S_BUC_09 Scheduled treatment - Request extension of authorisation in Member State of Stay

Annex Nr.15 to the note AC 370/16rev Annex Nr.15 to the note AC 370/16rev Annex Nr.15 to the note AC 370/16rev Annex Nr.15 to the note AC 370/16rev EESSI Business Use CaseEESSI Business Use Case EESSI Business Use Case EESSI Business Use Case S_BUC_09 Scheduled treatment - Request extension of authorisation in Member State of StayS_BUC_09 Scheduled treatment - Request extension of authorisation in Member State of Stay S_BUC_09 Scheduled treatment - Request extension of authorisation in Member State of Stay S_BUC_09 Scheduled treatment - Request extension of authorisation in Member State of Stay Table of Contents Table of Contents 2

1. Introduction 7

1.1. Purpose 7

1.2. Scope 7

1.3. Definitions, Acronyms and Abbreviations 7

1.4. References 8

1.5. Overview 8

2. Description 9

2.1. Business Scenario 9

2.2. Legal Base 9

3. Actors & Roles 10

4. Use Case 11

4.1. RUP Table Representation 11

4.2. Request – Reply SEDs 14

4.3. Attachments Allowed 14

4.4. Artefacts used 15

5. Business Processes 16

5.1. Case Owner and Counterparty 16

5.2. Sub Processes 17

6. Business Processes 18

6.1. Issues 18

Document Control Information Settings Value Document Title: Business Use Case S_BUC_09 Scheduled treatment - Request extension of authorisation in Member State of Stay Project Title: EESSI (Electronic Exchange of Social Security Information) Project Document Author: European Commission, DG EMPL F5 System Owner: European Commission, DG EMPL D2 Doc. Version: v4.1.0 Sensitivity: Public Date: 09/08/2018 Document history: The Document Author is authorised to make the following types of changes to the document without requiring that the document be re-approved: - Editorial, formatting, and spelling - Clarification To request a change to this document, contact the Document Author or Owner. Revision Date Created by Short Description of Changes v0.1 10/01/2015 Mirko Brusca First draft v0.2 03/07/2015 Carine Molle Correction of the title of the document (minor correction) v0.3 29/07/2015 Carine Molle Grammatical corrections (minor correction) based on feedback received from Alyson LONGSTAFF. Editorial changes : suggestion to insert an alternative scenario in section 4.1 (feedback received from Chris SEGAERT) The following chapters of the document have been changed : 2.2 Legal Regulations / Policy Issues / Other Mentions : SED 075 and S076 have been added

4.1 RUP Table Representation :

alternative scenario added Rule about invoking of branches added v0.4 07/08/2015 Carine Molle Chapter 5 : BPMN diagrams have been updated in order to insert "Request Info" sub-process for the Counterparty "Counterparty" has been renamed by "Other Party(ies)" in "Request Info" sub-process v0.5.0 20/01/2016 Carine Molle Parts of the document have been added in order to be in line with document presentation and content to be approved by Administrative Commission. As agreed during the AHG Members meeting 04/11/2015: H_BUC_01 is added for Case Owner AD_BUC_05 Forward is added for Counterparty Claimant is removed from the BUC. Chapter 2

2.1 Detailed description is renamed and updated. Last sentence is removed

2.2 Legal Base is updated

Chapter 3 Actors & Roles Claimant is removed Chapter 4

4.1 RUP Table Representation

"Actors" – Claimant is removed "Main Scenario" – step 8 is added "Exceptions" is added "Includes" is updated "Alternatives scenarios": - Branch 2 : H_BUC_01 is added for Case Owner - Branch 3 : AD_BUC_05 Forward is added for Counterparty "Special Requirements" is updated according to the branches added

