Key Benefits:
Publics concerned: health institutions and insured of compulsory health insurance plans.
Purpose: Invoicing and care for hospital benefits without hospitalization.
Entry into force: the text comes into force on the day after its publication, with the exception of Article 1 which comes into force on October 1, 2015.
Notice: This Order amends several rules relating to the invoicing and care by the health insurance of hospital benefits without hospitalization (reception and emergency treatment packages, small equipment, safety and environment and administration of products and services in the hospital environment).
It opens a new two-month period allowing the National Union of Health Insurance (UNCAM) to make a decision regarding the rate of health insurance coverage of hospital benefits without hospitalization and the acts and consultations associated with them, within the limits defined in the 12° and 13° of Article R. 322-1 of the Social Security Code. If there is no decision of UNCAM within this two-month period, the applicable rate of care will be determined by order of the Minister for Social Security.
The purpose of the Order is also to harmonize the regulations applicable to public and private health institutions regarding the prohibition of charging nursing services in addition to hospital services without hospitalization.
References: the provisions of Social Security Code Amended by this decree can be found 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 Social Security Codeincluding articles L. 162-22-6 and L. 322-2;
Having regard to the advice of the Federation of Hospitals and Private Non-profit Assistance dated 8 December 2014;
Considering the opinion of the French Hospital Federation of 12 December 2014;
Considering the opinion of the French Federation of Cancer Control Centres (Unicancer) of 12 December 2014;
Considering the opinion of the Private Hospital Federation of 14 December 2014;
Considering the opinion of the Central Board of Directors of the Agricultural Social Mutuality of 27 April 2015;
Having regard to the advice of the Board of the National Health Insurance Fund for Employees dated 5 May 2015;
Considering the opinion of the Commission on Industrial Accidents and Occupational Diseases of 13 May 2015;
Having regard to the advice of the Council of the National Health Insurance Union dated 21 May 2015;
Having regard to the opinion of the National Federation of Home Hospitals of 23 June 2015;
The State Council (Social Section) heard,
Decrete:
At the 3rd of Article R. 162-32-1 of the Social Security Code, after the words: "to the consultations and the acts carried out in these establishments", the words are inserted: "to the exclusion of those relating to nursing".
Article R. 322-1 of the Social Security Code is amended as follows:
1° At 12°, the words "and 5°" are replaced by the words ", 5° and 6°";
2° At 13°, the words "reported to 3° of Article R. 162-32-1" are deleted.
Derogation from provisions of the last paragraph of Article R. 322-9-4 of the Social Security Code, the Union nationale des caisses d'assurance maladie fixes, in accordance with the provisions of the first two paragraphs of the same article, the participation of the insured in the I of Article L. 322-1 of the same code for the packages mentioned in the 2°, 4°, 5° and 6° of Article R. 162-32 of this code and for the acts and consultations invoiced in addition to these plans, within the limits
In the absence of a decision by the Council of the National Health Insurance Union within the time limit provided for in the first paragraph, the applicable rates shall be fixed within the limits provided for in the 12° and 13° of Article R. 322-1 of the Social Security Code, by an order of the Minister for Social Security published in the Official Journal of the French Republic.
To first and third paragraphs of Article R. 322-11-2 of the Social Security Code, the reference to section R. 332-11-1 is replaced by the reference to section R. 322-11-1.
The provisions of Article 1 come into force on October 1, 2015.
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 July 21, 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
