{ "article": { "LEGIARTI000017844914": { "META": { "META_SPEC": { "META_ARTICLE": { "NUM": "L442-5", "ETAT": "VIGUEUR", "TYPE": "AUTONOME", "DATE_FIN": "2999-01-01", "DATE_DEBUT": "2007-12-22" } }, "META_COMMUN": { "ID": "LEGIARTI000017844914", "URL": "article/LEGI/ARTI/00/00/17/84/49/LEGIARTI000017844914.xml", "NATURE": "Article", "ORIGINE": "LEGI" } }, "LIENS": { "LIEN": [ { "@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": "LEGIARTI000017730909", "@num": "117", "#text": "LOI n°2007-1786 du 19 décembre 2007 - art. 117", "@sens": "cible", "@cidtexte": "JORFTEXT000017726554", "@nortexte": "BCFX0766311L", "@numtexte": "2007-1786", "@typelien": "MODIFIE", "@naturetexte": "LOI", "@datesignatexte": "2007-12-19" }, { "@id": "LEGIARTI000021957796", "@num": "D433-2", "#text": "Code de la sécurité sociale. - art. D433-2 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006742459", "@num": "L315-1", "#text": "Code de la sécurité sociale. - art. L315-1", "@sens": "source", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006742461", "@num": "L315-1", "#text": "Code de la sécurité sociale. - art. L315-1 (M)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "SPEC_APPLI", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006742465", "@num": "L315-2", "#text": "Code de la sécurité sociale. - art. L315-2", "@sens": "source", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" } ] }, "CONTEXTE": { "TEXTE": { "TM": { "TM": { "TM": { "TM": { "TM": { "TITRE_TM": [ { "@id": "LEGISCTA000006172948", "@fin": "2999-01-01", "#text": "Section 2 : Contrôle médical et contrôle administratif.", "@debut": "2004-04-17" } ] }, "TITRE_TM": [ { "@id": "LEGISCTA000006156332", "@fin": "2999-01-01", "#text": "Chapitre 2 : Expertises - Contrôles - Dispositions diverses", "@debut": "2004-04-17" } ] }, "TITRE_TM": [ { "@id": "LEGISCTA000006141637", "@fin": "2999-01-01", "#text": "Titre IV : Procédures, révision, rechute, accidents survenus hors du territoire métropolitain", "@debut": "1985-12-21" } ] }, "TITRE_TM": [ { "@id": "LEGISCTA000006126892", "@fin": "2999-01-01", "#text": "Livre IV : Accidents du travail et maladies professionnelles (Dispositions propres et dispositions communes avec d'autres branches)", "@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": "LEGIARTI000006743096", "@fin": "2004-04-17", "@num": "L442-5", "@etat": "MODIFIE", "@debut": "1985-12-21", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000006743097", "@fin": "2007-12-22", "@num": "L442-5", "@etat": "MODIFIE", "@debut": "2004-04-17", "@origine": "LEGI" } }, { "@etat": "VIGUEUR", "LIEN_ART": { "@id": "LEGIARTI000017844914", "@fin": "2999-01-01", "@num": "L442-5", "@etat": "VIGUEUR", "@debut": "2007-12-22", "@origine": "LEGI" } } ] }, "BLOC_TEXTUEL": { "CONTENU": "

Les articles L. 315-1 et L. 315-2 sont applicables aux accidents du travail.

