JUDGMENT NO. 26

YEAR 2026

ITALIAN REPUBLIC

IN THE NAME OF THE ITALIAN PEOPLE

THE CONSTITUTIONAL COURT

is composed of:

President: Giovanni AMOROSO;

Judges: Luca ANTONINI, Stefano PETITTI, Angelo BUSCEMA, Emanuela NAVARRETTA, Maria Rosaria SAN GIORGIO, Filippo PATRONI GRIFFI, Marco D’ALBERTI, Giovanni PITRUZZELLA, Antonella SCIARRONE ALIBRANDI, Massimo LUCIANI, Maria Alessandra SANDULLI, Roberto Nicola CASSINELLI, Francesco Saverio MARINI,
has pronounced the following

JUDGMENT

in the constitutional legitimacy trial concerning Article 6 of the Law of the Sicilian Region of June 10, 2025, No. 26 (Urgent Amendments to the Budget of the Region for the financial year 2025 and for the three-year period 2025-2027), initiated by the President of the Council of Ministers with an appeal notified on August 8, 2025, filed in the Registry on the same date, registered under No. 30 of the Appeals Register for 2025 and published in the Official Gazette of the Republic No. 38, first special series, of 2025.

Having examined the statement of defense of the Sicilian Region;

Having heard Judge Rapporteur Maria Alessandra Sandulli in the public hearing of January 14, 2026;

Having heard State Attorney Fabio Tortora for the President of the Council of Ministers and Attorney Nicola Dumas for the Sicilian Region;

Deliberated in the Council Chamber on January 14, 2026.

Facts Considered

1.‒ With an appeal notified and filed on August 8, 2025, registered under No. 30 of the Appeals Register for 2025, the President of the Council of Ministers, represented and defended by the Advocate General of the State, challenged the constitutional legitimacy of Article 6 of the Law of the Sicilian Region of June 10, 2025, No. 26 (Urgent Amendments to the Budget of the Region for the financial year 2025 and for the three-year period 2025-2027), with reference to Article 117, third paragraph, and Article 81, third paragraph, of the Constitution, as well as to the "statutory powers". The challenged provision establishes that "[i]n order to ensure equitable access to services by the assisted persons and guarantee the adequacy of the economic tariff values for certain services under the Decree of the Minister of Health of November 25, 2024, adopted by Regional Assessor Decree No. 1559 of December 20, 2024, pursuant to paragraph 322 of Article 1 of Law No. 207 of December 30, 2024, and subsequent amendments, an expenditure of 15,000 thousand Euros is authorized for the financial year 2025, to be recorded under Mission 13 'Health Protection', Programme 2 'Regional Health Service - additional current financing for levels of assistance exceeding the LEA [Essential Levels of Assistance]'", further providing that "[w]ith a decree of the Regional Assessor for Health, to be issued, after opinion from the VI Legislative Commission of the Sicilian Regional Assembly, within sixty days from the entry into force of this law, the tariff variations referred to in paragraph 1 and the methods for the allocation of financial resources among the provincial health authorities shall be established" and that "[t]he expenditure authorization referred to in paragraph 1 is intended to increase regional expenditure for outpatient specialist care provided by private entities for the year 2025".

2.– The appeal avers that, for certain outpatient specialist services provided in the regional territory, the aforementioned Article 6 of Regional Law No. 26 of 2025 would have provided for the application of tariffs higher than the national tariffs set by the Decree of the Minister of Health, in agreement with the Minister of Economy and Finance, of November 25, 2024 (Definition of tariffs related to outpatient specialist and prosthetic care), authorizing, pursuant to Article 1, paragraph 322, of Law No. 207 of December 30, 2024 (State Budget Law for the financial year 2025 and multi-year budget for the three-year period 2025-2027), an allocation of 15 million Euros from regional budget resources (Mission 13 'Health Protection', Programme 2 'Regional Health Service - additional current financing for levels of assistance exceeding the LEA), despite the current legislation on expenditure limits for purchases from accredited private entities already providing, for 2025, an increase in the threshold compared to the previous year sufficient to grant the Sicilian Region "an additional margin of expenditure of 15.914 million Euros for the purchase of outpatient specialist care from private entities" which "would be sufficient to accommodate the costs arising from the tariff increase provided for by the regional provision [...]" (Article 1, paragraph 277, of Law No. 207 of 2024; Article 1, paragraph 233, of Law No. 213 of December 30, 2023, establishing the "State Budget Law for the financial year 2024 and multi-year budget for the three-year period 2024-2026"). Furthermore, in authorizing an expenditure intended for outpatient specialist care from private entities, the challenged provision allegedly fails to consider that the "effects of the regional intervention would necessarily also affect the remuneration of public facilities, for which no specific financial coverage is provided".

