The Framework agreement on cross-border healthcare cooperation and its application agreement were signed on November 21, 2016 and came into force on October 1, 2019 and December 1, 2019 respectively (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 border area between the “Grand-Est” region in France and the Grand Duchy of Luxembourg
- a personal scope of application:
- any person covered by one of the parties' health insurance systems, residing or visiting the border area between the Grand-Est region in France and the Grand Duchy of Luxembourg;
- 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 in the border area;
- all (salaried or self-employed) health care professionals, as well as emergency medical volunteers working in the border area.
- Implementing authorities :
- for France: “L'Agence régionale de Santé du Grand-Est” (The Grand-Est region's public health agency), “Caisse primaire d'assurance maladie de la Moselle” (The Moselle department's local health insurance fund), as well as the prefect (préfet) for the civil defense area and the “département”-level prefects;
- For Luxembourg: the ministers in charge of health, emergency assistance services, and social security, as well as the Caisse Nationale de Santé (the public health care fund).
- What the cooperation agreements contain :
- health care professionals' involvement in cross-border care (rules, types of care, duration, hospital emergency services, and out-of-hours services for salaried or self-employed health care professionals);
- a framework for organizing emergency assistance and medical transport for patients (rules, regulation, and coordination of the means of communication used),
- mobility rules for health care professionals;
- guaranteed continuity of care, with a special emphasis on patient intake and information (access to care, medical transport, billing and reimbursement rules (including by supplementary insurance providers), 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, rules for organizing care, coverage of care, and pain management);
- the financing needed to implement the cooperation agreements;
- 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 of and rules for withdrawal from the cooperation agreements;
- the mechanisms for financial coverage of expenses, and rates and reimbursements of care covered by the cooperation agreement in question.
- 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 medical services providing care within the scope of the cross-border agreements or providing emergency care;
- Emergency medical personnel responding in the other Party's country are exempted from required membership in a professional association;
- The applicable law of the transport provider's State takes precedence in matters relating to driving permits and technical requirements for the vehicle when medical transport is provided in the other State.
- Rules for coverage and reimbursement of care:
- coverage by the country where care is provided, at the rates applied by that State, within the framework of (EC) regulations 883/2004 and 987/209, after a prior authorization (S2 form) has been issued;
- care is paid for by the patient with direct coverage by the State of membership at its own rates;
- 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, one year 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.
French-Luxembourg territorial framework agreement for cross-border cooperation in the health sector (effective on 19/10/2021)
Material scope:
This agreement specifies the framework to be used as basis for conclusion of special agreements relative to the organisation and financial coverage of services delivered by health, outpatient, local and alternative hospital and wellbeing structures, and by other health professionals, to persons habitually residing or temporarily staying in the cross-border zone defined below.
The coverage encompasses the following aspects:
- conditions of acceptance and treatment of patients;
- terms and conditions of financial coverage;
- terms and conditions of coverage of transport;
- terms and conditions of cross-border cooperation between health professionals.
The special health agreements relate to one or more types of service, within all or part of the zone defined below. They are entered into in compliance with this agreement and added as “additional protocols”.
Territorial scope:
- for France: the territory of the département of Meuse (55), Meurthe-et-Moselle (54) and Moselle (57), in whole or in part;
- for Luxembourg: the whole of the Grand Duchy of Luxembourg.
Personal scope
The agreement targets:
- persons able to obtain the health insurance benefits of one of the Parties and habitually living or temporarily staying in the border zone stated above (excluding beneficiaries of State medical assistance);
- persons affiliated to a social security scheme falling within the scope of Regulations (EC) nos. 883/2004 and 987/2009, habitually living or temporarily staying in the border zone stated above;
- health professionals, employed and self-employed, as defined by the respective national legislations of the two Parties, practising in the border zone stated above.
Signatory parties:
- For France: the Agence Régionale de Santé Grand Est, the Préfecture de Région Grand Est, and the Préfecture de la Zone de Défense et de Sécurité Est;
- For Luxembourg: the Prime Minister and the Ministry of Health and Social Security of the Grand Duchy of Luxembourg.
Content of the cooperation agreements:
They organise the cooperation between structures, health resources and emergency services located within the border zone. To this end they may provide for complementarity between the existing structures, health resources and emergency services, and the creation of cooperation bodies or shared structures, according to the care needs and deficits ascertained.
The cooperation agreements may notably relate to the following fields:
- cross-border intervention of health professionals;
- the organisation of the emergency services and the ambulance transportation of patients;
- the guarantee of continuity of care, including particularly acceptance of and providing information to patients;
- the criteria of assessment and control of the quality and safety of the care;
- the financial resources necessary to the implementation of the cooperation.
