Tax and health, why VAT is also due for home care workers

For socio-medical workers (Oss), the VAT exemption remains distant. As a result, the ordinary VAT rate of 22 per cent is also applied to integrated home care services. Reiterating the restrictive orientation is the answer provided by the undersecretary at the Ministry of the Economy Sandra Savino to the question presented by Antonio Trevisi (Forza Italia) in the Senate Finance Committee.

From a 'subjective' point of view, the question is resolved by the reply recalling that Article 99, paragraph 1, of the Testo Unico delle leggi sanitarie (Rd 1265/1934) does not include the figure of the socio-sanitary operator. The Ministry of Health's note 56436 of 22 November 2018 - it is recalled - concluded that 'due to the type of training and skills attributed as explained above, the socio-sanitary operator cannot be assimilated to the health professions'. Hence the conclusion that the services provided by these operators "were not considered applicable" to the VAT exemption as they "lack the characteristics of the health professions".

The other point raised by Mr Trevisi's question is whether, in the context of a unitary and complex integrated home care service provided by a company on behalf of the local health authority, the services provided by social workers can be qualified as ancillary to the main healthcare service provided by qualified healthcare professionals (doctors, nurses, physiotherapists). Here, the answer provided by the Economy clarifies that, in order for an ancillary relationship to exist between two operations, it is not sufficient for all the services to converge in the direction of the realisation of a single objective, but it is necessary for there to exist 'a functional dependency relationship between the ancillary services and the principal service' (Resolution 6/E of 11 February 1998), since the ancillary services respond to the need to offer the client, according to his specific requirements, the best possible result. Consequently, 'ancillary' are only 'those operations carried out by the same person in necessary connection with the main operation to which, therefore, they accede and which have, as a rule, the function of supplementing, completing or making possible the main service or supply'.

Therefore, as the reply explains, 'a generic connection of the "ancillary" service to the main activity does not appear sufficient, but rather it is necessary that it forms a whole with the main transaction'. The assessment of its recurrence in concrete cases must be made on a case-by-case basis and on the basis of purely factual elements.