What Differentiated Autonomy provides: healthcare and the Lep node (essential performance levels)

What Differentiated Autonomy provides: healthcare and the Lep node (essential performance levels)
What Differentiated Autonomy provides: healthcare and the Lep node (essential performance levels)

Rome, 19 June 2024 – La Room has approved today the bill signed by Calderoli containing the reform ondifferentiated autonomy, with 172 votes in favor, 99 against, at the end of an all-night marathon. The bill thus becomes law in all respects. It provides for the recognition of a greater level of autonomy to the regions with ordinary and special statute that request it, including the autonomous provinces of Trento and Bolzano. In 11 articlesthe reform defines the legislative and administrative procedures for the application of the third paragraph of article 116 of Constitution. That is, it regulates the agreements between the State and those Regions that decide to request a level of differentiated autonomy compared to the others limited to 23 subjects. Before submitting the request, each individual region must acquire opinions from municipalities, provinces and bodies in its territory.

Local flags in the chamber among the majority benches to celebrate the approval of the Autonomy bill in the Chamber (Ansa)

Various sectors are affected by the reform, including foreign trade, energy, transport, education, environment, culture, health protection and sport. Only in 23 subjects it will be possible to transfer functions from the State to the regions: fourteen are defined by the Lep, Essential Levels of Performancewhich must be ensured for all citizens regardless of their region of residence.

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The flag of Calabria waves to celebrate Autonomy, the photo of the Northern League deputy is viral

The flag of Calabria waves to celebrate Autonomy, the photo of the Northern League deputy is viral

State and individual regions will have time 5 months from the Region’s request to reach an agreement. The understandings they can last up to 10 years and then be renewed. They may be interrupted before the deadline by the State or region with at least 12 months’ notice.

The recognition of one or more “forms of autonomy” is subordinated, for most subjects, to the determination of Lep: criteria that determine the level of minimum service which it must be guaranteed uniformly across the entire national territory. The determination of costs and standard needs, and therefore of the Lep, takes place on the basis of a survey of the historical expenditure of the State in each Region in the last three years.

For two subjects, health and environmentthe Leps are already defined (in these cases they are called Leah And Lepta). Nine subjects are ‘non-Lep’, therefore immediately transferable: among these foreign trade, supplementary pensions, professions, civil protection, international relations and with the EU, coordination with public finance and the tax system.

The national government enters 24 months from the entry into force of the law will have to be enacted one or more legislative decrees to determine Lep levels and amounts.

The transfer of functions from the State to the regions will be possible only after the determination of the Lep e within the limits of resources made available in the budget law. Without the determination of the LEPs and their financing, it will not be possible for a region to obtain a greater level of autonomy.

THE powers granted in healthcare with differentiated autonomy are not few: the Anaao Assomed National Secretary Pierino Di Silverio lists them: “Determination of rates And ticket; management of supplementary funds, with the risk of the resurgence of mutual insurance systems; corporate governance, with the possibility of a harlequin system; free hand on the system postgraduate training. Until the birth of a market competitive forhiring of professionalsthe start of one wild competition in the acquisition of human resources nourished by wage dumping and regional incentives, which will deprive the employees’ CCNL of value”. According to Di Silverio, differentiated autonomy entails “greater burdens for the regions in difficulty, because more revenue at local level means less resources available at central level to guarantee a homogeneous level of essential services, and greater use of private healthcare”.

National control room of the Government

A control room of the national government will have to carry out periodic reconnaissance of the regulatory framework, in relation to each state administrative function and ordinary regions. It will have to identify subjects or areas of subjects relating to the Lep sui civil and social rights which must be guaranteed in the same way throughout the national territory. All the competent ministers are members, assisted by a technical secretariat at the Department of Regional Affairs and Autonomy of the Presidency of the Council.

Safeguard clause

The Government national can replace bodies of Regions, metropolitan cities, Provinces, Municipalities when it finds their non-compliance with international treaties, community regulations or in the case in which it finds a serious danger for public safety including the guarantee of civil and social rights and it is necessary to protect the legal or economic unit of the Republic.

 
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