22 AOUT 2002. - Health Care Act

ALBERT II, King of the Belgians,
To all, present and to come, Hi.
The Chambers adopted and We sanction the following:
TITLE I. - General provision
Article 1^er. This Act regulates a matter referred to in Article 78 of the Constitution.
PART II. - Social affairs
CHAPTER I. - General medicine provisions
Art. 2. Article 28, § 2, paragraph 6, of the Compulsory Health Care and Compensation Insurance Act, coordinated on 14 July 1994, is supplemented as follows:
"The King shall determine, after the opinion of the National Medico-mutualist Commission, the matters for which decisions within the Medical Technical Council must be approved by at least half of the general practitioners entitled to vote or special practitioners entitled to vote.
This notice is expected to have been given if it is not made in the month following the application. »
Art. 3. In article 36bis of the same law, inserted by the law of 10 December 1997, a paragraph 3 is inserted, as follows:
“§3. The King shall, according to the procedure referred to in § 1^er, the conditions and terms and conditions of a regime by which a bonus is granted to certain physicians if they meet qualitative or quantitative criteria of medical practice as set out by the National Council for the Promotion of Quality in the execution or prescription of health care benefits. It may determine that, for this purpose, the lump-sum intervention referred to in Article 50, § 6, last paragraph, is increased. »
Art. 4. An article 36quinquies, as follows, is inserted in the same law:
"Art. 36quinquies . The King determines the conditions and terms and conditions under which compulsory health care insurance and allowances will pay the availability fee to doctors who participate in organized custody services.
The decision is taken on the proposal of the National Medico-mutualist Commission. The Minister may request that the Commission make a proposal within one month. If the proposal is not made within the time limit or if the Minister cannot agree to it, he or she may submit his or her own proposal to the Commission. The Commission then renders an opinion on this proposal within one month: this notice is considered to have been given if it has not been made within that time limit. »
Art. 5. An article 36sexies, as follows, is inserted in the same law:
"Art. 36sexies . The King determines the conditions and terms and conditions under which mandatory health care insurance and allowances provide financial support to physicians for the use of telematics and for the electronic management of medical records.
The decision is taken on the proposal of the National Medico-mutualist Commission. The Minister may request that the Commission make a proposal within one month. If the proposal is not made within the time limit or if the Minister cannot agree to it, he or she may submit his or her own proposal to the Commission. The Commission then renders an opinion on this proposal within one month: this notice is considered to have been given if it has not been made within that time limit. »
Art. 6. A section 36septic, as follows, is inserted in the same law:
"Art. 36s. Without prejudice to the provisions of Article 35, §§ 1^er and 2, the King may determine the conditions and conditions under which compulsory health care insurance and allowances shall pay fees to the authorized general practitioner for the management of the overall medical record. »
Art. 7. Article 50, § 2, paragraph 4, of the Act, as amended by the Acts of 10 December 1994, 20 December 1995 and 10 December 1997, is supplemented as follows:
"The agreements between physicians and insurers may establish the substances for which the majority of members representing the medical body referred to in this paragraph must include, as the case may be, half of the members serving as general practitioners or half of the members serving as special physicians. »
CHAPTER II. - Clinical biology, medical imaging and dialysis
Art. 8. In Article 16, § 1^er, 1°, of the same law the words "for the approval of the Minister, the global budgets of financial means" are replaced by the words "for the approval of the Minister, the overall budgets of the financial means referred to in Article 69, § 4 and § 5. »
Art. 9. Article 59, paragraph 1^er, of the same Act, is supplemented by the following paragraph:
"The lump-sum fees payable by day hospitalization are part of the benefit budget provided to hospitalized beneficiaries. »
Art. 10. In title III, chapter V, of the same law is inserted a section XIV-bis, as follows:
"Section XIVbis . - Intervention in the costs for hemodialysis, peritoneal dialysis at home and dialysis in a collective autodialysis service
Art. 71bis . § 1^er. The King fixes, after the advice of the Health Care Insurance Committee, the conditions under which health care insurance intervenes in the costs for home hemodialysis and peritoneal dialysis at home, as well as in the costs for dialysis in a collective autodialysis service. It also sets out the amount of this intervention.
§ 2. The King sets out, after the Commission's advice to conclude the national convention between hospital facilities and insurance organizations, the conditions under which health care insurance intervenes in the costs for hemodialysis carried out in a chronic hemodialysis centre approved by the competent authority. It also sets out the amount of this intervention. »
CHAPTER III. - Reference amounts
Art. 11. An article 56ter, as follows, is inserted in the same law:
“Art. 56ter . § 1^er. By derogation from the provisions of this Act and its enforcement orders, reference amounts are applied annually by admission for the intervention of the insurance granted to hospitalized beneficiaries, with respect to the benefit groups referred to in § 8, provided that these are included in the APR-DRG groups referred to in § 9. APR-DRG is heard by group: the classification of patients in diagnostic groups as described in the manual "All Patient Refined Diagnosis Related Groups, Manual Definition, version 15.0".
§ 2. These reference amounts are calculated for APR-DRG groups referred to in § 1^er for classes 1 and 2 of clinical gravity and after the removal of the type 2 "outliers" referred to in the orders pursuant to section 87 of the Hospitals Act, coordinated on August 7, 1987.
