JUDGMENT NO. 169
YEAR 2024
ITALIAN REPUBLIC
IN THE NAME OF THE ITALIAN PEOPLE
THE CONSTITUTIONAL COURT
composed of: President:
Augusto Antonio BARBERA
Judges: Giulio PROSPERETTI, Giovanni AMOROSO, Francesco VIGANÒ, Luca ANTONINI, Stefano PETITTI, Angelo BUSCEMA, Emanuela NAVARRETTA, Maria Rosaria SAN GIORGIO, Filippo PATRONI GRIFFI, Marco D’ALBERTI, Giovanni PITRUZZELLA, Antonella SCIARRONE ALIBRANDI,
has pronounced the following
JUDGMENT
in the judgment of constitutional legitimacy of Articles 8 and 25, paragraph 2, of the Law of the Sicilian Region of January 16, 2024, No. 1 (Regional Stability Law 2024-2026), promoted by the President of the Council of Ministers with appeal notified on March 19, 2024, filed with the registry on March 26, 2024, registered under No. 13 of the 2024 appeals register and published in the Official Gazette of the Republic No. 18, first special series, of the year 2024.
Having seen the act of constitution of the Sicilian Region;
Having heard at the public hearing of September 24, 2024, the Judge Rapporteur Giovanni Amoroso;
Having heard the State Attorney Fabrizio Fedeli for the President of the Council of Ministers and the lawyer Nicola Dumas for the Sicilian Region;
Deliberated in the council chamber of September 24, 2024.
Considered in fact
1.– By appeal notified on March 19, 2024, filed on March 26, 2024, and registered under No. 13 of the 2024 appeals register, the President of the Council of Ministers, represented and defended by the State Attorney General's Office, has raised questions of constitutional illegitimacy of Articles 8 and 25, paragraph 2, of the Law of the Sicilian Region of January 16, 2024, No. 1 (Regional Stability Law 2024-2026), published in the Official Gazette of the Sicilian Region No. 4 of January 20, 2024.
1.1.– The appellant denounces, first of all, the violation, by Article 8 of the aforementioned regional law, of Articles 97, paragraphs one and two, and 117, paragraph three, of the Constitution, in relation to the principles of coordination of public finance, and for non-compliance with the limits on the exercise of the legislative power of the autonomous Region sanctioned by Article 14, paragraph 1, of Royal Legislative Decree No. 455 of May 15, 1946, converted into Constitutional Law No. 2 of February 26, 1948 (Approval of the Statute of the Sicilian Region), deriving from the necessary respect for the fundamental rules of economic and social reform of the Republic and the fundamental principles of the laws of the State.
In support of his complaints, the President of the Council of Ministers states that Article 8 of the challenged regional law, entitled "Remuneration benefits for employees referred to in Article 87 of the CCRL 2016-2018," establishes that the increases referred to in Article 87 of the Regional Collective Labour Agreement (CCRL) of the non-managerial personnel of the Sicilian Region and the entities referred to in Article 1 of Regional Law No. 10 of May 15, 2000, for the regulatory and economic three-year period 2016-2018, signed on May 9, 2019, provided for in replacement of the equalization element referred to in Article 1, paragraph 440, letter b), of Law No. 145 of December 30, 2018 (State Budget for the financial year 2019 and multi-year budget for the three-year period 2019-2021), in accordance with Article 1, paragraphs 869 and 959, of Law No. 178 of December 30, 2020 (State Budget for the financial year 2021 and multi-year budget for the three-year period 2021-2023), are financed on a permanent basis within the framework of the contract renewal contemplated for the three-year period 2019-2021 of the same sector.
He further specifies that paragraph 2 of the same provision provides that, for the relevant purposes, the financial resources for the renewal of collective labour agreements for the aforementioned three-year period are supplemented, starting from the financial year, by an amount equal to 4.3 million euros.
