REPUBLIC OF LITHUANIA
LAW ON HEALTHCARE INSTITUTIONS
6 June 1996 No. I-1367
(As last amended on 8 June 2010 - XI-886)
Vilnius
CHAPTER I
GENERAL PROVISIONS
SECTION I
PURPOSE OF THE LAW AND DEFINITIONS
Article 1. Purpose of the Law
This Law shall establish the classification of healthcare institutions, principles of their founding, reorganisation, liquidation, operation, state regulation thereof, control measures, special features of administration and financing thereof, the nomenclature of institutions of the National Healthcare System of Lithuania, relations between healthcare institutions and patients and the principles of liability for violations of this Law.
Article 2. Definitions and Abbreviations Used in the Law
1. Healthcare institution (hereinafter referred to as an “institution”) shall mean:
1) an institution or enterprise having the right to provide healthcare services according to the procedure established by this Law, other laws and legal acts (hereinafter referred to as “services”);
3. Clients of the LNHS activity shall mean state government and municipal executive institutions and also the National and Territorial Health Insurance Funds.
4. Institution of restricted access shall mean an institution whose services are available only to groups of residents specified by this Law.
5. University hospital shall mean a public personal healthcare and scientific institution that, together with the state school of higher education, offers three levels of medical studies and provides healthcare services of all levels and refresher courses for medical specialists. The founders of a university hospital – the Ministry of Health and a state school of higher education.
6. Healthcare services (hereinafter referred to as “services”) shall mean the result of activity based upon an agreement between an institution and clients. The clients of services may be the clients of the LNHS activities stipulated in the Law on the Health System and other legal and natural persons.
7. Licensing shall mean determining of conformity of institutional activity to the requirements of legal acts, recognition of the right to provide services by an institution and issuance of a licence.
8. State medical audit shall mean an official control and expert investigation of legal and natural persons of all types of ownership who are engaged in personal healthcare activity, and the availability, quality (suitability) and economic efficiency of the services supplied.
9. Patient shall mean a person who uses the services provided by institutions regardless of whether he is healthy or ill.
10. Free Services shall mean the services funded from the state or municipal budgets, or compulsory health insurance fund, or municipal health funds. These services shall be ordered for institutions and paid for by the clients of the LNHS activity.
SECTION II
THE TYPES OF INSTITUTIONS, THEIR LICENSING, ACCREDITATION, REGISTRATION AND THE PRINCIPLES OF STATE regulation OF ACTIVITIES
Article 3. Classification of Institutions
1. The following institutions licensed for healthcare shall be classified as the LNHS institutions:
1) state or municipal public (hereinafter referred to as “the LNHS public institutions”) and budgetary (hereinafter referred to as “the LNHS budgetary institutions”) institutions of personal healthcare. The Law on Public Establishments shall apply to public institutions of the LNHS to the extent it does not contradict this Law;
3) state and municipal enterprises and enterprises whose more than 50 per cent of shares belong to the state or municipality;
2. According to the types of healthcare services provided, there shall be the following groups of institutions:
3. According to the time and location of the provision of services, there shall be the following types of personal healthcare institutions:
4. According to healthcare services provided, there shall be the following kinds of institutions of personal healthcare:
5. According to the range of public health services, there shall be the following kinds of public healthcare institutions:
2) public health protection (food and non-food product safety, radiation safety, environmental hygiene, occupational medicine);
Article 4. The Use of Names by Institutions
1. The mark of an institution must be registered in accordance with the procedure established by the laws of the Republic of Lithuania.
Article 5. Licensing of Healthcare Institutions
1. Enterprises and institutions may provide healthcare services only upon obtaining a licence and having been registered in the National Register of Healthcare Institutions.
2. The State Accreditation Service under the Ministry of Health (hereinafter referred to as the “Accreditation Service”) shall issue (re-register) licenses, refuse to issue (re-register) them, suspend the validity of licenses, renew and revoke them.
3. The procedure for issuance of licenses and the requirements for obtaining a license shall be established by Healthcare Licensing Regulations approved by the Government or an institution authorised by it, which shall indicate:
5. The conditions for issuing of licenses and those for the licensed activity shall not depend on the type of enterprise or institution acquiring the license.
6. Licenses shall be issued for an indefinite period of time, but they must be re-registered. Licenses issued for the first time shall be re-registered after two years and afterwards - every five years.
7. A license or a substantiated written refusal to issue (re-register) a license shall be submitted to an enterprise or institution within 40 calendar days from the day of receipt of all the documents required for issuing (re-registering) a license.
9. The Accreditation Service shall have the right to refuse to issue a license, if:
2) the submitted documents fail to correspond to the established requirements or the documents have not been properly executed;
10. The Accreditation Service may, on its own initiative or on recommendation of state institutions supervising the healthcare activities, or of an acting administrator of the institution, shall suspend or revoke the validity of a license. The Accreditation Service shall inform the institution in writing within 5 calendar days from the day of adopting the decision.