§ 3. The reference amounts concerned are equal to the average of the annual expenses per admission, increased by 10%, and are based on the data referred to in section 206, § 2, of this Act and section 156, § 2, of the Act of 29 April 1996 dealing with social provisions.
§ 4. The reference amounts concerned shall be calculated annually by the Technical Cell referred to in Article 155 of the Act of 29 April 1996 referred to above on the basis of the data referred to in § 3 concerning the benefits referred to in § 1^er and submitted to the opinion of the Multi-Party Hospital Policy Structure, referred to in section 153 of the Act of 29 April 1996 on social provisions.
The reference amounts per admission are fixed for the first time in 2003 and are calculated on the basis of the data referred to in paragraph 1 for admissions that end after 1^er October 2002 and before 31 December 2003.
§ 5. When actual expenditures related to all admissions referred to in § 1^er exceed in a hospital of not less than 10% the reference expenses calculated in accordance with § 4, the difference is deducted by the central fee collection service referred to in section 135 and section 136 of the Hospitals Act, coordinated on 7 August 1987, of the fees paid to the insurance. The King determines the time limits and procedures for fixing and communicating the amounts concerned, how they are deducted by the central fee collection service and their accounting by insurers. Until the date fixed by the King, this adjustment is limited to the APR-DRG groups referred to in § 9, 1°.
The hospital manager and hospital physicians have a shared responsibility in accordance with the regulations referred to in section 135, 1°, paragraph 2 or section 136, paragraph 1^erof the Hospitals Act, coordinated on 7 August 1987, as amended by the Act of 14 January 2002.
The Administrative Control Service is responsible for monitoring the application of the provisions of paragraph 1^er.
§ 6. The King sets out the terms and conditions for the pricing of the amounts referred to in § 5, with a view to closing the health care insurance accounts and the application of the financial liability provisions of the insurers.
§ 7. When, for more than half of the APR-DRG groups, referred to in § 9, recorded in a hospital, the actual expenses relating to all admissions referred to in § 1^er exceed by 10% the expenses of the reference amounts calculated in accordance with § 4, the data relating to the institutions concerned are, after these institutions have had the opportunity to transmit their observations to the multi-party structure referred to in Article 153 of the aforementioned Law of 29 April 1996 for their possible correction, made public by the Institute on the Internet address http://www.inami.fgov.be, without prejudice to the application of 5. §
§ 8. The following benefit groups are considered:
1° The benefits taken in Article 3, § 1^er, A, II, and C, I, Article 18, § 2, B, e) and Article 24, § 1^erexcept for lump-sum reimbursements, from the Schedule to the Royal Order of September 14, 1984 establishing the nomenclature of health benefits in respect of compulsory health care and allowances;
2° The benefits of article 17, § 1^er, 1°, 2°, 3°, 4°, 5°, 6°, 7°, 8°, 9°, 10°, 11°, 12°, 17bis in 17ter, except for lump sum refunds and angiographies, from the annex to the royal decree of 14 September 1984 mentioned above.
3° The benefits provided in section 3, except for clinical biology benefits, section 7, section 11, section 20 and section 22, of the schedule to the Royal Order of September 14, 1984 referred to above.
§ 9. Diagnostic groups are based on "All Patients Refined Diagnosis Related Groups, Definitions Manual, Version 15.0" :
1° APR-DRG 73 - Interventions on the crystalline with or without a vitrectomy, APR-DRG
2° APR-DRG 45 - Brain vascular accident with infarctus, APR-DRG 46 - Unspecific vascular accident with infarct occlusion, APR-DRG 47 - Transient ischemic accident, APR-DRG 134 - Pulmonary occlusion, APR-DRG 136 - Respiratory system malignant conditions
§ 10. In order to take into account the evolution in medical practices and in the differences of practice, the King may, by order deliberately in the Council of Ministers and after notice of the Multi-Party Structure referred to in Article 153 of the aforementioned Law of 29 April 1996, adapt the benefits referred to in § 8 and the APR-DRG groups referred to in § 9. »
CHAPTER IV. - Limitation experiments
Art. 12. In article 56, § 2, 1°, of the same law, the words "prescription" are inserted after the word "special".
CHAPTER V. - Administrative amendments
Art. 13. Section 168, paragraph 3 of the Act, as amended by the Acts of 20 December 1995 and 24 December 1999, is replaced by the following provision:
"Without prejudice to the provisions of Article 52 of the Law of 14 February 1961 of economic expansion, social progress and financial recovery, administrative fines are imposed on doctors and dental practitioners who do not respect the fees and other amounts resulting from the provisions of Article 50, § 11, as well as to birth attendants, physiotherapists, practitioners of nursing art, paramedical assistants and managers.
The same administrative fine is imposed on the care provider who has acceded to the agreement or convention and who does not respect the fees and prices set out therein.
The amount of the administrative fine is three times the amount of the exceedance, with a minimum of EUR 125. »
Art. 14. In section 168bis of the Act, paragraphs 1^er and 2, inserted by the Act of 10 August 2001, are replaced by the following paragraphs:
"In the event of a breach of the provisions of Article 72bis , § 2, an administrative fine shall be imposed by the Administrative Control Service to the firm that markets the pharmaceutical specialty or the packaging(s) concerned and to which the offence has been found.
