Key Benefits:
Public concerned: health institutions, regional health agencies.
Purpose: modalities for the implementation of the contract to improve health practices.
Entry into force: the text comes into force on the day after its publication.
Notice: The aim of the contract to improve health practices is to support the least-performing institutions in terms of the quality and safety of certain practices.
This decree specifies the modalities for the implementation of this contract. In particular, it defines the three risks (infective risk, drug risk and risk of rupture of course) as the basis for defining the objectives of the contract as well as the rules that the penalties may be applied when the objectives set are not met or when the establishment refuses to sign the contract.
References: this decree is taken for the application of theArticle 51 of Act No. 2014-1554 of 22 December 2014 Social Security Funding for 2015. The provisions of Social Security Code Amended by this decree may be consulted, in their writing resulting from this amendment, 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 Code ;
Vu le Social Security Codeincluding article L. 162-30-3;
Having regard to the advice of the Board of the National Health Insurance Fund of Employees dated 8 September 2015;
Having regard to the advice of the National Union of Health Insurance Funds Council dated 17 September 2015;
Considering the opinion of the Central Board of Directors of the Agricultural Social Mutuality of October 21, 2015;
The State Council (Social Section) heard,
Decrete:
In section 5 of chapter II of title VI of Book I of the Social Security Code, after article R. 162-44-5, a sub-section 6 is inserted as follows:
"Subsection 6
"Competition to Improve Practices in Health Institutions
"Art. R. 162-45.-The regional health agency shall, at least every two years, appreciate the quality and safety of health care facilities referred to in Article L. 162-22-6 with respect to the following risks:
« 1° Infectious risk measured by indicators of infection associated with care;
« 2° The drug risk measured by indicators for patient therapeutic care;
« 3° The risk of rupture of patient care paths measured by indicators related to the organization and continuity of care.
"An Order of Ministers for Health and Social Security sets out, after the advice of the High Health Authority, the national indicators for the quality and safety of care taken into account in assessing the risks mentioned, as well as the limits to be reached by institutions.
"Art. R. 162-45-1.-I.-When the regional health agency finds that an establishment referred to in 1° of Article L. 162-22 does not reach one or more of the values fixed by the order referred to in Article L. 162-30-3, it shall notify the establishment of the risks identified by any means to report evidence of its date of receipt.
"The establishment has a period of thirty days, upon receipt of the notification from the regional agency, to propose a draft contract to improve practices with the commitments referred to in R. 162-45-2.
"When the health care establishment has not proposed a draft contract, it is proposed by the Director General of the regional health agency within 30 days of the expiry of the period specified in the second paragraph.
"In a period of thirty days after receipt by the agency of the proposed contract proposed by the health establishment or after receipt by the health establishment of the proposed contract or, where applicable, as amended by the agency, the Director General of the regional health agency and the legal representative of the health establishment sign the contract to improve health-care practices for a maximum period of four years, after notice of the medical establishment conference or
"II.-In the event of an establishment's refusal to sign the contract, the Director General of the Regional Health Agency may, after placing the institution in a position to submit its observations, issue a financial penalty commensurate with the magnitude and severity of the breaches of the quality and safety objectives of the care referred to in section R. 162-45 and set within the limit of 1% of the products received by the health care establishment on the part of the mandatory health insurance plans The penalty is notified to the establishment by reasoned order of the Director General of the Regional Health Agency.
"The Director of the Regional Health Agency shall make his decision as soon as possible to the credit union referred to in articles L. 174-2, L. 174-18 or L. 752-1 in charge of the recovery of dues.
"Art. R. 162-45-2.-I.-The contract for improvement of health-care practices, in accordance with the Model Contract referred to in Article L. 162-30-3, sets out its timetable for implementation, qualitative and quantitative objectives for improving the quality and safety of care, the action plan for achieving them.
"Each year, the health care institution informs the regional health agency of the achievement of the objectives in the time frame set. In the event of non-compliance by the institution, the Director General of the Regional Health Agency maintains the establishment to reduce discrepancies within a maximum period of one year.
"II.-A at the end of the period set, in the event of non-compliance by the institution, the Director General of the Regional Health Agency may impose a penalty against him for a fraction of the amount of products paid by the health insurance in the last year of the contract, proportionate to the extent and severity of the breaches observed and within 1% of those products.
"III.-The penalty is calculated according to the number of untreated risks in the contract for improvement of practices and the degree of implementation of improvement actions by the institution.
"The maximum amount of penalties that may be retained is set out in the following table:
| Improvement actions | |||
| Not at all implemented | 0.33 per cent | 0.66% | 1 per cent |
| Partially implemented | 0.16% | 0.33 per cent | 0.50 per cent |
| Full implementation | 0 per cent | 0 per cent | 0 per cent |
"The amount of the proposed penalty shall be communicated to the establishment by any means to report the evidence of the date of receipt. The facility transmits its written comments, in the same form, to the regional health agency within 30 days of this receipt. The penalty is determined by a reasoned order of the Director General of the Regional Health Agency. This order is notified to the institution.
"The Director General of the Regional Health Agency shall make his decision known as soon as possible to the credit union referred to in articles L. 174-2, L. 174-18 or L. 752-1 in charge of the recovery of dues. »
It is added, after the 5th of Article R. 161-73 of the Social Security Code, a 6th such written:
« 6° Provides advice on national indicators of quality and safety of care taken into account to assess the risks identified inArticle R. 162-45 of the Social Security Code and the limit values to health facilities. »
The Minister of Finance and Public Accounts, the Minister of Social Affairs, Health and Women's Rights and the Secretary of State responsible for the budget are responsible, each with regard to him, for the execution of this decree, which will be published in the Official Journal of the French Republic.
Done on November 19, 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
The Secretary of State in charge of the budget,
Christian Eckert
