REPUBLIC OF LITHUANIA

REPUBLIC OF LITHUANIA REPUBLIC OF LITHUANIA LAW ON HEALTH CARE INSTITUTIONS No. I - 1367 Vilnius June 6, 1996 PART  I GENERAL PROVISIONS Chapter I PURPOSE AND GENERAL CONCEPTS OF THE LAW Article 1. Purpose of the Law This Law shall designate the types 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 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 for 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, which has been accredited according to the procedure established by this Law and others and legal acts, to provide health care services (further - services); 2) institutions or enterprises engaged in other (non health care) activities, branches or departments, accredited to provide health care services. 2. LNHS denotes the Lithuanian National Health System, regulated by the Law on the National Health System. 3. Open Institution denotes an institution whose services are available to all or to population members of a corresponding (particular) territorial administration unit. 4. Closed Institution denotes an institution, whose services are only available to groups of residents specified by this Law. 5. Hospital denotes an institution accredited to carry on in-patient or also out-patient individual health care, to provide stipulated preventative, medical restorative aid, nursing, medical rehabilitation, social, health instruction and individual health expert examination services. 6. Vilnius University or Kaunas Medical Academy Hospital denotes a hospital in which the process of instruction, studies, professional improvement of the students in medical specialities, residents and health care specialists, is taking place and medical science is being developed. 7. Clinical Hospital denotes a hospital in which the active of Vilnius University or Kaunas Medical Academy carry on activities according to the procedure established by the Ministry of Health. 8. Clinic denotes a unit of the clinical department and hospital of the Vilnius University or Kaunas Medical Academy, wherein individual health care of the highest qualification is performed, health care specialists are trained and developed, and scientific work is conducted. 9. Rehabilitation Hospital denotes a hospital wherein specialised medical, social and professional rehabilitation of patients is conducted. 10. Hospital for Support Treatment and Nursing denotes an institution accredited to provide stipulated nursing and social services for patients with chronic diseases who have limited self help possibilities. 11. Tissue and Organ Transplant Bank denotes an institution accredited to carry out the functions of collection, storage, transportation and examination of tissue and organs intended for transplantation. 12. Sanatorium Health Resort Institution denotes an institution located in a resort area, accredited to provide designated medical rehabilitation services and to perform relapse prevention treatment of patients with chronic diseases. 13. Polyclinic denotes an institution accredited to render stipulated restorative and preventative medical aid, medical rehabilitation and health promotion services for patients (ambulatory as well as house-bound), and also one performing medical expert examinations regarding the patients’ ability to work. 14. Out-patient facility denotes an institution accredited to provide stipulated restorative, preventative medical aid, medical rehabilitation and health promotion services for patients (ambulatory as well as house-bound) and also one performing expert medical examinations regarding the patient's ability to work. 15. Medical Station denotes an institution accredited to render stipulated restorative, preventative medical assistance, medical rehabilitation and health promotion services to patients (ambulatory and house-bound). 16. Public Health Care Bureau denotes an institution, accredited to perform public health monitoring (the state of public health, social, economic and political factors influencing it, measures implemented by the local authorities, for health preservation and strengthening, primary health care resources and municipal health programmes), expert examination of public health (expert analysis of public health monitoring data) and prepare and implement according to its competence, health strengthening strategies within the municipal area. 17. Centre for Disease Prophylaxis and Control denotes an institution accredited to implement public health monitoring and perform expert public health examination in the area of non infectious (non contagious) disease prophylaxis and control, and to prepare and implement according to its competence, the strategies of disease prophylaxis and control within counties. 18. Public Health Centre denotes an institution, accredited to carry out state control of public hygiene, public health monitoring (work and living environment, food, drinking water), to perform expert examination of public health (to summarise and analyse corresponding data of public health monitoring in the municipalities of a county, and also monitoring data of labour and living environment, food, and pollution of drinking water), epidemiological care of contagious diseases, and to generalise implementation, application of health preservation and strengthening strategies within municipalities of corresponding counties and to propose measures for improving them. 19. Specialised Public Health Centre (labour medicine, environmental hygiene, nutrition, radiation protection, prophylaxis and control of contagious diseases etc.) denotes an institution accredited to perform state hygiene control, health expert examination, public health monitoring, epidemiological care of contagious diseases, prepare and implement measures of disease prophylaxis and control according to its competence. 20. Institution for Neutralisation of Infection - denotes an institution accredited to perform disinfection, disinsection and deratization services. 21. Accrediting of Institution denotes the granting an institution of the right to render services, the periodic review of the satisfaction of the legal act requirements, by the institution’s activities and the issuance of accrediting document license and accrediting certificate. 