{ "article": { "LEGIARTI000006758955": { "META": { "META_SPEC": { "META_ARTICLE": { "NUM": "27", "TYPE": "ENTIEREMENT_MODIF", "DATE_FIN": "2999-01-01", "DATE_DEBUT": "2999-01-01" } }, "META_COMMUN": { "ID": "LEGIARTI000006758955", "URL": "article/LEGI/ARTI/00/00/06/75/89/LEGIARTI000006758955.xml", "NATURE": "Article", "ORIGINE": "LEGI", "ANCIEN_ID": "SSEAFIXXXXX027AXXXXXXXAA" } }, "LIENS": { "LIEN": [ { "@id": "LEGIARTI000006742462", "@num": "L315-1", "#text": "Code de la sécurité sociale. - art. L315-1 (M)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "MODIFICATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006742468", "@num": "L315-2", "#text": "Code de la sécurité sociale. - art. L315-2 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "MODIFICATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006742470", "@num": "L315-2-1", "#text": "Code de la sécurité sociale. - art. L315-2-1 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "MODIFICATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006742474", "@num": "L321-2", "#text": "Code de la sécurité sociale. - art. L321-2 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "MODIFICATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006742520", "@num": "L323-6", "#text": "Code de la sécurité sociale. - art. L323-6 (M)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CREATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" } ] }, "CONTEXTE": { "TEXTE": { "TM": { "TM": { "TITRE_TM": [ { "@id": "LEGISCTA000006127138", "@fin": "2999-01-01", "#text": "Section 3 : Recours aux soins.", "@debut": "2004-08-17" } ] }, "TITRE_TM": [ { "@id": "LEGISCTA000006106348", "@fin": "2999-01-01", "#text": "TITRE Ier : DISPOSITIONS RELATIVES À L'ORGANISATION DE L'OFFRE DE SOINS ET À LA MAÎTRISE MÉDICALISÉE DES DÉPENSES DE SANTÉ", "@debut": "2004-08-17" } ] }, "@cid": "JORFTEXT000000625158", "@nor": "SANX0400122L", "@num": "2004-810", "@nature": "LOI", "TITRE_TXT": [ { "@fin": "2999-01-01", "#text": "LOI n° 2004-810 du 13 août 2004 relative à l'assurance maladie (1)", "@debut": "2999-01-01", "@id_txt": "JORFTEXT000000625158", "@c_titre_court": "Loi n°2004-810 du 13 août 2004" }, { "@fin": "2999-01-01", "#text": "Loi n° 2004-810 du 13 août 2004 relative à l'assurance maladie (1)", "@debut": "2004-08-17", "@id_txt": "LEGITEXT000005824192", "@c_titre_court": "Loi n° 2004-810 du 13 août 2004" } ], "@date_publi": "2004-08-17", "@date_signature": "2004-08-13" } }, "VERSIONS": { "VERSION": [ { "LIEN_ART": { "@id": "LEGIARTI000006758955", "@fin": "2999-01-01", "@num": "27", "@debut": "2999-01-01", "@origine": "LEGI" } } ] }, "BLOC_TEXTUEL": { "CONTENU": "a modifié les dispositions suivantes
\n
" } }, "LEGIARTI000006742462": { "META": { "META_SPEC": { "META_ARTICLE": { "NUM": "L315-1", "ETAT": "MODIFIE", "TYPE": "AUTONOME", "DATE_FIN": "2005-01-01", "DATE_DEBUT": "2004-08-17" } }, "META_COMMUN": { "ID": "LEGIARTI000006742462", "URL": "article/LEGI/ARTI/00/00/06/74/24/LEGIARTI000006742462.xml", "NATURE": "Article", "ORIGINE": "LEGI", "ANCIEN_ID": "SSAXXXXXXXX1X315L01AXXAD" } }, "LIENS": { "LIEN": [ { "@id": "LEGIARTI000006768245", "@num": "11", "#text": "Décret n°53-953 du 30 septembre 1953 - art. 11 (VT)", "@sens": "cible", "@cidtexte": "JORFTEXT000000299485", "@numtexte": "53-953", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "1953-09-30" }, { "@id": "JORFTEXT000000514653", "#text": "Décret 68-401 1968-04-30 art. 1 al. 2", "@sens": "source", "@cidtexte": "JORFTEXT000000514653", "@numtexte": "68-401", "@typelien": "CONCORDANCE", "@naturetexte": "DECRET", "@datesignatexte": "1968-04-30" }, { "@id": "LEGIARTI000032078893", "@num": "9", "#text": "Ordonnance n° 77-1102 du 26 septembre 1977 - art. 9 (M)", "@sens": "cible", "@cidtexte": "JORFTEXT000000699946", "@numtexte": "77-1102", "@typelien": "CITATION", "@naturetexte": "ORDONNANCE", "@datesignatexte": "1977-09-26" }, { "@id": "JORFTEXT000000866621", "#text": "Décret 85-1353 1985-12-17", "@sens": "source", "@cidtexte": "JORFTEXT000000866621", "@numtexte": "85-1353", "@typelien": "CODIFICATION", "@naturetexte": "DECRET", "@datesignatexte": "1985-12-17" }, { "@id": "LEGIARTI000006789710", "@num": "3", "#text": "Arrêté