In 1998, long-term care insurance became a new branch of social security in Luxembourg. Its main purpose is to grant the care and support of the dependent person who lives at home or in a care and support establishment, mainly by means of:
•benefits in kind (PN), cash benefits (PE) or mixed benefits;
•technical aids and housing adaptations
Different scenarios can arise for the granting of PNs and PEs:
• Only PEs: The applicant lives at home and one person, identified as a private caregiver, participates in care and support. In the case where only a caregiver intervenes, a care package can be paid, for the realization of the help to perform the essential acts of life and / or activities of assistance to the maintenance of the household by this caregiver.
• Only PNs: The applicant living at home or in a care and support establishment, only benefits from the intervention of a network of help and care. The package for PNs in the field of essential acts of life is paid directly by the National Health Fund (Caisse Nationale de Santé - CNS) to the network of help and care.
• PEs and PNs (mixed benefits): The applicant living at home is assisted by a caregiver, but also by a network of help and care. If a private caregiver and a support and care network are involved in the care, the respective PN and PE packages will be paid.
Decisions on the granting of long-term care benefits are the responsibility of the Dependency Insurance Assessment and Control Administration (AEC), which is under the authority of the Ministry of Social Security (MSS).
The missions of the AEC are as follows:
•Achievement of an individual assessment of the capacity of the dependent persons to perform the essential acts of life.
•Determination of the access rights of dependent persons to professional and technical services responding to their needs.
•Development of a promotion policy and quality control of services and their execution.
AEC agents carry out assessments of the need for help of dependent persons, either at the applicant's home or at the care and support establishment. Currently the long-term care insurance has about 14,000 beneficiaries.
The AEC interacts with different actors in the execution of its missions:
•The National Health Fund (CNS) is both the managing entity for health insurance and long-term care insurance. She generates the individual decisions and liquidates the benefits.
•The Social Security Informatics Centre (Centre informatique de la sécurité sociale - CISS), the IT department of the Joint Social Security Centre (Centre commun de la sécurité sociale - CCSS), is in close collaboration with the AEC as part of the organization of computerization, the collection and the processing of computer data. The CISS "MySecu" and "AEC Department" teams have both been involved in this project.
•Providers are private or public organizations that intervene in the care of the beneficiaries by offering help and care services.
The AEC is the competent authority to assess and determine the needs of insured persons at the national level. Since the reform of the long-term care insurance came into force in January 2018, the AEC is responsible for reassessing dependent persons according to defined legal deadlines. Article 366 of the social security code stipulates: "The reassessment of needs and the determination of the required benefits may be entrusted to the provider at the request of the Dependency Insurance Assessment and Control Administration ".
Since 2004 and before the legal obligation to reassess the files according to specific criteria the providers were already contributing to this activity by sending a paper document to the AEC. This paper process, however, showed a number of disadvantages.
In 2017, the AEC decided to computerize the process and acquire the use of the "MySecu" information exchange platform, created and developed by the CISS, to conduct reassessments of dependent person’s needs.
In the past, this platform had already been made available by the CISS on behalf of the health insurance in the framework of unidirectional secure information exchange between the CNS and the pharmacies.
The MySecu platform now enables two-way electronic exchange between AEC and the providers and represents the new standard for communication to an external provider. The platform allows long-term care insurance providers to reassess safely the needs of dependent person.
The implementation of this project is improving the service provided to beneficiaries by reducing file processing times, ensuring data protection and adapting care plans as quickly as possible to the clinical and environmental situation of the dependent person. It is also a major asset in working with the private sector and presents an innovative and effective solution.
The exchange of data will therefore take place only between health professionals, as this project only concerns applications for reassessment of benefits in kind for beneficiaries who only receive PNs.
|Award category:||new solutions to complex challenges - a public sector citizen-centric, sustainable and fit for the future - european or national level|
|Type of activity:|
|Keywords:||MySecu, Reassessment, Bidirectionnal digital platform, Secured communication|
|Short English description:||The MySecu platform now enables two-way electronic exchange between AEC and the providers and represents the new standard for communication to an external provider. The platform allows long-term care insurance providers to reassess safely the needs of dependent person.|
|Organisation:||Administration d'évaluation et de contrôle de l'assurance dépendance|
|Level of government:||national level|
|Size of organisation:||50-100|
|Number of people involved:||>15|
|EU membership:||EU member|