Given the above, with regard to the content of the challenged provision, the appeal emphasises that the agreement between the State and the Sicilian Region for the ten-year repayment of the deficit, signed on October 16, 2023 – then incorporated by Article 9, paragraph 2, of Decree-Law No. 145 of October 18, 2023 (Urgent measures in economic and fiscal matters, in favour of territorial entities, to protect employment and for urgent needs), converted, with amendments, into Law No. 191 of December 15, 2023 – contemplates, in point 10, the commitment of the Region to contain personnel expenses, net of contract renewals, within the limits provided for the same period at national level, including the ancillary treatment, and emphasizes that, precisely by virtue of this commitment, the same point allows the resumption of permanent recruitment of personnel, with rates of replacement of terminations of service higher, for the three-year period 2023-2025, to 100 percent of the turn over.
Hence the President of the Council of Ministers, given the classification of the administration allowance within the ancillary treatments, assumes that the challenged provision determines a circumvention of the financial limit to which the related funds are subject pursuant to Article 23, paragraph 2, of Legislative Decree No. 75 of May 25, 2017, containing "Amendments and additions to Legislative Decree No. 165 of March 30, 2001, pursuant to Articles 16, paragraphs 1, letter a), and 2, letters b), c), d) and e) and 17, paragraph 1, letters a), c), e), f), g), h), l) m), n), o), q), r), s) and z), of Law No. 124 of August 7, 2015, regarding the reorganisation of public administrations," as well as a violation of the aforementioned agreement, where it provides, as has been pointed out, in point 10, the commitment of the Sicilian Region to contain personnel expenses within the limits of the renewals contemplated for the sectors of national bargaining.
He stresses, in this regard, that, moreover, the appropriation equal to the amount of 4.3 million euros recognised by paragraph 2 of the challenged provision for the increase in the administration allowance of the regional non-managerial personnel is outside the agreement between the State and the Region because it refers to the one-off equalization element introduced by the national collective labour agreements for the three-year period 2016-2018, with charges to be borne by the relevant contractual resources, which was made structural by Article 1, paragraphs 869 and 959, of Law No. 178 of 2020, with inclusion in the basic treatment in the 2019-2021 round.
In particular, the appeal emphasises that Article 87 of the CCRL for the regional personnel of the aforementioned sector, referred to by the challenged provision, did not institute, as provided for by state legislation, a one-off equalization element, but rather increased a fixed component of the remuneration such as the administration allowance (and consequently reduced, in a corresponding manner, the resources for ancillary treatment allocated to the "Decentralized resources fund" referred to in Article 90 of the CCRL, resources intended for productivity, to be paid following the assessment of personnel performance).
According to the thesis of the President of the Council of Ministers, therefore, the sums thus allocated, insofar as they do not reinstate the contractual resources used for the one-off equalization element, as do the national collective agreements, but rather increase the administration allowance, effectively circumvent the regulatory constraint of respecting the financial limit of the sums globally allocated to the ancillary treatments of personnel referred to in Article 23, paragraph 2, of Legislative Decree No. 75 of 2017, given that the administration allowance falls within the scope of ancillary treatments, as confirmed by the application to it of the withholdings provided for the first ten days of absence due to illness by Article 71 of Decree-Law No. 112 of June 25, 2008 (Urgent provisions for economic development, simplification, competitiveness, stabilisation of public finances and tax equalization), converted, with amendments, into Law No. 133 of August 6, 2008.
Consequently, the challenged provision would violate the provisions of the agreement between the State and the Sicilian Region for the ten-year repayment of the deficit of October 16, 2023, with respect to the commitment of the regional entity to contain personnel expenses, net of contract renewals within the limits provided for the same period at national level, including the ancillary treatment.
The appeal emphasizes that, on the other hand, even after the signing of the first agreement for the ten-year repayment of the deficit on January 14, 2021 between the State and the Sicilian Region, the latter had already provided in some regional laws for an increase in the ancillary treatment of personnel, with provisions declared constitutionally illegitimate (Judgments Nos. 200 and 190 of 2022 of this Court are cited).
