sou · H9B340 · 2021-06-01 00:00:00 — Privata utförare, kommuner och skulle behöva lägga avsevärda resurser på att hantera uppgifter om de privata utförarnas faktiska kostnader för ingående mervärdesskatt. Även de övriga grundläggande problem med en ändrad ersättningsmodell som den tidigare utredningen räknat upp, som till exempel att en sådan ersätt- ning inte skulle fånga upp dold mervärdesskatt i tidigare led, är fortfarande aktuella och väger tungt mot en sådan ändring. Förhåll- andena har inte ändrats sedan den förra utredningen på ett sådant sätt att det tillkommit nya omständigheter som talar för en ändrad Denna utredning gör därför samma bedömning som den tidigare utredningen i frågan. Beräkningarna visar att kostnadsandelarna för ingående skatt av totala kostnader för kommuner respektive regioner uppgår till unge- fär samma storleksordning, för kommunerna respektive för regionerna. De tillkommande kostnaderna för ingå- ende skatt på inhyrd vårdpersonal har inte nämnvärt påverkat kost- nadsandelarna för ingående skatt eller hur de förhåller sig till varandra. Mot bakgrund av att kostnadsandelen för ingående skatt i genomsnitt är ungefär desamma för undantagen verksamhet inom kommunerna och regionerna samt att mervärdesskatteplikten för inhyrd vårdpersonal inte i nämnvärd omfattning påverkat kostnads- andelarna för ingående skatt mellan kommuner och regioner anser utredningen att det inte finns skäl att föreslå en differentiering av schablonersättningen mellan kommuner och regioner. Utredningen föreslår nya alternativa nivåer för ersättning enligt 5 § LEMK genom att två nya paragrafer, 1 b och 1 c §§, förs in i ersättningsförordningen. Vidare föreslår utredningen att vissa delar av vad som regleras i 1 § ersättningsförordningen flyttas till en ny paragraf, 1 a §, utan att det innebär någon ändring i sak i dessa delar. Ersättning enligt 5 § LEMK ska, om det framgår att viss del av kostnaden avser kostnad för inhyrd personal för sjukvård, tandvård och social omsorg, lämnas av kostnaden för denna del och av kostnaden för resterande del. Om ersätt- ning lämnas av kostnaden för del som avser inhyrd personal för sjukvård, tandvård och social omsorg och av kostnaden för del som avser lokalkostnad ska den resterande delen av kostnaden ersättas . De nya ersätt- ningsnivåerna ska utgöra alternativ till ersättning enligt huvudregeln i 1 § ersättningsförordningen, som uppgår till . Det är utredningens bedömning att de föreslagna nivåerna inne- bär ett mer träffsäkert system för ersättning för dold mervärdesskatt som därmed förbättrar förutsättningarna för neutralitet vid kom- munens val mellan att bedriva verksamhet i egen regi eller att över- lämna den till privata utförare. Förslaget innebär en ökad administrativ börda för privata utfö- rare, kommuner och i och med att kostnadsandelen för inhyrd personal måste styrkas för varje ansökan. Enligt utredningens bedömning överväger dock fördelarna med att införa ytterligare ersättningsnivåer nackdelarna. För de fall den privata utföraren inte kan presentera underlag som räcker för att styrka rätt till den högre ersättningsnivån återstår möjligheten för kommunen att ansöka om ersättning enligt huvudregeln (). Förslaget bedöms inte strida mot . Vid ett genomförande av utredningens förslag kommer den ersätt- ning för dold mervärdesskatt som kommunerna ansöker om att öka. Ökade statliga utbetalningar minskar statens budget som kommunernas intäkter ökar. Utredningen beräknar att statens budget försvagas med som kommunernas intäkter ökar samlat med år- ligen vid ett införande av den nya alternativregeln . Om det generella statsbidraget skulle justeras motsvarande storleken på den förändrade ersättningsutbetalning som följer av ut- redningens förslag skulle de finansiella effekterna för staten och kommunerna neutraliseras. Förordningen föreslås träda i kraft . Ändringen ska endast gälla sådana ansökningar som kommer in till efter och som avser ersättnings- perioder som påbörjats efter detta datum. The Inquiry’s remit care, dental care, social care and education in the school system are exempt under the Value Added Tax Act (1994:200) and in Council Directive (2006/112/EC) of on the common system of value added tax (the Value Added Tax Direc- tive). In the application of the law in in recent years these exemptions have been interpreted as not covering the hiring out of staff to work in these areas. In a number of rulings in 2018 and 2020, the Supreme Administrative Court (SAC) has interpreted the Value Added Tax Act’s care exemption taking account of the provisions of the Value Added Tax Directive and the jurisprudence of the Court of of Union (ECJ). In these rulings the Supreme Administrative Court has drawn up guidelines for determining whether supply