Key Benefits:
Public concerned: health institutions, regional health agencies.
Purpose: Derogatory funding for geographically isolated health facilities.
Entry into force: the text comes into force on the day after its publication.
Notice: isolated health institutions geographically benefit from derogatory funding in addition to that resulting from the activity pricing rules, intended to take into account their specificity.
The purpose of this Order is to determine the eligibility criteria for health care institutions for this derogatory funding, as well as the terms and conditions of this funding that will be part of contractual commitments with the regional health agency.
References: the provisions of the Social Security Code as amended by this Decree may be consulted, in their drafting resulting from this amendment, on the Légifrance website (http:// www. legifrance. gouv. en).
The Prime Minister,
On the report of the Minister of Social Affairs, Health and Women ' s Rights,
Vu the Public Health Code, including articles L. 1435-8 and L. 6114-1;
Vu the Social Security Code, including articles L. 162-22-6 and L. 162-22-8-1;
Having regard to the advice of the Board of the National Health Insurance Fund of Employees dated 23 September 2014;
Having regard to the advice of the Council of the National Health Insurance Union dated 2 October 2014;
Considering the central board of directors of the Agricultural Social Mutuality dated 2 October 2014;
Considering the opinion of the Industrial Accidents and Occupational Diseases Commission of 8 October 2014;
The State Council (Social Section) heard,
Decrete:
In subsection 2 of chapter II, section 5, title VI, of Book I of the Social Security Code, after section R. 162-42-7, an article R. 162-42-7-1 is added as follows:
"Art. R. 162-42-7-1.-I.-For the purposes of the provisions of Article L. 162-22-8-1, a care activity is considered to be geographically isolated and carried out by an establishment located in a low population density area, where it is carried out by a health institution authorized to carry out this activity under the provisions of 1°, 2°, 3° or 14° of Article R. 6122-25 publically satisfied
« 1° The establishment is located in a territory, defined as all of the places from which it is possible to reach the establishment by a road trip in automobiles of less than or equal to 45 minutes, comprising health facilities including the sum of the medical, surgical and gynaecology-obstetric activities, deducting from those produced by the establishment in question, does not exceed a ceiling level. The length of the road trip to the car is measured taking into account the travel times at full hours and at hollow times;
« 2° The length of the road journey by car, measured under the conditions set out in 1°, between this establishment and the nearest establishment carrying the same activity is greater than the threshold set for that activity;
« 3° For obstetric care activity, the share of the activity produced by the establishment exceeds a fraction of the obstetric activity produced in the attrition area defined in 4°;
« 4° The population density of the facility's attrition zone, defined as all the municipalities of the department or the neighbouring departments in which the patient is resident and whose stays represent at least 80% of the overall activity produced by the establishment, does not exceed a ceiling level.
"II.-The activities that meet the criteria for the isolation and placement of the facility that applies to them in I and which the Director General of the Regional Health Agency notes, after analysis of the existing care offer, its predictable evolution in the territory referred to in 1° of the I, and the financial situation of the institution, that the maintenance is necessary to ensure access to care or continuity of care, benefit from a national funding complement to the care services
"This funding is made up of a fixed portion paid in the form of annual national plans per activity and a variable portion paid in the form of a grant from the regional intervention fund.
"The list of institutions eligible for this funding is set, for each region, by ministers responsible for health and social security on the proposal of the Director General of the Regional Health Agency for a period of five years. This list is revisable every year.
"The list and the amendments come into force on March 1 after their publication.
"Proposals to amend the list are transmitted annually by the Directors General of the Regional Health Agencies to the Ministry of Health before February 1.
"When the Director General of the Regional Health Agency is considering proposing the exclusion of an establishment on the list, he must notify the institution beforehand and ask him to make his observations known within fifteen days in response.
"III.-For the calculation of annual national plans, activity thresholds, determined on the basis of national data, are taken into account from the information system provided for in sections L. 6113-7 and L. 6113-8 of the Public Health Code, allowing the balance of charges and products related to the exercise of the activity. The value of packages varies depending on the difference between these activity thresholds and the activity produced by the establishment.
"The value of these packages, which may be zero, shall be determined in the manner defined in the first paragraph of Article R. 162-42-1.
"The annual payment for the packages shall be determined for each institution by the Director General of the Regional Health Agency under the conditions set out in R. 162-42-4. The allocation of this annual package is subject to compliance by the establishment of commitments, including on the conditions for the maintenance of the activity in the territory defined in 1° I or on the cooperative actions to be carried out and, where applicable, on the improvement of its financial situation. These commitments are included in the multi-year contract of objectives and means set out in sections L. 6114-1 and L. 6114-2 of the Public Health Code.
"IV.-For the calculation of the allocation of the Regional Response Fund in II, it is taken into account the fulfilment of the commitments in III and, where applicable, specific factors related to isolation costs, including those relating to the conditions of employment of staff. The amount of this allocation, which may be null, is determined by the Director General of the Regional Health Agency pursuant to section L. 1435-8 of the Public Health Code.
"V.-The cumulative annual amount of packages and endowments that an institution benefits under the provisions of section L. 162-22-8-1 shall not exceed a limit set as a percentage of the products of the hospital activity financed by the health insurance collected by the institution, after deducting the amount of the funding of the missions of general interest and assistance to the contractualization referred to in section L. 162-22-14 and
"These packages and allowances are paid under the conditions set out in section R. 162-42-4.
"The terms and conditions for the distribution of the amounts paid in this respect by the mandatory health insurance plans are fixed by a decree of the ministers responsible for health and social security under the conditions laid down in Article L. 175-2.
"VI.- Orders of Ministers for Health and Social Security specify the conditions for the application of this Article, including:
« 1° The level of activity ceiling mentioned at 1° of I;
« 2° Methods for calculating the journey durations mentioned in 1° and 2° of I;
« 3° The thresholds mentioned in 2° of I;
« 4° The fraction of activity planned for 3° of I;
« 5° The ceiling level of population density mentioned at 4° of I;
« 6° Activity thresholds in III;
« 7° Methods for calculating the annual plans set out in III;
« 8° The ceiling of the cumulative annual amount of the packages and endowments referred to in V."
I.-A Article R. 162-42-4 of the Social Security Code, the first paragraph is supplemented by the words: "as well as, where applicable, the plans and allocations under Article L. 162-22-8-1. »
II.-A section R. 1435-17 of the Public Health Code, it is added a paragraph to read as follows:
« 7° Endowments to health facilities pursuant to Article II R. 162-42-7-1 of the Social Security Code. »
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 February 17, 2015.
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