11. The Accreditation Service shall have the right to suspend the validity of a license:
2) where it emerges that seeking to obtain a license an institution has submitted incorrect data or falsified documents;
3) where state institutions which supervise healthcare activities establish that during the current year an institution has repeatedly violated the laws and other legal acts of the Republic of Lithuania that regulate the licensed activity;
4) when more than 90 calendar days have passed from the day when a license should have been re-registered, and an institution has not submitted an application to re-register it;
12. The Accreditation Service shall set the time period for which a license shall be suspended. This time period may not exceed the period of 3 months. This time period may be extended by order of the Minister of Health.
13. By request of an institution, the Accreditation Service shall have the right to adopt a decision to renew the validity of a license, only when being convinced that the violations due to which the validity of the license had been suspended have been eliminated. The institution shall cover the expenses related to the renewal of lithe validity of the licence.
14. The Accreditation Service shall have the right to revoke the validity of a licence:
2) upon receiving a notice regarding liquidation or reorganisation of an institution (when an institution terminates its activity as an independent economic entity);
3) if, upon suspension of the validity of a license, an institution has failed to eliminate violations during the set period of time, or has failed to apply for renewal of the license;
4) upon recommendation of state institutions which supervise healthcare activities if, having suspended the provision of a part or all of the services, an institution fails to eliminate violations during the set period of time;
15. A decision adopted by the Accreditation Service to refuse to issue (re-register) a license or to suspend, renew or revoke its validity may be appealed against in accordance with the procedure established by laws within 30 calendar days from the day the decision was adopted. An appeal shall not suspend the execution of decisions of the Accreditation Service.
Article 6. Accreditation of Institutions for Healthcare
1. Institutions that hold a license and have at least three years of experience in providing respective healthcare services shall have the right to apply for accreditation for healthcare.
2. The Accreditation Service shall accredit institutions or revoke their accreditation by adopting a decision in accordance with the procedure for the Rules of Accreditation for Healthcare approved by the Ministry of Health.
3. The Accreditation Service’s decision to accredit or not to accredit an institution shall be adopted not later than within 120 calendar days from the day of receipt of all of the documents required for accreditation. The Accreditation Service must inform the institution in writing about the adopted decision within 5 calendar days.
5. The expenses related to accreditation shall be compensated by the institution that initiated the accreditation.
6. In accordance with the procedure established by laws, the Accreditation Service’s decision may be appealed against in court within 20 calendar days from the day it was adopted.
Article 7. Registration of Licensed Institutions
1. The licensed institutions shall be registered in accordance with the laws and other legal acts of the Republic of Lithuania.
2. The licensed institutions must be registered in the National Register of Healthcare Institutions (hereinafter referred to as the “Register of Institutions”). The institutions must be registered not later than within 3 working days from the day the license was issued.
3. The Ministry of Health or an institution authorised by it shall establish the Register of Institutions, register the institutions and manage the Register.
Article 8. Use of the Data contained in the Register of Institutions
1. Legal and natural persons shall have the right to use the data contained in the Register of Institutions in accordance with the procedure established by the regulations of this Register.
Article 9. Legal Acts and Regulatory Documents Determining the Activities of Institutions
1. The activities of institutions shall be determined by:
2) Lithuanian and international standards as well as those of foreign countries legitimised in accordance with the procedure established in the Republic of Lithuania;
2. If there are no effective legal acts or regulatory documents required for an institution’s activity, the institution shall prepare the internal standards or methodologies for healthcare in accordance with the procedure established by the Ministry of Health and the head of the institution shall approve them by its order.
3. The internal standards of institutions and methodologies for healthcare may not contradict the laws and other legal acts of the Republic of Lithuania referred to in paragraph 1 of this Article.
Article 10. The Rights of the Ministry of Health on Issues of State Regulation of the Activities of the Institutions
The Ministry of Health shall:
1) found, reorganise or liquidate the LNHS institutions subordinate to it in accordance with the procedure established by this Law;
2) together with state schools of higher education or state scientific institutions shall found, reorganise and liquidate institutions in accordance with the procedure established by this Law;
4) establish mandatory healthcare tasks for subordinate institutions and the procedure for funding and implementation thereof;
5) submit proposals to the Government regarding granting of guarantees for loans which the LNHS institutions receive from credit institutions;
7) prepare with the Ministry of Finance the proposals to the Government on allocations from the state budget for the LNHS institutions;
8) forecast the need for healthcare specialists and formulate a state request for training of such specialists;
9) supervise how institutions comply with the necessary requirements of healthcare, and those stipulated in laws, other legal acts and regulatory documents;
10) together with the Ministries of Internal Affairs and National Defence establish a procedure for providing the services in the institutions of restricted access within the national defence or internal affairs systems and supervise, together with these ministries, how these institutions comply with the requirements stipulated in legal acts and regulatory documents;
11) having coordinated with the Department of Statistics to the Government of the Republic of Lithuania, approve the forms of statistics on the activities of the institutions, and the procedure for accounting and reporting on the activities of the institutions;
12) together with the National Health Insurance Fund establish the minimum requirements for the distribution of the LNHS institutions and their structure, as well as the need for the services;
Article 11. Requirements for the Distribution of the LNHS Institutions and their Structure and the Need for the Services
1. The Ministry of Health together with the National Health Insurance Fund shall establish the minimum requirements for the distribution of the LNHS institutions and their structure, as well as the need for the services.
