Long-Term Care Insurance Act


Published: 2007

Subscribe to a Global-Regulation Premium Membership Today!

Key Benefits:

Subscribe Now for only USD$20 per month, or Get a Day Pass for only USD$4.99.

Long-Term Care Insurance Act

(Act No. 123 of December 17, 1997)

Chapter I General Provisions (Articles 1 to 8-2)

Chapter II Insured Persons (Articles 9 to 13)

Chapter III Certification Committee of Needed Long-Term Care (Articles 14 to

17)

Chapter IV Insurance Benefits

Section 1 General Rules (Articles 18 to 26)

Section 2 Certification (Articles 27 to 39)

Section 3 Long-Term Care Benefits (Articles 40 to 51-3)

Section 4 Prevention Benefits (Articles 52 to 61-3)

Section 5 Municipal Special Benefits (Article 62)

Section 6 Limitation on Insurance Benefits, etc. (Articles 63 to 69)

Chapter V Long-Term Care Support Specialists, Providers, and Facilities

Section 1 Long-Term Care Support Specialists

Subsection 1 Registration, etc. (Articles 69-2 to 69-10)

Subsection 2 Registration of an Organization that Prepares Registration

Examination Questions, and Appointment of a Designated Testing

Agencies and Designated Training Agency (Articles 69-11 to 69-33)

Subsection 3 Obligations, etc. (Articles 69-34 to 69-39)

Section 2 Designated In-Home Service Providers (Articles 70 to 78)

Section 3 Designated Community-Based Service Providers (Articles 78-2 to

78-11)

Section 4 Designated In-Home Long-Term Care Support Providers (Articles

79 to 85)

Section 5 Facilities Covered by Long-Term Care Insurance

Subsection 1 Designated Facilities Covered by Public Aid Providing Long-

Term Care to the Elderly (Articles 86 to 93)

Subsection 2 Long-Term Care Health Facilities (Articles 94 to 106)

Subsection 3 Designated Medical Long-Term Care Sanatoriums (Articles

107 to 115)

Section 6 Designated Providers of Preventive Service to Long-Term Care

(Articles 115-2 to 115-10)

Section 7 Designated Providers of Community-Based Preventive Service of

Long-Term Care (Articles 115-12 to 115-19)

Section 8 Designated Providers of Support for Prevention of Long-Term Care

(Articles 115-20 to 115-28)

Section 9 Publication of Long-Term Care Service Information (Articles 115-

1

29 to 115-37)

Chapter VI Community Support Projects, etc. (Articles 115-38 to 115-41)

Chapter VII Insured Long-Term Care Service Plans (Articles 116 to 120)

Chapter VIII Expenses, etc.

Section 1 Imposition of Expenses (Articles 121 to 146)

Section 2 Fiscal Stability Funds (Articles 147 to 149)

Section 3 Levies for Medical Insurers (Articles 150 to 159)

Chapter IX Business Related to Insured Long-Term Care for Social Insurance

Medical Fee Payment Funds (Articles 160 to 175)

Chapter X Business Related to a Long-Term Care Insurance Project for the

Federation of National Health Insurance Associations (Articles 176 to 178)

Chapter XI Examination Committee for Long-Term Care Benefit Expense

(Articles 179 to 182)

Chapter XII Application for Examination (Articles 183 to 196)

Chapter XIII Miscellaneous Provisions (Articles 197 to 204)

Chapter XIV Penalty Provisions (Articles 205 to 215)

Supplementary Provisions

Chapter I General Provisions

(Purposes)

Article 1 The purposes of this Act are to improve health and medical care and to

enhance the welfare of citizens. With regard to people who are under condition

of need for long-term care due to disease, etc., as a result of physical or

emotional changes caused by aging, and who require care such as for bathing,

bodily waste elimination, meals, etc., and require the functional training,

nursing, management of medical treatment, and other medical care, these

purposes are to be accomplished by establishing a long-term care insurance

system based on the principle of the cooperation of citizens, solidarity, and

determining necessary matters concerning related insurance benefits, etc., in

order to provide benefits pertaining to necessary health and medical services

and public aid services so that these people are able to maintain dignity and an

independent daily life routine according to each person's own level of abilities.

(Long-Term Care Insurance)

Article 2 (1) Long-Term Care Insurance shall provide necessary insurance

benefits for a Condition of Need for Long-Term Care or for a Needed Support

Condition of the insured person.

(2) Insurance benefits as set forth in the preceding paragraph shall be provided

in order to contribute to reduction or prevention of aggravation of a Condition

of Need for Long-Term Care or a Needed Support Condition, and shall be

2

provided with careful attention to cooperation with medical care.

(3) Insurance benefits as set forth in paragraph (1) shall be provided in

consideration of the appropriate health and medical services and public aid

services that are offered by diverse providers and facilities comprehensively

and effectively, according to the physical and mental conditions of the insured

person, said person's environment, etc., and based on the preferences of the

insured person.

(4) With regard to the contents and level of insurance benefits as set forth in

paragraph (1), it shall be considered that said person is able to live an

independent daily life according to that person's own abilities in his or her

home as much as possible, although said insured person becomes in a

Condition of Need for Long-Term Care.

(Insurers)

Article 3 (1) Municipalities and special city wards shall provide Long-Term Care

Insurance pursuant to the provisions of this Act.

(2) Municipalities and special city wards shall establish a special account for

income and expenses regarding Long-Term Care Insurance pursuant to the

provisions of Cabinet Orders.

(Citizen's Efforts and Obligations)

Article 4 (1) A citizen shall be aware of his or her physical and mental changes

due to aging and shall always strive to maintain and enhance good health in

order to prevent becoming in a Condition of Need for Long-Term Care. In a

case of becoming in a Condition of Need for Long-Term Care, a citizen shall

strive to maintain and improve his or her existing abilities through the will ing

use of rehabilitation and other appropriate health and medical services and

public aid services.

(2) Citizens shall be equally subjected to the expenses necessary for an Insured

Long-Term Care Project, based on the principle of cooperation and solidarity.

(Responsibilities of the National and Prefectural Governments)

Article 5 (1) The national government shall undertake measures to ensure the

system of providing health and medical services and public aid services, and

every other necessary action for the healthy and efficient operation of an

Insured Long-Term Care Project.

(2) Prefectural governments shall provide necessary advice and appropriate

support for the healthy and efficient operation of an Insured Long-Term Care

Project.

(Cooperation of Medical Insurers)

3

Article 6 Medical insurers shall cooperate for the healthy and efficient operation

of an Insured Long-Term Care Project.

(Definitions)

Article 7 (1) The term "Condition of Need for Long-Term Care" as used in this

Act means a condition assumed to require care on a continual and steady basis

for the whole or a part of basic movements in daily activities such as bathing,

bodily waste elimination, meals, etc., due to physical or mental problems

during the period specified by an Ordinance of the Ministry of Health, Labour,

and Welfare, and said condition shall conforms to any of the categories

stipulated by an Ordinance of the Ministry of Health, Labour, and Welfare

according to the degree of needed care (herein referred to as a "Category of

Condition of Need for Long-Term Care") (except when said condition is subject

to a Needed Support Condition).

(2) The term "Needed Support Condition" as used in this Act means a condition

assumed to require care on a continual and steady basis during the period

specified by an Ordinance of the Ministry of Health, Labour, and Welfare that

especially contributes to the reduction or prevention of the aggravation of the

condition requiring care for the whole or a part of basic movements in daily

activities such as bathing, bodily waste elimination, meals, etc., due to physical

or mental problems, or a condition assumed to cause continual difficulties in

performing daily activities due to physical or mental problems during the

period specified by an Ordinance of the Ministry of Health, Labour, and

Welfare, and said condition shall conforms to any category as stipulated by an

Ordinance of the Ministry of Health, Labour, and Welfare according to the

degree of needed support (herein referred to as "Category of Needed Support

Condition").

(3) The term "Person Requiring Long-Term Care" as used in this Act means a

person defined by any of the following items:

(i) a person that is in a Condition of Need for Long-Term Care and is the age of

65 or older;

(ii) a person that is in a Condition of Need for Long-Term Care and is the age

of 40 to less than the age of 65, and the physical or mental problems that are

the causes of said Condition of Need for Long-Term Care are a result of

diseases that are caused by the physical or mental changes due to aging,

specified by a Cabinet Order (herein referred to as "Specified Disease").

(4) The term "Person Requiring Support" as used in this Act means a person

defined by any of the following items:

(i) a person that is in a Needed Support Condition and is the age of 65 or older;

(ii) a person that is in a Needed Support Condition and is the age of 40 to less

than the age of 65, and the physical or mental problems that are the cause of

4

said Needed Support Condition are caused by a Specified Disease.

