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\n
" } }, "LEGIARTI000006740639": { "META": { "META_SPEC": { "META_ARTICLE": { "NUM": "L162-22-2", "ETAT": "MODIFIE", "TYPE": "AUTONOME", "DATE_FIN": "2005-12-20", "DATE_DEBUT": "2004-12-21" } }, "META_COMMUN": { "ID": "LEGIARTI000006740639", "URL": "article/LEGI/ARTI/00/00/06/74/06/LEGIARTI000006740639.xml", "NATURE": "Article", "ORIGINE": "LEGI", "ANCIEN_ID": "SSAXXXXXXXX1X162L22CXXAI" } }, "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": "LEGIARTI000006757448", "@num": "7", "#text": "Loi n°91-738 du 31 juillet 1991 - art. 7 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000000356641", "@nortexte": "SPSX9100075L", "@numtexte": "91-738", "@typelien": "CITATION", "@naturetexte": "LOI", "@datesignatexte": "1991-07-31" }, { "@id": "LEGIARTI000006776705", "@num": "10", "#text": "Décret n°92-1257 du 3 décembre 1992 - 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R162-42-1-11 (Ab)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" } ] }, "CONTEXTE": { "TEXTE": { "TM": { "TM": { "TM": { "TM": { "TM": { "TM": { "TITRE_TM": [ { "@id": "LEGISCTA000006186216", "@fin": "2010-02-26", "#text": "Sous-section 2 : Frais d'hospitalisation afférents aux activités de soins de suite ou de réadaptation et aux activités de psychiatrie de certains établissements de santé privés", "@debut": "2004-10-01" }, { "@id": "LEGISCTA000021939995", "@fin": "2022-01-01", "#text": "Sous-section 2 : Frais d'hospitalisation remboursés sur la base de tarifs journaliers propres à certains établissements de santé privés", "@debut": "2010-02-26" } ] }, "TITRE_TM": [ { "@id": "LEGISCTA000006172518", "@fin": "2010-02-26", "#text": "Section 5 : Etablissements de soins.", "@debut": "1985-12-21" }, { "@id": "LEGISCTA000021940000", "@fin": "2999-01-01", "#text": "Section 5 : Etablissements de santé", "@debut": "2010-02-26" } ] }, "TITRE_TM": [ { "@id": "LEGISCTA000006156028", "@fin": "2018-03-10", "#text": "Chapitre 2 : Dispositions générales relatives aux soins", "@debut": "1985-12-21" }, { "@id": "LEGISCTA000036687767", "@fin": "2999-01-01", "#text": "Chapitre 2 : Dispositions générales relatives aux soins et à la prévention", "@debut": "2018-03-10" } ] }, "TITRE_TM": [ { "@id": "LEGISCTA000006141605", "@fin": "2999-01-01", "#text": "Titre VI : Dispositions relatives aux prestations et aux soins - Contrôle médical - Tutelle aux prestations sociales", "@debut": "1985-12-21" } ] }, "TITRE_TM": [ { "@id": "LEGISCTA000006126885", "@fin": "2999-01-01", "#text": "Livre I : Généralités - Dispositions communes à tout ou partie des régimes de base", "@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": "LEGIARTI000006740631", "@fin": "1992-01-04", "@num": "L162-22-2", "@etat": "MODIFIE", "@debut": "1991-08-01", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000006740632", "@fin": "1996-04-25", "@num": "L162-22-2", "@etat": "MODIFIE", "@debut": "1992-01-04", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000006740633", "@fin": "1998-01-01", "@num": "L162-22-2", "@etat": "MODIFIE", "@debut": "1996-04-25", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000006740634", "@fin": "1999-12-30", "@num": "L162-22-2", "@etat": "MODIFIE", "@debut": "1998-01-01", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000006740635", "@fin": "2001-12-26", "@num": "L162-22-2", "@etat