Regolamento INAIL per l’erogazione di prestazioni in favore di infortunati e tecnopatici: la Circolare esplicativa

Con circolare n. 7 del 28 gennaio 2022 l’INAIL ha pubblicato le disposizioni attuative del nuovo Regolamento per l’erogazione di interventi per il recupero funzionale della persona, per l’autonomia e per il reinserimento nella vita di relazione, emanato dal Consiglio di amministrazione dell’Istituto lo scorso 14 dicembre.
Il Regolamento è suddiviso in quattro capi: il primo contiene le disposizioni comuni a tutte le tipologie di interventi, il secondo disciplina gli interventi volti al recupero funzionale della persona, il terzo quelli per favorire l’autonomia nell’ambito domestico e nella mobilità mentre il quarto disciplina gli interventi per il reinserimento nella vita di relazione. I vari interventi, indipendentemente dal capo in cui sono collocati, sono individuati ed erogati in una logica unitaria e coordinata. Si può, dunque, ricorrere alla combinazione e integrazione di una pluralità di interventi, anche se afferenti a diverse tipologie, allo scopo di perseguire il massimo recupero possibile dell’integrità psico-fisica dell’infortunato o tecnopatico.
L’appropriata e corretta individuazione di tali interventi avviene con approccio multidisciplinare, attraverso apposite équipe, disciplinate nell’allegato 1. L’attività delle equipe multidisciplinari è esercitata in base ad un assetto che si articola su tre livelli distinti sia sul piano strutturale che su quello disciplinare: l’equipe di I livello è costituita presso le sedi locali dell’Istituto e prende in carico l’assicurato e individua gli interventi necessari al massimo recupero possibile dell’integrità psico-fisica dello stesso, l’equipe di II livello è costituita presso le direzioni regionali e provinciali di Trento e Bolzano nonché presso la sede regionale di Aosta e svolge attività di orientamento, indirizzo e coordinamento dell’equipe di I livello, assicurando uniformità a livello regionale ed effettua le valutazioni di competenza su casi di particolare complessità.; l’equipe di III livello o centrale è costituita presso la Direzione Centrale prestazioni socio sanitarie e fornisce coordinamento e consulenza per la soluzione di casi particolarmente complessi o controversi sottoposti al suo esame dalle equipe multidisciplinari di II livello. 
Con la circolare sono individuati i destinatari degli interventi e sono illustrate le diverse tipologie degli stessi e le modalità di erogazione, in forma diretta e indiretta.
Sono inoltre fornite indicazioni per la manutenzione, il collaudo ed il rinnovo dei dispositivi forniti agli infortunati/tecnopatici e per il rimborso delle prestazioni economiche accessorie. 

  1. DISPOSIZIONI COMUNI

Destinatari
L’articolo 3 del Regolamento elenca i destinatari degli interventi, che sono:

  • Infortunati/tecnopatici assicurati dall’INAIL nei confronti dei quali siano riconosciute menomazioni fisiche e/o psichiche di qualsiasi grado conseguenti a infortunio o malattia professionale;
  • Infortunati/tecnopatici nel periodo di inabilità temporanea assoluta qualora sia prevedibile che residui una menomazione dell’integrità psicofisica di qualsiasi grado;
  • Infortunati e tecnopatici nel periodo di inabilità temporanea assoluta, per i quali non sia prevedibile che residui una menomazione dell’integrità psicofisica, ma limitatamente agli interventi per il recupero funzionale della persona.

I primi sono potenziali destinatari di tutti gli interventi disciplinati nel Regolamento, mentre per i secondi possono essere erogati soltanto gli interventi di cui al Capo II ossia quelli volti al recupero funzionale della persona.
È stato poi specificato che i soggetti diversi dall’infortunato/tecnopatico possono essere destinatari esclusivamente degli interventi di sostegno per il raggiungimento di livelli di consapevolezza, di autostima, di autonomia e di adattamento di cui all’art. 19 comma 1 lett. A del Regolamento. Tali destinatari possono essere anche coniuge, persona unita civilmente, figli, genitori, fratelli e sorelle nonché conviventi risultanti dallo stato di famiglia, limitatamente agli interventi volti a fronteggiare le problematiche conseguenti all’evento lesivo nella vita di relazione.

