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28 DECEMBER 1999. - An Act to amend the Compulsory Health Care and Compensation Insurance Act, coordinated on July 14, 1994 (1)

ALBERT II, King of the Belgians,
To all, present and to come, Hi.
The Chambers adopted and We sanction the following:
Article 1^er. This Act regulates a matter referred to in Article 77 of the Constitution.
Art. 2. In section 142, § 1 of the Compulsory Health Care Insurance Act, coordinated on 14 July 1994, as amended by the Act of 21 December 1994, paragraphs 2 to 5 are replaced by the following provisions:
"This commission consists of two sections. One is familiar with cases processed in the Dutch angel; the other person is familiar with cases in French and German.
The headquarters of the commission is established in Brussels, in the premises of the Institute. »
Art. 3. Section 143 of the Act is replaced by the following provision:
"Art. 143. § 1^er. Each section of the supervisory board is composed of a president, appointed from among the counsellors or judges of the courts and tribunals, referred to in Article 40 of the Constitution and four medical members. Two of these members are presented by the insurers, the other two by the representative organizations of the medical body.
They each have two alternates.
All are appointed by the King for a renewable term of six years. Any member appointed to replace a deceased or resigning member shall complete the term of his predecessor.
The age limit of the members is 65, except for the magistrates, where the age limit is 70 years.
§ 2. The exercise of a mandate within the supervisory board is incompatible with that exercised within the Medical Control Service Committee or in a profile board referred to in section 30. »
Art. 4. Section 144 of the Act is replaced by the following provision:
“Art. 144. § 1^er. Each section of the appeal board referred to in Article 142, § 2, is composed of three magistrates, one of whom assumes the presidency. It also includes four physician members: two are designated by the insurers, the other two by the representative organizations of the medical body.
Only members of the judiciary have a deliberate vote.
The provisions of Article 143, § 1^er, paragraphs 2 to 5, and § 2 are also applicable to the sections of the appeal board.
§ 2. The King may modify the composition of the supervisory board and appeal board by adding two effective members and two alternate members appointed by the representative organizations of all workers and of all employers. These members have only one advisory voice.
§ 3. When a representative organization in the composition of the committees referred to in section 142 fails to present or designate its representatives for appointment purposes, after the Minister has made two times, by setting a time limit, a request for presentation or designation, representatives who were provided for in the composition of the said bodies shall not be taken into consideration in the constitution of the seat or in the decision-making process.
When the chair of one of the committees referred to in the preceding paragraph finds in two successive sessions the impossibility of sitting because of the absence of members, these members are no longer taken into consideration for the constitution of the seat and the decision-making, as of the third sitting held in their absence.
§ 4. The supervisory board and appeal board shall be assisted each by an effective secretary and alternate secretaries appointed by the doctor and chief executive officer of the Medical Control Service among the staff of that service. »
Art. 5. Artikel 145, §§ 1^er and 2 of the Act are replaced by the following:
« § 1^er. Where the Medical Control Service or a profile board referred to in section 30 or an insurer is of the opinion that a care provider shall transgress with the provisions of section 73, the Medical Supervisory Board or the body established under section 142, § 3.
§ 2. The Medical Director General of the Medical Control Service or his or her delegate shall be among the staff of that service, the medical inspector responsible for reporting to the commission. It may order a medical inspector to conduct a preliminary investigation.
The rapporteur presents the presentation of the facts dependant on the individual. He may intervene in the debates.
The supervisory board as well as the appeal board may appeal to experts. »
Art. 6. Section 155 of the Act, as amended by the Acts of 20 December 1995 and 22 February 1998, is replaced by the following provision:
"Art. 155. § 1^er. The Medical Control Service Committee may:
1° to doctors-inspectors, pharmacists-inspectors and social controllers, referred to in article 146, the disciplinary sanctions provided for in the status of State officials, except for the demotion and revocation that are pronounced by the King on the Committee's proposal;
2° to medical consultants, referred to in section 154, who do not comply with the rules of insurance or the Committee's directives, the following disciplinary sanctions: warning, censorship, reprimand, suspension of the right to perform their duties for a term that cannot exceed two years and the final prohibition of performing these functions.
The status of medical consultants determines the following terms and conditions for disciplinary sanctions imposed under paragraph 1^er are brought to the attention of insurers.
§ 2. The Committee ' s decisions on disciplinary matters referred to in § 1 may be appealed.^er2°, before the appeal commissions established for this purpose; the appeal suspends the execution of the disciplinary penalty.
§ 3. The Committee may, in addition, whenever the interest of the service or the general interest so requires, suspend these consulting physicians for a maximum of two months.
§ 4. Whenever the interest of the service so requires, the Minister may, on the proposal of the Medical Control Service Committee, pre-emptively suspend medical inspectors and pharmacists-inspections and social controllers referred to in section 146 for a maximum period of two months. The Minister decides in each case whether or not the preventive suspension involves the total or partial suspension of the payment of the treatment.
This suspension may be renewed after a reasoned opinion from one of the appeal boards.
§ 5. Both before the Medical Control Committee and the appeal boards, the doctor, pharmacist or social controller must be heard beforehand and may be assisted by a person of his or her choice.
§ 6. The appeal boards are composed of:
(a) three counsellors or judges of the courts and tribunals referred to in Article 40 of the Constitution, effective members appointed by the King;
(b) three effective members appointed by the King among the candidates nominated on double lists by the groups referred to in article 140, 2°, 3°, 5° to 21° respectively.
These members sit only in cases of direct interest to the group that presented them. They have only an advisory voice.
The terms of reference of the members of the appeal boards are incompatible with that of a member of the Medical Control Service Committee.
The King sets the rules of operation of the appeal boards and may appoint alternate members of whom He determines the number. »
Art. 7. In section 156 of the Act, the following paragraph is inserted between paragraphs 1^er and 2:
"In addition, the restricted rooms are recovering from the care provider expenses related to health care benefits and allowances that have been deemed to be non-compliant with the legal and regulatory provisions referred to above. They also set the time limit for such reimbursement. They may also specify the modalities. The final decisions of the restricted chamber and the appeal board are executory on its own. The sums due shall be of full interest from the day after the term fixed by the decision.
In the event of a failure of the debtor, the Administration of the value added tax, registration and domains may be responsible for recovering the amounts due, in accordance with the provisions of Article 94 of the State Accounting Laws, coordinated on 17 July 1991.
The amounts recovered are recorded as health care insurance revenues. »
Promulgate this law, order that it be clothed with the seal of the State and published by the Belgian Monitor.
Given in Ciergnon on 28 December 1999.
ALBERT
By the King:
Minister of Social Affairs and Pensions,
F. VANDENBROUCKE
Seal of the state seal:
Minister of Justice,
Mr. VERWILGHEN
____
Note
(1) See:
Documents of the House of Representatives:
50-295-1999/2000:
No. 1. Bill.
No. 2. Report of Mrs. Cahay-André.
No. 3. Text adopted in plenary and transmitted to the Senate.
Chamber Annexes: 14-15 December 1999.
Documents of the Senate:
2-228-1999/2000:
No. 1. Project transmitted by the House of Representatives.
No. 2. Report.
No. 3. Text adopted by the Commission.
Annales du Sénat : 22 et 23 décembre 1999.