(5) The term "Long-Term Care Support Specialist" as used in this Act means a

person that provides consultation to a Person Requiring Long-Term Care or to

a Person Requiring Support (herein referred to as a "Person Requiring Long-

Term Care, etc.") and communicates with and coordinates Municipalities, a

person performing In-Home Services, a person performing Community-Based

Service Business, a Facility Covered by Long-Term Care Insurance, a person

performing Preventive Long-Term Care Service Business, a person performing

Community-Based Preventive Long-Term Care, etc., in order for a Person

Requiring Long-Term Care, etc., to be able to use appropriate In-Home Service,

Community-Based Service, Facility Service, Preventive Long-Term Care

Service, and Community-Based Service for Preventive Long-Term Care

according to the mental and physical conditions, etc., of a Person Requiring

Long-Term Care, etc., and who received Long-Term Care Support Specialist

Certification as set forth in Article 69-7, paragraph (1) as a person possessing

professional knowledge and skills regarding necessary support for a Person

Requiring Long-Term Care, etc., to live an independent daily life.

(6) The term "Medical Insurance Acts" as used in this Act means the following

acts:

(i) Health Insurance Act (Act No. 70 of 1992);

(ii) Seaman's Insurance Act (Act No. 73 of 1939);

(iii) National Health Insurance Act (Act No. 192 of 1958);

(iv) National Public Servants Mutual Aid Association Act (Act No. 128 of 1958);

(v) Local Public Service Mutual Aid Association Act (Act No. 152 of 1962);

(vi) Private School Personnel Mutual Aid Association Act (Act No. 245 of 1953).

(7) The term "Medical Insurers" as used in this Act means the national

government, health insurance societies, municipalities (including special city

wards), National Health Insurance Society, mutual aid associations, or

Promotion and Mutual Aid Society for Private Schools of Japan that provide

medical benefits pursuant to the provisions of Medical Insurance Acts.

(8) The term "Medical Insurance Subscriber" as used in this Act means the

following persons:

(i) an insured person pursuant to the provisions of the Health Insurance Act,

however, provided that it shall not apply to specially-insured day laborers

pursuant to the provision of Article 3, paragraph (2) of the same Act;

(ii) an insured person pursuant to the provisions of the Seaman's Insurance

Act;

(iii) an insured person pursuant to the provisions of the National Health

Insurance Act;

(iv) a member of a mutual aid association pursuant to the National Public

Servants Mutual Aid Association Law or the Local Public Care Service

5

Mutual Aid Association Act;

(v) a subscriber to a Private School Personnel Mutual Aid System pursuant to

the provisions of the Private School Personnel Mutual Aid Association Act;

(vi) an insured person's dependent pursuant to the provisions of the Health

Insurance Act, Seaman's Insurance Act, National Public Servants Mutual

Aid Association Law (including cases when applied mutatis mutandis

pursuant to other Acts), or the Local Public Care Service Mutual Aid

Association Act, however, provided that it shall not apply to a dependent

pursuant to the provisions of Article 3, paragraph (2) of the Health Insurance

Act of a specially-insured day laborer pursuant to the provisions of the same

Act;

(vii) a person that received a specially-insured day laborer certificate book

pursuant to the provisions of Article 126 of the Health Insurance Act and

within a certain period until the term when all of the blank space for stamps

for proof of health insurance of said certificate book are filled, and said

dependent pursuant to the provisions of the same Act, however, provided

that it shall not apply to a person that is within the period when said person

is not a specially-insured day laborer pursuant to the provision of Article 3,

paragraph (2) of the same Act with the approval pursuant to the proviso of

the same paragraph, and a person that has returned said specially-insured

day laborer certificate book pursuant to the provisions of Article 126,

paragraph (3) of the same Act, and said dependent pursuant to the provisions

of the same Act.

Article 8 (1) The term "In-Home Service" as used in this Act means Home-Visit

Long-Term Care, Home-Visit Bathing Long-Term Care, Home-Visit Nursing,

Home-Visit Rehabilitation, Guidance for Management of In-Home Medical

Long-Term Care, Outpatient Day Long-Term Care, Outpatient Rehabilitation,

Short-Term Admission for Daily Life Long-Term Care, Short-Term Admission

for Recuperation, Daily Life Long-Term Care Admitted to a Specified Facility,

Rental Service of Equipment for Long-Term Care Covered by Public Aid, and

Sale of Specified Equipment Covered by Public Aid. The term "In-Home Service

Business" as used in this Act means business performing In-Home Service.

(2) The term "Home-Visit Long-Term Care" as used in this Act means care

service that is for bathing, bodily waste elimination, meals, etc., and for other

daily activities provided by long-term care public aid workers and other

persons who determined by an Ordinance of the Ministry of Health, Labour,

and Welfare (except for care services defined as Home-Visit at Night for Long-

Term Care) and which are provided to a Person Requiring Long-Term Care at

his or her home (herein referred to as "In-Home Person Requiring Long-Term

Care") (including a residence room at a moderate-fee home for the elderly as

6

provided in Article 20-6 of the Public Aid for the Aged Act (Act No. 133 of

1963); a Fee-Based Home for the Elderly as prescribed in Article 29-1 of the

same Act (referred to as a "Fee-Based Home for the Elderly" in paragraphs (11)

and (19)); and other facilities as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare; the same shall apply hereinafter).

(3) The term "Home-Visit Bathing Long-Term Care" as used in this Act means

care service that provides bathing service and a bathtub to a Person Requiring

Long-Term Care by visiting his or her home.

(4) The term "Home-Visit Nursing" as used in this Act means medical care or

assistance for necessary medical care provided to a Person Requiring Long-

Term Care at his or her home (limited to those who are considered by an

attending physician to be a person in the degree of need of medical treatment

that conforms to standards as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare) by a nurse or other person as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare.

(5) The term "Home-Visit Rehabilitation" as used in this Act means physical

therapy, occupational therapy, and other necessary rehabilitation that is

provided to an In-Home Person Requiring Long-Term Care at his or her home

(limited to those who are considered by an attending physician to be a person

in the degree of need of medical treatment that conforms to standards as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare) in

order to maintain and recover mental or physical functions and to assist with

independently performing daily activities.

(6) The term "Guidance for Management of In-Home Medical Long-Term Care" as

used in this Act means management and instructions for medical care and as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare.

Said management and instructions are provided to an In-Home Person

Requiring Long-Term Care by a physician, dentist, pharmacist or other

personnel as determined by an Ordinance of the Ministry of Health, Labour,

and Welfare that are associated with a hospital, clinic, or pharmacy (herein

referred to as "Hospital, etc.")

(7) The term "Outpatient Day Long-Term Care" as used in this Act means care

that is for bathing, bodily waste elimination, meals, etc., and other care

provided for daily activities and which is provided as defined by an Ordinance

of the Ministry of Health, Labour, and Welfare, and functional training (except

for care defined as Outpatient Long-Term Care for a Dementia Patient) by

having an In-Home Person Requiring Long-Term Care commute to a facility as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare as

set forth in Article 5-2, paragraph (3) of the Public Aid for the Aged Act or a

Long-term care Day Service Center as provided in Article 20-2-2 of the same

Act.

7

(8) The term "Outpatient Rehabilitation" as used in this Act means physical

therapy, occupational therapy, and other necessary rehabilitation that is

provided to an In-Home Person Requiring Long-Term Care (limited to those

who are considered by an attending physician to be a person in the degree of

need of medical treatment that conforms to standards as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare) by having said

person commute to a Long-Term Care Health Facility, hospital, clinic, or other

facility as determined by an Ordinance of the Ministry of Health, Labour, and

Welfare and providing Outpatient Rehabilitation to said facility in order to

maintain and recover his or her mental or physical functions and to assist

independently performing daily activities.

(9) The term "Short-Term Admission for Daily Life Long-Term Care" as used in

this Act means to provide care for bathing, bodily waste elimination, meals,

etc., and other care for performing daily activities and to provide functional

training for an In-Home Person Requiring Long-Term Care by having said

person Short-Term Admission at a facility as determined by an Ordinance of

the Ministry of Health, Labour, and Welfare as set forth in Article 5-2,

paragraph (4) of the Public Aid for the Aged Act or at a Short-Term Admission

Facility for the Elderly as provided in Article 20-3 of the same Act.

(10) The term "Short-Term Admission for Recuperation" as used in this Act

means to provide nursing, long-term care and functional training under control

of medical management, or other necessary medical treatment, or to provide

care for performing daily activities to an In-Home Person Requiring Long-Term

Care (limited to persons with the degree of necessity for medical treatment

that conforms with standards as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare) by having said person Short-Term Admission at

a Long-Term Care Health Facility, Sanatorium Medical Facility for the Elderly

Requiring Long-Term Care or other facility as determined by an Ordinance of

the Ministry of Health, Labour, and Welfare.