Modalità di erogazione degli interventi

Il Regolamento chiarisce la distinzione tra l’erogazione in forma diretta e l’erogazione in forma indiretta.

  1. Erogazione diretta

La forma diretta ricorre tutte le volte in cui l’Istituto provvede a erogare l’intervento in favore del destinatario tramite le proprie strutture o per mezzo di un fornitore dallo stesso Istituto selezionato sul mercato, al quale la competente Struttura dell’Inail invia direttamente il relativo ordinativo. Il punto di riferimento per la qualificazione dell’erogazione in forma diretta è costituito dall’Istituto nella sua unitarietà, in quanto Ente gestore dell’intero processo di erogazione, anche quando l’erogazione stessa sia affidata a un operatore individuato dall’Inail. Sono, pertanto, irrilevanti sia la tipologia di articolazione organizzativa che provvede alla materiale erogazione o a effettuare l’ordinativo all’operatore prescelto, sia eventuali preliminari passaggi intermedi tra Strutture dell’Istituto.

  1. Erogazione indiretta

La forma indiretta si configura esclusivamente quando l’erogazione dell’intervento viene effettuata da un operatore abilitato, autonomamente prescelto dall’infortunato/tecnopatico.
L’autonoma scelta del fornitore da parte dell’infortunato/tecnopatico è ammessa nei casi di seguito descritti:

  • libertà di sceltadell’infortunato/tecnopatico: l’infortunato/tecnopatico ha libertà di scelta terapeutica, nel rispetto dei principi costituzionali. Tale principio trova applicazione con riguardo a dispositivi allestiti su misura da un professionista abilitato e a quelli di serie e con riguardo ad ogni altro intervento la cui realizzazione richieda l’opera di un professionista abilitato all’esercizio della specifica professione sanitaria o arte sanitaria ausiliaria. La rilevanza della volontà dell’infortunato/tecnopatico è, inoltre, riconosciuta nel rispetto del principio di tutela del domicilio, inteso come luogo di dimora. Al riguardo, i principi posti dall’ordinamento vigente non consentono che l’Istituto possa imporre all’infortunato/tecnopatico l’accesso alla sua abitazione di operatori prescelti dall’Istituto stesso per la realizzazione di opere murarie, adeguamenti funzionali e modifiche impiantistiche;
  • necessità e urgenza: ricorrono nei casi in cui un eventuale ritardo nell’erogazione dell’intervento potrebbe compromettere lo stato di salute e/o di autonomia dell’infortunato. In questo caso l’interessato può rivolgersi ad un fornitore di propria scelta senza la preventiva autorizzazione da parte dell’Istituto;
  • scelta dell’Istituto: qualora l’INAIL decidesse di non fare ricorso per determinati interventi all’erogazione diretta, gli infortunati/tecnopatici individuano autonomamente l’operatore al quale rivolgersi.

Valutazione di congruità

La valutazione di congruità è necessaria solo con riferimento all’erogazione in forma indiretta ed ha ad oggetto il preventivo/scheda progetto del fornitore individuato autonomamente. Il principale parametro in relazione al quale è espresso il giudizio di congruità è il costo che l’Istituto sosterrebbe in caso di erogazione diretta, dal momento che la libertà di scelta terapeutica non può tradursi in oneri maggiori. 
Per i dispositivi tecnici costruiti o allestiti su misura nonché per i dispositivi di fabbricazione continua o di serie, il parere di congruità deve essere sempre richiesto al Centro Protesi di Vigorso di Budrio in tutti i casi in cui il preventivo/scheda progetto sia di importo pari o superiore a euro 200,00.
Nel caso di dispositivi medici monouso e per gli ausili di serie pronti all’uso tale parametro è costituito dal Tariffario della Regione di appartenenza.