22. Patient denotes a person who avails himself of the services rendered by institutions, regardless of whether he is healthy or ill. 23. Types of Services denotes the types of health care and services stipulated by the Law on the Health System. 24. Free Services denotes health care supported by the state and municipal governments (free of charge), with the exception of services indicated in part 3 of Article 64 of this Law. Chapter II TYPES AND KINDS OF INSTITUTIONS, THEIR ACCREDITING, REGISTRATION AND THE PRINCIPLES OF STATE REGULATION OF ACTIVITIES Section I TYPES AND KINDS OF INSTITUTIONS Article 3. Types of Institutions 1. The types of institutions are as follows: 1) LNHS institutions; 2) Institutions that are not under LNHS. 2. LNHS Institutions: 1) state or municipal individual health care public institutions (non profit), whose activities shall be regulated by this Law and other laws of the Republic of Lithuania and legal acts. The principal source of funding for these institutions shall consist of compulsory health insurance funds, obtained according to the procedure established by the Law on Health Insurance. These institutions may obtain special purpose allocations as well, from the state or municipal budget for the purpose of providing free services and other funds designated by this Law and other laws; 2) state and municipal budgetary institutions for individual health care shall be regulated by institutions of the Budget in accordance with this Law or other laws. The principal funding source of these institutions shall be comprised of special purpose allocations from the state or municipal budget for the purpose of rendering free services. These institutions may obtain a contract order from the regional patients’ fund, for rendering individual health care services, guaranteed by compulsory health insurance as well as corresponding funds of the compulsory health insurance for implementing this order. For other services rendered and measures and health programmes implemented, they may also obtain other funds designated by this Law and other laws; 3) private individual health care state institutions, whose principal source of funding shall be comprised of the allocations earmarked for implementation of state-supported (free) individual health care. For services rendered, measures and health programmes implemented these institutions may obtain other funds also designated by this Law and other laws; 4) state and municipal public health care budgetary institutions, whose principal source of funding is comprised of state and municipal budgetary special purpose allocations for the implementation of requisite public health care measures. These institutions may also obtain other funds designated by this Law and other laws, for services being rendered and measures and health programmes being implemented; 5) state and municipal public health care institutions, whose principal source of funding is comprised of state or municipal authority budget-allocated special purpose funds for those requisite public health measures, which shall not be implemented by state or municipal public health care institutions. For services rendered, measures and health programmes implemented, these institutions may obtain also other funds designated by this Law and other laws. 6) profit health care institutions and public individual health care institutions of religious communities, associations and public organisations that may temporarily be subordinated to LNHS, if they shall draw up health care contracts, according to the conditions prescribed in Article 22 of this Law, with clients of LNHS with respect to the rendering or implementing of the services designated in paragraphs 1, 2 or 5 of part 2 of this Article, and perform the functions of LNHS institutions in accordance with these contracts. Health care contracts shall specify the duration of the institutions’ LNHS affiliation. Those profit institutions, who have formed contracts with the clients of LNHS activities, shall further in the Law, be referred to as LNHS institutions. 3. The institutions not under the LNHS, are profit institutions and also those individual public health care institutions of religious communities and associations and public organisations, who have not formed health care contracts with the clients of LNHS activities. Article 4. The Kinds of Institutions According to Services Being Rendered 1. In accordance with the individual health care services they render, institutions shall come under the following categories: 1) in-patient individual health care services such as hospitals, clinical hospitals and Vilnius University or Kaunas Medical Academy hospitals. According to their structure, these institutions may have departments or branches, rendering out-patient individual health care services; 2) specialised medical, social and professional patient rehabilitation hospitals; 3) support and nursing hospitals for the support treatment, nursing and social services for patients having chronic diseases and limited self-help abilities; 4) sanatoriums for medical rehabilitation of patients and relapse preventative treatment of patients having chronic diseases; 5) tissue and organ transplant banks for the collection, storage and transportation and examination of tissues and organs designated for transplantation; 6) blood donor institutions for reception of human blood for donorship purposes, its storage; 7) polyclinics and out-patient facilities for established replacement and preventative medical aid and medical rehabilitation services in accordance with the approved primary health care specialities of rendering to patients (those coming in for treatment and those at home, and other groups of individuals, stipulated by this Law), also for expert medical examination of patients’ ability to work and organising of health promotion work; 8) medical stations for rendering to patients (coming to obtain treatment and those at home, and other groups of persons established by this Law), the services of replacement and preventative medical aid, approved according to primary health care specialities; 9) offices of general practitioner doctors and general practitioner