The King determines the amount of fines that cannot be less than 5,000 eur, and the maximum of which may not exceed 100% of the turnover made on the Belgian market, with respect to the specialty or conditioning(s) in question, in the year preceding the year in which the offence was committed. It also sets out the terms and conditions for the application of this sanction. »
CHAPTER VI. - Financial arrangements
Art. 15. The following amendments are made to section 40 of the Act:
1° In § 1^eramended by the Act of 25 January 1999, 24 December 1999, 14 January 2002 and by the Royal Decrees of 10 December 1996 and 25 April 1997, paragraph 4 is replaced by the following provision:
"From 2002, the General Council of the Institute can determine each year, following the advice of the Insurance Committee and the Budget Control Board, which exceptional or particular expenses are not considered in the calculation base for the application of this maximum growth standard. The proposals of the General Council shall be approved only when they obtain a majority of the votes of the members entitled to vote, including the votes of all members of the group referred to in Article 15, paragraph 1 (a)."
2° It is inserted a § 3bis, written as follows:
"Without prejudice to the powers of the Insurance Committee and the General Council, the King may, by order deliberately in the Council of Ministers, adapt the overall annual budgetary objective and the partial annual budgetary objectives when certain specific services or missions are taken into charge by the budget of the financial means established under section 87 of the Hospitals Act. »
Art. 16. The following amendments are made to section 136 of the Act:
1° § 1^er, replaced by the Act of 24 December 1999 and amended by the Act of 12 August 2000, is supplemented by the following paragraph:
"The King sets out the rules that the amounts that, pursuant to the international legal order, are dependent on insurance, and that relate to the budget of the financial means allocated to hospitals, as defined in section 87 of the Hospitals Act, are fixed, accounted for, recovered and recorded. »
2° It is inserted a paragraph 5, which reads as follows:
“§ 5. The King sets out the rules that the portion of the repair or recovery that relates to the budget of the financial means allocated to hospitals, as defined in section 87 of the Hospitals Act, and which is included in the amounts paid in twelfths by insurers, is fixed, reported, recovered and recorded. »
Art. 17. Section 164, paragraph 2, of the Act, as amended by the Acts of 20 December 1995 and 24 December 1999, is supplemented as follows:
"The King sets out the rules that the unduly paid benefits, which relate to the budget of the financial means allocated to hospitals, as defined in section 87 of the Hospitals Act, and which are included in the amounts paid in twelfths by the insurers, are fixed, reported, recovered and recorded. »
Art. 18. In section 191, paragraph 1^erthe same Act, replaced by the Royal Decree of 12 August 1994 and amended by the Acts of 20 December 1995, 26 July 1996, 22 February 1998, 15 January 1999, 25 January 1999, 4 May 1999, 24 December 1999, 12 August 2000, 2 January 2001 and 10 August 2001 and by the Royal Decree of 25 April 1997, are amended as follows:
1° In 15°, quater, paragraph 1^er, the words "the lists that are annexed to the Royal Decree of September 2, 1980 setting out the conditions under which mandatory insurance against illness and disability is involved in the cost of pharmaceutical specialties and similar products" are replaced by the words "the list of refundable pharmaceutical specialties. »;
2° in 15°, quater, § 2, paragraph 1^er is replaced as follows:
« Pending the fixing of the supplementary contribution referred to in § 1^erParagraph 1^er, with respect to the possible overexpenditure of 2002 expenditures, the pharmaceutical companies concerned were, in 2002, liable to an advance of 1.35 p.c. of the turnover of 2001. A first part of the advance equal to 1 p.c. of the 2001 year's turnover is paid to the National Institute of Disability Insurance account number 001-1950023-11 before 1^er July 2002, with the reference to "first advance supplementary assessment year 2002". A second part of the advance equal to 0.35 p.c. of the 2001 year's turnover is paid to the National Disability Insurance Institute's account number 001-1950023-11 by December 15, 2002, indicating the reference to "second supplementary contribution year 2002";
3° it is inserted a point 15°, quinquies, written as follows:
"For the year 2002, an additional 1.5 p.c. of the turnover that was made during the year 2001 is introduced under the terms and conditions set out at 15°.
The declaration referred to in paragraph 4 of 15° shall be filed before 1^er November 2002.
The contribution must be paid before 1^er December 2002 on account No. 001-1950023-11 of the National Institute of Disability Health Insurance, indicating the following: "Additional contribution turnover 2001".
Revenues resulting from this additional contribution are charged in the accounts of the mandatory health care insurance for the year 2002. »
Art. 19. Article 195, § 1^er, 2°, of the same law, replaced by the Royal Decree of 25 April 1997 and amended by the Act of 22 February 1998, the following amendments are made:
1° Paragraph 3 is replaced by the following:
"In 2002, these amounts are set at EUR 732.075,000 for the five national unions and EUR 12.603.000 for the Belgian National Railway Company Health Care Fund. These amounts are adjusted annually by the King, by order deliberately in the Council of Ministers, taking into account:
- the evolution of the average daily wage based on the data of the Federal Office of the Plan in the credit and insurance sector and the Public Authority on the last three years preceding the preparation of budgets;
- half of the evolution of the real growth standard of expenditure in the health care sector, referred to in Article 40, § 1^er, paragraph 2, and the number of days indemnified in the insurance sector following a weighting of two-thirds and one-thirds, established for the same period.
This amount can also be adapted to take into account the new legal missions that are carried out by insurance agencies."