2.1.‒ Based on the above, the appeal notes that the Sicilian Region is subject to the rules of the healthcare deficit recovery plan (Article 1, paragraph 180, of Law No. 311 of December 30, 2004, establishing the "Provisions for the formation of the annual and multi-year State budget - Finance Law 2005") and that, consequently, pursuant to Article 2, paragraph 80, of Law No. 191 of December 23, 2009 (Provisions for the formation of the annual and multi-year State budget - Finance Law 2010), it is "called upon to repeal legislative provisions that conflict with the implementation of the recovery plan" and, as also affirmed by this Court, "cannot provide levels of assistance exceeding the LEA" (citing Judgment No. 1 of 2024). Furthermore, pursuant to Article 15, paragraph 17, of Decree-Law No. 95 of July 6, 2012 (Urgent provisions for the review of public spending without altering services to citizens as well as measures for strengthening the capital of banking sector companies), converted, with amendments, into Law No. 135 of August 7, 2012, as recently amended by Article 1, paragraph 322, of Law No. 207 of 2024 (Budget Law for 2025), any region intending to establish tariff amounts higher than the national maximum tariffs should nevertheless submit its annual forecast programming to the Monitoring Panel, providing evidence of the impact resulting from the tariff increase, so that compliance with the economic-financial balance of the healthcare sector can be verified. However, the Sicilian Region allegedly failed to implement the "preparatory compliance steps for the use of the exemption in question" nor provided "any evidence of the impacts, if any, resulting on final accounts in case of failure to comply with the balance of the SSR". Moreover, the preliminary consolidated income statement for 2025, transmitted on March 17, 2025, allegedly shows "a deficit of the SSR equal to 216.790 million Euros, without any evidence of the impact resulting from the increase in tariffs beyond the national maximum". Therefore, as already communicated to the Region "during monitoring meetings on April 9, 2025, by the competent technical Panels," the "conditions indicated by national law" are not met in this case, as "the preliminary consolidated income statement for the first quarter of 2025 filed by the Region with the information system of the Ministry of Health (New Health Information System - NSIS) shows a deficit" and "the Region has not submitted an Operational Programme adopted and positively assessed by the technical Panels". In other words, neither "the coverage of the new costs induced by the regional law" nor "compatibility with the Recovery Plan" appears to be guaranteed.

In conclusion, the appeal contests that the challenged provision "exceeds statutory powers and conflicts with the state legislation above-mentioned, which embodies the principle of coordination of public finance, and therefore with Article 117, third paragraph, of the Constitution," emphasizing that constitutional jurisprudence, since Judgment No. 100 of 2010, is settled "in recognizing the violation of the principle concerning the coordination of public finance for all regional rules that conflict with the Recovery Plan".

2.2.‒ With a second ground, the appeal challenges the challenged provision for violation of Article 81, third paragraph, of the Constitution "in relation to the aforementioned coverage issues".

3.‒ On September 8, 2025, the Sicilian Region appeared in the proceedings, requesting that the appeal be declared inadmissible and, in any case, unfounded.

As a preliminary matter, the Region objected to the inadmissibility of the appeal, arguing that it "merely asserts that, since it concerns healthcare matters and financial aspects reserved to the State's competence, the regional provision is unconstitutional solely on that basis" and that, therefore, it lacks "a real argumentative development demonstrating the effective impact of the challenged law on state powers or a concrete prejudice to the essential levels of assistance uniformly guaranteed at the national level". More specifically, the appellant allegedly failed to meet the burden of motivation required by the jurisprudence of this Court, "having limited the challenge to apodictic assertions regarding state competence in healthcare and financial matters, without concretely demonstrating how the challenged provision causes a violation of the uniformity of essential levels of assistance or a real prejudice to expenditure containment constraints".