The President of the Council of Ministers represents that the interventions aimed at containing public spending, as expressed by the interposed provisions, constitute fundamental principles in the area of coordination of public finance, which stand as fundamental rules of economic and social reform of the Republic and, therefore, also limit the regulatory power of the Region with special autonomy, to which Article 14, paragraph 1, letter q), of the Statute also attributes exclusive legislative competence in the area of the legal and economic status of its personnel.
The appellant further assumes that Article 8 of Sicilian Regional Law No. 1 of 2024 violates Article 97, first paragraph, of the Constitution, where it places on public administrations the duty to ensure the balance of budgets and the sustainability of public debt, in accordance with the European Union system, as it does not respect the commitment made by the Sicilian Region in point 10 of the agreement of October 16, 2023, in the sense of not contemplating, in the face of the recognition of a turn over of personnel higher than 100 percent, a treatment of personnel, including ancillary treatment, higher than that contemplated by national collective bargaining.
In this regard, the appellant emphasizes that the budget balance is a principle that cannot be derogated from by special statute regions, which, as clarified in the constitutional jurisprudence, also participate in the enlarged public finance (Judgment No. 165 of 2023 is cited), as also attested by Article 9, paragraph 5, of Law No. 243 of December 24, 2012 (Provisions for the implementation of the principle of budget balance pursuant to Article 81, sixth paragraph, of the Constitution).
The State appeal finally infers the violation, by the same Article 8 of Sicilian Regional Law No. 1 of 2024, of the principles of good performance and impartiality of administrative action sanctioned by Article 97, second paragraph, of the Constitution, and binding also for the respondent Region, as can be seen from Article 14, paragraph 1, of the Sicilian Regional Statute, which, also with respect to the organisation of offices and the legal and economic status of personnel (letters p and q), specifies that the Region must exercise its powers within the limits of the constitutional laws of the State.
In particular, the vulnus to the evoked parameter would be related to the circumstance that the one-off equalization element provided for in Article 47, paragraph 3, of the national collective labour agreement for the personnel of the central functions sector for the three-year period 2019-2021, signed on May 9, 2022, has the objective of rebalancing the lowest pay levels, in accordance with Article 1, paragraph 12, of Law No. 190 of December 23, 2014, containing "Provisions for the formation of the annual and multi-year State budget (2015 Stability Law)," while the regional standard, with opposite aims, increases the administration allowance already enjoyed in a manner that is increasing with the legal and economic classification of the employees, favouring those with medium-high classifications.
1.2.– The appellant also challenges Article 25, paragraph 2, of the same Sicilian Regional Law No. 1 of 2024, which, intervening on Article 20, paragraph 1, of the Law of the Sicilian Region No. 30 of November 3, 1993 (Rules on health planning and the territorial reorganisation of local health units), recognises, with effect from January 1, 2024, the nature of an entity of the Regional Health Service (SSR) to the Centre for Permanent Training and Updating of Health Service Personnel (CEFPAS, hereinafter, also: Centre), based in Caltanissetta.
In support of the censures, the President of the Council of Ministers points out that, as already held by this Court with reference to the Regional Agency for Environmental Protection (ARPA) of Sicily (Judgment No. 172 of 2018 is cited), the functions of CEFPAS are not strictly sanitary and, moreover, the entities of the National Health Service are listed in Article 19 of Legislative Decree No. 118 of January 23, 2011 (Provisions on the harmonisation of accounting systems and budget schemes of the Regions, local authorities and their bodies, pursuant to Articles 1 and 2 of Law No. 42 of May 5, 2009), so that the regional standard illegally extends the area of the health perimeter, thus affecting the methods and the amount of financing of the essential levels of assistance (LEA).