" } }, "LEGIARTI000006742459": { "META": { "META_SPEC": { "META_ARTICLE": { "NUM": "L315-1", "ETAT": "MODIFIE", "TYPE": "AUTONOME", "DATE_FIN": "1996-04-25", "DATE_DEBUT": "1985-12-21" } }, "META_COMMUN": { "ID": "LEGIARTI000006742459", "URL": "article/LEGI/ARTI/00/00/06/74/24/LEGIARTI000006742459.xml", "NATURE": "Article", "ORIGINE": "LEGI", "ANCIEN_ID": "SSAXXXXXXXX1X315L01AXXAA" } }, "NOTA": { "CONTENU": "
*Nota - Code de la sécurité sociale L442-5 : dispositions applicables aux accidents du travail.*
\n
" }, "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": "JORFTEXT000000866621", "#text": "Décret 85-1353 1985-12-17 art. 1 JORF 21 décembre 1985", "@sens": "source", "@cidtexte": "JORFTEXT000000866621", "@numtexte": "85-1353", "@typelien": "CREATION", "@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": "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. Annexe (Ab)", "@sens": "cible", "@cidtexte": "JORFTEXT000000788504", "@nortexte": "SANS0622622A", "@typelien": "CITATION", "@naturetexte": "ARRETE", "@datesignatexte": "2006-06-21" }, { "@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": "LEGIARTI000017730889", "@num": "103", "#text": "LOI n°2007-1786 du 19 décembre 2007 - art. 103 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000017726554", "@nortexte": "BCFX0766311L", "@numtexte": "2007-1786", "@typelien": "CITATION", "@naturetexte": "LOI", "@datesignatexte": "2007-12-19" }, { "@id": "LEGIARTI000031782650", "@num": "91", "#text": "LOI n° 2009-1646 du 24 décembre 2009 - art. 91 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000021528998", "@nortexte": "BCFX0922820L", "@numtexte": "2009-1646", "@typelien": "CITATION", "@naturetexte": "LOI", "@datesignatexte": "2009-12-24" }, { "@id": "LEGIARTI000022741684", "#text": "Décret n°2010-957\n du 24 août 2010 - art. (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000022740738", "@nortexte": "SASS1016818D", "@numtexte": "2010-957", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2010-08-24" }, { "@id": "LEGIARTI000024719504", "@num": "3", "#text": "Décret n°2011-1359 du 25 octobre 2011 - art. 3 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000024717811", "@nortexte": "ETSS1115782D", "@numtexte": "2011-1359", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2011-10-25" }, { "@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": "LEGIARTI000034405828", "@num": "1", "#text": "DÉCRET n°2015-389 du 3 avril 2015 - art. 1 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000030456649", "@nortexte": "AFSS1428487D", "@numtexte": "2015-389", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2015-04-03" }, { "@id": "LEGIARTI000030458287", "@num": "1", "#text": "DÉCRET n°2015-391 du 3 avril 2015 - art. 1 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000030456722", "@nortexte": "AFSS1428496D", "@numtexte": "2015-391", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2015-04-03" }, { "@id": "LEGIARTI000033343923", "#text": "Décret n°2016-1494 du 4 novembre 2016 - art. (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000033342215", "@nortexte": "AFSS1626934D", "@numtexte": "2016-1494", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2016-11-04" }, { "@id": "LEGIARTI000034576368", "@num": "3", "#text": "Décret n°2017-706 du 2 mai 2017 - art. 3 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000034566947", "@nortexte": "AFSS1706568D", "@numtexte": "2017-706", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2017-05-02" }, { "@id": "LEGITEXT000049898778", "#text": "Décret n°2024-692 du 5 juillet 2024 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000049888878", "@nortexte": "TSST2413453D", "@numtexte": "2024-692", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2024-07-05" }, { "@id": "LEGIARTI000041474120", "@num": "L251-2", "#text": "Code de l'action sociale et des familles - art. L251-2 (M)", "@sens": "cible", "@cidtexte": "LEGITEXT000006074069", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000022743570", "@num": "D315-4", "#text": "Code de la sécurité sociale. - art. D315-4 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006736472", "@num": "D323-3", "#text": "Code de la sécurité sociale. - art. D323-3 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000038622128", "@num": "D613-27", "#text": "Code de la sécurité sociale. - art. D613-27 (Ab)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006738835", "@num": "D712-25", "#text": "Code de la sécurité sociale. - art. D712-25 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000048687841", "@num": "L114-17-1", "#text": "Code de la sécurité sociale. - art. L114-17-1 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000028394739", "@num": "L162-1-14", "#text": "Code de la sécurité sociale. - art. L162-1-14 (VT)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000037857793", "@num": "L162-2-3", "#text": "Code de la sécurité sociale. - art. L162-2-3 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000042685903", "@num": "L162-4", "#text": "Code de la sécurité sociale. - art. L162-4 (VD)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000033691405", "@num": "L165-1-3", "#text": "Code de la sécurité sociale. - art. L165-1-3 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000045065602", "@num": "L315-2", "#text": "Code de la sécurité sociale. - art. L315-2 (VD)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006743096", "@num": "L442-5", "#text": "Code de la sécurité sociale. - art. L442-5 (M)", "@sens": "source", "@cidtexte": "LEGITEXT000006073189", "@typelien": "SPEC_APPLI", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000017844914", "@num": "L442-5", "#text": "Code de la sécurité sociale. - art. L442-5 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000036393217", "@num": "L461-1", "#text": "Code de la sécurité sociale. - art. L461-1 (VD)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000038219306", "@num": "L544-2", "#text": "Code de la sécurité sociale. - art. L544-2 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006743385", "@num": "L544-3", "#text": "Code de la sécurité sociale. - art. L544-3 (M)", "@sens": "cible", "@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": "LEGIARTI000006743632", "@num": "L613-13", "#text": "Code de la sécurité sociale. - art. L613-13 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "TXT_ASSOCIE", "@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": "LEGIARTI000006743597", "@num": "L615-13", "#text": "Code de la sécurité sociale. - art. L615-13 (T)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "TXT_ASSOCIE", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000022322772", "@num": "R147-10", "#text": "Code de la sécurité sociale. - art. R147-10 (VD)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000048831176", "@num": "R147-2", "#text": "Code de la sécurité sociale. - art. R147-2 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000046844912", "@num": "R147-6", "#text": "Code de la sécurité sociale. - art. R147-6 (VD)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000046844852", "@num": "R147-8", "#text": "Code de la sécurité sociale. - art. R147-8 (VD)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000044132041", "@num": "R147-9", "#text": "Code de la sécurité sociale. - art. R147-9 (VD)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000047502404", "@num": "R147-9-2", "#text": "Code de la sécurité sociale. - art. R147-9-2 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000022073076", "@num": "R315-1", "#text": "Code de la sécurité sociale. - art. R315-1 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000020987063", "@num": "R315-1-1", "#text": "Code de la sécurité sociale. - art. R315-1-1 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000044329321", "@num": "L1225-62", "#text": "Code du travail - art. L1225-62 (M)", "@sens": "cible", "@cidtexte": "LEGITEXT000006072050", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000043890553", "@num": "L4622-2-1", "#text": "Code du travail - art. L4622-2-1 (VD)", "@sens": "cible", "@cidtexte": "LEGITEXT000006072050", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000043908724", "@num": "L4622-8-1", "#text": "Code du travail - art. L4622-8-1 (VD)", "@sens": "cible", "@cidtexte": "LEGITEXT000006072050", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000049898800", "@num": "R1226-12", "#text": "Code du travail - art. R1226-12 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006072050", "@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": "LEGIARTI000028394654", "@num": "L752-12", "#text": "Code rural - art. L752-12 (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": "LEGISCTA000006156081", "@fin": "1996-04-25", "#text": "Chapitre 5 : Contrôle médical.", "@debut": "1985-12-21" } ] }, "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": "LEGIARTI000006742459", "@fin": "1996-04-25", "@num": "L315-1", "@etat": "MODIFIE", "@debut": "1985-12-21", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000006742460", "@fin": "2002-03-05", "@num": "L315-1", "@etat": "MODIFIE", "@debut": "1996-04-25", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000006742461", "@fin": "2004-08-17", "@num": "L315-1", "@etat": "MODIFIE", "@debut": "2002-03-05", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000006742462", "@fin": "2005-01-01", "@num": "L315-1", "@etat": "MODIFIE", "@debut": "2004-08-17", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000006742463", "@fin": "2005-12-20", "@num": "L315-1", "@etat": "MODIFIE", "@debut": "2005-01-01", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000006742464", "@fin": "2007-12-22", "@num": "L315-1", "@etat": "MODIFIE", "@debut": "2005-12-20", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000017844881", "@fin": "2009-12-28", "@num": "L315-1", "@etat": "MODIFIE", "@debut": "2007-12-22", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000021539637", "@fin": "2016-01-28", "@num": "L315-1", "@etat": "MODIFIE", "@debut": "2009-12-28", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000031928818", "@fin": "2019-07-27", "@num": "L315-1", "@etat": "MODIFIE", "@debut": "2016-01-28", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000038887516", "@fin": "2023-12-28", "@num": "L315-1", "@etat": "MODIFIE", "@debut": "2019-07-27", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000048687792", "@fin": "2024-01-01", "@num": "L315-1", "@etat": "MODIFIE", "@debut": "2023-12-28", "@origine": "LEGI" } }, { "@etat": "VIGUEUR", "LIEN_ART": { "@id": "LEGIARTI000048726222", "@fin": "2999-01-01", "@num": "L315-1", "@etat": "VIGUEUR", "@debut": "2024-01-01", "@origine": "LEGI" } } ] }, "BLOC_TEXTUEL": { "CONTENU": "
