This Decision is addressed to the Republic of Lithuania.

4.The release of instalments in accordance with the Financing Agreement shall be conditional on available funding and a decision by the Commission, taken in accordance with Article 24 of Regulation (EU) 2021/241, that Lithuania has satisfactorily fulfilled the relevant milestones and targets identified in relation to the implementation of the recovery and resilience plan. Subject to the entry into force of the legal commitments referred to in paragraph 1, to be eligible for payment, milestones and targets shall be completed no later than 31 August 2026.

3.The pre-financing shall be released subject to the entry into force and in accordance with the Financing Agreement provided for in Article 23(1) of Regulation (EU) 2021/241. Pre-financing shall be cleared by being proportionally deducted against the payment of the instalments.

2.The Union financial contribution shall be made available by the Commission to Lithuania in instalments in accordance with the Annex. An amount of EUR 289 145 365 shall be made available as a pre-financing payment, equal to 13 % of the financial contribution. The pre-financing and instalments may be disbursed by the Commission in one or several tranches. The size of the tranches shall be subject to the availability of funding.

1.The Union shall make available to Lithuania a financial contribution in the form of non-repayable support amounting to EUR 2 224 195 119. An amount of EUR 2 091 774 090 shall be available to be legally committed by 31 December 2022. Subject to the update provided for in Article 11(2) of Regulation (EU) 2021/241 calculating an amount for Lithuania equal to or more than this amount, a further amount of EUR 132 421 029 shall be available to be legally committed from 1 January 2023 until 31 December 2023.

The reforms and investment projects under the recovery and resilience plan, the arrangements and timetable for monitoring and implementation of the recovery and resilience plan, including the relevant milestones and targets, the relevant indicators relating to the fulfilment of the envisaged milestones and targets, and the arrangements for providing full access by the Commission to the underlying relevant data are set out in the Annex to this Decision.

The assessment of the recovery and resilience plan of Lithuania on the basis of the criteria provided for by Article 19(3) of Regulation (EU) 2021/241 is approved.

Article 1 Approval of the assessment of the recovery and resilience plan

(51)This Decision should be without prejudice to the outcome of any procedures relating to the award of Union funds under any other Union programme than Regulation (EU) 2021/241 or to procedures relating to distortions of the operation of the internal market that may be undertaken, in particular under Articles 107 and 108 of the Treaty. It does not override the requirement for Member States to notify instances of potential State aid to the Commission under Article 108 of the Treaty,

(50)Lithuania has requested pre-financing of 13% of the financial contribution. That amount should be made available to Lithuania subject to the entry into force and in accordance with the Financing Agreement provided for in Article 23(1) of Regulation (EU) 2021/241.

(49)The support to be provided is to be financed from the borrowing by the Commission on behalf of the Union on the basis of Article 5 of Council Decision (EU, Euratom) 2020/2053. The support should be paid in instalments once Lithuania has satisfactorily fulfilled the relevant milestones and targets identified in relation to the implementation of the recovery and resilience plan.

(48)In accordance with Article 11(2) of Regulation (EU) 2021/241, the calculation of the maximum financial contribution for Lithuania is to be updated by 30 June 2022. As such, in accordance with Article 23(1) of that Regulation, an amount for Lithuania should be made available now for a legal commitment by 31 December 2022. Where necessary following the updated maximum financial contribution, the Council, on a proposal from the Commission, should amend this Decision to include the updated maximum financial contribution without undue delay.

(47)The estimated total cost of the recovery and resilience plan of Lithuania is EUR 2 224 686 966. As the recovery and resilience plan satisfactorily complies with the criteria for assessment set out in Regulation (EU) 2021/241 and, furthermore, as the amount of the estimated total costs of the recovery and resilience plan is higher than the maximum financial contribution available for Lithuania, the financial contribution allocated for Lithuania’s recovery and resilience plan should be equal to the total amount of the financial contribution available for Lithuania.

(46)Following the positive assessment of the Commission concerning the Lithuanian recovery and resilience plan with the finding that the plan satisfactorily complies with the criteria for assessment set out in Regulation (EU) 2021/241, in accordance with Article 20(2) of that Regulation, this Decision should set out the reforms and investment projects necessary for the implementation of the plan, the relevant milestones, targets and indicators, and the amount made available from the Union for the implementation of the plan in the form of non-repayable financial support.

(45)The plan was subject to a public consultation which was held in April 2021, allowing citizens and organisations to participate. At the early stages of the plan development, a number of thematic discussions were organised, involving employer organisations, trade unions, local authorities and non-governmental organisations. To ensure ownership by the relevant actors, it is crucial to involve all local authorities and stakeholders concerned, including social partners, throughout the implementation of the investments and reforms included in the plan.

(44)The plan is contributing to the following cross-border and multi-country projects (MCPs): Genome Europe and Via Baltica and Rail Baltica 5G corridors. Some of those projects are funded by other programmes as well, such as Connecting Europe Facility and by structural funds.

(43)The plan includes a security self-assessment for investments in 5G connectivity, which refers to and describes the national legislation implementing key measures recommended in the context of the EU Toolbox for cybersecurity of 5G networks. These measures include, amongst others, strengthening the role of national authorities, and restricting the role of high-risk suppliers.

(42)The plan contains some measures that are expected to help Lithuania address the challenges posed by gender equality and equal opportunities for all. These include measures that directly and indirectly aim to address the needs of persons with disabilities such as facilitating accessibility to buildings, independent use of online public services and an increase in universal benefit for single people with disability. The development of digital skills especially for vulnerable groups including persons with disabilities, older persons, migrants and refugees is also included in the recovery and resilience plan of Lithuania. The reform of long-term care provision should improve the possibility for working-age carers, most of whom are middle-aged women, to return to the labour market. Reforms and investments included in the plan should reduce existing social, economic and territorial disparities. The plan refers to legislative and policy initiatives that are expected to complement the reforms and investments included in the plan.

(41)The Lithuanian recovery and resilience plan is coherent, with consistent, mutually reinforcing reforms and investments, and synergies between the different components. The plan has a strategic and consistent vision, displaying coherence within each component, between the objectives of different components and amidst individual reforms and investments in different components. The seven components are coherent in their aims, in structuring the investments and reforms and in showing their thematic relation and interlinkages well. The components reinforce each other, in particular the Green Transition and the Digital Transformation. The plan is also consistent with the National Progress Plan and with the Government's Programme.

(40)In accordance with Article 19(3), point (k) and section 2.11 of Annex V to Regulation (EU) 2021/241, the plan includes to a high extent (Rating A) measures for the implementation of reforms and public investment projects that represent coherent actions.

(39)Due amongst others to the significant changes in the management and control system of the EU Structural Funds, certain audit and control elements were not yet in place at the time of submission of the plan and therefore they need to be completed in due time. This concerns the adoption of decisions to establish legal mandates of the management, administering and audit authorities, the adoption of an audit strategy and the operationalisation and entry into service of a dedicated IT tool (IS2021), which is necessary for meeting the relevant requirements of Regulation (EU) 2021/241. Concerning the latter, a milestone to monitor the fulfilment of the respective requirements has been included in the plan and should be completed by the time of the first payment request.

(38)The internal control system described in the recovery and resilience plan of Lithuania is based on existing processes and structures and clearly identifies actors (bodies/entities) and their roles and responsibilities for the performance of the internal control tasks. The system relies on the model used for the structural funds for the 2021-2027 period and should encompass a set of functions and procedures to be carried out by the managing authority, the administering authority and the audit authority within their remit, ensuring compliance with the provisions and principles of the applicable legislation. These bodies should be granted full access to the relevant information. However, while additional expertise and administrative capacity of the newly created audit authority is planned, it still needs to be built up.

(37)In accordance with Article 19(3), point (j) and section 2.10 of Annex V to Regulation (EU) 2021/241, the arrangements proposed in the recovery and resilience plan and the additional measures contained in this Decision are adequate (Rating A) to prevent, detect and correct corruption, fraud and conflicts of interests when using the funds provided under that Regulation, and the arrangements are expected to effectively avoid double funding from that Regulation and other Union programmes. This is without prejudice to the application of other instruments and tools to promote and enforce compliance with Union law, including for preventing, detecting and correcting corruption, fraud and conflicts of interests, and for protecting the Union finances in line with Regulation (EU, Euratom) 2020/2092 of the European Parliament and of the Council.

(36)Lithuania has provided individual cost estimates for all investments included in the recovery and resilience plan. The cost breakdown is generally detailed and well-substantiated. The estimates are based on comparisons with past investments of a similar nature. While Lithuania did not provide an independent validation for the cost estimates proposed, the assessment of the cost estimates and inherent supporting documents show that most of the costs are well justified and reasonable. The amounts proposed for financing were deemed appropriate and seen as establishing the plausibility of the cost estimates to a medium extent. Although most amounts are in the low to medium range compared to costs of similar reforms or investments, for a limited set of measures the costing is deemed to be plausible to a low extent. Finally, the estimated total cost of the recovery and resilience plan is in line with the principle of cost-efficiency and is commensurate to the expected national economic and social impact.

(35)In accordance with Article 19(3), point (i) and section 2.9 of Annex V to Regulation (EU) 2021/241, the justification provided in the plan on the amount of the estimated total costs of the recovery and resilience plan is to a medium extent (Rating B) reasonable and plausible, is in line with the principle of cost-efficiency and is commensurate to the expected national economic and social impact.