dentists for rendering established primary health care services and also, for performing expert medical examination of the patient’s ability to work and health promotion; 10) institutional (out-patient or in-patient) capable of rendering urgent medical aid - first medical aid or emergency hospitals; 11) maternity homes for supervision of those pregnant and rendering of stipulated individual health services to them; 12) mental health centres and psychiatric hospitals for the prophylaxis and control of stipulated mental diseases and rendering of individual health care to people with mental disabilities and mental patients; 13) dispensaries for the treatment of persons with skin and venereal diseases, and AIDS, out-patient and in-patient individual health care, health promotion, skin and venereal diseases and AIDS centres; 14) detoxification centres for those suffering of alcohol, narcotics or psychotropic substance poisoning, for individual detoxification or (and) elimination of the withdrawal syndrome; 15) individual health potential expert examination, medical rehabilitation and health promotion centres; 16) infants’ homes for support treatment, nursing, social services and medical and social rehabilitation of infants with congenital developmental disabilities as well as, sight deficiencies; 17) pathoanatomical expert examination, legal medical expert examination, legal psychiatric and narcological expert examination and medical and social expert examination institutions of established types of individual health expert examination institutions; 18) commissions of medical expert examiners of persons entering into service of national defence, internal affairs system, police or national defence institutions and also health potential expert examinations of military and internal affairs system officials; 2. The following institutions are listed according to public health services being rendered: 1) public health protection, including physician consultations in labour medicine, labour medicine centres, environmental hygiene (ecological medicine), radiation protection centres, nutrition centres and other specialised public health centres; 2) disease prophylaxis and control of diseases (non-infectious and (or) contagious diseases) prophylaxis and control centres; 3) public health monitoring, public health expert examinations, public health care bureaux, public health centres and health information centres; 4) public health strengthening, public health promotion centres; 5) institutions for prophylactic neutralisation of infection of the environment and sources of contagious diseases (disinfection, deratization and disinsection); 6) quarantine stations for the quarantine and medical protection of the borders and territory of the Republic of Lithuania from particularly dangerous contagious diseases. 3. The status of institutions indicated in parts 1 and 2 of this Article, shall be established by their founders (owners) according to the procedure established by laws. 4. The institutions of the kinds indicated in this Article, and the types and range of the services they shall be permitted to provide shall be indicated in documents attesting to the accrediting of the institutions, which shall be issued according to the procedure established by this Law and other legal acts. Article 5. The Name of Institutions 1. The name of an institution must be in keeping with the kinds of services provided by it, indicated in parts 1 and 2 of Article 4 of this Law. The symbol of the institution must be registered in accordance with the procedure established by the laws of the Republic of Lithuania. 2. The names of the types of institutions, indicated in parts 1 and 2 of Article 4 of this Law, or the combinations thereof, may be used by institutions only. Section II ACCREDITING OF INSTITUTIONS FOR HEALTH CARE Article 6. Accrediting 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 (or) public health care and have obtained a document (license, accrediting certificate), attesting to accrediting from the State Service of Accrediting for Health Care Activities at the Ministry of Health (further - Accrediting 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 Accrediting 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 for institution accrediting and the issuance of licenses and accrediting certificates attesting thereof. 3. An accredited institution shall have the right to render only the services stipulated on the license or accrediting certificate. An institution may not transfer the license or accrediting certificate to other persons. A fee in the amount established by the Government, shall be paid for issuance of a license or accrediting certificate. Issuance of an accrediting certificate and (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 6 months, in the course of which the institution must apply for issuance of an accrediting certificate. An accrediting certificate for all institutions is issued for a five-year period only. The term of validity of an accrediting 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 accrediting requirements of institutions, while the accrediting requirements of closed institutions shall be handled by the Ministry of Health, in conjunction with the Ministry of National Defence or the Ministry of Internal Affairs. Article 7. Decisions of the Accrediting Service Regarding the Accrediting                             of Institutions 1. The Service for Accrediting must adopt a justifiable decision regarding accrediting of an institution within a period of two months from the receipt of the statement and other documents. 2. The Service for Accrediting shall examine the submitted documents within a period of 30 business 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 Accrediting shall assign experts to assess the local activities of the institution. 