Official Translation

Official Translation Official Translation REPUBLIC OF LITHUANIA LAW ON THE AMENDMENT OF THE LAW ON HEALTH CARE INSTITUTIONS June 6, 1996, No. I-1367 Vilnius (As amended June 24, 1997. No. VIII – 288) ARTICLE 1. The New Edition of the Republic of Lithuania Law on Health are Institutions To change and to amend the Law on Health Care Institutions as follows: “REPUBLIC OF LITHUANIA LAW ON HEALTH CARE INSTITUTIONS PART I GENERAL PROVISIONS CHAPTER I PURPOSE AND GENERAL CONCEPTS OF THE LAW ARTICLE 1. Purpose of the Law This law shall designate the classification of health care institutions, principles of their founding, reorganisation, liquidation, activities, state regulation, control measures, special features of administration and financing thereof, the nomenclature of the National Health Care System of Lithuania, procedure of individual free health care services rendering at institutions of the National Health System of Lithuania, relations between health care institutions and patients and the principles of liability in violations of this Law. ARTICLE 2. The Basic Concepts and Abbreviations Employed in the Law 1. Health Care Institution (further - institution): 1) institution or enterprise having the right according to the procedure established by this Law and others and legal acts, to provide health care services (further - services); 2) branch or department of an institution or enterprise engaged in other (non health care) activities, having the right to provide health care services. 2. LNHS denotes the Lithuanian National Health System, regulated by the Law on the National Health System. 3. LNHS Activity Clients denote state administration and municipal executive institutions and also, territorial patients’ funds. 4. Closed Institution denotes an institution, whose services are only available to groups of residents specified by this Law. 5. Health Care Services (further - services) denotes the result of activity based upon an agreement between an institution and clients. Clients of services may be the clients of LNHS activity designated by the Law on the Health System and other legal and natural persons. 6. Accreditation denotes determining of the conformity of institutional activity to the requirements of legal acts, recognition of the right to provide services to an institution and the issuance of a certificate of accreditation. 7. State Medical Audit denotes official control and expert investigation of all types of property forms of legal and natural persons, who are engaged in personal health care activity, and the availability of the services supplied, quality (suitability) and economic effectiveness. 8. Patient denotes a person who avails himself of the services rendered by institutions, regardless of whether he is healthy or ill. 9. Free Services denote services paid from the state or local budgets, or compulsory health insurance fund, or state and local government health fund monies. These services are ordered for enterprises and paid for by the LNHS activity funds. CHAPTER II THE KINDS OF INSTITUTIONS, THEIR ACCREDITATION, REGISTRATION AND THE PRINCIPLES OF STATE ADMINISTRATION OF ACTIVITIES FIRST SECTION CLASSIFICATION OF INSTITUTIONS ARTICLE 3. Classification of Institutions 1. LNHS institutions are classified as follows: 1) state or local government institutions of individual health care (further - public LNHS institutions). The basic portion of the source of the financing of these institutions is comprised of compulsory insurance funds, obtained according to the procedure established by the Law on Health Insurance: the Law on Public Institutions shall apply to the LNHS insofar as it shall not contradict this Law; 2) state or local government institutions of personal health care budgetary institutions (further - LNHS budgetary institutions), whose principal source of funding is comprised of special purpose allocations from the state budget; 3) state and local government institutions of individual health care, whose principal source of funding is comprised of special purpose allotments from the State and local government budgets, for the implementation of measures of required public health care; 4) state public institutions of public health care, whose principal source of funding is comprised of allocations from the state and local government budgets; 5) institutions, the shares whereof, belong to the state or the local government; 2. Institutions not under LNHS, are classified as follows: 1) enterprises, with the exception of enterprises, indicated in item 5 of part 1 of this Article; 2) public institutions, except state and local government public health care institutions. 3. The following institutions are grouped in accordance with health care services: 1) personal health care; 2) public health care; 3) miscellaneous 4) The institutions of individual health care which are comprised according to the time and location of the care provided and are divided into the following sub groups; 1) out-patient 2) in-patient 3) miscellaneous, 5. The kinds of individual health care institution according to the assortment of individual health care services are: 1) medical assistance; 2) nursing care and support treatment (nursing); 3) medical rehabilitation; 4) medical expert examination; 5) miscellaneous. 6. The public health care institution kinds according to the public health care services assortment are: 1) public health monitoring and public health expert examination; 2) public health protection (food and non-food product protection, radiation protection, environmental hygiene, labour medicine); 3) non-infectious diseases prophylaxis and control; 4) prophylaxis and control of contagious diseases; 5) public health training 6) miscellaneous 7. The legal acts and regulations (statutes) of these institutions which regulate the grouping of institutions according to classification indicators shall establish the accreditation of these institutions for health care. ARTICLE 4. The Use of Name by Institutions 1. The sign of an institution must be registered according to the procedure established by the laws of the Republic of Lithuania. 2. The names of the types of institutions or the groupings thereof must conform to their classification indicators. SECOND SECTION ACCREDITATION OF INSTITUTIONS FOR HEALTH CARE ARTICLE 5. Accreditation of an Institution to Provide Services 1. In the Republic of Lithuania, services may be provided only by institutions, that are accredited for individual and (

1. or)public health care and have obtained a document (license, accreditation certificate), attesting to accreditation from the State Service of Accreditation at the Ministry of Health (further - Accreditation Service). In order to obtain this document, a declaration and documents, concerning readiness of an institution to engage in health care activities, must be submitted to the Accreditation Service. Accredited institutions shall have the right to commence implementation of health care activities, from the day of their registration in the State Health Care Institution Register (further - Institution Register). Institutions may also be registered in other registers established by laws. 2. This Law and Regulations on Health Care and Pharmaceutical Activities approved by the Government, shall comprise the procedure of institution accreditation and the issuance of licenses and accreditation certificates attesting thereof. 3. An accredited institution shall have the right to render only the services stipulated on the license or accreditation certificate. An institution may not transfer the license or accreditation certificate to other persons. A fee in the amount established by the Government, shall be paid for issuance of a license or accreditation certificate. Issuance of an accreditation certificate and (
2. or)license will be announced in the “Official Gazette.” 4. For institutions, in the process of being established, a license shall be issued to cover no more than a period of 12 months, in the course of which the institution must apply for issuance of an accreditation certificate. An accreditation certificate for all institutions is issued for a 5-year period only. The term of validity of an accreditation certificate may be extended according to the procedure established by this Law and other legal acts, or a new certificate shall be issued. 5. The Ministry of Health shall prepare and approve the general and special accreditation requirements of institutions, while the accreditation requirements of institutions whose founders are the Ministry of National Defence and the Ministry of Internal Affairs, shall be handled by the Ministry of Health along with the founders. ARTICLE 6. Decisions of the Accreditation Service Regarding the Accreditation of Institutions 1. The Service For Accreditation must adopt a justified decision regarding accreditation of an institution within a period of two months from the receipt of the statement and other documents. 2. Accreditation Service shall examine the submitted documents within a period of 30 work days from the day of receipt of the application and other documents and shall establish whether they are in keeping with the approved requirements. Having established that the submitted data meet with the approved requirements, the Service For Accreditation shall assign experts to assess the local activities of the institution. 3. The Service for Accreditation shall adopt a decision: 1) to accredit an institution or department (departments) thereof, for health care activities; 2) to accredit an institution or it’s department (departments) for health care activities with stipulations: 3) to postpone accreditation of an institution or department (departments) thereof for health care activities; 4) not to accredit an institution or department (departments) thereof for health care activities; 5) to annul accreditation of an institution or department (departments) thereof, for all services or a part of such, should they fail to meet the requirements of legal acts and (
