The major reform set to take effect in December mandates obtaining Prior Agreement (Accord Préalable – AP) for costly wheelchair (FR) funding by the National Health Insurance (AM). As the Autonomy Coordination Manager responsible for administrative aid, I view the AP as a mechanism for securing the funding file that validates the multidisciplinary expertise.
Securing Funding and the Challenge of Time
The optimistic scenario is administrative security. The AP validates the PLV funding, reducing the risk of the AM rejecting the file. This is a process that Social Workers can approach with more confidence once the clinical part is validated. My role is to fluidify the exchange of necessary documents between the different parties (provider, specialist, AM).
The major pessimistic scenario is the risk of a timeline bottleneck. The AP depends on the consultation and signature of the specialist doctor. I have no hierarchical authority over the specialist, but I am responsible for coordinating the deadlines. If the waiting times for this consultation are long, the beneficiary will be deprived of their adapted FR. Our team must establish priority referral circuits in liaison with medical secretariats to accelerate AP acquisition. Our home helpers and Social Workers are key to alerting us to the criticality of the current equipment. We must win the battle of the deadline to realize the funding.