Article 12. Investments in Healthcare
1. The use of funds to expand the range of the services, to implement new healthcare technologies and improve healthcare accessibility and quality (adequacy) shall be considered as investments in healthcare.
Article 13. State Regulation of the Prices for the Services
1. The Ministry of Health shall establish the prices for the services provided by the LNHS institutions.
2. The prices for the services provided by institutions which do not belong to the LNHS shall be established by their management bodies or owners in accordance with the procedure established in the bylaws of these institutions.
3. The LNHS institutions must furnish to natural and legal persons the written information, including the confidential information, about a patient and the services provided to him in accordance with the procedure and on the basis laid down by the Law on the Rights of Patients and Compensation of the Damage to their Health as well as other legal acts.
Article 14. Privatisation of the LNHS Public Institutions of Personal Healthcare
The LNHS public institutions of personal healthcare or their independent functional branches may be privatised in accordance with the procedure established by laws and other legal acts, if:
3) there is a conclusion submitted by the State Medical Audit Inspectorate that further activities of the institution are inexpedient;
Article 15. The Procedure for Employing the Heads of the LNHS Budgetary and Public Institutions, Their Divisions and Branches, and Healthcare Specialists
1. The heads of state and municipal budgetary and public institutions shall be employed by public tender. The heads of university hospitals shall be employed by public tender for a period of 5 years. The founder or the general meeting of the members of a respective institution shall organise the public tender and approve its regulations.
2. The heads of divisions and branches of state and municipal budgetary and public institutions shall be employed by public tender. The heads of divisions and branches of university hospitals shall be employed by public tender for a period of 5 years. The head of a respective institution shall organise the public tender and approve its regulations. The head of an institution shall have the right to organise the evaluation of the heads of divisions and branches.
3. Persons who meet the qualification requirements approved by the Ministry of Health may become heads of the LNHS budgetary and public institutions and divisions and branches thereof. The heads of the LNHS budgetary and public institutions must regularly improve their managerial skills. The procedure for compulsory development shall be established by order of the Minister of Health.
4. The heads of state and municipal budgetary and public institutions cannot be simultaneously employed as the heads of divisions or branches of such institutions.
5. The rights and duties of the heads of the LNHS budgetary and public institutions, their divisions or branches shall be established by the statutes (regulations) and job descriptions of these institutions.
6. Healthcare specialists of university hospitals shall be employed by public tender for a period of 5 years. The head of a respective institution shall organise the public tender and approve its regulations. Heads of the LNHS budgetary and public institutions, their divisions and branches and healthcare specialists of such institutions shall be employed and dismissed in accordance with the procedure and on the basis established by the Labour Code.
Article 16. Office Work of the Institutions
1. The office work of the institutions shall be done in Lithuanian. Medical documents (the history of illness or nursing care, the outpatient records, the prescribed procedures, etc.) shall be filled in Lithuanian. The diagnosis of an illness, the prescribed medications and prescriptions may be written in Latin.
2. The Ministry of Health shall establish the procedure for storage of the documents of the institutions.
Article 17. Founding of the Institutions that do not belong to the LNHS
Issues of founding, reorganisation and liquidation of institutions that do not belong to the LNHS shall be regulated by the Law on Enterprises, the Law on Public Establishments, the Law on the Register of Enterprises, the laws for individual types of enterprises, other laws and legal acts.
Article 18. Restrictions on the Activities of Institutions that do not belong to the LNHS
Institutions that do not belong to the LNHS shall be allowed to provide all types of personal and public healthcare services, except for personal and public healthcare services included on the list approved by the Ministry of Health.
Article 19. Specific Features of the Activities of Institutions that do not belong to the LNHS
1. The expenses incurred by institutions that do not belong to the LNHS for the provision of basic medical aid to patients shall be reimbursed from the funds of natural and legal persons who have caused harm to these patients through their illegal activities. The Law on Health Insurance shall regulate the principles and procedure for reimbursement of these expenses from the compulsory health insurance fund.
2. An expert medical investigation of temporary incapacity for work at institutions that do not belong to the LNHS shall be performed in accordance with the procedure established by the Ministries of Health and Social Security and Labour.
3. Institutions that do not belong to the LNHS may use the services of the LNHS institutions (examinations, specialist consultations, etc.) only pursuant to agreements concluded between these institutions. The services shall be paid for according to contractual prices, which may not be less than those set for the LNHS institutions.
4. Institutions that do not belong to the LNHS must, within their competence and at their own expense, implement the basic public healthcare measures, which shall be established by the Ministry of Health.
5. If institutions that do not belong to the LNHS receive funds from the state or municipal budgets according to the procedure established by laws, the Ministry of Health and the officers of the National Audit Office authorised by it as well as municipal controllers shall have the right to check how these funds are being used.
Article 20. The Concept and Founders of the LNHS Budgetary Institution
1. The LNHS budgetary institution is an institution entirely or partially funded from the state or municipal budgets. It also may receive funding from the compulsory health insurance fund, health funds and receive other non-budgetary funds.
