{ "article": { "LEGIARTI000047564362": { "META": { "META_SPEC": { "META_ARTICLE": { "NUM": "4", "TYPE": "ENTIEREMENT_MODIF", "DATE_FIN": "2999-01-01", "DATE_DEBUT": "2999-01-01" } }, "META_COMMUN": { "ID": "LEGIARTI000047564362", "URL": "article/LEGI/ARTI/00/00/47/56/43/LEGIARTI000047564362.xml", "NATURE": "Article", "ORIGINE": "LEGI" } }, "LIENS": { "LIEN": [ { "@id": "LEGIARTI000044564813", "@num": "74", "#text": "LOI n°2021-1754 du 23 décembre 2021 - art. 74 (Ab)", "@sens": "source", "@cidtexte": "JORFTEXT000044553428", "@nortexte": "ECOX2126627L", "@numtexte": "2021-1754", "@typelien": "ABROGE", "@naturetexte": "LOI", "@datesignatexte": "2021-12-23" }, { "@id": "LEGIARTI000047568519", "@num": "L4341-1", "#text": "Code de la santé publique - art. L4341-1 (V)", "@sens": "source", "@cidtexte": "LEGITEXT000006072665", "@typelien": "MODIFIE", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" }, { "@id": "LEGIARTI000047568507", "@num": "L162-9", "#text": "Code de la sécurité sociale. - art. L162-9 (M)", "@sens": "source", "@cidtexte": "LEGITEXT000006073189", "@typelien": "MODIFIE", "@naturetexte": "CODE", "@datesignatexte": "2999-01-01" } ] }, "CONTEXTE": { "TEXTE": { "@cid": "JORFTEXT000047561956", "@nor": "SPRX2301496L", "@num": "2023-379", "@nature": "LOI", "TITRE_TXT": [ { "@fin": "2999-01-01", "#text": "LOI n° 2023-379 du 19 mai 2023 portant amélioration de l'accès aux soins par la confiance aux professionnels de santé (1)", "@debut": "2999-01-01", "@id_txt": "JORFTEXT000047561956", "@c_titre_court": "LOI n°2023-379 du 19 mai 2023" }, { "@fin": "2999-01-01", "#text": "LOI n° 2023-379 du 19 mai 2023 portant amélioration de l'accès aux soins par la confiance aux professionnels de santé (1)", "@debut": "2023-05-21", "@id_txt": "LEGITEXT000047564355", "@c_titre_court": "LOI n°2023-379 du 19 mai 2023" } ], "@date_publi": "2023-05-20", "@date_signature": "2023-05-19", "@num_parution_jo": "0116" } }, "VERSIONS": { "VERSION": [ { "LIEN_ART": { "@id": "LEGIARTI000047564362", "@fin": "2999-01-01", "@num": "4", "@debut": "2999-01-01", "@origine": "LEGI" } }, { "LIEN_ART": { "@id": "JORFARTI000047561960", "@fin": "2999-01-01", "@num": "4", "@debut": "2999-01-01", "@origine": "JORF" } } ] }, "BLOC_TEXTUEL": { "CONTENU": "
A abrogé les dispositions suivantes :

- LOI n°2021-1754 du 23 décembre 2021
\n Art. 74\n
\n

\n
\n
A modifié les dispositions suivantes :

- Code de la santé publique
\n Art. L4341-1\n
\n

- Code de la sécurité sociale.
\n Art. L162-9\n
\n

\n
" } }, "LEGIARTI000044564813": { "META": { "META_SPEC": { "META_ARTICLE": { "NUM": "74", "ETAT": "ABROGE", "TYPE": "AUTONOME", "DATE_FIN": "2023-05-21", "DATE_DEBUT": "2021-12-25" } }, "META_COMMUN": { "ID": "LEGIARTI000044564813", "URL": "article/LEGI/ARTI/00/00/44/56/48/LEGIARTI000044564813.xml", "NATURE": "Article", "ORIGINE": "LEGI" } }, "LIENS": { "LIEN": [ { "@id": "LEGIARTI000047564362", "@num": "4", "#text": "LOI n°2023-379 du 19 mai 2023 - art. 4", "@sens": "cible", "@cidtexte": "JORFTEXT000047561956", "@nortexte": "SPRX2301496L", "@numtexte": "2023-379", "@typelien": "ABROGE", "@naturetexte": "LOI", "@datesignatexte": "2023-05-19" } ] }, "CONTEXTE": { "TEXTE": { "TM": { "TM": { "TM": { "TITRE_TM": [ { "@id": "LEGISCTA000044564605", "@fin": "2999-01-01", "#text": "Chapitre IV : Renforcer l'accès aux soins et les actions de prévention en santé", "@debut": "2021-12-25" } ] }, "TITRE_TM": [ { "@id": "LEGISCTA000044564596", "@fin": "2999-01-01", "#text": "Titre IER : DISPOSITIONS RELATIVES AUX DÉPENSES", "@debut": "2021-12-25" } ] }, "TITRE_TM": [ { "@id": "LEGISCTA000044564610", "@fin": "2999-01-01", "#text": "QUATRIÈME PARTIE : DISPOSITIONS RELATIVES AUX DÉPENSES DE LA SÉCURITÉ SOCIALE POUR L'EXERCICE 2022", "@debut": "2021-12-25" } ] }, "@cid": "JORFTEXT000044553428", "@nor": "ECOX2126627L", "@num": "2021-1754", "@nature": "LOI", "TITRE_TXT": [ { "@fin": "2999-01-01", "#text": "LOI n° 2021-1754 du 23 décembre 2021 de financement de la sécurité sociale pour 2022 (1)", "@debut": "2999-01-01", "@id_txt": "JORFTEXT000044553428", "@c_titre_court": "LOI n°2021-1754 du 23 décembre 2021" }, { "@fin": "2999-01-01", "#text": "LOI n° 2021-1754 du 23 décembre 2021 de financement de la sécurité sociale pour 2022 (1)", "@debut": "2021-12-25", "@id_txt": "LEGITEXT000044564593", "@c_titre_court": "LOI n°2021-1754 du 23 décembre 2021" } ], "@date_publi": "2021-12-24", "@date_signature": "2021-12-23", "@num_parution_jo": "0299" } }, "VERSIONS": { "VERSION": [ { "@etat": "ABROGE", "LIEN_ART": { "@id": "LEGIARTI000044564813", "@fin": "2023-05-21", "@num": "74", "@etat": "ABROGE", "@debut": "2021-12-25", "@origine": "LEGI" } }, { "LIEN_ART": { "@id": "JORFARTI000044553532", "@fin": "2999-01-01", "@num": "74", "@debut": "2999-01-01", "@origine": "JORF" } } ] }, "BLOC_TEXTUEL": { "CONTENU": "