Les avis du contrôle médical, lorsqu'ils ont un caractère médical et portent sur des cas individuels, s'imposent aux organismes d'assurance maladie.
\n
" } }, "LEGIARTI000006742460": { "META": { "META_SPEC": { "META_ARTICLE": { "NUM": "L315-1", "ETAT": "MODIFIE", "TYPE": "AUTONOME", "DATE_FIN": "2002-03-05", "DATE_DEBUT": "1996-04-25" } }, "META_COMMUN": { "ID": "LEGIARTI000006742460", "URL": "article/LEGI/ARTI/00/00/06/74/24/LEGIARTI000006742460.xml", "NATURE": "Article", "ORIGINE": "LEGI", "ANCIEN_ID": "SSAXXXXXXXX1X315L01AXXAB" } }, "NOTA": { "CONTENU": "
*Nota - Code de la sécurité sociale L442-5 : dispositions applicables aux accidents du travail.*
\n
" }, "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": "LEGIARTI000006759820", "@num": "10", "#text": "Ordonnance n°96-345 du 24 avril 1996 - art. 10 () JORF 25 avril 1996", "@sens": "source", "@cidtexte": "JORFTEXT000000192992", "@nortexte": "TASX9600042R", "@numtexte": "96-345", "@typelien": "MODIFICATION", "@naturetexte": "ORDONNANCE", "@datesignatexte": "1996-04-24" }, { "@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": "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. Annexe (Ab)", "@sens": "cible", "@cidtexte": "JORFTEXT000000788504", "@nortexte": "SANS0622622A", "@typelien": "CITATION", "@naturetexte": "ARRETE", "@datesignatexte": "2006-06-21" }, { "@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": "LEGIARTI000017730889", "@num": "103", "#text": "LOI n°2007-1786 du 19 décembre 2007 - art. 103 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000017726554", "@nortexte": "BCFX0766311L", "@numtexte": "2007-1786", "@typelien": "CITATION", "@naturetexte": "LOI", "@datesignatexte": "2007-12-19" }, { "@id": "LEGIARTI000031782650", "@num": "91", "#text": "LOI n° 2009-1646 du 24 décembre 2009 - art. 91 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000021528998", "@nortexte": "BCFX0922820L", "@numtexte": "2009-1646", "@typelien": "CITATION", "@naturetexte": "LOI", "@datesignatexte": "2009-12-24" }, { "@id": "LEGIARTI000022741684", "#text": "Décret n°2010-957\n du 24 août 2010 - art. (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000022740738", "@nortexte": "SASS1016818D", "@numtexte": "2010-957", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2010-08-24" }, { "@id": "LEGIARTI000024719504", "@num": "3", "#text": "Décret n°2011-1359 du 25 octobre 2011 - art. 3 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000024717811", "@nortexte": "ETSS1115782D", "@numtexte": "2011-1359", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2011-10-25" }, { "@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": "LEGIARTI000034405828", "@num": "1", "#text": "DÉCRET n°2015-389 du 3 avril 2015 - art. 1 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000030456649", "@nortexte": "AFSS1428487D", "@numtexte": "2015-389", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2015-04-03" }, { "@id": "LEGIARTI000030458287", "@num": "1", "#text": "DÉCRET n°2015-391 du 3 avril 2015 - art. 1 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000030456722", "@nortexte": "AFSS1428496D", "@numtexte": "2015-391", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2015-04-03" }, { "@id": "LEGIARTI000033343923", "#text": "Décret n°2016-1494 du 4 novembre 2016 - art. (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000033342215", "@nortexte": "AFSS1626934D", "@numtexte": "2016-1494", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2016-11-04" }, { "@id": "LEGIARTI000034576368", "@num": "3", "#text": "Décret n°2017-706 du 2 mai 2017 - art. 3 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000034566947", "@nortexte": "AFSS1706568D", "@numtexte": "2017-706", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2017-05-02" }, { "@id": "LEGITEXT000049898778", "#text": "Décret n°2024-692 du 5 juillet 2024 (V)", "@sens": "cible", "@cidtexte": "JORFTEXT000049888878", "@nortexte": "TSST2413453D", "@numtexte": "2024-692", "@typelien": "CITATION", "@naturetexte": "DECRET", "@datesignatexte": "2024-07-05" }, { "@id": "LEGIARTI000041474120", "@num": "L251-2", "#text": "Code de l'action sociale et des familles - art. L251-2 (M)", "@sens": "cible", "@cidtexte": "LEGITEXT000006074069", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000022743570", "@num": "D315-4", "#text": "Code de la sécurité sociale. - art. D315-4 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006736472", "@num": "D323-3", "#text": "Code de la sécurité sociale. - art. D323-3 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000038622128", "@num": "D613-27", "#text": "Code de la sécurité sociale. - art. D613-27 (Ab)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006738835", "@num": "D712-25", "#text": "Code de la sécurité sociale. - art. D712-25 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000048687841", "@num": "L114-17-1", "#text": "Code de la sécurité sociale. - art. L114-17-1 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000028394739", "@num": "L162-1-14", "#text": "Code de la sécurité sociale. - art. L162-1-14 (VT)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000037857793", "@num": "L162-2-3", "#text": "Code de la sécurité sociale. - art. L162-2-3 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006741382", "@num": "L162-29", "#text": "Code de la sécurité sociale. - art. L162-29 (M)", "@sens": "source", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006741384", "@num": "L162-29-1", "#text": "Code de la sécurité sociale. - art. L162-29-1 (M)", "@sens": "source", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000042685903", "@num": "L162-4", "#text": "Code de la sécurité sociale. - art. L162-4 (VD)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006740754", "@num": "L162-5-9", "#text": "Code de la sécurité sociale. - art. L162-5-9 (M)", "@sens": "source", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000033691405", "@num": "L165-1-3", "#text": "Code de la sécurité sociale. - art. L165-1-3 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006740964", "@num": "L183-1", "#text": "Code de la sécurité sociale. - art. L183-1 (T)", "@sens": "source", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006742253", "@num": "L211-2-1", "#text": "Code de la sécurité sociale. - art. L211-2-1 (M)", "@sens": "source", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006741735", "@num": "L221-1", "#text": "Code de la sécurité sociale. - art. L221-1 (M)", "@sens": "source", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000045065602", "@num": "L315-2", "#text": "Code de la sécurité sociale. - art. L315-2 (VD)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006743096", "@num": "L442-5", "#text": "Code de la sécurité sociale. - art. L442-5 (M)", "@sens": "source", "@cidtexte": "LEGITEXT000006073189", "@typelien": "SPEC_APPLI", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000017844914", "@num": "L442-5", "#text": "Code de la sécurité sociale. - art. L442-5 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000036393217", "@num": "L461-1", "#text": "Code de la sécurité sociale. - art. L461-1 (VD)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000038219306", "@num": "L544-2", "#text": "Code de la sécurité sociale. - art. L544-2 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000006743385", "@num": "L544-3", "#text": "Code de la sécurité sociale. - art. L544-3 (M)", "@sens": "cible", "@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": "LEGIARTI000006743632", "@num": "L613-13", "#text": "Code de la sécurité sociale. - art. 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R147-10 (VD)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000048831176", "@num": "R147-2", "#text": "Code de la sécurité sociale. - art. R147-2 (V)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000046844912", "@num": "R147-6", "#text": "Code de la sécurité sociale. - art. R147-6 (VD)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000046844852", "@num": "R147-8", "#text": "Code de la sécurité sociale. - art. R147-8 (VD)", "@sens": "cible", "@cidtexte": "LEGITEXT000006073189", "@typelien": "CITATION", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000044132041", "@num": "R147-9", "#text": "Code de la sécurité sociale. - 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. 162-5-9.
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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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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. 162-5-9.
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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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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.
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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.
