Hospital Network of Appenzell Ausserrhoden Act (Spitalverbundgesetz; SVARG) - Legal Form and Seat (SVARG)

1. The Hospital Network of Appenzell Ausserrhoden (Hospital Network, SVAR) is an autonomous public law institution of the canton, headquartered in Herisau.

2. ...

1. The SVAR contributes to the medical care of the population. It is required to offer inpatient basic services according to the specifications of hospital planning.

1a. The SVAR provides additional tasks assigned to it by the canton, particularly public service obligations.

2. As long as the fulfillment of these tasks is not impaired, the SVAR may freely engage in entrepreneurial activities within the healthcare sector.

1. Organs of the SVAR are

a) the Board of Directors;

b) the Executive Management;

c) the Auditing Body.

1. The Board of Directors is the highest executive body of the SVAR.

2. It is responsible for the strategic management of the company. It ensures the fulfillment of the statutory duties of the SVAR.

1. The Board of Directors shall consist of five to seven members.

2. The Government Council delegates one member to the Board of Directors.

3. The term of office is four years. Re-election is possible. The Government Council may dismiss a member of the Board of Directors for important reasons.

4. The Director generally participates in the meetings of the Board of Directors with an advisory vote and holds the right to submit motions. The Board of Directors may invite additional members of the management as well as third parties to its deliberations.

1. The Board of Directors

a) regulates the organization of the SVAR by statute, determines the composition and competencies of the executive management, and elects the executive management;

b) determines the principles of corporate governance and establishes the strategy of the SVAR based on legal duties;

c) agrees on the framework contract with the canton;

d) is responsible for the hiring and dismissal of senior management staff;

e) decides on the multi-year task and financial plan with annual notification to the Cantonal Government;

f) submits proposals to the Cantonal Government for the budget and special loans of the canton, as well as the annual report, the annual financial statements, and the audit report;

g) enacts a financial regulation that determines, in particular, the spending competencies, the basics of accounting, and internal control;

h) issues a tariff regulation for outpatient and additional inpatient services;

i) regulates the framework conditions for affiliated physicians;

j) supervises the executive management;

k) assesses the concept for the construction, renewal, and maintenance of buildings and technical facilities with notification to the Cantonal Government;

l) ensures the internal control and quality management of the SVAR;

m) may conclude cooperation agreements, considering legal duties, with other cantonal or out-of-cantonal health institutions and with insurers;

n) may privatize certain operating areas, sell them to third parties, or participate in other companies within the framework of legal duties, subject to the approval of the Cantonal Government;

o) approves the data protection concept and appoints a commissioner for patients' rights and data protection;

p) ensures operations in extraordinary situations;

q) addresses other fundamental tasks of the SVAR;

r) * ...

s) enacts regulations for the Personnel Commission;

t) appoints an independent functional evaluation commission and enacts its regulations;

u) informs the representation of employees early and comprehensively about intended decisions, hears them, and grants them, as well as the employee associations, the right to be heard;

v) establishes necessary social plans in analogous application of the Personnel Act and subject to approval by the Cantonal Government.

1. The Management

a) assumes the operational management of SVAR;

b) ensures internal controlling;

c) handles all business relevant to the operation of SVAR, as long as these are not reserved for another body;

d) organizes itself through regulations;

e) * ...

f) issues a data protection concept;

g) issues a concept for quality management.

1. The Director shall chair the Executive Management. He or she represents the Executive Management to the Board of Directors and the authorities.

2. The medical departments, the nursing department, and the administration must be adequately represented in the Executive Management.

1. The Personnel Commission represents the concerns and interests of the employees to the management and the board of directors in accordance with Article 7, Paragraph 4 of the Personnel Act.

2. It consists of at least five members, who are elected every two years by the employees of the SVAR. Re-election is possible.

1. The audit office is responsible for the accounting audit.

2. It performs its duties according to the principles of the Financial Budget Act and the recognized standards of auditing practice.