2. The Government, the Ministry of Health, state services under the Ministry of Health, the Ministry of Social Security and Labour, the Ministry of Internal Affairs, the Ministry of National Defence may be the founders of the LNHS budgetary institutions maintained from the state budget.
Article 21. Legal Acts of the Republic of Lithuania Regulating the Founding, Activities, Reorganisation and Liquidation of Budgetary Institutions
The Law on Budgetary Institutions, the Law on the Health System, this Law and other laws and legal acts shall regulate issues concerning the founding, activities, management, reorganisation and liquidation of budgetary institutions.
Article 22. Specific Features of Management, Activities and the Use of Funds of Budgetary Institutions
1. The regulations of budgetary institutions shall establish the procedure for forming their management bodies, competence, functions and liability of budgetary institutions. The administration which manages an institution in accordance with the procedure established in its regulations shall be the management body of a budgetary institution. Collegiate management bodies whose regulations shall be approved by the head of the administration may be formed in a budgetary institution.
2. A budgetary institution shall have the right to conclude healthcare contracts with the clients of the LNHS activities, other legal and natural persons regarding the provision of free and paid services, and to receive non-budgetary funds for the provision of paid services. Budgetary institutions of public healthcare shall have the right to engage in publishing activity related to their competence and to receive non-budgetary funds from these activities.
Article 23. The Nomenclature of the LNHS Budgetary Institutions of Personal Healthcare
There shall be the following LNHS budgetary institutions of personal healthcare:
5) budgetary institutions of restricted access of personal healthcare specified in this Law and other laws;
Article 24. The Nomenclature of the LNHS Budgetary State and Municipal Institutions of Public Healthcare
1. A LNHS budgetary municipal institution of public healthcare shall be the healthcare bureau of the municipality.
2. There shall be the following LNHS budgetary state institutions of public healthcare:
Article 25. The Concept of a Budgetary Institution of Restricted Access and Specific Features of Founding and Activities thereof
1. A budgetary institution of restricted access shall be an institution founded and maintained from state property and budget funds which provides services to groups of persons specified in laws and implements health programmes.
2. Budgetary institutions of restricted access may be founded to provide personal healthcare services exclusively to servicemen and cadets of active service, to persons in places of imprisonment, pre-trial detention institutions, police detention or processing stations, to mentally ill persons who have committed hostile acts against the society and have been recognised as legally incapable, and to illegal immigrants. These institutions shall also implement public healthcare measures included on the list of the Ministries of Internal Affairs or National Defence and approved by the Ministry of Health.
3. The Ministry of Health shall have the right to found a budgetary institution of restricted access for provision of healthcare to mentally ill persons who have committed hostile acts against the society and have been recognised as legally incapable. Having coordinated with the Ministry of Health, other state institutions stipulated in laws shall also have the right to found budgetary institutions of restricted access to provide healthcare services to servicemen of active service, to persons in places of imprisonment, pre-trial detention institutions, police detention or processing stations, and to illegal immigrants.
4. The regulations of budgetary institutions of restricted access founded within the national defence and internal affairs systems shall be approved by their founders after coordination with the Ministry of Health.
Article 26. The Concept and Status of a LNHS Public Institution
1. A LNHS public institution shall be a public institution founded from state or municipal property and funds that provides the services stipulated in its statutes according to the contracts with clients.
Article 27. Founders of a LNHS Public Institution
1. The following may be the founders of a LNHS public institution:
4) state schools of higher education together with the Ministry of Health upon obtaining the authorisation of the Government;
Article 28. The Competence of the Founder (Founders) of a LNHS Public Institution
The competence of the founder (founders) of a LNHS public institution shall include:
4) establishing or participating in the establishment of the price for the services and the methods of calculating it in accordance with the procedure established by law;
5) establishing the ratio of expenses of the LNHS public institution for wages and pharmaceuticals, or authorise the LNHS public institution to approve it;
6) organising a public tender for the position of the head of the administration of the LNHS public institution and approving the regulations of this tender. They shall also conclude an employment contract with the winner of the tender as well as to terminate this contract in accordance with the procedure established by law;
7) specifying the procedure for the use, management and disposal of the assets of the LNHS public institution in accordance with the procedure established by the Government or an institution authorised by it.
9) founding of the branches of the LNHS public institution, reorganise and liquidate the LNHS public institution;
Article 29. Statutes of a LNHS Public Institution
1. The statutes shall constitute a legal document and a LNHS public institution shall operate in conformity with it.
2. The following information shall be indicated in the statutes of a public institution:
6) the competence of the meeting of the founders and the procedure for its convocation (if there are several founders);
8) the procedure for organisation of a public tender for employing the heads administration, branches and divisions and the procedure for employing healthcare specialists;
9) the procedure for forming management bodies and that of removing from office of the members thereof, and the competence, functions and liability of these bodies;
3. The administration of the institution, its collegiate management body and the founder (founders by joint decision) shall have the right of initiative to amend the statues of the institution. The amended statutes shall be approved by the founder (founders).