3. The Service for Accrediting shall approve a decision: 1) to accredit an institution or department (departments) thereof for health care activities; 2) to accredit an institution or its department (departments) for health care activities with stipulations: 3) to postpone accrediting 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 accrediting 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 (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 Accrediting must inform no later than within 10 business days following the 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 accrediting certificate in the established form. 5. Upon expiration of the accrediting term of validity, the institution or department (departments) thereof may continue their activities for a term not to exceed 90 business days. 6. The Ministry of Health shall determine the conditions of accrediting with stipulations. 7. The Service for Accrediting shall have the right to postpone the accrediting 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 Accrediting may fail to accredit an institution or structural department (departments) thereof, for health care activities or annul its accrediting, 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 Accrediting must inform in writing the institution founders (owners) concerning deliberation of the accrediting 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 Accrediting must furnish a written notice, within 3 business 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 accrediting of an institution or the department (departments) thereof. 11. The decision of the Service for Accrediting, to interrupt the accredited activities of an institution or the department (departments) thereof, must be approved by the Minister of Health within three business days from adoption of the decision by the Service for Accrediting. 12. The decisions of the Service for Accrediting, regarding the accrediting of an institution or department (departments) thereof , may be appealed in court according to the procedure established by laws, during the period of 30 days following the approval of the decision. The appeal does not suspend implementation of the decisions by the Service for Acrediting. Section III REGISTRATION OF ACCREDITED INSTITUTIONS Article 8. 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. The 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 9. Procedure for the Registration in and Striking from the Institution                             Register of Accredited Institutions 1. Upon the accrediting of an institution, the Service for Accrediting 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 business 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 business 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 the law, the authorities must inform the Keeper of the Institution Register within a period of ten business days. 5. Institutions shall be removed from the Institution Register under the following circumstances: 1) upon annulment by the Service for Accrediting of an institution’s accrediting 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 accrediting 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 Accrediting, institution founder (founders), institution administration head or institution liquidator must, within 7 business 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 business 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 this decision, the Keeper of the Institution Register must inform the administration of the institution. 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 they shall be transferred to the archives. 8. Institutions shall pay stamp duty for registration, in the amount stipulated by the Government. Article 10. Use of the Institution Register Data 1. Legal and natural persons shall have the right to make use of Institution Register data 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, that concerns closed institutions of the Ministries of Internal Affairs and National Defence. Section IV THE PRINCIPLES OF STATE REGULATION OF INSTITUTION ACTIVITIES Article 11.   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; 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 orders of the Chief State Hygiene Officer of the Republic of Lithuania; 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 required for institution activities legal acts or normative documents, the institution shall prepare and per order by head of the institution, shall approve standards of the institution and the health care methodologies and regulations of internal procedure. 3. Institutional standards and health care methodology and internal procedural regulations must not be contrary to the legal acts, currently in effect in Lithuania and the 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 12.   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 in conjunction with Vilnius University or Kaunas Medicine Academy, the Vilnius University or Kaunas Medicine Academy hospitals, in accordance with the procedure established by law; 3) keep the Institution Register; 4) establish for subordinate institutions the requisite health care tasks and the procedure for 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 order 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 on institution activities, records of institution activities and accounting procedure; 12) implement the other functions established by this and other laws. Article 13. Approval of the Normative Acts of LNHS Institutions 1. The Government shall approve the following minimal normative acts of the LNHS infrastructure: 1) the nomenclature of the number of institutions established by this Law of the primary, secondary and tertiary level of organising of activities of LNHS institutions; 2) nomenclature of individual and public health care specialities of primary, secondary and tertiary levels of organising of LNHS activities; 3) specific profiles of the number of beds within in-patient institutions of individual health care; 2. The Ministry of Health, county governors and executive institutions of municipal government must ensure minimal normative acts on the infrastructure of LNHS institutions, stipulated by the Government; 3. Other laws of the Republic of Lithuania may establish also other normative acts of infrastructure of LNHS institutions. Article 14.   