is taxable hiring out of staff or exempt care. Since activities in care, dental care, social care, and educa- tion are VAT-exempt, private providers conducting these activities do not have the right to deductions for input value added tax. The private provider’s cost is therefore higher on account of hidden value added tax, resulting in a higher price. Under Section 5 of the Act on compensation for certain value added tax for municipalities, regions, local federations and coordination federations (2005:807), the Com- pensation Act, these bodies are entitled to compensation for ‘hidden value added tax’, which means that they can obtain compensation for the added expense assumed to result from the hidden value added tax. Section 1 of the Compensation Ordinance1 states that compen- 1Ordinance on compensation for certain value added tax for municipalities, regions, local federations and coordination federations (2005:811). sation for hidden value added tax shall, as the main rule, be paid as 6 precent of the cost in cases of procurement or contributions. The remit of the Inquiry is to examine, in the first place, the conditions under EU law for amending the Value Added Tax Act so that the hiring out of staff for care, dental care and social care is exempted from value added tax. If is not judged to be possible to amend the Value Added Tax Act, the Inquiry is to examine whether there is any other way of neutralising the consequences of a change in tax liability when hiring out staff for care, dental care and social care. One example of measures that the Inquiry is to examine in that case is amend- ments within the framework of the system of compensation for value added tax for municipalities and regions. When doing so, the Inquiry is to consider whether the standard compensation should be differentiated for municipalities and regions. The Inquiry is also to examine the possibilities of introducing alternative standard levels in the case of a high share of costs for hired staff. Furthermore, the Inquiry is to examine whether there is reason, for instance on account of changed circumstances, to make a differ- ent assessment from that made by a previous inquiry2 regarding the question of compensation for the private providers’ actual costs for input tax instead of the standard compensation applied today. Deliberations about amendments concerning value added tax The Inquiry notes that the terms hospital and care and close- ly related activities in Article 132(1)(b) and care in Article 132(1)(c) are terms in EU law and must be applied in a uni- form way in all Member States. The ECJ has clarified what is meant by these terms and has laid down the principle of diagnostic purpose. It follows from the rulings of the ECJ that, in certain circum- stances, provision by subsuppliers can also be considered to fulfil the diagnostic purpose. This is because the care exemption does 2The inquiry to review compensation to municipalities and county councils for ‘hidden value added tax’ presented its final report Review of compensation to municipalities and county councils for ‘hidden value added tax’ (SOU 2015:93) to the Government on . not require a contractual relationship or a relationship of trust between the supplier and the patient. The purpose of the whole process can still be diagnostic. So, it is possible for exempt care to be provided at several stages. However, the requirement of a diagnostic purpose applies both to the transactions where the provider is in a direct contractual relationship with the patient and to the transactions where the provider is not.3 The key point regarding which subsuppliers’ provision can be exempt is how the Value Added Tax Directive’s requirement of a diagnostic purpose is to be interpreted. Should a narrow perspective be applied, i.e. should provision in each stage be assessed by itself, or can it be sufficient for it to be part of an overall process that has a diagnostic purpose? There is no judgment from the ECJ about the hiring out of staff and the exemption for care. In case SAC 2018 case report 41, SAC 2020 case report 5, SAC 2020 notice 3 and SAC 2020 case report 35 the Supreme Administrative Court examined the question of care and different staffing situations. In these rulings the Court found that the ECJ's and ”go fair” Zeitarbeit4 judgments, which concern the exemptions for education and social care shall be applied analogously in the area of care. Against the back- ground of these judgments, the Court found that in the case of the hiring out of care staff, it is the actual hiring out service that has to be examined in relation to the care exemption and that a hiring out service can never in itself be exempt care under the Directive, irrespective of who is the seller or buyer of the service. In SAC 2020 case report 55 the Supreme Administrative Court drew up, with reference to the same ECJ judgments, guide- lines for determining whether provision is hiring out of staff or care. Like the other exemptions in Article 132(1), the exemption for care is to be interpreted restrictively but in accordance with the purpose of the exemption.6 The purpose of the exemption is to reduce the costs of care and guarantee the individual’s access to care.7 3L.u.P, C-106/05, and , C-156/09. 