3.1.– On the merits, Article 6 of Regional Law No. 26 of 2025 allegedly represents the response to a critical issue in the Decree of the Minister of Health, in agreement with the Minister of Economy and Finance, of November 25, 2024, which, by significantly reducing the tariffs for certain healthcare services, would have made "economic sustainability difficult for accredited private facilities and thus creating an effective risk of contraction of the supply to citizens". To "prevent this reduction from resulting in prejudice to the levels of assistance," the Region thus authorized, for the financial year 2025, an allocation of 15 million Euros from its own budget, recorded under Mission 13, Programme 2, "intended to guarantee greater remuneration for services that are already included in the essential levels of assistance and are already subject to state tariffs," deferring the concrete application of the rule to a subsequent assessor decree, "aimed at establishing a selective and limited basket to only those sectors most penalized by the state tariff revision, such as laboratory medicine and cardiology (Annex No. 1)".

According to the regional defense, the provision under examination is founded on Article 117, third paragraph, of the Constitution, which grants regions concurrent legislative power in matters of health protection, and therefore the Sicilian Region legitimately exercised its normative power "without introducing new services extraneous to the essential levels, but merely intervening on the measure of remuneration, in a targeted and temporally circumscribed manner, with the sole objective of ensuring the effective provision of services already included in the essential levels and therefore falling within the minimum core of rights that the State has recognized as enforceable".

3.2.‒ The challenged provision also allegedly complies with the constraints imposed by Article 81, third paragraph, of the Constitution and Article 20 of Legislative Decree No. 118 of June 23, 2011 (Provisions on the harmonization of accounting systems and budget formats of Regions, local authorities and their bodies, pursuant to Articles 1 and 2 of Law No. 42 of May 5, 2009), having "punctually identified the means and resources for coverage of the expenditure, allocating them in the Region's budget for the year 2025 and without drawing on the national health fund, intended for other purposes". Similarly, it allegedly respects the commitments arising from the healthcare deficit recovery plan, as "[t]he committed resources are additional and borne exclusively by the regional budget, without altering the balances agreed at the state level," as confirmed by the fact that "the economic programming was already adjusted in 2025 through the POCS 2025-2026 transmitted via SiVeAS on April 8, 2025 (Annex No. 2) and through the preliminary consolidated economic budget of the SSR, approved by Board Resolution No. 121 of April 24, 2025 (Annex No. 3)".

3.3.‒ To confirm the reasonableness and proportionality of the legislative intervention, the Region emphasizes that, in sectors such as laboratory medicine and cardiology, a tariff reduction has been recorded that affects the sustainability of accredited private facilities, and since in Sicily "laboratory medicine outpatient production is eighty-one percent held by private entities and physiotherapy services are provided ninety percent by private entities," without a timely corrective action borne by the regional budget, "there is a concrete risk of contraction of supply and lengthening of access times, with territorial discriminatory effects". In this context, the increased remuneration established by the challenged provision "is limited, selective, temporally circumscribed, and calibrated to the objective of ensuring equity of access and continuity of the essential levels of assistance". Moreover, the increases in spending caps established at the state level for purchases from private entities (Article 1, paragraph 233, of Law No. 213 of 2023 and Article 1, paragraph 277, of Law No. 207 of 2024) would not be sufficient to avoid the feared risk, as they, while positively impacting the system, would still be "insufficient to fully compensate for the effects produced by the new tariff nomenclature, which has led to a significant reduction in the remuneration of certain services".

3.4.‒ Reaffirming that the challenged provision does not introduce additional services but intervenes to ensure the sustainability of those already included in the essential levels, guaranteeing their effective provision (and that, therefore, the reference to the judgment of this Court No. 1 of 2024, according to which regions are not allowed to finance services extraneous to the essential levels, is irrelevant), the regional defense notes that the "deficit reported in the preliminary consolidated Economic Model 2025 (Annex No. 4) cannot be used as a binding parameter, as it reflects provisional data subject to adjustment, formulated when neither the hypotheses for the allocation of the national health fund nor the final regional programming were yet available" and that, in fact, in April 2025, "the Region defined and adjusted these figures, achieving economic balance through the POCS 2025-2026, transmitted via SiVeAS to the compliance panel on April 8, 2025, as well as through the preliminary consolidated economic budget of the SSR approved by DGR No. 121 of April 24, 2025". "Precisely for this reason" – the Region specifies – "the regional provision will be incorporated into the updated programming instruments, with full integration into the Economic Models and accounting documents". In particular, in the meeting of July 31, 2025, the Region allegedly already submitted to the "Ministerial Panels [...] an operational measure which provides: on the one hand, the inclusion in the programming Economic Models of financing from regional budget funds for the tariff recognition to private facilities, with the consequent accounting of additional costs for the purchase of outpatient specialist services; on the other hand, the description of the measure also in relation to the recognition of the tariff increase to public facilities, whose services will find coverage within the intra-regional mobility matrices". Therefore, the regional legislative intervention allegedly constitutes "a targeted, proportionate, and fully financed corrective measure, which is situated within the framework of the recovery plan and the programming agreed with the State, with the exclusive purpose of making effective rights already recognized at the national level".