3. or)normative documents and also if this should actually endanger the patients’ health or cause harm to people’s health and result in damages to legal or physical persons. 4. The Service For Accreditation must inform no later than within 10 work days following approval of the decision, the founder (owner) of the institution, regarding the adopted decision and if they have decided to accredit the institution for health care activities, to issue an accreditation certificate in the established form. 5. Upon expiration of the accreditation term of validity, the institution or department (departments) thereof, may continue their activities for a term not to exceed 90 work days. 6. The Ministry of Health shall determine the conditions of accreditation with stipulations. 7. The Service For Accreditation shall have the right to postpone the accreditation for health care activities of an institution or department (departments) thereof. In this case it must indicate in writing, to the founder (owner) of the institution the concrete shortcomings in the submitted documents, or in the rendering of services by an institution or department (departments) thereof and the terms of eliminating such. The institution or department (departments) thereof shall be accredited upon fulfilment of these conditions. 8. The Service For Accreditation may fail to accredit an institution or structural department (departments) thereof for health care activities or annul its accreditation, only upon a justified recommendation by its authorised experts and also that of an inspector authorised by the State Medical Audit Inspectorate or the Minister of Health, approving a justified decision. 9. The Service For Accreditation must inform in writing the institution founders (owners) concerning deliberation of the accreditation material, no later than 7 work days prior to the deliberation, while the enterprise administration must be informed of the deliberation contents and date. Founders (owners) of the institution and their representatives shall have the right to participate during discussion of the question. 10. The Service For Accreditation must furnish a written notice, within 3 work days of adoption of the decision, to institution founders (owners), institution administration and the administrator of the institution register, concerning its decision not to accredit, or to annul the accreditation of an institution or the department (departments) thereof. 11. The decision of the Accreditation Service, to interrupt the accredited activities of an institution or the department (departments) thereof, must be approved by the Minister of Health within three work days from adoption of the decision by the Accreditation Service. 12.The decisions of the Accreditation Service, regarding accreditation of an institution or department (departments) thereof, may be appealed in court according to the procedure established by laws, during the period of 30 work days following the approval of the decision. An appeal does not suspend implementation of the decisions by the Accreditation Service. THIRD SECTION REGISTRATION OF ACCREDITED INSTITUTIONS ARTICLE 7. Registration of Accredited Institutions 1. Accredited institutions must be registered in the Institution Register. 2. The Ministry of Health shall establish an Institution Register, registering the institutions therein and keeping it. The Ministry of Health may authorise another state institution to keep the Institution Register. 3. Keeper of the Institution Register shall approve the rules for the establishment of the identification code of the registered institution. 4. The Government shall approve the Register regulations. ARTICLE 8. Procedure for the Registration in and Striking from the Institution Register of Accredited Institutions 1. Upon the accreditation of an institution, the Accreditation Service must submit registration data to the keeper of the Institution Register, within 3 days from approval of the decision to accredit the institution. 2. The keeper of the Institution Register must register the accredited institution no later than within 5 work days from the submittal of the registration data to the keeper of the Institution Register. If the registration data are not submitted in full or are inexact, the keeper of the Institution Register may demand from the applicant to correct them within a period of 10 work days. 3. A registration certificate of the type established by the Ministry of Health shall be issued to the institution registered in the Institution Register. 4. Upon the occurrence of a change in the registration data and under other circumstances established by law, the authorities must inform the Institution Register keeper within a period of ten work days. 5. Institutions shall be removed from the Institution Register under the following circumstances: 1) upon annulment by the Service for Accreditation of an institution’s accreditation for health care activities; 2) upon expiration of the time limit of activity designated in the bylaws of the institution; 3) upon change in the type of activity of the institution (upon cessation of rendering of services); 4) upon reorganisation or liquidation of the institution, per decision of institution founder (founders) or owner (owners); 5) upon completion of bankruptcy procedure of the institution accredited for health care activities; 6) upon adoption of a court decision to liquidate institution, resultant from legal violations, established by laws; 7) in the event it should become evident that the submitted accreditation documents and registration data do not correspond with reality or have been registered in violation of this and other laws. 6. In the event of the circumstances denoted in part 5 of this Article being present, the Service For Accreditation, institution founder (founders), institution administration head or institution liquidator must, within 7 work days from the coming to light of these circumstances and registering of documents, submit before the keeper of the register copies of the decision by the founder (founders) or owners to reorganise or liquidate the institution, the act of institution liquidation, court decision to liquidate institution, or other documents in connection with the procedure of striking of the institution’s registration from the Institution Register. 7. Within 3 work days, following the striking of an institution from the register, the keeper of the Institution Register must declare its registration certificate no longer valid and must publish this in the “Official Gazette.” Within 3 days of adoption of this decision, the keeper of the Institution Register must inform the administration of the institution of this. Following the striking of an institution from the register, the data relevant to the institution shall remain kept within the register, for a period of no less than 2 years and later shall be transferred to the archives. 8. Institutions shall pay stamp duty for registration, in the amount stipulated by the Government. ARTICLE 9. Use of the Register Data of Institutions 1. Legal and natural persons shall have the right to make use of the Register data of Institutions in accordance with the procedure established by the regulations of this register. 2. State and municipal institutions shall have access to Institution Register data free of charge. Other legal and natural persons must pay a stamp duty in the amount established by the Government, for the use of register data. 3. Only the keeper of the Institution Register and State institutions shall have the right to use the data of the Institution Register, pertaining to closed institutions of the Ministries of Internal Affairs and National Defence. FOURTH SECTION THE PRINCIPLES OF STATE REGULATION OF INSTITUTION ACTIVITIES ARTICLE 10. Legal Acts and Normative Documents, Establishing the Activities of Institutions 1. The activities of institutions shall be established by: 1) this and other laws of the Republic of Lithuania and other legal acts; 2) Lithuanian standards and also, international standards, legalised according to the procedure established in the Republic of Lithuania; 3) medical norms of Lithuania, approved by the decrees of the Minister of Health; 4) hygiene norms of Lithuania, approved by the decrees of the Minister of Health; 5) certified health care methodology, approved by the decrees of the Minister of Health; 6) institution bylaws (statutes). 2. In the absence in Lithuania, of current and legal acts required for institution activities legal acts or normative documents, the institution shall prepare and the head of the institution, shall issue an order of approval of the standards of the institution, the health care methodologies and internal procedure regulations. 3. Institutional standards and health care methodology and internal procedural regulations must not contradict the legal acts currently in effect in Lithuania and normative documents listed in paragraphs 2, 3 and 4 of part 1 of this Article. 4. Institution bylaws (statutes) shall be approved by their founders according to the procedure established by laws. ARTICLE 11. The Rights of the Ministry of Health Regarding State Regulation of Institution Activities The Ministry of Health shall: 1) establish, reorganise or liquidate the institutions of tertiary level of organising of LNHS activities, in accordance with the procedure established by this law; 2) establish, reorganise or liquidate institutions in conjunction with state universities or state science institutions, according to the procedure established by law; 3) keep the Institution Register; 4) establishes for subordinate institutions the requisite health care tasks and the procedure of their financing and implementation; 5) furnish the Government with proposals concerning guarantees for granting loans, which the LNHS institutions obtain from credit institutions; 6) establish the requirements of health care suitability and acceptability; 7) prepare proposals for the Government, in conjunction with the Ministry of Finance on state budgetary allocations to LNHS institutions; 8) anticipate the need for health care specialists and formulate the state requirement for the training of these specialists; 9) control how institutions observe the essential health care conditions, laws and other requirements of legal acts and normative documents; 10) establish in conjunction with the Internal Affairs and National Defence Ministries, the procedure for rendering of services within the closed institutions of the national defence system or the internal affairs system and control, along with these ministries, how the requirements of legal acts and normative documents are being adhered to; 11) approve, upon co-ordination with the Statistics Department at the Government of the Republic of Lithuania, the forms of statistics and the procedure of accounting and accountability procedure of institution activities; 12) implement the other functions established by this and other laws. ARTICLE 12. Approval of the Normative Acts of Distribution and Structure of LNHS Institutions 1. The Government shall approve the minimal normative acts of the LNHS institution distribution and structure: 2. The Ministry of Health, county governors and executive institutions of local government must ensure minimal normative acts on the LNHS institution structure and distribution, stipulated by the Government. ARTICLE 13. Health Care Investments 1. The use of funds in expanding the range of services, implementation of new health care technologies, and improvement of availability and quality (adequacy) of health care shall be considered health care investments. 