\n
I. - A titre expérimental, dans le cadre des structures d'exercice coordonné mentionnées aux articles L. 1411-11-1, L. 1434-12, L. 6323-1 et L. 6323-3 du code de la santé publique, l'Etat peut autoriser les orthophonistes à exercer leur art sans prescription médicale pour une durée de trois ans, dans six départements. Un bilan initial et un compte rendu des soins réalisés par l'orthophoniste sont adressés au médecin traitant et reportés dans le dossier médical partagé.
II. - Un décret, pris après avis de la Haute Autorité de santé et de l'Académie nationale de médecine, précise les modalités de mise en œuvre de l'expérimentation mentionnée au I du présent article, les départements concernés par cette expérimentation ainsi que les conditions d'évaluation de l'expérimentation en vue d'une éventuelle généralisation. Si les avis prévus à la première phrase du présent II n'ont pas été transmis au Gouvernement dans un délai de trois mois à compter de la notification du projet de décret à la Haute Autorité de santé et à l'Académie nationale de médecine, ces avis sont réputés avoir été rendus. Un rapport d'évaluation est réalisé au terme de l'expérimentation et fait l'objet d'une transmission au Parlement par le Gouvernement.

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Les rapports entre les organismes d'assurance maladie et les chirurgiens-dentistes, les sages-femmes et les auxiliaires médicaux sont définis par des conventions nationales conclues entre l'Union nationale des caisses d'assurance maladie et une ou plusieurs des organisations syndicales nationales les plus représentatives de chacune de ces professions.

Ces conventions déterminent :

1°) les obligations des caisses primaires d'assurance maladie et celles des chirurgiens-dentistes, des sages-femmes et des auxiliaires médicaux ;

2°) Les mesures que les partenaires conventionnels jugent appropriées pour garantir la qualité des soins dispensés aux assurés sociaux par les chirurgiens-dentistes, les sages-femmes ou les auxiliaires médicaux et notamment la sélection des thèmes des références professionnelles, l'opposabilité de ces références et ses conditions d'application ;

3°) La possibilité de mettre à la charge du chirurgien-dentiste, de la sage-femme ou de l'auxiliaire médical qui ne respecte pas les mesures prévues au 2° du présent article, tout ou partie des cotisations mentionnées aux articles L. 621-2 et L. 645-2, ou une partie de la dépense des régimes d'assurance maladie, correspondant aux honoraires perçus au titre des soins dispensés dans des conditions ne respectant pas ces mesures ;

4°) Pour les chirurgiens-dentistes, le cas échéant, les conditions tendant à éviter à l'assuré social de payer directement les honoraires ;

5°) Le cas échéant :

a) Les conditions particulières d'exercice propres à favoriser la coordination des soins ;

b) Les conditions particulières d'exercice permettant la prise en charge globale de patients dans le cadre de réseaux de soins et les modes de rémunération des professionnels mentionnés au 1° participant à ces réseaux ;

c) Les droits et obligations respectifs des professionnels mentionnés au 1°, des patients et des caisses, ainsi que les modalités d'évaluation associées aux formes d'exercice et modes de rémunération mentionnés aux a et b ci-dessus ;

6°) Le cas échéant, les modes de rémunération, autres que le paiement à l'acte, des activités de soins ainsi que les modes de rémunération des activités non curatives des professionnels mentionnés au 1° ;