du 8 décembre 1994 - art. 3 (M)", "@sens": "cible", "@cidtexte": "JORFTEXT000000734106", "@nortexte": "SPSS9403800A", "@typelien": "CITATION", "@naturetexte": "ARRETE", "@datesignatexte": "1994-12-08" }, { "@id": "LEGIARTI000025022467", "@num": "23-1", "#text": "Ordonnance n°96-1122 du 20 décembre 1996 - art. 23-1 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000000368749", "@nortexte": "DOMX9600135R", "@numtexte": "96-1122", "@typelien": "CITATION", "@naturetexte": "ORDONNANCE", "@datesignatexte": "1996-12-20" }, { "@id": "LEGIARTI000006758954", "@num": "26", "#text": "Loi n°2004-810 du 13 août 2004 - art. 26 () JORF 17 août 2004", "@sens": "source", "@cidtexte": "JORFTEXT000000625158", "@nortexte": "SANX0400122L", "@numtexte": "2004-810", "@typelien": "MODIFICATION", "@naturetexte": "LOI", "@datesignatexte": "2004-08-13" }, { "@id": "LEGIARTI000006758955", "@num": "27", "#text": "Loi n°2004-810 du 13 août 2004 - art. 27 () JORF 17 août 2004", "@sens": "source", "@cidtexte": "JORFTEXT000000625158", "@nortexte": "SANX0400122L", "@numtexte": "2004-810", "@typelien": "MODIFICATION", "@naturetexte": "LOI", "@datesignatexte": "2004-08-13" }, { "@id": "LEGIARTI000006758977", "@num": "48", "#text": "Loi n°2004-810 du 13 août 2004 - art. 48 () JORF 17 août 2004", "@sens": "source", "@cidtexte": "JORFTEXT000000625158", "@nortexte": "SANX0400122L", "@numtexte": "2004-810", "@typelien": "MODIFICATION", "@naturetexte": "LOI", "@datesignatexte": "2004-08-13" }, { "@id": "LEGIARTI000026514356", "@num": "31", "#text": "Décret n°2004-942 du 3 septembre 2004 - art. 31 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000000253592", "@nortexte": "SANS0422327D", "@numtexte": "2004-942", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2004-09-03" }, { "@id": "LEGIARTI000006726171", "@num": "32", "#text": "Décret n°2004-942 du 3 septembre 2004 - art. 32 (Ab)", "@sens": "cible", "@cidtexte": "JORFTEXT000000253592", "@nortexte": "SANS0422327D", "@numtexte": "2004-942", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2004-09-03" }, { "@id": "LEGIARTI000006726172", "@num": "33", "#text": "Décret n°2004-942 du 3 septembre 2004 - art. 33 (Ab)", "@sens": "cible", "@cidtexte": "JORFTEXT000000253592", "@nortexte": "SANS0422327D", "@numtexte": "2004-942", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2004-09-03" }, { "@id": "LEGIARTI000026596555", "@num": "Annexe", "#text": "Arrêté du 21 juin 2006 - art. 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I. - Le contrôle médical porte sur tous les éléments d'ordre médical qui commandent l'attribution et le service de l'ensemble des prestations de l'assurance maladie, maternité et invalidité.
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II. - Le service du contrôle médical constate les abus en matière de soins, de prescription d'arrêt de travail et d'application de la tarification des actes et autres prestations.
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III. - Le service du contrôle médical procède à l'analyse, sur le plan médical, de l'activité des établissements de santé mentionnés aux articles L. 162-29 et L. 162-29-1 dans lesquels sont admis des bénéficiaires de l'assurance maladie.
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IV. - Il procède également à l'analyse, sur le plan médical, de l'activité des professionnels de santé dispensant des soins aux bénéficiaires de l'assurance maladie, notamment au regard des règles définies par les conventions qui régissent leurs relations avec les organismes d'assurance maladie ou, en ce qui concerne les médecins, du règlement mentionné à l'article L. 162-14-2. La procédure d'analyse de l'activité se déroule dans le respect des droits de la défense selon des conditions définies par décret.
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Par l'ensemble des actions mentionnées au présent article, le service du contrôle médical concourt, dans les conditions prévues aux articles L. 183-1, L. 211-2-1 et au 5° de l'article L. 221-1, à la gestion du risque assurée par les caisses d'assurance maladie.
