#SPRH2235892AOrder on Payment Modalities for Health Establishments by Social Security Funds
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This law outlines the payment modalities for various health establishments in France, specifically detailing how payments are calculated and distributed by social security funds. It establishes criteria for reimbursement based on the type of care provided, including hospital stays and healthcare services, and specifies the roles of the different health agencies involved. The law aims to standardize and improve the financial management of health services within the framework of the national health insurance system.
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Key Changes
- Introduction of new reimbursement calculations for hospital stays and healthcare services.
- Standardization of financial management procedures for health establishments.
- Detailed responsibilities of health agencies in processing payments.
Obligations
What this law requires
Health establishments must transmit monthly data on activities (medicine, gynecology-obstetrics, dentistry, psychiatry, follow-up care, rehabilitation) and pharmaceutical consumption to the regional health agency (ARS) or ARS Ile-de-France for military hospitals, accompanied by anonymized patient administrative information, by the end of the month following the month being reported.
Health establishments must transmit activity data for the previous exercise or preceding months that could not be submitted at the initial deadline or require corrections, within the timeframe defined in article L. 162-25 of the social security code.
Payment calculations for health establishments must apply the specified coefficients (geographic coefficient CG, prudential coefficient CP, charge relief coefficient CAC, and salary revaluation coefficient CS/Ségur) to the GHS tariff according to the patient's co-payment exemption status and daily hospitalization forfait amounts.
Social security funds must calculate reimbursement amounts (M_AMO) using differentiated formulas depending on patient co-payment status: patients with 20% co-payment, exempted patients, patients with flat 24€ co-payment, and fully covered patients.
Hospitalization data, pharmaceutical consumption, products and services data related to MCO activities, as well as non-reimbursed external consultations and procedures must be transmitted but not valued in payment calculations.