(34)Member States should ensure that financial support under the Facility is communicated and acknowledged in line with Article 34 of Regulation (EU) 2021/241. Technical support may be requested under the Technical Support Instrument to assist Member States in the implementation of their plan.

(33)The Ministry of Finance should be the managing authority which coordinates the implementation and monitoring of the plan and should be the main contact point for the Commission. The Central Project Management agency should be an administrating authority of the plan, which assesses and selects projects and ensures their compliance with project contracts, national and the Union legislation. Sectoral ministries and authorities under their control should be mainly responsible for the implementation and reporting on the milestones and targets. The monitoring indicators are relevant, acceptable and robust. They reflect the overall level of ambition of the plan adequately and are realistic. The distribution of milestones and targets across time is somewhat uneven, with a backloading towards 2026. Milestones and targets are also relevant for measures already completed which are eligible according to Article 17(2) of Regulation (EU) 2021/241. The satisfactory fulfilment of those milestones and targets over time is required to justify a disbursement request.

(32)In accordance with Article 19(3), point (h) and section 2.8 of Annex V to Regulation (EU) 2021/241, the arrangements proposed in the recovery and resilience plan are adequate (Rating A) to ensure effective monitoring and implementation of the recovery and resilience plan, including the envisaged timetable, milestones and targets, and the related indicators.

(31)Long-lasting structural changes can be expected from the implementation of the envisaged investments. Green investments are expected to support Lithuania’s transition to a circular economy, to boost innovative and smart mobility, and to reduce Lithuania’s dependence on non-renewable energy and resources. Investments fostering digitalisation in the public sector, businesses and academia, are expected to bring greater efficiency in those sectors. In addition, the increase in funding and coverage of active labour market policies is expected to have lasting impact on the functioning of the labour market, as well as on poverty reduction and income equality. The lasting impact of the plan can also be enhanced through synergies between the plan and other programmes including those financed by the cohesion policy funds, notably by addressing in a substantive manner the deeply rooted territorial challenges and promoting a balanced development.

(30)Long-lasting structural changes can be expected from the implementation of the envisaged reforms. In particular, the envisaged reforms that aim at fostering the green and digital transitions, as well as reforms in the education, vocational education and training systems, are expected to have a lasting impact on Lithuania’s economy, by strengthening people’s skills for the labour market, fostering export capacity, productivity, and, overall, sustainable long-term growth. In addition, the envisaged reforms in higher education are expected to improve the quality and efficiency of higher education programmes. The streamlining of the state innovation policy is expected to have a sizeable lasting impact on innovation. The envisaged reforms of the health sector, such as the consolidation of the hospitals’ network, the re-organisation of ambulance services, the establishment of the Health Professionals Competency Platform and the development of the digital health system are expected to increase the efficiency, accessibility and strengthen resilience of the healthcare system. Furthermore, reforms to modernise the public sector, both in terms of civil service management and budget planning, including spending reviews, are expected to trigger long-lasting improvements in the efficiency of the public sector. Reforms to strengthen tax compliance and improve the efficiency of the tax system and the redistributive capacity of the tax-benefit system are expected to alleviate poverty and social exclusion and help improve fiscal sustainability and economic efficiency.

(29)In accordance with Article 19(3), point (g) and section 2.7 of Annex V to Regulation (EU) 2021/241, the recovery and resilience plan is expected to have a lasting impact on Lithuania to a large extent (Rating A).

(28)In the context of the pandemic, the digitalisation of health and education systems has also become a prominent challenge and a priority for action. The plan includes measures to promote digital solutions related to e-health and online learning. In addition, the plan includes important measures to integrate digital solutions into the organisation of the Employment Service, tax and customs duties collection, and the greening of the economy.

(27)The plan addresses all aspects of Lithuania’s digital transformation: connectivity, the digitalisation of the public and private sectors, and digital skills. The plan includes measures to further develop the rollout of very high capacity networks, including in rural and remote areas. In addition, substantial reforms and investments aim to digitalise the public sector. This should play a key role in the digitalisation of the economy, improving the business environment and reducing administrative costs. The plan includes measures to promote digital skills for children, employees, civil servants and senior citizens. Measures are also planned to address the shortage of IT employees in the labour market. Furthermore, the plan puts forward investments to promote the take-up of advanced digital technologies in the private sector, particularly regarding science-business cooperation for innovative technologies and the digitalisation of the cultural sector.

(26)In accordance with Article 19(3), point (f) and section 2.6 of Annex V to Regulation (EU) 2021/241, the recovery and resilience plan contains measures that contribute to a large extent (Rating A) to the digital transition or to addressing the challenges resulting from it. The measures supporting digital objectives account for an amount which represents 31,5% of the plan’s total allocation calculated in accordance with the methodology of Annex VII to Regulation (EU) 2021/241.

(25)As a result of the implementation of the measures in the plan, and in particular investments aimed at accelerating renovation of buildings, a primary energy saving of 215 GWh is expected to be attained by 2026 which could be translated into the reduction of greenhouse gas emissions by 21,500 tCO2eq. This is in addition to the energy and greenhouse gas savings expected from the replacement of polluting vehicles with zero and low emission vehicles, accompanied by the creation of the necessary alternative fuels production and recharging/filling infrastructure. Furthermore, a Circular Economy Action Plan should be adopted by 2023 to ensure Lithuania’s transition to a circular economy by 2035. The measures in the recovery and resilience plan are expected to contribute to reaching Lithuania’s 2030 and 2050 climate and energy targets.

(24)Regarding renewable energy, the plan is expected to contribute to the creation of at least 301,9 MW of additional electricity generation capacity from renewable energy sources. Out of this new capacity at least 271,8 MW should consist of solar power plants including 4 MW solar power in the Utena region and at least 30,1 MW of onshore wind power. Moreover, individual electricity storage facilities of at least 15,2 MWh and other electricity storage of at least 200 MW should be installed.

(23)The measures in Lithuania’s recovery and resilience plan are expected to effectively contribute to the green transition, and to addressing the challenges resulting therefrom. The plan supports Lithuania’s decarbonisation and energy transition objectives, as set out in the National Energy and Climate Plan. The green component contains measures aimed at increasing the generation and storage of renewable energy, sustainable mobility, renovation of buildings, restoration of degraded peatlands and circular economy. In addition, the public sector component contains a measure on the review of the current tax system with a view to identifying and phasing out tax breaks and exemptions that are most harmful to the environment. The implementation of those proposed measures is expected to have a lasting impact, notably by contributing to the green transition, the enhancement of biodiversity, and environmental protection.

(22)In accordance with Article 19(3), point (e) and section 2.5 of Annex V to Regulation (EU) 2021/241, the recovery and resilience plan contains measures that contribute to a large extent (Rating A) to the green transition, including biodiversity, or to addressing the challenges resulting therefrom. The measures supporting climate objectives account for an amount which represents 37,8 % of the plan’s total allocation calculated in accordance with the methodology of Annex VI to Regulation (EU) 2021/241. In accordance with Article 17 of Regulation (EU) 2021/241, the recovery and resilience plan is consistent with the information included in the National Energy and Climate Plan 2021-2030.

(21)The plan pays particular attention to measures whose impact on environmental objectives warrants close scrutiny. The green component puts particular focus on sustainable mobility with a reform “Moving without polluting the environment”. This notably entails support to develop renewable fuels sector such as biomethane and second generation liquid biofuels and the establishment of filling stations for these alternative fuels. Those investments could potentially harm several environmental objectives, such as climate change mitigation, prevention and control of air pollution and biodiversity. This should be prevented by the requirement that biomethane gas or biofuels are produced exclusively from the feedstocks listed in Annex IX to Directive (EU) 2018/2001 of the European Parliament and the Council and that the final production complies with the provisions of that Directive, and related implementing and delegated acts. The producers should submit certificates attesting to the sustainability of their production. Furthermore, Lithuania provided assurances, reiterated in the corresponding target, that exclusively biofuels, bio liquid and biomass fuels compliant with Directive (EU) 2018/2001 should be used by the vehicles supported under the recovery and resilience plan and that the share of biofuels in the national fuel mix should increase over time. A system of renewable fuel accounting units should be created to record the quantities of biomethane gas and other renewable fuels supplied to the transport sector according to which the operators should obtain certificates commensurate to the expected renewable fuel use. Finally, the Law on alternative fuels establishes new requirements on the fuel producers.

(20)The recovery and resilience plan ensures for each reform and investment that no significant harm is done to any of the six environmental objectives within the meaning of Article 17 of Regulation (EU) No 2020/852, namely climate change mitigation, climate change adaptation, sustainable use and protection of water and marine resources, circular economy, pollution prevention and control, and protection and restoration of biodiversity and ecosystems. Lithuania provided justifications following the ‘do no significant harm’ technical guidance of the Commission (2021/C 58/01). Where needed, the requirements of the ‘do no significant harm’ assessment are enshrined in the design of a measure and specified in a milestone or target of that measure. This ensures that any disbursement for the respective measures can only be made once compliance with the ‘do no significant harm’ principle is ensured.

(19)In accordance with Article 19(3), point (d) and section 2.4 of Annex V to Regulation (EU) 2021/241, the recovery and resilience plan is expected to ensure that no measure (Rating A) for the implementation of reforms and investments projects included in the recovery and resilience plan does significant harm to environmental objectives within the meaning of Article 17 of Regulation (EU) 2020/852 of the European Parliament and of the Council (the principle of ‘do no significant harm’).

