#SPRH2334455AOrder of December 19, 2023, Setting Transitional Financing Rules for Rehabilitation Care Activities
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This law establishes transitional financing rules for rehabilitation care activities within the healthcare system in France, aimed at improving the clarity and efficiency of financial resources allocation. It revises previous regulations by modifying certain articles related to the calculation of hospital stay tariffs and reimbursement rates, thereby adjusting how health insurance reimbursements are processed. The changes apply to various healthcare establishments, including civilian hospitals and military healthcare services, ensuring that all relevant parties are adequately funded during the transitional period.
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Key Changes
- Introduction of new calculation methods for hospital stay tariffs and reimbursement rates.
- Modification of existing articles to include additional financial provisions.
- Clarification of funding mechanisms for both civilian and military healthcare establishments.
Obligations
What this law requires
Healthcare establishments must apply the GMT (tarif des séjours) multiplied by geographic coefficient (CG), prudential coefficient (CP), specialization coefficient (CSP), charge relief coefficient (CAC), and salary revaluation coefficient (CS) when calculating reimbursement amounts for rehabilitation care activities
Health insurance funds (caisses d'assurance maladie) must calculate and pay monthly allocations equal to one-twelfth of annual dotations, with specific fractional payment schedules: 60% by the 20th of the month, 15% by the 5th of the following month, and 25% by the 15th of the following month
Healthcare establishments must differentiate reimbursement calculations based on patient ticket modérateur exemption status and daily hospitalization fee exemption status, applying the appropriate formula for each of five patient categories outlined in Annex III
Pharmaceutical specialties and medical devices mentioned in Article L. 162-22-7 of the Social Security Code must be valued at either purchase price plus a portion of compensable margin (when purchase price is below reference tariff) or at reference tariff (when below purchase price)
The provisions of Title III apply to establishments mentioned in articles a, b, and c of Article L. 162-22-6 of the Social Security Code and military hospitals, with certain exceptions for articles 4 and 5 section III which also apply to establishments in articles d and e