(11) The term "Specified Facility" as used in this Act means a Fee-Based Home

for the Elderly or other facility as determined by an Ordinance of the Ministry

of Health, Labour, and Welfare that is not a Community-Based Specified

Facility as provided in this Article, paragraph (19) of this Act. The term "Daily

Life Long-Term Care Admitted to a Specified Facility" as used in this Act

means care for bathing, bodily waste elimination, meals, etc., and other care

for performing daily activities that is as determined by an Ordinance of the

Ministry of Health, Labour, and Welfare, functional training, and medical care.

Said care is provided to a Person Requiring Long-Term Care who is staying in

a Specified Facility and is based on a plan which stipulates the content of

services to be provided by said Specified Facility, the personnel in charge of the

services, and other items as determined by an Ordinance of the Ministry of

8

Health, Labour, and Welfare.

(12) The term "Rental Service of Equipment for Long-Term Care Covered by

Public Aid" as used in this Act means the rental of equipment covered by public

aid undertaken pursuant to provisions of a Cabinet Order of those types of

equipment as determined by the Minister of Health, Labour, and Welfare

among equipment covered by public aid for an In-Home Person Requiring

Long-Term Care (equipment for the convenience of performing daily activities

by a Person Requiring Long-Term Care, etc., whose physical or mental

functions are underactive and that cause problems with performing daily

activities, equipment to assist an Insured Person Requiring Long-Term Care,

etc., independently performing daily activities and equipment for functional

training or an Insured Person Requiring Long-Term Care, etc.,; the same shall

apply in the following paragraph (13), and to the following Article, paragraph

(12) and paragraph (13) of this Act).

(13) The term "Sale of Specified Equipment Covered by Public Aid" as used in

this Act means the sale, undertaken pursuant to provisions of a Cabinet Order,

of equipment covered by public aid among equipment provided for use in

bathing or bodily waste elimination and other items provided by the Minister

of Health, Labour, and Welfare (herein referred to as "Specified Equipment

Covered by Public Aid") to an In-Home Person Requiring Long-Term Care.

(14) The term "Community-Based Service" as used in this Act means Home-Visit

at Night for Long-Term Care, Outpatient Long-Term Care for a Dementia

Patient, Multifunctional Long-Term Care in a Small Group Home, Communal

Daily Long-Term Care for a Dementia Patient, Daily Life Long-Term Care for a

Person Admitted to a Community-Based Specified Facility, and Admission to a

Community-Based Facility for Preventive Daily Long-Term Care of the Elderly

Covered by Public Aid. The term "Community-Based Service Business" as used

in this Act means a business that provides Community-Based Service.

(15) The term "Home-Visit at Night for Long-Term Care" as used in this Act

means care provided for bathing, bodily waste elimination, meals, etc., and for

other daily activities that are as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare. Said care is provided to an In-Home Person

Requiring Long-Term Care at his or her home by a long-term care public aid

worker or other personnel specified by a Cabinet Order and as set forth in

paragraph (2) of this Article, according to periodic night visits or as requested

during the night.

(16) The term "Outpatient Long-Term Care for a Dementia Patient" as used in

this Act means to provide care for bathing, bodily waste elimination, meals,

etc., and for other daily activities as determined by an Ordinance of the

Ministry of Health, Labour, and Welfare, and functional training for an In-

Home Person Requiring Long-Term Care who is in the condition that memory

9

functions and other cognitive functions have become underactive as far as

causing disorder with performing daily activities due to organic changes of the

brain that are caused by cerebral vascular disease, Alzheimer's disease, or

other factors (herein referred to as "Dementia"). This is accomplished by

having said person commute to a facility as determined by an Ordinance of the

Ministry of Health, Labour, and Welfare as set forth in Article 5-2, paragraph

(3) of the Public Aid for the Aged Act or Long-Term Care Day Service Centers

for the elderly as provided in Article 20-2-2 of the same Act.

(17) The term "Multifunctional Long-Term Care in a Small Group Home" as used

in this Act means to provide care for bathing, bodily waste elimination, meals,

etc., and for other daily activities as determined by an Ordinance of the

Ministry of Health, Labour, and Welfare, and functional training to an In-

Home Person Requiring Long-Term Care at his or her home, or said bases of

services as determined by an Ordinance of the Ministry of Health, Labour, and

Welfare by having the person commute daily to a location or stay for short-

term at said bases, according to the person's mental and physical condition,

surroundings, etc., and based on his or her preference.

(18) The term "Communal Daily Long-Term Care for a Dementia Patient" as used

in this Act means to provide care for bathing, bodily waste elimination, meals,

etc., and for other daily activities, and functional training for a Person

Requiring Long-Term Care who is suffering from Dementia (except for a person

with the cause of Dementia being an acute disease), at a residence where the

person lives communally.

(19) The term "Daily Life Long-Term Care for a Person Admitted to a

Community-Based Specified Facility" as used in this Act means to provide care

for bathing, bodily waste elimination, meals, etc., and for other daily activities

as determined by an Ordinance of the Ministry of Health, Labour, and Welfare,

functional training and medical care based on a plan that stipulates the

content of services to be provided by said Community-Based Specified Facility,

the personnel in charge of the services, and other items as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare. This service is

provided to a Person Requiring Long-Term Care who is staying in a Fee-Based

Home for the Elderly and other facilities as determined by an Ordinance of the

Ministry of Health, Labour, and Welfare as set forth in paragraph (11) of this

Article and for which the capacity of the fixed number of said residents is

twenty-nine (29) or less (hereinafter referred to as "Community-Based

Specified Facility"), among facilities for which residents are limited to a Person

Requiring Long-Term Care, said person's spouse, and other personnel as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare

(herein referred to as a "Specialized Long-Term Care Specified Facility").

(20) The term "Community-Based Facility for the Elderly Covered by Public Aid

10

Requiring Long-Term Care" as used in this Act means an Intensive Care Home

for the Elderly (limited to facilities for which the capacity of residents is

twenty-nine (29) or less; the same shall apply hereinafter in this paragraph)

provided in Article 20-5 of the Public Aid for the Aged Act that aims to provide

care for bathing, bodily waste elimination, meals, etc., and for other daily

activities, functional training, health management, and medical care to a

Person Requiring Long-Term Care who is staying in said Intensive Care Home

for the Elderly based on a Community-Based Facility Service Plan (one that

provides the content of services provided to a Person Requiring Long-Term

Care who is staying in a Community-Based Facility for the Elderly Covered by

Public Aid Requiring Long-Term Care by said facility, the personnel in charge

of said services, and other items as determined by an Ordinance of the

Ministry of Health, Labour, and Welfare; the same shall apply hereinafter in

this paragraph). The term "Admission to a Community-Based Facility for

Preventive Daily Long-Term Care of the Elderly Covered by Public Aid" as

used in this Act means to provide care for bathing, bodily waste elimination,

meals, etc., and for other daily activities, functional training, health

management, and medical care to a Person Requiring Long-Term Care who is

staying in a Community-Based Facility for the Elderly Covered by Public Aid

Requiring Long-Term Care, based on a Community-Based Facility Service Plan.

(21) The term "In-Home Long-Term Care Support" as used in this Act means to

establish a plan (herein referred to as an "In-Home Service Plan" in this

paragraph, Article 115-38, paragraph (1), item (v), and the appended table to

this Act) that provides the types and contents of Designated In-Home Service,

etc. (herein referred to as "Designated In-Home Service, etc." in this

paragraph), the personnel in charge of said services to be used by an In-Home

Person Requiring Long-Term Care, and other items as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare, at the request of

said Person Requiring Long-Term Care and in consideration of his or her

mental and physical condition, surroundings, and the person's and his or her

family's preferences, etc., in order for an In-Home Person Requiring Long-Term

Care to be able to use appropriately the Designated In-Home Service as

prescribed in Article 41, paragraph (1) of this Act, In-Home Service related to

Exceptional Allowance for In-Home Long-Term Care Service or equivalent

services, Designated Community-Based Service as prescribed in Article 42-2,

paragraph (1) of this Act, Community-Based Service related to Exceptional

Allowance for Community-Based Long-Term Care Service or equivalent

services, and other necessary health and medical services or public aid services

for performing daily activities at home (hereinafter referred to as "Designated

In-Home Service, etc." in this paragraph); the term also means to provide

communication and coordination among Designated Providers of In-Home

11

Long-Term Care as prescribed in Article 41, paragraph (1) of this Act,

Designated Community-Based Service Provider as prescribed in Article 42-2,

paragraph (1) of this Act and other person and to provide other conveniences in

order to ensure provision of the Designated In-Home Service, etc., based on

said In-Home Service Plan, and in a case when said In-Home Person Requiring

Long-Term Care requires admission to a Community-Based Facility for the

Elderly Covered by Public Aid Requiring Long-Term Care or a Facility

Providing Insured Long-Term Care, the term means to introduce a Community-

Based Facility for the Elderly Covered by Public Aid Requiring Long-Term

Care or Facility Providing Insured Long-Term Care and to provide other

conveniences. The term "Designated In-Home Long-Term Care Support

Business" as used in this Act means a business to provide In-Home Long-Term

Care Support.