3. It submits the audit reports to the Board of Directors. It submits a confirmation report regarding the audit of the annual financial statements to the Government Council and the relevant cantonal council commissions.

1. The Cantonal Council

a) * approves the annual operating contributions to the SVAR within the framework of the budget;

b) * decides on investment contributions to the SVAR subject to the rights of the eligible voters;

c) exercises overall supervision over the SVAR;

d) * acknowledges the annual financial statements and the business report.

1. The Government Council

a) elects the members of the Board of Directors and its chairperson and sets their remuneration;

b) * elects the auditing body;

c) concludes the framework agreement of the canton with the SVAR;

d) * decides within the scope of hospital planning on the basic services to be provided by the SVAR;

e) * determines within the framework of service agreements the public services and other additional tasks to be provided by the SVAR;

f) * approves the implementation regulations issued by the Board of Directors concerning the Personnel Act and the Salary Ordinance;

fbis) * approves, at the request of the Board of Directors, necessary social plans;

g) approves decisions of the Board of Directors regarding the autonomy or sale of individual operational areas or the participation in or takeover of other companies;

h) concludes, at the request of the Board of Directors, agreements with other cantons concerning the provision and compensation of hospital services for the SVAR;

i) * decides, at the request of the Board of Directors, on the closure of existing facilities that serve inpatient medical care.

2. It exercises the cantonal supervision over the SVAR.

1. The Department of Health and Social Affairs prepares the matters that fall under the responsibility of the Executive Council according to this law.

2. Moreover, its supervisory activities are governed by the Health Act.

3. ...

1. The employment relationships within the SVAR are governed by the Personnel Act and the Salary Ordinance. The Board of Directors issues the implementing regulations thereto.

2. For the remuneration of the medical staff, the management, and specialized employees, the Board of Directors may establish compensation that deviates from the Salary Ordinance.

3. The Board of Directors regulates the personnel-related responsibilities and tasks.

1. Employees of the SVAR are insured with the pension fund of Appenzell Ausserrhoden in accordance with the pension fund law.

1. The treatments of patients by employees of the SVAR are subject to public law.

1. The SVAR prepares a medium-term task and financial plan, updated annually. This plan provides information particularly on

a) the range of services in medicine and care;

b) the development of standards and quality of services in medicine and care;

c) the planned education and training;

d) the intended research;

e) the cooperation with other healthcare institutions within and outside the canton;

f) the planned investments;

g) the resources, financing, and details regarding the development of the financial situation.

1. The canton grants SVAR a building right over all properties of the hospitals Heiden and Herisau, insofar as these properties are necessary for operations, including the independent and permanent rights associated with these properties, at the time of the SVAR's establishment as an independent entity. This building right is independent and limited to a period of 60 years, but it can be extended by the contracting parties.

2. The building right is subject to the principles set forth in Articles 779-779l of the Swiss Civil Code (ZGB).

3. The canton transfers to SVAR, under the building right, all buildings of the hospitals Heiden and Herisau that are part of the properties at the time of the establishment of independence as stated in paragraph 1, in the form of a contribution in kind to conditional ownership. The protected operational sites of the hospitals Heiden and Herisau are excluded.

4. The building right interest respects the property value. It is reviewed at least every ten years.

1. The canton leases the operationally necessary land and buildings of the Psychiatric Center of Appenzell Ausserrhoden to the SVAR under market conditions.

2. The government council may transfer the Psychiatric Center of Appenzell Ausserrhoden under building rights. Article 19 shall apply mutatis mutandis.

1. The moveable assets, including medical and technical devices, installations, and facilities, shall transfer to the ownership of SVAR as a contribution in kind coinciding with its independence. The value of the moveable assets is determined in accordance with generally accepted accounting principles in the hospital sector.

2. The procurement, maintenance, and replacement of moveable assets, including medical and technical devices, installations, and facilities, are the responsibility of SVAR.

3. The existing artworks in SVAR remain the property of the canton; the canton may provide artworks to SVAR through a loan agreement.

