Key Benefits:
Minister of Economy and Finance, Minister of Social Affairs and Health and Minister Delegate to the Minister of Social Affairs and Health, responsible for the elderly and self-reliance,
Considering the code of social action and families, including articles L. 314-9, R. 314-170-1, R. 314-170-4, R. 314-171 and R. 314-171-3;
Vu le Public Health Codeincluding article L. 6111-3;
Based on the advice of the Local Finance Committee (the Standards Assessment Advisory Board) dated 12 September 2013,
Stop:
Each institution saves and transfers to the regional health agency territorially competent the databases from the evaluations of the loss of autonomy and of the medical-technical care needs carried out by the medical coordinator using the AGGIR and PATHOS repositories for their validation.
This transfer takes the form of a repository, by computer connection, of databases in GALAAD format in a secure platform for exchange and storage set up by the National Solidarity Fund for Autonomy, known as the "GALAAD-CNSA platform", to allow their operation by the doctors mentioned in the fourth and fifth paragraphs of Article L. 314-9 of the code of social action and families.
A right of access to the GALAAD-CNSA platform (Gerontology logistics approach for analysis and decision assistance) is open:
(a) To the GALAAD reference doctors of regional health agencies by the National Solidarity Fund for Autonomy;
(b) To the medical coordinators of the establishments by the competent regional health agency, which assigns them user rights;
(c) To the doctors of the medical-social teams of the departments of its jurisdiction by the regional health agency so that they access the databases of the institutions subject to their validation and the computer tool (vanced GALAAD functions) associated with the GALAAD-CNSA platform.
1° The validation of the evaluations is organized in a coordinated manner by a doctor of the regional agency for territorially competent health, appointed by the Director General of the said agency, and by a doctor from a medical-social team of the department, designated by the President of the General Council.
Its terms and conditions may result in the signing of a protocol of cooperation between the regional health agency and the General Council for the joint validation of the average level of self-reliance of each institution. The doctor designated by the President of the General Council has the initiative of the General Council because of the department's competence in the evaluation of loss of autonomy;
2° The validation of the evaluations carried out at the conclusion or renewal of the tripartite convention referred to in Article L. 313-12 or the multi-year contract referred to in Article L. 313-11 of the above-mentioned code shall be carried out in the following manner, as set out in the annex to this Order:
(a) Preliminary monitoring of the consistency and compatibility of the codings carried out using the AGGIR and PATHOS software carried out in a coordinated manner by the doctors of the General Council and the Regional Health Agency on the databases transmitted by the institution;
(b) On-site validation, in the presence of the co-ordinating physician and, where applicable, professionals from the health care team, on a differentiated sample of permanent residents, based on the validation of the GIR ranking or PATHOS cut;
3° The validation of the intermediate evaluation carried out during the execution of the tripartite agreement or multi-year contract shall be effected on parts if the value of the "weighted middle-resource group" (GMP) or "weighted medium pathos" (PMP) does not increase by more than 5% compared to the previous on-site assessment. It intervenes in the light of the consistency and compatibility of the codings carried out by the medical coordinator exercised by the doctors responsible for their validation. If the value of the GMP or PMP is greater than 5%, the on-site validation procedure is carried out under the conditions set out in 2°.
In the event of a disagreement between the doctor of the General Council and the doctor of the Regional Health Agency or in the event of a disagreement with the doctor coordinator of the establishment with the doctor of the General Council and/or the doctor of the Regional Health Agency, an argument sheet showing the views of each doctor is communicated to the Regional Medical Coordination Commission responsible for determining the final classification. This may be the subject of an institution's appeal to the Interregional Health and Social Pricing Court.
No later than 31 January of the current year, the President of the General Council shall communicate to the Director General of the Territorially Competent Regional Health Agency the value of the average GMP of the establishments installed in his jurisdiction as of 31 December of the previous year and referred to in Article R. 314-170-3 of the Code of Social Action and Families.
Each year, the regional medical coordination commission transmits the validated classification statement, in a form that respects the anonymity of the hosted persons:
(a) As the pricing authorities as well as each institution for the data that concern it;
(b) Before March 1 of the year following the reference year of these data to the National Solidarity Fund for Self-Government and Ministers responsible for health and the elderly.
The decision of 26 April 1999 on the modalities for the organization and operation of the departmental medical coordination commission referred to in article 12 of Decree No. 99-316 of 26 April 1999 on the modalities for the pricing and financing of institutions hosting dependent older persons is repealed.
The Director General of Social Cohesion and the Director of Social Security are responsible for the execution of this Order, which will be published in the Official Journal of the French Republic.
A N N E X E
VALIDATION MODALITIES ON MENTIONAL PLACE
AT 2° OF ARCHIVED 2
I. ∙ Terms of validation of the iso-resource group
weighted average (GMP)
The procedure is carried out in two stages:
1° Remote control of the coding of the discriminating variables performed (1): a rate of inconsistencies greater than 1% results in a new assessment of the average level of self-reliance by the co-ordinating physician within one month. In this context, the PATHOS repository database is not used;
2° Implementing an on-site validation procedure for data produced by each facility on the basis of a random sample representing 10% of permanent residents without being less than 20 residents:
– an error rate found on the discriminating variables of the AGGIR grid less than or equal to 5% takes the validation of the GIR ranking of the establishment;
- a rate of error greater than 5%, if it is not the subject of a disagreement before the regional medical coordination commission (CRCM), results in the non-validation of the classification and the completion of a new assessment by the coordinator physician;
― if an error rate of more than 5% persists at the end of the second assessment without disagreement before the MRC, the value of the previously validated GMP on site is maintained, reduced by 1%, or the value of the GMP proposed by the doctor responsible for its validation is retained if it is the first assessment of a newly authorized establishment.
The validation procedure for the GMP is at the initiative of the physician of the Department's medical and social teams, taking into account the department's competence in assessing the loss of autonomy of older persons, except for specific local agreements. Its result is the subject of a validation certificate indicating the value of the validated GMP, sent on the one hand to the doctor of the regional health agency for joint validation, on the other hand to the director of the institution for signature of the doctor coordinator.
II. ― Method of validation of weighted medium pathos (MPPs)
The procedure is carried out in three times:
1° Remotely conducts a PATHOS cup consistency check and a sampling check to detect atypies that may trigger a medical alert procedure from the regional health agency responsible for validation with the coordinator doctor.
2° Implementing an on-site validation procedure for data produced by each facility on the basis of a sample of between 50% and 70% of permanent residents, mostly selected from those with the heaviest care profiles, while including 15% of residents with the lowest PMP values.
3° Correction by the regional health agency of the validated base that is accessible to the facility on the GALAAD-CNSA platform for a period set up jointly, at the end of which the SRA is closing access to the GALAAD-CNSA platform for the facility.
The PMP validation procedure is up to the doctor of the regional health agency. Its result is a validation certificate indicating the value of the validated PMP, sent by the ARS to the director of the institution for signature by the co-ordinating physician.
Done on 15 November 2013.
Minister of Social Affairs
and Health,
For the Minister and by delegation:
Director General
social cohesion,
S. Fourcade
Minister of Economy and Finance,
For the Minister and by delegation:
The Director of Social Security,
T. Fatome
Minister Delegate
Minister of Social Affairs
and Health,
of the elderly
and autonomy,
For the Minister and by delegation:
Director General
social cohesion,
S. Fourcade