3.5.‒ Finally, in implementing the challenged provision, the Region allegedly maintained constant and transparent dialogue with the competent state administrations and the Presidency of the Council of Ministers, as evidenced by the numerous formal exchanges that took place between March and July 2024 (citing notes prot. No. 5888 of March 14, 2025, No. 34581 of July 22, 2025, and No. 35785 of July 30, 2025) and the already mentioned session "of July 31, 2025, of the Verification Panel". This confirms full compliance with the principle of loyal collaboration, through constant institutional communication "which has guaranteed transparency, programming coherence, and full coordination between the state and regional levels".

4.‒ In preparation for the public hearing, only the Region filed a brief, insisting on its arguments and invoking the principles of reasonableness, proportionality, and effectiveness of social rights.

5.‒ Shortly before the same hearing, this Court, pursuant to Article 10, paragraph 3, of the Supplementary Rules for proceedings before the Constitutional Court, asked the parties to clarify "[...] what were the outcomes of the mentioned meeting of July 31, 2025 [and] of the evaluations/verifications carried out during the monitoring phase by the Ministries of Health and Economy and Finance, or by the competent technical Panels, even before the adoption of Regional Law No. 26 of 2025, regarding the anticipated increase in regional tariffs for outpatient specialist care," as well as whether, in addition to the agreement signed on July 31, 2007, and approved by Assessor Decree of August 6, 2007, "further agreements under Article 1, paragraph 180, of Law No. 311 of 2004 have been entered into between the Sicilian Region and the Ministries of Health and Economy and Finance".

5.1.‒ At the public hearing of January 14, 2026, the parties responded to the aforementioned questions, essentially reiterating what had already been set out in the appeal and the statement of defense, respectively. The Advocate General of the State requested permission to file the minutes of the joint meetings of the "Technical Panel for the verification of regional compliance with the Permanent Committee for the verification of Essential Levels of Assistance" held on April 9 and July 31, 2025, respectively. The Region did not object to the request, and this Court therefore authorized the filing of the said documents. The minutes of the meeting of April 9, 2025, acknowledge that the Region had communicated its intention to "increase certain tariffs related to laboratory analysis," but that the "Panels" noted that the Region had not met the conditions required by Article 1, paragraph 322, of Law No. 207 of 2024 for cases of divergence between regional tariffs and national tariffs. The minutes of the meeting of July 31, 2025, on the other hand, note the approval, in the interim, of Regional Law No. 26 of 2025, which is the subject of this trial, highlighting the critical issues denounced by the President of the Council of Ministers in his appeal.

Considerations in Law

6.‒ With the appeal indicated in the heading (Reg. App. No. 30 of 2025), the President of the Council of Ministers challenged the constitutional legitimacy of Article 6 of Regional Law No. 26 of 2025.

6.1.‒ The first ground of appeal challenges the provision for violation of Article 117, third paragraph, of the Constitution, asserting that it, by exceeding statutory powers and conflicting with state legislation embodying the principle of coordination of public finance (Article 1, paragraph 180, of Law No. 311 of December 30, 2004; Article 2, paragraph 80, of Law No. 191 of December 23, 2009; and Article 1, paragraph 322, of Law No. 207 of December 30, 2024, which amends Article 15, paragraph 17, of Decree-Law No. 95 of 2012, as converted), provided for the application of tariffs for outpatient specialist care from private entities higher than those set at the national level by the Decree of the Minister of Health, in agreement with the Minister of Economy and Finance, of November 25, 2024, for the year 2025, without the Region having provided evidence of the impact resulting from the aforementioned tariff increase and of compliance with the economic-financial balance of the Regional Health Service, and without the operational programme having been positively assessed by the competent Technical Panels, so that neither "the coverage of the new costs [...] nor the compatibility with the Recovery Plan" from the healthcare deficit, to which the Region is subject, would be guaranteed.

6.2.‒ The second ground of appeal alleges the violation of Article 81, third paragraph, of the Constitution "in relation to the coverage issues mentioned above" (i.e., those raised with reference to Article 117, third paragraph, of the Constitution).