(18)The plan is expected to contribute to the implementation of the European Pillar of Social Rights through a significant positive short-to-medium-term impact on the labour market functioning, education, poverty and income inequality, inter alia thanks to an increase in the funding and coverage of active labour market policies; an increase in universal benefits for single elderly and people with disability; and an increase in the coverage of the unemployment social insurance system. The long-term impact is expected to be reinforced by improving educational performance and efficiency of the tax-benefit system. The impact of the plan on territorial cohesion was not quantified, but a qualitative analysis suggests a positive impact on the reduction of socio-economic disparities between Lithuanian regions.

(17)Simulations by the Commission services show that the plan has the potential to increase the GDP of Lithuania by between 1,0% and 1,6% by 2026.Sustainable and growth-enhancing reforms and investments included in the plan are expected to address the structural weaknesses of Lithuania’s economy and enhance its resilience and productivity. Measures supporting renewable energy generation and storage, energy-efficient renovation, digitalisation of public administrative services, training and entrepreneurship support measures as well as innovation and science and business cooperation are in line with the updated European Industrial Strategy and are expected to directly contribute to greater job creation, economic competitiveness and sustainable long-term growth. The reform of minimum income scheme, measures to modernise general education and reforming the vocational education and training system together with measures to improve quality and accessibility to health services are expected to have a lasting effect on Lithuania’s social inclusion and skills. The long-term impact of those measures is expected to be reinforced by the fiscal and economic benefits of planned reforms related to the public sector, especially to improve the budgetary framework, tax compliance and the efficiency of the tax system.

(16)In accordance with Article 19(3), point (c) and section 2.3 of Annex V to Regulation (EU) 2021/241, the recovery and resilience plan is expected to have a high impact (Rating A) on strengthening the growth potential, job creation, and economic, social and institutional resilience of the Member State, contributing to the implementation of the European Pillar of Social Rights, including through the promotion of policies for children and youth, and on mitigating the economic and social impact of the COVID-19 crisis, thereby enhancing the economic, social and territorial cohesion and convergence within the Union.

(15)Continued convergence remains a priority for Lithuania, and requires reducing regional disparities, addressing a lack of a skilled workforce and low investment, including in research and development. Lithuania’s business environment should be improved through reforms and investments aimed at improving tax collection, efficiency of the tax system and digitalising the public sector. The plan aims at improving the quality of education and training at all levels and at increasing the participation rates in adult learning for better skills management. Reforms and investments in higher education, vocational education and training systems are expected to help these systems to better respond to the green and digital transition in the labour market and social policies. The consolidation of agencies responsible for innovation promotion is expected to help make research and innovation policies more efficient. Regional disparities, high risks of poverty and social exclusion are tackled through reforms to improve the adequacy of the minimum income support, and the redistributive capacity of the tax-benefit system, improvements in long-term care, and the measures to improve the quality and accessibility of the healthcare system. Policies to support the country’s digital transformation and green transition, such as further developing the rollout of very high capacity networks, supporting renewable energy generation and storage and replacing polluting vehicles with the zero emission ones to some extent also contribute to address significant regional disparities. On this basis the plan is expected to provide a significant boost to the growth potential of the Lithuanian economy in a sustainable manner.

(14)The recommendations regarding the immediate fiscal policy response to the pandemic can be considered as falling outside the scope of Lithuania’s recovery and resilience plan, notwithstanding the fact that Lithuania has generally responded adequately and sufficiently to the immediate need to support the economy through fiscal means in 2020 and 2021, in line with the provisions of the General Escape Clause. Furthermore, the recommendations related to energy interconnections and liquidity support for the private sector can also be considered as falling outside the scope of the plan as firstly, the energy interconnection projects are on track and secondly, the Lithuanian government introduced tax deferrals, allocated funds for direct payments and committed to providing additional loan guarantees to support liquidity for businesses, in response to the COVID crisis.

(13)The reforms and investments included in the plan are expected to boost the growth potential of the economy in a sustainable manner. The plan aims to foster renewed growth by supporting the digital and green transitions, innovation, education and skills development, and a more efficient public sector.

(12)The plan includes an extensive set of mutually reinforcing reforms and investments that contribute to effectively addressing to varying degrees all or a significant subset of the economic and social challenges outlined in the country-specific recommendations addressed to Lithuania by the Council in the European Semester in 2019 and in 2020, notably those in the areas of healthcare, such as the resilience, accessibility, quality, affordability and efficiency of the healthcare system; education and skills, such as the quality and efficiency of all education and training levels; social inclusion such as the minimum income benefits; tax compliance and the effectiveness of the tax and benefit system; innovation, energy and resource efficiency, sustainable transport and energy interconnections.

(11)In accordance with Article 19(3), point (b) and section 2.2 of Annex V to Regulation (EU) 2021/241, the recovery and resilience plan is expected to contribute to effectively addressing all or a significant subset of challenges (Rating A) identified in the relevant country-specific recommendations, including fiscal aspects thereof addressed to the Member State concerned or challenges identified in other relevant documents officially adopted by the Commission in the context of the European Semester.

Addressing all or a significant subset of challenges identified in Country-Specific Recommendations

(10)Following the pandemic crisis, the Lithuanian plan includes measures aimed at strengthening the health and economic, social, and institutional resilience that is the fifth Pillar referred to in Article 3 of Regulation (EU) 2021/241. Whilst the plan focuses directly on improving the resilience, quality, accessibility and efficiency of the healthcare system, it also includes measures aimed at reforming the social infrastructure of Lithuania. The plan pledges to improve the efficiency of the public sector through civil service reform and digitalisation, through a reform of the tax system oriented towards higher compliance, fairness, better redistributive capacity and growth-friendliness, as well as through improvements to the budgetary framework, including spending reviews. The measures included in the plan also aim at improving employment support and guaranteed minimum income protection, with the view to alleviating poverty and improving social cohesion. These measures are expected to improve territorial cohesion.

(9)The plan is expected to contribute towards the improvement of macro-economic performance through the mitigation of the economic and social impact of the COVID-19 crisis, while enhancing the economic, social and territorial cohesion, thus supporting the third pillar referred to in Article 3 of Regulation (EU) 2021/241 on smart, sustainable and inclusive growth. This includes increasing investments and supporting long-term innovation, improving educational performance and expanding active labour market policies. The plan focuses on education and innovation, in particular, on the improvement of the education and training framework, therefore contributing to the fourth and sixth pillars referred to in Article 3 of that Regulation. Improving education in Lithuania is expected to contribute directly to economic and social resilience by reducing the education gap caused by socio-economic backgrounds of pupils. The plan aims at ensuring that people have the skills for future jobs through improved vocational education and training systems, expanded career guidance system and a restructured adult learning system. Measures that promote higher education and innovation are expected to increase the productivity and the competitiveness of Lithuania.

(8)The plan includes measures that contribute towards all of the six pillars, with each of the seven components of the plan addressing one or more pillars. Such an approach contributes to ensuring that each pillar is comprehensively addressed in a coherent manner. At the same time, the plan includes one component dedicated specifically to the green transition and another one to the digital transition. The achievement of the green objective is set to be supported through the increase of locally produced renewables, the promotion of sustainable transport, the green public procurement measures as well as the renovation of buildings to foster a sustainable urban environment, thus promoting the reduction of greenhouse gas emissions. Investments and reforms geared towards the digitalisation of the public sector, business and industrial ecosystems as well as improving the level of digital skills and promoting the 5G rollout are all expected to contribute to achieving the digital objectives.

(7)In accordance with Article 19(3), point (a) and section 2.1 of Annex V to Regulation (EU) 2021/241, the recovery and resilience plan represents to a large extent (Rating A) a comprehensive and adequately balanced response to the economic and social situation, thereby contributing appropriately to all six pillars referred to in Article 3 of Regulation (EU) 2021/241, taking the specific challenges and the financial allocation of the Member State concerned into account.

(6)The implementation of the Member States’ recovery and resilience plans will constitute a coordinated effort of investment and reforms across the Union. Through the coordinated and simultaneous implementation of these reforms and investments and the implementation of cross-border projects, those reforms and investments will mutually reinforce each other and generate positive spillovers across the whole Union. Therefore, about one third of the impact of the Facility on Member States’ growth and job creation will come from spillovers from other Member States.

(5)The recovery and resilience plans should pursue the general objectives of the Recovery and Resilience Facility established by Regulation (EU) 2021/241 and of the EU Recovery Instrument set up by Council Regulation (EU) 2020/2094 in order to support the recovery in the aftermath of the COVID-19 crisis. They should promote the Union´s economic, social and territorial cohesion by contributing to the six pillars referred to in Article 3 of Regulation (EU) 2021/241.

(4)On 14 May 2021, Lithuania submitted its national recovery and resilience plan to the Commission, in accordance with Article 18(1) of Regulation (EU) 2021/241. That submission followed a consultation process, conducted in accordance with the national legal framework. The national ownership of the recovery and resilience plans is underpinning their successful implementation and lasting impact at national level and credibility at Union level. Pursuant to Article 19 of that Regulation, the Commission has assessed the relevance, effectiveness, efficiency and coherence of recovery and resilience plan, in accordance with the assessment guidelines of Annex V to that Regulation.

