# C_2019139EN.01002201.xml

| 15.4.2019 | EN | Official Journal of the European Union | C 139/22 |
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15.4.2019

EN

Official Journal of the European Union

C 139/22

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Request for a preliminary ruling from the Szombathelyi Közigazgatási és Munkaügyi Bíróság (Hungary) lodged on 11 December 2018 — WO v Vas Megyei Kormányhivatal

(Case C-777/18)

(2019/C 139/21)

Language of the case: Hungarian

Referring court

Szombathelyi Közigazgatási és Munkaügyi Bíróság

Parties to the main proceedings

Applicant: WO

Defendant: Vas Megyei Kormányhivatal

Questions referred

| 1. | Does national legislation, such as that at issue in the main proceedings, which, as regards the reimbursement of the costs of cross-border healthcare, precludes the healthcare provided in another Member State without prior authorisation from being subsequently authorised, even when there is a genuine risk that the patient’s state of health may irreversibly deteriorate while waiting for that prior authorisation, amount to a restriction contrary to Article 56 of the Treaty on the Functioning of the European Union (TFEU)? |
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1.

Does national legislation, such as that at issue in the main proceedings, which, as regards the reimbursement of the costs of cross-border healthcare, precludes the healthcare provided in another Member State without prior authorisation from being subsequently authorised, even when there is a genuine risk that the patient’s state of health may irreversibly deteriorate while waiting for that prior authorisation, amount to a restriction contrary to Article 56 of the Treaty on the Functioning of the European Union (TFEU)?

| 2. | Does a Member State’s authorisation system which, as regards the reimbursement of the costs of cross-border healthcare, precludes subsequent authorisation, even when there is a genuine risk that the patient’s state of health will irreversibly deteriorate while waiting for prior authorisation, comply with the principles of necessity and proportionality set out in Article 8(1) of Directive 2011/24/EU (1) of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross-border healthcare and with the principle of the free movement of patients? |
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2.

Does a Member State’s authorisation system which, as regards the reimbursement of the costs of cross-border healthcare, precludes subsequent authorisation, even when there is a genuine risk that the patient’s state of health will irreversibly deteriorate while waiting for prior authorisation, comply with the principles of necessity and proportionality set out in Article 8(1) of Directive 2011/24/EU (1) of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross-border healthcare and with the principle of the free movement of patients?

| 3. | Does national legislation which, regardless of the state of health of the patient submitting the request, establishes a procedural time limit of 31 days within which the competent authority may grant prior authorisation and of 23 days within which it may refuse authorisation, comply with the requirement to set a reasonable procedural period taking into account specific medical conditions, urgency and individual circumstances, laid down in Article 9(3) of Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross-border healthcare? The authority may assess, in respect of the request, whether the provision of healthcare is covered by social security and, if so, whether it may be delivered, within a time limit that is medically justifiable, by a publicly-funded healthcare provider, whereas if it is not covered by social security, the authority assesses the quality, safety and cost effectiveness of the healthcare delivered by the provider indicated by the patient. |
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3.

Does national legislation which, regardless of the state of health of the patient submitting the request, establishes a procedural time limit of 31 days within which the competent authority may grant prior authorisation and of 23 days within which it may refuse authorisation, comply with the requirement to set a reasonable procedural period taking into account specific medical conditions, urgency and individual circumstances, laid down in Article 9(3) of Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross-border healthcare? The authority may assess, in respect of the request, whether the provision of healthcare is covered by social security and, if so, whether it may be delivered, within a time limit that is medically justifiable, by a publicly-funded healthcare provider, whereas if it is not covered by social security, the authority assesses the quality, safety and cost effectiveness of the healthcare delivered by the provider indicated by the patient.

| 4. | Must Article 20(1) of Regulation (EC) No 883/2004 (2) of the European Parliament and of the Council of 29 April 2004 on the coordination of social security systems be interpreted as meaning that the reimbursement of cross-border healthcare costs may only be requested if the patient has applied for prior authorisation to the competent authority? Or does Article 20(1) not in itself in such a case preclude applying for subsequent authorisation for reimbursement of the costs? |
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4.

Must Article 20(1) of Regulation (EC) No 883/2004 (2) of the European Parliament and of the Council of 29 April 2004 on the coordination of social security systems be interpreted as meaning that the reimbursement of cross-border healthcare costs may only be requested if the patient has applied for prior authorisation to the competent authority? Or does Article 20(1) not in itself in such a case preclude applying for subsequent authorisation for reimbursement of the costs?

| 5. | Does the situation where a patient travels to another Member State having obtained a specific appointment for a medical examination and a provisional appointment for possible surgery or medical intervention on the day following the examination and, given the state of the patient’s health, the surgery or intervention is actually performed, come within the scope of Article 20(1) of Regulation (EC) No 883/2004 of the European Parliament and of the Council of 29 April 2004 on the coordination of social security systems? Is it possible, in that case, to apply for subsequent authorisation for reimbursement of the costs under Article 20(1)? |
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5.

Does the situation where a patient travels to another Member State having obtained a specific appointment for a medical examination and a provisional appointment for possible surgery or medical intervention on the day following the examination and, given the state of the patient’s health, the surgery or intervention is actually performed, come within the scope of Article 20(1) of Regulation (EC) No 883/2004 of the European Parliament and of the Council of 29 April 2004 on the coordination of social security systems? Is it possible, in that case, to apply for subsequent authorisation for reimbursement of the costs under Article 20(1)?

| 6. | Is the situation where a patient travels to another Member State having obtained a specific appointment for a medical examination and a provisional appointment for possible surgery or medical intervention on the day following the examination and, given the state of the patient’s health, the surgery or intervention is actually performed, covered by the concept of scheduled treatment within the meaning of Article 26 of Regulation (EC) No 987/2009 (3) of the European Parliament and of the Council of 16 September 2009 laying down the procedure for implementing Regulation (EC) No 883/2004 on the coordination of social security systems? If so, is it possible, under Article 26, to apply for subsequent authorisation for reimbursement of the costs? In the case of an urgent vitally necessary treatment, referred to in Article 26(3), does the regulation also require prior authorisation in terms of Article 26(1)? |
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6.

Is the situation where a patient travels to another Member State having obtained a specific appointment for a medical examination and a provisional appointment for possible surgery or medical intervention on the day following the examination and, given the state of the patient’s health, the surgery or intervention is actually performed, covered by the concept of scheduled treatment within the meaning of Article 26 of Regulation (EC) No 987/2009 (3) of the European Parliament and of the Council of 16 September 2009 laying down the procedure for implementing Regulation (EC) No 883/2004 on the coordination of social security systems? If so, is it possible, under Article 26, to apply for subsequent authorisation for reimbursement of the costs? In the case of an urgent vitally necessary treatment, referred to in Article 26(3), does the regulation also require prior authorisation in terms of Article 26(1)?

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(1)  OJ 2011 L 88, p. 45.

(2)  OJ 2004 L 166, p. 1.

(3)  OJ 2009 L 284, p. 1.

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