Social Security Financing Act 2023: Key measures

The law of 23 December 2022 on financing social security for 2023 was published in the Official Journal of 24 December 2022. It provides for measures relating to prevention; improving access to health, and in particular to cope with medical deserts; support for families in the area of childcare; support for the elderly who are losing their independence and the fight against social fraud.

The Social Security Financing Bill (PLFSS) for 2023 was presented to the Council of Ministers on September 26, 2022, and the National Assembly definitively adopted the text without a vote on December 2, 2022.

Main measures for individuals

The main measures taken by the law are presented along different axes:

Strengthening preventive health actions

• Preventive appointments fully covered by the Sickness Insurance without advance payment at the key ages of life (20-25 years, 40-45 years and 60-65 years) to prevent and combat the appearance of risk factors or pathologies. These consultations will be age-appropriate and should also be “the place where gender-based violence is tracked.”
• Non-prescription testing expanded to include sexually transmitted infections (STIs) other than human immunodeficiency virus (HIV). These screenings are fully reimbursed by the Health Insurance for those under 26.
• Free and non-prescription access to emergency contraception (morning after pill) in pharmacies for all women, minors and adults.
• Simplify access to immunization by allowing pharmacists, nurses and midwives to prescribe vaccines based on the recommendations of the High Health Authority (HAS).
• Three-year experiment with mandatory screening of newborns for sickle cell disease.
• Combat smoking by providing for inflation-linked increases in tobacco prices. The average price of a pack of cigarettes is expected to increase by 50 cents in 2023 and 35 cents in 2024, bringing it to €11.

Improving access to care

• Facilitate the recruitment of liberal medical regulators in the Samu and access services.
• Exemption from old-age insurance contributions in respect of 2023 for retired doctors returning to work. But their 2023 professional income must be below an amount set by decree.
• Creating a 4^e year of consolidation to the diploma of specialized studies of general medicine (residency). In order to combat medical deserts, this additional year will be carried out on an outpatient basis as a priority in medically tense areas.
• Simplify and strengthen the coordination of the installation of healthcare professionals by harmonizing the installation aids. A departmental one-stop-shop to support the establishment of health professions will be created.
• Possibility for doctors and nurses to work in the hospital until the end of 2035 until age 72.
• 3-year experiment with direct patient access to advanced practice nurses (APIs) in coordinated exercise settings.
• Extension in 2023 of derogatory sick leave “Covid” without day of absence for persons having a positive PCR or antigen test.
• Improve reparations for harm to child victims of pesticides in utero.
• 100% reimbursement for prosthetic hair for people with cancer.
• One-year extension of the experiment on medical cannabis.
• Allow nurses, on an experimental basis for one year and in some territories, to sign death certificates to relieve doctors of this burden and to address the lack of available doctors in a timely manner.

Better funding of childcare facilities

• To financially assist single-parent families in providing care for their children aged 6 to 12 by extending the CMG supplement paid by the CAF or the MSA to the child's 12th birthday (instead of 6).
• Upgrade of the Family Support Allowance (FSA) for single parents by 50%, starting in November 2022. It increased to €184.41 per month per child, from €122.93.
• Allow each parent to benefit from the additional freedom to choose the "direct use" mode of care in the case of alternate care.
• Decrease the cost of using a childminder for parents by reforming the calculation of the free choice supplement of the "direct use" childminder mode, which would make childminder care as accessible as the nursery and harmonize the dependent remnants between these two modes of care from 2025.
• The Law of 15 November 2021 on improving the conditions of parental presence with a child whose pathology requires sustained support is made applicable to civil servants.

Strengthening the policy of support for self-reliance

• Addressing the isolation of seniors by adding two hours of social connection per week to the plans for loss of autonomy for recipients of personalized autonomy allowance (PDA) from 1^er January 2024. In addition, the use of personalized autonomy allowance (AAL) is simplified.
• A scheme called "MaprimeAdapt" will be deployed to help elderly people with a gradual loss of autonomy to adapt their housing.
• Funding home nursing care for seniors and persons with disabilities. An additional 4,000 spaces will be created in home support services in 2023. The rate for home support services (SAAD) will be increased from €22 to €23 per hour of intervention.
• Provide the facilities for elderly dependent persons (Ehpad) with an additional 3,000 nurses and care aides in 2023. By 2027, 50,000 positions are expected to be created in these institutions.
• Improve Ehpad controls and the new rules on transparency and financial regulation. These rules have been tightened up by parliamentarians, as have the financial penalties incurred (maximum 5% of turnover compared to 1% today).
• Create a coordinated city-based rehabilitation pathway for children with multiple disabilities and cerebral palsy.

Combating social fraud

• Improve fraud prevention and detection. The aim is to increase detected fraud by 10% by 2024. Non-pension social benefits will no longer be paid into non-European bank accounts.
• Better punish fraud by health professionals. Emergency decommissioning will be extended to all healthcare professionals in case of major fraud.
• Increase the efficiency and effectiveness of fraud recovery.