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L752-12 (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": "LEGIARTI000006742459", "@fin": "1996-04-25", "@num": "L315-1", "@etat": "MODIFIE", "@debut": "1985-12-21", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000006742460", "@fin": "2002-03-05", "@num": "L315-1", "@etat": "MODIFIE", "@debut": "1996-04-25", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000006742461", "@fin": "2004-08-17", "@num": "L315-1", "@etat": "MODIFIE", "@debut": "2002-03-05", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000006742462", "@fin": "2005-01-01", "@num": "L315-1", "@etat": "MODIFIE", "@debut": "2004-08-17", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000006742463", "@fin": "2005-12-20", "@num": "L315-1", "@etat": "MODIFIE", "@debut": "2005-01-01", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000006742464", "@fin": "2007-12-22", "@num": "L315-1", "@etat": "MODIFIE", "@debut": "2005-12-20", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000017844881", "@fin": "2009-12-28", "@num": "L315-1", "@etat": "MODIFIE", "@debut": "2007-12-22", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000021539637", "@fin": "2016-01-28", "@num": "L315-1", "@etat": "MODIFIE", "@debut": "2009-12-28", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000031928818", "@fin": "2019-07-27", "@num": "L315-1", "@etat": "MODIFIE", "@debut": "2016-01-28", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000038887516", "@fin": "2023-12-28", "@num": "L315-1", "@etat": "MODIFIE", "@debut": "2019-07-27", "@origine": "LEGI" } }, { "@etat": "MODIFIE", "LIEN_ART": { "@id": "LEGIARTI000048687792", "@fin": "2024-01-01", "@num": "L315-1", "@etat": "MODIFIE", "@debut": "2023-12-28", "@origine": "LEGI" } }, { "@etat": "VIGUEUR", "LIEN_ART": { "@id": "LEGIARTI000048726222", "@fin": "2999-01-01", "@num": "L315-1", "@etat": "VIGUEUR", "@debut": "2024-01-01", "@origine": "LEGI" } } ] }, "BLOC_TEXTUEL": { "CONTENU": "
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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Lorsque l'activité de prescription d'arrêt de travail apparaît anormalement élevée au regard de la pratique constatée chez les professionnels de santé appartenant à la même profession, des contrôles systématiques de ces prescriptions sont mis en oeuvre dans des conditions définies par la convention mentionnée à l'article L. 227-1.
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Lorsqu'un contrôle effectué par un médecin à la demande de l'employeur, en application du dernier alinéa de l'article 1er de la loi n° 78-49 du 19 janvier 1978 relative à la mensualisation et à la procédure conventionnelle, conclut à l'absence de justification d'un arrêt de travail, ce médecin transmet son avis au service du contrôle médical de la caisse. Si ce service conclut également, au vu de cet avis, à l'absence de justification de l'arrêt de travail, la caisse suspend le versement des indemnités journalières après en avoir informé l'assuré.
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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 notamment au regard des règles définies en application des dispositions de l'article L. 162-1-7.
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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.
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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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Lorsque l'activité de prescription d'arrêt de travail apparaît anormalement élevée au regard de la pratique constatée chez les professionnels de santé appartenant à la même profession, des contrôles systématiques de ces prescriptions sont mis en oeuvre dans des conditions définies par la convention mentionnée à l'article L. 227-1.
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Lorsqu'un contrôle effectué par un médecin à la demande de l'employeur, en application du dernier alinéa de l'article 1er de la loi n° 78-49 du 19 janvier 1978 relative à la mensualisation et à la procédure conventionnelle, conclut à l'absence de justification d'un arrêt de travail, ce médecin transmet son avis au service du contrôle médical de la caisse. Si ce service conclut également, au vu de cet avis, à l'absence de justification de l'arrêt de travail, la caisse suspend le versement des indemnités journalières après en avoir informé l'assuré.
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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 notamment au regard des règles définies en application des dispositions de l'article L. 162-1-7.
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III. bis. - Le service du contrôle médical procède auprès des établissements de santé visés à l'article L. 162-22-6, des pharmaciens et des distributeurs de produits ou prestations, dans le respect des règles déontologiques, aux contrôles nécessaires en matière de délivrance et de facturation de médicaments, produits ou prestations donnant lieu à remboursement par les caisses d'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.
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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.
\n
Si, indépendamment des dispositions particulières qui subordonnent le bénéfice de certaines prestations à l'accord préalable de l'organisme de prise en charge, 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. Les contestations d'ordre médical portant sur cette décision donnent lieu à l'expertise médicale mentionnée à l'article L. 141-1.
" } }, "LEGIARTI000006742466": { "META": { "META_SPEC": { "META_ARTICLE": { "NUM": "L315-2", "ETAT": "MODIFIE", "TYPE": "AUTONOME", "DATE_FIN": "2003-12-19", "DATE_DEBUT": "2001-12-26" } }, "META_COMMUN": { "ID": "LEGIARTI000006742466", "URL": "article/LEGI/ARTI/00/00/06/74/24/LEGIARTI000006742466.xml", "NATURE": "Article", "ORIGINE": "LEGI", "ANCIEN_ID": "SSAXXXXXXXX1X315L02AXXAB" } }, "NOTA": { "CONTENU": "
Nota : Loi 2001-1246 2001-12-21 art. 29 III : Les présentes dispositions entrent en vigueur à la date de publication du décret prévu à l'article L. 315-2 du code de la sécurité sociale.
\n
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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.
\n
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 :
\n
- la nécessité doit être appréciée au regard d'indications déterminées ou de conditions particulières d'ordre médical ;
\n
- 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 ;
\n
- 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.
\n
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.
\n
Les conditions d'application des alinéas précédents sont fixées par décret.
\n
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. 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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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.
\n
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 ;
\n
- 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 ;
\n
- 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.
\n
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.
\n
Les conditions d'application des alinéas précédents sont fixées par décret.
\n
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. 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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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.
\n
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 :
\n
- la nécessité doit être appréciée au regard d'indications déterminées ou de conditions particulières d'ordre médical ;
\n
- 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 ;
\n
- 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.
\n
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.
\n
Les conditions d'application des alinéas précédents sont fixées par décret.
\n
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.
\n
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.
" } }, "LEGIARTI000017730909": { "META": { "META_SPEC": { "META_ARTICLE": { "NUM": "117", "TYPE": "ENTIEREMENT_MODIF", "DATE_FIN": "2999-01-01", "DATE_DEBUT": "2999-01-01" } }, "META_COMMUN": { "ID": "LEGIARTI000017730909", "URL": "article/LEGI/ARTI/00/00/17/73/09/LEGIARTI000017730909.xml", "NATURE": "Article", "ORIGINE": "LEGI" } }, "LIENS": { "LIEN": [ { "@id": "LEGIARTI000017844910", "@num": "L433-1", "#text": "Code de la sécurité sociale. - art. L433-1 (V)", "@sens": "source", "@cidtexte": "LEGITEXT000006073189", "@typelien": "MODIFIE", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000017844914", "@num": "L442-5", "#text": "Code de la sécurité sociale. - art. L442-5 (V)", "@sens": "source", "@cidtexte": "LEGITEXT000006073189", "@typelien": "MODIFIE", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" } ] }, "CONTEXTE": { "TEXTE": { "TM": { "TM": { "TITRE_TM": [ { "@id": "LEGISCTA000017730676", "@fin": "2999-01-01", "#text": "Section 7 : Dispositions relatives au contrôle et à la lutte contre la fraude", "@debut": "2007-12-22" } ] }, "TITRE_TM": [ { "@id": "LEGISCTA000017730681", "@fin": "2999-01-01", "#text": "QUATRIÈME PARTIE : DISPOSITIONS RELATIVES AUX DÉPENSES POUR 2008", "@debut": "2007-12-22" } ] }, "@cid": "JORFTEXT000017726554", "@nor": "BCFX0766311L", "@num": "2007-1786", "@nature": "LOI", "TITRE_TXT": [ { "@fin": "2999-01-01", "#text": "LOI n° 2007-1786 du 19 décembre 2007 de financement de la sécurité sociale pour 2008", "@debut": "2999-01-01", "@id_txt": "JORFTEXT000017726554", "@c_titre_court": "LOI n° 2007-1786 du 19 décembre 2007" }, { "@fin": "2999-01-01", "#text": "LOI n° 2007-1786 du 19 décembre 2007 de financement de la sécurité sociale pour 2008 (1)", "@debut": "2007-12-22", "@id_txt": "LEGITEXT000017730663", "@c_titre_court": "LOI n° 2007-1786 du 19 décembre 2007" } ], "@date_publi": "2007-12-21", "@date_signature": "2007-12-19" } }, "VERSIONS": { "VERSION": [ { "LIEN_ART": { "@id": "LEGIARTI000017730909", "@fin": "2999-01-01", "@num": "117", "@debut": "2999-01-01", "@origine": "LEGI" } }, { "LIEN_ART": { "@id": "JORFARTI000017727190", "@fin": "2999-01-01", "@num": "117", "@debut": "2999-01-01", "@origine": "JORF" } } ] }, "BLOC_TEXTUEL": { "CONTENU": "
A modifié les dispositions suivantes :