(3)The Council recommendation on the economic policy of the euro area recommended to euro area Member States to take action, including through their recovery and resilience plans, to, inter alia, ensure a policy stance which supports the recovery and to further improve convergence, resilience and sustainable and inclusive growth. The Council recommendation also recommended to strengthen national institutional frameworks, to ensure macro-financial stability and to complete EMU and strengthen the international role of the euro.

(2)On 9 July 2019 and on 20 July 2020, the Council addressed recommendations to Lithuania in the context of the European Semester. In particular, the Council recommended to Lithuania to improve tax compliance and broaden the tax base to sources less detrimental to growth, address income inequality, poverty and social exclusion, including by improving the design of the tax and benefit system. Moreover, it recommended to improve the quality and efficiency at all education and training levels, including adult learning, and to increase the quality, affordability and efficiency of the healthcare system. Lithuania was also recommended to focus investment-related economic policy on innovation, energy and resource efficiency, sustainable transport and energy interconnections, taking into account regional disparities, and stimulate productivity growth by improving the efficiency of public investment. In addition it was also recommended to develop a coherent policy framework to support science-business cooperation and consolidate research and innovation implementing agencies. To tackle the COVID-19 crisis, Lithuania was recommended to take all necessary measures to effectively address the pandemic, sustain the economy and support the ensuing recovery. In addition, the Council recommended to Lithuania to strengthen the resilience of the health system, including by mobilising adequate funding and addressing shortages in the health workforce and of critical medical products and improve the accessibility and quality of health services. Furthermore, it was recommended to mitigate the impact of the crisis on employment, increase the funding and coverage of active labour market policy measures and promote skills, ensure the coverage and adequacy of the social safety net and improve the effectiveness of the tax and benefit system to protect against poverty. It was also recommended to support liquidity for businesses, especially for small- and medium-sized enterprises and export-oriented sectors, front-load mature public investment projects, and promote private investment to foster the economic recovery. Finally, the Council recommended Lithuania to focus investment on the green and digital transition, in particular on the coverage and take-up of very high-capacity broadband, on clean and efficient production and use of energy, and sustainable transport and to promote technological innovation in small and medium-sized enterprises. Having assessed progress in the implementation of those country-specific recommendations at the time of submission of the recovery and resilience plan, the Commission finds that the recommendation on taking all necessary measures to effectively address the pandemic, sustain the economy and support the ensuing recovery has been fully implemented. Substantial progress has been achieved with respect to the recommendation to focus investment on energy interconnections.

(1)The COVID-19 outbreak has had a disruptive impact on the economy of Lithuania. In 2019, the gross domestic product per capita (GDP per capita) of Lithuania was 56 % of the Union average. According to the Commission’s Spring 2021 forecast, the real GDP of Lithuania declined by 0,9 % in 2020 and is expected to increase by 2 % cumulatively in 2020 and 2021. Longer-standing issues with an impact on medium-term economic performance include poor health and educational outcomes, high income inequality and poverty rates, poor tax compliance, untapped research and innovation potential and low levels of private and public investment.

Having regard to the proposal from the European Commission,

Having regard to Regulation (EU) 2021/241 of the European Parliament and of the Council of 12 February 2021 establishing the Recovery and Resilience Facility and in particular Article 20 thereof,

Having regard to the Treaty on the Functioning of the European Union,

on the approval of the assessment of the recovery and resilience plan for Lithuania

on the approval of the assessment of the recovery and resilience plan for Lithuania

EUROPEAN COMMISSION Brussels, 2.7.2021 COM(2021) 386 final ANNEX

to the Proposal for a Council Implementing Decision on the approval of the assessment of the recovery and resilience plan for Lithuania {SWD(2021) 187 final}



ANNEX SECTION 1: REFORMS AND INVESTMENTS UNDER THE RECOVERY AND RESILIENCE PLAN 1.Description of Reforms and Investments A. COMPONENT 1: A resilient and future-proof health system The component of the Lithuanian recovery and resilience plan contributes to addressing challenges related to the resilience, quality, accessibility and efficiency of the healthcare system. These challenges have been exacerbated in particular by the crisis caused by the COVID-19 pandemic. The component includes a set of reforms and investments related to: (1) improving the quality and accessibility of health services and promoting innovation, (2) improving long-term care services and (3) strengthening the resilience of the healthcare system to deal with emergencies. In terms of reforms, they focus on further shift to outpatient care, reorganisation of the hospital network, digitalisation of healthcare, improving working conditions of health professionals, shortages and skills of healthcare staff, introduction of measures to improve the quality of healthcare, scaling up prevention measures and improving access to long-term care, reforming the ways of financing healthcare to reduce dependence on employment-related contributions. Regarding the investments, the plan includes targeted measures to create a centre for advanced therapies, establish a health professionals’ competence platform, digitalise the health system, develop an integrated healthcare quality assessment model, set up long-term care day-care centres and mobile teams. To increase an efficient delivery of health services in health emergencies and strengthen the resilience of the health system, investments are envisaged to modernise the infrastructure of healthcare facilities to adapt work in emergency and crisis situations. The measures included in the component are expected to address some challenges highlighted by the country-specific recommendation to strengthen the resilience of the health system and to improve the accessibility and quality of health services (country-specific recommendation 2020) as well as increase the quality, affordability and efficiency of the healthcare system (country-specific recommendation 2019). It is expected that no measure in this component does significant harm to environmental objectives within the meaning of Article 17 of Regulation (EU) 2020/852, taking into account the description of the measures and the mitigating steps set out in the recovery and resilience plan in accordance with the DNSH Technical Guidance (2021/C58/01). A.1. Description of the reforms and investments for non-repayable financial support A.1.1. Reform 1: “Improving the quality and accessibility of health services and promoting innovation” The objective of the reform is to increase the quality and accessibility of health care, with a focus on strengthening primary care, specialised outpatient care, digitalisation of the health sector and innovation. In particular, the envisaged measures focus on strengthening the role of primary health care, the development of innovative and science-based public health services, setting up a network of centres of excellence and a network of personal health facilities based on a model of regional cooperation reorienting the healthcare system from inpatient to outpatient care, improving health resource planning and skills development processes, digitalisation of the health system, monitoring of the performance of the health system and improving the financing model of the health system. This reform is accompanied by 11 sub-measures: (1) Legislative framework regulating the organisation, management and provision of ambulance services (sub-measure 1); (2) Development of digital health system facilitating the secondary use of health data (sub-measure 2); (3) Action Plan on Family Medicine Development 2016-2025 (sub-measure 3); (4) Establishment of a basic public health service delivery model (sub-measure 4); (5) Improving working conditions and professional qualifications of health professionals. (sub-measure 5); (6) Establishment of a network of personal health care institutions based on the model of regional cooperation (sub-measure 6); (7) Creation of Centre for Advanced Therapies (sub-measure 7); (8) Creation of a representative collection of reference genome data within the health project “Genome Europe” (sub-measure 8); (9) Creation of Health Professionals Competence Platform (sub-measure 9); (10) Development of healthcare quality assessment model (sub-measure 10); (11) Digitalisation of the healthcare sector (sub-measure 11). A.1.1.1. Sub-measure 1: Legislative framework regulating the organisation, management and provision of ambulance services The objective of this sub-measure is to adopt a legislation on Emergency Medical Services and the related legislation establishing a centralized model for the organization of emergency care by integrating ambulance dispatch centres into a single system of the Emergency Response Centre. The sub-measure shall be completed by 31 December 2022. A.1.1.2. Sub-measure 2: Development of digital health system facilitating the secondary use of health data The objective of this sub-measure is to adopt legislation on secondary use of health data. In this context, a mapping of health care system information resources shall be prepared and information systems maturity analysis shall be performed, assessing its integrity with other information systems. On this basis resources shall be optimised contributing to the coordinated, high-quality and interoperable IT health care system. The action plan for the development of the Digital Health System shall be implemented. The sub-measure shall be completed by 30 September 2022. A.1.1.3. Sub-measure 3: Action Plan on Family Medicine Development 2016-2025

