Cross-border cooperation agreement for severe burn victims
(signed on and effective date 10/02/2009)
The agreement organizes care for severe burn victims in France''s Alsace region, whatever their scheme of membership, at the severe burn trauma center BG Unfallklinik in Ludwigshafen, Germany, whenever France''s facilities are unable to meet demands.
This setup excludes any emergency transfer to another German facility (European regulations apply in those cases), as well as follow-up care and rehabilitation, and the costs of repatriating the body in the event of death, except if an industrial accident is involved.
Responses are always by France''s emergency medical service (SAMU). When the patient returns to France, follow-up care is set up by the Strasbourg University hospital (CHRU de Strasbourg)''s plastic and reconstructive surgery department, which decides on the patient''s transfer to a French hospital. The German hospital prescribes the type of transport that is most appropriate to the patient''s state of health.
The agreement organizes the coverage of care, including the cost of transport to the foreign facility and the cost of transport back to France, outside of any prior approval. Expenses are paid directly by the patient''s French health insurance fund, on the basis of the specific rates set out by the agreement (appendix 4).
The agreement sets forth requirements for the German health care facility with regard to patient information (out-of-pocket charges, therapeutic choices, complaint procedures, and follow-up care in the home country) and as regards the quality and safety of care and best practices in hygiene and pain treatment.
An oversight committee is tasked with drawing up an annual assessment of the agreement. It is presented to a joint committee (statistics and financial data, quality of care assessment) and then submitted to the competent authorities. In the event of a dispute, this committee meets within 90 days to work out the application issues that have been encountered.
Alsace / Bade-Wurttemberg cross-border cooperation agreement on emergency medical services et and its appendices signed respectively on 10/02/2009 and on 01/03/2009. Effective date : 01/03/2009
The agreement covers emergency medical services with the aim of shortening emergency response times in France''s Alsace region and Germany''s Land of Bade-Wurtemberg by not restricting responses to each country''s national borders. Under the agreement, the nearest available responders are to provide initial emergency services and set up transport to the nearest health care facility (in the country where the response took place, or in the other country if required by the patient''s condition).
The two countries'' emergency care team work together to set up the response and coordinate its oversight from end to end. During a response in the neighboring country, emergency services are only authorized to perform procedures that they are licensed to carry out in their home country. The two countries cooperate on ongoing training programs and staff exchanges.
Appendices 1 and 2 of the financial agreement list the applicable specific rates. Expenses are paid directly to the emergency response services by the patient''s French or German health insurance fund.
An oversight committee is tasked with drawing up an annual assessment of the agreement. It is presented to a joint committee (statistics and financial data, quality of care assessment) and then submitted to the competent authorities. In the event of a dispute, this committee meets within 60 days to work out the application issues that have been encountered. Its responsibilities include drawing up patient coverage protocols and medical team training.
Cross-border cooperation agreement between Alsace and Rhineland-Palatinate on emergency medical services and its appendices signed respectively on 10/02/2009 and 01/03/2009. Effective date: 01/03/2009
The agreement signed on February 10, 2009, covers emergency medical services with the aim of shortening emergency response times in France''s Alsace region and Germany''s Land of Rhineland-Palatinate by not restricting responses to each country''s national borders. Under the agreement, the nearest available responders are to provide initial emergency services and set up transport to the nearest health care facility (in the country where the response took place, or in the other country if required by the patient''s condition).
The two countries'' emergency care team work together to set up the response and coordinate its oversight from end to end. During a response in the neighboring country, emergency services are only authorized to perform procedures that they are licensed to carry out in their home country. The two countries cooperate on ongoing training programs and staff exchanges.
Appendices 1 and 2 of the financial agreement list the applicable specific rates. Expenses are paid directly to the emergency response services by the patient''s French or German health insurance fund.