For these reasons, Article 25, paragraph 2, of the Sicilian Regional Law No. 1 of 2024 would be in conflict with Article 117, third paragraph, of the Constitution, in relation to Article 20 of Legislative Decree No. 118 of 2011 and, in particular, with the principle of containment of public health spending, which constitutes a principle of coordination of public finance. And this even more so as the inclusion of CEFPAS in the health perimeter determines a derogation treatment for a series of expenses, which would end up, in fact, being governed by Title II of the same Legislative Decree No. 118 of 2011.
The challenged provision would also conflict with the provisions of Title I of Legislative Decree No. 502 of December 30, 1992 (Reorganisation of the regulations on health matters, pursuant to Article 1 of Law No. 421 of October 23, 1992), as well as with the regulations on the health recovery plan, because the recognition of the aforementioned Centre as an entity of the SSR could entail an unquantified increase in costs, incompatible with the financial economic balance of the health budget of the Sicilian Region committed to the plan, given that any modification of health planning must pass, in this case, through an update of the related operational program for consolidation and development for the three-year reference period, so that its economic compatibility can be assessed, in compliance with the principle of coordination of public finance expressed by Article 2, paragraph 80, of Law No. 191 of December 23, 2009, containing "Provisions for the formation of the State budget, annual and multi-year (financial law 2010)".
The state appeal further emphasizes that the qualification of the aforementioned Centre as an entity of the Regional Health Service could lead to a violation of the prohibition of non-compulsory expenses on the part of the Sicilian Region, a prohibition which, as repeatedly affirmed in constitutional jurisprudence, is imposed on regions subject to the constraints of health deficit recovery plans (Judgments Nos. 142 and 36 of 2021 and 166 of 2020 are cited), constraints which, in turn, constitute an expression of a principle of coordination of public finance.
According to the presentation of the President of the Council of Ministers, moreover, the reasons for the challenge are not contradicted by the circumstance that the matter of health care falls within those contemplated by Article 17 of the Statute of Autonomy, because the Sicilian Region can exercise its legislative powers only within the limits of the principles and general interests to which state legislation is informed, as confirmed by the same constitutional jurisprudence, which has recognized the binding nature of the provisions of the health deficit recovery plan, as principles of coordination of public finance, also in relation to special statute regions (Judgment No. 155 of 2023, rendered against the same Sicilian Region, is referred to).
2.– On April 29, 2024, the Sicilian Region was constituted in judgment, requesting the rejection of the appeal.
2.1.– In particular, with regard to the challenge of Article 8 of Sicilian Regional Law No. 1 of 2024, the regional defence has highlighted, first of all, that Article 1, paragraph 440, letter b), of Law No. 145 of 2018, had provided, pending the definition of the national collective labour agreements and the bargaining measures concerning personnel under public law for the three-year period 2019-2021, the payment to the personnel referred to in Article 2, paragraph 2, of Legislative Decree No. 165 of March 30, 2001 (General rules on the organisation of work for public administrations), of a one-off equalization element (where provided for by the relevant collective labour agreements referring to the three-year period 2016-2018).
In particular, Article 75, paragraph 1, of the CCNL for the non-managerial sector of the central functions area had established, due to the effects of pay increases on the personnel targeted by the measures referred to in Article 1, paragraph 12, of Law No. 190 of 2014, as well as the greater impact on the lowest pay levels of the measures to contain pay dynamics, the recognition to the personnel identified in the attached Tables D of a one-off equalization element paid on a monthly basis in the amounts indicated in the same Tables, for ten months in the period March 1-December 31, 2018.
The Sicilian Region specifies that, subsequently, the principle of the reabsorption of the equalization element in the 2019-2021 contract renewals was overcome by Article 1, paragraphs 869 and 959, of Law No. 178 of 2020, which allowed it to be incorporated into the basic salaries. This measure – it further emphasizes – meant that the total resources allocated were significantly higher than the 3.78 percent of the treatment already enjoyed by employees originally provided for (and, in particular, equal to 4.16 percent for the state sector and 4.51 percent for that of local authorities), as attested by the documentation produced both by the Agency for the Negotiating Representation of Public Administrations (ARAN) and by the Court of Auditors.