6.3.‒ In its statement of defense, the Sicilian Region preliminarily objected to the inadmissibility of the appeal, asserting that the State's defense failed to demonstrate "how the challenged provision determines a violation of the uniformity of essential levels of assistance or a real prejudice to expenditure containment constraints".

6.4.‒ On the merits, the respondent refuted the alleged challenges, noting that the challenged provision is designed to guarantee, with the Region's own resources and not from the national health fund, the effectiveness of the LEA in light of the reduction in national tariffs for certain healthcare services enacted by the aforementioned Ministerial Decree of November 25, 2024. In particular, it observes that the provision did not introduce new services extraneous to the essential levels identified by state legislation, but merely "intervened on the measure of remuneration, in a targeted and temporally circumscribed manner," solely for the purpose of "ensuring the effective provision of services already included in the essential levels and therefore falling within the minimum core of rights that the State has recognized as enforceable". It would therefore be founded on the concurrent legislative competence of the Region in matters of health protection. The Region also stated that it had achieved economic balance through the Consolidation and Development Operational Programme (POCS) 2025-2026 and the preliminary consolidated economic budget of the SSR, and that it had always maintained constant and transparent dialogue with the competent state administrations, in compliance with the principle of loyal collaboration.

7.– The objection of inadmissibility of the appeal raised by the Sicilian Region must first be examined.

7.1.– The objection is well-founded with reference to the alleged violation of Article 81, third paragraph, of the Constitution.

In providing financial coverage for the various commitments envisaged, Article 13 of Regional Law No. 26 of 2025 establishes that "[t]he charges arising from the provisions of this law, amounting to a total of EUR 52,237,092.02 for the financial year 2025 and EUR 10,932,000.00 for each of the financial years 2026 and 2027, shall be met: a) for the financial year 2025 by increasing the revenues specified in Table 'A' annexed to this law, for an amount equal to EUR 49,730,247.43, and by reductions made to the Missions and Programmes specified in Table 'B' annexed to this law, for a total amount equal to EUR 2,506,844.59, of which EUR 6,844.59 as a reduction of the expenditure authorization referred to in paragraph 1 of Article 20 of Regional Law No. 1 of January 9, 2025 - Table 'A' - (Mission 20, Programme 3, Chapter 215704); b) for each of the financial years 2026 and 2027 by reductions made to the Missions and Programmes specified in Table 'B' annexed to this law, for a total amount equal to EUR 10,932,000.00, of which EUR 8,432,000.00 as a reduction of the expenditure authorization referred to in paragraph 1 of Article 20 of Regional Law No. 1 of January 9, 2025 - Table 'A' - (Mission 20, Programme 3, Chapter 215704)", thus indicating coverage based on revenue increases and expenditure reductions.

Notwithstanding this, the Advocate General of the State does not contest the financial coverage as indicated by the aforementioned Article 13, but deduces the absence of coverage solely from the reasons set forth in the preceding parts of the appeal with reference to the violation of Article 117, third paragraph, of the Constitution, merely asserting that the challenged provision is also contrary to Article 81, third paragraph, of the Constitution, "in relation to the coverage issues mentioned above" and generally and apodictically observing that "the effects of the regional intervention would necessarily also affect the remuneration of public facilities, for which no specific financial coverage is provided".

Thus, the requirement of adequate motivation, which, as repeatedly affirmed by this Court, "is rigorous in principal proceedings, where the appellant has the duty not only to identify the challenged provisions and the constitutional parameters whose violation is alleged, but also to support the reasons for the alleged conflict with clear, complete, and sufficiently detailed arguments (inter alia, Judgments of No. 125 of 2023, No. 265, No. 259 and No. 135 of 2022, No. 170 of 2021 and No. 279 of 2020)" (Judgment No. 169 of 2024, paragraph 4 of Considerations in Law) is not met.

7.2.‒ The challenge concerning the excess of statutory powers is likewise inadmissible, as it is merely alluded to and therefore entirely unsubstantiated.

7.3.‒ Regarding the alleged violation of Article 117, third paragraph, of the Constitution, it is observed that, although the appeal is particularly concise – and, as will be seen, imprecise – in reconstructing the regulatory framework and supporting arguments, this does not prevent the comprehension of the essential core of the challenge, which lies in the alleged failure to meet the prescribed conditions for increasing the maximum tariffs set at the national level. The inadmissibility objection must, therefore, be dismissed, considering that, despite the noted deficiencies, the terms of the issue appear understandable and such as to allow this Court to exercise its review (among others, Judgments No. 286 and No. 54 of 2013).