": "MODIFIE", "@debut": "1999-12-30", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000006740636", "@fin": "2002-12-24", "@num": "L162-22-2", "@etat": "MODIFIE", "@debut": "2001-12-26", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000006740637", "@fin": "2005-01-01", "@num": "L162-22-2", "@etat": "MODIFIE", "@debut": "2002-12-24", "@origine": "LEGI" } }, { "@etat": "MODIFIE_MORT_NE", "LIEN_ART": { "@id": "LEGIARTI000006740638", "@fin": "2004-12-21", "@num": "L162-22-2", "@etat": "MODIFIE_MORT_NE", "@debut": "2005-01-01", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000006740639", "@fin": "2005-12-20", "@num": "L162-22-2", "@etat": "MODIFIE", "@debut": "2004-12-21", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000006740640", "@fin": "2006-12-22", "@num": "L162-22-2", "@etat": "MODIFIE", "@debut": "2005-12-20", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000006740641", "@fin": "2008-12-19", "@num": "L162-22-2", "@etat": "MODIFIE", "@debut": "2006-12-22", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000019955036", "@fin": "2010-02-26", "@num": "L162-22-2", "@etat": "MODIFIE", "@debut": "2008-12-19", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000021940011", "@fin": "2010-12-22", "@num": "L162-22-2", "@etat": "MODIFIE", "@debut": "2010-02-26", "@origine": "LEGI" } }, { "@etat": "ABROGE", "LIEN_ART": { "@id": "LEGIARTI000023268008", "@fin": "2022-01-01", "@num": "L162-22-2", "@etat": "ABROGE", "@debut": "2010-12-22", "@origine": "LEGI" } }, { "@etat": "VIGUEUR", "LIEN_ART": { "@id": "LEGIARTI000048702942", "@fin": "2999-01-01", "@num": "L162-22-2", "@etat": "VIGUEUR", "@debut": "2024-01-01", "@origine": "LEGI" } } ] }, "BLOC_TEXTUEL": { "CONTENU": "
I. - Chaque année est défini un objectif quantifié national relatif aux activités de psychiatrie et de soins de suite ou de réadaptation exercées par les établissements de santé privés mentionnés aux d et e de l'article L. 162-22-6. Cet objectif est constitué par le montant annuel des charges afférentes aux frais d'hospitalisation au titre des soins dispensés dans le cadre de ces activités au cours de l'année et supportées par les régimes obligatoires d'assurance maladie. Le contenu de cet objectif est défini par décret.
\n
Le montant de l'objectif quantifié national est arrêté par l'Etat en fonction de l'objectif national de dépenses d'assurance maladie. Ce montant prend en compte, outre la part mentionnée à l'article L. 162-43, les évolutions de toute nature à la suite desquelles des établissements, des services ou des activités sanitaires ou médico-sociaux se trouvent placés pour tout ou partie sous un régime juridique ou de financement différent de celui sous lequel ils étaient placés auparavant, notamment celles relatives aux conversions d'activité.
\n
II. - Un décret en Conseil d'Etat, pris après avis des organisations nationales les plus représentatives de ces établissements, détermine les modalités selon lesquelles, chaque année, sont déterminées les évolutions des tarifs des prestations compatibles avec le respect de cet objectif. Il prend en compte à cet effet notamment l'évolution des charges au titre des soins dispensés l'année précédente, des prévisions de l'évolution de l'activité des établissements pour l'année en cours et les changements de régime juridique et financier de certains établissements.