2° in paragraph 4, the words "this adaptation" are replaced by "the amounts";
3° Paragraph 4 as amended is supplemented by the following words:
"In 2002 and 2003, this part amounts to EUR 49.578.700 and EUR 61.973.370 for the five national unions, respectively EUR 852.760 and EUR 1.065.950 for the Belgian National Railway Company Health Care Fund.
As of 2004, these amounts are set at 10% of the annual amount of administration fees. »
Art. 20. In Article 200, § 1^er, of the same law, replaced by the Act of 21 December 1994, it is inserted in paragraph 2, as follows:
"The expenses in these accounts, which are recorded by insurers on the basis of billing data provided by magnetic care providers, under the third-party payment plan referred to in section 53, are charged by insurers in the month of receipt of accepted magnetic media. This imputation shall take place after the necessary validity checks are carried out. »
Art. 21. Article 217, paragraph 1^er, of the same law, is supplemented as follows:
"The accounting documents, which corroborate these amounts paid in twelfths, are constituted by the orders of payment that the Minister, or the proceeding that he designates to that effect, transmits to the insurers on the basis of the data and distribution keys set out in the Hospitals Act, coordinated on August 7, 1987. If these payment orders are not or cannot be executed by the insurers within the time limits set by the competent minister to set the financial resources budget, care institutions may take care of the default interest to the insurers. The rate of interest is the rate of money deposited with the European Central Bank on the due date of the payment period. The burden of these late-duty interests is recorded as a minimum charge for the Institute's Health Care Service when the delay is attributable to the late or insufficient transmission of advances referred to in section 202. The King may set rules for late interest when actual spending exceeds the budgetary objective. Otherwise, such interest shall be refunded by the dependant insurers of the amount of the administrative expenses referred to in section 195. The payment of these payment orders is not subject to the payment rules according to the chronological order of registration in the Entry Factor, except for payments made prior to the due date of the payment period. »
CHAPTER VII
Financing of care institutions for older persons
Art. 22. In section 69, § 4, of the same law, as amended by the Royal Decree of 24 March 1997, the following amendments are made:
1° In paragraph 1, the words "Article 34, 11° and 12°" are replaced by the words "Article 34, first paragraph, 11°, with respect to rest and care homes and/or day care centres, and/or 12°";
2° Paragraph 2 is replaced by the following:
"The King may, on the proposal or after notice of the competent convention commission, formulate within thirty days of the Minister's request, set out the terms and criteria for the calculation of a budget of the financial means and one intervention per day for an institution referred to in article 34, paragraph 1, 11°, with respect to rest and care homes and/or day care centres, and/or an institution referred to in first paragraph 12, If an institution is approved both as a rest and care home and/or as a day care centre and/or as an institution referred to in section 34, paragraph 1 and 12, the King may set out the terms and criteria for calculating a financial means budget and an intervention per day for the entire institution. In order to avoid this budget of financial means being exceeded, the King may set additional terms and criteria that may take into account the number of beds for which the institution is approved, its occupancy rate, a quota of days and/or the overall budget referred to in the preceding paragraph. »;
3° Paragraphs 3 and 4 are repealed.
CHAPTER VIII. - Representation in INAMI bodies
Art. 23. Article 21, § 1^erthe same Act, as amended by the Acts of 10 December 1997 and 24 December 1999, is supplemented by the following paragraph:
"A representative of the Supervisory Service referred to in Article 49 of the Act of 6 August 1990 on Hospitals and National Mutual Unions attends meetings of the Committee with an advisory vote. »
Art. 24. Section 79 of the Act is supplemented by the following paragraph:
"A representative of the Supervisory Board referred to in section 49 of the Act of 6 August 1990 on mutuality and national mutuality unions attend meetings of the Committee with an advisory vote. »
Art. 25. In section 86, § 3, of the Act, the following paragraph shall be inserted between paragraphs 4 and 5:
"A representative of the Supervisory Board referred to in section 49 of the Act of 6 August 1990 on mutuality and national mutuality unions attend meetings of the Committee with an advisory vote. »
CHAPTER IX. - Podologists and dietitians
Art. 26. In section 2, (m) , of the same law, as amended by the Act of 24 December 1999, the words "Diététicians and Podologists" are inserted after the words "orthoptists".
Art. 27. In Article 23, § 2, paragraph 2, of the Act, amended by the Act of 25 January 1999 and the Royal Decree of 25 April 1997, the words "the nomenclature of the functional rehabilitation services referred to in Article 34, 7°" are replaced by the words "the nomenclature of the functional rehabilitation services referred to in Article 34, paragraph 1, 7°, 7° and 7°quater".
Art. 28. In article 34, paragraph 1, of the same law as amended by the laws of 21 December 1994, 20 December 1995, 22 February 1998, 25 January 1999, 24 December 1999, 12 August 2000, 2 January 2001 and 10 August 2001, it is inserted a 7°ter and a 7°quater, as follows:
"7°ter the care given by podologists; »
"7°quater the care given by dietitians; "
Art. 29. Article 37, § 1^erthe following amendments are made:
1° in paragraph 1^er, the reference "Article 34, 1°, and 7°bis" is replaced by the reference "Article 34, paragraph 1, 1°, 7°bis, 7°ter and 7°quater",
2° in paragraph 4, the words "in the cost of the services of logopedia, physiotherapy and physiotherapy" are replaced by the words "in the cost of the services of logopedia, physiotherapy, podology and dietary".
