An ordinance sets the framework for CPTS and relaxes the regime for nursing homes

Published on May 18, 2021through

Jean-Noël Escudié / P2C for Localtis


Health, medico-social, aging,
Social

An ordinance of 12 May intends to promote the development of the coordinated exercise of health professionals thanks to the territorial professional communities of health (CPTS), formed in the form of associations agreeing with the ARS and the CPAM to ensure various missions related to the ” access to care, prevention, etc. It also makes the functioning of multidisciplinary health centers (MSPs) more flexible, particularly with regard to the possible salaried positions of the professionals who work there. Another ordinance of the same day concerns heavy equipment, sometimes subsidized by communities, and home hospitalization (HAD).

A order of May 12, 2021 brings significant progress on two systems intended, among other things, to fight against medical deserts and to develop the practice of health professionals in a more collective and transversal sense. The first system, already well installed and meeting with great success, is that of multidisciplinary health centers, currently numbering 1,740 (see our article of April 22, 2021). The second – that of the territorial professional health communities (CPTS) – is in the process of ramping up and counts even more in projects than in achievements (idem).

Public service missions for the CPTS

The ordinance of May 12, 2021 results from an authorization provided for by article 64 of the law of July 24, 2019 relating to the organization and transformation of the health system. As this article sets a deadline of 18 months for the prescription to be taken, the latter therefore seriously lacks a legal basis, just like the ordinance of the same day on local hospitals (see our article of May 17, 2021).

The purpose of the first part of the ordinance is to promote the development of the coordinated exercise and to make the supervision of the latter more flexible, from a legal and fiscal point of view. It specifies that the territorial professional health community may be called upon, by an agreement concluded with the ARS and the territorially competent primary health insurance fund, to ensure, in whole or in part, one or more public service missions. These missions may concern the improvement of access to care, the organization of care pathways involving several health professionals, the development of territorial prevention actions, the development of the quality and relevance of care, support for health professionals in their territory and finally – in direct connection with the Covid-19 pandemic – participation in the response to health crises. When the CPTS has concluded such an agreement, it benefits from specific aid from the State or from the CNAM (National Health Insurance Fund), as well as tax exemptions “to offset the burden of public service missions that she exercises “. These exemptions relate to corporation tax and business property tax.

In statutory terms, the territorial professional health community must be constituted, at the end of a maximum transitional period of one year, in the form of an association governed by the law of 1901 (or by the local Civil Code for those whose the head office is located in Haut-Rhin, Bas-Rhin or Moselle). A decree will come to specify the operating methods of the CPTS and in particular the conditions of payment of indemnities or remuneration for the benefit of their members, as well as their maximum annual amount.

Flexibilities for nursing homes

On its second point, the ordinance of May 12 eases the operating conditions of multidisciplinary health centers (MSP). As soon as they are set up in the form of a Sisa (interprofessional ambulatory care company), they can in fact choose to pay the medical assistants themselves (or not) (largely financed by insurance). disease) and, more broadly, any healthcare professional. The objective of this measure is to facilitate the recruitment of professionals. The report to the President of the Republic who accompanies the ordinance specifies in fact that the employment of health professionals “is particularly useful to meet the needs of areas experiencing medical demographic difficulties, the salaried position being highly prized in particular by the younger generations and retirees wishing to continue their exercise “. In the same spirit, the ordinance provides that salaried doctors can be chosen as treating doctors and that the rates applicable to the acts of salaried health professionals are the conventional rates applied to liberal professionals. The number of health professionals carrying out primary and secondary care activities who can be employed by a SISA must however remain lower than the number of associated liberal health professionals.

Likewise, the ordinance allows the sharing of fees, in order to further facilitate multi-professional practice and comprehensive care, “without resorting to salaried workers but simply to occasional interventions, both with internal health professionals or external than other professionals externally “. For this, Sisa may receive flat-rate subsidies, on condition of its redistribution to each stakeholder concerned.

To promote the sustainability of PSM in sub-dense areas, the ordinance extends the time to find a solution when the number or quality of associates (at least two doctors and a medical assistant) are no longer respected. The deadlines allowing a judge to pronounce the dissolution of the Sisa can thus be extended up to 18 months (instead of the initially planned period of 6 months) “in the event that, in the meantime, an employee has been recruited. replacing the missing professional “.

Finally, the ordinance authorizes the SISAs to develop grouping activities of employers for the benefit of all or part of their associates. They will thus be able to place medical assistants at the service of general practitioners, who will define their missions alone, without this representing a burden or a responsibility for the other partners.

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