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IV. bis. - Le service du contrôle médical s'assure de l'identité du patient à l'occasion des examens individuels qu'il réalise, en demandant à la personne concernée de présenter sa carte nationale d'identité ou tout autre document officiel comportant sa photographie.
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V. - Les praticiens-conseils du service du contrôle médical et les personnes placées sous leur autorité n'ont accès aux données de santé à caractère personnel que si elles sont strictement nécessaires à l'exercice de leur mission, dans le respect du secret médical.
" } }, "LEGIARTI000006742468": { "META": { "META_SPEC": { "META_ARTICLE": { "NUM": "L315-2", "ETAT": "MODIFIE", "TYPE": "AUTONOME", "DATE_FIN": "2007-12-22", "DATE_DEBUT": "2004-08-17" } }, "META_COMMUN": { "ID": "LEGIARTI000006742468", "URL": "article/LEGI/ARTI/00/00/06/74/24/LEGIARTI000006742468.xml", "NATURE": "Article", "ORIGINE": "LEGI", "ANCIEN_ID": "SSAXXXXXXXX1X315L02AXXAD" } }, "LIENS": { "LIEN": [ { "@id": "JORFTEXT000000866621", "#text": "Décret 85-1353 1985-12-17", "@sens": "source", "@cidtexte": "JORFTEXT000000866621", "@numtexte": "85-1353", "@typelien": "CODIFICATION", "@naturetexte": "DECRET", "@datesignatexte": "1985-12-17" }, { "@id": "LEGIARTI000046813093", "@num": "20-5-6", "#text": "Ordonnance n°96-1122 du 20 décembre 1996 - art. 20-5-6 (VD)", "@sens": "cible", "@cidtexte": "JORFTEXT000000368749", "@nortexte": "DOMX9600135R", "@numtexte": "96-1122", "@typelien": "CITATION", "@naturetexte": "ORDONNANCE", "@datesignatexte": "1996-12-20" }, { "@id": "LEGIARTI000006684619", "@num": "124", "#text": "Décret n°2003-1010 du 22 octobre 2003 - art. 124 (Ab)", "@sens": "cible", "@cidtexte": "JORFTEXT000000610356", "@nortexte": "SOCA0323026D", "@numtexte": "2003-1010", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2003-10-22" }, { "@id": "LEGIARTI000006758955", "@num": "27", "#text": "Loi n°2004-810 du 13 août 2004 - art. 27 () JORF 17 août 2004", "@sens": "source", "@cidtexte": "JORFTEXT000000625158", "@nortexte": "SANX0400122L", "@numtexte": "2004-810", "@typelien": "MODIFICATION", "@naturetexte": "LOI", "@datesignatexte": "2004-08-13" }, { "@id": "LEGIARTI000006726174", "@num": "35", "#text": "Décret n°2004-942 du 3 septembre 2004 - art. 35 (Ab)", "@sens": "cible", "@cidtexte": "JORFTEXT000000253592", "@nortexte": "SANS0422327D", "@numtexte": "2004-942", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2004-09-03" }, { "@id": "LEGIARTI000026930574", "@num": "Annexe", "#text": "Arrêté du 21 juin 2006 - art. 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L732-5 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006071367", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006580926", "@num": "1106-2", "#text": "Code rural ancien - art. 1106-2 (Ab)", "@sens": "cible", "@cidtexte": "LEGITEXT000006071366", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" } ] }, "CONTEXTE": { "TEXTE": { "TM": { "TM": { "TM": { "TM": { "TITRE_TM": [ { "@id": "LEGISCTA000006156082", "@fin": "2999-01-01", "#text": "Chapitre 5 : Contrôle médical", "@debut": "1996-04-25" } ] }, "TITRE_TM": [ { "@id": "LEGISCTA000006141616", "@fin": "2999-01-01", "#text": "Titre I : Généralités", "@debut": "1985-12-21" } ] }, "TITRE_TM": [ { "@id": "LEGISCTA000006126889", "@fin": "2999-01-01", "#text": "Livre III : Dispositions relatives aux assurances sociales et à diverses catégories de personnes rattachées au régime général", "@debut": "1985-12-21" } ] }, "TITRE_TM": [ { "@id": "LEGISCTA000006106050", "@fin": "2999-01-01", "#text": "Partie législative", "@debut": "1985-12-21" } ] }, "@cid": "LEGITEXT000006073189", "@nature": "CODE", "TITRE_TXT": [ { "@fin": "2999-01-01", "#text": "Code de la sécurité sociale", "@debut": "1958-10-16", "@id_txt": "LEGITEXT000006073189", "@c_titre_court": "Code de la sécurité sociale." } ], "@date_publi": "2999-01-01", "@date_signature": "2999-01-01" } }, "VERSIONS": { "VERSION": [ { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000006742465", "@fin": "2001-12-26", "@num": "L315-2", "@etat": "MODIFIE", "@debut": "1996-04-25", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000006742466", "@fin": "2003-12-19", "@num": "L315-2", "@etat": "MODIFIE", "@debut": "2001-12-26", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000006742467", "@fin": "2004-08-17", "@num": "L315-2", "@etat": "MODIFIE", "@debut": "2003-12-19", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000006742468", "@fin": "2007-12-22", "@num": "L315-2", "@etat": "MODIFIE", "@debut": "2004-08-17", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000017844895", "@fin": "2008-12-19", "@num": "L315-2", "@etat": "MODIFIE", "@debut": "2007-12-22", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000019954048", "@fin": "2016-01-01", "@num": "L315-2", "@etat": "MODIFIE", "@debut": "2008-12-19", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000031687215", "@fin": "2018-01-01", "@num": "L315-2", "@etat": "MODIFIE", "@debut": "2016-01-01", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000036393651", "@fin": "2019-12-28", "@num": "L315-2", "@etat": "MODIFIE", "@debut": "2018-01-01", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000045065557", "@fin": "2021-07-01", "@num": "L315-2", "@etat": "MODIFIE", "@debut": "2019-12-28", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000042686005", "@fin": "2021-12-25", "@num": "L315-2", "@etat": "MODIFIE", "@debut": "2021-07-01", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000045065602", "@fin": "2022-01-01", "@num": "L315-2", "@etat": "MODIFIE", "@debut": "2021-12-25", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000041398082", "@fin": "2023-12-28", "@num": "L315-2", "@etat": "MODIFIE", "@debut": "2022-01-01", "@origine": "LEGI" } }, { "@etat": "VIGUEUR", "LIEN_ART": { "@id": "LEGIARTI000048687768", "@fin": "2999-01-01", "@num": "L315-2", "@etat": "VIGUEUR", "@debut": "2023-12-28", "@origine": "LEGI" } } ] }, "BLOC_TEXTUEL": { "CONTENU": "
Les avis rendus par le service du contrôle médical portant sur les éléments définis au I de l'article L. 315-1 s'imposent à l'organisme de prise en charge.
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Le bénéfice de certaines prestations mentionnées au I de l'article L. 315-1 peut être subordonné à l'accord préalable du service du contrôle médical. Cet accord préalable peut être exigé pour les prestations dont :
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- la nécessité doit être appréciée au regard d'indications déterminées ou de conditions particulières d'ordre médical ;
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- la justification, du fait de leur caractère innovant ou des risques encourus par le bénéficiaire, doit être préalablement vérifiée eu égard notamment à l'état du bénéficiaire et aux alternatives thérapeutiques possibles ;
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- le caractère particulièrement coûteux doit faire l'objet d'un suivi particulier afin d'en évaluer l'impact sur les dépenses de l'assurance maladie.
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Il est précisé lors de l'admission au remboursement des prestations mentionnées au I de l'article L. 315-1 que leur bénéfice est, le cas échéant, subordonné à l'accord préalable mentionné ci-dessus.
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Les conditions d'application des alinéas précédents sont fixées par décret.
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Si, indépendamment des dispositions des deuxième à cinquième alinéas, le service du contrôle médical estime qu'une prestation mentionnée à l'article L. 321-1 n'est pas médicalement justifiée, la caisse, après en avoir informé l'assuré, en suspend le service. En cas de suspension du service des indemnités mentionnées au 5° de l'article L. 321-1, la caisse en informe l'employeur. Lorsque le praticien-conseil procède à l'examen du patient et qu'à l'issue de celui-ci il estime qu'une prescription d'arrêt de travail n'est pas ou n'est plus médicalement justifiée, il en informe directement l'intéressé. Sauf si le praticien-conseil en décide autrement, la suspension prononcée par la caisse prend effet à compter de la date à laquelle le patient a été informé. Les contestations d'ordre médical portant sur cette décision donnent lieu à l'expertise médicale mentionnée à l'article L. 141-1.
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Sous réserve des dispositions de l'article L. 324-1, tout assuré est tenu de se soumettre aux contrôles organisés par le service du contrôle médical. La caisse suspend le versement des indemnités journalières lorsque l'assuré qui en bénéficie ne respecte pas cette obligation.