Article 30. Management Bodies of a LNHS Public Institution
1. A public institution must have the head of the administration who shall conclude and terminate employment contracts with healthcare specialists and other employees of the institution. The head of the administration, having coordinated with the supervisory board of the institution, shall approve the procedure for remuneration for work of the employees of the institution. The statutes of the LNHS public institution shall establish other functions and competence of the head of the administration.
2. The administration shall be the essential management body of a LNHS public institution. It shall organise and administer the institution’s activity. The head of the administration shall approve the rules of procedure for the administration.
Article 31. Advisory Management Bodies of the LNHS Public Institutions
1. The LNHS personal public healthcare institutions must have the supervisory board, and the councils for treatment and nursing. A LNHS public institution of public healthcare, which is engaged in secondary and tertiary healthcare, must have the supervisory board.
Article 32. Heads of Administration of State Schools of Higher Education, State Scientific Institutions and Institutions Founded by the Ministry of Health
A state school of higher education or a scientific institution together with the Ministry of Health shall organise a public tender for the position of the head of the administration of state schools of higher education, state scientific institutions and institutions that were established by the Ministry of Health. The Minister of Health shall conclude and terminate an employment contract with the head of the institution who has won the public tender.
Article 33. The Supervisory Board of the LNHS Public Institution
1. The supervisory board shall be set up in order to ensure the transparency of activities of a LNHS public institution.
2. The supervisory board of an LNHS public institution (hereinafter referred to as the “supervisory board”) shall be an advisory body set up for a period of 5 years.
3. The supervisory board of an LNHS public institution, except for institutions founded by the state schools of higher education or state scientific institutions and the Ministry of Health, shall consist of 2 representatives appointed by joint decision by the founder (founders) of the institution, 1 member of the board shall be appointed by the municipal council of the municipality in which the institution is located, 1 public representative appointed by the municipal council of the municipality in which the institution is located, and 1 representative appointed by the trade union of healthcare specialists of the institution.
4. The supervisory board of the state schools of higher education or state scientific institution and institutions founded by the Ministry of Health shall consist of 2 representatives appointed by the Ministry of Health, 2 representatives appointed by the heads of state schools of higher education or state scientific institutions, 1 member of the council appointed by the municipal council from the municipality in which the state school of higher education is located, 1 public representative appointed by the municipal council of the municipality in which the institution is located, and 1 representative appointed by the trade union of healthcare specialists of the institution.
Article 34. The Councils for Treatment and Nursing of a LNHS Public Institution
1. The council for treatment of a LNHS public institution (hereinafter referred to as the “council for treatment”) shall consist of doctors of divisions and branches of the institution.
2. The council for treatment shall consider issues of organisation and improvement of personal healthcare, regularly organise clinical conferences, and consider issues related to acquisition of new personal healthcare technologies. The council for treatment may submit recommendations to the administration of the institution regarding the issues under consideration. Should the administration fail to agree with the recommendation, the council for treatment may submit its recommendation to the founder (founders).
3. The council for nursing of a personal healthcare institution (hereinafter referred to as the “council for nursing”) shall consist of nursing specialists of divisions and branches of the institution.
4. The council for nursing shall consider issues of organisation and improvement of nursing care for patients. This council may submit recommendations to the administration of the institution regarding the issues under consideration. Should the administration fail to agree with the recommendation, the council for nursing may submit its recommendation to the founder (founders).
5. The head of the administration of the institution or an employee of the administration authorised by him shall chair the councils for treatment or nursing. The statutes of public institutions shall establish the formation of the council for treatment or the council for nursing, the rights and obligations of these councils, the rules of procedure, the rights and obligations of their members, the conditions of appointing or dismissing them, the conditions of remuneration for work and liability.
Article 35. The Medical Ethics Commission of a LNHS Public Institution
1. The Medical Ethics Commission shall be established at the LNHS public institution to control the compliance with the requirements of medical ethics.
Article 36. Assets of a Public Institution
1. Assets of a public institution shall be comprised of tangible fixed assets, assets received as charity or assistance, assets received as inheritance, financial resources and other legally acquired assets related to the activity of the institution.
2. State and municipal institutions (founders) shall transfer the assets to public institutions on the basis of a loan for use in accordance with the procedure established by laws, the Government or an institution authorised by it.
3. The LNHS public and state institutions of public healthcare may, in accordance with the procedure established by the Government or an institution authorised by it, sell, transfer, lease, exchange tangible fixed assets, and also warrant or guarantee with it the 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 schools of higher education or state scientific institutions and institutions founded by the Ministry of Health.
Article 37. Liquidation of a Public Institution
1. The basis for liquidation of a public institution may be:
2) a decision adopted by the founder (founders) to liquidate the public institution in accordance with the procedure established by laws and statutes of the institution;
2. An institution which has decided to liquidate a public institution shall appoint a liquidator, establish the terms of liquidation and the procedure for inventory and transfer of assets. As of the day of appointing the liquidator, the administration and management bodies shall lose their powers and their functions shall be performed by the liquidator.
3. The documents of the public institution under liquidation shall be kept in accordance with the procedure established by the Law on Archives.
4. When liquidating an institution, its employees shall be dismissed in accordance with the procedure established by the Law on the Employment Contract.
