In connection with the sixth State reform, a number of important competences in the field of Welfare, Public Health and Family were transferred from the federal to the community level. In the Decree of 15 July 2016 introducing miscellaneous provisions in the field of Welfare, Public Health and Family, known as the "Mosaic Decree", the Flemish legislator has now exercised its newly acquired competences in various areas. We provide here a short overview of the main changes brought about by this elaborate Decree.
The Flemish Institute for Quality and Care (art. 2-3 of the Decree)
The Decree provides a legal basis for the establishment of a "Flemish Institute for Quality and Care". The Institute will constitute the overarching structure in which the quality policy for the sectors of the Flemish health and residential care can be developed. For now, the scope of the Institute is limited to general hospitals, mental health care, and primary and elderly care.
The purpose is to actively involve the facilities in the sector of health and residential care and the care providers in the development of the quality indicators.
Reimbursement of tobacco rehabilitation (art. 4–5 of the Decree)
The federal regulation for reimbursement of tobaccologists' services will be abolished as of 1 January 2017. By that date, the Flemish Community intends to have provided its own regulation for the reimbursement of tobacco rehabilitation on the basis of its new competence regarding preventive health care. For now, however, that regulation does not yet exist.
Support for general practitioners and funding and recognition of general practitioners' circles, integrated home-based care services and consultation platforms in mental health care (art. 17–33 and 37–38 of the Decree)
Given the new competences concerning the organisation and funding of primary health care, the legislator has instructed the Flemish Government to take measures to support general medicine. The Flemish Government may further regulate the organisation, recognition and funding of integrated home-based care services and the partnerships that are active in mental health care and are aimed at creating a consultation platform.
Recognition of health care professions (art. 34–36 of the Decree)
Subject to observation of the federal recognition conditions, the Flemish Community is now competent for the recognition of health care professions. In implementation of this, the Decree introduces automatic recognition of physiotherapists, provided that certain diploma conditions are met. Additionally, the opportunity has been created for doctors and dentists to file an objection against a refusal of recognition before the "Advisory Committee for Facilities of Welfare, Public Health and Family and (Candidate) Foster Care Givers" ("Adviescommissie voor Voorzieningen van Welzijn, Volksgezondheid en Gezin en (Kandidaat )pleegzorgers").
Price policy for residential elderly care (art. 39 of the Decree)
The Flemish Community is also competent with regard to the price policy for residential elderly care. The legislator has now stipulated that the "Price Regulation Commission" ("Commissie tot Regeling van de Prijzen") no longer needs to be consulted when determining the maximum prices for residential elderly care. According to the legislator, the compulsory consultation of this Committee did not promote uniformity of assessment, as the body dealing with the applications was not always composed in the same way. For this reason, the choice was made to work with a new list of evaluation criteria and a standardised application form in the future.
Cultural activities subsidies for all residential and care centres (art. 43 of the Decree)
Cultural activities subsidies will no longer be granted only to non-commercial residential care centres and short-term residential centres, but also to commercial residential care centres and short-term residential centres.
Expansion of the competences of the child welfare agency "Kind en Gezin" (art. 90–91 of the Decree)
The competences of the child welfare agency "Kind en Gezin" are expanded to include family benefits. In future, exercising the competences with regard to family benefits will constitute one of the core tasks of "Kind en Gezin", as soon as the Flemish Government has determined the specific date for this to enter into force.
Financing infrastructure for matters relating to individuals (art. 100–104 of the Decree)
From now on, the Flemish Community is also competent for financing the investment costs for the infrastructure and medical-technical services of the hospitals. These costs will be financed by the Flemish Infrastructure Fund for Matters relating to Individuals ("Vlaams Infrastructuurfonds voor Persoonsgebonden Aangelegenheden" (VIPA)). The Decree creates a legal basis from which the Flemish Government can develop a more detailed regulation for this financing. In addition, the Flemish Community no longer has to seek the advice of the Financing department of the National Council for Hospital Facilities ("Nationale Raad voor Ziekenhuisvoorzieningen") when regulating the financing of the investment costs for the infrastructure and medical-technical services of the hospitals, or when taking a decision on individual cases concerning this financing.
Access to documents when supervising compliance with Welfare, Public Health and Family regulations (art. 107 of the Decree)
Finally, the Decree provides for general access for the inspectors of the Flemish Care Inspectorate, entrusted with the supervision of compliance with all the regulations in the field of Welfare, Public Health and Family Regulations, to all documents (and other information carriers) necessary for the exercise of their supervisory tasks, e.g. when monitoring the application of the coordinated law on hospitals.