«(VAT – Article 13A(1)(b) and (c) of the Sixth Directive 77/388/EEC – Exemption – Psychotherapeutic treatment given in an out-patient facility provided by a foundation governed by private law (charitable establishment) employing qualified psychologists who are not doctors – Direct effect)»

1.. Tax provisions – Harmonisation of laws – Turnover taxes – Common system of value added tax – Exemptions provided for by the Sixth Directive – Exemption for hospital and medical care and closely related activities – Concept of closely related activities and medical care – Psychotherapeutic treatment given by qualified psychologists (Council Directive 77/388, Art. 13A(1)(b) and (c))

2.. Tax provisions – Harmonisation of laws – Turnover taxes – Common system of value added tax – Exemptions provided for by the Sixth Directive – Exemption for hospital and medical care and closely related activities – Concept of other duly recognised establishment of a similar nature – Recognition subject to services being provided under medical supervision – Not permissible (Council Directive 77/388, Art. 13A(1)(b))

3.. Tax provisions – Harmonisation of laws – Turnover taxes – Common system of value added tax – Exemptions provided for by the Sixth Directive – Exemption for hospital and medical care and closely related activities – Concept of other duly recognised establishment of a similar nature – Member States' discretion – Limits – Duties of national courts (Council Directive 77/388, Art. 13A(1)(b))

4.. Tax provisions – Harmonisation of laws – Turnover taxes – Common system of value added tax – Exemptions provided for by the Sixth Directive – Exemption for medical care provided in the exercise of the medical and paramedical professions – Scope – Treatment provided by practitioners employed by a foundation governed by private law – Covered (Council Directive 77/388, Art. 13A(1)(c))

5.. Tax provisions – Harmonisation of laws – Turnover taxes – Common system of value added tax – Exemptions provided for by the Sixth Directive – Exemption for hospital and medical care and closely related activities and exemption for medical care provided in the exercise of the medical and paramedical professions – Possibility for taxable persons to rely on the corresponding provisions (Council Directive 77/388, Art. 13A(1)(b) and (c))

JUDGMENT OF THE COURT (Fifth Chamber) 6 November 2003 (1)

((VAT – Article 13A(1)(b) and (c) of the Sixth Directive 77/388/EEC – Exemption – Psychotherapeutic treatment given in an out-patient facility provided by a foundation governed by private law (charitable establishment) employing qualified psychologists who are not doctors – Direct effect))

In Case C-45/01,

REFERENCE to the Court under Article 234 EC by the Bundesfinanzhof (Germany) for a preliminary ruling in the proceedings pending before that court between

and

on the interpretation of Article 13A(1)(b) and (c) of Sixth Council Directive 77/388/EEC of 17 May 1977 on the harmonisation of the laws of the Member States relating to turnover taxes ─ Common system of value added tax: uniform basis of assessment (OJ 1977 L 145, p. 1),

THE COURT (Fifth Chamber),,

composed of: D.A.O. Edward, acting as President of the Fifth Chamber, P. Jann and of A. Rosas (Rapporteur), Judges,

Advocate General: C. Stix-Hackl,

after considering the written observations submitted on behalf of:

having regard to the Report for the Hearing,

after hearing the oral observations of Christoph-Dornier-Stiftung für Klinische Psychologie, of the German Government and of the Commission at the hearing on 18 September 2002,

after hearing the Opinion of the Advocate General at the sitting on 10 December 2002,

gives the following

Community legislation

...

.

National legislation

...

...

.

The third question

The first question

Activities closely related to hospital and medical care

─ Observations submitted to the Court

─ Findings of the Court

The term of medical care

─ Observations submitted to the Court

─ Findings of the Court

The second question

Observations submitted to the Court

Findings of the Court

The fourth question

On those grounds,

THE COURT (Fifth Chamber),

in answer to the questions referred to it by the Bundesfinanzhof by order of 14 December 2000, hereby rules:

Edward

Jann

Rosas

Delivered in open court in Luxembourg on 6 November 2003.

R. Grass

V. Skouris

Registrar

President