5. Upon drawing up of the liquidation act of a public institution, it shall be publicly announced about the liquidation of the institution two times with an interval of not less than 1 month occurring between these announcements.
Article 38. The Powers of the Liquidator of a Public Institution
1. The liquidator of a public institution shall have the rights and duties of a head of the administration of the institution. He shall represent the institution under liquidation in 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 report (the liquidation balance sheet) of the institution at the time of commencement of the liquidation;
3) fully discharge the obligations under previously made transactions of the institution and enter into transactions related to the liquidation of the institution;
Article 39. The Nomenclature of the LNHS State and Municipal Institutions of Personal Healthcare
1. The nomenclature of the LNHS municipal public institutions of personal healthcare shall be as follows:
Article 41. Funding of the LNHS Institutions from the State and Municipal Budgets
1. The allocations from the state budget for healthcare shall be used for the following purposes:
2) maintenance of budgetary institutions whose founders are the Government or an institution authorised by it (ministries, state services);
4) funding of public healthcare measures established by the Ministry of Health together with the Ministries of Internal Affairs or National Defence at institutions and units subordinate to the Ministries of National Defence and Internal Affairs;
5) funding of public healthcare measures intended to prevent the occurrence and spread of dangerous and especially dangerous communicable diseases, to liquidate the outbreaks of communicable diseases and epidemics, and also to prevent the occurrence of medical effects of radiation accidents and ecological disasters, and measures for liquidation thereof;
7) funding of the applied research in medical science according to priority programmes approved by the Ministry of Health, provided that this research is dedicated to resolve the relevant problems of the LNHS management, health security of people, restoration and strengthening of health, adequacy and accessibility of services and their provision, and development of social justice.
2. The allocations from the municipal budget for healthcare shall be used for the following purposes:
2) provision of additional assistance for healthcare of persons requiring social support and belonging to the categories established by the municipal councils;
3. Public institutions shall have the right to receive funds from the state and municipal budgets for provision of services under contracts on healthcare concluded with the Ministry of Health, the mayor of a municipality.
Article 42. Accounting of Non-medical Expenses of the LNHS Institutions
Where a LNHS institution is engaged not only in healthcare but also in non-medical activity, it must keep separate accounting of expenses for healthcare and for non-medical activity in accordance with the procedure established by legal acts.
Article 43. The Procedure for Funding of Studies for Students and Doctors Residents and Qualification Improvement of Labour and Healthcare Specialists at the LNHS Institutions
1. The expenses of the LNHS institutions, where studies of students and medical residents are taking place and where medical residents are employed as doctors residents, related to studies or wages of students and doctors residents shall be compensated in accordance with the procedure established by the Government or an institution authorised by it.
2. The LNHS institutions shall have the right to pay for studies of students and doctors residents and conclude loan contracts with doctors residents and credit institutions in accordance with the procedure established by the Ministry of Health.
Article 44. The Rights of Institutions
The Law on the Health System, this Law and other laws and legal acts shall establish the rights of healthcare institutions.
Article 45. The Duties of a Personal Healthcare Institution
A personal healthcare institution must:
2) implement the basic public healthcare measures required under the list approved by the Ministry of Health;
3) provide only such personal healthcare services as indicated in the license issued to the institution;
4) use only those healthcare technologies which are approved according to the established procedure and/or permitted to be used in the Republic of Lithuania. The medical products must be included in the Register of Medical Products whose regulations shall be approved by the Ministry of Health;
5) fill in and keep the patient case histories and outpatient cards and provide information about the patient to state institutions and together with other institutions in accordance with the procedure established by the Ministry of Health;
8) protect medical confidentiality of a patient except for the cases where a personal healthcare institution must provide information about a patient or where a patient gives his consent to make public the information concerning the state of his health;
9) inform, in accordance with the procedure established by legal acts, the Ministry of Health, the founders or owners of the institution about the instances or outbreaks of internal infections and other cases of damage inflicted on patients’ health;
Article 46. The Rules of Procedure for Personal Healthcare Institutions
1. Personal healthcare institutions must have the rules of procedure and ensure that they would be accessible for patients to get familiar with them.
2. The rules of procedure must indicate:
4) the procedure for visiting, discharge and transfer of the patients to other personal healthcare institutions;
6) the procedure for the provision of information to a patient and his family concerning the state of his health;
7) the procedure for making of copies of case histories, outpatient cards and other documents, and the procedure for issuance thereof to a patient or any other natural or legal persons;
9) the provisions of laws, legal acts and other regulatory documents regulating occupational safety;
Article 47. The Procedure for Admitting a Patient to an Inpatient Institution
2. It shall be prohibited to admit a minor or legally incapable person to an inpatient institution without the approval of his legal representatives.
3. The approval of a patient or of his legal representatives shall not be required if:
2) the minor’s or legally incapable person’s life is in danger and it is impossible to quickly locate his legal representatives;
Article 48. Registration of Patients in Personal Healthcare Institutions
1. Institutions must administer the registration of patients and submit to the Ministry of Health or an institution authorised by it the reports of the approved form concerning the healthcare of patients. Every patient’s case history, nursing record or outpatient card shall be managed or an entry in the registration journal concerning his application shall be made. The originals of these documents shall be kept at the institution.