Code de la sécurité sociale.
\n Art. L433-1\n
\n

\n
A modifié les dispositions suivantes :

Code de la sécurité sociale.
\n Art. L442-5\n
\n

" } }, "LEGIARTI000017844881": { "META": { "META_SPEC": { "META_ARTICLE": { "NUM": "L315-1", "ETAT": "MODIFIE", "TYPE": "AUTONOME", "DATE_FIN": "2009-12-28", "DATE_DEBUT": "2007-12-22" } }, "META_COMMUN": { "ID": "LEGIARTI000017844881", "URL": "article/LEGI/ARTI/00/00/17/84/48/LEGIARTI000017844881.xml", "NATURE": "Article", "ORIGINE": "LEGI" } }, "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": "JORFARTI000001691496", "@num": "1", "#text": "Loi n° 78-49 du 19 janvier 1978 - art. 1", "@sens": "source", "@cidtexte": "JORFTEXT000000704804", "@numtexte": "78-49", "@typelien": "CITATION", "@naturetexte": "LOI", "@datesignatexte": "1978-01-19" }, { "@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": "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 ainsi que des prestations prises en charge en application des articles L. 251-2 et L. 254-1 du code de l'action sociale et des familles.

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.

Lorsque l'activité de prescription d'arrêt de travail apparaît anormalement élevée au regard de la pratique constatée chez les professionnels de santé appartenant à la même profession, des contrôles systématiques de ces prescriptions sont mis en oeuvre dans des conditions définies par la convention mentionnée à l'article L. 227-1.

Lorsqu'un contrôle effectué par un médecin à la demande de l'employeur, en application du dernier alinéa de l'article 1er de la loi n° 78-49 du 19 janvier 1978 relative à la mensualisation et à la procédure conventionnelle, conclut à l'absence de justification d'un arrêt de travail, ce médecin transmet son avis au service du contrôle médical de la caisse. Si ce service conclut également, au vu de cet avis, à l'absence de justification de l'arrêt de travail, la caisse suspend le versement des indemnités journalières après en avoir informé l'assuré.

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, de l'aide médicale de l'Etat ou de la prise en charge des soins urgents mentionnée à l'article L. 254-1 du code de l'action sociale et des familles, notamment au regard des règles définies en application des dispositions de l'article L. 162-1-7.

III. bis.-Le service du contrôle médical procède auprès des établissements de santé visés à l'article L. 162-22-6, des pharmaciens et des distributeurs de produits ou prestations, dans le respect des règles déontologiques, aux contrôles nécessaires en matière de délivrance et de facturation de médicaments, produits ou prestations donnant lieu à remboursement par les caisses d'assurance maladie ou à prise en charge par l'Etat en application des articles L. 251-2 ou L. 254-1 du code de l'action sociale et des familles.

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, de l'aide médicale de l'Etat ou de la prise en charge des soins urgents mentionnée à l'article L. 254-1 du code de l'action sociale et des familles, 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.

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.

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.

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.

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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.

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 :

- la nécessité doit être appréciée au regard d'indications déterminées ou de conditions particulières d'ordre médical ;

- 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 ;

- 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 ou de l'Etat en ce qui concerne les prestations servies en application des articles L. 251-2 et L. 254-1 du code de l'action sociale et des familles .

Il est précisé lors de la prise en charge 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.

Les conditions d'application des alinéas précédents sont fixées par décret.

article L. 254-1 du code de l'action sociale et des familles, 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.Sous réserve des dispositions de l'article L. 324-1, tout assuré ou bénéficiaire de l'aide médicale de l'Etat ou de la prise en charge des soins urgents mentionnée à l'article L. 254-1 du code de l'action sociale et des familles 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.

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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.

-la nécessité doit être appréciée au regard d'indications déterminées ou de conditions particulières d'ordre médical ;

-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 ;

-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 ou de l'Etat en ce qui concerne les prestations servies en application des articles L. 251-2 et L. 254-1 du code de l'action sociale et des familles.

Il est précisé lors de la prise en charge 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.

Les conditions d'application des alinéas précédents sont fixées par décision du collège des directeurs de l'Union nationale des caisses d'assurance maladie.

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 ou le bénéficiaire de l'aide médicale de l'Etat ou de la prise en charge des soins urgents mentionnée à l'article L. 254-1 du code de l'action sociale et des familles, 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.