1. The SVAR receives an endowment capital from the canton at the time of becoming independent.

2. This shall not bear interest.

1. The SVAR receives ownership and purpose-bound use of the funds and foundations established for public hospitals and similar institutions in Appenzell Ausserrhoden at the time of its autonomy.

1. The Government Council may grant loans to the SVAR, including in the form of mortgage loans.

2. Loans and mortgage loans shall bear interest at market rates.

1. Revenues of the SVAR include, in particular

a) Contributions from the canton for operating, investment, and capital costs;

b) Reimbursements from health insurers and other social insurers;

c) Compensation for services;

d) Any compensation paid under health legislation for services of general economic interest;

e) Income from assets;

f) Third-party contributions to the SVAR.

1. The services of SVAR are compensated in accordance with the Federal Act on Health Insurance.

2. Patients who claim services beyond the basic insurance shall pay special service compensations. Additionally, a supplementary medical fee may be charged.

3. The Board of Directors shall issue a tariff regulation.

1. The SVAR conducts its accounts in accordance with the provisions of federal legislation on health insurance, the principles of the Financial Budget Act, the financial regulations, and the principles customary in the Swiss hospital system.

1. SVAR, its organs, employees, and agents are liable for damages caused in accordance with the principles of state liability law of Appenzell Ausserrhoden.

2. SVAR must adequately insure against its risks.

1. The government council regulates, in a framework agreement with the SVAR, in particular the use of the real estate.

2. The framework agreement specifically sets forth

a) the operationally necessary plots, buildings, and real rights and the non-operationally necessary buildings and plots;

b) the building rights granted to the SVAR by the canton concerning the plots according to Art. 19 para. 1 and Art. 20 para. 2;

c) in principle, the consequences of the reversion of the building rights;

d) the building rights fee;

e) the possible extension of the duration of the building rights;

f) the conditions for encumbering the building rights in favor of third parties;

g) the conditions for the partial transferability of the building rights to third parties;

h) the preemptive right granted to the SVAR for leasing or purchasing non-operationally necessary buildings;

i) the preemptive right granted to the SVAR for purchasing non-operationally necessary plots;

j) the transfer of the movables to the SVAR;

k) the rental conditions for the operationally necessary plots and buildings of the Psychiatric Center of Appenzell Ausserrhoden;

l) the compensation to be paid by the SVAR to the canton for the amortization of the endowment capital under good business conditions;

m) the amount of the insurable risks.

1. Upon the enactment of this law, the SVAR assumes the operation of the former SVAR.

2. At this time

a) the SVAR enters into the legal relationships previously pertaining to the SVAR, in particular the treatment contracts with patients as well as the existing employment relationships of the employees;

b) the rights and obligations of the SVAR towards third parties as well as the ownership of the operational facilities according to the inventory of assets are transferred to the independent institution;

c) the SVAR assumes all previous rights and fulfills all previous obligations from inter-cantonal agreements of the canton with other cantons regarding cooperation in the hospital sector;

d) the government council and the board of directors of the SVAR agree on the framework contract;

e) the canton endows the SVAR with a capital grant of CHF 45,000,000.- and a loan of up to CHF 68,000,000.-.

1. The real estate and movable assets of the Heiden and Herisau hospitals, as well as the movable assets of the Psychiatric Center of Appenzell Ausserrhoden, shall be valued at the time of corporatization.

2. The resulting revaluation surplus in relation to the balance sheet shall be allocated to the new account "Special Financing/Pre-financing."

3. The Special Financing/Pre-financing serves the purpose of providing investment contributions and covering capital costs for the SVAR.

1. The canton is liable for debts that have arisen or may arise from a situation that occurred before the regional hospital association became autonomous and whose cost implications were not covered under the previous cost and contribution regulations.

1. The Health Act of November 25, 2007, is amended as follows

1. This law is subject to the optional referendum.

2. The government council determines the commencement.