2. The laws and other legal acts shall establish the procedure of economic investment in health care incentive. ARTICLE 14. State Regulation of Service Costs 1. The Ministry of Health, shall set the costs of services. 2. The costs of services rendered by profit-seeking institutions shall be set by their founders (owners). These costs may not exceed the costs set by the Ministry of Health for services rendered by LNHS institutions, by more than 60 (sixty) per cent. ARTICLE 15. Special Features of Privatisation of LNHS Public Institutions of Individual Health Care 1. LNHS public institutions of individual health care, or independent functional departments, thereof may be privatised, which are capable of acting as independent functional departments, may be privatised according to procedure established by laws and other legal acts if: 1) they are no longer being accredited; 2) their accreditation shall be annulled; 3) a conclusion by the State Medical Audit Inspection concerning further expediency of the institution’s activity 2. The funds obtained upon privatisation of these health care institutions or independent functional departments thereof, shall be transferred according to the procedure established by the Government, to an appropriate state or local government health fund. ARTICLE 16. Heads of Institution Administration, Departments and Branches and Health Care Specialists 1. Heads of LNHS institutions, heads of departments and branches shall be hired for a period of 5 years by way of legal tender. The founder of a corresponding institution shall organise the legal tender and approve its regulations. 2. Persons who meet the qualification requirements approved by the Ministry of Health, may become heads of administration of the LNHS institution, departments and branches. 3. A person older than 65 years of age may not hold a position as the head of an administration, department or branch of a LNHS institution. 4. The rights and obligations of the heads of LNHS institution administration, departments and branches shall be established by the standard regulations of those institutions, which shall be approved by the Ministry of Health. 5. LNHS institutions, which implement tertiary health care shall hire health specialists for a period of 5 years, by way of legal tender. The administration head of the corresponding institution shall organise the legal tender and approve its regulations. ARTICLE 17. Institution Records 1. Institution records shall be kept in the Lithuanian language. Disease diagnosis, instructions on medicines for the patient during the history of his illness or nursing, and prescriptions shall be written in Latin, and other medical terms, and procedural designations shall be written in the Lithuanian or Latin languages. 2. The Ministry of Health shall regulate the preservation of institution documents, according to the procedure established by laws. 3. Upon co-ordination with the Ministry of Health, the founder of an institution shall regulate the procedure for keeping documents of the institutions founded by the Ministries of National Defence and Internal Affairs. PART II HEALTH CARE INSTITUTIONS CHAPTER I PROFIT-SEEKING HEALTH CARE INSTITUTIONS ARTICLE 18. Legal Acts of the Republic of Lithuania, Establishing the Founding, Reorganisation and Liquidation of Profit-Seeking Institutions The Law on Enterprises, The Law on Register of Enterprises, laws on individual types of enterprises and other laws and legal acts shall regulate the questions of the establishment, reorganisation and liquidation of profit-seeking health care institutions (further - profit institutions), accredited to provide services, and also of enterprises which are engaged in other (non health care type of ) activity and branches accredited for providing services. ARTICLE 19. Restrictions of Profit-Seeking Activities of Institutions 1. Profit-seeking institutions may be established for all types of individual health care, with the exception of the individual health care services, included on the list approved by the Ministry of Health. 2. Profit-seeking institutions may be established only for these types of public health care activities: 1) health education and popularising of health information; 2) expert hygienic examination according to the list approved by the Ministry of Health; 3) assessment of labour and environmental hygiene; 4) for research in hygiene and (
4. or)microbiology, included on the list approved by the Ministry of Health; 5) disinfection, deratization and disinsection. 3. The Ministry of Health shall establish the procedure of providing the services indicated in part 2 of this Article. 20 ARTICLE 20. Special Features of Profit-Seeking Institution Activities 21 1.Expenses of a profit-seeking institution for rendering urgent medical assistance to patients shall be compensated from the funds of legal and natural persons, who by their unlawful actions have inflicted harm upon the health of these patients. The Law on Health Insurance shall regulate the basis and procedure of compensating such expenses from the budget of the compulsory health insurance fund. 2. Medical expert examination relevant to the temporary work disability shall be conducted at profit-seeking institutions in accordance with the procedure established by the Ministries of Health, Social Security and Labour. 3. Profit-seeking institutions may make use of the services (examinations, specialist consultations, etc.) of LNHS institutions only according to contracts drawn up with these institutions, through payment in prices agreed upon, which may not be less than those established for LNHS institutions. 4. Profit-seeking institutions must implement, according to their competence and funds, the requisite public health care measures, which shall be established by the Ministry of Health. 5. Should profit-seeking institutions, according to established procedure, obtain funds from the state or municipal budgets, the Ministry of Health and its authorised State Control officers, shall have the right to verify how these funds are utilised. 6. The clients of LNHS activity shall form health care contracts with institutions which do not belong to LNHS institutions, concerning services, compensated from the compulsory health insurance fund, state and municipal budgets, state and municipal fund monies, according to the procedure established by the Ministry of Health. CHAPTER II LNHS INSTITUTIONS FIRST SECTION LNHS BUDGETARY INSTITUTIONS ARTICLE 21. LNHS Budgetary Institutions 1. A LNHS budgetary institution is an institution maintained by state or local authority budgets wholly or in part. It also may be funded by a private health insurance fund, health funds and other non-budgetary funds. 2. The founders of LNHS budgetary institutions, maintained by the state budget may be The Government, Ministry of Health, the state services at the Ministry of Health, Ministry of Social Security and Labour, Ministry of Internal Affairs, Ministry of National Defence and County Governors. 3. The Government, the Ministry of Health, the Ministry of Internal Affairs, the Ministry of National Defence and the county governors may be founders of budgetary institutions, supported from the State Budget. 4. Municipal councils are founders of budgetary institutions supported from municipal budgets. ARTICLE 22. Legal Acts of the Republic of Lithuania, Establishing the Founding, Reorganisation and Liquidation of Activities of Budgetary Institutions The Law on Budgetary Institutions, the Law on the Health System, this Law and other laws and legal acts shall regulate the questions of the founding, activities, management, reorganisation and liquidation of budgetary institutions. ARTICLE 23. Special Features of Budgetary Institution Management, Activities and Utilisation of Funds 1. The statutes of budgetary institutions shall establish the procedure of formation, area of competence, functions and liability of the managing bodies of budgetary institutions. The administration which will administer the institution according to the procedure established by its statutes, shall be the managing body of the budgetary institution. Collective managing bodies, whose statutes shall be approved by the chief of the administration, may be established at the budgetary institution. 2. A budgetary institution shall have the right to enter into health care contracts with the LNHS activity clients, other legal and natural persons, concerning provision of free and paid services and to obtain non-budgetary services. Budgetary institutions of public health care, shall have the right to engage in publishing activity in connection with their area of competence and to receive non-budgetary funds from this activity. ARTICLE 24. Nomenclature of LNHS Budgetary Institutions of Individual Health Care Budgetary institutions of individual health care include: 1) medical centres for sport; 2) infants’ homes for infants with developmental disabilities; 3) organ and tissue transplant bank, established by the Ministry of Health; 4) Court psychiatric and narcological and court medical expert examination institutions; 5) pathologoanatomical expert examination institutions; 6) medical and social expertise institutions; 7) closed budgetary institutions of individual health care identified in this and other laws; 8) other LNHS budgetary institutions whose nomenclature shall be established by the Government; ARTICLE 25. Nomenclature of LNHS Budgetary Institutions of Public Health Care 1. The LNHS budgetary institution of public health care is the health care bureau of the municipal authority. 2. LNHS budgetary institutions of public health care are: 1) county doctor’s consultation in labour medicine; 2) nutrition centre; 2) county centre for the development of public health ; 3) county centre for disease prophylaxis and control; 4) public health care institutions, whose founders are the State Public Health Service at the Ministry of Health (county public health centres, state public health centre, public health development centre, nutrition centre, radiation protection centre, centre for the prophylactics and control of infectious diseases, centre for health information and centre for the control of toxic materials). 