8.– Turning to the merits, it is necessary to first define the exact scope of the issue raised with reference to Article 117, third paragraph, of the Constitution.

In arguing the challenge, the appellant states that the Sicilian Region is subject to the rules of the recovery plan pursuant to Article 1, paragraph 180, of Law No. 311 of 2004, recalling that, pursuant to Article 2, paragraph 80, of Law No. 191 of 2009, it is called upon to repeal legislative provisions that conflict with the implementation of the aforementioned plan and "cannot provide levels of assistance exceeding the LEA, as also recalled by the Constitutional Court (most recently in Judgment No. 1 of 2024)". From the general premises mentioned concerning the constraints arising from subjection to recovery plans, the state defense draws the direct consequence, as also revealed by the use of the conjunction "therefore," that the challenged "operation" would have been subject to the prior evaluation of the monitoring Technical Panels, by virtue of Article 15, paragraph 17, of Decree-Law No. 95 of 2012, as converted, and as amended by Article 1, paragraph 322, of Law No. 207 of 2024, of which it merely cites and reports only the first three sentences (infra). It is, therefore, evident that, from the appeal's perspective, the sole reason for the conflict of the challenged provision with Article 117, third paragraph, of the Constitution, and therefore with the fundamental principles of coordination of public finance, lies in the alleged failure to comply with the conditions prescribed by the aforementioned Article 15, paragraph 17.

9.– In light of these premises, the issue is unfounded.

9.1.– For present purposes, the aforementioned Article 15, paragraph 17, indeed stipulates, in the first sentence, that "[t]ariff amounts set by individual regions, exceeding the maximum tariffs referred to in paragraph 15, shall remain at the charge of the regional budgets," reiterating what was already generally stated by Article 8-sexies of Legislative Decree No. 502 of December 30, 1992 (Reorganization of discipline in health matters, pursuant to Article 1 of Law No. 421 of October 23, 1992). In the original text of the said paragraph, this provision was followed (only) by a second one, which stipulated that "this provision [i.e., the provision in the first sentence] shall be considered complied with in any case by the regions for which the Compliance Verification Panel, established pursuant to Article 12 of the Agreement ratified by the Permanent Conference for relations between the State, the Regions and the Autonomous Provinces of Trento and Bolzano in the meeting of March 23, 2005, has verified compliance with the economic-financial balance of the healthcare sector, except as specifically provided for the regions that have signed the agreement referred to in Article 1, paragraph 180, of Law No. 311 of December 30, 2004, and subsequent amendments, on an operational programme for the reorganization, requalification, or strengthening of the Regional Health Service, for which the maximum tariffs constitute an insurmountable limit."

Law No. 207 of 2024 (2025 Budget Law), with Article 1, paragraph 322, (implicitly) evoked as an intervening rule by the President of the Council of Ministers, intervened on the regulation in question with the declared aim "to safeguard the appropriateness of care and equity in access to it". In its current formulation, paragraph 17 of Article 15 provides that: "[t]ariff amounts set by individual regions, exceeding the maximum tariffs referred to in paragraph 15, shall remain at the charge of the regional budgets. This provision shall be considered complied with in any case by the regions for which the Compliance Verification Panel, established pursuant to Article 12 of the Agreement ratified by the Permanent Conference for relations between the State, the Regions and the Autonomous Provinces of Trento and Bolzano in the meeting of March 23, 2005, has verified compliance with the economic-financial balance of the healthcare sector. If the regions make use of the exemption referred to in the second sentence, the said regions shall submit the annual forecast programming to the Compliance Verification Panel, providing evidence of the impact resulting from the tariff increase beyond the maximum and of compliance with the economic-financial balance of the regional health service. For regions that have signed the agreement referred to in Article 1, paragraph 180, of Law No. 311 of December 30, 2004, the evaluation shall be carried out within the scope of the implementation methods provided for by the agreement itself. Regions that have made use of the exemption referred to in the second sentence shall submit to the Compliance Verification Panel, also within the scope of the examination of the balance of the regional health service, the annual final accounts which provide evidence of the impact resulting from the tariff increase beyond the maximum. In the event that, within individual financial years, tariffs higher than the national maximum value have been applied and the balance of the regional health service is not achieved, the regions shall implement the necessary recovery measures in the following financial year. Such regions shall be precluded from the option to use the exemption referred to in the second sentence in the financial year following the one in which the failure to achieve the balance of the budget was verified. The contractual agreements referred to in Article 8-quinquies of Legislative Decree No. 502 of December 30, 1992, shall take these circumstances into account."