It assumes that, consequently, at least on the economic level, the measures taken by the regional legislator are absolutely analogous.
The regional defence represents, in this regard, that, in fact, the CCRL for the employees of the non-managerial sector for the three-year period 2016-2018 had provided, for the same purpose of compensating for the loss of the support measure for the lowest incomes contemplated by Article 1, paragraph 12, of Law No. 190 of 2014, some increases in the administration allowance, inversely proportional to the category of belonging (and, therefore, higher for the lowest levels), aimed at replacing the equalization element, as attested by Article 87 of the relevant contract and by Table D referred to by the same, financed from the Fund for decentralized resources intended for the ancillary treatments of personnel, as provided for by Article 23, paragraph 2, of Legislative Decree No. 75 of 2017.
The Sicilian Region notes that, although the certification report attached to the deliberation No. 76/2019/CCR of the Court of Auditors, control section for the Sicilian Region, of March 26, 2019, had highlighted the different nature of the increases in question and the equalization element provided for by national bargaining, at the same time it had suggested that the improvements in the administration allowance could have been reabsorbed by the future economic increases relating to the 2019-2021 bargaining three-year period.
Hence, it emphasizes that Article 87, paragraph 2, of the CCRL for the regulatory and economic three-year period 2016-2018 contemplated, in line with this indication, the reabsorption of increases in the administration allowance in subsequent contract renewals, in place of the equalization element paid to public employees in accordance with the national collective agreement.
In the context of contract renewal, taking into account the national appropriations aimed at making the equalization element not paid to regional employees structural because they are recipients of the increases referred to in the aforementioned Article 87 with the same purposes, the tool identified was to make such increases structural and no longer reabsorbable, with additional overall appropriations in the amount of 4.48 percent, and therefore not higher but, on the contrary, lower than 4.51 percent of the wage bill of the benefits granted within the framework of the local functions sector to make the equalization element structural.
In light of what has been represented, the regional defence emphasizes that the planned increase is consistent with the agreements reached between the State and the Sicilian Region on October 16, 2023 and, in particular, with the commitment made to contain the contract renewals of regional personnel within the limits provided for the same period at the national level, the relative percentage increases being respected, and also highlights that a different choice, in the sense of the provision and stabilisation of the equalization element, would have penalised, and not favoured, employees with lower salaries. Any violation of the interposed parameter constituted by Article 23, paragraph 2, of Legislative Decree No. 75 of 2017 would therefore be excluded.
This would also result in the lack of the alleged violation of Article 97 of the Constitution, since the relevant arguments are based on the untrue assumption that the increases referred to in Article 87 and Table D of the 2016/2018 CCRL "have rewarded the higher categories", while the exact opposite has occurred (with an increase of 30 euros per month for category A and 16 euros per month for category D).
2.2.– With regard to the challenge of Article 25, paragraph 2, of the same Sicilian Regional Law No. 1 of 2024, the Region's defence assumes that CEFPAS must be included among the entities of the Regional Health Service, since its establishment, which took place with Sicilian Regional Law No. 30 of 1993.