The objective of this sub-measure is to adopt an updated action plan on Family Medicine Development for 2016-2025. The action plan to be adopted by the Ministry of Health shall enable general practitioners to focus more effectively on patients and patients to access a wider range of healthcare. Social partners shall be consulted. The sub-measure shall be completed by 31 December 2022. A.1.1.4. Sub-measure 4: Establishment of a basic public health service delivery model The objective of this sub-measure is to adopt legislation on basic model of public health service delivery establishing equal conditions to receive necessary and high-quality services for all groups in society, especially for the vulnerable and socially excluded. An analysis of the population’s health and health care inequalities shall be performed and target specific groups identified. The demand and supply of public health services for each group shall be assessed. The basic list of public health services, quality criteria, responsibilities, monitoring mechanism shall be established and approved by the order of the Minister of Health. The sub-measure shall be completed by 31 March 2023. A.1.1.5. Sub-measure 5: Improving working conditions and professional qualifications of health professionals The objective of this sub-measure is to adopt a legislation on improving working conditions and professional qualifications of health professionals. Decisions on the financial capacity of the State to fulfil the provisions of the draft agreement shall be assessed and adopted. Furthermore, an action plan for improving the psycho-emotional state of doctors shall be prepared and approved by an order of the Minister of Health. A working group shall be set up to develop a mechanism for in-service training of health care professionals. The sub-measure shall be completed by 30 June 2023. A.1.1.6. Sub-measure 6: Establishment of a network of personal health care institutions based on the model of regional cooperation The objective of this sub-measure is to adopt a legislation on the establishment and regulation of a network of personal health care institutions based on the model of centres of excellence and regional cooperation. The principles and criteria for the formation of a network of personal health care institutions shall be developed and a mechanism for cooperation between personal health care institutions and centres of excellence shall be established. A decision of the Government on the necessary regulatory, investment and communication actions to form a sustainable network of health care institutions shall be adopted. The sub-measure shall be completed by 30 September 2023. A.1.1.7. Sub-measure 7: Creation of Centre for Advanced Therapies The objective of this sub-measure is to create a Centre for Advanced Therapies to ensure the availability of innovative advanced therapies and improve the quality of health services. The project foresees an extension of the University Hospital in Vilnius for the development and production of Advanced Therapy Medicinal Products. Investments include an extension of infrastructure, purchase of medical equipment, and professional development. The Centre for Advanced Therapies shall be fully integrated with the activities of the University Hospital in Vilnius. The sub-measure shall be completed by 31 December 2024. A.1.1.8. Sub-measure 8: Creation a representative collection of reference genome data within the health project “Genome Europe” The objective of this sub-measure is to complete sequencing tests and to enable Lithuania to participate in the EU cross-border health project "Genome Europe". In particular, the investments in the project “Surveys for the sequencing of the human genome in a representative sample of the total population of Lithuania” shall create a representative collection of reference genome data of Lithuanian citizens. It aims to strengthen Lithuania’s genetic research in order to facilitate secure matching and analysing of these data within the framework of the project. The sub-measure shall be completed by 31 March 2026. A.1.1.9. Sub-measure 9: Establishment of Health Professionals Competence Platform The objective of this sub-measure is to establish a health professionals competence platform to be used for identifying, monitoring and managing health professionals’ skills development. It shall keep a record of health professionals' licences in line with the relevant regulatory framework and linked to the Licensing Register of Healthcare and Pharmaceutical Professional Practices. The sub-measure shall be completed by 31 March 2026.

A.1.1.10. Sub-measure 10: Development of healthcare quality assessment model The objective of this sub-measure is to develop an integrated healthcare quality assessment model and a patient feedback tool. The model is to assess the efficiency and quality of the health services provided by public health offices, primary care centres and hospitals and to create a framework to compare the performance of health institutions. The sub-measure shall be completed by 30 June 2024. A.1.1.11. Sub-measure 11: Digitalisation of the healthcare sector The objective of this sub-measure is to integrate various health information resources into a system based on uniform principles and modernise the electronic health elements. This includes the development of e-health records of patients and the digitalisation of personal health services, the development of telemedicine and digital solutions for communicable disease surveillance and analytical data processing, Big Data and Artificial intelligence as well as exchange of health data. The investment shall contribute to various multi-country projects related to cross-border exchange of health data, e-prescription and patient summary, European Reference Networks (ERNs) and other international networking structures, the projects aiming at developing an efficient, interoperable, secure cross-border platform for electronic health record exchange for X-eHealth for the transition to the Common Data Sharing System and creating a common European health data space. The investment aims at improving accessibility, quality and resource efficiency of health services and to promote digitally integrated healthcare system. The sub-measure shall be completed by 31 December 2025. A.1.2. Reform 2 “Provision of long-term care services” The objective of the reform is to improve the accessibility of integrated social and healthcare services by developing and implementing a sustainable long-term care model. An action plan for training, re-skilling and upskilling of long-term care professionals shall be developed and a plan for ensuring the necessary infrastructure for the provision of long-term care services at the level of each municipality and region shall ensure an optimal use of existing infrastructure for health and social protection and resources of municipal and non-governmental organisations. For each region, the analysis of resources for institutional, community-based and home-based long-term care shall be made and a new model for the provision of long-term care shall become operational. This reform is accompanied by 2 sub-measures: (1) Adoption of the long-term care model (sub-measure 1); (2) Increase of human resources and infrastructure capacity for the provision of long-term care services (sub-measure 2). A.1.2.1. Sub-measure 1: Adoption of the long-term care model The objective of this sub-measure is to adopt a legislation governing the implementation of the long-term care model. The model for the provision and financing of social and personal healthcare, thus establishing a one-stop shop for the provision of long-term care shall be developed. An in-depth analysis shall be carried out to determine the model for the provision of long-term care services. The sub-measure shall be completed by 31 March 2024. A.1.2.2. Sub-measure 2: Increase of human resources and infrastructure capacity for the provision of long-term care services The objective of this sub-measure is to set up 10 specialised long-term care day centres where patients shall have access to integrated health and social services and community-based activities. Equipment and vehicles needed for the development of outpatient long-term care services and the necessary human resources for 90 mobile teams shall be provided. At least 1000 professionals shall be trained as home carers, comprising mobile team staff and staff in the established day centres. While the specialised day centres shall be located in cities, the mobile teams shall be formed throughout the country, with special attention being paid to rural municipalities. The sub-measure shall be completed by 31 March 2026. A.1.3. Reform 3 “Systemic improvement of the health system resilience to deal with emergencies” The objective of the reform is to ensure a balanced, safe and efficient delivery of health services in emergency situations improving cooperation between health care institutions and adapting infrastructure to emergency situations. This reform is accompanied by 3 sub-measures: (1) Action plan on improving cooperation between health care institutions and modernization of infrastructure for emergency situations. (sub-measure 1); (2) Modernisation of Centres of expertise in the cluster of infectious diseases (sub-measure 2); (3) Modernisation of emergency departments and resuscitation units in regional hospitals (sub-measure 3). A.1.3.1. Sub-measure 1: Action plan improving cooperation between health care institutions and modernization of infrastructure for emergency situations The objective of this sub-measure is to adopt an action plan on improving cooperation between health care institutions and modernization of infrastructure for emergency situations. It shall include requirements for the healthcare institutions to ensure their preparedness and the effectiveness of the system's response to emergencies. The preconditions shall be created for more efficient cooperation of available human resources. An assessment of the emergency preparedness of healthcare institutions shall be carried out.

The sub-measure shall be completed by 31 March 2023. A.1.3.2. Sub-measure 2: Modernisation of Centres of expertise in the cluster of infectious diseases The objective of this sub-measure is to modernise and expand the centres of excellence of the cluster of infectious diseases in five hospitals located in major cities, including Vilnius, Kaunas, Klaipeda, Siauliai and Panevezys adapting to emergency and crisis situations. Investments shall include renovation, adaptation of buildings, reconstruction and refurbishment of premises as well as for the procurement of the medical and laboratory equipment to ensure affordable, high-quality and safe diagnostic and treatment services for infectious diseases. Overall, investments in hospital infrastructure shall help reorganising the ambulance services to ensure that the necessary and timely medical assistance is provided to the population. It shall also ensure the capacity to treat infectious diseases without increasing the total number of curative and long-term care beds at national level. The sub-measure shall be completed by 31 December 2024. A.1.3.3. Sub-measure 3: Modernisation of emergency departments and resuscitation units in regional hospitals The objective of this sub-measure is to modernise emergency, resuscitation and intensive care medical units in seven hospitals/trauma centres in Vilnius, Kaunas, Alytus, Marijampole, Utena, Telsiai and Taurage hospitals. The investments shall include reconstruction and modernisation of emergency medical units and the provision of necessary medical equipment. The sub-measure shall be completed by 31 December 2024. A.2. Milestones, targets, indicators, and timetable for monitoring and implementation for non-repayable financial support Nr. Related Measure (Reform or Investment) Milestone/Target Title Qualitative indicators

