The practice of medicine has changed profoundly in recent years. Increasingly, complex treatments, rehabilitation programmes and intensive therapies are delivered outside traditional hospital wards: in advanced outpatient facilities, specialised residential centres and therapeutic communities. Yet the social security system had been slow to adapt to this reality. Until now.
With Circular No. 65 of 16 June 2026, INPS has taken a decisive step: it has redrawn the boundaries of the sickness benefit, recognising that the inability to work does not depend on the type of facility in which care is received, but rather on the nature and intensity of the therapeutic pathway being undertaken. This development potentially affects millions of workers throughout Italy.
Why This Circular Was Necessary
The National Health Service (Servizio Sanitario Nazionale) has over the years developed increasingly sophisticated models of care, designed to reduce traditional hospital admissions without compromising the quality of treatment. The problem was that these new forms of treatment — however demanding and debilitating from a work capacity perspective — did not fall within the classical social security categories, leaving many workers without adequate coverage.
The INPS circular intervenes precisely to address this gap, establishing uniform criteria across the entire national territory and ensuring that workers undergoing treatment are protected in a manner proportionate to the actual impact of that treatment on their working capacity.
Complex Outpatient Procedures Equated with Day Hospital Treatment
One of the most significant developments concerns certain categories of outpatient procedures which, by reason of their complexity and impact on the patient, are now recognised as equivalent to day hospital treatment for social security purposes. The following fall within this category:
- Day Service Ambulatoriale (DSA) — Ambulatory Day Service
- Day Surgery
- Macro Attività Ambulatoriale Complessa (MAC) — Complex Outpatient Macro-Activity
- Bassa Intensità Chirurgica (BIC) — Low-Intensity Surgical Procedure
- Pacchetto Ambulatoriale Complesso (PAC) — Complex Outpatient Package
- Percorsi Diagnostico-Terapeutici Assistenziali (PDTA) — Diagnostic-Therapeutic-Assistential Pathways
These are pathways requiring scheduled attendances at a healthcare facility which, in practice, render normal work activity impossible or extremely difficult. Social security recognition now finally reflects this clinical reality.
Mental Health and Rehabilitation: Stronger Protections for Historically Overlooked Pathways
The circular gives particular attention to facilities operating in the fields of mental health and rehabilitation — areas that have historically received less robust social security protection.
Days of attendance at Centri di Salute Mentale (CSM) — Mental Health Centres — for