(22) The term "Facility Covered by Long-Term Care Insurance" as used in this

Act means a Designated Facility Covered by Public Aid Providing Long-Term

Care to the Elderly or a Long-Term Care Health Facility as prescribed in

Article 48, paragraph (1), item (i) of this Act, and a Designated Medical Long-

Term Care Sanatorium as prescribed in item (iii) of the same paragraph.

(23) The term "Facility Service" as used in this Act means a Facility Service for

Long-Term Care Covered by Public Aid, Long-Term Care Health Facility

Service, or Sanatorium Long-Term Care Service. The term "Facility Service

Plan" as used in this Act means a plan for a Person Requiring Long-Term Care

staying at a Designated Facility Covered by Public Aid Providing Long-Term

Care to the Elderly, a Long-Term Care Health Facility, or a Sanatorium

Medical Facility for the Elderly Requiring Long-Term Care that stipulates the

content of services provided by said facilities, the personnel in charge of said

services, and other items as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare.

(24) The term "Facility Covered by Public Aid Providing Long-Term Care to the

Elderly" as used in this Act means an Intensive Care Home for the Elderly

provided in Article 20-5 of the Public Aid for the Aged Act (limited to a facility

with a capacity of thirty (30) residents or more; the same shall apply

hereinafter in this paragraph). The purpose of said facility is to provide care

for bathing, bodily waste elimination, meals, etc., and for other daily activities,

functional training, health management, and medical care to a Person

Requiring Long-Term Care who is staying in said Intensive Care Home for the

Elderly based on a Facility Service Plan. The term "Facility Service for Long-

Term Care Covered by Public Aid" as used in this Act means care that is

provided based on a Facility Service Plan for bathing, bodily waste elimination,

meals, etc., and for other daily activities, functional training, health

management, and medical care to a Person Requiring Long-Term Care who is

12

staying in said Facility Covered by Public Aid Providing Long-Term Care to the

Elderly.

(25) The term "Long-Term Care Health Facility" as used in this Act means a

facility which has obtained permission from the prefectural governor as set

forth in Article 94, paragraph (1) of this Act as a facility with the purpose of

providing nursing, care and functional training under control of medical

management, and other necessary care for medical treatment and daily

activities to a Person Requiring Long-Term Care (limited to persons whose

degree of necessity for medical treatment conforms with standards as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare;

the same shall apply hereinafter in this paragraph) based on a Facility Service

Plan. The term "Long-Term Care Health Facility Service" as used in this Act

means nursing, care and functional training under control of medical

management, and other necessary care for medical treatment and daily

activities for a Person Requiring Long-Term Care who is staying in a Long-

Term Care Health Facility, based on a Facility Service Plan.

(26) The term "Sanatorium Medical Facility for the Elderly Requiring Long-Term

Care as used in this Act means a facility such as a hospital or clinic that

maintains a sanatorium ward or other beds ("Sanatorium Ward, etc.") that are

specified by a Cabinet Order to provide appropriate nursing services according

to the mental and physical characteristics of a Person Requiring Long-Term

Care among Sanatorium Ward, etc., as prescribed in Article 7, paragraph (2)

item (iv) of the Medical Care Act (Act No. 205, 1948), or beds which are

specified by a Cabinet Order to provide appropriate nursing services according

to the mental and physical characteristics of a Person Requiring Long-Term

Care with Dementia among beds other than those for Long-Term Care Beds in

the hospital; the same shall apply hereinafter), and with the purpose of

providing medical care management, nursing, long-term care and other care

under medical management, functional training, and other necessary medical

care to a Person Requiring Long-Term Care who is in said bed for long-term

care, etc., (limited to a person with the degree of need for medical treatment

that conforms with standards as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare; the same shall apply hereinafter in this

paragraph), based on a Facility Service Plan. The term "Sanatorium Long-

Term Care Service" as used in this Act means medical care management,

nursing, long-term care under medical management, and other care, functional

training, and other necessary medical care provided to a Person Requiring

Long-Term Care who is in a Sanatorium Ward, etc., for long-term care of a

Sanatorium Medical Facility for the Elderly Requiring Long-Term Care based

on a Facility Service Plan.

13

Article 8-2 (1) The term "Preventive Long-Term Care Service" as used in this Act

means Home-Visit Service for Preventive Long-Term Care, Home-Visit Bathing

Service for Preventive Long-Term Care, Home-Visit Nursing Service for

Preventive Long-Term Care, Home-Visit Rehabilitation Service for Preventive

Long-Term Care, Management and Guidance for In-Home Medical Service for

Preventive Long-Term Care, other Outpatient Preventive Long-Term Care,

Outpatient Rehabilitation for Preventive Long-Term Care, Short-Term

Admission for Daily Preventive Long-Term Care, Short-Term Admission for

Recuperation for Preventive Long-Term Care, Daily Preventive Long-Term

Care Admitted to a Specified Facility, Rental of Specified Equipment for

Preventive Long-Term Care Covered by Public Aid, and the Sale of Specified

Equipment for Preventive Long-Term Care Covered by Public Aid. The term

"Preventive Long-Term Care Service Business" as used in this Act means a

business that provides Preventive Long-Term Care Service.

(2) The term "Home-Visit Service for Preventive Long-Term Care" as used in this

Act means support for bathing, bodily waste elimination, meals, etc., and for

other daily activities as determined by an Ordinance of the Ministry of Health,

Labour, and Welfare. Said support is provided to a Person Requiring Support

who receives support (herein referred to as a "Person Requiring In-Home

Support"), at his or her home for the purpose of prevention of long-term care

(reduction or prevention of deterioration of conditions for which a person

requires continuous care for the whole or a part of basic movements during

daily activities, such as bathing, bodily waste elimination, meals, etc., or a

person that has difficulty performing daily activities due to physical or mental

disabilities; the same shall apply herein) by a long-term care public aid worker

or other personnel as provided by a Cabinet Order and for the period as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare.

(3) The term "Home-Visit Bathing Service for Preventive Long-Term Care" as

used in this Act means bathing care provided to a Person Requiring In-Home

Support with the purpose of preventing the long-term care of said person by

visiting said person at his or her home and providing a bathing tub for the

period as determined by an Ordinance of the Ministry of Health, Labour, and

Welfare.

(4) The term "Home-Visit Nursing Service for Preventive Long-Term Care" as

used in this Act means medical care or assistance of a necessary medical care

provided to a Person Requiring In-Home Support (limited to a person that is

considered by an attending physician to be a person with the degree of need for

medical treatment that conforms to standards as determined by an Ordinance

of the Ministry of Health, Labour, and Welfare) at his or her home for the

purpose of prevention of long-term care, and by a nurse or other personnel as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare

14

and for the period as determined by an Ordinance of the Ministry of Health,

Labour, and Welfare.

(5) The term "Home-Visit Rehabilitation Service for Preventive Long-Term Care"

as used in this Act means physical therapy, occupational therapy, and other

necessary rehabilitation provided to a Person Requiring In-Home Support

(limited to a person that is considered by an attending physician to be a person

with the degree of need for medical treatment that conforms to standards as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare) at

his or her home for the purpose of prevention of long-term care and for the

period as determined by an Ordinance of the Ministry of Health, Labour, and

Welfare.

(6) The term "Management and Guidance for In-Home Medical Service for

Preventive Long-Term Care" as used in this Act means management and

guidance for medical care that is stipulated by an Ordinance of the Ministry of

Health, Labour, and Welfare and said management and guidance for medical

care is provided to a Person Requiring In-Home Support for the purpose of

prevention of long-term care, and by a physician in a Hospital, etc., dentist,

pharmacist, or other personnel as determined by an Ordinance of the Ministry

of Health, Labour, and Welfare.

(7) The term "Outpatient Preventive Long-Term Care" as used in this Act means

care for bathing, bodily waste elimination, meals, etc., and other support for

daily activities as determined by an Ordinance of the Ministry of Health,

Labour, and Welfare and performing functional training (except that which is

defined as Preventive Long-Term Care for a Dementia Outpatient) that is

provided to a Person Requiring In-Home Support for the purpose of prevention

of long-term care by having said person commute to a facility as determined by

an Ordinance of the Ministry of Health, Labour, and Welfare as set forth in

Article 5-2, paragraph (3) of the Public Aid for the Aged Act, or a Long-Term

Care Day Service Center as provided in Article 20-2-2 of the same Act, at said

facility and for the period as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare.