3. LNHS state and local authority public health care institutions are prohibited from performing the functions of state hygienic control. 4. State administration and management institutions shall be prohibited from performing functions of LNHS state and local authority health care institutions. ARTICLE 26. Concept of Closed Budgetary Institution and Special Features of the Establishment and Activities Thereof 1. A closed budgetary institution is an institution founded and maintained by state property and budgetary funds, providing services to groups of persons indicated by laws and implementing health programmes. 2. A closed budgetary institutions may be founded to provide health care only within locations of active service military, persons located in deprivation of liberty and pre-trial detention centre areas, mental patients, who have committed dangerous crimes against society and have been adjudged criminally incapable and illegal immigrants. These institutions shall also implement public health care measures, included on the list of the Ministry of Internal Affairs or Ministry of National Defence and approved by the Ministry of Health. 3. The Ministry of Health shall have the right to establish a closed budgetary institution for the health care of mental patients, who have committed dangerous crimes against society and have been adjudged criminally incapable. Following co-ordination with the Ministry of Health, other state institutions, designated by laws, shall also have the right to found closed budgetary institutions for the health care of active service military personnel and persons posted in deprivation of liberty or pre-trial detention areas, police detention facilities, distribution units and illegal immigrants. 4. The statutes of closed budgetary institutions established within national defence and also the internal affairs systems, shall be approved by their founders, following co-ordination with the Ministry of Health. 5. The laws shall establish the nomenclature of closed budgetary institutions. 6. State medical audit of a closed budgetary institution shall be conducted in accordance with the procedure established by the Government. SECOND SECTION LNHS PUBLIC INSTITUTIONS ARTICLE 27. The Concept and Status of a LNHS State and Municipal Public Institution 1. A LNHS public institution is a public institution founded from state or local authority property and funds, which shall provide stipulated services in accordance to contracts with their clients (legal and natural persons). Their main source of funding shall be derived from the compulsory health insurance fund budget. 2. A public institution shall be a non-profit institution. It may not distribute the profit it shall receive, among its founders, but shall use it solely in accordance with the procedure established by laws and other legal acts. ARTICLE 28. The Founders of a LNHS Public Institution 1. Founders of a LNHS public institution may be: 1) the Ministry of Health, 2) county governors; 3) municipal councils; 4) state universities along with the Ministry of Health, upon obtaining Government approval; 5) state science institutions along with the Ministry of Health, upon obtaining Government approval. 2. The Ministry of Health, may authorise the State Service of Public Health Care to implement all or part of the functions of the founder of public health care institutions for the public health care institutions established by it. ARTICLE 29. Competence of the LNHS Public Institution Founder (Founders) The following functions fall within the competence of the public institution founder (founders): 1) to approve, change and amend the bylaws of a LNHS public institution; 2) to establish requisite activity targets; 3) to obtain information regarding the activities of the LNHS public institution; 4) according to the procedure established by law, to establish or participate in determining the costs of services and methodologies of the calculation thereof; 5) to establish the normative acts of the expenses of a LNHS public institution, designated for labour compensation and medicines, or task the LNHS public institution itself to confirm them; 6) to organise a public tender for the position of the administration head of the LNHS public institution and to approve the regulations of this tender. To draw up a labour contract with the person who has won the tender and also, to discontinue the contract in accordance with the procedure established by laws; 7) to detail the procedure of the use, management and spending and disposition of the resources of the LNHS in accordance with the procedure established by the Government; 8) to establish the salaries of members of administrative bodies and inspector; 9) to establish LNHS institution branches, reorganise and liquidate a LNHS public institution; 10) have other rights and obligations provided they shall not contradict laws. Article 30. The Bylaws of a Public Institution 1. Bylaws shall constitute a legal document which shall serve as a guide for the LNHS public institution. 2. The bylaws of a LNHS public institution must indicate: 1) name of institution; 2) headquarters; 3) founders of institution; 4) rights and obligations of founders; 5) area of institution’s activity, goals and tasks; 6) competence of founders’ meeting and procedure of convocation (if there are several founders); 7) competence of the council of observers and the procedure of this council’s convocation; 8) organisation of procedure of employing public tender administration and department heads and experts; 9) procedure of creating management bodies and recall of the membership competence, functions and liability thereof; 10) procedure of founding and liquidating branches; 11) procedure of disposition of property; 12) sources of funding and procedure of the use thereof; 13) financial control of activities; 14) procedure of amending and supplementing bylaws; 15) procedure of reorganisation and liquidation of institution; 16) terms of institution activity; 17) other provisions concerning the special features (specifics) of the activities of the institution, which are not contrary to laws. 3. The administration of an institution, its collective body of leadership and founder (founders by joint decision) shall have the right of initiative to amend and supplement bylaws. The amended or supplemented bylaws shall be approved by the founder (founders). 4. Amendments and supplements of the bylaws shall come into effect from their legal re-registration in accordance with the procedure established by laws. ARTICLE 31. The Registration, Re-registration and Deregistration of LNHS Public Institution LNHS public institutions and their branches shall be registered, re-registered and deregistered in accordance with the procedure established by the Government for registration of public institutions. ARTICLE 32. The Managing Bodies of the Public Institution 1. The managing bodies of a public institution shall be comprised by taking into account the type of institution and its inclusion into the nomenclature of institutions of the corresponding level of organising of LNHS activities. 2. The administration is an essential body of LNHS institution management, which organises the institution’s activity and manages it. A public institution must have an administration head and a senior finance officer (accountant). 3. The administration head of a LNHS public institution shall establish employee positions and form and break off labour contracts with health care experts and other employees of an institution. The statutes of LNHS public institution shall establish the competence and functions of the head of the administration. 4. According to an agreement the functions of the chief finance officer (accountant) may be performed by another legal person or an institution not having the rights of a legal person. 5. The head of administration shall approve the labour regulations of the administration of the public institution. ARTICLE 33. The Advisory Managing Bodies of LNHS Public Institution 1. LNHS public institutions must have a supervisory board, medical treatment board and nursing board. A LNHS public institution of public health care, which shall engage in secondary or (and) tertiary health care, must have a public health council. 2. The statutes of the institution shall establish the membership number of collective management bodies in LNHS public institutions, the procedure of formation of these organs, the rights and duties of its members, conditions of payment of salaries and liability. ARTICLE 34. Administration Heads of Universities, State Science Institutions and Institutions Established by the Ministry of Health The corresponding state university or science institution along with the Ministry of Health shall organise and implement public tenders for filling the positions of heads of administration of state universities, state science institutions and the institutions established by the Ministry of Health. The Minister of Health shall draw up and terminate a labour contract with the institution head who won the tender. ARTICLE 35. The Supervisory Council of a LNHS Public Institution 1. In order to ensure the openness of their activity the LNHS public institutions form a supervisory council. 2. The supervisory council of LNHS public institution (further -supervisory council) shall be a consultative body, established for a 5-year term. 3. The supervisory council of LNHS public institutions, with the exception of state universities and institutions established by the Ministry of Health, shall be comprised of two representatives appointed per general decision of the founder (founders); one council member of the local government in whose area the institution is located, appointed by the council; one public representative appointed by the council from the local government in whose territory the institution is located and one representative appointed by the labour union of health care experts. 4. The supervisory council of state universities or state science institutions and institutions founded by the Ministry of Health shall be comprised of two representatives appointed by the Ministry of Health, two representatives appointed by the heads of state universities or state institutions of science; one from the municipality within whose territory the state institution of science is located, and one public representative appointed by the council and one representative appointed by the trade union of health care specialists of this institution. 