" } }, "LEGIARTI000006742470": { "META": { "META_SPEC": { "META_ARTICLE": { "NUM": "L315-2-1", "ETAT": "MODIFIE", "TYPE": "AUTONOME", "DATE_FIN": "2007-12-22", "DATE_DEBUT": "2004-08-17" } }, "META_COMMUN": { "ID": "LEGIARTI000006742470", "URL": "article/LEGI/ARTI/00/00/06/74/24/LEGIARTI000006742470.xml", "NATURE": "Article", "ORIGINE": "LEGI", "ANCIEN_ID": "SSAXXXXXXXX1X315L02BXXAB" } }, "LIENS": { "LIEN": [ { "@id": "JORFTEXT000000866621", "#text": "Décret 85-1353 1985-12-17", "@sens": "source", "@cidtexte": "JORFTEXT000000866621", "@numtexte": "85-1353", "@typelien": "CODIFICATION", "@naturetexte": "DECRET", "@datesignatexte": "1985-12-17" }, { "@id": "LEGIARTI000046813093", "@num": "20-5-6", "#text": "Ordonnance n°96-1122 du 20 décembre 1996 - art. 20-5-6 (VD)", "@sens": "cible", "@cidtexte": "JORFTEXT000000368749", "@nortexte": "DOMX9600135R", "@numtexte": "96-1122", "@typelien": "CITATION", "@naturetexte": "ORDONNANCE", "@datesignatexte": "1996-12-20" }, { "@id": "LEGIARTI000006758955", "@num": "27", "#text": "Loi n°2004-810 du 13 août 2004 - art. 27 () JORF 17 août 2004", "@sens": "source", "@cidtexte": "JORFTEXT000000625158", "@nortexte": "SANX0400122L", "@numtexte": "2004-810", "@typelien": "MODIFICATION", "@naturetexte": "LOI", "@datesignatexte": "2004-08-13" }, { "@id": "LEGIARTI000006726175", "@num": "36", "#text": "Décret n°2004-942 du 3 septembre 2004 - art. 36 (Ab)", "@sens": "cible", "@cidtexte": "JORFTEXT000000253592", "@nortexte": "SANS0422327D", "@numtexte": "2004-942", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2004-09-03" }, { "@id": "LEGIARTI000026930574", "@num": "Annexe", "#text": "Arrêté du 21 juin 2006 - art. Annexe (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000000609522", "@nortexte": "SANS0622624A", "@typelien": "CITATION", "@naturetexte": "ARRETE", "@datesignatexte": "2006-06-21" }, { "@id": "LEGIARTI000029736056", "#text": "ARRÊTÉ du 27 octobre 2014 - art. (Ab)", "@sens": "cible", "@cidtexte": "JORFTEXT000029735834", "@nortexte": "AFSS1425785A", "@typelien": "CITATION", "@naturetexte": "ARRETE", "@datesignatexte": "2014-10-27" }, { "@id": "LEGIARTI000006742522", "@num": "L324-1", "#text": "Code de la sécurité sociale. - art. L324-1 (M)", "@sens": "source", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006743632", "@num": "L613-13", "#text": "Code de la sécurité sociale. - art. L613-13 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006743597", "@num": "L615-13", "#text": "Code de la sécurité sociale. - art. L615-13 (T)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006749193", "@num": "R315-2-1", "#text": "Code de la sécurité sociale. - art. R315-2-1 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006585500", "@num": "L732-5", "#text": "Code rural - art. L732-5 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006071367", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006580926", "@num": "1106-2", "#text": "Code rural ancien - art. 1106-2 (Ab)", "@sens": "cible", "@cidtexte": "LEGITEXT000006071366", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" } ] }, "CONTEXTE": { "TEXTE": { "TM": { "TM": { "TM": { "TM": { "TITRE_TM": [ { "@id": "LEGISCTA000006156082", "@fin": "2999-01-01", "#text": "Chapitre 5 : Contrôle médical", "@debut": "1996-04-25" } ] }, "TITRE_TM": [ { "@id": "LEGISCTA000006141616", "@fin": "2999-01-01", "#text": "Titre I : Généralités", "@debut": "1985-12-21" } ] }, "TITRE_TM": [ { "@id": "LEGISCTA000006126889", "@fin": "2999-01-01", "#text": "Livre III : Dispositions relatives aux assurances sociales et à diverses catégories de personnes rattachées au régime général", "@debut": "1985-12-21" } ] }, "TITRE_TM": [ { "@id": "LEGISCTA000006106050", "@fin": "2999-01-01", "#text": "Partie législative", "@debut": "1985-12-21" } ] }, "@cid": "LEGITEXT000006073189", "@nature": "CODE", "TITRE_TXT": [ { "@fin": "2999-01-01", "#text": "Code de la sécurité sociale", "@debut": "1958-10-16", "@id_txt": "LEGITEXT000006073189", "@c_titre_court": "Code de la sécurité sociale." } ], "@date_publi": "2999-01-01", "@date_signature": "2999-01-01" } }, "VERSIONS": { "VERSION": [ { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000006742469", "@fin": "2004-08-17", "@num": "L315-2-1", "@etat": "MODIFIE", "@debut": "1999-12-30", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000006742470", "@fin": "2007-12-22", "@num": "L315-2-1", "@etat": "MODIFIE", "@debut": "2004-08-17", "@origine": "LEGI" } }, { "@etat": "VIGUEUR", "LIEN_ART": { "@id": "LEGIARTI000017844901", "@fin": "2999-01-01", "@num": "L315-2-1", "@etat": "VIGUEUR", "@debut": "2007-12-22", "@origine": "LEGI" } } ] }, "BLOC_TEXTUEL": { "CONTENU": "
Si, au vu des dépenses présentées au remboursement ou de la fréquence des prescriptions d'arrêt de travail, le service du contrôle médical estime nécessaire de procéder à une évaluation de l'intérêt thérapeutique, compte tenu de leur importance, des soins dispensés à un assuré dans les cas autres que ceux mentionnés à l'article L. 324-1, il peut convoquer l'intéressé. Le service du contrôle médical peut établir, le cas échéant conjointement avec un médecin choisi par l'assuré, des recommandations sur les soins et les traitements appropriés. Ces recommandations sont transmises à l'assuré par le médecin choisi par celui-ci, lorsque ces recommandations sont établies conjointement ou, à défaut, par le service du contrôle médical.
