Key Benefits:
Publics concerned: health institutions.
Purpose: regulation of the national health insurance expenditure target by applying a prudential coefficient.
Entry into force: the text comes into force on the day after its publication.
Notice: the decree determines the conditions for the application of theArticle L. 162-22-9-1 of the Social Security Code which provides for the possibility to apply to the rates of hospitalization benefits of the health facilities referred to in Article L. 162-22-6 a prudential factor lowering these rates in order to contribute to the respect of the national objective of health insurance expenses and to pay to the establishment, in the event of compliance with the objective, all or part of the sum so relieved.
References: the provisions of Social Security Code Amended by this decree may be consulted, in their writing resulting from this amendment, on the website Légifrance (http://www.legifrance.gouv.fr).
The Prime Minister,
On the report of the Minister of Social Affairs and Health,
Vu le Public Health Code ;
Vu le Social Security Codeincluding articles L. 162-22-9-1 and L. 162-22-10;
Considering the opinion of the Central Council of the Agricultural Social Mutuality of 7 February 2013;
Having regard to the advice of the Board of Occupational Accidents and Diseases of 13 February 2013;
Having regard to the opinion of the National Health Insurance Fund for Employees dated 14 February 2013;
Having regard to the referral of the Board of the National Health Insurance Union dated 29 January 2013;
The State Council (Social Section) heard,
Decrete:
After article R. 162-42-1 of the Social Security Code, articles R. 162-42-1-1 are inserted to R. 162-42-1-3 as follows:
"Art. R. 162-42-1-1. - The value of the coefficient referred to in I of Article L. 162-22-9-1 shall be determined by order of ministers responsible for health and social security, within fifteen days of the publication of the order referred to in Article R. 162-42, on the recommendation of the hospitalization council taken after advice of the most representative national organizations of health institutions. The value of this coefficient, which may be differentiated by class of establishments, is determined taking into account the difference between the observed evolution of the activity of the establishments referred to in section L. 162-22-6 and the forecasts established at the beginning of each year as well as, if any, events that may affect the activity of the establishments or the evolution of the health insurance expenditures during the current year.
"Art. R. 162-42-1-2. - As from the notice of the warning committee referred to in the penultimate paragraph of Article L. 114-4-1, the ministers responsible for health and social security shall, as appropriate, stop before December 31 of the current year and after consultation with the economic observatory of public and private hospitalization, the amount of credits to be paid to institutions within the limit provided for in Article II of Article 162-9. This amount can be differentiated by category of establishments.
"The distribution between the regions is carried out on the basis of the activity of the facilities measured in particular from the data mentioned in the articles L. 6113-7 and L. 6113-8 of the Public Health Code.
"Art. R. 162-42-1-3. - Within fifteen days of the publication of the order referred to in article R. 162-42-1-2, the Director General of the Regional Health Agency shall, for each institution, determine the amount of the package allocated under section L. 162-22-9-1. This package is prorated to the activity of each facility measured in particular from the data mentioned in the data articles L. 6113-7 and L. 6113-8 of the Public Health Code. This package is paid in one time by the designated body under sections L. 174-2 and L. 174-18. »
The Minister of Economy and Finance, the Minister of Social Affairs and Health and the Minister Delegate to the Minister of Economy and Finance, responsible for the budget, are responsible, each with respect to it, for the execution of this Order, which will be published in the Official Journal of the French Republic.
Done on 28 February 2013.
Jean-Marc Ayrault
By the Prime Minister:
Minister of Social Affairs
and Health,
Marisol Touraine
Minister of Economy and Finance,
Pierre Moscovici
Minister Delegate
to the Minister of Economy and Finance,
Budget Officer
Jérôme Cahuzac