(for Milestones) Quantitative indicators

(for targets) Indicative timeline for completion Description and clear definition of each milestone and target Unit Baseline Goal Quarter Year 1 A.1.1. Improving the quality and accessibility of services and promoting innovation A.1.1.1. Legislative framework regulating the organisation, management and provision of ambulance services Milestone Entry into force of the legislation on Emergency Medical Services and the related legislation Legislation entered into force N/a N/a N/a Q4 2022 The Law on Emergency Medical Services and the related legislation such as Law on Health Care Institutions, Law on Emergency Response Centre, secondary law stipulating the requirements for the provision of ambulance services and payment procedures shall regulate the organisation, management and provision of ambulance services. 2 A.1.1. Improving the quality and accessibility of services and promoting innovation A.1.1.2. Development of digital health system facilitating the secondary use of health data Milestone Entry into force of the legislation governing the secondary use of health data Legislation entered into force N/a N/a N/a Q3 2022 Legislation on secondary use of health data and the implementing provisions on procedures for issuing permits for secondary use of data, preparation of health data for the secondary use, reimbursement of costs of providing health data by health data controllers to an institution authorized by the Government shall (i) create conditions for efficient and safe secondary use of health data for public interest purposes (research, experimental development and innovation, education and training, knowledge management in health, health policy-making, statistics), (ii) ensure sustainable development of digital health and (iii) regulate the organizational and technical measures necessary for a harmonized, coordinated and high-quality secondary use of data, while ensuring the protection of personal data. 3 A.1.1. Improving the quality and accessibility of services and promoting innovation A.1.1.3. Action Plan on Family Medicine Development 2016-2025 Milestone Adoption of the updated Action Plan on Family Medicine Development for 2016-2025 Adoption of the Action Plan on Family Medicine Development by the Ministry of Health N/a N/a N/a Q4 2022 An Action plan on Family Medicine Development for 2016-2025 shall be developed and approved by the Ministry of Health. The Action Plan shall define functions of a family doctor not directly interlinked with the provision of health care services; and redistribute responsibilities between general practitioners and other members of the medical team (nurses, midwives, nursing assistants, lifestyle professionals, social workers or physiotherapists). 4 A.1.1. Improving the quality and accessibility of services and promoting innovation A.1.1.4. Establishment of a basic public health service delivery model Milestone Entry into force of a basic model of public health service delivery establishing equal conditions to receive necessary and high-quality services for all groups in society, especially vulnerable and socially excluded Legislation entered into force N/a N/a N/a Q1 2023 The basic public health service delivery model shall establish a basic list of public health services including health promotion and disease prevention, quality criteria, service monitoring mechanism as well as of health services for target groups, especially the vulnerable and socially excluded. The necessary and high-quality services shall be provided in all municipalities in an equal manner. 5 A.1.1. Improving the quality and accessibility of services and promoting innovation A.1.1.5. Improving working conditions and professional qualifications of health professionals Milestone Entry into force of legislation on improving working conditions and professional qualifications of health professionals Legislation entered into force N/a N/a N/a Q2 2023 The legislation to improve working conditions and professional qualifications of health professionals shall include provisions on wage regulation, workload, measures to improve the psycho-emotional state of doctors and a mechanism for the in-service training of health professionals. 6 A.1.1. Improving the quality and accessibility of services and promoting innovation A.1.1.6. Establishment of a network of personal health care institutions based on the model of regional cooperation Milestone Entry into force of legislation on the establishment and regulation of a network of personal health care institutions based on the model of centres of excellence and regional cooperation Legislation entered into force N/a N/a N/a Q3 2023 Legislation governing the network of personal health care institutions based on the model of centres of excellence and regional cooperation shall establish the principles and criteria for the formation of a network of personal health care institutions and a mechanism for cooperation between personal health care institutions and centres of excellence. 7 A.1.1. Improving the quality and accessibility of services and promoting innovation A.1.1.7. Creation of Centre for Advanced Therapies Milestone Establishment of an Advanced Therapy Centre The establishment of an Advanced Therapy Centre N/a N/a N/a Q4 2024 Establishment of the advanced therapy centre shall enable the preparation of advanced therapy medicinal products and ensure the provision of innovative cell therapy services to the population throughout the country. The advanced therapy centre infrastructure design and construction works shall be completed, medical / laboratory equipment, IT equipment and furniture purchased and installed, methodological guidelines implemented, professional development training completed and the necessary operating licenses obtained. 8 A.1.1. Improving the quality and accessibility of services and promoting innovation A.1.1.8. Creation a representative collection of reference genome data within the health project “Genome Europe” Target Number of sequencing tests performed for the whole human genome N/a Number 0 750 Q2 2025 Number of completed sequencing tests performed to participate in the implementation of the EU cross-border project "Genome Europe" shall be at least 750. The Lithuanian institutions participating in the project shall be equipped with laboratory and computer equipment necessary for the development of national genomic reference data. A sustainable unified national genomic medicine infrastructure shall be created. The target is linked to the adoption of the legal framework for genome research and the exchange of this information with EU countries. 9 A.1.1. Improving the quality and accessibility of services and promoting innovation A.1.1.8. Creation a representative collection of reference genome data within the health project “Genome Europe” Target Number of sequencing tests performed for the whole human genome N/a Number 750 1570 Q1 2026 Number of completed sequencing tests performed to participate in the implementation of the EU cross-border project "Genome Europe" shall be at least 1570. The Lithuanian institutions participating in the project shall be equipped with laboratory and computer equipment necessary for the development of national genomic reference data. A sustainable unified national genomic medicine infrastructure shall be created. The target is linked to the adoption of the legal framework for genome research and the exchange of this information with EU countries. 10 A.1.1. Improving the quality and accessibility of services and promoting innovation A.1.1.9. Establishment of Health Professionals Competence Platform Milestone Establishment of a Health Professionals Competence Platform The establishment of Health Professionals Competence Platform N/a N/a N/a Q4 2023 Health Professionals Competence Platform shall be established and include modalities to identify, monitor, plan and manage health professionals such as doctors, nurses, public health, pharmaceutical specialists’ skills development (reskilling and upskilling). The Platform shall store records of health professionals' licences and be linked to the Licensing Register of Healthcare and Pharmaceutical Professional Practices. Health care institutions shall monitor and plan the professional development of specialists, monitor upskilling and reskilling of specialists of national health providers and public health care institutions. 11 A.1.1. Improving the quality and accessibility of services and promoting innovation A.1.1.10. Development of healthcare quality assessment model Target Share of health care institutions included in the Lithuanian national health system display panel based on a set of performance indicators % (Percentage) 0 100 Q2 2024 Share of health care institutions included in the health system display panel based on a set of performance indicators shall be monitored by the Ministry of Health and the State Health Care Accreditation Agency under the Ministry of Health. An IT tool for monitoring the quality of health services provided at national, municipal and health care provided level shall be put in place. The IT monitoring tool shall allow assessing the quality of the overall national health system, as well as individual municipalities and health care institutions, compare the values of indicators with the target values at the national, municipal and health care institutions level, compare the activities of all health care institutions according to the selected indicators. On the basis of monitored information, decisions shall be made on the planning of investments aimed at improving the quality of the health system. 12 A.1.1. Improving the quality and accessibility of services and promoting innovation A.1.1.11. Digitalisation of the healthcare sector Target Share of the country’s population provided with healthcare-related electronic services N/a % (Percentage) 30 60 Q4 2025 Share of Lithuanian population receiving the relevant healthcare services electronically. The services shall include the outpatient visits, electronic prescriptions, issuing of a child's birth certificate, issuing of a medical death certificate, medical examination of drivers, referrals for consultation, research, treatment, diagnostic test and vaccination records. The achievement of the target is directly linked to the creation of an information system integrated with the Electronic Health Services and Cooperation Infrastructure Information System (ESPBI IS) established by the State Enterprise Centre of Registers. The existing LNKC information system shall be integrated with the ESPBI IS and to enable the LNKC IS to exchange web service documents with national contact points of other EU countries. 13 A.1.1. Improving the quality and accessibility of services and promoting innovation A.1.1.11. Digitalisation of the healthcare sector Target Share of outpatient and inpatient personal health care institutions using e-health products N/a % (Percentage) 50 70 Q4 2025 Share of inpatient and outpatient personal health care institutions using eHealth products to increase from 50% to 70%. The institutions shall adapt their internal processes and information systems in line with the Order No. V-657 “On the approval of the description of the procedure for the use of the electronic health services and cooperation infrastructure information system" of the Minister of Health and manage data in the Electronic Health Services and Collaborative Infrastructure Information System (ESBPI IS). 14 A.1.1. Improving the quality and accessibility of services and promoting innovation A.1.1.11. Digitalisation of the healthcare sector Target Share of healthcare professionals whose license is recorded and digitally monitored % (Percentage) 0 50 Q1 2026 Share of country’s healthcare professionals, whose licence shall be recorded and digitally monitored in an IT system. The State Health Care Accreditation Agency shall monitor compliance with the license conditions of healthcare specialists and institutions. 15 A.1.2. Reform of long-term care services A.1.2.1. Adoption of the long-term care model Milestone Entry into force of legislation governing the implementation of the long-term care model Legislation entered into force N/a N/a N/a Q1 2024 Legislation governing the implementation of the long-term care model shall include the concept of long-term care services, service provision requirements, the administration of long-term care services, clear assignment of service administration functions to specific institutions, set out the basic requirements for relevant entities to provide long-term care services and establish principles and mechanisms for the financing of long-term care services. 16 A.1.2. Reform of long-term care services A.1.2.2. Increase of human resources and infrastructure capacity for the provision of long-term care services Target Share of long-term care patients receiving out-patient long-term care services (%) N/a % (Percentage) 5 30 Q2 2025 Share of Lithuanian long-term care patients receiving relevant services at home and / or in day centres to increase to 30%. The achievement of the target is directly linked to forming ninety teams of specialists providing outpatient services in the residents' homes, establishment of ten specialized day care centres in cities for the provision of more integrated long-term care services and training for at least 1000 long-term care professionals. The indicator shall be monitored by the Ministry of Health. 17 A.1.2. Reform of long-term care services A.1.2.2. Increase of human resources and infrastructure capacity for the provision of long-term care services Target Share of long-term care patients receiving out-patient long-term care services (%) N/a % (Percentage) 30 60 Q1 2026 Share of Lithuanian long-term care patients receiving relevant services at home and / or in day centres to increase to 60%. The achievement of the target is directly linked to forming ninety teams of specialists providing outpatient services in the residents' homes, establishment of ten specialized day care centres in cities for the provision of more integrated long-term care services and training for at least 1000 long-term care professionals. The indicator shall be monitored by the Ministry of Health. 18 A.1.3. Systemic improvement of the resilience of the health system to work in emergencies A.1.3.1. Action plan improving cooperation between health care institutions and modernization of infrastructure for emergency situations Milestone Entry into force of an Action plan on improving cooperation between health care institutions and modernization of infrastructure for emergency situations Adoption of the Action Plan on cooperation between health care institutions and modernisation of infrastructure for emergency situations by the Ministry of Health N/a N/a N/a Q1 2023 The action plan to improve cooperation between health care institutions and to adapt infrastructure to emergency situations shall include requirements on preparedness to emergencies for healthcare institutions and ensure efficient deployment of human resources. 19 A.1.3. Systemic improvement of the resilience of the health system to work in emergencies A.1.3.2. Modernisation of Centres of expertise in the cluster of infectious diseases Target Number of modernised health care facilities which include centres of expertise in the cluster of infectious diseases Number 0 5 Q4 2024 The investments shall be used to modernize the infrastructure of 5 infectious disease cluster centres, which is necessary to ensure the efficiency, quality and safety of the diagnosis and treatment of dangerous infections. It shall be ensured that the total number of curative and long-term care beds at national level does not increase. The target shall be deemed achieved after the following actions: (i) updated requirements for infectious diseases and admission departments have been established; (ii) investment projects for the modernised health care facilities including centres of expertise in the cluster of infectious diseases implemented. 20 A.1.3. Systemic improvement of the resilience of the health system to work in emergencies A.1.3.3. Modernisation of emergency departments and resuscitation units in regional hospitals Target Number of modernised health care facilities in hospital emergency, resuscitation and intensive care units Number 0 7 Q4 2024 The investment shall be used to modernize the emergency departments and resuscitation (intensive care) units of seven regional level hospitals in order to ensure the readiness of institutions to provide quality and safe services in emergency situations. The target shall be deemed achieved after the following actions: (i) updated requirements for the operation of emergency departments; (ii) updated requirements for resuscitation and intensive care units; (iii) investment projects for the modernised health care facilities in hospital emergency, resuscitation and intensive care units implemented. B. COMPONENT 2: Green transformation of Lithuania The component of the Lithuanian recovery and resilience plan contributes to addressing challenges linked to the green transition, and in particular the need to lower GHG emissions, including from the transport sector, increase energy efficiency in buildings and transport, enhance resource efficiency and contribute to GHG absorption through nature-based solutions. The component envisages the development of offshore wind power plant and related infrastructure, support for the construction of onshore renewable energy (RES) plants (solar and wind power plants onshore), individual storage facilities and the establishment of renewable energy communities, and installation of other electricity storage infrastructure, dedicated to public use during a first period of time. As regards mobility, key measures entail support for the replacement of polluting road transport vehicles used by the public sector and business with clean vehicles, to improve the quality and attractiveness of public transport services by upgrading public transport vehicles with zero or low emission vehicles, establishment of charging/refilling infrastructure for all types of clean vehicles using alternative fuels, and to develop alternative fuels sectors (biomethane, second generation liquid biofuels, hydrogen). As regards energy efficiency, this is planned to be achieved by the building renovation packages and standards, municipal development plans, sustainable urban development methodologies and district renovation projects, promoting the supply of construction products and services that speed up the renovation of buildings and funding for renovation. To restore the capacity of degraded wetlands to absorb and store GHG, a reform on restoring these wetlands is envisaged as result of which 8000ha of such lands shall be restored upon the plan’s implementation. Finally, resource efficiency shall be advanced with the adoption of the Circular Economy Action Plan, which shall lay out the direction to more resource efficient Lithuania by 2035. The measures included in the component support addressing the country-specific recommendation to focus on investment-related economic policy on energy and resource efficiency, sustainable transport and energy interconnections (CDR3 2019). It is expected that no measure in this component does significant harm to environmental objectives within the meaning of Article 17 of Regulation (EU) 2020/852, taking into account the description of the measures and the mitigating steps set out in the recovery and resilience plan in accordance with the DNSH Technical Guidance (2021/C58/01). It is also expected that if the support is provided to any installation covered by the EU Emissions Trading System (ETS), the ETS activities need to achieve greenhouse gas emissions lower than the relevant ETS benchmarks .