Depending on the material scope concerned, these agreements shall specify the mandatory terms and conditions of intervention of the care structures, the emergency services, the social security bodies, and the health professionals and emergency services agents. In all cases, these agreements shall specify:
- the material, territorial and personal scopes to which the agreement applies;
- the duration and the conditions of termination of the cooperation agreement;
- the mechanisms of financial coverage of the costs, the tariffs, and the reimbursements of the services, in compliance with the national law of the parties.
Public health: health promotion and prevention:
The parties shall pool their good practice with the aim of mutually enhancing their health promotion and prevention initiatives. They shall conduct shared initiatives and complementary, notably in the fields of prevention of addiction (smoking, alcohol, psychoactive substances, gambling, etc.), preservation of physical mobility and independence (health and fitness, ageing well, etc.), and environmental health (air and water quality, home adaptations, rural and urban spaces, adaptation to climate change, etc.).
Health crisis management:
The Parties undertake to implement shared and complementary strategies in the matter of health crisis management, notably pandemic or in case of disaster.
They shall identify the available and complementary cross-border health offering, and undertake to share good practice models within the framework of their operational crisis management plans, and their regular updates. They shall regularly examine the functionality and relevance of the cross-border crisis management plans, via the implementation of shared exercises.
Article 6 of the agreement describes the information having to be presented in the crisis management plans.
Health and epidemiology watchdog:
The Parties agree to set up a shared cross-border health watchdog, bringing together institutional and professional participants. Qualitative and quantitative data will be exchanged with a view to identifying and analysing first the existing preventative health, outpatient care and hospital offering and also in the wellbeing sector, and second the needs on each side of the border.
Human resources management:
To favour efficient management of human resources (cooperation of health professionals and exchange of good practice on both sides of the border), it is planned:
- to reinforce cooperation in the matter of training, acceptance of trainees and management of human resources in the health sector;
- to constitute cross-border nursing and wellbeing teams;
- to list the requests for initial or continuing training and courses in the neighbouring country submitted by health professionals and institutions.
These objectives will be set out in specific agreements.
Communication initiatives:
- the Parties undertake to carry out regular information and communication campaigns targeted at users and health professionals on the content and terms of application of the health cooperation projects and agreements;
- they shall inform all health structures, establishments and professionals of the need to ensure coordination of their interventions to the benefit of persons covered by the health insurance schemes, notably by exchanging the information necessary to the quality and continuity of care; special agreements shall provide for the use of the most appropriate cross-border voice, visual and electronic communication resources for that coordination;
- they shall communicate to the public about the provisions of this agreement and of the operational cross-border initiatives. They shall contact the existing cross-border platforms (e.g. Info-best, Transfrontaliers.eu, Maison du Luxembourg de Metz et Thionville, etc.) and use social networks to inform professionals, users, institutions and local authorities about the cooperation systems put in place, their evolutions, and the events promoting them.
Conditions of coverage and reimbursement of treatment:
- coverage of treatment within the framework of Regulations (EC) no. 883/2004 and (EC) no. 987/209;
- possibility for the signatories of agreements to negotiate specific tariffs, after the agreement of the ministers responsible for social security.
Timeframe for compliance:
The cooperation agreements already existing must, if necessary, be brought into compliance with theframework agreement of 21/11/2016.
Monitoring committee:
A cross-border monitoring committee of the regional framework agreement shall be constituted. It shall be composed of one member representing each of the signatory Parties. This committee shall be chaired by a chairman appointed for one year from each of the Parties in turn.
This committee shall be tasked:
- with monitoring the implementation of the agreement and any amendments thereto;
- with collecting the information useful to the annual evaluation of the flow of patients and the financial amounts incurred, and also the adaptation of the health and wellbeing offering within the framework of additional protocols;
- with the qualitative and quantitative evaluation of the cross-border cooperation in health matters;
- with the identification and validation of any cooperation project liable to facilitate access to the health and wellbeing offered in the cross-border zones concerned by this agreement;
- with the promotion of new objectives and operational derivatives.
The monitoring committee shall meet as often as necessary, on the request of the Parties, and at least once a year. Third parties may be invited to the meetings of the committee if necessary (health institutions, primary health insurance funds, points of contact of additional protocols).
• Effect:
The agreement shall take effect on the date of its signing, which is 19/10/2021, and it is valid for an undefined duration. It may be revised by means of addendum and it may be terminated with notice of six months.