Sous réserve des dispositions de l'article L. 324-1, tout assuré ou bénéficiaire de l'aide médicale de l'Etat ou de la prise en charge des soins urgents mentionnée à l'article L. 254-1 du code de l'action sociale et des familles 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.

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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.

\n
Lorsqu'un contrôle effectué par un médecin à la demande de l'employeur, en application de l'article L. 1226-1 du code du travail, conclut à l'absence de justification d'un arrêt de travail ou fait état de l'impossibilité de procéder à l'examen de l'assuré, ce médecin transmet son rapport au service du contrôle médical de la caisse dans un délai maximal de quarante-huit heures. Le rapport précise si le médecin diligenté par l'employeur a ou non procédé à un examen médical de l'assuré concerné. Au vu de ce rapport, ce service :

1° Soit demande à la caisse de suspendre les indemnités journalières. Dans un délai fixé par décret à compter de la réception de l'information de suspension des indemnités journalières, l'assuré peut demander à son organisme de prise en charge de saisir le service du contrôle médical pour examen de sa situation. Le service du contrôle médical se prononce dans un délai fixé par décret ;

2° Soit procède à un nouvel examen de la situation de l'assuré. Ce nouvel examen est de droit si le rapport a fait état de l'impossibilité de procéder à l'examen de l'assuré.

\n
\n

" } }, "LEGIARTI000031687215": { "META": { "META_SPEC": { "META_ARTICLE": { "NUM": "L315-2", "ETAT": "MODIFIE", "TYPE": "AUTONOME", "DATE_FIN": "2018-01-01", "DATE_DEBUT": "2016-01-01" } }, "META_COMMUN": { "ID": "LEGIARTI000031687215", "URL": "article/LEGI/ARTI/00/00/31/68/72/LEGIARTI000031687215.xml", "NATURE": "Article", "ORIGINE": "LEGI" } }, "LIENS": { "LIEN": [ { "@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": "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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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.

-la nécessité doit être appréciée au regard d'indications déterminées ou de conditions particulières d'ordre médical ;

-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 ;

-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 ou de l'Etat en ce qui concerne les prestations servies en application des articles L. 251-2 et L. 254-1 du code de l'action sociale et des familles.

Il est précisé lors de la prise en charge 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.

Les conditions d'application des alinéas précédents sont fixées par décision du collège des directeurs de l'Union nationale des caisses d'assurance maladie.

Si, indépendamment des dispositions des deuxième à cinquième alinéas, le service du contrôle médical estime qu'une prestation mentionnée aux articles L. 160-8 et L. 321-1 n'est pas médicalement justifiée, la caisse, après en avoir informé l'assuré ou le bénéficiaire de l'aide médicale de l'Etat ou de la prise en charge des soins urgents mentionnée à l'article L. 254-1 du code de l'action sociale et des familles, en suspend le service. En cas de suspension du service des indemnités mentionnées à 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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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.

Lorsqu'un contrôle effectué par un médecin à la demande de l'employeur, en application de l'article L. 1226-1 du code du travail, conclut à l'absence de justification d'un arrêt de travail ou fait état de l'impossibilité de procéder à l'examen de l'assuré, ce médecin transmet son rapport au service du contrôle médical de la caisse dans un délai maximal de quarante-huit heures. Le rapport précise si le médecin diligenté par l'employeur a ou non procédé à un examen médical de l'assuré concerné. Au vu de ce rapport, ce service :

2° Soit procède à un nouvel examen de la situation de l'assuré. Ce nouvel examen est de droit si le rapport a fait état de l'impossibilité de procéder à l'examen de l'assuré.

VI.-Le service du contrôle médical transmet, sauf opposition du bénéficiaire, les informations de nature médicale qu'il détient, notamment le protocole de soins mentionné à l'article L. 324-1, en cas de changement d'organisme ou de régime d'assurance maladie, au nouveau service chargé du contrôle médical dont relève l'assuré.

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I.-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.

II.-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. A défaut de réponse du service du contrôle médical dans un délai fixé par décret, l'accord est réputé avoir été donné ; ce délai peut être différent selon la nature de la prestation. Cet accord préalable peut être exigé pour une prestation dans l'un des cas suivants :

-sa nécessité doit être appréciée au regard d'indications déterminées ou de conditions particulières d'ordre médical, notamment lorsqu'il existe un risque, prévisible ou avéré, de non-respect des indications ouvrant droit à la prise en charge ou de mésusage ;

-sa justification, du fait de son 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 ;

-la prestation, à titre unitaire ou compte tenu de son volume global, a, de manière prévisible ou constatée, un caractère particulièrement coûteux pour l'assurance maladie ou pour l'Etat en ce qui concerne les prestations servies en application des articles L. 251-2 et L. 254-1 du code de l'action sociale et des familles ;

-le recours à une autre prestation est moins coûteux.

Il est précisé lors de la prise en charge 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.

Les conditions d'application des alinéas précédents sont fixées par décision du collège des directeurs de l'Union nationale des caisses d'assurance maladie.

Pour des motifs de santé publique, les ministres chargés de la santé et de la sécurité sociale peuvent saisir le collège des directeurs de l'Union nationale des caisses d'assurance maladie d'une proposition tendant à l'application de la procédure d'accord préalable à certaines prestations mentionnées au I de l'article L. 315-1. En l'absence de décision de mise en œuvre d'une procédure d'accord préalable par ce collège à l'expiration d'un délai fixé par décret, cette décision peut être prise par arrêté des mêmes ministres.
\n
Indépendamment des dispositions des deux précédents alinéas, la décision de subordonner le bénéfice de certaines prestations à l'accord préalable du service du contrôle médical peut être prise par arrêté des ministres chargés de la santé et de la sécurité sociale à l'occasion de l'inscription ou du renouvellement d'inscription d'un produit sur les listes ou sur l'une des listes prévues aux premier et deuxième alinéas de l'article L. 162-17, aux articles L. 162-22-7, L. 162-23-6 et L. 165-1 du présent code et à l'article L. 5123-2 du code de la santé publique, à la suite d'une autorisation temporaire d'utilisation prévue à l'article L. 5121-12 du même code ou à la suite d'une prise en charge en application des articles L. 162-16-5-2 ou L. 162-17-2-1 du présent code. Dans ces cas, les conditions d'application du présent article sont fixées par décret en Conseil d'Etat.

III.-Si, indépendamment des dispositions du présent article relatives à la procédure d'accord préalable, le service du contrôle médical estime qu'une prestation mentionnée aux articles L. 160-8 et L. 321-1 n'est pas médicalement justifiée, la caisse, après en avoir informé l'assuré ou le bénéficiaire de l'aide médicale de l'Etat ou de la prise en charge des soins urgents mentionnée à l'article L. 254-1 du code de l'action sociale et des familles, en suspend le service. En cas de suspension du service des indemnités mentionnées à 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.