Richieste di prestazioni al Centro protesi di Vigorso di Budrio

Le sedi dell’Istituto possono richiedere al Centro protesi di Vigorso di Budrio l’effettuazione di prestazioni di assistenza protesica nonché consulenza e supporto tecnico, le cui modalità operative saranno descritte in apposite istruzioni operative

  1. INTERVENTI PER IL RECUPERO FUNZIONALE DELLA PERSONA

Gli interventi per il recupero funzionale della persona consistono nell’erogazione in forma diretta o indiretta dei seguenti dispositivi:

  • costruiti o allestiti su misura da un professionista abilitato, compresi aggiuntivi e prestazioni di manutenzione, riparazione e adattamento;
  • di fabbricazione continua o di serie, che devono essere applicati da parte di un professionista sanitario abilitato;
  • di fabbricazione continua o di serie, che non necessitano di essere applicati da parte di un professionista sanitario abilitato.

I tempi di consegna, rinnovo e di garanzia sono indicati nell’allegato 2 alla circolare.

La circolare ribadisce che gli infortunati/tecnopatici in stato di inabilità temporanea assoluta, per i quali sia prevedibile che non residui alcuna menomazione, sono potenziali destinatari di tutti gli interventi di recupero funzionale. Non assume quindi più alcuna rilevanza la distinzione tra le finalità funzionale e curativa del dispositivo. Uno stesso dispositivo, infatti, può contemporaneamente compensare limitazioni nel funzionamento della persona e rispondere a esigenze di cura della lesione.

  1. INTERVENTI PER L’AUTONOMIA NELL’AMBITO DOMESTICO E NELLA MOBILITÀ

Si tratta degli interventi finalizzati a consentire l’accessibilità e la fruibilità dell’abitazione e a restituire autonomia all’infortunato/tecnopatico. Alcuni di detti interventi consistono esclusivamente nella fornitura di dispositivi, come, per esempio, quelli informatici o domotici e gli arredi, mentre in altri casi richiedono anche la realizzazione di opere murarie per l’installazione dei dispositivi o, comunque, per l’abbattimento e/o il superamento di barriere architettoniche, come accade, per esempio, nel caso di ascensori, montascale fissi, modifiche impiantistiche o installazione di impianti per il controllo del microclima.
L’individuazione degli interventi è sempre effettuata sulla base di una valutazione sociale, sanitaria e tecnica dell’équipe multidisciplinare, integrata, se del caso, da professionalità dell’Istituto di specifica competenza in funzione delle peculiarità del caso concreto.
Tra gli interventi indicati sono compresi anche la fornitura di comandi speciali per la guida dell’automobile, gli allestimenti e/o adattamenti per agevolare l’accesso, l’uscita e il trasporto anche con carrozzina. 

  1. INTERVENTI PER IL REINSERIMENTO NELLA VITA DI RELAZIONE

Gli interventi per il reinserimento nella vita di relazione hanno lo scopo di perseguire il massimo recupero possibile dell’integrità psico-fisica dell’infortunato/tecnopatico attraverso la realizzazione delle condizioni necessarie per il reinserimento nella vita familiare, sociale e lavorativa. Nell’ambito di tali interventi sono compresi anche quelli mirati a fornire sostegno ai familiari dell’infortunato/tecnopatico per il raggiungimento di livelli maggiori di consapevolezza delle conseguenze dell’evento lesivo di origine lavorativa e per l’acquisizione di competenze e strategie idonee alla gestione delle problematiche derivanti dalla disabilità acquisita. Gli interventi di sostegno sono erogati in favore dei familiari del lavoratore anche in caso di decesso di quest’ultimo.
In questo ambito, il Regolamento individua quattro tipologie di interventi:

  • sostegno all’infortunato/tecnopatico e ai familiari per il raggiungimento di livelli di consapevolezza, autostima, autonomia e adattamento volti a fronteggiare le problematiche conseguenti all’evento lesivo;
  • sostegno all’infortunato/tecnopatico per lo sviluppo delle abilità sociali e relazionali, al fine di prevenire l’isolamento e l’emarginazione;
  • sostegno all’infortunato/tecnopatico nel recupero dei livelli di motivazioni delle abilità necessarie per favorire l’occupazione e il reinserimento lavorativo;
  • sostegno all’infortunato/tecnopatico per la pratica dell’attività sportiva e ludico-motoria.

