Key Benefits:
Minister of Finance and Public Accounts and Minister of Social Affairs, Health and Women's Rights,
Considering the general code of territorial authorities, including article L. 1424-42;
Considering the Public Health Code, including articles L. 6312-5 and L. 6314-1;
Considering the social security code, including articles L. 322-2 and L. 322-5-2;
Having regard to Act No. 2011-1906 of 21 December 2011 on the financing of social security for 2012, including article 66;
In light of Decree No. 2014-1584 of 23 December 2014 on experiments on the modalities for the organization and financing of urgent sanitary transport provided for in Article 66 of the Social Security Financing Act for 2012,
Stop:
The terms of reference set out in Article 1 of the Experimental Decree on the Organization and Financing of Urgent Health Transport are set out in the annex to this Order.
The Director General of the Care Offer 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.
Annex
Preamble
Section 66 of Act No. 2011-1906 of 21 December 2011 on the financing of social security for 2012 allows the experimentation of new modalities for the organization and financing of emergency pre-hospital health transport carried out at the request of the urgent medical aid service. To this end, it is possible to derogate from certain forms of custodial organization provided for in sections R. 6312-18 to R. 6312-22 of the Public Health Code and the related rules of financing defined by the national private sanitary carriers convention provided for in Article L. 322-5-2 of the Social Security Code.
The objective of these experiments is to improve within the selected territory:
- the organization of urgent sanitary transport in order to optimize the quality of the ambulance response to the pre-hospital emergency organized during and outside the periods of custody;
- the efficiency of the system in terms of funding.
This Terms of Reference specifies the general conditions of experimentation, lists the elements to be included in the local experimental convention and the obligations inherent to the parties involved in experimentation. It defines the elements to which SRAs must pay attention when evaluating the experiment. It outlines the modalities for the application of regional voluntary health agencies.
1. General framework of experimentation
The experimentation organizes a unique system of response to all urgent health transport needs made at the request of the urgent medical assistance service in accordance with the order of May 5, 2009 on the implementation of the SAMU-health transfer repository, which organizes the ambulance response to the pre-hospital emergency.
The establishment of the experimental organization is based on a pre-analysis work on the identified activity and the needs of the population for urgent health transport in the territory concerned, including the identification of all needs.
The selected experimental organization is described in a local experimental agreement between regional voluntary health agencies, local health insurance organizations, the establishment of the emergency medical service and the association of the most representative emergency health carriers at the departmental level. The territorially competent SDISs in the territory concerned are consulted on the draft convention.
2. Local Convention for Experimentation
The local experimental convention includes provisions relating to the territorial organization and financing of urgent sanitary transport.
It requires that:
- the definition of territory of experimentation;
- the assessment of the activity identified and potential in the territory concerned to dimension the device;
- the territorial organization chosen, i.e. the division of the experimental territory with the corresponding means, for each sector and for each time range, as well as the evolution of this organization according to the times and seasons;
- the organizational arrangements selected for the participation of sanitary transport companies, including the organization of a guard, the management of the guard schedules, the communication of the custody table to the UAS, the CPAM responsible for the payment of compensation to health transport companies and health transport companies involved in the experimentation of the replacement modalities, ambulance coordination;
- the procedures for traceability of all the interventions of private health carriers regulated by the emergency medical assistance service, as well as the monitoring and identification of certain interventions, including: interventions regulated by the UAS and not followed by transport, interventions carried out in the context of the permanence of care defined in article L. 6314-1 of the Public Health Code and interventions for the return to home of emergency patients and non-hospital structures
- procedures for the initiation of ambulance interventions and monitoring of the intervention (including transmission of balance sheets...) and activity;
- the follow-up of ambulance unavailability and their characterization;
- a mechanism for the accountability of health transport companies involved in experimentation for unjustified ambulance unavailability;
- the modalities of participation in the device (common guards, guards in the establishments, vehicle equipment, vehicle categories, development of geolocation software, etc.);
- the modalities for the financing of devices and the pricing of interventions and custody packages;
- where applicable, the specific pricing of non-transport interventions, home returns of patients supported by emergency and non-hospital facilities, or interventions carried out as part of the care permanence;
- the billing and payment processes for ambulance interventions;
- the objective of spending control (amounts or rates defined on the duration of experimentation and declined annually) and the mechanisms of return to equilibrium set up locally in the event of a tendency to excessive consumption of credits;
- the obligations of each party;
- the conditions under which a company failing to comply with the commitments of the convention, is sanctioned or excluded from the scheme by ensuring compliance with the principle of the contradictory;
- the procedures for monitoring budget execution and evaluation of experimentation.
3. Evaluation of experimentation
The evaluation of the experiment focuses on the quality of the response and the financial efficiency of the devices and allows a minima to monitor and appreciate the activity, from a quantitative and qualitative point of view, by analyzing the following:
- the relevance of the device to the needs of the number of interventions by territorial sector and vehicle, typology of the interventions, in order to anticipate, where appropriate, the evolution of the devices against the objectives;
- the fulfilment of the commitments in terms of response quality, including delays of intervention, rates of ambulance unavailability;
- qualitative improvement compared to current devices.
It also allows to measure the financial aspects and improve their efficiency with respect to current devices.
The evaluation results in an evaluation report that shows a minimum of the following:
- the number of interventions by private ambulance operators in the experimental setting and the evolution over the previous year;
- the average number of exits per period and guard sector;
- the number of ambulance unavailability and cost of unavailability;
- the number of companies participating in the device;
- the average cost of the intervention integrating the details of the funding elements;
- the state of the expenditure (amount and consumption of the global envelope);
- quantitative and qualitative analysis of these elements in relation to the objectives of the local experimentation project.
4. Content of applications for experimentation
Regional voluntary health agencies formalize an experiment project, which must present:
- the experimental territory envisaged;
- assessment of the transport activity and needs to be covered;
- organizational and financial guidance;
- significant changes in the device in relation to the current situation: impact assessment and elements that demonstrate the feasibility of experimentation;
- the encrypted analysis of expenditures of year N-1;
- the sources of savings envisaged and their estimated amounts or the mechanisms of expenditure control;
- the effective date of the proposed convention;
- the main criteria for monitoring and evaluating the experimental device;
- the recognition of the involvement of the actors involved in experimentation.
Done on 23 December 2014.
Minister of Social Affairs, Health and Women ' s Rights,
Marisol Touraine
Minister of Finance and Public Accounts,
Michel Sapin