CHAPTER X. - Miscellaneous provisions
Art. 30. Article 35, § 1^erthe same Act, as amended by the Act of 24 December 1999 and replaced by the Act of 10 August 2001, are amended as follows:
1° The mention "19°" is inserted in the third sentence between the words "and 5°, (a) ," and the mention "and 20" and the mention "19°" is inserted in the fourth sentence between the words "as long as it is implants", and the mention "and 20°".
2° In the last paragraph, the words "15°, 19° and 20°" are added each time after the words "article 34, paragraph 1, 5°, (a)".
Art. 31. In section 37quater of the Act, inserted by the Act of 30 December 2001, the following amendments are made:
1° In paragraph 1, the words "if it is found that this exemption applies, unawarely significantly, the assessment instrument used to determine the intervention of compulsory insurance for one or more beneficiaries" are replaced by the words "if it is found that the assessment instrument used also to determine the intervention of compulsory health care insurance for one or more beneficiaries is applied incorrectly in a meaningful way";
2° In paragraph 2, (b) , of the French text, the words "unconscious" are replaced by the word "inaccurately".
Art. 32. In section 37sexies , of the same Act, inserted by the Act of 5 June 2002, paragraph 1 is supplemented as follows:
"It is also considered as a personal intervention, the contribution, required by the hospital, of patients present in an emergency care unit, pursuant to section 107quater of the hospital law, coordinated on August 7, 1987.
The King shall conduct an assessment of this device two years after the coming into force of this device and report thereon to the Federal Legislative Chambers. »
Art. 33. Article 51, § 2, paragraph 5, of the Act, is supplemented as follows:
"These reductions may consist of a limitation of the indexation referred to in section 207bis, without taking into account the specific terms fixed by the King in execution of this article. »
Art. 34. Section 153 of the Act, amended by the Acts of 20 December 1995 and 24 December 1999, and by the Royal Decree of 25 April 1997, paragraph 1^er is replaced by the following paragraphs:
"The purpose of the consulting physicians is to ensure medical control of primary disability and health benefits, in accordance with the provisions of this Act.
They shall, under the conditions and deadlines established by the King, address the reports referred to in article 94, paragraph 1^erand exercise the skills assigned to them under Articles 23, § 1^erand 94, paragraph 2.
They also verify whether all the conditions referred to in articles 35, paragraph 4, and 37, paragraphs 12 and 13, are well respected and report on the offences raised to the relevant bodies:
1° the Administrative Control Service for the presence and conditions of remuneration of staff;
2° the Medical Control Service for the effective delivery of care covered by the interventions referred to in Article 37, §§ 12 and 13;
3° the Health Care Service for other deficiencies found.
On the proposal of the Insurance Committee, the King may establish, in order to carry out monitoring missions of the benefits referred to in article 34, paragraph 1, 1°, (b) , and of the establishments referred to in article 34, paragraph 1, 11° and 12° to the consulting physicians, a National College of Consulting Physicians and local colleges, placed under the supervision of the aforementioned National College of Practitioners and may, in addition to at least The King determines, on the proposal of the Insurance Committee, the composition, operation and missions of this National College and these local colleges. »
Art. 35. In Article 155, § 1^er, paragraph 1, 2°, of the same law replaced by the law of December 28, 1999, the words "in the rules of insurance or in the directives of the committee" are replaced by the words "in the rules of insurance, the directives of the committee or the conditions and rules laid down under section 115, § 3, of the Hospitals Act, coordinated on August 7, 1987."
Art. 36. In section 165, paragraph 11, of the Act, the words "that produces its effects on 1^er July 1983", are deleted.
Art. 37. In Article 59, § 1^erof the Act of 10 August 2001 on health care measures, the second dash is replaced by the following:
" - articles 2 to 10 and articles 14, 16, 20, 22 which produce their effects on 1^er January 2002, on the understanding that section 6 comes into force without prejudice to the application of section 23. »
PART III. - Social Affairs and Public Health
CHAPTER I. - Amendment of the Hospitals Act, coordinated on 7 August 1987
Art. 38. § 1^er. Section 4 of the Hospitals Act, coordinated on August 7, 1987, as amended by the Act of January 14, 2002, is replaced by the following provision:
“Art. 4. For the application of this coordinated law are considered as university hospitals, hospitals which, in view of their own function in the field of care, teaching and applied scientific research, meet the conditions fixed by the King and are designated as such by Him on the proposal of the academic authorities of a Belgian university. »
§ 2. From a date to be fixed by the King and, by 31 March 2003, Article 4 of the same Law, as amended by § 1^er, is replaced by the following provision:
"For the purposes of this coordinated law, are considered as university hospitals, university hospital services, university hospital functions, or university care programs, hospitals, hospital services, hospital functions or health care programs that, in view of their own function in the field of patient care, clinical education and applied scientific research, the development of new technologies and the evaluation of medical activities, meet the conditions established by the King and are designated as
Pursuant to paragraph 1^er, one hospital can be designated for each university that has a faculty of medicine offering a complete curriculum. »
Art. 39. Section 18 of the Act is supplemented by the following paragraph:
"The powers of the National Council of Hospital Institutions, as set out in this Act, shall be exercised, subject to the application of sections 154 and 154ter of the Act of 29 April 1996 on social provisions. »
Art. 40. In section 86, paragraph 2, of the Act, as amended by the Act of 12 August 2000, the words "public servants or agents" are replaced by the words "public servants, officers or consultants".