In support of this assumption, it highlights the content of some provisions of the aforementioned regional law, namely: Article 19, paragraph 1, according to which the training and updating of personnel are activities of central importance for the development of the health service; Article 20, paragraph 1, which establishes that the Centre, among other competences, provides for the permanent training and professional updating of socio-health operators, in accordance with the regional programming in the matter prepared by the regional health department, for research in the field of health sciences in the areas of training, health education and prevention, for the activities of health promotion and education and preventive medicine, for collaboration with Sicilian universities for their respective teaching and scientific needs; Article 20, paragraph 4, which specifies that the Centre contributes to the pursuit of the purposes referred to in Article 6 of Legislative Decree No. 502 of 1992; Article 21, paragraph 5, which contemplates the application for the director of training and the administrative director of the center of the rules provided for by Legislative Decree No. 502 of 1992 regarding the general directors, health directors and administrative directors of the local health units; Article 21, paragraph 17, according to which the board of auditors is appointed by decree of the President of the Region and has the same composition as the corresponding body of the local health units of the Region; Article 22, paragraph 4, which establishes that the operating expenses are financed annually with a share of the regional health fund and the subsequent paragraph 6, according to which the provisions in force for the budgets of local health units apply to the Centre.
The Sicilian Region further observes that Article 6, paragraph 1, letter g), of the Law of the Sicilian Region No. 5 of April 14, 2009 (Rules for the reorganisation of the Regional Health Service), establishes that the financial resources available annually for the SSR are determined and allocated by the regional councillor for health, in addition to the SSR companies, also to the Centre, for the performance of the activities of competence, as well as that the same Centre is subject, by Article 16 of the same law, to the control of the regional health department.
The regional defence adds, finally, that the statute of the entity assigns to CEFPAS the task of carrying out, in favour of the components of the entire SSR, technical and operational support activities for the regional policies of governing the health system and tasks of measurement, analysis, evaluation and monitoring of the performance of the health services of the SSR and of support for the revision of the integrated hospital-territory clinical networks and also carries out the monitoring of good practices for the safety of care, the management of clinical risk and patient safety.
Therefore, according to the view of the Region, from the complex of these regulatory and statutory provisions it must be inferred that the Centre performs a function complementary to the regional health department and in support of the functions of the SSR companies with which it operates in close liaison.
The respondent represents, moreover, that the genesis of the challenged provision consists of an opinion of the Ministry of Health, rendered in response to its request regarding the affiliation of the Centre to the SSR, in order to apply to the precarious staff of the same the state provisions on the stabilisation of staff in the health and social-health roles. This opinion, in fact, after a reconnaissance of the functions and regulations applicable to the Centre, had observed that, following the amendment of Title V of the Constitution, the regions have initiated a modification of the organisational structure of their Health Service, establishing specific bodies to which services and functions in support of the companies and entities that provide health services are centrally entrusted, financed with resources of the National Health Service. The Ministry, noting that there are indices that characterize CEFPAS as an instrumental entity in the sense indicated, had highlighted that, however, to qualify it as an entity of the SSR, a specific regional regulatory provision in this direction was necessary, which would explain its nature and instrumental functions.
The express provision contained in the challenged provision, the Sicilian Region emphasizes, as highlighted in the accompanying report, does not entail any additional charges and, moreover, as established by Article 22 of the Sicilian Regional Law No. 30 of 1993, the Centre has always been part of the so-called health perimeter, since the related operating expenses are financed annually with a share of the regional health fund (paragraph 4) and the provisions in force for the budgets of the local health units apply to it (paragraph 6).
Moreover, there would be no circumvention of the prohibition of non-compulsory expenses contemplated for regions subject to a recovery plan, because, pursuant to Article 19, paragraph 1, of the Sicilian Regional Law No. 30 of 1993, the training and updating of personnel represent an activity of central importance for the development of the Health Service and, therefore, the expenses for the operation of CEFPAS can be qualified as compulsory, also in order to ensure a high quality of essential health services, with the aim of protecting people's health.
3.– By memorandum filed on August 26, 2024, the President of the Council of Ministers has retraced the censures developed in the appeal and has replied to some deductions of the regional defence.