State Regulation of the Cost of Services Rendered by Profit                                Institutions 1. The founders (owners) of profit institutions shall establish the costs of services rendered by the institutions. These costs may not exceed the service costs established for the LNHS institutions, by more than 60 (sixty) per cent. 2. The pure income (profit), obtained by the institutions for services rendered, shall be taxed according to procedure established by laws, in applying a preferential tax rate, if the institution uses more than 75 per cent of its pure income (profit) for investments in expanding its assortment of services, for implementation of new health care technologies and improvement of health care availability and suitability. Article 15.   Pricing Principles of Services Rendered by LNHS Institutions                                and the Special Features of Cost Compensation 1. The Health Ministry, having co-ordinated this with the State Service for Competition and Consumer Rights Protection at the Government of the Republic of Lithuania, shall determine the cost of services rendered by LNHS institutions. Pricing principles of the services rendered by LNHS institutions: 1) fair competition; 2) information availability on the cost of services; 3) cost limitation; 2. The costs of services of requisite health promotion activities of equal complexity level, rendered at LNHS institutions, may not vary by more than 20 percent with the basic costs, which shall be established in accordance with the procedure established by the Law on the Health System. If the factual costs of the services rendered by an institution, amount to more than 20 per cent of income, received for services rendered according to established basic costs, the client of LNHS activities may reimburse for the difference in cost, only in the course of one calendar year. It is prohibited for institutions which render services of more than one kind, to include the cost of one service into the cost of another being rendered. The Ministry of Health shall determine the procedure of reimbursing the difference between the costs of services. Article 16. Special Features of the Privatisation of LNHS Institutions 1. LNHS institutions or the parts thereof, which are capable of acting as independent functional departments, may be privatised according to procedure established by laws and other legal acts, if they are no longer being accredited. 2. The funds obtained upon privatisation of these health care institutions or the parts thereof, shall be transferred according to procedure established by law or other legal acts, to state or municipal health funds, correspondingly. 3. The Seimas upon the recommendation of the Government, shall approve the decision on privatisation of LNHS institutions. Proposals on privatisation of an LNHS public institution may be submitted to the Government: 1) for privatisation of institutions of primary level of organising of LNHS activities, by the municipal council, having co-ordinated with the Ministry of Health; 2) for privatisation of institutions of secondary level of organising of LNHS activities, by the Ministry of Health having co-ordinated with the county governor; 3) for privatisation of institutions of tertiary level of organising of LNHS activities, by the Ministry of Health. 4. The privatisation of LNHS institutions must not worsen the level of compulsory health promotion activities established by legal acts. Article 17.   Legal Protection of the Institution Activities of Health Care                                Specialists 1. Employers shall be prohibited from exerting influence upon the institutions, regarding labour relations in connection with the professional activities of health care specialists, if these do not violate the legal acts and requirements or normative documents. 2. Employers shall be held liable in accordance with the laws, for interference with the performance by health care specialists, of their professional duties and adoption of legal decisions. Article 18. Keeping of 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 Lithuanian or Latin. 2. The Ministry of Health shall regulate the preservation of institution documents, according to the procedure established by laws. PART II HEALTH CARE INSTITUTIONS Chapter I PROFIT HEALTH CARE INSTITUTIONS Article 19.   Legal Acts of the Republic of Lithuania, Establishing the Founding,                                Reorganisation and Liquidation of Profit Institutions The Law on Enterprises, the Law on Register of Enterprises, laws on individual types of institutions and other laws and legal acts shall regulate the questions of the establishment of accredited branches, reorganisation and liquidation of profit health care institutions (further - profit institutions), accredited to provide services, and also of enterprises which are engaged in other (non health care) activity, to provide services. Article 20. Restrictions of Profit Institution Activities 1. Profit 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 organisations may be established only for these types of public health care activities: 1) health promotion; 2) expert hygienic examination according to the list approved by the Ministry of Health; 3) assessment of labour and environmental hygiene; 4) for list approved by the Ministry of Health and (or) microbiological research; 5) disinfection, deratization and disinsection. 3. The Ministry of Health shall establish the procedure for approval of conclusions of assessment of the rendering of services indicated in part 2 of this Article, expert hygienic examination, of labour and environment. Article 21. Special Features of Profit Institution Activities 1. First aid and out-patient urgent medical aid provision to patient shall be reimbursed to the profit institution out of municipal budgetary funds in accordance with the approved costs of LNHS institution services and also, the nomenclature and assortment thereof. 2. Medical and social expert examination of labour potential at profit institutions shall be performed in accordance with the procedure established by the Ministries of Health, and Social Protection and Labour. 3. For use of LNHS institution services (tests, specialist consultations) profit institutions must reimburse them in accordance with the service costs established for LNHS institutions. 