Key Benefits:
Publics concerned: health institutions.
Purpose: regulation of the activity of health facilities through the application of a tariff deressivity mechanism.
Entry into force: the text comes into force on January 1, 2015.
Explanatory Note: This Order determines the conditions for the application of theArticle L. 162-22-9-2 of the Social Security Code, which introduces a rate de-ressivity mechanism to reduce the rates of health facilities when the activity produced by these institutions for the calendar year in question exceeds a threshold whose value is expressed in evolution rates or volume of activity.
References: the texts mentioned in this decree are available on the website Légifrance (http://www.legifrance.gouv.fr).
The Prime Minister,
On the report of the Minister of Social Affairs, Health and Women ' s Rights,
Vu le Public Health Codeincluding articles L. 6113-7 and L. 6122-6;
Vu le Social Security Codearticles L. 162-22-6, L. 162-22-9-2 and L. 162-22-10;
Vu la Act No. 2003-1199 of 18 December 2003 of 2004 amended social security financing, including article 33;
Having regard to the advice of the Council of the National Health Insurance Union dated 2 October 2014;
Considering the opinion of the Central Board of Directors of the Agricultural Social Mutuality of 2 October 2014;
Having regard to the opinion of the National Health Insurance Fund for Employees dated 6 October 2014;
Having regard to the advice of the Board of Occupational Accidents and Diseases on 8 October 2014;
The State Council (Social Section) heard,
Decrete:
After article R. 162-42-1-3 of the Social Security Code, articles R. 162-42-1-4 to R. 162-42-1-8 are inserted as follows:
"Art. R. 162-42-1-4.-I.- Within fifteen days of the publication of the order referred to in R. 162-42, the ministers responsible for health and social security shall, on the recommendation of the board of hospitalization taken after notice of the most representative national organizations of health institutions:
« 1° The value of the thresholds mentioned in the first paragraph of Article L. 162-22-9-2 expressed in evolution rates or volume of activity. The value of these thresholds can be differentiated by region, given the geographical variations in the rates of treatment observed on certain activities;
« 2° The value of rate reductions applied on the activity produced beyond these thresholds. The value of these minorations is expressed by coefficients applied to the national tariffs mentioned in 1° of I of Article L. 162-22-10;
« 3° The scope of the relevant hospitalization benefits, including those for which there are geographical variations in rates of treatment.
"II.-The value of these thresholds and the value of tariff reductions shall be determined taking into account the following:
« 1° The state of the evolution of the activities identified under the two years prior to the national and regional level;
« 2° Forecasts of developments at the national level and, where applicable, at the regional level for the year under review.
"Art. R. 162-42-1-5.-I.-The activity produced by each institution, under the calendar year in question, in the field of the benefits concerned is measured:
« 1° When the thresholds are expressed in volume of activity, in number of packages mentioned in article R. 162-32 covered by health insurance;
« 2° When the thresholds are expressed in evolutionary rates, in financial amounts corresponding to the valuation of the activity produced by the national rates of benefits referred to in Article L. 162-22-10.
"II.-The activity is measured on the basis of the following activity data:
« 1° For establishments referred to in a, b and c of Article L. 162-22-6, the activity data referred to inArticle L. 6113-7 of the Public Health Code ;
« 2° For private health institutions referred to in Article L. 162-22-6, the activity data transmitted to the State by the National Health Insurance Fund of employed workers pursuant to the provisions of Article R. 162-42-2.
"III.-In order to neutralize the effect of a group referred to in theArticle L. 6122-6 of the Public Health Code, the activity produced prior to consolidation is measured from the sum of the data from the activities grouped in the field of the benefits concerned.
"Art. R. 162-42-1-6.-I.-For hospitalization benefits subject to a threshold expressed in volume of activity, the lowering coefficients of the rates set under section R. 162-42-1-4 apply to packages produced by the establishment beyond the corresponding thresholds.
"For hospitalization benefits subject to a threshold expressed in evolutionary rates, the lowering factor applies where the amount derived from the valuation of the activity produced under the current year is greater than the amount derived from the valuation of the activity produced under the previous year plus the value of that threshold. The lowering coefficient applies to a fraction of the health insurance revenues. This fraction is equal to the amount derived from the application to the health insurance revenues of the calendar year considered from the ratio corresponding to the difference between the amount derived from the valuation of the activity for the calendar year under review and that derived from the valuation of the activity for the previous year plus the value of this threshold reported to the amount derived from the valuation of the activity for the calendar year under review.
"For the determination of the amount derived from the valuation for the previous year, consideration is given to the impact of the rate perimeter changes as well as the rate changes of any kind, calculated by the Technical Hospital Information Agency, referred to inArticle R. 6113-33 of the Public Health Codebased on the data referred to in Article L. 6113-7 of the same code.
"II.-The amounts due by establishment resulting from the application of the minoration coefficients are determined on the basis of the data available as of May 15 of the year following the calendar year in question. To take into account the one-year period referred to in Article L. 162-25, these amounts may be corrected on the basis of the final data available as of May 15 of the following year. These amounts are the amounts to be recovered.
"Art. R. 162-42-1-7.-The lowering of the rates under section L. 162-22-9-2 does not apply to establishments with new authorization under theArticle L. 6122-1 of the Public Health Code, entering the scope of the benefits concerned, issued during the year and the previous two years.
"In the case of a change-rate threshold, the reduction does not apply to the benefit(s) for which it is found to be a decline in activity the year before the calendar year in question.
"Art. R. 162-42-1-8.-The Director General of the Regional Health Agency shall determine the amount of the amounts to be recovered from each institution for the year under review and, where applicable, the amount resulting from the correction made pursuant to the second sentence of section II of R. 162-42-1-6 and shall communicate it to the establishment, which shall have a period of one month to present its observations.
"At the end of this period, the Director General of the Regional Health Agency shall, by reason of order, issue the final amount of the amounts to be recovered, forward the order to the credit union referred to in section L. 174-2 or L. 174-18 and notify the establishment of the order, which shall pay the sums corresponding to the amounts due within two months of the notification of the order.
"The credit union shall recover the amount and, if no payment of any or part of the amount notified within the two-month period, shall collect the amounts owing by deduction on future benefits.
"The maximum amount of money to be recovered is set at 1% of the health insurance revenues related to the activity financed by the national tariffs referred to in article L. 162-22-10 of the institution for the year under review and the minimum amount below which the amounts due do not give rise to recovery is fixed, taking into account the cash management costs, by an order of the Ministers of Health and Social Security. »
For establishments mentioned in a, b and c of Article L. 162-22-6 of the Social Security Code and by derogation from the third paragraph of section R. 162-42-1-8 of the same code, the amount of money to be recovered shall be deducted from the amount determined by the regional health agency pursuant to the provisions of section 33 of the Social Security Financing Act, 2004.
The provisions of this Order come into force on 1 January 2015.
For the first calendar year following their entry into force, they apply to the activity of health facilities carried out in 2015. However, the activity of health facilities for prior years is taken into account for the application of 2° of II of Article R. 162-42-1-4, III of Article R. 162-42-1-5, I of Article R. 162-42-1-6 and R. 162-42-1-7.
The Minister of Finance and Public Accounts and the Minister of Social Affairs, Health and Women ' s Rights are responsible for the execution of this Order, which will be published in the Official Journal of the French Republic.
Done on 30 December 2014.
Manuel Valls
By the Prime Minister:
Minister of Social Affairs, Health and Women ' s Rights,
Marisol Touraine
Minister of Finance and Public Accounts,
Michel Sapin