4.2 Request – Reply SEDs is added

4.3 Attachments Allowed is added

4.4 RUP UC Diagram is updated (H_BUC_01 and AD_BUC_05 are added, Claimant is removed)

4.5 SED and Sub-process Versioning is added

Chapter 5

5.1 Case Owner (BPMN is updated – Claimant is removed and H_BUC_01 is added)

5.2 Counterparty (BPMN is updated – AD_BUC_05 is added)

5.3 Called Sub Processes

Identify Participants BPMN is updated

5.4 Main Scenario is removed

Chapter 6 Section 6.1 Related Use Cases is removed Section 6.2 Privacy and Security Assumptions is removed Version number of the document has been changed to be in line with the convention M.m.p where : - M = Major version (e.g. Approved by AC) - m = Minor version (e.g. changes in the process) - p = Patch version (e.g. wording…any changes without any impact on the process itself) v0.6.0 01/03/2016 Carine Molle Add H_BUC_01 for the Counterparty Section 4 : RUP Table Description is updated Branch 3 is added, other branch is renumbered Branch 4 : At [step 5] has been replaced by After [step 5] and before [step 6] Section 5 : Business Processes has been replaced v0.99.0 15/04/2016 Carine Molle Candidate for AC Approval as agreed by the Sickness rapporteur. v1.0.0 28/06/2016 Valérie Banchereau Status logo set to 'Approved' following AC approval of June, 20th 2016. Alignment to the standard description and layout of the BUC. v1.1.0 13/06/2017 Joël Fiora Change Requests EESSI-1798: As agreed by AHG members, "AD_BUC_07 – Reminder" has been added for Case Owner and Counterparty: - Correction Section 4: description of Branches 'Reminder' – Branches 4 and 5 -Correction Section 4, Branch 1 and 2, withdraw the use of H_BUC_01 as 'Reminder' Change Request EESSI-1849: "H_BUC_01" is added for the Case Owner "H_BUC_08" is added for the Counterparty and replaces S075 and S076 Section 4.1 has been updated (Branch 4 and 5 added) Section 4.4 has been updated (Reminder is added) Section 4.5 SED and Sub-process Versioning: H_BUC_01 and H_BUC_08 are added) S075 and S076 are removed v1.1.2 30/06/2017 Joël Fiora -Included BPMN picture in section 5 -Correction in the horizontal sub-process table in 4.5 - removed Use Case diagram v4.1.0 09/08/2018 Eric Briffoz - Section 4.4: merged 2 tables (for SED & for Subprocesses) into 1 Artefact table. - Version adaptations to release 4.1.0.

1. Introduction

Purpose The purpose of this document is to construct an external view of the 'EESSI business system' as described in EC Regulations 883/2004 and 987/2009. The ‘EESSI Business System’ describes the business and expected business processes without any consideration as to which part(s) may be realised by an IT System (i.e. the proposed EESSI IT System). The external view comprises of models and descriptions of business use cases, the services of a business system offered to business actors: customers, business partners, or other business systems, and business processes. A business use case is described from an actor's perspective; it describes the interaction between an actor and the business system, meaning it describes the behaviours of the business system that the actor utilises. The Business Use Case includes Use Case Diagrams and Business Process Models. Use case diagrams show actors, business use cases, and their relationships. Use case diagrams do not describe procedures. Alternative scenarios also remain hidden. These diagrams give a good overview of the behaviours of the EESSI business system which will direct and govern part of the expected behaviours and functionality delivered by the EESSI IT System. Scope This document is limited to the external view of the Sickness´ sector process concerning Scheduled treatment - Request extension of authorisation in Member State of Stay. The different elements like use case description, business actors, and business process as well as supporting UML diagrams and BPMN models pertaining to the Scheduled Treatment - Information on Coverage of Specific Benefit in Kind case. Definitions, Acronyms and Abbreviations Please see the EESSI Project Glossary here References # Description EC Regulation 883/2004 Regulation EC No 883- 2004.pdf EC Regulation 987/2009 Regulation EC No 987-2009.pdf UML 2.x http://www.omg.org/spec/UML/ BPMN 2.0 http://www.omg.org/spec/BPMN/index.htm UML 2.0 In Action Henriette Baumann, Patrick Grassle & Philippe Baumann, 2005, ISBN 1904811558 RUP@EC standard 5.0 http://www.cc.cec/RUPatEC_Standard/ RUP op maat http://www.rupopmaat.nl/ Overview Chapter 1 introduces the external view on the business system under review and lists the elements of this specification. Chapter 2 introduces the Scheduled treatment - Request extension of authorisation in Member State of Stay business process. This chapter gives a short and detailed description as well as a reference to the business process´ legal base. Chapter 3 lists the actors involved in the Scheduled treatment - Request extension of authorisation in the Member State of Stay business process. Chapter 4 describes in detail the Scheduled treatment - Request extension of authorisation in Member State of Stay business process based on the RUP use case template, as well as the relationship to other use cases. Chapter 5 describes the Scheduled treatment - Request extension of authorisation in Member State of Stay business process using business process modelling notation (BPMN).

2. Description

Business Scenario When an insured person who is receiving treatment outside the competent Member State having being previously authorized (portable document S2) needs an extension of the authorization, the institution of the Member State requests the competent institution of the Competent Member State for an extension of it. In practice it will likely be at the demand of the care provider (hospital, doctor ...) treating the patient. Legal Base This Business Use Case document's the legal base is described in the following Regulations - Basic Regulation (EC) No 883/994 - Implementing Regulation (EC) No 987/2009. The following matrix specifies the SEDs that are used in this Business Use Case and documents the articles that provide the legal basis for each SED. SED Basic Reg (883/04) Implementing Reg (987/09) S035 S037 Table 1: SED – Legal base relationship matrix

3. Actors & Roles

This chapter captures details of the actors which are important to understand the different types of system users. An actor is anyone or anything that exchanges data with the business system. An actor can be a user, external hardware or another system. The overarching description of each actor described in this Business Use Case can be found in the Glossary. Below you will find a short description which provides further clarity of this actor within the context of this Business Use Case. Actor name Description Case Owner In this BUC the Case Owner is Institution of the Member State of stay where the insured person is receiving an appropriate (scheduled) treatment. Counterparty In this BUC The Counterparty is the Institution of the competent Member State entitled to grant an authorization to receive an appropriate treatment. Table 2: Actors & Roles