4. Profit institutions must, according to their competence and their funds, implement the requisite public health care measures, which shall be established by the Ministry of Health. 5. If a state or municipal institution seeking to obtain profit during the current calendar year, receives more than 75 percent of its income for work performed according to a contract with clients of LNHS activities (budgetary funds and compulsory health insurance funds, obtained for the extent and quality of services rendered to the population, are included in the limit), thus, it may be re-registered into a LNHS public institution during the next calendar year. Article 22.   Basic Conditions in Contracts of Profit Institutions with the Clients                                of LNHS Activities 1. If the LNHS institutions have no possibilities of rendering individual types and assortments of services, reimbursed from state and municipal budgets or compulsory health insurance funds, LNHS clients shall have the right to form health care contracts with a profit institution, through public tenders for rendering these services. The Government shall establish the conditions and procedure of the public tenders. 2. The basic conditions of contracts of LNHS clients and profit institutions shall be established by the Government: 1) the costs of health care services rendered by profit institutions, may not exceed the costs of health care services established for LNHS institutions. 2) individual health care profit institutions must carry civil responsibility insurance in order to compensate damages incurred by the patients in the course of rendering of individual health care services, if other laws do not provide for this type of insurance; 3) profit institutions must render services in accordance with established indicators of accessibility of services; 4) a profit institution must possess no less than two years of service- rendering experience in services corresponding to those for which health care contracts shall be formed and a state medical evaluation (upon establishment of a state medical audit inspectorate). 3. Advance payment shall not be required for services rendered during account settling of the clients of LNHS activities with profit institutions. Chapter II LNHS INSTITUTIONS Section I LNHS BUDGETARY INSTITUTIONS Article 23. The Concept and Founders of LNHS Budgetary Institution 1. LNHS budgetary (further - budgetary institution) is an institution founded by state or local authority institutions and accredited in accordance with the procedure established by this Law, to render free services or implement the requisite public health care measures. 2. A budgetary institution is an institution maintained by the state or local authority budget and thus listed in its founding act and statutes. 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. 5. The Ministry of Health shall approve the standard statutes of budgetary institutions, in accordance with the nomenclature of budgetary institutions established by this Law. Article 24.   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 (open and closed) institutions. Article 25.   Special Features of Budgetary Institution Management, Activities                                and Utilisation of Funds 1. The statutes of budgetary institutions shall establish the procedure of the formation, area of competence, functions and liability of the managing bodies of budgetary institutions. The administration shall be the managing body of the budgetary institution, which will administer the institution according to the procedure established by its statutes. A board of directors, treatment, nursing, and public health boards and other boards and medical ethics commissions may be established within the budgetary institution. 2. Heads of administration, branches and departments of a budgetary institution, accredited for secondary and tertiary level of organising of LNHS activities, and health care specialists shall be hired for a term of five years, by means of public tender. 3. Persons who may become heads of administration, branches and structural departments of a budgetary institution, accredited for secondary or tertiary levels of organising of LNHS activities, must be individuals who satisfy the qualification requirements and conditions approved by the Ministry of Health and tender conditions for heads of administration or structural departments of this institution. 4. An individual over the age of 65 may not become an administrator or a branch head of a budgetary institution, accredited for secondary or tertiary level of organising of LNHS activities. 5. The statutes of budgetary institutions must indicate the procedure of rendering the requisite level of health promotion services and implementing of requisite state or municipal health programmes and also the procedure of informing the public concerning the activities of a budgetary institution. 6. The state or municipal budget funds obtained by budgetary institutions, shall be used to implement the requisite level of health promoting activities and to render services. 7. A budgetary institution shall have the right to obtain non-budgetary funds for rendering of services in accordance with health care contracts, if these services are not attributable by laws and other principles designated by the Government. Expenses in connection with service rendering are totally reimbursed from non budgetary funds. Article 26.   Nomenclature of Budgetary Institutions of Individual Health Care                                Levels of Organising of LNHS Activities 1. Municipal budgetary institutions of individual health care of primary level of organising of LNHS activities: 1) municipal medical stations; 2) municipal mental health centres; 3) municipal authority detoxification centres; 4) municipal emergency aid stations; 5) municipal support treatment and nursing hospitals; 2. A municipal executive institution shall organise and administer the regional institutions of the nomenclature indicated in part 1 of this Article, according to the normatives approved by the Government. 