IV.-Sous réserve des dispositions de l'article L. 324-1, tout assuré ou bénéficiaire de l'aide médicale de l'Etat ou de la prise en charge des soins urgents mentionnée à l'article L. 254-1 du code de l'action sociale et des familles 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.

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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.

2° Soit procède à un nouvel examen de la situation de l'assuré. Ce nouvel examen est de droit si le rapport a fait état de l'impossibilité de procéder à l'examen de l'assuré.

VII.-Le service du contrôle médical peut, en application de l'article L. 1435-7 du code de la santé publique, procéder au contrôle du recueil des indicateurs de qualité et de sécurité des soins mentionnés aux articles L. 6144-1 et L. 6161-2-2 du même code.

" } }, "LEGIARTI000041398082": { "META": { "META_SPEC": { "META_ARTICLE": { "NUM": "L315-2", "ETAT": "MODIFIE", "TYPE": "AUTONOME", "DATE_FIN": "2023-12-28", "DATE_DEBUT": "2022-01-01" } }, "META_COMMUN": { "ID": "LEGIARTI000041398082", "URL": "article/LEGI/ARTI/00/00/41/39/80/LEGIARTI000041398082.xml", "NATURE": "Article", "ORIGINE": "LEGI" } }, "NOTA": { "CONTENU": "

Conformément aux III de l'article 87 de la loi n° 2019-1446 du 24 décembre 2019, ces dispositions sont applicables aux contestations, aux recours préalables et aux recours juridictionnels introduits à compter d'une date fixée par décret en Conseil d'Etat, et au plus tard le 1er janvier 2022.

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I.-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.

II.- A. - 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. A défaut de réponse du service du contrôle médical dans un délai fixé par décret, l'accord est réputé avoir été donné ; ce délai peut être différent selon la nature de la prestation. Cet accord préalable peut être exigé pour une prestation dans l'un des cas suivants :

-le recours à une autre prestation est moins coûteux.

Il est précisé lors de la prise en charge 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.

Les conditions d'application des alinéas précédents sont fixées par décision du collège des directeurs de l'Union nationale des caisses d'assurance maladie.

Indépendamment des dispositions des deux précédents alinéas, la décision de subordonner le bénéfice de certaines prestations à l'accord préalable du service du contrôle médical peut être prise, à tout moment, par arrêté des ministres chargés de la santé et de la sécurité sociale concernant les produits pris en charge au titre des listes, ou de l'une des listes, prévues aux premier et deuxième alinéas de l'article L. 162-17, ou au titre des articles L. 162-16-5-1-1, L. 162-16-5-2, L. 162-17-2-1, L. 162-22-7, L. 162-23-6, L. 165-1, L. 165-1-1, L. 165-1-5 ou L. 165-11 du présent code ou de l'article L. 5123-2 du code de la santé publique, ou à la suite d'une autorisation d'utilisation et de prise en charge en association dans les conditions mentionnées à l'article L. 162-18-1 du présent code. Dans ces cas, les conditions d'application du présent article sont fixées par décret en Conseil d'Etat.

B. - Pour l'application du présent II :

1° Dans le cas d'une transmission électronique des éléments permettant de demander l'accord en vue de la prise en charge d'une prestation par les établissements de santé, ou par les professionnels exerçant en leur sein, l'identification de l'émetteur, son authentification et la sécurisation des échanges sont assurées dans des conditions définies par décret en Conseil d'Etat ;

2° Il peut être dérogé en tant que de besoin aux dispositions relatives à l'obligation d'homologation de certains formulaires administratifs, prévues aux articles 38 et 39 de l'ordonnance n° 2004-637 du 1er juillet 2004 relative à la simplification de la composition et du fonctionnement des commissions administratives et à la réduction de leur nombre.

III.-Si, indépendamment des dispositions du présent article relatives à la procédure d'accord préalable, le service du contrôle médical estime qu'une prestation mentionnée aux articles L. 160-8 et L. 321-1 n'est pas médicalement justifiée, la caisse, après en avoir informé l'assuré ou le bénéficiaire de l'aide médicale de l'Etat ou de la prise en charge des soins urgents mentionnée à l'article L. 254-1 du code de l'action sociale et des familles, en suspend le service. En cas de suspension du service des indemnités mentionnées à 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 sont soumises aux règles prévues au chapitre II du titre IV du livre Ier.

" } }, "LEGIARTI000042686005": { "META": { "META_SPEC": { "META_ARTICLE": { "NUM": "L315-2", "ETAT": "MODIFIE", "TYPE": "AUTONOME", "DATE_FIN": "2021-12-25", "DATE_DEBUT": "2021-07-01" } }, "META_COMMUN": { "ID": "LEGIARTI000042686005", "URL": "article/LEGI/ARTI/00/00/42/68/60/LEGIARTI000042686005.xml", "NATURE": "Article", "ORIGINE": "LEGI" } }, "NOTA": { "CONTENU": "

Conformément au A du IV de l'article 78 de la loi n° 2020-1576 du 14 décembre 2020, ces dispositions entrent en vigueur à une date fixée par décret, et au plus tard le 1er juillet 2021.

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I.-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.

-le recours à une autre prestation est moins coûteux.

Il est précisé lors de la prise en charge 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.

Les conditions d'application des alinéas précédents sont fixées par décision du collège des directeurs de l'Union nationale des caisses d'assurance maladie.

Indépendamment des dispositions des deux précédents alinéas, la décision de subordonner le bénéfice de certaines prestations à l'accord préalable du service du contrôle médical peut être prise par arrêté des ministres chargés de la santé et de la sécurité sociale à l'occasion de l'inscription ou du renouvellement d'inscription d'un produit sur les listes ou sur l'une des listes prévues aux premier et deuxième alinéas de l'article L. 162-17, aux articles L. 162-22-7, L. 162-23-6 et L. 165-1 du présent code et à l'article L. 5123-2 du code de la santé publique, à la suite de l'une des autorisations ou d'un cadre de prescription compassionnelle prévus aux articles L. 5121-12 et L. 5121-12-1 du même code et de la prise en charge associée au titre des articles L. 162-16-5-1 ou L. 162-16-5-2 du présent code. Dans ces cas, les conditions d'application du présent article sont fixées par décret en Conseil d'Etat.

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I.-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.

II.-A.-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. A défaut de réponse du service du contrôle médical dans un délai fixé par décret, l'accord est réputé avoir été donné ; ce délai peut être différent selon la nature de la prestation. Cet accord préalable peut être exigé pour une prestation dans l'un des cas suivants :

-le recours à une autre prestation est moins coûteux.

Il est précisé lors de la prise en charge 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.

Les conditions d'application des alinéas précédents sont fixées par décision du collège des directeurs de l'Union nationale des caisses d'assurance maladie.

