Regione Lazio
Decreti del Commissario ad Acta
Decreto del Commissario ad Acta 22 luglio 2020, n. U00101
Approvazione del documento tecnico "Criteri di eleggibilità ai percorsi di riabilitazione territoriale".
IL PRESIDENTE IN QUALITÁ DI COMMISSARIO AD ACTA
VISTI per quanto riguarda il Piano di rientro dai disavanzi del settore sanitario:
l’art. 120 della Costituzione;
l’articolo 8, comma 1 della legge 5 giugno 2003, n. 131;
l’articolo 1, comma 180, della legge 30 dicembre 2004, n. 311;
le deliberazioni della Giunta regionale n. 66 del 12 febbraio 2007 e n. 149 del 6 marzo 2007, rispettivamente di approvazione del Piano di Rientro e Presa d’atto dell’Accordo Stato-Regioni;
art. 1 comma 796, lettera b) della legge 27 dicembre 2006, n. 296;
il decreto legge 1° ottobre 2007, n. 159 convertito con modificazioni dalla L. 29 novembre 2007, n. 222;
la legge 23 dicembre 2009, n. 191;
il decreto del Commissario ad Acta n. U00018 del 20.1.2020 “Adozione in via definitiva del piano di rientro "Piano di riorganizzazione, riqualificazione e sviluppo del Servizio Sanitario Regionale 2019-2021" ai sensi e per gli effetti dell'art. 2, comma 88 della L. 191/2009, secondo periodo". Modifiche ed integrazioni al DCA 469 del 14 novembre 2019 in esito al verbale del Tavolo di verifica del 27 novembre 2019”;
VISTI per quanto riguarda i poteri:
la legge costituzionale 18 ottobre 2001, n. 3;
lo Statuto della Regione Lazio;
la legge regionale 18 febbraio 2002 n. 6 e s.m.i.;
il regolamento regionale 6 settembre 2002, n. 1 e s.m.i.;
la deliberazione del Consiglio dei Ministri del 21 marzo 2013 con la quale è stato conferito al Presidente pro-tempore della Giunta della Regione Lazio, Nicola Zingaretti, l’incarico di Commissario ad acta per la prosecuzione del vigente Piano di Rientro dai disavanzi nel settore sanitario della Regione Lazio, secondo i Programmi Operativi di cui all’art. 2, comma 88, della legge 23 dicembre 2009, n. 191;
la deliberazione del Consiglio dei Ministri del 1° dicembre 2017 che ha assegnato al Commissario ad acta il compito di proseguire le azioni già intraprese al fine di procedere al rientro nella gestione ordinaria;
la deliberazione del consiglio dei Ministri del 10 aprile 2018 che ha assegnato al Commissario ad acta il compito di proseguire nell’attuazione dei Programmi operativi 2016-2018 e negli interventi necessari a garantire, in maniera uniforme su tutto il territorio regionale, l’erogazione dei livelli essenziali di assistenza in condizioni di efficienza, appropriatezza, sicurezza e qualità, nei termini indicati dai Tavoli tecnici di verifica, nell’ambito della cornice normativa vigente;
la deliberazione della Giunta regionale 5 giugno 2018, n. 271, con quale è stato conferito al dott.