(8) The term "Outpatient Rehabilitation for Preventive Long-Term Care" as used

in this Act means physical therapy, occupational therapy, and other necessary

rehabilitation provided to a Person Requiring In-Home Support (limited to a

person that is considered by an attending physician to be a person with the

degree of need for medical treatment that conforms to standards as determined

by an Ordinance of the Ministry of Health, Labour, and Welfare) by having

said person commute to a Long-Term Care Health Facility, hospital, clinic, or

other facility as determined by an Ordinance of the Ministry of Health, Labour,

and Welfare at said facility for the purpose of prevention of long-term care for

the period as determined by an Ordinance of the Ministry of Health, Labour,

15

and Welfare.

(9) The term "Short-Term Admission for Daily Preventive Long-Term Care" as

used in this Act means to provide care for bathing, bodily waste elimination,

meals, etc., support for other daily activities, and functional training to a

Person Requiring In-Home Support by having said person stay for a short-term

in a facility as determined by an Ordinance of the Ministry of Health, Labour,

and Welfare as set forth in Article 5-2, paragraph (4) of the Public Aid for the

Aged Act, or in a Short-Term Admission Facility for the Elderly as provided in

Article 20-3 of the same Act, for the purpose of prevention of long-term care for

the period as determined by an Ordinance of the Ministry of Health, Labour,

and Welfare at said facility.

(10) The term "Short-Term Admission for Recuperation for Preventive Long-Term

Care" as used in this Act means to provide nursing, long-term care, functional

training and other necessary care for medical treatment under control of

medical management, and support for daily activities to a Person Requiring In-

Home Support (limited to a person with the degree of need for medical

treatment that conforms with an Ordinance of the Ministry of Health, Labour,

and Welfare) by having the person stay for a short-term in a Long-Term Care

Health Facility, a Sanatorium Medical Facility for the Elderly Requiring Long-

Term Care or other facility as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare for the purpose of prevention of long-term care for

the period as determined by an Ordinance of the Ministry of Health, Labour,

and Welfare at said facility.

(11) The term "Daily Preventive Long-Term Care Admitted to a Specified

Facility" as used in this Act means care for bathing, bodily waste elimination,

meals, etc., and support for other daily activities as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare, functional training,

and medical care that is provided to a Person Requiring Support who is staying

in a Specified Facility (except for a Specialized Long-Term Care Specified

Facility) for the purpose of prevention of long-term care, and based on a plan

for providing services of specified content by said Specified Facility, the

personnel in charge of said services, and other items as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare.

(12) The term "Equipment Rental for Preventive Long-Term Care Covered by

Public Aid" as used in this Act means a rental of equipment undertaken for a

Person Requiring In-Home Support pursuant to the provisions of a Cabinet

Order for equipment covered by public aid that is specified by the Minister of

Health, Labour, and Welfare as equipment contributing to the prevention of

long-term care to a Person Requiring In-Home Support among equipment

covered by public aid.

(13) The term "Sale of Specified Equipment for Preventive Long-Term Care

16

Covered by Public Aid" as used in this Act means sales undertaken for a

Person Requiring In-Home Support pursuant to the provisions of a Cabinet

Order of equipment covered by public aid that contributes to the prevention of

long-term care that is provided for use in bathing or bodily waste elimination,

as specified by the Ministry of Health, Labour, and Welfare, among equipment

covered by public aid (herein referred to as "Specified Equipment for

Preventive Long-Term Care Covered by Public Aid").

(14) The term "Community-Based Service for Preventive Long-Term Care" as

used in this Act means Preventive Long-Term Care for a Dementia Outpatient,

Multifunctional Preventive Long-Term Care in a Small Group Home, and

Preventive Long-Term Care for a Dementia Patient in Communal Living. The

term "Community-Based Preventive Long-Term Care Business" as used in this

Act means a business that provides Community-Based Service for Preventive

Long-Term Care.

(15) The term "Preventive Long-Term Care for a Dementia Outpatient" as used

in this Act means to provide care for bathing, bodily waste elimination, meals,

etc., and support for other daily activities as determined by an Ordinance of

the Ministry of Health, Labour, and Welfare, and functional training to a

Person Requiring In-Home Support who is suffering from Dementia, for the

purpose of prevention of long-term care by having the person commute to a

facility as determined by an Ordinance of the Ministry of Health, Labour, and

Welfare as set forth in Article 5-2, paragraph (3) of the Public Aid for the Aged

Act or a Long-Term Care Day Service Center as provided in Article 20-2-2 of

the same Act, at said facility and for the period as determined by an Ordinance

of the Ministry of Health, Labour, and Welfare.

(16) The term "Multifunctional Preventive Long-Term Care in a Small Group

Home" as used in this Act means to provide care for bathing, bodily waste

elimination, meals, etc., and support for other daily activities as determined by

an Ordinance of the Ministry of Health, Labour, and Welfare, and functional

training to a Person Requiring In-Home Support according to the mental and

physical conditions of said person and according to the environment, etc., of

said person based on the preferences of said person at his or her home or at a

base of service as determined by an Ordinance of the Ministry of Health,

Labour, and Welfare by having the person commute daily or stay for a short-

term for the purpose of prevention of long-term care.

(17) The term "Preventive Long-Term Care for a Dementia Patient in Communal

Living" as used in this Act means to provide care for bathing, bodily waste

elimination, meals, etc., support for other activities, and functional training to

a Person Requiring Support (limited to a person that corresponds to a Category

of Needed Support Condition as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare) who are suffering from Dementia (except for a

17

person that cause of Dementia is an acute disease) at a residence where the

person lives communally and for the purpose of prevention of long-term care.

(18) The term "Preventive Long-Term Care Support" as used in this Act means

that a person as determined by an Ordinance of the Ministry of Health, Labour,

and Welfare among the personnel of a community general support center as

prescribed in Article 115-39, paragraph (1) of this Act, with regard to a Person

Requiring In-Home Support, considers said a Person's mental and physical

condition, the present environment of said Person, the preferences, etc., of said

Person Requiring In-Home Support and those of his or her family according to

the request of said Person Requiring In-Home Support, and establishes a plan

that stipulates the type and content of a Designated Provider of a Preventive

Service to Long-Term Care Service, etc., that said Person will use, the

personnel in charge of said services, and other items as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare (herein referred to

as "Preventive Long-Term Care Service Plan" in this paragraph and the

appended table) in order for the Person Requiring In-Home Support to be able

to use appropriately those services as prescribed in Article 53, paragraph (1) of

this Act that are of a Designated Preventive Long-Term Care Service,

Preventive Long-Term Care Service pertaining to Exceptional Allowance for

Preventive Service of Long-Term Care or services equivalent to said service,

those services as prescribed in Article 54-2, paragraph (1) that are Designated

Community-Based Preventive Service of Long-Term Care, Community-Based

Service for Preventive Long-Term Care pertaining to Exceptional Allowance for

Community-Based Preventive Service of Long-Term Care, or equivalent

services to said service, or other health and medical services or public aid

services contributing to prevention of long-term care (herein referred to as

"Designated Preventive Long-Term Care Service, etc.") and that said personnel

provide liaison and coordination among those who are a Designated Provider of

a Preventive Service to Long-Term Care prescribed in Article 53, paragraph (1)

of this Act, those who are a Designated Person Providing Community-Based

Preventive Service of Long-Term Care as prescribed in Article 54-2, paragraph

(1), and other personnel, and other convenience in order to ensure the provision

of the Designated Preventive Long-Term Care Service, etc., based on said

Preventive Long-Term Care Service Plan. The term "Preventive Long-Term

Care Support Business" as used in this Act means a business that provides a

Preventive Long-Term Care Support.

Chapter II Insured Persons

(Insured Person)

Article 9 A person that corresponds to any of the following items shall be an

18

Insured Person of Long-Term Care for the Aged Insurance provided by a

municipality or special city ward (herein referred to simply as "Municipality"):

(i) a person that is domiciled in the Municipality and is 65 years of age or more

(herein referred to as "Primary Insured Person");

(ii) a person insured by medical insurance that is domiciled in the Municipality

and is 40 years of age or more but less than 65 years of age (herein referred

to as "Secondary Insured Person").

(Time of Acquisition of Qualifications)

Article 10 An Insured Person by Long-Term Care Insurance as provided by a

Municipality pursuant to the provisions of the preceding Article shall acquire

said eligibility on the date when said Person first corresponds to any of the

following items:

(i) when a Medical Insurance Subscriber who is domiciled in said Municipality

becomes 40 years of age;

(ii) when a Medical Insurance Subscriber who is 40 years of age or more but

less than 65 years of age acquires domicile in said Municipality;

(iii) when a person that is domiciled in said Municipality and is 40 years of age

or more but less than 65 years of age becomes a Medical Insurance

Subscriber;

(iv) when a person that is domiciled in said Municipality (other than a Medical

Insurance Subscriber) becomes 65 years of age.