\n
" } }, "LEGIARTI000006740916": { "META": { "META_SPEC": { "META_ARTICLE": { "NUM": "L174-1-1", "ETAT": "MODIFIE", "TYPE": "AUTONOME", "DATE_FIN": "2006-12-22", "DATE_DEBUT": "2004-12-21" } }, "META_COMMUN": { "ID": "LEGIARTI000006740916", "URL": "article/LEGI/ARTI/00/00/06/74/09/LEGIARTI000006740916.xml", "NATURE": "Article", "ORIGINE": "LEGI", "ANCIEN_ID": "SSAXXXXXXXX1X174L01BXXAF" } }, "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": "LEGIARTI000006700488", "@num": "6", "#text": "Décret n°96-687 du 31 juillet 1996 - art. 6 (Ab)", "@sens": "cible", "@cidtexte": "JORFTEXT000000194663", "@nortexte": "TASH9622736D", "@numtexte": "96-687", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "1996-07-31" }, { "@id": "LEGIARTI000006698071", "@num": "14", "#text": "Ordonnance n°96-1122 du 20 décembre 1996 - 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art. 1 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000043297334", "@nortexte": "SSAH2109470A", "@typelien": "CITATION", "@naturetexte": "ARRETE", "@datesignatexte": "2021-03-24" }, { "@id": "LEGIARTI000043299631", "@num": "2", "#text": "Arrêté du 24 mars 2021 - art. 2 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000043297334", "@nortexte": "SSAH2109470A", "@typelien": "CITATION", "@naturetexte": "ARRETE", "@datesignatexte": "2021-03-24" }, { "@id": "LEGIARTI000044965188", "@num": "3", "#text": "Arrêté du 24 mars 2021 - art. 3 (VD)", "@sens": "cible", "@cidtexte": "JORFTEXT000043297334", "@nortexte": "SSAH2109470A", "@typelien": "CITATION", "@naturetexte": "ARRETE", "@datesignatexte": "2021-03-24" }, { "@id": "LEGIARTI000043299639", "@num": "6", "#text": "Arrêté du 24 mars 2021 - art. 6 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000043297334", "@nortexte": "SSAH2109470A", "@typelien": "CITATION", "@naturetexte": "ARRETE", "@datesignatexte": "2021-03-24" }, { "@id": "LEGIARTI000043299641", "@num": "7", "#text": "Arrêté du 24 mars 2021 - 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Chaque année est défini un objectif des dépenses d'assurance maladie constitué des activités suivantes :
\n
1° Les activités de psychiatrie exercées par les établissements de santé mentionnés à l'article L. 174-1 ;
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1° bis Les activités de soins de suite et de réadaptation exercées par les établissements de santé mentionnés à l'article L. 174-1 ;
\n
2° L'ensemble des activités des établissements mentionnés à l'article L. 162-22-16 ;
\n
3° Les activités des unités de soins de longue durée ;
\n
4° Les activités de soins dispensés par le service de santé des armées et l'Institution nationale des invalides ;
\n
5° Les activités de soins dispensés par l'établissement public territorial de Saint-Pierre-et-Miquelon ;
\n
6° Les activités de soins dispensés par l'établissement public de santé de Mayotte.
\n
Cet objectif est constitué du montant total des charges supportées par les régimes obligatoires d'assurance maladie au titre des dotations annuelles de financement fixées en application des articles L. 162-22-16, L. 174-1, L. 174-5 et L. 174-15 et de celles fixées en application des articles L. 6147-5 et L. 6416-1 du code de la santé publique.
\n
Le montant de cet objectif est arrêté par l'Etat en fonction de l'objectif national de dépenses d'assurance maladie. Ce montant prend en compte, outre la part mentionnée à l'article L. 162-43, les évolutions de toute nature à la suite desquelles des établissements, des services ou des activités sanitaires ou médico-sociaux se trouvent placés pour tout ou partie sous un régime juridique ou de financement différent de celui sous lequel ils étaient placés auparavant.
\n
Le montant de cet objectif est constitué, après imputation de la part mentionnée à l'article L. 162-43, en dotations régionales. Certaines des dépenses incluses dans l'objectif mentionné au premier alinéa peuvent ne pas être incluses dans ces dotations régionales. Le montant des dotations régionales, qui présente un caractère limitatif, est fixé par l'Etat en tenant compte de l'activité des établissements, des orientations des schémas d'organisation sanitaire et des priorités nationales ou locales en matière de politique sanitaire.
