Key Benefits:
Public concerned: High Health Authority, regional health agencies, health institutions.
Purpose: funding to improve the quality and safety of care.
Entry into force: the text comes into force on January 1, 2016.
Notice: This draft decree sets out the conditions for the eligibility of health facilities for supplementary funding on improving the quality and safety of care provided for in Article L. 162-22-20 of the Social Security Code. It also sets out the procedures for determining the amount of staffing for each institution.
References: the provisions of the Social Security Code as amended by 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,
Considering the Public Health Code, including articles L. 6113-3, L. 6144-1 and L. 6161-2;
Considering the social security code, including its article L. 162-22-20;
Having regard to the opinion of the National Health Insurance Fund for Employees dated 15 December 2015;
Considering the opinion of the Central Board of Directors of the Agricultural Social Mutuality of 15 December 2015;
Having regard to the advice of the Council of the National Health Insurance Union dated 17 December 2015;
The State Council (Social Section) heard,
Decrete:
Sub-section 6 of chapter II, section 5, title VI of Book I (regulatory party-decrees in the Council of State) of the Social Security Code is amended as follows:
1° The title of subsection 6 is replaced by the following title:
"Subsection 6
"Improving the quality and safety of care"
2° After the article R. 162-45-2, three articles were added:
"Art. R. 162-45-3.-Health institutions carrying out the activities referred to in 1° of Article L. 162-22 are eligible for the supplementary staffing referred to in Article L. 162-22-20 when they meet, as of 15 November of the calendar year under review, the following cumulative conditions:
« 1° be certified by the High Health Authority following the procedure referred to in Article L. 6113-3 of the Public Health Code, with the required level of certification;
« 2° A compendium of all mandatory indicators, the list of which is decided by the ministers responsible for health and social security before 1 December prior to the calendar year in question. This decree identifies mandatory indicators:
“(a) Those whose results must be made available to the public under articles L. 6144-1 and L. 6161-2 of the Public Health Code;
“(b) Those retained for the calculation of the amount of the supplementary endowment;
« 3° Not having been the subject of an invalidation by the regional health agency of the collection of one or more of the indicators selected for the calculation of the amount of staffing under section R. 162-45-4 as part of the quality control of the data reported by the health establishment.
"Art. R. 162-45-4.-I.-The amount of the supplementary staffing provided for in section L. 162-22-20 for each health institution meeting the eligibility criteria referred to in section R. 162-45-3 is determined on the basis of:
« 1° Results of the establishment with respect to the appropriate evaluation criteria, consisting of the mandatory indicators mentioned in b of 2° of R. 162-45-3 and the level of certification of the establishment. These criteria can be weighted;
« 2° From the evolution of the facility's results to the criteria mentioned in the previous paragraph measured in the calendar year as compared to the last available measures. These criteria can be weighted;
« 3° From the activity produced by the health establishment, measured by the financial amount corresponding to the valuation of the activity produced by the establishment in the calendar year preceding the year under review on the basis of the national tariffs referred to in Article L. 162-22-10.
"II.-In accordance with the order referred to in R. 162-45-5, each eligible establishment is assigned a rate of pay associated with the aggregate results mentioned in 1° and 2° of I, or a rate associated with the results of the establishment referred to in 1° of I and a rate of pay associated with the evolution of the results mentioned in 2° of I.
"The amount of the endowment allocated to each institution is determined by the application of this or these rates of pay to the financial amount referred to in 3° of I.
"III.-At the latest on December 15 of the calendar year under review, the Director General of the Regional Health Agency shall determine, for each institution, the amount of the additional staffing allocated to it. This amount is paid in one time by the primary health insurance fund under sections L. 174-2 and L. 174-18.
"Art. R. 162-45-5.-A joint decree of ministers responsible for health and social security shall determine, after the advice of the High Health Authority, no later than 31 December of the year preceding the calendar year in question:
« 1° The level of certification required for the application of Article R. 162-45-3;
« 2° The weighting coefficients applied to the criteria mentioned in 1° and 2° of Article R. 162-45-4;
« 3° The terms and conditions of determination and the value of the rates of pay referred to in II of Article R. 162-45-4, which may be expressed as a range and may be differentiated according to the perimeter of the available results of the mandatory indicators referred to in 2° of Article R. 162-45-3;
« 4° The floor amount and the ceiling of the allocation for each institution.
"This Order, which may be multi-year, may be amended where there is a serious risk of overtaking the national objective of health insurance expenditures, as found under the conditions set out in Article L. 162-22-10, II bis. »
I. - The provisions of this Order come into force from 2016.
II. - For the year 2016, the decrees mentioned in articles R. 162-45-3 and R. 162-45-5 are published within three months of the publication of this decree.
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 December 30, 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