(Time of Loss of Qualification)

Article 11 (1) An Insured Person by Long-Term Care Insurance provided by said

Municipality pursuant to the provisions of Article 9 of this Act shall lose said

qualification from the day following the date when said person fails to have

domicile in said Municipality, however, provided that said person shall lose

this qualification on said date when the person fails to have domicile in said

Municipality and obtains domicile in another Municipality on the same day.

(2) A Secondary Insured Person shall lose this qualification on the date when

said person becomes a non-Medical Insurance Subscriber.

(Notifications, etc.)

Article 12 (1) A Primary Insured Person shall notify the Municipality of matters

regarding acquisition and loss of qualification of Insured Person status and

other necessary matters pursuant to the provisions of an Ordinance of the

Ministry of Health, Labour, and Welfare, however, provided that this provision

shall not apply to a case when the Primary Insured Person acquired the

qualification of an Insured Person due to becoming subject to Article 10, item

(iv) of this Act (except for a case pursuant to the provisions of an Ordinance of

19

the Ministry of Health, Labour, and Welfare).

(2) The householder of said family in which a Primary Insured Person resides

may provide the notification pursuant to the provisions of the preceding

paragraph regarding said Primary Insured Person on behalf of a Primary

Insured Person that resides in the household.

(3) An Insured Person may request the Municipality to issue a Certificate of

Insured Person pertaining to said Insured Person.

(4) An Insured Person shall return the Certificate of Insured Person pursuant to

the provisions of an Ordinance of the Ministry of Health, Labour, and Welfare

when said Person no longer meets said qualifications.

(5) When a notification is issued pursuant to the provisions of Articles 22 to 24,

or Article 25 of the Basic Resident Registration Act (Act No. 81 of 1967)

(limited to a case when a supplementary note is appended to the document

pertaining to said notification pursuant to the provisions of Article 28-2 of the

same Act), it shall be deemed as a notification pursuant to the main clause of

paragraph (1) based on the same reason for said notification.

(6) In addition to the provisions as prescribed in each of the preceding

paragraphs of this Article, necessary matters for notification pertaining to an

Insured Person and that pertaining to the Certificate of Insured Person shall

be as determined by an Ordinance of the Ministry of Health, Labour, and

Welfare.

(Domicile Exception of an Insured Person that is Admitted to or has been a

Resident of a Facility Subject to Domicile Exception)

Article 13 (1) An Insured Person for whom it is determined that his or her

domicile has changed to a location of one of the following facilities (herein

referred to as "Facility Subject to Domicile Exception") and is located by

admission or residence (herein referred to as "Admission, etc.") in said Facility

Subject to Domicile Exception (an Insured Person for whom it is determined

that his or her domicile has changed to a location where said Facility is located

by moving into said Facility as listed in item (iii) is limited to a person for

whom the admission measures are pursuant to the provisions of Article 11,

paragraph (1), item (i) of the Public Aid for the Aged Act; hereinafter referred

to as "Insured Person Subject to Domicile Exception" in this Article) and for

whom it is determined to have had domicile in another Municipality (a

Municipality other than the Municipality where said Facility Subject to

Domicile Exception is located) at the time of moving in for Admission, etc., at

said Facility Subject to Domicile Exception, shall be an Insured Person of

Long-Term Care Insurance provided by said other Municipality of prior

domicile, notwithstanding the provisions of Article 9; however, provided that

this provision shall not apply to an Insured Person Subject to Domicile

20

Exception who moved in for Admission, etc., into two or more of a said Facility

Subject to Domicile Exception, and said Person is determined to have moved

consecutively from one said Facility Subject to Domicile Exception in which

said Insured Person was admitted immediately prior to the said Facility

Subject to Domicile Exception where said Insured Person is currently residing

for Admission, etc. (herein referred to as the "Facility of First Prior Admission

of an Insured Person" in this paragraph) into a Facility Subject to Domicile

Exception in which said Insured Person is currently residing (herein referred

to as the "Facility of Current Admission of an Insured Person" in this

paragraph and the following paragraph) (collectively herein referred to as

"Specified Continuous Admission of an Insured Person" in the following

paragraph):

(i) Facility Covered by Long-Term Care Insurance;

(ii) Specified Facility;

(iii) a Care Facility for the Elderly as provided in Article 20-4 of the Public Aid

for the Aged Act.

(2) A person described in any of the following items that corresponds to the

conditions of a Specified Continuous Admission of an Insured Person shall be

an Insured Person of Long-Term Care Insurance of the Municipality as

prescribed respectively in the following items, notwithstanding the provisions

of Article 9:

(i) an Insured Person Subject to Domicile Exception for whom it is determined

to have changed his or her domicile consecutively from one location where a

Facility Subject to Domicile Exception is located to another such Facility by

moving in for Admission, etc., at two or more of a Facility Subject to Domicile

Exception, where in each said Facility the Insured Person moved in for

Admission, etc., continuously, and is considered to have had domicile in

another Municipality (a Municipality other than the Municipality where the

Facility of Current Admission of an Insured Person is located) when said

Insured Person moved in for Admission, etc., at said Facility of First Prior

Admission of an Insured Person, from among two or more of a said Facility

Subject to Domicile Exception, said other Municipality;

(ii) an Insured Person Subject to Domicile Exception for whom it is determined

to have changed domicile from a location other than where one of a Facility

Subject to Domicile Exception is located to a place where another said

Facility Subject to Domicile Exception is located (herein referred to as

"Change of Specified Domicile" in this item) by moving in for continuous

Admission, etc., from one of two or more of a said Facility Subject to Domicile

Exception where the Insured Person continues Admission, etc., to another

said Facility Subject to Domicile Exception (herein referred to as

"Continuous Admission, etc." in this item), and is considered to have had a

21

domicile in another Municipality (a Municipality other than the Municipality

where the Facility of Current Admission of an Insured Person is located)

when moving in for Continuous Admission, etc., pertaining to a Change of

Specified Domicile for the most recent occurrence, said other Municipality.

(3) A Facility Subject to Domicile Exception where an Insured Person Subject to

Domicile Exception is in Admission, etc., shall provide the necessary

cooperation to the Municipality where said Facility Subject to Domicile

Exception is located and is the Municipality that provides Long-Term Care

Insurance to said Insured Person Subject to Domicile Exception.

Chapter III Certification Committee of Needed Long-Term Care

(Certification Committee of Needed Long-Term Care)

Article 14 A Certification Committee of Needed Long-Term Care (herein referred

to as "Certification Committee") shall be established in a Municipality in order

to perform the examination and determination as prescribed in Article 38,

paragraph (2) of this Act.

(Certification Committee Members)

Article 15 (1) The fixed number of Certification Committee members shall be the

number specified by prefectural ordinance in accordance with standards

specified by a Cabinet Order.

(2) Certification Committee members shall be appointed by the mayor of a

Municipality (or the ward mayor, for special city wards; the same shall apply

hereinafter) and shall be a person with relevant knowledge and experience

pertaining to health care, medical care, or for the administration of public aid

of an Insured Person Requiring Long-Term Care, etc.

(Support for Co-Establishment)

Article 16 (1) A prefecture may perform the necessary coordination among

Municipalities according to a request from a Municipality that intends to co-

establish a Certification Committee pursuant to Article 252-7, paragraph (1) of

the Local Autonomy Act (Act No. 67 of 1947).

(2) A prefecture may provide to Municipalities that have co-established a

Certification Committee the technical advice and other support necessary for

ensuring its efficient operation.

(Provisions Pertaining to Delegation of a Cabinet Order)

Article 17 In addition to the provisions of this Act, necessary matters pertaining

to a Certification Committee shall be provided by a Cabinet Order.

22

Chapter IV Insurance Benefits

Section 1 General Rules

(Types of Insurance Benefits)

Article 18 Insurance benefits provided by this Act shall be the following

insurance benefits:

(i) insurance benefits pertaining to the Condition of Need for Long-Term Care

of an Insured Person (hereinafter referred to as "Long-Term Care Benefit");

(ii) insurance benefits pertaining to the Needed Support Condition of an

Insured Person (herein referred to as "Prevention Benefit");

(iii) in addition to the provisions of the preceding two items, insurance benefits

provided by a municipal ordinance as insurance benefits that contribute to

the reduction or prevention of deterioration of a Condition of Need for Long-

Term Care or a Needed Support Condition (herein referred to as "Municipal

Special Benefit" in Section V).

(Certification by a Municipality)

Article 19 (1) An Insured Person that intends to receive a Long-Term Care

Benefit shall obtain certification by a Municipality pertaining to the fact that

said Insured Person qualifies as a Person Requiring Long-Term Care and as to

the Category of Condition of Need for Long-Term Care for which said Insured

Person qualifies (herein referred to as "Certification of Needed Long-Term

Care").

(2) An Insured Person that intends to receive a Prevention Benefit shall obtain

certification by a Municipality pertaining to the fact that said Insured Person

qualifies as a Person Requiring Support and as to the Category of Needed

Support Condition for which said Insured Person qualifies (herein referred to

as "Certification of Needed Support").