In essence, with the objective recalled above of "safeguarding the appropriateness of care and equity in access to it," the amendment has, on the one hand, clarified the exceptional nature of the provision in the second sentence ("[t]his provision [i.e., the provision in the first sentence, which, as reported above, requires that increases to the national maximum tariffs made by regions remain at the charge of their budgets] shall be considered complied with in any case by the regions for which the Compliance Verification Panel [...] has verified compliance with the economic-financial balance of the healthcare sector"), specifying its applicable methods, and defining the effects of applying increased tariffs, should the balance of the Regional Health Service not be achieved; and, on the other hand, by eliminating the preclusion provided for in the original text, it has extended the application of the said exemption, with the necessary procedural adaptations, to regions subject to recovery plans.

Therefore, in light of the normative evolution reported above, contrary to the reconstruction proposed by the appellant and also resulting from the minutes of the "joint meeting of the Technical Panel for the verification of regional compliance with the Permanent Committee for the verification of Essential Levels of Assistance" of July 31, 2025, the provision in the first sentence of the current paragraph 17 of the cited Article 15 cannot be interpreted as conditioning in every case, by the compliance requirements of the subsequent sentences of the same paragraph, the power of the regions to increase the tariffs for services included in the LEA.

9.2.‒ In order to identify when it is necessary to initiate the exceptional procedure referred to in the latter sentences, the actual scope of the general rule in the first sentence must be clarified with reference to the expression "at the charge of the regional budgets." Interpreted in coherence with the principle of financial autonomy enunciated in Article 119 of the Constitution, this expression must be understood to refer to situations where regions use their own autonomous resources for the increase, not expressly withdrawn, even by virtue of the recovery plan, from their availability as to their destination.

Understood in this way, the obligation to place "at the charge of the regional budgets" tariff increases for which regions do not intend to follow the exemption procedure thus ensures that, for regions in a recovery plan, the resources of the Health Fund remain in any case allocated to the implementation of such plans, so as to preserve the dual objective of economic-financial balance in the healthcare sector and full realization of the LEA to which these plans are specifically oriented.

Moreover, the very configuration of the right to health as a fundamental right, specified in the perimeter of its concrete enjoyment through the determination of the LEA, requires, as a necessary condition for its implementation, financing sufficient and adequate to guarantee the effectiveness of the healthcare services included in the relevant list. As this Court has stated on several occasions, "[i]n this sense, the principle must be reaffirmed that, 'once the unassailable core of minimum guarantees for making [the right to a social service of a fundamental nature] effective has been normatively identified, it cannot be financially conditioned in absolute and general terms'" (Judgment No. 275 of 2016)" (Judgment No. 62 of 2020, paragraph 4.3. of Considerations in Law).

9.3.– In the present case, as also appears from Article 13 of Regional Law No. 26 of 2025 itself (on which, furthermore, infra), the increase contemplated by the challenged provision is borne by the Region's own resources (not subject to the constraints of the recovery plan) not drawn from the Regional Health Fund, such as those deriving from the increase in revenues from stamp duty and motor vehicle taxes, which constitute its predominant source of funding; and it was established because it was deemed necessary for the declared purpose of "ensuring equitable access to services by the assisted persons and guaranteeing the adequacy of the economic tariff values for certain services under the Decree of the Minister of Health of November 25, 2024 [...]". The constitutional legitimacy of the challenged provision must, therefore, be scrutinized with reference to the first sentence of Article 15, paragraph 17, of Decree-Law No. 95 of 2012, as converted and as amended by Article 1, paragraph 322, of Law No. 207 of 2024, and not to the exemption referred to in its second sentence (and those that develop it). It has already been clarified in this regard that, beyond some uncertainties that, if an improper meaning were attributed to the term "in any case," the original text could generate, the current formulation of paragraph 17 removes any residual doubt, since, by expressly qualifying the second sentence as an "exemption," it conceives of the first sentence as the general rule. The invocation in the appeal of the second and third sentences (but the observation would also apply to the fourth, specifically dedicated to regions in a recovery plan, which the state defense neither reports nor invokes), respectively relating to the exemption and the connected procedural compliance, does not therefore appear relevant. The circumstance, it is reiterated, not contested, that the resources allocated for the tariff increase are the Region's own resources, not previously earmarked for other specific destinations, therefore excludes the alleged violation of paragraph 17.