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I. - Chaque année est défini un objectif des dépenses d'assurance maladie commun aux activités de médecine, chirurgie, obstétrique et odontologie mentionnées au a du 1° de l'article L. 6111-2 du code de la santé publique, y compris les activités d'alternative à la dialyse en centre et d'hospitalisation à domicile, exercées par les établissements de santé mentionnés à l'article L. 162-22-6. Cet objectif est constitué du montant annuel des charges supportées par les régimes obligatoires d'assurance maladie afférentes aux frais d'hospitalisation au titre des soins dispensés au cours de l'année dans le cadre de ces activités. Le contenu de cet objectif est défini par décret.
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Le montant de cet objectif commun est arrêté par l'Etat en fonction de l'objectif national de dépenses d'assurance maladie.
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Cet objectif prend en compte, outre la part mentionnée à l'article L. 162-43, les évolutions de toute nature à la suite desquelles des établissements, des services ou des activités sanitaires ou médico-sociaux se trouvent placés pour tout ou partie sous un régime juridique ou de financement différent de celui sous lequel ils étaient placés auparavant, notamment celles relatives aux conversions d'activité.
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II. - Un décret en Conseil d'Etat précise les modalités selon lesquelles, chaque année, sont déterminés les éléments mentionnés aux 1° à 3° du I de l'article L. 162-22-10 compatibles avec le respect de l'objectif, en prenant en compte à cet effet, notamment, les prévisions d'évolution de l'activité des établissements pour l'année en cours, mesurée notamment à partir des données mentionnées aux articles L. 6113-7 et L. 6113-8 du code de la santé publique, ainsi que les changements de régime juridique et de financement de certains établissements ou services ou activités des établissements concernés. Pour les éléments mentionnés aux 1° et 2° du I de l'article L. 162-22-10, il est également tenu compte de l'état provisoire des charges au titre des soins dispensés l'année précédente communiqué dans les conditions prévues au II dudit article. Les tarifs nationaux des prestations mentionnés au 1° du I du même article sont également déterminés à partir des données afférentes au coût relatif des prestations établi sur un échantillon représentatif d'établissements.
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I. - Dans le respect des lois de financement de la sécurité sociale, l'autorité compétente de l'Etat conclut respectivement avec la Caisse nationale de l'assurance maladie des travailleurs salariés, la Caisse nationale d'assurance vieillesse des travailleurs salariés, la Caisse nationale des allocations familiales et l'Agence centrale des organismes de sécurité sociale des conventions d'objectifs et de gestion comportant des engagements réciproques des signataires.
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Ces conventions déterminent, pour les branches mentionnées aux 1°, 2°, 3° et 4° de l'article L. 200-2 et pour les organismes de recouvrement, les objectifs pluriannuels de gestion, les moyens de fonctionnement dont les branches et les organismes disposent pour les atteindre et les actions mises en oeuvre à ces fins par chacun des signataires.
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Elles précisent :
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1° Les objectifs liés à la mise en oeuvre des dispositions législatives et réglementaires qui régissent la gestion du risque, le service des prestations ou le recouvrement des cotisations et des impôts affectés ;
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2° Les objectifs liés à l'amélioration de la qualité du service aux usagers ;
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2° bis Les objectifs d'amélioration de la productivité du réseau et de son organisation territoriale ;
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3° Les objectifs de l'action sociale, de prévention et de lutte contre l'exclusion ;
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4° Les règles de calcul et d'évolution des budgets de gestion administrative et, s'il y a lieu, des budgets de contrôle médical, d'action sanitaire et sociale et de prévention ;
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5° Le cas échéant, les conditions de constitution ou d'amélioration et d'évolution du réseau des caisses locales.
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Ces conventions prévoient, le cas échéant, les indicateurs quantitatifs et qualitatifs associés à la définition des objectifs.
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Elles déterminent également :
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1° Les conditions de conclusion des avenants en cours d'exécution de chaque convention, notamment en fonction des lois de financement de la sécurité sociale et des modifications importantes de la charge de travail des organismes liées à l'évolution du cadre législatif et réglementaire de leur action ;
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2° Le processus d'évaluation contradictoire des résultats obtenus au regard des objectifs fixés.