4Horizon College, C-434/05, and ”go fair” Zeitarbeit, C-594/13. 5The guidelines were repeated in SAC 2020 notice 3 and SAC 2020 case report 35. 6Kügler, C-141/00. 7See, for example, Klinikum Dortmund, C-366/12, and , C-700/17. In the Inquiry’s assessment the area of care has certain distinctive features. The area of care has well-developed cooperation between different care units, known as ‘care chains”. The purpose of cooperation of this kind is to enable the patient to receive good care without needing to see several different care providers. A further distinctive feature is that, to a great extent, care staff act within the framework of their licence to practice and under a statutory liability.8 These distinctive features, along with the purpose of reducing the costs of care means, accor- ding to the Inquiry, that it cannot be excluded that the ECJ would argue in a different way regarding staffing in care than the Court did in its and ”go fair” Zeitarbeit rulings.9 What circumstances the ECJ would attach weight to concerning the assessment of value added tax and staffing in care has, quite simply, not been established. The absence of guidance from the ECJ regarding the care exemption means that it is uncertain how the Value Added Tax Directive should be interpreted regarding where to draw the dividing line between exempt care and taxable hiring out of staff. On account of that uncertainty, amending the Swedish exemption would be risky. An expansion of the exemption from tax liability for the hiring out of personnel for care/dental care or for a certain type of staffing might be overturned by the ECJ in a possible infringement procedure. The uncertainty about the legal position cannot be solved by Swedish legislation and must instead be solved at EU level. Against this background the Inquiry has chosen not to propose any legislative amendment in this part of the remit. , and , care and the hiring out of staff [Sjukvård och personaluthyrning], Skattenytt no 9 2020. 9Horizon College, C-434/05, and ”go fair” Zeitarbeit, C-594/13. The social care exemption Following the ECJ’s judgments in ”go fair” Zeitarbeit and Finanzamt D v. E10 it is clear that the hiring out of social care staff is not, in itself, a service of a social character even though the staff are to perform services of that kind. As regards other types of services than the hiring out of staff, the ECJ stated in its judgment in Finanzamt D v. E that there is scope to exempt provision performed by subsuppliers. The key points are the inherent characteristics of the transaction provided and the status of the operator providing the services or delivering the goods concerned.11 This means that the provision in itself must be judged to be a care service and the subsupplier must be a body recognised as being devoted to social wellbeing. The Articles of the Value Added Tax Directive on exemptions for social care cover transactions closely related to the social area. This means that there is scope to exempt transactions that are not in themselves devoted to social wellbeing. The ECJ’s jurisprudence has clarified the circumstances when this is possible. Both the buyer and the seller must be bodies governed by public law or bodies recognised as being devoted to social wellbeing and the goods or service must be essential to the exempt care service. Moreover, the basic purpose must not be to obtain additional income through transactions that are in direct competition with those of commercial enterprises subject to value added tax. The are no possibilities under EU law to amend the Value Added Tax Act so that the hiring out of staff for social care is exempted from VAT liability. If the conditions laid down by the ECJ are met, the hiring out of staff for social care can be exempted if it is considered to be closely related to social care. It is not possible to expand or restrict this scope at national level. 10”go fair” Zeitarbeit, C-594/13, and Finanzamt D v. E, C-657/19. 