Pour des motifs de santé publique, les ministres chargés de la santé et de la sécurité sociale peuvent saisir le collège des directeurs de l'Union nationale des caisses d'assurance maladie d'une proposition tendant à l'application de la procédure d'accord préalable à certaines prestations mentionnées au I de l'article L. 315-1. En l'absence de décision de mise en œuvre d'une procédure d'accord préalable par ce collège à l'expiration d'un délai fixé par décret, cette décision peut être prise par arrêté des mêmes ministres.
\n
\nIndépendamment des dispositions des deux précédents alinéas, la décision de subordonner le bénéfice de certaines prestations à l'accord préalable du service du contrôle médical peut être prise , à tout moment, par arrêté des ministres chargés de la santé et de la sécurité sociale concernant les produits pris en charge au titre des listes, ou de l'une des listes, prévues aux premier et deuxième alinéas de l'article L. 162-17, ou au titre des articles L. 162-16-5-1-1, L. 162-16-5-2, L. 162-17-2-1, L. 162-22-7, L. 162-23-6, L. 165-1, L. 165-1-1, L. 165-1-5 ou L. 165-11 du présent code ou de l'article L. 5123-2 du code de la santé publique. Dans ces cas, les conditions d'application du présent article sont fixées par décret en Conseil d'Etat.
\n
\nB.-Pour l'application du présent II :
\n
\n1° Dans le cas d'une transmission électronique des éléments permettant de demander l'accord en vue de la prise en charge d'une prestation par les établissements de santé, ou par les professionnels exerçant en leur sein, l'identification de l'émetteur, son authentification et la sécurisation des échanges sont assurées dans des conditions définies par décret en Conseil d'Etat ;

\n
" } }, "LEGIARTI000045065602": { "META": { "META_SPEC": { "META_ARTICLE": { "NUM": "L315-2", "ETAT": "MODIFIE", "TYPE": "AUTONOME", "DATE_FIN": "2022-01-01", "DATE_DEBUT": "2021-12-25" } }, "META_COMMUN": { "ID": "LEGIARTI000045065602", "URL": "article/LEGI/ARTI/00/00/45/06/56/LEGIARTI000045065602.xml", "NATURE": "Article", "ORIGINE": "LEGI" } }, "NOTA": { "CONTENU": "

Conformément au A du IV de l'article 78 de la loi n° 2020-1576 du 14 décembre 2020, ces dispositions entrent en vigueur à une date fixée par décret, et au plus tard le 1er juillet 2021.

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I.-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.

-le recours à une autre prestation est moins coûteux.

Il est précisé lors de la prise en charge 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.

Les conditions d'application des alinéas précédents sont fixées par décision du collège des directeurs de l'Union nationale des caisses d'assurance maladie.

Indépendamment des dispositions des deux précédents alinéas, la décision de subordonner le bénéfice de certaines prestations à l'accord préalable du service du contrôle médical peut être prise par arrêté des ministres chargés de la santé et de la sécurité sociale à l'occasion de l'inscription ou du renouvellement d'inscription d'un produit sur les listes ou sur l'une des listes prévues aux premier et deuxième alinéas de l'article L. 162-17, aux articles L. 162-22-7, L. 162-23-6 et L. 165-1 du présent code et à l'article L. 5123-2 du code de la santé publique, à la suite de l'une des autorisations ou d'un cadre de prescription compassionnelle prévus aux articles L. 5121-12 et L. 5121-12-1 du même code et de la prise en charge associée au titre des articles L. 162-16-5-1 ou L. 162-16-5-2 du présent code. Dans ces cas, les conditions d'application du présent article sont fixées par décret en Conseil d'Etat.

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I.-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.

-le recours à une autre prestation est moins coûteux.

Il est précisé lors de la prise en charge 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.

Les conditions d'application des alinéas précédents sont fixées par décision du collège des directeurs de l'Union nationale des caisses d'assurance maladie.

B. - Pour l'application du présent II :

III.-Si, indépendamment des dispositions du présent article relatives à la procédure d'accord préalable, le service du contrôle médical estime qu'une prestation mentionnée aux articles L. 160-8 et L. 321-1 n'est pas médicalement justifiée, la caisse, après en avoir informé l'assuré ou le bénéficiaire de l'aide médicale de l'Etat ou de la prise en charge des soins urgents mentionnée à l'article L. 254-1 du code de l'action sociale et des familles, en suspend le service. En cas de suspension du service des indemnités mentionnées à l'article L. 321-1, la caisse en informe l'employeur. Lorsque le service du contrôle médical estime, à l'issue de l'examen d'un assuré, qu'une prescription d'arrêt de travail n'est pas ou n'est plus médicalement justifiée, l'intéressé en est directement informé. Sauf si le service du contrôle médical 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 sont soumises aux règles prévues au chapitre II du titre IV du livre Ier.

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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.

2° Soit procède à un nouvel examen de la situation de l'assuré. Ce nouvel examen est de droit si le rapport a fait état de l'impossibilité de procéder à l'examen de l'assuré.

VIII. - Les missions du service du contrôle médical sont exercées par les praticiens conseils mentionnés à l'article L. 224-7 du présent code. Ceux-ci peuvent déléguer, sous leur responsabilité, la réalisation de certains actes et de certaines activités au personnel du contrôle médical disposant de la qualification nécessaire. Lorsque ces délégations concernent des auxiliaires médicaux, lesdites missions sont exercées dans la limite de leurs compétences prévues par le code de la santé publique. Lorsque, dans le cadre de ces délégations, des auxiliaires médicaux rendent des avis qui commandent l'attribution et le service de prestations, elles s'exercent dans le cadre d'un protocole écrit.

" } }, "LEGIARTI000048726222": { "META": { "META_SPEC": { "META_ARTICLE": { "NUM": "L315-1", "ETAT": "VIGUEUR", "TYPE": "AUTONOME", "DATE_FIN": "2999-01-01", "DATE_DEBUT": "2024-01-01" } }, "META_COMMUN": { "ID": "LEGIARTI000048726222", "URL": "article/LEGI/ARTI/00/00/48/72/62/LEGIARTI000048726222.xml", "NATURE": "Article", "ORIGINE": "LEGI" } }, "NOTA": { "CONTENU": "

Conformément au VII de l'article 49 de la loi n° 2023-1250 du 26 décembre 2023, ces dispositions entrent en vigueur le 1er janvier 2024.

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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.

2° Soit procède à un nouvel examen de la situation de l'assuré. Ce nouvel examen est de droit si le rapport a fait état de l'impossibilité de procéder à l'examen de l'assuré.

III. bis.-Le service du contrôle médical procède auprès des établissements de santé visés à l'article L. 162-22, des pharmaciens et des distributeurs de produits ou prestations, dans le respect des règles déontologiques, aux contrôles nécessaires en matière de délivrance et de facturation de médicaments, produits ou prestations donnant lieu à remboursement par les caisses d'assurance maladie ou à prise en charge par l'Etat en application des articles L. 251-2 ou L. 254-1 du code de l'action sociale et des familles.

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Article L442-5 AUTONOME VIGUEUR, en vigueur depuis le 22/12/2007 (Code de la sécurité sociale)