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II. - Pour la branche maladie, la convention d'objectifs et de gestion mentionne notamment les orientations pluriannuelles de l'action du Gouvernement dans les domaines de la santé publique, de la démographie médicale, du médicament et de la lutte contre l'exclusion en matière d'accès aux soins. La convention comporte également un plan de contrôle des prestations servies.
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Un avenant annuel à la convention d'objectifs et de gestion de la branche maladie du régime général détermine, en fonction de l'objectif national de dépenses d'assurance maladie voté par le Parlement, l'objectif prévisionnel des dépenses de soins de ville et, en son sein, la part mentionnée à l'article L. 162-43 et l'objectif de dépenses déléguées et précise les conditions et modalités de mise en oeuvre de ces objectifs. Cet objectif prévisionnel des dépenses de soins de ville prend en compte les évolutions de toute nature à la suite desquelles des établissements, des services ou des activités sanitaires ou médico-sociaux se trouvent placés pour tout ou partie sous un régime juridique ou de financement différent de celui sous lequel ils étaient placés auparavant.
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Les dépenses de soins de ville comprennent :
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1° La rémunération des soins dispensés en ville par les professions médicales, les auxiliaires médicaux et les directeurs de laboratoires, ainsi que les soins dispensés dans les établissements visés à l'article L. 162-22 et tarifés à l'acte et les honoraires des praticiens exerçant en secteur privé à l'hôpital public ;
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2° Les dépenses résultant de l'exécution des prescriptions des professions médicales délivrées en ville ;
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3° Les prestations en espèces.
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Les dépenses déléguées comprennent les dépenses mentionnées au 1° ci-dessus ainsi que les frais de transport mentionnés à l'article L. 322-5.
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III. - Les conventions d'objectifs et de gestion sont conclues pour une période minimale de quatre ans. Elles sont communiquées aux conseils de surveillance mentionnés à l'article L. 228-1.
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Les conventions et, le cas échéant, les avenants qui les modifient sont transmis à la commission mentionnée à l'article L. 111-9.
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Le financement de celles des prestations des établissements et services sociaux et médico-sociaux publics et privés qui sont à la charge des organismes de sécurité sociale est soumis à un objectif de dépenses.
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Les ministres chargés de la sécurité sociale, de l'action sociale, de l'économie et du budget fixent annuellement cet objectif, en fonction de l'objectif national de dépenses d'assurance maladie voté par le Parlement, et corrélativement, le montant total annuel des dépenses prises en compte pour le calcul des dotations globales, forfaits, prix de journée et tarifs afférents aux prestations correspondantes. Ce montant total annuel est fixé par application d'un taux d'évolution aux dépenses de l'année précédente au plus tard dans les quinze jours qui suivent la publication de la loi de financement de la sécurité sociale.
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Ce montant total annuel est constitué, après imputation de la part mentionnée à l'article L. 162-43 du code de la sécurité sociale, en dotations régionales limitatives. Le montant de ces dotations est fixé par les ministres chargés de la sécurité sociale et de l'action sociale, en fonction des besoins de la population, des orientations définies par les schémas prévus à l'article L. 312-5, des priorités définies au niveau national en matière de politique médico-sociale, en tenant compte de l'activité et des coûts moyens des établissements et services et d'un objectif de réduction progressive des inégalités dans l'allocation des ressources entre régions. Il prend en compte les évolutions de toute nature à la suite desquelles des établissements, des services ou des activités sanitaires ou médico-sociaux se trouvent placés pour tout ou partie sous un régime juridique ou de financement différent de celui sous lequel ils étaient placés auparavant.
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Chaque dotation régionale est répartie par le représentant de l'Etat dans la région, en liaison avec le directeur de l'agence régionale de l'hospitalisation et les représentants de l'Etat dans les départements en dotations départementales limitatives. Ces dotations départementales peuvent, dans les mêmes conditions, être réparties par le représentant de l'Etat dans le département en dotations affectées par catégories de bénéficiaires ou à certaines prestations dans des conditions fixées par décret.
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Article 28 ENTIEREMENT_MODIF (LOI n° 2004-1370 du 20 décembre 2004 de financement de la sécurité sociale pour 2005 (1))