9.4.‒ The challenged provision falls, moreover, within the scope of the Region's concurrent legislative competence in matters of health protection. As this Court has, in fact, stated several times, "the interplay between constitutional and organizational aspects means that public health function is exercised on two levels of government: the state level, which defines the services that the National Health Service is required to provide to citizens – i.e., the essential levels of assistance – and the total amount of economic resources necessary for their financing; the regional level, which has the task of organizing the respective service on the territory and guaranteeing the provision of services in compliance with constitutionally compliant standards" (Judgment No. 62 of 2020, paragraph 4.3. of Considerations in Law). While state competence to define the LEA uniformly across the national territory remains, regions indeed have the competence to organize their respective health services with the objective of ensuring the concrete implementation of the healthcare services identified by the State.

Article 6 of Regional Law No. 26 of 2025 does not introduce additional services compared to those identified at the state level, but merely envisages an increase in tariffs for certain outpatient specialist services already included in the LEA, in a regulatory context that allows regions to increase tariffs using resources borne by them, when this is necessary to ensure the effective provision of state LEA. As, in fact, emerges from the defenses of the Region and the preparatory work for Regional Law No. 26 of 2025, the need to increase tariffs "arises from the need to ensure compliance with [these] Essential Levels [...], ensuring equity in access to services by citizens, as well as mitigating the difficulties recorded, in certain specialisms, by facilities accredited with the Regional Health Service, given that the new tariff nomenclature under Ministerial Decree of November 25, 2024, has reduced the tariff values of certain specialist services compared to those of the previous nomenclature" (thus, report of the Regional Government for the presentation of the bill establishing "Urgent Amendments to the Budget of the Region for the financial year 2025 and for the three-year period 2025-2027"). This confirms that the challenged provision is founded on the concurrent legislative competence of the Region in matters of health protection, and is further justified, generally, based on the principle of financial autonomy established in Article 119 of the Constitution.

9.5.‒ The appeal does not allege further reasons for the conflict of the challenged regional norm with Article 117, third paragraph, of the Constitution, in matters of public finance coordination.

As reconstructed above, the generic reference to the constraints arising from subjection to the recovery plan does not constitute any autonomous ground for challenge, because, from the appeal's perspective, their invocation is only instrumental to asserting the alleged prerequisite for applying the conditions set out in Article 15, paragraph 17, second and third sentences, of Decree-Law No. 95 of 2012, as converted and amended (sentences which, in the erroneous reading proposed by the state defense, would serve to integrate the first sentence and not to identify an exemption from it). Moreover, if it intended to draw autonomous grounds for challenge from the said constraints, the appellant, in compliance with the required burdens of motivation, should have illustrated the content of the healthcare deficit recovery plan, so as to identify the exact point of conflict between the latter and the challenged regional provision (Judgment No. 161 of 2025, paragraph 3.2. of Considerations in Law).

9.6.‒ In light of the foregoing considerations, the challenge of violation of Article 117, third paragraph, of the Constitution, concerning the matter of "coordination of public finance," is therefore unfounded.

for these reasons

THE CONSTITUTIONAL COURT

1) declares inadmissible the question of constitutional legitimacy of Article 6 of the Law of the Sicilian Region of June 10, 2025, No. 26 (Urgent Amendments to the Budget of the Region for the financial year 2025 and for the three-year period 2025-2027), raised, with reference to Article 81, third paragraph, of the Constitution, by the President of the Council of Ministers with the appeal indicated in the heading;

2) declares inadmissible the question of constitutional legitimacy of Article 6 of Regional Law No. 26 of 2025, raised, with reference to the statutory powers of the Sicilian Region, by the President of the Council of Ministers with the appeal indicated in the heading;

3) declares unfounded the question of constitutional legitimacy of Article 6 of Regional Law No. 26 of 2025, raised, with reference to Article 117, third paragraph, of the Constitution, concerning the matter of "coordination of public finance," by the President of the Council of Ministers with the appeal indicated in the heading.

Decided in Rome, at the seat of the Constitutional Court, Palazzo della Consulta, on January 14, 2026.

Signed:

Giovanni AMOROSO, President

Maria Alessandra SANDULLI, Rapporteur

Roberto MILANA, Registrar

Filed in the Registry on March 9, 2026