5. Persons who are employed at the administration of the institution, state or territorial patients’ funds and also insurance organisations, who are involved in health care work, may not be included in the supervisory council. ARTICLE 36. The Treatment Council And Nursing Council of a LNHS Public Institution 1. The treatment council of a LNHS public institution (further - treatment council) shall be made up of department and branch heads. 2. The treatment council shall deliberate questions of health care organising and improvement, periodically prepare clinical conferences and deliberate acquisition of new individual health care technologies. The treatment council may submit proposals to the institution administration of a recommendation variety on questions under discussion. Should the administration of the institution fail to agree with the proposal, the treatment council may submit its proposal before the founder (founders). 3. The nursing council of an individual health care institution (further - nursing council) shall be comprised of health care specialists from the departments and branches of the institution. 4. The nursing council shall deliberate questions of organising and improving the nursing of patients. This council may also submit recommendations to the administration of the institution. If the administration of the institution fail to agree with the proposal, the nursing council may submit its proposal before the founder (founders). 5.The administration head of the institution or his authorised administration staff member shall chair the treatment or nursing council. The laws and statutes of public institutions shall establish the formation of the treatment and nursing councils, the rights and obligations of these councils, work procedure, members’ rights, obligations, conditions of their appointment and dismissal and labour compensation and liability. ARTICLE 37. The Medical Ethics Commission of a LNHS Public Institution 1. A medical ethics commission, which will supervise, how medical ethics requirements are being adhered to, shall be set up at the LNHS public institution,. 2. Having been approved by the Ministry of Health, the standard statutes of a Medical Ethics Commission of a Health Care Institution, shall establish the procedure of the formation and activity of a LNHS public institution medical ethics commission. ARTICLE 38. The Public Health Council of a Public Institution for Public Health Care 1. The public health council (further - public health council) of the public institution for public health care shall be comprised of institution specialists and of institution departments or branches (if there are such). 2. The public health council shall deliberate questions of organising and improving public health care, prepare conferences on public health care questions, deliberate questions regarding the acquisition of new health care technologies. The public health council of the institution shall submit recommendations on the questions under discussion, to the administration of the institution. Should the administration of the institution fail to agree with the proposals, the public health council may submit these proposals before the founder. 3) The head of administration or an administration representative authorised by him, of the institution shall chair the public health council. The laws and statutes of the institution shall establish the procedure of forming the public health council, members’ rights and obligations, work procedure of the health council, conditions of member appointment and dismissal, work compensation and liability. ARTICLE 39. The Funds of LNHS Public And State Public Institutions of Health Care 1. The funding sources of LNHS public and state public institutions of individual health care, are: 1) budgetary funds from the compulsory health insurance fund; 2) voluntary health insurance funds; 3) state and municipal budgetary funds; 4) state, municipal health fund monies intended to finance the required state and municipal compulsory health programmes; 5) funds of state investment programmes; 6) funds from enterprise health funds 7) funds for paid services; 8) funds obtained as charity, support or gift, and also obtained through inheritance; 9) allocations by the Ministry of Culture and Science to cover corresponding study and science needs of state universities and institutions established by the Ministry of Health; 10) other legally obtained funds. 2. Estimates of expenditures must be compiled from the state or municipal budgets of Lithuania, funds obtained by the compulsory insurance and state and municipal health fund monies. The public institution shall compile it every year. The estimates of expenditures shall be approved by the founder (founders) of the public institution. The estimate of expenditure shall be comprised of the funds obtained from other sources, should this be required by the entities providing the funds. ARTICLE 40. The Property of the Public Institution 1. The assets of the public institution shall be comprised of long-term material assets, assets received as charity or assistance, assets received as inheritance, financial resources and other legally-acquired assets linked with the activity of the institution. 2. The founder (founders) of state and municipal institutions shall transfer assets to public institutions on a use basis in accordance with the procedure established by laws and the Government. 3. The LNHS public and state public health organisations may, according to the procedure established by the Government sell, transfer, lease, exchange long-term material assets, and also warrant or guarantee by it fulfilment of obligations of the other entities, only upon written approval of the founder (founders). The Ministry of Health shall issue such a license to state university institutions or state science institutions and institutions founded by the Ministry of Health. . 4. The public institution, having sold obsolete or not required by its activities material assets, shall use the acquired assets according to the procedure established by the statutes. ARTICLE 41. Liquidation of a Public Institution 1. The basis for liquidation of a public institution may be: 1) expired time limit of the institution’s activity stipulated by the statutes; 2. decision adopted by the founder (founders) to liquidate the public institution, adopted according to the procedure established by laws and institution statutes; 3) court decision to liquidate public institution for violations of the law, established by laws; 2. An institution which has decided to liquidate the public institution, shall appoint a liquidator, establish terms of liquidation and the procedure of inventorisation and transfer of assets. The collective governing body and administration shall lose its authorisation and its functions shall be performed by the liquidator. 3. Documents of the public institution under liquidation, shall be kept in accordance with the procedure established by the Law On Archives. 4. In liquidating an institution, its employees shall be relieved of their duties in accordance with the procedure established by the Law on Labour. Upon drawing up of the act of liquidation of a public institution, public announcements shall be issued twice within an interval of no less than one month occurring between these. 6. The remaining assets shall be transferred to the founders in accordance with the procedure established in the bylaws. ARTICLE 42.The Powers of the Liquidator of a Public Institution 1. The liquidator of a public institution shall have the rights and responsibilities of a head of administration of the institution. He shall represent the institution being liquidated among state or municipal institutions, in court and in relations with other legal or natural persons. 2. The liquidator of a public institution shall: 1) prepare the financial accounting record (balance of liquidation) of the institution at the time of the commencement of the liquidation; 2) settle with the creditors according to the procedure established by laws; 3) complete the implementation of various obligations in accordance with previously formed transactions of the institution and forms transactions in connection with the liquidation of an institution; 4) shall transfer the remainder of the public institution’s assets to the founder (founders). 5) draw up the act of liquidation of a public institution; 6) strike the liquidated institution from the register according to the procedure established by laws. 3. The liquidator shall be liable to the institution and the founder (founders) for the losses incurred through his fault. ARTICLE 43. Income Distribution and Tax Privileges of LNHS Public and State Public Institutions of Public Health Care The income of LNHS public and state public health care public institutions shall be distributed in the following order: 1) for implementation of the fundamental activities and obligations established in the institution bylaws; 2) for the tax payments into the budget, established by the law; 3) to raise the qualifications of institution personnel; 4) to acquire and introduce new health care technologies; 5) for capital repairs and reconstruction; 6) for the cultural and social needs of institution employees, provided for in group contracts. ARTICLE 44. The Nomenclature of LNHS Municipal and State Public Institutions 1. The nomenclature of LNHS municipal public institutions: 1) primary health care centres; 2) municipal polyclinics; 3) municipal out-patient facilities; 4) mental health centres; 5) general practitioner doctors’ offices; 6) general practitioner dentists’ offices; 7) municipal medical units; 8) municipal first aid station with its subsidiaries; 9) municipal support treatment and nursing hospitals; 10) city and district municipal hospitals, included on the list approved by the Ministry of Health; 11) medical rehabilitation and sanatorium treatment institutions, included on the list approved by the Ministry of Health. 2. The municipal council shall have the right to reorganise the institutions indicated in items 2 - 9 of part one, into primary health care centre departments or into separate legal persons. 3. The local executive institution of the municipality shall organise and administer the institutions of the nomenclature indicated in part one of this Article located in the territory of the municipality, according to the minimum normatives established by the Government on the apportionment and structure of the institution network. 4. The nomenclature of state personal health care public institutions which are subordinate to counties: 1) county hospitals, included on the list approved by the Ministry of Health (they may have branches namely, consultative polyclinics); 2) specialised hospitals, institutions of medical rehabilitation and sanatorium treatment, included on the list approved by the Ministry of Health; 3) county maternity homes. 