, the forecast of updating the tariff every three years has remained a dead letter.

The new LEAs were approved only in 2017, while the prosthetic tariff remained unchanged for another 6 years, until the revision with the Ministerial Decree of 23 June 2023. However, the new tariffs will only come into force in April 2024 and no compensation is foreseen for the 25 years of failure to update which has forced and still forces the 3 million disabled people in Italy to face at their own expense the increased costs of life-saving devices and other aids essential to their existence and autonomy.

Representatives of orthopedic companies they are therefore asking the TAR of Lazio to cancel the tariff decree and numerous operators are organizing legal action to ask for an account of the failure to adjust tariffs over the last quarter of a century. (1)

On the skin of the disabled

Criticalities that affect companies in the sector first and foremost have repercussions on the skin of disabled people. According to a survey on the provision of assistive devices conducted in October 2023 by the Medical Devices sector of Confindustria:

– over half (52,2%) of people who use assistive devices did not receive a clinical evaluation of the living, working or school context when choosing the aid,

– 50% of patients waited between 3 and 6 months for the delivery of the identified aid,

– 43,4% of recipients of the aid had to pay a supplement out of their own pocket for the delivery of the aid,

– 37% of users are dissatisfied with the supply service (times, procedures, etc.),

– 58,7% of users are dissatisfied with maintenance and technical assistance. (2)

Aids without customization

With the new LEAs it has also become very complicated to obtain a personalized aid, as is necessary for those who move in a wheelchair or wear a prosthesis, for example. The latest regulatory revision provides that local health authorities purchase aids directly, through tenders. Massive purchases that prevent the provision of 'tailor-made' aids for the recipients and their concrete needs.

This aspect it created chaos. In some Regions and/or ASLs the prosthetic assistance offices continue to apply the old list - with the rates of the lira times (1999) - for the aids necessary for particular clinical conditions. The asymmetric application of LEAs on different territorial levels is a historic shame for the NHS. (3) And it is only thanks to an appeal promoted by the Luca Coscioni Association on the provision of prostheses that the TAR of Lazio ordered the Minister of Health to find a solution. (4)

The position of operators in orthopedic techniques

'In 24 years of invariance of the nomenclature of prosthetic assistance, the NHS obtained that prostheses, orthoses and assistive technologies in step with technological innovation were provided by the "affiliated orthoprosthetic structures", but at reimbursement rates belonging to another political-economic era', reiterates the Italian Federation of operators in orthopedic techniques. (5)

The two measures of revision of rules and tariffs (DPCM 12.1.2017 and Ministerial Decree tariffs 23.6.2023) were in fact developed on data and knowledge from twenty years ago, a geological era prior to the development of information and digital technologies, without adequately involving the associations of category.

Budget law 2024, further cuts to measures to eliminate architectural barriers

The 2024 budget law (law 30 December 2023 n. 213), in force since 1.1.2024, has meanwhile drastically reduced the 75% tax credit introduced to encourage the removal of architectural barriers, the operation of which had been expected until 2025.

Consequently, people with severe disabilities who must adapt their homes and offices to their needs will have to pay at their own expense for all investments other than lifts and stairlifts (e.g. bathrooms, kitchens, fixtures, home automation). Nor will they be able to assign the related credits to third parties.

There is no limit to the worst.

Marta Strinati