Renato Botti, soggetto esterno all’amministrazione regionale, l’incarico di Direttore della Direzione regionale Salute e Integrazione Sociosanitaria;
VISTI per quanto riguarda le norme in materia sanitaria:
il regio decreto 27 luglio 1934, n. 1265 e s.m.i.;
la legge 23 dicembre 1978, n. 833 e s.m.i.;
il decreto legislativo 30 dicembre 1992, n. 502 e s.m.i.;
il decreto legislativo 29 aprile 1998, n.124 e s.m.i.;
il decreto del Presidente del Consiglio dei Ministri del 12 gennaio 2017 “Definizione e aggiornamento dei livelli essenziali di assistenza, di cui all'articolo 1, comma 7, del decreto legislativo 30 dicembre 1992, n. 502”;
l’Intesa tra il Governo, le Regioni e le Province Autonome di Trento e Bolzano (rep. Atti 209 CSR del 18 dicembre 2019) concernente il nuovo Patto per la Salute per gli anni 2019-2021;
il decreto del Commissario ad acta n. U00606 del 30 dicembre 2016 con il quale si istituiscono le AASSLL “Roma 1” e “Roma 2”, si sopprimono le AASSLL “Roma A”, “Roma B”, “Roma C”
e “Roma E” e si ridenominano le AASSLL “Roma D” come “Roma 3”, “Roma F” come “Roma 4”, “Roma G” come “Roma 5” e “Roma H” come “Roma 6;
VISTI per quanto riguarda le norme in tema di riabilitazione territoriale con particolare riferimento alla individuazione dei criteri di eleggibilità ai percorsi riabilitativi nonché alla programmazione territoriale nell’area della disabilità:
la deliberazione della Giunta regionale 10 maggio 2002, n. 583 “Attività riabilitativa estensiva e di mantenimento - Definizione della cartella clinica riabilitativa, degli standard di attività e di personale e del flusso informativo. Tariffe dell'attività riabilitativa nei diversi livelli assistenziali”;
le Linee-guida del Ministro della Sanità per le attività di riabilitazione, approvate in sede di Conferenza Stato-Regioni in data 7 maggio 1998;
l’Accordo tra il Governo, le Regioni e le Province autonome di Trento e Bolzano, del 10 febbraio 2011, sul documento concernente “Piano di indirizzo per la riabilitazione”. Accordo ai sensi dell’articolo 4 del decreto legislativo 28 agosto 1997, n. 281”;
il decreto del Commissario ad acta n. U00039 del 20 marzo 2012 “Assistenza Territoriale.
Ridefinizione e riordino dell’offerta assistenziale residenziale e semiresidenziale a persone non autosufficienti, anche anziane e a persone con disabilità fisica, psichica e sensoriale”;
il decreto del Commissario ad acta n. U00431 del 24 dicembre 2012 “La Valutazione Multidimensionale per le persone non autosufficienti, anche anziane e per le persone con disabilità fisica, psichica e sensoriale: dimensioni e sottodimensioni. Elementi minimi di organizzazione e di attività dell’Unità di Valutazione Multidimensionale Distrettuale nella Regione Lazio”;
il decreto del Commissario ad acta n. U00306 del 1 ottobre 2014 “Adozione della Scheda S.Va.M.Di. per la valutazione delle persone con disabilità fisica, psichica e sensoriale per l’accesso alla residenzialità, semiresidenzialità e domiciliarità”;
il decreto del Commissario ad acta n. U00159 del 13 maggio 2016 “Approvazione del documento “Riorganizzazione dei percorsi riabilitativi in ambito ospedaliero e territoriale” e s.m.i.;
il decreto del Commissario ad acta n. U00258 del 4 luglio 2019 “Regione Lazio: Piano per il potenziamento delle reti territoriali. Adozione documento tecnico”;
il decreto del Commissario ad acta n. U00520 del 28 dicembre 2018 “Percorso di riorganizzazione della riabilitazione territoriale”;
CONSIDERATO che nel sopra menzionato decreto commissariale n. U00520/2018 era previsto di dare mandato alla Direzione Regionale Salute e Integrazione Sociosanitaria di:
ridefinire i requisiti organizzativi per le strutture che erogano attività riabilitativa territoriale rivolta a persone con disabilità fisica, psichica e sensoriale;
definire le relative tariffe e il sistema di remunerazione delle prestazioni;
attivare un tavolo di confronto periodico con una rappresentanza ristretta delle associazioni