\n
Les modalités d'application de ces dispositions sont fixées par décret en Conseil d'Etat.
" } }, "LEGIARTI000006742474": { "META": { "META_SPEC": { "META_ARTICLE": { "NUM": "L321-2", "ETAT": "MODIFIE", "TYPE": "AUTONOME", "DATE_FIN": "2016-01-01", "DATE_DEBUT": "2004-08-17" } }, "META_COMMUN": { "ID": "LEGIARTI000006742474", "URL": "article/LEGI/ARTI/00/00/06/74/24/LEGIARTI000006742474.xml", "NATURE": "Article", "ORIGINE": "LEGI", "ANCIEN_ID": "SSAXXXXXXXX1X321L02AXXAC" } }, "LIENS": { "LIEN": [ { "@id": "JORFTEXT000000866621", "#text": "Décret 85-1353 1985-12-17", "@sens": "source", "@cidtexte": "JORFTEXT000000866621", "@numtexte": "85-1353", "@typelien": "CODIFICATION", "@naturetexte": "DECRET", "@datesignatexte": "1985-12-17" }, { "@id": "LEGIARTI000006758955", "@num": "27", "#text": "Loi n°2004-810 du 13 août 2004 - art. 27 () JORF 17 août 2004", "@sens": "source", "@cidtexte": "JORFTEXT000000625158", "@nortexte": "SANX0400122L", "@numtexte": "2004-810", "@typelien": "MODIFICATION", "@naturetexte": "LOI", "@datesignatexte": "2004-08-13" }, { "@id": "LEGIARTI000042523685", "@num": "2", "#text": "Décret n°2020-73 du 31 janvier 2020 - art. 2 (Ab)", "@sens": "cible", "@cidtexte": "JORFTEXT000041513432", "@nortexte": "SSAS2002571D", "@numtexte": "2020-73", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2020-01-31" }, { "@id": "LEGIARTI000041704884", "@num": "1", "#text": "Décret n°2020-227 du 9 mars 2020 - art. 1", "@sens": "cible", "@cidtexte": "JORFTEXT000041704122", "@nortexte": "SSAS2006807D", "@numtexte": "2020-227", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2020-03-09" }, { "@id": "LEGIARTI000041867550", "@num": "1", "#text": "Décret n°2020-549 du 11 mai 2020 - art. 1 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000041865522", "@nortexte": "SSAS2009743D", "@numtexte": "2020-549", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2020-05-11" }, { "@id": "LEGIARTI000042521897", "@num": "1", "#text": "Décret n°2020-1386 du 14 novembre 2020 - art. 1", "@sens": "cible", "@cidtexte": "JORFTEXT000042521293", "@nortexte": "SSAS2026677D", "@numtexte": "2020-1386", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2020-11-14" }, { "@id": "LEGIARTI000043541495", "@num": "3", "#text": "Décret n°2021-13 du 8 janvier 2021 - art. 3 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000042895619", "@nortexte": "SSAS2036847D", "@numtexte": "2021-13", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2021-01-08" }, { "@id": "LEGIARTI000042985954", "@num": "1", "#text": "Décret n°2021-24 du 13 janvier 2021 - art. 1 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000042963237", "@nortexte": "SSAS2036176D", "@numtexte": "2021-24", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2021-01-13" }, { "@id": "LEGIARTI000045735366", "@num": "3", "#text": "Décret n°2022-772 du 29 avril 2022 - art. 3", "@sens": "cible", "@cidtexte": "JORFTEXT000045734248", "@nortexte": "AGRS2207791D", "@numtexte": "2022-772", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2022-04-29" }, { "@id": "LEGITEXT000006073189", "#text": "Code de la sécurité sociale L292 ELEMENTS LEGISLATIFS", "@sens": "source", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CONCORDANCE", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000047803322", "@num": "L16-10-1", "#text": "Code de la sécurité sociale. - art. 