4. Use Case

RUP Table Representation Use Case ID: S_BUC_09 Use Case Name: Scheduled Treatment - Request extension of authorisation in Member State of Stay Created By: Mirko Brusca Last Updated By: Carine Molle Date Created: 10/01/2015 Last Revision Date: 01/03/2016 Actors: Case Owner Counterparty Description: This case deals with the situation when an insured person has been granted an authorization for a scheduled treatment outside the Member State of residence / competent Member State and he/she requires an extension of it. Thus, this BUC models the exchange of information required for an institution of the Member State of stay to request for an extension of this authorization. Trigger: The insured person, in practice through the care provider, requests the institution of the Member State of stay for an extension of the authorisation (portable document S2) to receive the treatment Preconditions: The insured person stays outside the competent Member State. Post Conditions: Institution of Member State of stay is informed whether the authorization is extended or not Main Scenario: Identify Participants 1. The Case Owner identifies the Competent Member State entitled to grant the extension of the authorisation; 2. The Case Owner then identifies the correct institution in the Competent Member State. There will be only one counterparty. The Case Owner and the Counterparty are herein collectively referred to as the Participants. Request for an extension 3. The Case Owner fills in the Information of "Request for extension of entitlement document" (S035) entering the date on which the authorisation (portable document S2) was issued and other relevant information, among which the start and end date of the requested extension of the authorisation;

4. The Case Owner sends the S035 to the Counterparty.

Reply to the request

5. The Counterparty receives the request for an extension (S035);

6. The Counterparty fills in a "Reply to request for extension of entitlement document" (S037) specifying its decision in respect of the extension of the entitlement document for a scheduled treatment;

7. The Counterparty sends the S037 to the Case Owner;

8. The Case Owner receives the S037;

9. This use case ends here.

Alternative Scenarios: The Following Branches determine the use of Horizontally Defined Sub Processes within the Business Process Branch 1:. At any step after [step 7] the Counterparty may optionally choose to request medical information from Case Owner

1. The Counterparty executes business use case H_BUC_08 – Medical Information

2. [This Branch] Ends.

Branch 2:. At any step after [step 8] the Case Owner may optionally choose to request AdHoc Information from Counterparty

1. The Case Owner executes business use case H_BUC_01 – Adhoc Exchange of Info;

2. [This Branch] Ends.

The Following Branches determine the use of Administrative Defined Sub Processes within the Business Process Branch 3:. At any step after [step 5] the Counterparty may optionally choose to Forward this Business Process to another Institution within its MS who assumes responsibility for changing it

1. The Counterparty executes business use case AD_BUC_05 – Forward Case;

2. [This Branch] Ends.

Branch 4:. after Branch 1 [step 1] Counterparty may optionally choose to send a reminder in order to receive the Information expected and not yet received

1. The Counterparty executes business use case AD_BUC_07 -_Reminder;

2. [This Branch] Ends

Branch 1:. At any step after [step 4] Case Owner may optionally choose to send a reminder in order to receive Information expected and not yet received.

1. The Case Owner executes business use case AD_BUC_07_ -_Reminder;

2. [This Branch] Ends

Exceptions: None Includes: See diagram at part 4.4 Special Requirements: SR0: General Rule As the request is individualized the case can concern only one person. SR1: Rules about invoking of Branches [Branch 1] – May be invoked more than once [Branch 2] – May be invoked more than once [Branch 3] – May be invoked once when the first SED is received by ounterparty and before sending the answer [Branch 4] – May be invoked more than once. [Branch 5] – May be invoked more than once . Assumptions: Notes and Issues: Request – Reply SEDs The following table specifies the SED that have a logical pairing to one another, usually this is known as a request-reply pair. REQUEST SED REPLY SED(s) S035 S037 Attachments Allowed The following table specifies whether attachments are permitted to be included when sending a SED type. SED Attachments S035 Allowed S037 Allowed Artefacts used The following table specifies the artefacts that are used in this Business Use Case. Artefact name Artefact type S035 SED S037 SED H_BUC_01_Subprocess BUC H_BUC_08_Subprocess BUC AD_BUC_05_Subprocess – Forward Case BUC AD_BUC_07_Subprocess – Reminder BUC AD_BUC_11_Subprocess – Business Exception BUC AD_BUC_12_Subprocess – Change of Participant BUC

5. Business Processes

This chapter describes the Business Use Case Scheduled treatment - Request extension of authorization in Member State of Stay using BPMN 2.0. Case Owner and Counterparty Figure 2: depicts the use case end-to-end for the Case Owner and Counterparty, from a high level. Sub Processes Not applicable.

6. Business Processes

Issues # Issue date Description Replies Action/Resolution Close date 28/06/2016 Conversion of BPMN to split between Case Owner and Counterparty. Scheduled for update.