3. Budgetary institutions of individual health care of secondary level of organising of LNHS activities: 1) specialised hospitals (tuberculosis, skin and venereal diseases, oncology, narcology, psychoneurology, psychiatry, infectious diseases and others), included on the list approved by the Ministry of Health; 2) county maternity homes; 3) county infants’ homes, dedicated to the care of infants with developmental defects; 4) county medical and social expert examination institutions. 4. The county governor shall organise and manage the nomenclature institutions in the county, indicated in part 3 of this Article, in accordance with the normatives approved by the Government. 5. Budgetary institutions of individual health care of tertiary level of organising of LNHS activities: 1) tissue and organ transplant banks; 2) specialised hospitals (oncological, physiopulmonary, tuberculosis, psychiatry, infectious and medical rehabilitation etc.), included on the list approved by the Ministry of Health; 3) institutions of pathologoanatomical expert examination, court medical expert examination, court psychiatric and narcological expert examination, medical and social expert examination. 6. Upon recommendation by the Government and adhering to the normatives approved by the Government, the Ministry of Health and the Ministry of Labour and Social Protection shall organise and administer, according to their competence, the nomenclature of the institutions, indicated in part 5 of this Article, of the tertiary level of organising of LNHS activities. Article 27.   Nomenclature of the Budgetary Institutions of Individual Health                                Care Levels of Organising of LNHS Activities 1. Nomenclature of the municipal authority budgetary institutions of individual health care of primary level of organising of LNHS activities: 1) municipal authority labour medical consultation station; 2) municipal authority health care bureau. 2. A municipal authority executive institution shall organise and administer institutions within the municipal region, that are included in the nomenclature, indicated in part 1 of this Article, according to the normatives approved by the Government. 3. Nomenclature of budgetary county institutions of public health care of the secondary organising level of LNHS activities: 1) county centre for public health promotion; 2) county centre for disease prophylaxis and control; 3) public health centres subordinated to the State Service for Public Health Care. 4. The county governor shall found and maintain the district institutions indicated in paragraphs 1 and 2 of part 3 of this Article in accordance with the normatives approved by the Government. 5. The State Service for Public Health Care, at the Ministry of Health, shall found and maintain the county institutions, indicated in paragraph 3 of part 3 of this Article, in accordance with the normatives approved by the Government. 6. Nomenclature of budgetary institutions of public health care of tertiary level of organising of LNHS activities: 1) centre for the promotion of public health; 2) nutrition centre; 3) centre for labour medicine; 4) centre for environmental hygiene (ecological medicine); 5) centre for radiation protection; 6) centre for the prophylactics and control of contagious diseases; 7) health information centre; 8) other specialised public health centres. 7. The Ministry of Health or with its recommendation, the State Service for Public Health Supervision at the Ministry of Health shall, upon the recommendation of the Government, organise and manage the institutions of the tertiary level of organising of LNHS activities, indicated in part 6 of this Article, according to the normatives approved by the Government. Article 28.   Concept of Closed Budgetary Institution and Special Features                                of the Foundation and the Activities thereof 1. A closed budgetary institution is an institution founded and maintained by state property and budgetary funds, rendering services of the requisite health promotion level, for indicated groups of individuals, indicated in the statutes of this institution and implementing health programmes. 2. 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. Closed budgetary institutions, analogous to institutions of primary level of organising of LNHS may be founded only for the health care of active military personnel. 3. The Ministry of Health shall have the right to found 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, located in deprivation of liberty or pre-trial detention areas. 4. The statutes of closed budgetary institutions established within national defence and 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. Section II LNHS PUBLIC INSTITUTIONS Article 29.   The Concept and Status of a LNHS State and Municipal Public                                Institution 1. A LNHS state or municipal public institution (further-public institution) is a non-profit institution established with state or municipal property and funds, accredited for health care activity and rendering the requisite and contract level of health promotion activities and health insurance services. 2. Profit shall not be the goal of public institution activities. It may not designate the obtained profit for its founders. A public institution shall be public with respect to the services it shall render to members of the public. Article 30. The Founders of a Public Institution 1. The Ministry of Health, the county governor and municipal council may be founders of a public institution. 2. With the permission of the Government the Ministry of Health, in conjunction with the University of Vilnius, shall found the Vilnius University Hospital. 3. With the permission of the Government, the Ministry of Health in conjunction with the Kaunas Medical Academy, shall found the Kaunas Medical Academy Hospital. 4. The municipal council shall found the public institutions of the primary, the county governor, the secondary, and the Ministry of Health, the tertiary levels of organising of LNHS activities, with the exception of the Vilnius University and Kaunas Medical Academy hospitals. 