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Decree Of January 13, 2015, Establishing The List Of Health Care Experimenters Of Individual Billing Of Hospital Care To Insurance Compulsory Health As Well As The Perimeter Of Billing Conce...

Original Language Title: Arrêté du 13 janvier 2015 fixant la liste des établissements de santé expérimentateurs de la facturation individuelle des prestations de soins hospitaliers aux caisses d'assurance maladie obligatoire ainsi que le périmètre de facturation conce...

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JORF n°0031 of 6 February 2015 page 1759
text No. 67



Judgment of January 13, 2015 setting out the list of experimental health facilities for the individual billing of hospital benefits to compulsory health insurance funds and the billing perimeter for each of these health facilities

NOR: AFSZ1502478A ELI: https://www.legifrance.gouv.fr/eli/arrete/2015/1/13/AFSZ1502478A/jo/texte


Minister of Finance and Public Accounts and Minister of Social Affairs, Health and Women's Rights,
Vu le Social Security Codeincluding articles L. 162-22-6 and L. 174-2;
Vu la Act No. 2003-1199 of 18 December 2003 the financing of social security for 2004, including article 33;
Vu la Act No. 2008-1330 of 17 December 2008 Social Security Funding for 2009, including Article 54;
Vu le Decree No. 2011-1217 of 29 September 2011 on the experimentation of the individual billing of health facilities a, b and c of Article L. 162-22-6 of the Social Security Codeincluding article 11;
In light of the amended decision of 23 January 2008 on the modalities for the payment of resources from public health institutions and institutions referred to in a, b and c of Article L. 162-22-6 of the Social Security Codeincluding article 3,
Stop:

Article 1 Learn more about this article...


In application of theArticle 11 of Decree No. 2011-1217 of 29 September 2011, the list of the experimental health institutions concerned by a start-up of the individual billing experiment of the acts and consultations external to the health insurance funds on 1 January 2015 and the scope of this experiment are set out in Appendix 1 to this Order.
As soon as the date of care is after December 31, 2014, the activity data referred to in section 3 of the decision of January 23, 2008 relating to the terms and conditions for the payment of the resources of public health institutions and institutions referred to in a, b and c of Article L. 162-22-6 of the Social Security Code by compulsory health insurance funds mentioned in theArticle R. 174-1 of the Social Security Code are no longer valued.
As a result, no amount is included in the monthly order of the Director General of the Regional Health Agency to fix the activity elements referred to in section 5 of the above-mentioned Order.
The amount taken into account for the determination of the payments referred to in 1° and 2° of I of Article 7 of the above-mentioned Order must be reduced by the share of this activity data for payments made as of February 2015.

Article 2 Learn more about this article...


In application of theArticle 11 of Decree No. 2011-1217 of 29 September 2011, the list of the experimental health institutions concerned by a start-up of the individual billing experiment of the acts and consultations external to the health insurance funds on 1 February 2015 and the scope of this experiment are set out in Appendix 2 to this Order.
As soon as the date of care is after January 31, 2015, the activity data referred to in the g of section 3 of the decision of January 23, 2008 on the terms and conditions for the payment of the resources of public health institutions and institutions referred to in a, b and c of Article L. 162-22-6 of the Social Security Code by compulsory health insurance funds mentioned in theArticle R. 174-1 of the Social Security Code are no longer valued.
As a result, no amount is included in the monthly order of the Director General of the Regional Health Agency to fix the activity elements referred to in section 5 of the above-mentioned Order.
The amount taken into account for the determination of the payments referred to in 1° and 2° of I of Article 7 of the above-mentioned Order must be reduced by the share of this activity data for payments made as of March 2015.

Article 3 Learn more about this article...


In Appendix 1 of the October 2, 2014 Order setting out the list of health facilities experimenting with the individual billing of hospital care benefits to health insurance funds and the billing perimeter for each health facility, the date of July 1, 2014 is replaced by the date of October 1, 2014.

Article 4 Learn more about this article...


The Director General of the Care Offer, the Director of Social Security and the Director General of Public Finance are responsible for the execution of this Order, which will be published in the Official Journal of the French Republic.

  • Annex


    ANNEXES
    Annex 1
    LIST OF HEALTH EXPERITURES CONCERNED BY A DRAFT EXPERITURE ON 1st JANUARY 2015 IN IMPLEMENTATION OF THE ARTICLE 1ER OF THE PRESENT ARREST AND PERIODY OF CELLE-CI


    Fines legal

    880007059

    Fines
    geographical

    880006663
    880000021

    Establishment

    CHI EMILE DURKHEIM EPINAL

    Accounting code

    088022

    City
    of the Accountant

    HOSPITAL MANAGEMENT

    CPU Code

    542

    Libellé CPU

    Meurthe-et-Moselle

    Perimeter
    Billing

    Individual billing includes the following hospital care services:
    - external acts and consultations referred to inArticle L. 162-26 of the Social Security Codeincluding technical imaging packages;
    - Retrocession of drugs;
    - the billing of UNMCC and the benefits to migrants;
    - for AME recipients: external consultations and actions, ATU, FFM, SE and APE packages and IVG packages.
    Not included in the perimeter of the individual billing:
    - external acts and consultations carried out in the context of the liberal activity of full-time hospital practitioners;
    - ATU, FFM, SE and APE packages that continue to be funded through payment orders for social insured persons and are to be sent in direct billing only for AAME beneficiaries;
    - consultations or actions associated with the packages mentioned in the 2°, 4°, 5° and 6° of article R. 162-32 of the Social Security Code (ATU, FFM, SE and APE).

  • Annex


    Annex 2


    LIST OF HEALTH EXPERITURES CONCERNED BY A DRAFT EXPERITURE ON 1st FEBRUARY 2015 IN IMPLEMENTATION OF ARTICLE 2 OF THE PRESENT ARREST AND PERIODY OF CELLE-CI


    Fines legal

    670780345

    Fines
    geographical

    670000165

    Establishment

    CH SAINTE-CATHERINE DE SAVERNE

    Accounting code

    067124

    City of Accountant

    SAVERNE COLLECTIVITIES

    CPU Code

    2681

    Libellé CPU

    MSA Alsace

    Perimeter
    Billing

    Individual billing includes the following hospital care services:
    - external acts and consultations referred to inArticle L. 162-26 of the Social Security Codeincluding technical imaging packages;
    - Retrocession of drugs;
    - the billing of UNMCC and the benefits to migrants;
    - for AME recipients: external consultations and actions, ATU, FFM, SE and APE packages and IVG packages.
    Not included in the perimeter of the individual billing:
    - external acts and consultations carried out in the context of the liberal activity of full-time hospital practitioners;
    - the ATU, FFM, SE and APE packages, which continue to be funded through the payment orders for social insured persons and are to be sent in direct billing only for AAME beneficiaries;
    - consultations or actions associated with the packages mentioned in the 2°, 4°, 5° and 6° of article R. 162-32 of the Social Security Code (ATU, FFM, SE and APE).


Done on January 13, 2015.


Minister of Social Affairs, Health and Women ' s Rights,

For the Minister and by delegation:

The Chief of Service, Assistant to the Director of Social Security,

F. Godineau

The Deputy Director of Management of the Performance of Care Providers,

Y. The Guen


Minister of Finance and Public Accounts,

For the Minister and by delegation:

The Head of Local Government Service to the General Directorate of Public Finance,

N. Biquard


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