CSN: physician's medication-plan approvals ancillary, VAT-free in care bundle

The question was whether A Ab must charge VAT on approving care units' medication-treatment plans and signing off staff medication permits, sold to a wellbeing services county as part of a bundle of responsible-physician (ansvarsläkare) servicesVero.

Under A Ab's application, the responsible-physician services provided medical care to older people in their own living environment: the county's 24-hour and community assisted-living units and home care. Under the contract the responsible physician carried overall responsibility for patients' medical care and total medication, made a holistic assessment and care plan, and handled day-to-day care together with care-home or home-care staff.

According to the application and the attached contract, the responsible physician signed each operating unit's medication-treatment plan, verifying that the plan and its principles were appropriate and expressly applicable to that unit's practical patient care. Drafting and updating the plan was not part of the service — each unit's manager kept it current. The physician was also responsible for staff medication permits, signing them as laid down in the plan; permits were set unit by unit and patient by patient. The permit system's purpose was to ensure carers had sufficient competence and theoretical knowledge for tasks their basic training did not automatically qualify them for.

The units were mainly the county's social-care units. The company was registered unit by unit in the Soteri provider register for the units where it supplied the services, under "outpatient specialised somatic healthcare" with the place of supply "either service point or the patient's or client's home".

Because the responsible physician was in charge of medication treatment at the units, the plan and permit approvals were closely connected to the medical care given to patientsVero. They were not priced separately within the fee charged to the countyVero. The Board held that in the described circumstances the approvals could not be distinguished from the physician's other servicesVero, and that splitting the bundle this way would be artificialVero. Objectively, the responsible-physician service was one single indivisible economic supplyVero whose principal component was the medical care given to the county's social-care clients in assisted living and home careVero. In those circumstances the plan and permit approvals were ancillary to the company's tax-free service within the meaning of 34 and 35 § of the Value Added Tax ActVero. The company therefore owed no VAT on them when sold as part of the responsible-physician bundleVero.

The advance ruling covers 23 September 2026 to 31 December 2027. It is not final. Legal basis: 1 §(1)(1), 34 § and 35 § of the Value Added Tax Act; Articles 2(1)(c), 132(1)(b)–(c) and 134 of Council Directive 2006/112/EC; 1, 3, 4 and 5 § of the Act on Supervision of Social and Healthcare Services.