7°) Les mesures d'adaptation, notamment incitatives, des dispositions de l'article L. 162-14-1 et du présent article applicables aux chirurgiens-dentistes, sages-femmes et auxiliaires médicaux en fonction du niveau de l'offre en soins au sein de chaque région dans les zones définies par l'agence régionale de santé en application de l'article L. 1434-4 du code de la santé publique. Ces modalités sont définies après concertation des organisations les plus représentatives des étudiants et jeunes chirurgiens-dentistes, sages-femmes et auxiliaires médicaux ;

7° bis) Les propositions d'orientations pluriannuelles prioritaires en matière de développement professionnel continu, relevant de l'article L. 4021-2 du code de la santé publique ;

8° Les conditions à remplir par les sages-femmes et les chirurgiens-dentistes pour être conventionné, notamment celles relatives aux modalités de leur exercice professionnel et à leur formation, ainsi que celles relatives aux zones d'exercice définies par l'agence régionale de santé en application de l'article L. 1434-4 du code de la santé publique.

9° Pour les masseurs-kinésithérapeutes, les conditions de prise en charge des actes qui résultent des renouvellements qu'ils établissent sur le fondement de l'article L. 4321-1 du code de la santé publique ;

10° Pour les orthophonistes, les modalités d'application du sixième alinéa de l'article L. 4341-1 du code de la santé publique.

Elles fixent également les modalités d'application du 3°, et notamment les conditions dans lesquelles le professionnel concerné présente ses observations.

Si elle autorise un dépassement pour les soins visés au 3° de l'article L. 861-3, la convention nationale intéressant les chirurgiens-dentistes fixe le montant maximal de ce dépassement applicable aux bénéficiaires du droit à la protection complémentaire en matière de santé mentionnés à l'article L. 861-1 ; à défaut de convention, ou si la convention ne prévoit pas de dispositions spécifiques aux bénéficiaires de cette protection, un arrêté des ministres chargés de la santé et de la sécurité sociale détermine la limite applicable à ces dépassements pour les intéressés.

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La pratique de l'orthophonie comporte la promotion de la santé, la prévention, le bilan orthophonique et le traitement des troubles de la communication, du langage dans toutes ses dimensions, de la cognition mathématique, de la parole, de la voix et des fonctions oro-myo-faciales.
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L'orthophoniste dispense des soins à des patients de tous âges présentant des troubles congénitaux, développementaux ou acquis.
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Il contribue notamment au développement et au maintien de l'autonomie, à la qualité de vie du patient ainsi qu'au rétablissement de son rapport confiant à la langue.
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L'exercice professionnel de l'orthophoniste nécessite la maîtrise de la langue dans toutes ses composantes.
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L'orthophoniste pratique son art sur prescription médicale. Il peut adapter, sauf indication contraire du médecin, dans le cadre d'un renouvellement, les prescriptions médicales initiales d'actes d'orthophonie datant de moins d'un an.
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Par dérogation au cinquième alinéa, dans les établissements de santé mentionnés à l'article L. 6111-1, dans les établissements et services sociaux et médico-sociaux mentionnés aux articles L. 312-1 et L. 344-1 du code de l'action sociale et des familles et dans le cadre des structures d'exercice coordonné mentionnées aux articles L. 1411-11-1, L. 1434-12, L. 6323-1 et L. 6323-3 du présent code, l'orthophoniste pratique son art sans prescription médicale. Un bilan initial et un compte rendu des soins réalisés par l'orthophoniste sont adressés au médecin traitant du patient ainsi qu'à ce dernier et reportés dans le dossier médical partagé de celui-ci. A défaut, les actes réalisés par l'orthophoniste sont mis à sa charge.
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Dans le cadre des structures prévues à l'article L. 1434-12, le sixième alinéa du présent article s'applique à la condition que les modalités de prise en charge et de coordination sans prescription médicale soient inscrites dans le projet de santé de la structure.
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En cas d'urgence et en l'absence d'un médecin, l'orthophoniste est habilité à accomplir les soins nécessaires en orthophonie en dehors d'une prescription médicale. Un compte rendu du bilan et des actes accomplis dans ces conditions est remis au médecin dès son intervention.
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Sauf indication contraire du médecin, il peut prescrire ou renouveler la prescription de certains dispositifs médicaux dont la liste est limitativement fixée par arrêté des ministres chargés de la santé et de la sécurité sociale pris après avis de l'Académie nationale de médecine.
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L'orthophoniste exerce en toute indépendance et pleine responsabilité, conformément aux règles professionnelles prévues à l'article L. 4341-9.
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Il établit en autonomie son diagnostic et décide des soins orthophoniques à mettre en œuvre.
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Dans le cadre des troubles congénitaux, développementaux ou acquis, l'orthophoniste met en œuvre les techniques et les savoir-faire les plus adaptés à l'évaluation et au traitement orthophonique du patient et participe à leur coordination. Il peut également concourir à la formation initiale et continue ainsi qu'à la recherche.
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La définition des actes d'orthophonie est précisée par un décret en Conseil d'Etat pris après avis de l'Académie nationale de médecine.

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Article 4 ENTIEREMENT_MODIF (LOI n° 2023-379 du 19 mai 2023 portant amélioration de l'accès aux soins par la confiance aux professionnels de santé (1))