Art. 41. In the same Act, an article 86ter is inserted, which reads as follows:
“Art. 86ter . § 1^er. Within the Federal Public Service Public Health, Food Chain Safety and Environment, a Commission for the Control of the Registration of Medical Activity Data in the Hospital and for the Evaluation of a Justified Intake Policy can be established, as described below as the "Commission".
§ 2. The King shall determine the rules of operation, the composition of the Commission, and the number of effective and alternate members.
Members referred to in paragraph 1^er are appointed by the King.
The Commission is chaired by the Director General of the Health Care Administration.
§ 3. The Commission shall, on initiative or at the request of the Minister who has Public Health in his or her powers or the Chairman of the Commission or the Chairman of the Multi-Party Structure with respect to items 1 to 3°, make proposals on the following matters:
1° the methodology for the control of medical activity data in the hospital referred to in section 86;
2° the methodology for the evaluation of the admission policy;
3° the organization and realization of the control and evaluation referred to in points 1° and 2°;
4° the problems submitted to the Commission relating, on the one hand, to the accuracy and completeness of the records referred to in point 1°, in accordance with the findings and conclusions of the officials, staff members or consultants referred to in section 115, and on the other hand, with respect to the evaluation of the admission policy referred to in point 2°;
5° the problems submitted to the Commission with respect to the comments of the persons concerned following the notification of a report, as referred to in Article 115, § 2, or the notification of a correction or deduction with respect to the budget of the financial means, as referred to in Article 107, § 4, provided that these documents relate to a recording of data relating to the medical activity of the hospital.
The competencies referred to in paragraph 1^er, 4° and 5°, are exercised by the Commission only to the extent that the problems in question have been submitted by the Director General of the Health Care Administration. The Commission exercises the relevant skills, based on anonymous records by hospital.
§ 4. The methodology referred to in § 3, 1 and 2 is fixed by the King.
Art. 42. In section 99, paragraph 2, of the Act, the words "The Minister who has public health in his duties" are replaced by the words "The King".
Art. 43. Section 107 of the Act, replaced by the Act of 14 January 2002, is supplemented by §§ 3 and 4, which reads as follows:
Ҥ3. If it is found by the persons referred to in section 115 that the registration of data relating to medical activities, referred to in section 86, does not correspond to reality or is incomplete, each impact on the level of funding is, pursuant to this Act and the coordinated law of 14 July 1994 on compulsory health care and allowances, corrected ex officio.
To this end, the Director General of the Health Care Administration reports each offence found at the Administrator General of the National Institute of Disability Insurance.
The King may determine rules and procedures with respect to the application of this paragraph.
§ 4. Before the provisions referred to in §§ 1^er and 3, are not applied, the hospital in question is informed.
Within four weeks of the notification, the hospital may make written submissions to the Director General of Health Care Administration. »
Art. 44. In the same Act, it is inserted in Chapter V of Part II, an article 107quater, which reads as follows:
« § 1^er. A lump-sum contribution of patients in an emergency care unit may only be required by the hospital in accordance with the conditions laid down by the King by a deliberate order in the Council of Ministers. The King sets the amount of this contribution by a deliberate decree in the Council of Ministers.
§ 2. The King shall conduct an assessment of this device two years after the coming into force of this device and report thereon to the Federal Legislative Chambers. »
Art. 45. In section 115 of the Act, as amended by the Act of 14 January 2002, the following amendments are made:
1° In § 2, the word "three" is replaced by the word "ten";
2° § 2 is supplemented by paragraph 2, which reads as follows:
"In a period of four weeks after notification, offenders referred to in paragraph 1^er may make written submissions to the Director General of Health Care Administration. »;
3° The article is supplemented by § 3, which reads as follows:
Ҥ3. For the control of the recording of medical activity data, referred to in section 86, officials or employees referred to in paragraph 1^er may be assisted by medical consultants of insurance organizations, referred to in section 154 of the Compulsory Health Care and Allowance Act, coordinated on July 14, 1994, which are designated by the King on the proposal of the Intermutualist College.
For the fulfilment of their mission referred to in paragraph 1^er, medical consultants referred to in paragraph 1^er have access to the medical records referred to in section 15.
The King determines the conditions and rules to which medical consultants referred to in paragraph 1^er must respond. Such conditions and rules may, inter alia, relate to incompatibility with the mission referred to in this paragraph and the time limit for which they are made available for this mission.
Any irregularity committed by a consulting physician in the course of his or her mission is reported by the Director General of the Health Care Administration to the Committee of the Medical Evaluation and Control Service of the National Institute of Disability Health Insurance for the purpose of applying section 155, § 1^erof the above-mentioned Act, coordinated on 14 July 1994. »
Art. 46. In the same Act, Part IV, Chapter I, is supplemented by Section 3, which reads as follows:
“Section 3. - Financial Transparency
Art. 129bis . § 1^er. To ensure financial transparency of financial flows within the hospital, regular consultation between the manager and the medical board is required.
To this end, a financial commission is established in each hospital, unless a permanent consultation committee is already established and is responsible for the financial commission's tasks.