(Coordination with Benefits Provided by Other Laws and Regulations)

Article 20 A Long-Term Care Benefit or Prevention Benefit (herein referred to as

"Long-Term Care Benefit, etc.") with regard to said Condition of Need for Long-

Term Care or Needed Support Condition (herein referred to as "Condition of

Need for Long-Term Care, etc.") shall not be provided within the limit provided

by a Cabinet Order when a benefit equivalent to a Long-Term Care Benefit,

etc., can be received from among benefits that is a medical compensation

benefit pursuant to the provisions of the Worker Accident Compensation

Insurance Act (Act No. 50 of 1947), a medical benefit, or other benefits based

on laws and regulations and provided by a Cabinet Order, or within said limit

when benefits other than those provided by said a Cabinet Order and those

benefits equivalent to a Long-Term Care Benefit, etc., are granted under the

23

covered expenses of a plan of the national government or a local government.

(Right to Claim Compensation for Damages)

Article 21 (1) When the basis for benefit claim is caused by the act of a third

party and a Municipality provides insurance benefits, the Municipality shall

obtain the right to claim compensation for the damages which an Insured

Person holds against the third party within the limit of the amount of said

benefit.

(2) In a case as prescribed in the preceding paragraph, when a person to be

granted an insurance benefit receives compensation for damages for the same

reason from a third party, a Municipality shall not be responsible for payment

of said insurance benefit within the limit of the compensation amount.

(3) A Municipality may entrust affairs of the collection or receipt of compensation

for damages pertaining to the claim of right obtained pursuant to the

provisions of paragraph (1) of this Article to the Federation of National Health

Insurance Associations as prescribed in Article 45, paragraph (5) of the

National Health Insurance Act (herein referred to as "Association") as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare.

(Collection, etc., of Fraudulent Gain)

Article 22 (1) In a case when a person receives an insurance benefit by deception

or other wrongful act, a Municipality may collect in whole or a portion of said

benefit amount from said person.

(2) In a case as prescribed in the preceding paragraph, with regard to Home-Visit

Nursing, Home-Visit Rehabilitation, Outpatient Rehabilitation, Short-Term

Admission for Recuperation, Home-Visit Nursing Service for Preventive Long-

Term Care, Home-Visit Rehabilitation Service for Preventive Long-Term Care,

Outpatient Rehabilitation for Preventive Long-Term Care, Short-Term

Admission for Recuperation for Preventive Long-Term Care, when an

insurance benefit for said services is granted because a physician who

diagnoses the degree of necessity of said treatment or another physician or

dentist who engages in In-Home Long-Term Care or equivalent services,

Facility Service, Preventive Long-Term Care Service or equivalent services,

has made a false entry on the medical certification which is to be submitted to

a Municipality, the Municipality may order said physician or dentist to pay the

levy as prescribed by the above paragraph jointly and severally with the person

that received the insurance benefit.

(3) When a Designated In-Home Service Provider as prescribed in Article 41,

paragraph (1) of this Act; a Designated Community-Based Service Provider as

prescribed in Article 42-2, paragraph (1); a Designated In-Home Long-Term

Care Support Provider as prescribed in Article 46, paragraph (1); a Facility

24

Covered by Long-Term Care Insurance; a Designated Provider of a Preventive

Service to Long-Term Care as prescribed in Article 53, paragraph (1); a

Designated Provider of Community-Based Preventive Service of Long-Term

Care as prescribed in Article 54-2, paragraph (1); or a Designated Provider of

Support for Prevention of Long-Term Care as prescribed in Article 58,

paragraph (1) (hereinafter collectively referred to as "Designated In-Home

Service Provider, etc." in this paragraph) receives a payment pursuant to the

provisions of Article 41, paragraph (6), Article 42-2, paragraph (6), Article 46,

paragraph (4), Article 48, paragraph (4), Article 51-2, paragraph (4), Article 53,

paragraph (4), Article 54-2, paragraph (6), Article 58, paragraph (4), or Article

61-2, paragraph (4) by deception or other wrongful act, a Municipality may

require said Designated In-Home Service Provider, etc., to return the amount

paid, or to pay the amount obtained by multiplying 40 percent of the principal

amount to be returned.

(Submission, etc., of Documents)

Article 23 A Municipality may, when it determines necessity with regard to an

insurance benefit, demand or request submission or presentation of documents

and other items, or direct its personnel to ask questions and inquiries to a

person that receives said insurance benefit, a person that is in charge of In-

Home Service, etc. pertaining to said insurance benefit (which means In-Home

Service (including equivalent services), Community-Based Service (including

equivalent services), In-Home Long-Term Care Support (including equivalent

services), Facility Service, Preventive Long-Term Care Service (including

equivalent services), Community-Based Service for Preventive Long-Term Care

(including equivalent services), or a Preventive Long-Term Care Support

(including equivalent services); the same shall apply hereinafter) , or a person

that provides a house modification for in-home care as prescribed in Article 45,

paragraph (1) which pertains to an insurance benefit, or a person that was said

person (hereinafter referred to as "Person, etc., Subject to Inquiry").

(Presentation, etc., of Record Books and Documents)

Article 24 (1) The Minister of Health, Labour, and Welfare or a prefectural

governor may, when it is determined that it is necessary as pertaining to a

Long-Term Care Benefit, etc. (except for payments of an Allowance for Home

Modification for In-Home Long-Term Care and an Allowance for Preventive

Long-Term Care Home Modification; the same shall apply in the following

paragraph and Article 208), order a person that has provided In-Home Service,

etc., or employees of said Services, etc., to report and provide records of said

In-Home Service, etc., to present record books and documents, and other items,

and direct personnel to ask questions concerning the In-Home Service, etc.,

25

provided by said person.

(2) The Minister of Health, Labour, and Welfare or a prefectural governor, when

it is determined that it is necessary, may order an Insured Person that

received a Long-Term Care Benefit, etc., and a person that was the Insured

Person to report and direct its personnel to ask questions concerning the

content of the In-Home Service, etc., pertaining to said Long-Term Care

Benefit, etc. (herein referred to as "Service Covered by Long-Term Care

Benefits, etc.").

(3) In a case of asking questions pursuant to the provisions of the preceding two

paragraphs, said personnel shall carry identification and shall present the

same if required by the relevant person to be questioned.

(4) The authority granted pursuant to the provisions of paragraphs (1) and (2)

shall not be construed as an approval of a criminal investigation.

(Designated and Entrusted Juridical Person for Municipal Affairs)

Article 24-2 (1) A Municipality may entrust a portion of the following affairs to a

juridical person that qualifies as per the requirements as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare, and is designated by

a prefectural governor as a person that can perform said affairs appropriately

(herein referred to as "Designated and Entrusted Juridical Person for

Municipal Affairs" in this Article):

(i) affairs as prescribed in Article 23 of this Act (except for affairs pertaining to

the selection of a Person Subject to an Inquiry, etc.);

(ii) affairs pertaining to an inspection pursuant to the provisions of Article 27,

paragraph (2) (including a case when applied mutatis mutandis pursuant to

Article 28, paragraph (4), Article 29, paragraph (2), Article 30, paragraph (2),

Article 31, paragraph (2), and Article 32, paragraph (2) (including a case

when applied mutatis mutandis pursuant to Article 33, paragraph (4), Article

33-2, paragraph (2), Article 33-3, paragraph (2), and Article 34, paragraph

(2)));

(iii) other affairs as determined by an Ordinance of the Ministry of Health,

Labour, and Welfare.

(2) A Designated and Entrusted Juridical Person for Municipal Affairs, when

performing affairs as set forth in item (ii) of the preceding paragraph, shall

assign a Long-Term Care Support Specialist or other person as determined by

an Ordinance of the Ministry of Health, Labour, and Welfare to implement the

inspection pertaining to said entrustment.

(3) An Officer or personnel of a Designated and Entrusted Juridical Person for

Municipal Affairs (including a Long-Term Care Support Specialist or other

person as determined by an Ordinance of the Ministry of Health, Labour, and

Welfare as set forth in the preceding paragraph; the same shall apply in the

26

following paragraph) or a person that held that position shall not divulge any

confidential information learned pertaining to said entrusted affairs without a

justifiable reason.

(4) An Officer or personnel of a Designated and Entrusted Juridical Person for

Municipal Affairs who engage in said entrusted affairs shall be deemed as

personnel engaged in public service pursuant to the provisions of laws and

regulations with regard to the application of the Penal Code (Act No. 45 of

1907) and other penal provisions.

(5) A Municipality, when entrusting affairs pursuant to the provisions of

paragraph (1), shall issue public notice of this effect pursuant to the provisions

of an Ordinance of the Ministry of Health, Labour, and Welfare.