5. The nomenclature of the state personal health institutions, which are subordinate to the Ministry of Health: 1) institutions founded by state universities or state scientific institutions and the Ministry of Health; 2) blood donorship institutions; 3) specialised hospitals, medical rehabilitation and sanatorium treatment institutions, included on the list approved by the Ministry of Health. 6. County governors shall administer the public institutions of the nomenclature indicated in part 4 of this Article, in accordance with the minimum Government-approved normatives of the placement and structure of the network of these institutions. 7. The Ministry of Health shall organise and administer the public institutions of the nomenclature indicated in part 5 of this Article, in accordance with the Government-approved minimum normatives of the placement and structure of the network of these institutions. ARTICLE 45. Nomenclature of LNHS State Public Institutions of Public Health Care The LNHS state public institutions of public health care are : 1) A centre for health law and economics supplying, according to its area of competence, legal and economics consultation services, preparing legal act draft plans in accordance to contracts with state administrative institutions, health insurance organisations, other natural and legal persons, generalising the practice of application of legal acts in the sphere of health promotion and submitting proposals to the Ministry of Health, to improve them, and engaging in publishing. The founder of this centre shall be the Ministry of Health; 2) public institutions, supplying services of public health monitoring, expert public health examination, hygienic and microbiological research and hygiene certification. These public institutions shall be organised from subdivisions of public health care institutions subordinate to the State Public Health Care Service at the Ministry of Health. This service shall implement the functions of the founder of these public organisations, according to the instructions of the Ministry of Health. THIRD SECTION SPECIAL CHARACTERISTICS OF LNHS INSTITUTION FINANCING AND MATERIAL SUPPLY ARTICLE 46. THE Financing of LNHS Institutions from State and Municipal Budgets 1. From the allocations of the state budget intended for health care: 1) supported closed budgetary institutions established by this and other laws; 2) supported state budgetary institutions as established in items 1-8 of part 1 of Article 24 and items 1-4 of part 2 of Article 25, of this Law; 3) funded refugee, illegal immigrant individual and public health care; 4) public health care measures funded by the Ministry of Health along with the Ministry of Internal Affairs, or the Ministry of National Defence, established at institutions and units subordinate to the Ministry of National Defence and the Ministry of Internal Affairs; 5) funded public health care measures, intended to prevent the occurrence and spread of dangerous and especially dangerous communicable diseases, liquidate outbreaks of communicable diseases and epidemics, and also to prevent the occurrence of medical effects of radiation accidents and ecological disasters, and measures of the liquidation thereof; 6) funded compulsory state health care programmes; 7) funded applied research in medical science according to priority programmes approved by the Ministry of Health, provided that this research shall be dedicated to resolve actual problems of LNHS administration and the protection, restoration and fortification of health, service appropriateness, accessibility, rendering thereof, and development of social justice. 2. From municipal budget allocations intended for health care: 1) budgetary institutions stipulated in items 1-2 of Article 24 and part 1 of Article 25 of this Law shall be supported; 2) additional support shall be provided for the care of persons in need of social support categories as established by the municipal councils; 3) compulsory health programmes of municipalities shall be funded; 4) primary public health care measures established by the Ministry of Health, shall be financed. These measures must be co-ordinated with the municipality association of Lithuania; 3. Public institutions shall have the right to obtain state and municipal budgetary funds for providing services according to health care contracts with the Ministry of Health, county governor and mayor of the municipality. 4. Extraordinary LNHS expenses may be funded from the state or municipal budgets and through state investment programmes. ARTICLE 47. Accounting of Non-medical Expenditures at LNHS Institutions Should a LNHS institution engage not only in basic medical care, but also in non-medical activity, it must keep separate health care and non-medical expenditure accounting. ARTICLE 48. The Procedure for Funding of Student and Resident Training and Raising of Specialist Qualifications at LNHS Institutions 1. The corresponding training institutions or the persons being trained themselves, shall cover student and resident training at LNHS institutions according to the procedure and conditions established by the Ministry of Health. 2. LNHS institutions shall have the right to compensate for the training of residents in accordance with the procedure and conditions established by the Ministry of Health or the Compulsory Health Insurance Council at the Government of the Republic of Lithuania. 3.The Ministry of Health along with the Compulsory Health Insurance Council shall establish the procedure of raising the qualifications of specialists in health care institutions. CHAPTER III THE RIGHTS AND RESPONSIBILITIES OF INSTITUTIONS ARTICLE 49. Institution Rights The Law on the Health System, this and other laws and legal acts shall establish the rights of health care institutions. ARTICLE 50. The Responsibilities of an Individual Health Care Institution 1. An individual health care institution must: 1) ensure urgent medical assistance; 2) ensure that the urgent public health care measures, required in accordance with the list approved by the Ministry of Health be implemented; 3) provide only such individual health care services indicated on the certification document issued to the institution; 4) ensure, that only such health care technologies be employed, as are approved according to established procedure and (
5. or)permitted to be used in the Republic of Lithuania. The medical products must be included on the State Register of Medical Products, which is established and administered by the Accreditation Service. The government shall approve the regulations of this register; 5) ensure that patient’s medical case histories and out patient cards would be recorded and protected and information concerning the patient, be furnished to state institutions and other institutions according to the procedure established by the Ministry of Health; 6) ensure equal rights for patients to health care services that are being rendered; 7) compensate for the harm inflicted upon the patient’s health in rendering services; 8) protect the medical confidentiality of patient, with the exception of instances, when a personal health care institution must provide information regarding the patient or when the patient agrees to have the information concerning the state of his health, made public; 9) inform the Ministry of Health, institution founders or owners, according to the procedure established by legal acts, concerning instances or outbreaks of internal infection and other cases of harm inflicted upon the health of patients. 2.The laws and other legal acts may establish other obligations, for individual health care institutions. ARTICLE 51. Internal Procedure Regulations of Individual Health Care Institutions 1) Individual health care institutions must have internal procedure regulations and ensure that they would be accessible for patient familiarisation. 2. The internal procedure regulations must indicate: 1) the procedure of patient application to the institution; 2) nomenclature and assortment of free services and procedure of the rendering thereof; 3) patient rights and responsibilities at the institution; 4) procedure of patient visiting, discharge and transfer to other individual health care institutions; 5) procedure of settling disputes and conflicts between the institution and patient; 6) procedure of providing information to patient and his family, concerning the state of his health; 7) procedure of making duplicate copies of case histories of illness, out-patient cards and other documents, and issuance thereof to patient or other natural or legal persons; 8) work hours of the administration of the institution and its other support services; 9) provisions of the laws regulating work safety, and of other legal acts and normative documents; 10) procedure of registration and safekeeping of articles made of precious metals, expensive prostheses and money, in the patient’s possession. 3. Institution employees must have a job description. ARTICLE 52. The Procedure of Admitting a Patient to an In-Patient Institution 1. It shall be prohibited to admit a person to an in-patient institution without his approval. 2. It shall be prohibited to admit to an in-patient institution a minor or legally incapable person without the approval of his legal representatives. 3. The approval of a patient or of his legal representatives shall not be required if: 1) the person’s life is endangered and he himself is unable to give such approval; 2) the minor’s or legally incapable person’s life is endangered and it is not possible to locate his legal representatives quickly; 3) other instances established by laws. 4. The procedure of a person’s speedy admission to an institution shall be established by the Ministry of Health. ARTICLE 53. Patient Registration at Individual Health Care Institutions 1. Institutions must implement patient registration and submit accounting according to approved forms concerning the health care of patients, to the Ministry of Health, or an institution authorised by it. For every patient, there must be an illness or nursing history, an out-patient card or an entry in the registration journal concerning his application. The originals of these documents shall be kept at the institution. 