§ 2. The financial commission is composed by a delegation of the manager and, on the other hand, a delegation of the medical council. The delegations shall consist of members of the management and management referred to in section 12, including at least one manager, and hospital physicians appointed by the medical board.
They may be assisted by a financial expert.
§ 3. The financial commission has all the data as provided for in section 128bis.
§ 4. The financial commission shall at least consider:
Annual budget estimates;
Annual accounts;
- reports of the corporate reviewer referred to in sections 82 and 84;
- the nature of the charges.
§ 5. If, following the discussions referred to in § 4, measures are proposed in consensus, the members of the financial commission are required to defend them with the manager, on the one hand, and the medical council, on the other.
§ 6. The data referred to in § 3 may be communicated to the medical council by the delegate of the medical council. »
Art. 47. Section 137 of the Act is supplemented by the following paragraphs:
"The regulation referred to in section 135, 1°, paragraph 2, or section 136, paragraph 1^er, in particular, determines the method of imputation of the difference between actual expenditures and the reference expenditures deducted by the central collection service to compulsory health insurance, as referred to in section 56ter of the Compulsory Health Care and Compensation Insurance Act, coordinated on July 14, 1994.
As long as the regulation, referred to in the preceding paragraph, is not included in the regulations concerned, the imputation against hospital physicians shall be carried out according to each of them in the mass of the fees of the group of providers to which it belongs in the three months preceding the imputation, the amount to be charged to the group concerned being fixed on the basis of the relative share of that group in the overtaking found, taking into account the exclusion of the fee^er2° and § 2. In the event that the application of Article 140, § 1, 1°, gives rise to the fees concerned, to a "pool" of pay by benefit, the share of the remuneration is also charged proportionally to the "pool" and according to the rules in force with respect to individual hospital doctors.
For the purposes of paragraph 3, the assignment referred to in Article 140, § 1 shall not be taken into account.^er, 3°, and § 3, provided that the cost coverage is expressed on the basis of evidenced and actual costs and in agreement with the medical board; in any other case, the imputation referred to is performed by the hospital doctor up to 75 p.c. and the hospital manager up to 25 p.c."
Art. 48. The following amendments are made to section 127 of the Health Care Measures Act of 14 January 2002:
"Section 114 ceases to produce its effects two years after this Act comes into force. »
CHAPTER II. - Amendments to the Act of 29 April 1996 on social provisions
Art. 49. The title of Chapter XII of the Act of 29 April 1996 on social provisions is replaced by the following title:
CHAPTER XII. - From the Multi-Party Hospital Policy Structure »
Art. 50. Article 153, § 1^erthe same law shall be replaced by the following provision:
"Art. 153. § 1^er. It is established with the Federal Public Service Public Health, Food and Environment Safety and the National Institute of Disability Health Insurance a Multi-stakeholder Hospital Policy Structure, referred to as "Multipartite Structure". »
Art. 51. Section 154 of the Act is replaced by the following provision:
"Art. 154. Ministers who have public health and social affairs in their responsibilities may seek advice from the Multi-Party Structure on:
1° any regulations relating to the use and dissemination of hospital activity data coupled by the Technical Cell referred to in section 155 of this Act;
2° the registration, collection, processing and use of statistical data on medical activities, referred to in section 86 of the Hospitals Act, coordinated on 7 August 1987;
3° the measures to be taken to ensure the reliability and confidentiality of the data referred to in 2°, including the methodology referred to in article 86ter, § 3, 1°, of the Hospitals Act, coordinated on 7 August 1987;
4° offer, licensing standards and funding for hospital activities, without prejudice to procedures establishing and amending the nomenclature of medical benefits, referred to in section 35 of the Compulsory Health Care Insurance Act, coordinated on 14 July 1994;
5° the establishment of financial regulations and incentives to promote the effectiveness of the activities of the hospital and hospital physicians, without prejudice to the procedures establishing and amending the nomenclature of medical benefits, referred to in section 35 of the Compulsory Health Care and Compensation Insurance Act, coordinated on 14 July 1994;
If a notice referred to in 4° and 5° of paragraph 1^er, has been approved by majority in each class of members, referred to in Article 159, 2°, 3° and 4°, of this Act, no other body referred to in the Hospitals Act shall, by derogation from the other legal provisions in this matter, make a notice. »
Art. 52. In the same Act, an article 154bis, which reads as follows:
"Art. 154bis . The Multi-Party Structure provides an assessment and information role for medical practice in hospitals, as long as it generates expenses.
It may, as part of the assessment referred to in paragraph 1^er, take note of the data in relation to hospital benefits and conditions.
It prepares annually to the attention of ministers who have public health and social affairs in their responsibilities, an assessment report on the system of reference amounts.
The King may set conditions and rules according to which data, where the identity of the hospital concerned is known, are transmitted to the Multiparty Structure.
The assessment referred to in paragraph 1^er can include information and awareness-raising for hospitals initiated by the Multi-Party Structure.
The results of the evaluations referred to in this section may be forwarded to the Medical Evaluation and Control Service of the National Institute of Disability Insurance.
As a result of the evaluations referred to in this Article, the Multi-Party Structure may make proposals to ministers with public health and social affairs in their responsibilities regarding measures to mitigate unwarranted differences in medical practice.
The Multi-Party Structure may, with respect to the above-mentioned evaluation, entrust missions to the organizational structures referred to in Article 15, § 2, of the Hospitals Act, coordinated on August 7, 1987.