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L313-1 (P)", "@sens": "source", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006742902", "@num": "L321-1", "#text": "Code de la sécurité sociale. - art. L321-1 (M)", "@sens": "source", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000042686342", "@num": "L441-6", "#text": "Code de la sécurité sociale. - art. L441-6 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000036393199", "@num": "L461-5", "#text": "Code de la sécurité sociale. - art. L461-5 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000047803294", "@num": "L622-1", "#text": "Code de la sécurité sociale. - art. L622-1 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006749208", "@num": "R321-2", "#text": "Code de la sécurité sociale. - art. R321-2 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006749209", "@num": "R321-3", "#text": "Code de la sécurité sociale. - art. R321-3 (Ab)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006749209", "@num": "R321-3", "#text": "Code de la sécurité sociale. - art. R321-3 (Ab)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "TXT_SOURCE", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000031827804", "@num": "R331-2", "#text": "Code de la sécurité sociale. - art. R331-2 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000039036687", "@num": "R441-10", "#text": "Code de la sécurité sociale. - art. R441-10 (VD)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000030900842", "@num": "D732-2-7", "#text": "Code rural et de la pêche maritime - art. D732-2-7 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006071367", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" } ] }, "CONTEXTE": { "TEXTE": { "TM": { "TM": { "TM": { "TM": { "TITRE_TM": [ { "@id": "LEGISCTA000006156083", "@fin": "2999-01-01", "#text": "Chapitre 1er : Dispositions générales", "@debut": "1985-12-21" } ] }, "TITRE_TM": [ { "@id": "LEGISCTA000006141617", "@fin": "2999-01-01", "#text": "Titre II : Assurance maladie", "@debut": "1985-12-21" } ] }, "TITRE_TM": [ { "@id": "LEGISCTA000006126889", "@fin": "2999-01-01", "#text": "Livre III : Dispositions relatives aux assurances sociales et à diverses catégories de personnes rattachées au régime général", "@debut": "1985-12-21" } ] }, "TITRE_TM": [ { "@id": "LEGISCTA000006106050", "@fin": "2999-01-01", "#text": "Partie législative", "@debut": "1985-12-21" } ] }, "@cid": "LEGITEXT000006073189", "@nature": "CODE", "TITRE_TXT": [ { "@fin": "2999-01-01", "#text": "Code de la sécurité sociale", "@debut": "1958-10-16", "@id_txt": "LEGITEXT000006073189", "@c_titre_court": "Code de la sécurité sociale." } ], "@date_publi": "2999-01-01", "@date_signature": "2999-01-01" } }, "VERSIONS": { "VERSION": [ { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000006742472", "@fin": "1996-04-25", "@num": "L321-2", "@etat": "MODIFIE", "@debut": "1985-12-21", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000006742473", "@fin": "2004-08-17", "@num": "L321-2", "@etat": "MODIFIE", "@debut": "1996-04-25", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000006742474", "@fin": "2016-01-01", "@num": "L321-2", "@etat": "MODIFIE", "@debut": "2004-08-17", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000031686673", "@fin": "2020-12-16", "@num": "L321-2", "@etat": "MODIFIE", "@debut": "2016-01-01", "@origine": "LEGI" } }, { "@etat": "VIGUEUR", "LIEN_ART": { "@id": "LEGIARTI000042686361", "@fin": "2999-01-01", "@num": "L321-2", "@etat": "VIGUEUR", "@debut": "2020-12-16", "@origine": "LEGI" } } ] }, "BLOC_TEXTUEL": { "CONTENU": "
Sous réserve des dispositions des articles L. 161-8 et L. 311-9, les prestations prévues au 1° de l'article L. 321-1 sont attribuées sans limitation de durée si l'assuré remplit, à la date des soins dont le remboursement est demandé, les conditions fixées à l'article L. 313-1.
\n
En cas d'interruption de travail, l'assuré doit envoyer à la caisse primaire d'assurance maladie, dans un délai déterminé et, sous les sanctions prévues par décret, une lettre d'avis d'interruption de travail dont le modèle est fixé par arrêté ministériel et qui doit comporter la signature du médecin.
\n
Le directeur de la caisse primaire met en oeuvre le dispositif de sanctions prévu à l'alinéa précédent.