2. The Ministry of Health shall establish the procedure of submitting patient registration and accounting about the patients’ health care. 3. The Ministry of Health, having co-ordinated with its founders, shall establish the procedure of patient registration and accounting of patient health care, for institutions whose founders are the Ministries of National Defence or of Internal Affairs. ARTICLE 54. The Responsibilities of a Health Care Institution Following The Death of a Patient 1. Following the death of a patient, the institution must inform the members of his family, his legal representatives, or in the event he is still living, to persons, designated by him no later than within a period of 12 hours. 2. The Ministry of Health shall establish the procedure of certification of a patient’s death at the institution. 3. Upon death of a patient at the institution, an anatomical examination shall b e performed by a pathologist, when: 1) members of the family of the deceased or his legal representatives demand this; 2) death occurs suddenly and unexpectedly; 3) cause of death is unclear; 4) death occurs following surgical interventions, diagnostic or treatment procedures; 5) death occurs as a result of occupational or infectious diseases or suspicion exists that an occupational or infectious disease is the cause of death; 6) a new-born infant or child dies; 7) a pregnant woman or one giving birth dies; 8) a person, who has not spent 24 hours as an in-patient dies; 9) in other instances stipulated by law. 4. Following the death of a patient, a legal medical expert examination shall be performed in instances when: 1) death occurs as a result of an injury, poisoning or criminal abortion; 2) identity of the deceased is unknown; 3) suspicion exists that violence is the cause of sudden death; 4) it is impossible to establish the cause of death by any other means; 5) in other instances stipulated by law, upon obtaining a requirement from law protection institutions. 5. The institution shall guarantee free protection of the body of the deceased until such time as it shall be claimed by members of the family of the deceased, his legal representatives, or the persons stipulated by the patient, while still alive, but no longer than covering a period of 4 days, following an anatomical examination by a pathologist or performance of a legal medical expert examination. 6. Upon expiration of the time limit indicated in part 5 of this Article, the body of the deceased is released to the local morgue. ARTICLE 55. The Responsibilities of a Public Health Care Institution 1. A public health care institution must: 1) ensure implementation of urgent public health care measures; 2) provide only such services, as are stipulated by the accreditation certificate issued to the institution; 3) employ only such research methods and only those health care technologies which are approved and allowed in the Republic of Lithuania; 4) ensure the commercial confidentially of natural and legal persons. 2. The laws and other legal acts may also establish other responsibilities for public health care institutions. ARTICLE 56. Internal Procedure Regulations of Public Health Care Institutions 1. Public health care institutions must have internal procedure regulations which have been approved according to the procedure established by the statutes of the institution. 2. The internal procedure regulations must indicate: 1) the procedure governing applications by natural and legal persons to the institution; 2) the rights and responsibilities of legal and natural persons linked with the institution; 3) the procedure of resolving disputes and conflicts arising between the institution and legal or natural persons; 4) the procedure of providing information to interested legal and natural persons, concerning the institution’s activity; 5) the institution’s work hours and distribution thereof. 3. Employees of the institution must possess work description. PART III CONTROL OF THE ACTIVITY OF INSTITUTIONS ARTICLE 57. State Control of the Services Provided by Institutions 1. State Control of the services provided by the Minister of Health shall be implemented by: 1) officers appointed by the Minister of Health; 2) State Medical Audit Inspection - of institutions, regardless of the form of their property, accessibility of their individual health care services, quality (suitability) and economic effectiveness of state control; 3) State Patients’ Fund - of individual health care services, compensated from the compulsory health insurance fund budget, quantity and quality control, and the financial and economic analysis of the use of compulsory health insurance fund money at institution having contracts with local patients’ funds for rendering services. 4) the Medical Ethics Committee of Lithuania - of state control of the correspondence of services, rendered by a health care institution, to medical ethics requirements; 5) State Public Health Care Service - of state control of accessibility, adequacy and effectiveness of services rendered by public health care institutions; 6) State Hygiene Inspectorate at the State Public Health Care Service - of state hygiene control of all institutions, regardless of their form of property. 2. State Control at health care institutions, the founders whereof are the Ministries of National Defence and Internal Affairs, shall be exercised according to the procedure established by the Government. ARTICLE 58. The Rights and Responsibilities of State Institutions Controlling The Rendering of Services 1. The heads of the institutions, indicated in Article 57 of this Law, or the officers appointed by them, (further officers) shall have the right: 1) to enter an institution without hindrance and check, at any time, upon submitting a document of appointment to the head or his representative, whether the requirements of legal acts and (
6. or)normative documents are being violated; 2) to request and obtain the necessary information, documents, material, laboratory exams, data on patient medical check ups and test results, verbal and written explanations of institution heads and other employees, which are needed to effect verification; 3) to request that additional tests for patients; 4) to submit a substantiated proposal to the Minister of Health or his authorised representative, to interrupt or annul the validity of doctor’s medical practice licenses or other licenses established by laws, to engage in health care; 5) to request the head of administration of an institution to remove within a one month-period, health care specialists and verify their professional competence, if professional shortcomings have been established in the activities of these experts, that could have posed or did pose harm or danger to patients’ health, or if the qualifications of health care experts do not meet the stipulated requirements, or if these specialists are unable to perform their duties, due to the state of their health. The Ministry of Health shall establish the procedure of verification of the professional competence of health care specialists. During the period of suspension from work, work compensation shall be withheld from health care specialists; 6) to bring charges against workers of an institution for violations of laws and other legal acts in health promotion. 2. The head of administration of an institution must comply with the request of an officer to dismiss a health care expert. A health care expert shall have the right to lodge a complaint against such a decision by an officer, with the Ministry of Health, which must examine his application within 7 days from the day it was submitted. 3. An officer must submit an act of verification, conclusions and recommendations to the head of the institution who ordered the verification investigation and the head of the institution which was being investigated. 4. Interference with the officer’s performance of his duty, shall bring upon the head of the institution liability established by laws. 5. For exceeding their authority, officers shall be liable in accordance with the procedure established by laws. ARTICLE 59. Termination of the Rendering of Services at an Institution 1. he Accreditation Service, State Medical Audit Inspection, State Public Health Care Service and State Hygiene Inspectorate shall have the right to terminate the rendering of certain or all of the services at an institution, by decisions adopted according to their competence if: 1) the institution or a department (branch) thereof, shall engage in non-accredited type of activity; 2) health care engaged in by an institution or by a division thereof, shall fail to correspond to legal acts or requirements of normative documents and therefore, shall pose an actual danger to the health of patients or cause harm to people’s health and losses to legal and natural persons; 3) the institution is not registered in the institution register or is registered in violation of the requirements of this Law and has not been implementing the requirements of the register administrator for more than 3 months; 4) persons not having the right engage in health care are engaged in it, at the institution; 5) the premises, operation and health care technologies of an institution or a branch thereof, fail to correspond to requirements of legal acts and (or)normative documents. 2. The rendering of services by an institution may be interrupted for no more than 3 months. The state institutions indicated in part 1 of this Article, having adopted such a decision, must inform the head of the institution about actual motives behind such a decision and the time limit for the elimination of violations or shortcomings. 3. Heads of the institution, who fail to implement the decisions adopted according to this Law to interrupt rendering of all of part of the services, shall be liable in accordance with the procedure established by laws. 4. Following interruption of personal health care rendering at the health care institution, patients of the institution shall be transferred (re-registered) in other institutions according to the procedure established by the Ministry of Health. 5. An institution must remove the shortcomings over the time limit indicated in Part 1 of this Article by state institutions. Following the elimination of obstacles, the activity of the institution may be renewed per directive of the state institutions indicated in part 1 of this Article. 