The Framework agreement on cross-border healthcare cooperation and its application agreement were signed on September 27, 2016 and came into force on October 1, 2019 and October 1, 2019 (decree 2019-1319 of December 9, 2019):
These instruments pertain to cross-border health care cooperation and also cover emergency medical services.
The local agreements that have been set up pursuant to these instruments are designed to organize cooperation between healthcare facilities and resources in the border area so that they work in a complementary manner that is determined by previously identified shortages and needs in terms of delivery of care.
These agreements are intended to provide a framework for how and when the health care facilities and professionals become involved in cross-border care.
They take up the main provisions of these local agreements and set forth:
- a geographic scope of application:
- the “Grand-Est,” “Bourgogne-Franche Comté,” and “Auvergne-Rhône-Alpes” regions for France
- the cantons bordering on France for Switzerland (“Bâle-Campagne,” “Bâle-Ville,” “Berne,” “Genève,” “Jura,” “Neuchâtel,” “Soleure,” “Valais,” and “Vaud”)
- a personal scope of application:
- any person covered by one of the parties’ health insurance systems, residing or visiting the border area;
- any person belonging to a social security system that falls within the scope of application of (EC) regulations 883/2004 and 987/2009 who needs emergency medical services and care while residing in or visiting the border area;
- the cooperation agreements can be extended to foreign citizens residing legally in either State but not covered by regulations No. 883/2004 and 987/2009;
- all (salaried or self-employed) health care professionals working in the border area.
- Implementing authorities :
- for France: the border regions’ ”Agences régionales de santé” (public health agencies): for the “Grand-Est,” “Bourgogne-Franche-Comté,” and “Auvergne-Rhône-Alpes” regions, and the “Caisse primaire d’assurance maladie de Haute-Savoie” (The Upper Savoy department’s local health insurance fund);
- For Switzerland: the “Office federal de la santé publique” (Federal public health office”) and the cantons bordering on France (“Bâle-Campagne,” “Bâle-Ville,” “Berne,” “Genève,” “Jura,” “Neuchâtel,” “Soleure,” “Valais,” and “Vaud”)
- What the cooperation agreements contain:
- health care professionals’ involvement in cross-border care (rules, types of care, duration),
- a framework for organizing emergency assistance and medical transport for patients (rules, regulation, and coordination of the means of communication used),
- border-crossing rules;
- hospital care-related cooperation (types of care, hospital emergency services, and out-of-hours services for salaried or self-employed health care professionals);
- guaranteed continuity of care, with a special emphasis on patient intake and information (access to care, medical transport, discharge rules, and patient information (medical file, patient handbook);
- health care quality and safety assessment and monitoring criteria (public health risk management, health care professionals’ skills, patient medical information, and rules for organizing care);
- cooperation in the management of public health crises, over and above existing international health care regulations;
- the material, geographic, and personal scopes to which the agreement applies;
- the duration and rules for withdrawal from the cooperation agreement;
- the mechanisms for financial coverage of expenses, and rates and reimbursements of care covered by the cooperation agreement.
- Applicable law with regard to the cross-border practice of medicine by health care professionals
:
- compliance with applicable law, particularly with regard to medical liability, in the country where care is provided;
- underwriting of third-party liability insurance by all volunteers, professionals, facilities, health care services, and emergency assistance services providing care within the scope of the cross-border agreements or providing emergency care;
- measures are taken by the competent authorities to make it easier to cross the shared border.
- Rules for coverage and reimbursement of care:
- coverage, within the framework of (EC) regulations 883/2004 and 987/209, based on the automatic issuance of a S2 form for the specific types of care listed in the health care cooperation agreements, when these types of care are among those covered by the legislation of the State of membership;
- the State of membership can provide direct coverage of care at specific rates negotiated by the parties to any local health care cooperation agreements.
- A deadline for compliance: where necessary, two years after the framework agreement has come into force, all existing cooperation agreements will need to be brought into compliance with the framework agreement.
- Rules for how the agreement will be evaluated: creation of a joint committee made up of representatives of both States’ competent authorities that will meet at least once every two years or on an as-needed bases upon request by either Party. This committee is in charge of:
- overseeing how the framework agreement is applied and proposing any potential amendments;
- sorting out any difficulties in connection with the application or interpretation of the framework agreement;
- producing an assessment of the cross-border health care cooperation program every four years.