B1. Description of the reforms and investments for non-repayable financial support B.1.1. Reform 1 “More sustainable electricity produced in the country The objective of the reform is to promote the production, transmission and consumption of electricity from renewable sources, improving institutional and legal mechanisms, and providing investment incentives for businesses and citizens. In particular, this reform aims to: (i) increase the production of electricity from RES to at least 7 TWh by 2030, which shall ensure that RES generate 50% of total national electricity consumption; (ii) increase local electricity production capacities; (iii) facilitate the development of capacities required for the production of electricity from RES by supporting the most economically efficient technologies; (iv) gradually integrate the electricity producers using RES into the market; (v) ensure a minimum financial burden on electricity consumers; (vi) ensure non-discrimination against the producers of imported electricity and allowing other Member States to benefit from the support mechanism introduced by the draft Law on Energy from Renewable Sources; (vii) ensure the dismantling of power plants which stopped their operation; (viii) ensure that electricity is not produced at negative prices; (ix) create appropriate conditions for prosumers and RES communities.

This reform is accompanied by 3 sub-measures: (1) preparatory work for the development of offshore wind park and related infrastructure (sub-measure 1); (2) support for the construction of onshore RES plants (solar and wind power) and individual storage facilities (sub-measure 2); (3) installation of other electricity storage infrastructure (sub-measure 3). B.1.1.1 Sub-measure 1: Preparatory work for the development of offshore wind power plant and related infrastructure The objective of this sub-measure is to carry out preparatory works for the development of offshore wind power plants. The sub-measure shall include the following: (i) assessment of the environmental impact of offshore wind power plants; (ii) measurements of wind speeds and other parameters; (iii) studies on the seabed of the area dedicated to the development of offshore wind power plants and the connection to the onshore grids; (iv) consultancy services for the offshore wind connection to the onshore grids; (v) studies on the implementation of the infrastructure and the identification of the offshore wind power plant connection to onshore grid route and place of marine substation; (vi) preparation, adoption and implementation of the spatial planning documents for offshore wind connection to onshore grid; and (vii) preparation of technical specifications for contracting the connection to the onshore grid. The sub-measure shall be completed by 31 December 2023. B.1.1.2 Sub-measure 2: Support for the construction of onshore RES plants (solar and wind power) and individual storage facilities The objective of this sub-measure is to provide support for the RES production and storage installations and to connect renewable energy communities. The sub-measure shall include support provided to legal entities, farmers and renewable energy communities for the acquisition and installation of onshore solar and wind power plants and storage, prioritising self-consumption, farm or economic needs. The recipients of the support shall have the possibility to sell electricity back to the electricity grid. Support shall be provided through a competitive bidding process, giving the priority to renewable energy communities. As a result of the investment, at least 302 MW of additional electricity generation capacity from RES, of which at least 271.8 MW shall consist of solar power plants (including 4 MW solar power plant in the Utena region) and at least 30.1 MW of onshore wind power plants, as well as individual electricity storage facilities of at least 15.2 MWh shall be created. The sub-measure shall be completed by 30 June 2026. B.1.1.3 Sub-measure 3: Installation of other electricity storage infrastructure The objective of this sub-measure is to ensure the security, stability and readiness of the Lithuanian electricity system for the operation of isolated work prior to its interconnection with the electricity grids of continental Europe. The sub-measure shall consist of support to install four energy storage installations, each of 50 MW that shall provide synthetic inertia in response to frequency change, congestion management of the grids, which is necessary to integrate 100 % of electricity generated from RES. The sub-measure shall be completed by 31 December 2022. B.1.2. Reform 2 “Moving without polluting the environment” The objective of this reform is to significantly reduce GHG emissions by phasing out the most polluting road transport vehicles (private, public, commercial, public transport and freight fleet) in cities and regions and by increasing the share of renewable energy sources in the transport sector. The implementation of the reform is to start in 2021 with the adoption in the Seimas of the Law on Alternative Fuels. It shall be further continued with the adoption and entry into force of a legislative framework, establishing a procedure for determining energy efficiency and environmental protection requirements for the purchase of road transport vehicles and for cases in which they are mandatory. This framework shall enter into force by 31 December 2021. The Sustainable Mobility Fund shall be established, which shall provide support, in certain defined cases, for the purchase and usage of clean vehicles as well as installation, modernisation and development of alternative fuels infrastructure for these vehicles. The fund shall also be used to support restrictions for the usage of internal combustion engine powered vehicles, with the exception of zero and low-emission vehicles. The support shall be provided in a targeted and continuous manner, until at least 2030. The fund shall become operational by 31 March 2022. In addition to the replacement of polluting vehicles, the reform shall also replace the road user charge paid by the owners of vehicles for the period of use with an e-toll charge. The distance-based toll system is expected to encourage vehicle owners/operators to use more environmentally friendly vehicles, as well as to rationalise the planning and optimisation of their travel routes, as the length of the journey shall determine the amount of the toll. The legislation introducing e-toll charge shall enter into force by 31 March 2023. As regards public transport, in addition to the replacement of polluting public transport vehicles, a reform of the inter-urban transport system shall review and optimise the existing long-distance network, align coach routes with rail routes and the local transport system ensuring inter- connectivity between regional hubs. The legislative amendments enforcing this reform shall be adopted by 31 December 2024. This reform is accompanied by four sub-measures: (1) support for the purchase of clean vehicles by the public sector and business (Sub-measure 1); (2) support for the purchase of clean public transport vehicles (Sub-measure 2); (3) installation of vehicle charging/filling infrastructure (Sub-measure 3); and (4) support the development of RES fuels (biomethane gas, second-generation liquid biofuels for transport and green hydrogen) (Sub-measure 4). B.1.2.1. Sub-measure 1: Support for the purchase of clean vehicles by the public sector and business The objective of this sub-measure is to reduce the number of polluting vehicles to promote sustainable mobility and consequently to reduce air pollution in urban environments. Under this sub-measure support shall be provided for the purchase of passenger cars, minibuses, buses, lorries and heavy goods vehicles in the following categories and quantities: - Light vehicles (class M1 or N1) – zero emissions (such as electric or hydrogen), priority given for vehicles for urban passenger and logistics services, total 22 500 units;