Article 49. The Duties of a Personal Healthcare Institution in case of a Patient’s Death
1. Following the death of a patient, the institution must inform the members of his family, his legal representatives, or the persons specified by the patient before his death, about his death within 12 hours.
2. The Ministry of Health shall establish the procedure for certification of a patient’s death at the institution.
3. Upon the death of a patient at an institution, an autopsy shall be performed by a pathologist in the following cases:
5) death occurs as a result of occupational or infectious diseases or a suspicion arises that an occupational or infectious disease was the cause of death;
4. Upon the death of a patient, a forensic medical expert examination shall be performed in the following cases:
5. The institution shall guarantee free protection of the body of the deceased until it shall be claimed by the members of the family of the deceased, his legal representatives, or the persons specified by the patient prior to his death, but not longer than for a period of 4 days after an autopsy by a pathologist or a forensic medical expert examination.
Article 50. The Duties of a Public Healthcare Institution
1. A public healthcare institution must:
3) employ only such research methods and only those healthcare technologies which are approved in the Republic of Lithuania;
Article 51. The Rules of Procedure for Public Healthcare Institutions
1. The public healthcare institutions must have the rules of procedure approved in accordance with the procedure established by the statutes of the institution.
2. The rules of procedure must indicate:
3) the procedure for settling the disputes and conflicts between the institution and the legal and natural persons;
4) the procedure for providing information to the interested legal and natural persons concerning the institution’s activity;
Article 52. State Supervision of the Services Provided by Institutions
1. State supervision of the services provided by institutions, irrespective of their form of ownership, shall be implemented by:
2) the State Medical Audit Inspectorate - state supervision regarding accessibility, quality (adequacy) and economic efficiency of personal healthcare services;
3) the National and Territorial Health Insurance Funds – supervision of the quantity and control of personal healthcare services covered from the compulsory health insurance fund budget, and the financial and economic analysis of the use of compulsory health insurance fund money at institutions that have concluded contracts with the Territorial Health Insurance Funds on the provision of the services and compensating for them;
4) the Lithuanian Committee on Medical Ethics - state supervision of the compliance of the services provided by a personal healthcare institution to the requirements of medical ethics;
Article 53. The Rights and Duties of State Institutions Controlling the Provision of the Services
1. The heads of state institutions referred to in Article 53 of this Law, or the officials appointed by them (hereinafter referred to as “officials”), 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 acting head of the institution, whether the requirements of legal and regulatory documents are not being violated;
2) to request and obtain all the required information, documents, material, laboratory samples, data on a patient’s medical examination and test results, verbal and written explanations of the heads and other employees of the institution which are required for inspection;
4) to submit a substantiated proposal to the Minister of Health or a person authorised by him, to suspend or revoke the validity of a doctor’s medical practice license or any other licences established by laws to engage in healthcare;
5) to request the head of the administration of an institution to remove healthcare experts for up to one month, and check their professional competence, if shortcomings have been identified in the professional activities of these experts that could have inflicted or inflicted harm or danger to the patients’ health, or if the qualifications of healthcare experts do not meet the set 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 for checking of professional competence of healthcare specialists. During the period of suspension from work, the payment of a wage to a healthcare specialist shall be withheld;
2. The head of the administration of an institution must comply with the request of an officer to suspend from work a healthcare expert. A healthcare expert shall have the right to lodge a complaint against such a decision of an official with the Ministry of Health, which must examine his application within 7 days from the day of its receipt.
3. An official must submit, within the stipulated time limit, an inspection report, the conclusions and recommendations to the head of the institution which ordered the inspection and the head of the institution which was investigated.
4. Preventing the official to perform his duties shall bring liability established by laws upon the head of the institution.
Article 54. Suspension of Provision of Services at an Institution
1. The Accreditation Service, the State Medical Audit Inspectorate, and the State Public Health Service shall have the right to suspend the provision of all or part of services at an institution by decisions adopted within their competence if:
1) the institution or a division (branch) thereof is engaged in activity for which it does not hold a licence or accreditation certificate;
2) healthcare provided by an institution or by a division (branch) thereof, fails to meet the requirements stipulated in legal acts or regulatory documents and consequently poses actual danger to the patients’ health or inflicts harm to people’s health or causes losses to legal and natural persons;
3) the institution is not registered in the Register of Institutions or is registered breaching the requirements of this Law and has failed to comply with the requirements of the manager of the Register of Institutions for more than 3 months;
4) persons who do not have the right to engage in healthcare are nevertheless engaged in it at the institution;
2. The provision of services by an institution may be suspended for a period not exceeding 3 months. State institutions referred to in paragraph 1 of this Article, having adopted such a decision, must inform the head of the institution about the actual motives behind such decision and the time limit for the elimination of violations or shortcomings.
3. The heads of an institution who fail to implement the decisions adopted under this Law to suspend the provision of all or a part of the services shall be held liable in accordance with the procedure established by laws.
4. After the suspension of the provision of services at a personal healthcare institution, the patients of the institution shall be transferred (re-registered) to other institutions in accordance with the procedure established by the Ministry of Health.