11Finanzamt D v. E, C-657/19. The Inquiry's work and method to calculate the share of input value added tax The inquiry report Review of compensation to municipalities and county councils for ‘hidden value added tax’ (SOU 2015:93) calcula- ted input tax for municipalities and regions on the basis of the operating accounts in the summary financial statements compiled each year by Statistics . The Inquiry has studied the previous inquiry's calculations in order to take account of the criticism they received in the consultation held. However, the Inquiry finds that the previous inquiry's calculations of input tax for municipalities and regions are thorough. The summary financial statements are the statistical information that this Inquiry also considers to be most suitable for calculating input tax for municipalities and regions. This Inquiry has chosen to calculate the cost of input tax as a share of total costs, including the cost share for input tax on hired staff, by starting from the previous inquiry's calculation of the share of input tax for municipalities and for regions and supplementing this with an additional calculation of input tax on hired staff for care and social care. The Inquiry has calculated the size of the costs for input tax on hired staff for care and social care at private providers. To obtain information about the private providers' costs the Inquiry has conducted a survey. The survey questionnaire was sent to private providers in various areas of care, social care and education in different parts of the country. The survey has been carried out during the ongoing pandemic, which may have had a negative impact on the response rate. In all, the Inquiry has received 223 replies from private providers in social care, 313 replies from private providers in care and 68 replies from private providers in education. This means an overall corrected response rate of 25 percent. For social care the corrected response rate was 26 percent, for care it was 33 percent and for education it was 12 percent. The calculated average cost shares for input tax, including the additional cost of input tax on hired staff for care, social care and education in activities conducted by municipalities, regions and private providers, has turned out to be lower than the standard compensation applicable at present under Section 5 of the Compen- sation Act (6 percent). The average cost shares calculated for input tax for care, social care and education conducted by regions and municipalities shows that when the additional cost of input tax on hired staff is added to the costs for input tax on other costs, the total cost shares for input tax do not differ substantially from the cost shares calculated by the previous inquiry. The average cost shares calculated for input tax, including the cost share for input tax for hired staff, for all private providers in care and social care that replied to the survey are of the same size as the costs of input tax as shares of total costs calculated for municipalities and regions. See tables 1 and 2 below for the estimated cost shares for input tax for activities conducted by municipalities and regions and for activities conducted by private providers. Table 1 Cost calculated for input tax, taking account of the additional liability for value added tax on hired staff, as a share of the total costs of care conducted by the regions and care conducted by private providers in 2016, 2017, 2018 and 2019 care conducted by the regions care conducted by private providers Source: to municipalities and county councils for ‘hidden value added tax’ (SOU 2015:93) and own calculations based on our questionnaire survey. Table 2 Cost calculated for input tax, taking account of the additional liability for value added tax on hired staff, as a share of the total costs of social care conducted by the municipalities and private providers and of education in 2016, 2017, 2018 and 2019 Social care conducted by the Social care conducted by private providers Source: to municipalities and county councils for ‘hidden value added tax’ (SOU 2015:93) and own calculations based on our questionnaire survey. *The cost of input tax for hired staff for education has been calculated on the basis of private providers’ costs, while the cost of input tax for other costs has been taken from the previous inquiry’s calculations of input tax for education. At the same time as the aggregate costs of input tax in the activities do not show any noteworthy increase since the previous inquiry made its calculations in 2013, the Inquiry’s calculations show that the cost of hired staff in care and social care conducted by municipalities and regions has increased, on average, by around 45 percent between 2013 and 2019. The largest increase in the cost of hired personnel as a share of total costs has been in social care. The Inquiry is able to conclude that the aggregate costs of hired staff make up a relatively small share of the total costs of conducting the activities, so