Gli interventi per la vita di relazione sono, di norma, individuati dall’équipe multidisciplinare di I livello. Specifici interventi destinati a infortunati/tecnopatici sono, altresì, programmati dalle Direzioni Centrali competenti nella materia nonché dalle Direzioni regionali o provinciali. I dispositivi e l’adattamento dell’attrezzatura per la pratica sportiva, ricreativa e/o ludico-motoria sono individuati nel verbale dell’équipe multidisciplinare di I livello. Per tutti gli altri interventi, l’individuazione avviene nell’ambito di un progetto personalizzato elaborato dall’équipe.
Il progetto dell’équipe multidisciplinare definisce il percorso di sostegno dell’infortunato/tecnopatico e/o dei suoi familiari nonché di reinserimento familiare e sociale dell’infortunato/tecnopatico indicando motivazioni e contesto di riferimento, obiettivi perseguiti, interventi individuati e risorse attivate, tempi e costi di realizzazione nonché modalità di verifica e di valutazione dei risultati del progetto.

  1. PRESTAZIONI ECONOMICHE ACCESSORIE

L’Istituto rimborsa le spese di viaggio all’infortunato/tecnopatico che debba recarsi in località diversa da quella di abitazione per prescrizione, fornitura, collaudo, adattamento, rinnovo e riparazione dei dispositivi di cui al Capo II del Regolamento, per accertamenti e trattamenti sanitari o per l’erogazione di interventi di sostegno. Le spese di viaggio rimborsabili sono quelle sostenute e documentate per l’uso di mezzi di trasporto pubblico. L’uso del taxi o del mezzo di trasporto privato è consentito quando necessitato dallo stato di salute dell’infortunato/tecnopatico accertato dal Dirigente medico dell’Istituto o dalla insufficienza dei mezzi di trasporto pubblici o di quelli messi a disposizione dall’Istituto stesso. In caso di utilizzo del mezzo di trasporto privato il rimborso della relativa spesa sarà effettuato con il criterio vigente per il rimborso spettante ai funzionari di vigilanza dell’Istituto nell’esercizio delle loro funzioni. Nel caso in cui lo stato di salute dell’infortunato/tecnopatico sia incompatibile con l’utilizzazione di altri mezzi di trasporto, è consentito l’uso dell’ambulanza. Il diritto al rimborso delle spese di viaggio è riconosciuto anche quando l’infortunato/tecnopatico debba recarsi presso strutture di un fornitore dallo stesso individuato nell’esercizio della libertà di scelta terapeutica.
In questi casi l’Istituto rimborsa le spese nel limite dei costi che l’infortunato/tecnopatico avrebbe sostenuto per raggiungere la struttura abilitata all’erogazione dell’intervento più prossima al luogo di abitazione.
L’Istituto, ove necessario per la distanza della struttura erogatrice della prestazione di assistenza protesica dal luogo di abitazione dell’infortunato/tecnopatico, si fa carico anche delle spese sostenute e documentate per il soggiorno.