di categoria del settore e delle ASL, al fine di effettuare una attenta valutazione sugli impatti
organizzativi ed assistenziali che il percorso che sarà delineato produrrà;
VISTO l’atto di organizzazione n. G003394 del 25 marzo 2019 “Istituzione gruppo di lavoro Riabilitazione territoriale”;
CONSIDERATO che nell’atto di organizzazione sopra menzionato viene stabilito che il gruppo di lavoro deve svolgere le seguenti attività:
analizzare la casistica trattata;
ridefinire i criteri di eleggibilità per l’accesso ai percorsi di riabilitazione territoriale anche valutando la possibilità di riorganizzare l’offerta per gruppi omogenei di attività;
rideterminare il fabbisogno assistenziale;
ridefinire i requisiti organizzativi per le strutture che erogano attività riabilitativa territoriale rivolta a persone con disabilità fisica psichica e sensoriale;
ridefinire le tariffe e il sistema di remunerazione delle prestazioni;
ridefinire i contratti;
RITENUTO NECESSARIO all’esito degli incontri effettuati con gli operatori del settore ed esperti clinici e dell’analisi della casistica trattata modificare i criteri di eleggibilità ai percorsi riabilitativi territoriali nonché aggiornare i criteri clinici per l'accesso ai trattamenti riabilitativi non residenziali precedentemente disciplinati con il sopra menzionato decreto commissariale U00159/2016 e s.m.i.;
RITENUTO NECESSARIO, inoltre, disciplinare una specifica modalità di presa in carico per gli utenti in condizione di gravissima compromissione a livello comportamentale e/o delle capacità funzionali di base;
DATO ATTO che per le finalità sopra rappresentate è stato elaborato il documento tecnico "Criteri di eleggibilità ai percorsi di riabilitazione territoriale", allegato al presente provvedimento;
CONSIDERATO, inoltre, che durante una serie di incontri tenutisi presso la sede regionale e da ultimo quello del giorno 5 marzo u.s., il suddetto documento tecnico è stato condiviso con le associazioni di categoria del settore così come previsto nel sopramenzionato decreto commissariale n. U00520/2018;
RITENUTO necessario stabilire che le indicazioni contenute nel documento tecnico allegato al presente provvedimento superano quanto previsto dai precedenti provvedimenti regionali in materia fatta eccezione per quanto non espressamente trattato;
RITENUTO pertanto necessario, alla luce di quanto sopra rappresentato, approvare il documento tecnico allegato denominato “Criteri di eleggibilità ai percorsi di riabilitazione territoriale”
(ALLEGATO 1);
RITENUTO necessario, infine, avviare, con la collaborazione di una rappresentanza delle
associazioni degli utenti, un monitoraggio di verifica delle ricadute dell’applicazione delle
indicazioni contenute nel documento tecnico allegato, anche al fine di apportare, laddove ritenuto
necessario, modifiche migliorative per la presa in carico degli utenti.
DECRETA
Per le motivazioni indicate in premessa che si intendono parte integrante del presente provvedimento
-
di approvare il documento allegato denominato “Criteri di eleggibilità ai percorsi di riabilitazione territoriale” (ALLEGATO 1);
-
di dare mandato alla Direzione Salute e Integrazione Sociosanitaria di adottare i provvedimenti e gli atti conseguenti;
-
di avviare, con la collaborazione di una rappresentanza delle associazioni degli utenti, un monitoraggio di verifica delle ricadute dell’applicazione delle indicazioni contenute nel documento tecnico allegato, anche al fine di apportare, laddove ritenuto necessario, modifiche migliorative per la presa in carico degli utenti.
Avverso il presente provvedimento è ammesso ricorso giurisdizionali dinanzi al Tribunale Amministrativo Regionale del Lazio entro 60 giorni dalla sua pubblicazione, ovvero ricorso straordinario al Presidente della repubblica entro 120 giorni dalla sua pubblicazione.
Il presente provvedimento sarà pubblicato sul Bollettino Ufficiale e sul sito della Regione Lazio.
IL PRESIDENTE
Nicola Zingaretti
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