An oversight committee is tasked with drawing up an annual assessment of the agreement. It is presented to a joint committee (statistics and financial data, quality of care assessment) and then submitted to the competent authorities. In the event of a dispute, this committee meets within 60 days to work out the application issues that have been encountered. Its responsibilities include drawing up patient coverage protocols and medical team training.
Cross-border agreement on third-party payment by the Bas-Rhin health insurance fund (CPAM, for disabled children, teens and adults admitted to the Diakonie Kork facility (signed on 10/01/2022 and entered into force on 01/09/202)
Material scope
The agreement defines and sets out the conditions for referral and admission, the terms for financial cover and reimbursement of costs incurred for the accommodation and care provided to disabled children, teens and adults suffering from non-stabilised drug resistant epilepsy referred to:
Medical care is provided by the Kork clinic for epilepsy.
Diakonie Kork undertakes to admit beneficiaries subject to available spots and based on their needs, and to provide the care required by their condition and the appropriate level of training and specialised education. In case of specific drug treatment, a nominative care protocol indicating such care is provided to the school.
It replaces the previous agreement of 01/07/2019.
Personal scope
This agreement applies to:
• minors with disabilities whose guardians are beneficiaries of a French health insurance scheme (general, agricultural and special schemes) and whose right to health cover has been activated by their assigned fund;
• adults with disabilities who are beneficiaries of the French general, agricultural or special health insurance schemes and whose right to health cover has been activated by the assigned fund.
Signatories
• For France: the Grand-Est Regional Agency, the Bas-Rhin health insurance fund (CPAM) and the Bas-Rhin Office for disabled persons;
• For Germany: Diakonie Kork.
Procedure for the referral and accommodation of disabled persons
The decision to refer the child, teen, young adult or adult is made by the Commission for the rights and autonomy of persons with disabilities within the Office for Disabled Persons' (MDPH) of the place where the beneficiary resides. The Commission takes account of each person's individual circumstances with regard to their disability resulting from severe, non-stabilised, drug resistant epilepsy, along with any major disorders and/or multiple disabilities. Where necessary, a notice of human assistance may be granted on an individual or shared basis, or provided by a specialised teacher. Such assistance is covered by the health insurance fund.
Liaison fund
The Bas-Rhin CPAM acts as a liaison fund for all French social security bodies and issues authorisations or refusals for administrative and financial cover. Refusals may be issued where no clear decision is made by the MDPH. It receives invoices from the Oberlin educational facility, or from the Heilpadagogische Forderung and forwards them where necessary to the relevant fund after ensuring their conformity. Expenses are paid directly by the French funds (third-party payment).
Financial provisions
Annex 3 to the agreement pertains to the terms for the financial cover of expenses which may arise from referral to the Oberlin educational facility, i.e., administrative costs, tuition and meal expenses, transportation costs, the costs of school aides and group or one-on-one assistance.
Annex 4 pertains to the terms for the financial cover of expenses which may arise from referral to the Heilpadagogische Forderung and lists specific rates:
• for day accommodation: sheltered workshop tuition;
• for residential accommodation: sheltered workshop tuition and housing costs.
Transport costs for day or residential accommodation are covered on an individual basis.
Transport is provided using the vehicle most suited to the referred person's condition, by a French licensed transport provider, and must be prescribed by a doctor.
Annexes 3 and 4 may be amended during Agreement oversight committees.
Agreement oversight committees
This committee is comprised on representatives of each of the signatories and meets at least once a year, within 30 days of the request made by any of the signatories. It is referred to for issues and disagreements relating to compliance with the agreement. It is tasked with finding amicable solutions. It may request any useful information and is bound by medical confidentiality.
The committee is tasked with drafting an annual assessment report which mainly pertains to the contributions made by the agreement and may propose changes were necessary. This report is sent to the signatories to the agreement.