6. Should the institution fail to remove obstacles over the established time limit, the institution which has interrupted activities shall apply to the Accreditation Service regarding annulment of institution accreditation (limitation) and to the Ministry of Health concerning the removal of the administrative bodies of the institution and appointment of a temporary administrator. ARTICLE 60. Procedure of Removal of the Administrative Bodies of an Institution and Appointment of a Temporary Administrator 1. The administrative organs of the institution shall be removed and a temporary administrator appointed if: 1) the institution shall not remove the established violations or shortcomings and a threat be posed as a result of that to the suitability of services rendered by it and the health of patients, however there still exists an actual possibility of remedying the situation; 2) in the course of the same year an outbreak of hospital infection shall reoccur at the institution, due to shortcomings in the institution’s administrative activity; 3) more than one case of death occurs within the same calendar year, at the institution, through the fault of an institution specialist or several specialists. 2. A temporary administrator shall be appointed for a period of up to 6 months. Upon request of the temporary administrator, the Minister of Health may extend this request for up to a one-year term. ARTICLE 61. The Temporary Administrator of an Institution 1. The temporary administrator of an institution is a head of the health care institution designated by the Minister of Health during the period of removal of the administrative bodies of an institution. The Ministry of Health shall establish qualification requirements of temporary administrators. The employee of an institution whose administrative bodies are being removed, may not become a temporary administrator of the institution. The Minister of Health or his appointed representative, shall form or annul the contract with a temporary administrator. 2. All of the authorisations of the governing bodies of the institution shall be transferred to the temporary administrator from the day of the temporary administrator’s appointment. 3. The temporary administrator shall have the right to annul or form, labour contracts with members of the administrative bodies and other employees. 4. The temporary administrator is not obligated to comply with the decisions of the institution founder with the exception of the instances cited in part 5 of this Article. 5. The temporary administrator can not sell or otherwise transfer, exchange property, mortgage property, reorganise or liquidate the institution, resolve other questions within the exclusive competence of the institution founder or owner. 6. The temporary administrator must inform the Minister of Health, the Accreditation Service and the institution founder or owner about the progress and results of administrating, according to the procedure and terms established by them. 7. The temporary administrator must establish revision of the institution and perform hygienic, epidemiological, labour safety and medical audit expert examinations. Expert examinations must be conducted within a 3-month period from the day of appointment of the temporary administrator. 8. Having established violations of laws, other legal acts and (
7. or)normative documents, in the course of revision, the temporary administrator shall apply to the Accreditation Service for annulment of accreditation and inform the Ministry of Health thereof. 9. The temporary administrator shall answer for the harm caused to the institution through his fault, according to the procedure established by laws. ARTICLE 62. Recall of the Temporary Administrator of the Institution The temporary administrator of an institution shall be recalled per order of the Minister of Health prior to the expiration of his term, if: 1) the Accreditation Service establishes, that the institution may function in a reliable and stable manner; 2) accreditation of the institution is cancelled. ARTICLE 63. The Rights of State Institutions Which Control Institution Activities 1.The state institutions indicated in this Law, which control the activity of institutions, shall according to their competence, have the right to: 1) admonish the institution regarding the shortcomings and violations in its activities and establish the terms of their elimination; 2) issue administrative reprimands to the heads of administrative bodies in accordance with the law; 3) require, that the professional qualification of the institution’s health care specialists be verified; 4) to interrupt the rendering of all or a part of the services; 5) to enjoy the other rights established in this and other laws. 2. The state institutions, indicated in this law, which control institution activity shall apply control measures and sanctions to institutions, taking into consideration the content of violation on the basis whereof the control measure shall be applied. 3. The decisions of the state institutions indicated in this Law, which control institution activity, concerning control measures or application of sanctions, may be appealed during a period of 30 days, in accordance with the procedure established by law. The appeal shall not interrupt implementation of the decisions by the state institutions controlling the activities of institutions, cited in this Law. ARTICLE 64. The Principles and Procedure of Applying Control Measures of Institutions’ Activities 1. State institutions which control the activities cited in this law, shall adopt a decision concerning the measures of control of institution activities and application of sanctions stipulated in this Law, if at least one of the following conditions is present: 1) the state institutions cited in this Law which control the activity of institutions, have not been furnished the information or documents necessary in control of institution activity, or such information and documents fail to correspond to reality; 2) the laws which have been violated and requirements of other legal acts and (
8. or)normative documents, regulating the activity of institutions. 2. The question of applying a control measure to an institution shall be deliberated in the presence of its representatives. Should the representatives of an institution fail to be present at the deliberation of the question, the decision to apply a control measure shall be adopted without them. 3. The decision regarding application of control measures, with the exception of the control measure, indicated in paragraph 2 part 1 of Article 63, must be adopted within 3 months of the day of the establishment of the violation. Control measures may not be applied for violations from the day of establishment of the committal whereof, more than one year has elapsed. ARTICLE 65. Activity Control of Closed Budgetary Institution 1. Activity control of a closed budgetary institution shall be carried out according to the procedure established by the Government. 2. The privacy of a closed budgetary institution shall be ensured according to the procedure established by institution bylaws. ARTICLE 66. The Procedure of Rendering Free Services At Institutions 1. Persons who have compulsory health insurance shall have a right to free services extended by LNHS institutions and other institutions which have formed agreements with the local patients’ fund. The Law on Health Insurance shall establish a list of these. 2.. Urgent medical assistance shall be extended free of charge to all residents of the Republic of Lithuania, without regard as to whether they are insured by the compulsory health insurance, as well as, not taking into consideration the number of times the patient has visited the institution during the calendar year, and his place of residence. For citizens of foreign countries, persons without citizenship, those not insured by compulsory health insurance, the LNHS institutions extend only urgent medical assistance in accordance with the procedure established by the Government, unless international agreements of the Republic of Lithuania shall establish otherwise. 3. The principal conditions of extending free services at the LNHS institutions shall be: 1) the patient’s applying or obtain free services from primary health care physicians (general practitioners etc.), the list of whose specialities shall be decided by the Ministry of Health; 2) the patient’s application to obtain free services at secondary or tertiary health care institutions. In these cases a patient must submit a referral from a primary health care physician regarding the extension of free services or a substantiated attestation from another institution for continued free services, according to the procedure established by the Ministry of Health; 3) a patient’s right to select any LNHS primary health care institution and physician and also, according to the conditions provided for in this Article, secondary and tertiary health care institution and doctor to provide free services in accordance with the procedure established by the Ministry of Health and the Council of Compulsory Health Insurance. 4.The requirements set forth in Part 3 of this Article, shall not be applied for patients, who had sought urgent medical assistance. 5. Health care institutions of state universities and the Ministry of Health tertiary health care institutions shall have the right to provide primary and secondary health care services for science and instruction purposes 6. Institutions shall have no right to require additional payment from a patient for free services rendered. Should patients who have the right to free services, choose on their own initiative more costly services, they shall themselves compensate the difference between the actual costs of these services and free services, according to the procedure established by the Ministry of Health. If patients having the right to free services, choose additional services of their own initiative. They shall pay the cost of these services themselves according to the procedure established by the Ministry of Health. 7. Institutions must furnish information to the population concerning the kinds of free services available, their range and base costs. 8. The basic conditions of provision of free services by the closed budgetary institutions of the Ministries of National Defence and Internal Affairs shall be established by the Government. ARTICLE 67. Final Provisions 1. This Law shall come into force according to the procedure established by the Amendment of the Republic of Lithuania Law on the Implementation of the Law on the Health Care Institutions. 2. Active institutions must be accredited for health care activities and registered in the Institution Register prior to December 31, 1998. 3. Following the entry into force of this Law, the Republic of Lithuania Laws and other legal acts pertaining to questions of organising health care, shall be in effect insofar they shall not contradict the Law on Health Care Institutions. I promulgate this Law passed by the Seimas of the Republic of Lithuania PRESIDENT OF THE REPUBLIC ALGIRDAS BRAZAUSKAS