Consulta la Circolare INAIL

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    launched on his technique to the hospital, I consumed what he had left on the
    dish–one fried egg and a gammon rasher–and, having tidied up the
    Doctor’s bedroom and my very own, went forth to wind up the affairs of Polton,
    the destitute, and inaugurate Polton, the opulent; to “ring out the previous
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    wonderful shoes and a comfortable felt hat. The parcel being a big and heavy
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    with an occasional relaxation, to convey it to Foubert’s Place, where I
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    However, he claimed none, having let my room after i didn’t return. But
    he had saved my property in an attic, from which he very kindly assisted
    me to fetch it, so that I had, presently, the satisfaction of seeing all
    my worldly goods piled up on the counter: the software-chest that I had made
    in Mr. Beeby’s workshop, my entire collection of clockmaker’s tools, and
    my beloved books, together with Mr. Denison’s invaluable monograph. After they
    have been all assembled, I went out and chartered a 4-wheeled cab, in which
    I stowed them all–chest, instruments, books, and the enormous parcel from the
    out-fitters. Then I bade Mr. Stokes a fond farewell, gave the cabman the
    tackle (at which he appeared surprised; and I’m afraid that I was a
    somewhat shabby little ragamuffin) shut myself in the cab and began for
    residence.

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    away out of my ken. But now, because the cab rattled over the stones till it
    made my teeth chatter, I had before me the vision of that noble room in
    the Temple which was my very personal, to have and to carry in perpetuity, and
    the gracious pal and grasp whose presence would have turned a hovel
    into a mansion.

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    I deposited in the future workshop as the primary instalment of its
    furnishing, the books and parcel I carried up to my own apartment. And
    there the ultimate scene was enacted. Once i had arranged my little library
    lovingly within the bookshelves, I opened the parcel and laid out its
    unbelievable contents on the bed. For a while I was so overcome by their
    magnificence that I might solely gloat over them in ecstasy. I had never
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    a snowy and reasonably stiff collar, a silk neck-tie, and the sober however
    elegant black coat.

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    unreality, the trimly-dressed gentleman who confronted me. At size, I
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    the discarded clothes to be used in the workshop, went right down to await the
    Doctor’s return.

    And here I think I had better stop, leaving Dr. Jervis to relate the
    sequel. Gladly would I go on–having now bought into my stride–to inform of
    my pleased companionship with my beloved master, and the way he and that i fitted
    out the workshop, after which, engaged on our joiner’ bench, regularly
    furnished the laboratory with benches and shelves. But I had higher not.
    My tale is told; and now I need to lay down my pen and hold my peace. Yet
    nonetheless I like to look back on that great morning within the hospital
    laboratory when just a few magical phrases banished in an instant the night of
    my adversity and ushered in the daybreak.

    However it was not only the daybreak; it was the sunrise. And the solar has by no means
    set. A benevolent Joshua has ordained that I shall stay the days of my
    life in perpetual sunshine; and that Joshua’s name is John Thorndyke.

    Part II. THE CASE OF MOXDALE DECEASED.

    Narrated by Christopher Jervis, M.D.

    CHAPTER X. Fire

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    language of the mariner, shouldn’t be without its sights. For nevertheless a lot
    he might love his fellow-creatures, it is restful, at least for a time, to
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    south-east in the route of the Temple. Through what aspect streets I
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    with out consciously considering my route. And as I walked in a silence on
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    hammer and repeating the one observe in a fast succession of strokes–the
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    too far off to concern me–and in contrast the sound with that of the
    hearth-engines of my young days. It was extra distinctive, however much less
    thrilling. The bell gave its message plainly enough, nevertheless it lacked that
    high quality of urgency and velocity that was conveyed by the rattle of iron
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    Ding, ding, ding, ding, ding. The sound was extra distinct. Then the
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    glow within the sky over the house-tops; and presently, reaching another
    nook, came into full view of the burning home, though it was nonetheless
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    I watched it with some shock as I walked rapidly in direction of it, for there
    gave the impression to be something unusual in its look. I had not seen many
    burning homes however none that I had seen had seemed fairly like this one.
    There was a furious intensity in the way that it flared up that impressed
    me as abnormal. From the chimneys, flames shot up just like the jets from a
    fuel-blowpipe, and the windows emitted tongues of fireplace that looked as if
    they were being blown out by bellows. And the progress of the hearth was
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    sounds of the approaching engines, now fairly near and coming from several
    different directions.

    “It’s a satan of a blaze,” I remarked to one of the constables. “What’s
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