- Heavy duty transport vehicles (class N2 or N3) - zero emission and low emission, as defined in the Regulation 2019/1242 (electric, hydrogen, biogas produced from RED II compliant raw materials), total 500 units, of which 200 electric or hydrogen and 300 biomethane; - Low-floor and high-floor minibuses and buses (class M2 or M3) - zero emission (such as electric, hydrogen), total 450 units; - High-floor buses (class M3) - buses running on biomethane produced from RED II compliant raw materials, total 50. As regards vehicles running on biomethane, it is expected that this measure does not do significant harm to environmental objectives within the meaning of Article 17 of Regulation (EU) 2020/852, taking into account the description of the measure and the mitigating steps set out in the recovery and resilience plan in accordance with the DNSH Technical Guidance (2021/C58/01). In particular, heavy duty vehicles and high-floor buses shall be zero-emission or low emission or run solely on biomethane, which shall comply with the criteria set out in Directive 2018/2001 (RED II Directive). Biofuel and biomethane gas and biofuel producers shall have to provide certificates (Proof of Sustainability) issued by independent evaluators, as provided for in Directive 2018/2001. Furthermore, it shall be ensured that vehicles supported under the Lithuanian plan only use RED II compliant biofuels, bioliquids and biomass fuels. Finally, the level of RES fuels in the national fuel mix shall also gradually increase due to the obligation on fuel suppliers regarding the blending of biofuels, which shall reach 16.8 % in 2030, according to the Law on Alternative Fuels, which shall enter into force on 30 June 2021. A system of renewable fuel accounting units shall be created to record the quantities of biomethane gas and other renewable fuels supplied to the transport sector and the certificates given to producers to fulfil their RES fuels supply obligations, and therefore ensuring the consumption of biomethane and other RES fuels produced. The system shall become operational by 31 December 2021. All these elements together shall ensure that produced biofuels and biogas are consumed in the transport sector and replace the equivalent share of fossil fuels. Under this sub-measure, support shall also be provided to support the production (assembly) of electric buses in Lithuania. As a result of this support, at least 25 units of electric buses shall be produced. In order to ensure that the measure complies with the ‘Do no significant harm’ Technical Guidance (2021/C58/01), the legal agreement between Lithuania and the entrusted entity or the financial intermediary in charge of the financial instrument and the subsequent investment policy of the financial instrument will: I.require the application of the Commission’s technical guidance on sustainability proofing for the InvestEU Fund; and II.exclude the following list of activities and assets from eligibility: (i) activities and assets related to fossil fuels, including downstream use5; (ii) activities and assets under the EU Emission Trading System (ETS) achieving projected greenhouse gas emissions that are not lower than the relevant benchmarks6; (iii) activities and assets related to waste landfills, incinerators7 and mechanical biological treatment plants8; and (iv) activities and assets where the long-term disposal of waste may cause harm to the environment; and III.require the verification of legal compliance with the relevant EU and national environmental legislation of the projects by the entrusted entity or financial intermediary for all transactions, including those exempted from sustainability proofing. The sub-measure shall be completed by 30 June 2026. B.1.2.2. Sub-measure 2: Support for the purchase zero-emission public transport vehicles The objective of the investment is to make public transport more environmentally friendly by replacing polluting vehicles with cleaner ones and consequently reducing emissions and increasing the attractiveness public transport. Under this sub-measure, the following shall be carried out: (1) a review and optimisation of the existing long-distance network in order to align coach routes with rail routes and the local transport system ensuring inter- connectivity between regional hubs (to be completed by 31 December 2024); and (2) support provided to municipal administrations and natural and legal persons providing public transport services (both concerning municipalities that have not developed and implemented Sustainable Urban Mobility Plans (SUMPs) under 2014-2020 financial period) to purchase 230 new, zero-emission buses (class M2 and M3). The sub-measure shall be completed by 30 June 2026. B.1.2.3. Sub-measure 3: Installation of vehicle charging/alternative fuel filling infrastructure The objective of this sub-measure is to create an optimal network of public, semi-public and private charging and alternative fuel filling infrastructure, in order to create favourable conditions for business and citizens to operate clean vehicles. Under this sub-measure, the following shall be carried out: (1) an information system for public and semi-public charging/refilling points for electric vehicles made operational (by 31 March 2022); and (2) support provided to business and natural persons and the municipalities that have not developed and implemented SUMPs under 2014-2020 financial period to install and make operational: - Public and semi-public electric vehicle charging points for natural/legal persons (in cities and near national roads) – 4840 public and 400 semi-public units in total; - Public very high-power charging infrastructure for electric heavy-duty vehicles and buses – 10 units in total; - Public compressed biogas stations (adapted for biomethane) – 30 units in total; - Public hydrogen refuelling stations – 4 units in total; - Private charging points in households, apartment yards, workplaces – 53 200 units in total.

The sub-measure shall be completed by 30 June 2026. B.1.2.4. Sub-measure 4: Support to develop RES fuels sector (biomethane gas, second generation liquid biofuels for transport, and green hydrogen) The objective of this investment is to create a supply of renewable fuels and to promote their use in transport sector. Under this sub-measure, the following shall be carried out: (1) support provided to establish and make operational a biomethane gas production facility with a total capacity of 27.1 MW (by 30 June 2026); (2) support provided to develop second-generation biofuel sector’s capacities with the outlook to achieve a capacity for liquid second generation biofuels of 12.4 KTOE (by 31 December 2024); and (3) support provided to establish and operational green hydrogen production from renewable energy sources, as a result of which a total of 1 680 000 m³ of green hydrogen shall be produced (560.000 m³ on an annual basis) by 30 June 2026. As regards the development of biomethane gas and second-generation biofuel, it is expected that this sub-measure does not do significant harm to environmental objectives within the meaning of Article 17 of Regulation (EU) 2020/852, taking into account the description of the measure and the mitigating steps set out in the recovery and resilience plan in accordance with the DNSH Technical Guidance (2021/C58/01). In particular, this investment is in line with the provisions of the Directive (EU) 2018/2001 of the European Parliament and of the Council (RED II), and the biofuels and biomethane gas supplied to refuelling points shall only be produced from feed stocks classified as waste or residues (raw materials in Annex IX of Directive 2018/2001) and shall not be made from food and feed crops. The sub-measure shall be completed by 30 June 2026. B.1.3. Reform 3 “Accelerating renovation of buildings and a sustainable urban environment” The objective of the reform is to increase the pace of the building renovation process by exploiting the benefits of the digitalised serial renovation of buildings, by broadening the integrated approach to the living environment, including adaptation of buildings to the needs of persons with disabilities, and by promoting a climate- and environment-friendly transformation of the construction sector and products. The reform is accompanied by four sub-measures: (1) update and testing in practice of building renovation packages and standards and creation of a methodology for the development of sustainable cities (Sub-measure 1); (2) creation of tools to facilitate building renovation coordination and technical assistance (Sub-measure 2); (3) promoting the supply of construction products and services that speed up the renovation of buildings (Sub-measure 3); and (4) support for faster renovation of buildings in line with up-to-date building renovation standards (Sub-measure 4). B.1.3.1. Sub-measure 1: Update and testing in practice of building renovation packages and standards and creation of a methodology for the development of sustainable cities The objective of this sub-measure is to make the necessary regulatory changes in order to accelerate the renovation of building and to contribute to the greening of regions. Under this sub-measure, a number of regulatory changes and pilot projects to improve the energy performance of buildings shall be carried out. As regards the regulatory changes, the following shall be adopted and enter into force: a) Resolution of the Republic of Lithuania approving the Plan of Implementation of the Long-term Building Renovation Strategy, which shall provide for a legislative plan to accelerate the conversion of sites and the conversion of the existing buildings, taking into account the Bauhaus initiative, and to formalise the use of building information modelling (BIM) techniques, a plan for district renovation initiatives and investment projects; b) Amendment of Construction Technical Regulation “Design and Certification of the Energy Performance of Buildings”, legitimising the energy performance class of the renovated building at least Class B; c) Amendment of Construction Technical Regulation “Design of Wooden Structures”; d) Guidelines for Sustainable Urban Development. These legislative acts shall enter into force by 31 March 2023. As a result of several pilot green renovation projects, at least 22 000 m2 of experimental buildings shall be renovated aiming to achieve on average at least a reduction of 30-60 % of primary energy consumption, as defined in Commission Recommendation (EU) 2019/786 on building renovation. The sub-measure shall be completed by 30 September 2025. B.1.3.2. Sub-measure 2: Tools to facilitate building renovation coordination and technical assistance The objective of this sub-measure is to create tools to facilitate building renovation coordination and technical assistance. The sub-measure shall consist of a creation of the competence centre for building renovation (by 31 December 2022) and three digital tools as follows: 1) Digital methodological tools (for the preparation of investment projects, standard technical specifications for design and contracted works) for planning of green and innovative energy efficiency measures in renovated buildings;

2) Operationalisation and provision of service of two information systems for building data and building renovation projects administration. The sub-measure shall be completed by 30 September 2025. B.1.3.3. Sub-measure 3: Promoting the supply of construction products and services that speed up the renovation of buildings The objective of this sub-measure is to create a local market for the production of standardised modular structures from organic materials, and to provide