5. The Ministry of Health may authorise the State Service of Public Health Care to implement all or a part of the designated functions of the founder of public institutions of public health care. Article 31. Competence of the Public Institution Founder (Founders) The competence of the public institution founder (founders) shall enable: 1) to approve, change and amend the bylaws of a public institution; 2) to establish requisite activity targets; 3) to obtain information regarding the activities of the public institution; 4) according to the procedure established by law, to establish or participate in determining the costs of services and methodologies of their calculation; 5) to appoint the administration chief of an institution by means of public tender, to determine his salary, on the basis of laws and, also to dismiss this chief from his duties. 6) to establish the salaries of the members of governing bodies (if such have been established) and of the inspector (auditor); 7) to establish institution branches, reorganise and liquidate a public institution; 8) to appeal in court according to the procedure established by laws; 9) to have other rights and obligations not established by this Law, if they are not contrary to laws; Article 32. Foundation of Public Institutions 1) The founder (founders) of public institutions must form an agreement of establishment of a public institution. If the founder shall be one person, he must draw up an act of establishment, in order to establish a public institution. 2. The agreement (act) of the establishment of a public agreement (act) must indicate: 1) founder, founders (legal persons titles and their addresses); 2) name of institution; 3) area of institution activities, goals and targets; 4) obligations of founder (founders); 5) compensation of founding expenses; 6) time limits of institution activities; 3. The founder (founders) or persons authorised by them, shall sign the agreement (act) of establishment. Article 33. The Rights of a Public Institution A public institution shall have the right to carry on the activities designated in the bylaws: 1) to hold settlement and currency accounts; 2) to administer and use institution property and dispose of it according to the Republic of Lithuania laws, other legal acts and its own bylaws; 3) form agreements; 4) establish the internal structure of institution; 5) to publish tenders for implementation of health programmes and other measures; 6) to found branches; 7) to use funds in accordance with the procedure established by estimates; 8) to establish ties with public institutions of other states and to exchange specialists; 9) to join associations of public institutions according to procedure established by laws, including international ones, and to participate in their activities; 10) to have other undefined rights and obligations, provided they do not contradict the laws of the Republic of Lithuania. Article 34. The Bylaws of the Public Institution 1. The bylaws are a document, which must provide guidelines for the public institution. Bylaws shall be approved by the founder (founders) of the institution. 2. Public institution bylaws must indicate: 1) the name of the institution; 2) the location; 3) the institution founders; 4) the rights and obligations of founders; 5) the area of activities, goals and tasks of the institution; 6) the competence and convocation procedure of founders’ meeting (if there are several founders); 7) the competence of observer board and procedure of the convocation of this board; 8) the procedure of organisation of public tender for the hiring of administration and branch heads and specialists; 9) the procedure of establishing managing bodies and the recall of their members and competence, and the functions and responsibility of such organs. 10) the procedure for founding and liquidation of branches; 11) the procedure for disposing of institution property; 12) funding sources and the procedure for fund utilisation; 13) the control of financial activities; 14) the procedure of changing and amending the bylaws; 15) the procedure for reorganising and liquidation of an institution; 16) the duration of institution activities; 17) other regulations in connection with the special features (specifics) of the institution, not contrary to laws. 3. The administration, the collective managing body and the founder (founders by joint decision) of an institution shall have the right to change and amend the bylaws by right of initiative. The founder (founders) shall approve the changed or amended bylaws. 4. The bylaw changes and amendments shall come into effect from their legal re-registration according to the procedure established by laws. Article 35. The Registration, Accrediting and Registration of the Accreditors 1. Public institutions shall be registered, re-registered and struck from the register in accordance with the procedure established by laws. 2. Accrediting of public institutions and registration of the accreditors shall be conducted in accordance with the procedure established by this Law and the regulations of the Service for Accrediting. Article 36. The Branches of the Public Institution 1. A branch is the subdivision of an institution, having an individual location and administration. A branch is not a legal person and shall act in accordance with the statutes of the public institution and the authorisation given it by the head of its administration, which must be stipulated in the institution bylaws and branch statutes. The number of public institution branches shall not be limited. 3. The branch shall be registered and struck from the register in accordance with the procedure established by this Law. 4. A public institution shall be prohibited from founding branches which are not related to health care activities. Article 37. The Managing Bodies of the Public Institution 1. The managing bodies of a public institution shall be comprised by taking into consideration the type of an institution and its inclusion into the nomenclature of institutions of the corresponding level of organising of LNHS activities. 2. The administration is a necessary body of institution governing, which organises administration activities and manages them. A public institution must have an administration head and a senior …