The King may specify rules regarding the execution of this article. »
Art. 53. In the same Act, an article 154ter is inserted, which reads as follows:
“Art. 154ter . § 1^er. The Multi-Party Structure provides, with respect to hospital policy, advice on:
1° the introduction or modification of financial regulations, provided that they result simultaneously in funding both by the financial means budget, referred to in section 87 of the Hospitals Act, coordinated on August 7, 1987, and by the nomenclature of medical benefits, referred to in section 35 of the Act respecting compulsory health care and compensation, coordinated on July 14, 1994 and so on
2° the establishment of the rules for fixing the reference amounts for standard interventions, as referred to in Article 56ter of the Act of 14 July 1994;
3° compensation for the drug consumption of hospitalized patients;
4° the general rules for the financing of endoscopic equipment and viscerosynthesis and all other medical products used in the hospital;
5° the methodology for the evaluation of the admission policy.
If a notice, referred to in 1°, 4° and 5°, of paragraph 1^er, has been approved by majority in each class of members, referred to in Article 159, 2°, 3° and 4°, of this Act, no other body referred to in the Hospitals Act shall, by derogation from other legal provisions in this matter, make a notice.
Two years after the appointment of the members of the Commission, referred to in section 86ter of the Coordinated Hospitals Act on 7 August 1987, the Multi-Party Structure prepares an assessment report on the function of insurers with respect to registration controls, intake policy and medical practice. »
Art. 54. In the same Act, an article 154quater, which reads as follows:
"Art. 154quater . The Multi-Party Structure's mission is to initiate a dialogue within it, either at the request of at least one of the above-mentioned ministers, or on its own initiative, on all issues that affect the problems of the coherence of activities as well as the opinions and decisions formulated, on the one hand, by the federal Public Service bodies and, on the other, by the Institute, with regard to hospital policy. »
Art. 55. In section 159 of the Act, the following amendments are made:
1° At 1°, the words "and a vice-president" are inserted between the words "of a president" and the word "named";
2° At 2°, 3° and 4°, the word "8" is replaced each time by "six";
3° At 5°, the word "four" is replaced each time by "five";
4° At 5°, the provision " - an effective member and an alternate member who are members of the Commission for the Protection of Privacy", is replaced by the following:
" - two effective members and two alternate members, including a representative of the Federal Public Service and the Institute";
5° At 5°, the provision " - an effective member, namely the Chairman of the Commission for the Supervision and Evaluation of Statistical Data on Medical Activities in Hospitals, or its representative and an alternate member who is a member of the same commission" is repealed;
6° The article is supplemented by paragraph 2, which reads as follows:
"On all the members referred to in 2°, 3° and 4°, at least two thirds must be members, either of the National Hospital Board or of the National Medico-mutualist Commission. They must be specialists. »
Art. 56. Section 162 of the Act is supplemented by the following provisions:
"The King may specify rules for administrative support of the Multi-Party Structure and its sections, as well as the financing of them.
The King may subdivide the Multi-Party Structure into sections, each of which has a portion of the competencies referred to in Article 154, 154bis, 154ter and 154quarter, under delegation and supervision of the Multi-Party Structure. The Multi-Party Structure determines in its rules of procedure the rules relating to the composition of the sections. »
Art. 57. Section 164 of the Act, inserted by the Act of 22 February 1998, is replaced as follows:
“Article 164. The King may specify rules concerning the operation of the Multiparty Structure. »
Art. 58. In sections 141 and 153 to 162, the words "The Ministry of Social Affairs, Public Health and the Environment", the words "The Department" and the word "Ministry" are replaced each time, respectively by the words "Federal Public Service, Food and Environment Safety", the words "Federal Public Service" and the words "Federal Public Service".
Art. 59. § 1^er. In chapter XII of the same law, the word "Council Structure" is replaced each time by the words "Multipartite Structure".
§ 2. In the Hospitals Act, coordinated on August 7, 1987, the words "Consolidation Structure" are replaced each time by the words "Multipartite Structure".
PART IV. - Entry into force
Art. 60. This Act comes into force on the day of its publication in the Belgian Monitor, with the exception of:
- Article 4, which comes into force on 1^er September 2002;
- articles 9, 20 and 37 that produce their effects on 1^er January 2002;
- of Article 11 which comes into force on 1^er October 2002;
Articles 38 and 48 that produce their effects on 22 February 2002;
- of Article 22 which comes into force on a date fixed by the King.
Promulgate this law, order that it be clothed with the seal of the State and published by the Belgian Monitor.
Given at Châteauneuf-de-Grasse, August 22, 2002.
ALBERT
By the King:
Minister of Public Health,
Ms. M. AELVOET
The Miinistre of Social Affairs,
F. VANDENBROUCKE
Seal of the state seal:
Minister of Justice,
Mr. VERWILGHEN
____
Note
Documents of the House of Representations: 50-1905 - 2001/2002: No. 1: Bill. - n^bones 2-3: Amendments. - Number four: Report. - No. 5: Text adopted by the commissions. - No. 6: Text adopted in plenary and transmitted to the Senate.
Full report: 12 July 2002.
Documents of the Senate: 2-1245 - 2001/2002: No. 1: Project referred to by the Senate. - No. 2: Amendments. - Number three: Report. - No. 4: Decision not to amend.
Annales du Sénat : 17 et 18 juillet 2002.