Entry into force
The agreement entered into force on 01/09/2021. It was entered into for a period of one year and may be automatically renewed. It replaces the cross-border agreement of 01/07/2019 on third-party payment by the Bas-Rhin CPAM for disabled children or teens enrolled in the Oberlin educational facility of Diakonie Kork or the Heilpadagogische Forderung Hanauerland sheltered workshops.
Cross-border cooperation agreement on cardiology
(Signed on 19/03/2013. Effective date: 02/04/2013)
The agreement organizes relations between the hospital group Unisanté+, including the Forbach and St Avold hospitals in France, and the SHG Kliniken Völklingen hospital in Germany, regarding care for patients with acute myocardial infarction. It covers reinforcements for the medical team at the Forbach hospital''s cardiac intensive care unit (formation of a cross-border medical team and shared management of shifts), and promotes professional and linguistic exchanges focusing on best practices (observation programs to improve the consistency of professional practices).
The agreement applies to patients belonging to any health insurance scheme, including foreign schemes, who fall within the province of the Lorraine region''s coal-mining towns listed in appendix 1 (towns of Alsting, Behren, Belle-Roche, Béning-les-St-Avold, Betting, Bousbach, Cocheren, Ebring, Etzling, Farébersviller, Folking, Forbach, Freyming-Merlebach, Gaubiving Homburg-Haut and Bas, Kerbach, Macheren, Morsbach, Moulin-Neuf, Oeting, Petite-Rosselle, Rosbruck, Schoeneck, Spicheren, Stiring-Wendel, Tenteling, and Théding). After stabilization, the patient is transferred to the French hospital group (Unisanté +). The response is always launched by the French emergency service SAMU''s call assignment center, which decides to send the patient to a French or German hospital, unless the latter declines.
It organizes the coverage of care, including the costs of transportation to the assigned facility and transport expenses entailed by the return to France. There is no S2 prior approval requirement. The German hospital prescribes the type of transportation that is most appropriate to the patient''s condition. Hospital readmissions and post-operative care are not covered by this agreement, nor are the costs of repatriating the body in the event of death, except if an industrial accident is involved.
It lists the applicable rates for care, which are revised periodically. Either the Moselle department health insurance fund (« CPAM de Moselle »), which acts as the coordinating fund, or the Unisanté hospital group, will receive the bills from the German hospital and pay them within a 45-day deadline.
An oversight committee conducts and presents an annual assessment (statistics and financial data, quality of care assessment, care coordination programs). This committee is also in charge of settling disputes and proposing changes to the agreement.
Cross-border healthcare agreement on hospital care for patients with epilepsy (signed et effective date on 14/11/2014)
The agreement, which was signed on November 14, 2014, organizes relations between the Strasbourg university hospitals in France and the Diakonie Kork Epilepsy Center in Germany regarding care for patients with epilepsy belonging to either a French or a German scheme and residing in France''s Alsace or German''s Bade-Wurttemberg regions. Under the agreement, these patients receive appropriate, expedited care through the complementary use of the two facilities'' resources and benefit from advances in the research and treatment of epilepsy and epilepsy-related disabilities.
Decisions to accept patients are made collectively by both facilities'' teams, which approve each patient''s treatment protocol and plan their medical tests (article 2 of the agreement specifies exactly which types of care are covered). They also complete the patient''s shared medical record.
The agreement organizes the coverage of care, including the costs of transportation to the assigned facility and transport expenses entailed by the patient''s return to France. There is no S2 prior approval requirement. For French patients hospitalized in Germany, expenses are covered by the Strasbourg University hospitals, which receive and pay the bills. For German patients admitted to the Strasbourg University hospitals, applicable rates for care and transportation expenses are listed in a separate agreement and are revised on an annual basis. The hospital bills the patient''s health insurance fund directly.
An assessment is conducted each year by an oversight committee (statistics and financial data, quality of care assessment) and presented to a joint committee which is also in charge of settling disputes and proposing changes to the agreements. In the event of a dispute, this committee meets within 30 days in order to work out an amicable solution.