5. An institution must eliminate the shortcomings over the time period set by state institutions referred to in paragraph 1 of this Article. After the elimination of shortcomings, the activity of the institution may be renewed by order of state institutions referred to in paragraph 1 of this Article.
6. Where an institution fails to remove shortcomings over the set period of time, the institution which has suspended the activities shall apply to the Accreditation Service regarding revocation of the licence of the institution and to the Ministry of Health concerning the removal from office of the management bodies of the institution and the appointment of a temporary administrator.
Article 55. The Procedure for Removal of the Management Bodies of an Institution and Appointment of a Temporary Administrator
1. The management bodies of an institution shall be removed and a temporary administrator shall be appointed if:
1) the institution failed to eliminate the identified violations or shortcomings and consequently it poses a threat that the services provided by it are improper and harmful to the health of patients, but there still exists an actual possibility of remedying the situation;
2) during the period of one year, an outbreak of hospital infection reoccurs at the institution due to the shortcomings of the organisational activity of the administration of the institution;
Article 56. The Temporary Administrator of an Institution
1. The temporary administrator of an institution shall be the head of a healthcare institution appointed by the Minister of Health for a period of removal of the management bodies of the institution. The Ministry of Health shall establish qualification requirements for temporary administrators. An employee of the institution whose management bodies are being removed may not become the temporary administrator of the institution. The Minister of Health or a representative authorised by it shall conclude and terminate the contract with the temporary administrator.
2. All the powers of the management bodies of the institution shall be transferred to the temporary administrator as of the day of appointment of the temporary administrator.
3. The temporary administrator shall have the right to terminate or conclude employment contracts with members of the management bodies and other employees.
4. The temporary administrator shall not be obligated to comply with the decisions of the founder or owner of the institution, except for the cases referred to in paragraph 5 of this Article.
5. The temporary administrator shall not be allowed to sell or otherwise transfer or pledge the assets, reorganise or liquidate the institution, or resolve issues that are within the exclusive competence of the founder or owner of the institution without the authorisation or approval of the founder or owner of the institution.
6. The temporary administrator must inform the Minister of Health, the Accreditation Service and the founder or owner of the institution about the progress and results of administration according to the procedure and terms established by them.
7. The temporary administrator must order an audit of the institution and perform hygiene, epidemiological, occupational safety and medical audit expert examinations. Expert examinations must be performed within 3 months from the day of appointment of the temporary administrator.
8. Having established violations of laws, other legal acts or regulatory documents during the audit, the temporary administrator shall apply to the Accreditation Service for revocation of the licence and shall inform the Ministry of Health thereof.
Article 57. Removal from Office of the Temporary Administrator of an Institution
The temporary administrator of an institution shall be removed from office prior to the expiration of his term of office by order of the Minister of Health if:
1) the Accreditation Service establishes that the institution may function in a reliable and stable manner;
Article 58. The Rights of State Institutions that Supervise the Activities of Institutions
1. State institutions referred to in this Law, which supervise the activities of institutions, shall, within the sphere of their competence, have the right to:
1) give a warning to the institution regarding the shortcomings and violations in its activities and establish the terms for their elimination;
2) impose an administrative penalty to the heads of the institution and other employees in accordance with the procedure established by laws;
2. State institutions referred to in this Law, which supervise the activities of institutions, shall apply the control measures and sanctions to institutions taking into consideration the content of a violation on the basis whereof the control measure are to be applied.
3. The decisions of state institutions referred to in this Law, which supervise the activities of institutions, on application of the control measures or sanctions may be appealed against during the period of 30 days in accordance with the procedure established by law. The appeal shall not interrupt the implementation of the decisions adopted by state institutions referred to in this Law, which supervise the activities of institutions.
Article 59. The Principles and Procedure for Applying the Control Measures in respect of Activities of Institutions
1. State institutions referred to in this Law, which supervise the activities of institutions shall adopt a decision on application of the control measures or sanctions stipulated in this Law, where at least one of the following grounds exists:
1) state institutions referred to in this Law, which supervise the activities of institutions, have not received the information or documents required for the performance of supervision of the activities of the institution, or such information and documents do not comply with reality;
2. The issue of applying a control measure in respect of an institution shall be considered in the presence of its representatives. Where the representatives of the institution fail to appear at the consideration of this issue, the decision to apply the control measure shall be adopted without them.
3. The decision on application of the control measures, except for the case referred to in subparagraph 2 of paragraph 1 of Article 58 of this Law, must be adopted within 3 months after the day of identification of the violation. The control measures may not be applied for violations committed more than a year ago.
Article 60. Supervision of Activities of a Budgetary Institution of Restricted Access
Supervision of activities of a budgetary institution of restricted access shall be carried out in accordance with the procedure established by the Government or institutions authorised by it.
Article 61. Final Provisions
Already operating personal and public healthcare institutions must obtain licences for healthcare activities that they are engaged in, by 31 December 2002 in accordance with a schedule approved by the Ministry of Health of the Republic of Lithuania. From 1 January 2003, healthcare services provided by these institutions without a licence shall be treated as illegal.