that the cost of input tax does not increase appreciably even after value added tax has been added to the costs of hired staff. The Inquiry’s calculations based on its survey show that the total cost of hired staff as a share of total costs can vary strongly between different private providers in care. Around 7 percent of the private providers in care have such high costs for hired staff that their total costs for input tax exceed the standard compensation of 6 percent. Looking instead at the private providers that have stated costs for hired staff, around 50 percent have stated costs for hired staff that mean that their total costs for input tax exceed the standard compensation of 6 percent. In social care, however, no private providers have stated cost shares for hired staff that are so high that their total cost share for input tax exceeds the standard compensation of 6 percent of their total costs. Deliberations and proposal concerning compensation under the Compensation Act Compensation for private providers’ actual costs for input value added tax The previous inquiry's examination of the increase in administration that would result from a change of compensation model is still a weighty reason against changing the compensation model. Private providers, municipalities and the would need to put considerable resources into handling data about the private providers’ actual costs for input value added tax. The other funda- mental problems following from a change of compensation model enumerated by the previous inquiry, such as the failure of such a model to capture hidden value added tax in previous stages, are still relevant and carry weight as reasons against such a change. Circum- stances have not changed since the previous inquiry in such a way that new circumstances have emerged that are arguments for a change of compensation model. This Inquiry therefore makes the same assessment of this matter as the previous inquiry. The calculations presented show that the cost shares for input tax of total costs for municipalities and for regions are of around the same size, 4.7 percent for the municipalities and 5.1 percent for the re- gions. The additional costs of input tax on hired staff have not had a noteworthy effect on their cost shares for input tax or their rela- tionship to one another. Considering that the cost share for input tax is, on average, roughly the same for exempt activities in municipalities and regions and that VAT liability for hired staff has not had a noteworthy impact on the cost shares for input tax between municipalities and regions, the Inquiry considers that there is no reason to propose a differentiation of the standard compensation between municipalities and regions. The Inquiry proposes new alternative levels for compensation under Section 5 of the Compensation Act by adding two new sections, Sections 1 b and 1 c, to the Compensation Ordinance. The Inquiry also proposes moving certain parts of what is now regulated in Section 1 of the Compensation Ordinance to a new section, Section 1 a, without this involving any substantive change here. Compen- sation under Section 5 of the Compensation Act, should, if it is shown that a certain part of the cost relates to the cost for hired staff for care, dental care and social care, be paid for 20 percent of the cost of this part and for 5 percent of the cost of the remainder. If compensation is paid for 20 percent of the cost of the part that relates to hired staff for care, dental care and social care and for 18 percent of the cost of the part that relates to costs for prem- ises, compensation should be paid for 3 percent of the remainder of the cost. The new compensation levels should be alternatives to compensation under the main rule in Section 1 of the Compensation Ordinance, which is 6 percent. The Inquiry’s assessment is that the proposed levels mean a more precise system of compensation for hidden value added tax that will therefore improve the conditions for neutrality in the municipality’s choice between conducting the activity in house or contracting out to private providers. This proposal entails a greater administrative burden for private providers, municipalities, and the since the cost share for hired staff must be proved for every application. In the Inquiry’s assessment, however, the advantages of introducing addi- tional compensation levels outweigh the disadvantages. In cases where the private provider is unable to present supporting informa- tion that is sufficient to prove the right to the higher level of com- pensation, the municipality still has the possibility of applying for compensation under the main rule (6 percent). The proposal is not judged to conflict with the EU’s State aid rules.