3.1.– Under the latter profile, in particular, with regard to the challenge of Article 8 of Sicilian Regional Law No. 1 of 2024, the State Attorney General's Office has emphasized the structural diversity as well as the distinct purposes pursued by the one-off equalization element and the administration allowance. It also pointed out that the aforementioned allowance is intended to increase regional spending over time because it increases the pension and severance pay. It therefore reiterated the circumvention of the prohibition of the invariance of expenditure for the ancillary treatment of personnel sanctioned by Article 23, paragraph 2, of Legislative Decree No. 75 of 2017, constituting a principle of coordination of public finance, and the incompatibility, resulting in a violation of Article 97, paragraphs one and two, of the Constitution, with the agreement reached in this regard between the State and the Sicilian Region on October 16, 2023 for the ten-year repayment of the deficit.
3.2.– With reference to Article 25, paragraph 2, of Sicilian Regional Law No. 1 of 2024, the state defence has highlighted that CEFPAS does not perform any function attributable to the provision of LEAs, so that the qualification of the same as an entity of the Regional Health Service would determine an alteration of the structure of the related perimeter prescribed by Article 20 of Legislative Decree No. 118 of 2011, improperly placing the expenses of the Centre on the health fund, and not on the regional budget, and thus diverting the resources of the fund from the provision of LEAs, in violation of the principles expressed by the recent Judgment No. 1 of 2024 of this Court.
4.– By memorandum filed on September 3, 2024, the defence of the Sicilian Region has in turn made further defensive deductions.
4.1.– Specifically, with regard to the question raised against Article 8 of Sicilian Regional Law No. 1 of 2024, it emphasized that there would be no violation of the agreement of October 16, 2023, since the total treatment paid as a result of the increase in the administration allowance to regional employees has not been increased to a greater extent than that due to state employees as a result of the introduction of the one-off equalization element and the subsequent reabsorption of the same into the remuneration.
4.2.– With reference to Article 25, paragraph 2, of the same Sicilian Regional Law No. 1 of 2024, the regional defence has raised the inadmissibility of the appeal due to the generality of the censures and the inadequate reconstruction of the regulatory framework relating to CEFPAS. In particular, the provisions of the Sicilian Regional Law No. 30 of 1993, which have always placed the expenses for the operation of the same to be charged to the regional health fund, as well as previous laws that already qualify the entity as part of the health sector, would not have been considered. Furthermore, the state appeal would have failed to consider that, also within the framework of the recovery plans and implementation programmes concerning the Sicilian Region, the expenses relating to CEFPAS have always been charged to the health fund and that, already with resolution of the Regional Council of August 10, 2015, No. 201, these expenses were qualified as "current health expenditure for the financing of LEAs". In considering the list referred to in Article 19 of Legislative Decree No. 118 of 2011 to be mandatory for identifying the entities of the Health Service, a series of entities from other regions not included in the relevant list would have been neglected.
The regional defence has also raised the inadmissibility of the appeal because the State, in adhering to the health deficit recovery plans and the related implementation programmes in which the operating expenses of CEFPAS had always been charged to the health fund, would have acquiesced with respect to the referral of the entity to those belonging to the health sector.
On the merits, the Sicilian Region has deduced the unfounded nature of the question relating to Article 25, paragraph 2, emphasizing that, in general, CEFPAS, since its establishment and subsequently with all the additional regulatory sources of reference, has always been configured and governed as an entity of the SSR, and the related activity, since the first regional recovery plan of 2007, has always been correlated to the achievement of LEAs and the objectives of the recovery plans subsequently intervened, so that the challenged provision does not have an innovative character but is a kind of authentic interpretative standard, recognitive of a pre-existing situation also shared by the Government.
In particular, the Region has observed that, on a regulatory level, in addition to the law establishing the Centre, the close correlation between the same and the SSR is confirmed: by the Law of the Sicilian Region No. 1 of January 18, 1997 (Establishment of the Regional Health Inspectorate Service. Integration of the Regional Council for the prevention of drug addiction. Extension of scholarships of the Epidemiological Observatory. Establishment of the Territorial Pathology Register Office - Syracuse), which establishes the "Regional Health Inspectorate Service", providing that the same operates in