" } }, "LEGIARTI000006742520": { "META": { "META_SPEC": { "META_ARTICLE": { "NUM": "L323-6", "ETAT": "MODIFIE", "TYPE": "AUTONOME", "DATE_FIN": "2006-12-22", "DATE_DEBUT": "2004-08-17" } }, "META_COMMUN": { "ID": "LEGIARTI000006742520", "URL": "article/LEGI/ARTI/00/00/06/74/25/LEGIARTI000006742520.xml", "NATURE": "Article", "ORIGINE": "LEGI", "ANCIEN_ID": "SSAXXXXXXXX1X323L06AXXAA" } }, "LIENS": { "LIEN": [ { "@id": "JORFTEXT000000866621", "#text": "Décret 85-1353 1985-12-17", "@sens": "source", "@cidtexte": "JORFTEXT000000866621", "@numtexte": "85-1353", "@typelien": "CODIFICATION", "@naturetexte": "DECRET", "@datesignatexte": "1985-12-17" }, { "@id": "LEGIARTI000035903361", "@num": "20-7-1", "#text": "Ordonnance n° 96-1122 du 20 décembre 1996 - art. 20-7-1 (VD)", "@sens": "cible", "@cidtexte": "JORFTEXT000000368749", "@nortexte": "DOMX9600135R", "@numtexte": "96-1122", "@typelien": "CITATION", "@naturetexte": "ORDONNANCE", "@datesignatexte": "1996-12-20" }, { "@id": "LEGIARTI000006758955", "@num": "27", "#text": "Loi n°2004-810 du 13 août 2004 - art. 27 () JORF 17 août 2004", "@sens": "source", "@cidtexte": "JORFTEXT000000625158", "@nortexte": "SANX0400122L", "@numtexte": "2004-810", "@typelien": "CREATION", "@naturetexte": "LOI", "@datesignatexte": "2004-08-13" }, { "@id": "LEGIARTI000022833785", "@num": "3", "#text": "Décret n°2010-1095\n du 17 septembre 2010 - art. 3 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000022825331", "@nortexte": "MTSS1008418D", "@numtexte": "2010-1095", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2010-09-17" }, { "@id": "LEGIARTI000043169640", "@num": "L114-15", "#text": "Code de la sécurité sociale. - art. 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L622-2 (VD)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000037053566", "@num": "L646-5", "#text": "Code de la sécurité sociale. - art. L646-5 (VT)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000031687397", "@num": "L722-8-2", "#text": "Code de la sécurité sociale. - art. L722-8-2 (T)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000035918604", "@num": "D732-2-9", "#text": "Code rural et de la pêche maritime - art. D732-2-9 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006071367", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000048685895", "@num": "L732-4", "#text": "Code rural et de la pêche maritime - art. 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Le service de l'indemnité journalière est subordonné à l'obligation pour le bénéficiaire :
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1° D'observer les prescriptions du praticien ;
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2° De se soumettre aux contrôles organisés par le service du contrôle médical prévus à l'article L. 315-2 ;
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3° De respecter les heures de sorties autorisées par le praticien, qui ne peuvent excéder trois heures consécutives par jour ;
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4° De s'abstenir de toute activité non autorisée.
\n
En cas d'inobservation volontaire des obligations ci-dessus indiquées, la caisse peut retenir, à titre de pénalité, tout ou partie des indemnités journalières dues.
\n
En cas de recours formé contre les décisions de la caisse, les juridictions visées à l'article L. 142-2 contrôlent l'adéquation du montant de la sanction prononcée par la caisse à l'importance de l'infraction commise par l'assuré.
" } } }, "article_lien": [ { "article_id": "LEGIARTI000006742462", "cible": false, "cidtexte": "JORFTEXT000000625158", "id": "LEGIARTI000006758955", "typelien": "MODIFICATION" }, { "article_id": "LEGIARTI000006742474", "cible": false, "cidtexte": "JORFTEXT000000625158", "id": "LEGIARTI000006758955", "typelien": "MODIFICATION" }, { "article_id": "LEGIARTI000006742468", "cible": false, "cidtexte": "JORFTEXT000000625158", "id": "LEGIARTI000006758955", "typelien": "MODIFICATION" }, { "article_id": "LEGIARTI000006742470", "cible": false, "cidtexte": "JORFTEXT000000625158", "id": "LEGIARTI000006758955", "typelien": "MODIFICATION" }, { "article_id": "LEGIARTI000006742520", "cible": false, "cidtexte": "JORFTEXT000000625158", "id": "LEGIARTI000006758955", "typelien": "CREATION" } ], "follow": [ "LIENS.LIEN[@sens=cible,@typelien=CREATION].@id" ], "id": "LEGIARTI000006758955", "liens_entrants": true }

Article 27 ENTIEREMENT_MODIF (LOI n° 2004-810 du 13 août 2004 relative à l'assurance maladie (1))