The Court of Cassation, with five orders filed between 27 and 28 May 2026 by the First Civil Section, established that the fees for RSAs are entirely borne by the National Health Service for patients suffering from advanced Alzheimer’s disease, a permanent vegetative state or serious degenerative neurological diseases. Families who have paid the co-payment, usually 50% of the tuition, are entitled to a refund.
The news was spread by the Veronese social promotion association Noctua Aps, which assisted the pilot case in the Supreme Court.
What the judges of the Supreme Court decided
The Supreme Court recalls the Prime Ministerial Decree of 14 February 2001, art. 3, paragraph 3: when a service has, as the judges underline, particular therapeutic relevance and the assistance cannot be separated from the cure, the cost is healthcare and falls entirely on the NHS.
It means that for advanced Alzheimer’s and for the permanent vegetative state, the hotel fee requested by the local health authorities and the structures has no legal basis: the service is healthcare in all respects. Furthermore, you do not need a personalized therapeutic plan formalized in writing. The proven clinical severity of the pathology alone is sufficient to establish the right.
The lawyer Maria Luisa Tezza, from the legal department of Noctua Aps and defender in the main proceedings, explains:
The rule requiring total coverage by the NHS has existed since 2001. For 20 years, local health authorities and facilities have applied the 50% split even in cases where it was clear that the services provided were of a healthcare nature.
The key ordinances on Rsa tuition
There are 5 ordinances. Noctua Aps has published the full texts of three, all from the First Civil Section:
- Cass. Section I, order. 16601/2026 – concerns a woman from Verona in a permanent vegetative state due to post-anoxic encephalopathy, hospitalized from October 2008 to March 2017 with a disputed amount of 169,408.85 euros and restitution of 129,657.62 euros (this is the pilot case);
- Cass. Section I, order. 16603/2026 – concerns a patient with Alzheimer’s hospitalized in the Parma area;
- Cass. Section I, order. 16777/2026 – concerns a patient with Alzheimer’s hospitalized in Tuscany.
The other two ordinances have not yet been disclosed.
Which pathologies trigger coverage
The Supreme Court has identified three clinical frameworks in which the healthcare provision is inseparable from the healthcare provision and the RSA fee must fall entirely on the NHS:
- Advanced Alzheimer’s with cognitive and behavioral impairment requiring continuous surveillance and clinical management of the disease;
- permanent vegetative statetypically due to post-anoxic encephalopathy, with continuous ventilatory, nutritional and healthcare assistance;
- serious degenerative neurological diseases (this could be the case of ALS, advanced Parkinson’s, dementia with Lewy bodies and multiple sclerosis in the terminal phase).
What to do to request a refund
Anyone who has paid the co-payment for the hospitalization of a family member in the RSA, even for hospitalizations years ago, can request its refund. The way is that of repetition of the objective undue paymentforeseen by the art. 2033 of the Civil Code, because the contract that imposed the co-payment is void due to contrary to mandatory legislation.
The reimbursement request must be submitted to the local health authority responsible for the area, attaching the payment receipts, the patient’s clinical documentation and the hospitalization contract. The statute of limitations runs from each single payment.
If the ASL rejects the request or does not respond, you can take legal action.