(6) In addition to the provisions as prescribed in each of the preceding

paragraphs of this Article, other necessary matters pertaining to a Designated

and Entrusted Juridical Person for Municipal Affairs shall be as prescribed by

a Cabinet Order.

(Protection of Right to Benefit)

Article 25 The right to receive an insurance benefit may not be transferred,

pledged as collateral, or levied.

(Prohibition of Taxation and Other Public Dues)

Article 26 Taxation and other public dues may not be imposed by establishing

money or goods that are provided as an insurance benefit as a standard.

Section 2 Certification

(Certification of Needed Long-Term Care)

Article 27 (1) An Insured Person that intends to obtain a Certification of Needed

Long-Term Care, pursuant to the provisions of an Ordinance of the Ministry of

Health, Labour, and Welfare, shall submit an application with attachment of

Certificate of Insured Person to a Municipality. In this case, said Insured

Person, pursuant to the provisions of an Ordinance of the Ministry of Health,

Labour, and Welfare, may have a Designated In-Home Long-Term Care

Support Provider as prescribed in Article 46, paragraph (1), a Community-

Based Facility for the Elderly Covered by Public Aid Requiring Long-Term

Care, or a Facility Covered by Long-Term Care Insurance, and those which are

determined by an Ordinance of the Ministry of Health, Labour, and Welfare, or

a community general support center as prescribed in Article 115-39, paragraph

(1) implement procedures pertaining to said application on behalf of said

Insured Person.

(2) A Municipality shall, when the application as prescribed in the preceding

27

paragraph is submitted, direct its personnel to interview said Insured Person

pertaining to said application and investigate the mental and physical

condition and surroundings of said Insured Person, and other matters as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare. In

this case, the Municipality may, when said Insured Person has a residence in a

remote place, commission said investigation to another Municipality.

(3) A Municipality shall, when the application as prescribed in paragraph (1) is

submitted, request an attending physician of the Insured Person pertaining to

said application for opinions regarding the status of illness or injury that is the

cause of the physical or mental problems of said Insured Person, however,

provided that the Municipality may, when there is no attending physician of

the Insured Person pertaining to said application, or it is difficult to request

for said opinion, etc., order said Insured Person to obtain the diagnosis of a

designated physician or from the Municipality's personnel who is a physician.

(4) A Municipality shall notify the relevant Certification Committee of the result

of the investigation as set forth in paragraph (2) (in a case of entrustment

pursuant to the provisions of Article 24-2, paragraph (1), item (ii), including an

investigation pertaining to said entrustment) of the opinion of the attending

physician as prescribed in the preceding paragraph, the result of a diagnosis by

the designated physician or its personnel who is a physician, and other matters

as specified by an Ordinance of the Ministry of Health, Labour, and Welfare,

and request an examination and judgment pertaining to matters as prescribed

in each said item according to the Category of the Insured Person as listed in

the following items with regard to the Insured Person pertaining to an

application as prescribed in paragraph (1):

(i) Primary Insured Person: those who qualify with a Condition of Need for

Long-Term Care and Category of Condition of Need for Long-Term Care that

said condition is subject to;

(ii) Secondary Insured Person: those who qualify with a Condition of Need for

Long-Term Care and Category of Condition of Need for Long-Term Care that

said condition is subject to, and the physical or mental problems causing said

Condition of Need for Long-Term Care is caused by a Specified Disease.

(5) A Certification Committee shall, when being requested to conduct an

examination and provide judgment pursuant to the provisions of the preceding

paragraph, act in compliance with standards as determined by the Minister of

Health, Labour, and Welfare, examine and judge matters as prescribed in each

item of the same paragraph of the Insured Person pertaining to said

examination and judgment, and notify said result to the Municipality. In this

case, a Certification Committee may, when it determines it necessary, state

opinions to the Municipality regarding the matters listed as follows:

(i) matters concerning the necessary medical care for the reduction or

28

prevention of deterioration of the Condition of Need for Long-Term Care of

said Insured Person;

(ii) matters that said Insured Person shall heed for the appropriate and

effective use of a Designated In-Home Service as prescribed in Article 41,

paragraph (1) of this Act, a Designated Community-Based Service as

prescribed in Article 42-2, paragraph (1), or a Designated Facility Service,

etc., as prescribed in Article 48, paragraph (1).

(6) A Certification Committee may, when it determines it necessary in an

examination or judgment referred to in the first sentence of the preceding

paragraph, hear opinions of the Insured Person pertaining to said examination

and judgment, said Person's family members, the attending physician as set

forth in paragraph (3), and other relevant persons.

(7) A Municipality, when providing a Certification of Needed Long-Term Care

based on the results of an examination and judgment of a Certification

Committee as notified pursuant to the provisions of the first sentence of

paragraph (5), shall notify the Insured Person pertaining to said Certification

of Needed Long-Term Care of said result. In this case, the Municipality shall

enter the following items on the Certificate of Insured Person of said Insured

Person and return the Certificate of Insured Person to the Insured Person:

(i) applicable Category of Condition of Need for Long-Term Care;

(ii) opinions of the Certification Committee pertaining to the matters listed in

paragraph (5), item (ii).

(8) A Certification of Needed Long-Term Care shall become effective retroactively

on the date that said application was submitted.

(9) A Municipality, when it determined the Insured Person pertaining to the

application as set forth in paragraph (1) fails to be qualified as a Person

Requiring Long-Term Care based on the results of an examination and

judgment of a Certification Committee as notified pursuant to the provisions of

the first sentence of paragraph (5), shall notify said Insured Person of that

effect, indicating the reason(s), and return the Certificate of Insured Person of

said Insured Person.

(10) A Municipality may dismiss an application submitted pursuant to paragraph

(1) when the Insured Person pertaining to the application as set forth in

paragraph (1) fails to respond to an investigation pursuant to the provisions of

paragraph (2) (in a case of entrustment pursuant to the provisions of Article

24-2, paragraph (1), item (ii), an investigation pertaining to said entrustment

shall be included) without a justifiable reason or when said Insured Person

fails to comply with an order for a diagnosis pursuant to the provisions of the

proviso of paragraph (3).

(11) Action for an application as set forth in paragraph (1) shall be performed

within thirty (30) days from the date of submission of said application, however,

29

provided that in a case that there are special reasons that an investigation of

the mental or physical conditions of the Insured Person pertaining to said

application may require additional hours or days, etc., said action for the

matter may be postponed after notifying said Insured Person of the additional

period necessary for the action for said application (herein referred to as the

"Prospective Processing Period" in the following paragraph) and said reasons

within thirty (30) days from the date of submission of said application.

(12) In a case when the action for an application as set forth in paragraph (1) has

not been executed within thirty (30) days from the date of submission of said

application or the notification as set forth in the proviso of the preceding

paragraph has not been issued, or when the action for said application has not

been executed by the date that the Prospective Processing Period expires, the

Insured Person pertaining to said application may deem that the Municipality

has dismissed said application.

(Renewal of Certification of Needed Long-Term Care)

Article 28 (1) A Certification of Needed Long-Term Care shall be effective

according to the Category of Condition of Need for Long-Term Care during the

period as determined by an Ordinance of the Ministry of Health, Labour, and

Welfare (herein referred to as the "Effective Period" in this Article).

(2) An Insured Person that is issued a Certification of Needed Long-Term Care,

when he or she is expected to be in a Condition of Need for Long-Term Care

although after the expiry of the Effective Period, may apply to the Municipality

for an application of renewal of said Certification of Needed Long-Term Care

(herein referred to as a "Renewal of Certification of Needed Long-Term Care")

pursuant to the provisions of an Ordinance of the Ministry of Health, Labour,

and Welfare.

(3) In a case when an Insured Person that may apply for the renewal application

as set forth in the preceding paragraph was not able to apply for said renewal

application prior to the expiry of the Effective Period of Certification of Needed

Long-Term Care pertaining to said application due to a disaster or other

compelling reason, said Insured Person may apply for a Renewal of

Certification of Needed Long-Term Care within one month following the date

on which said reason for delay is no longer valid.

(4) The provisions of the preceding Article (except paragraph (8)) shall apply

mutatis mutandis to an application as set forth in the preceding two

paragraphs and to an application for Renewal of Certification of Needed Long-

Term Care pertaining to said application. In this case, the necessary technical

replacement of terms used in the provisions of the same Article shall be

provided by a Cabinet Order.

(5) A Municipality may entrust an investigation as set forth in the preceding

30

Article, paragraph (2), as applied mutatis mutandis pursuant to the preceding

paragraph, to a Designated In-Home Long-Term Care Support Provider as

prescribed in Article 46, paragraph (1), a Community-Based Facility for the

Elderly Covered by Public Aid Requiring Long-Term Care, a Facility Covered

by Long-Term Care Insurance, other providers or facilities as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare (herein referred to

as "Designated In-Home Long-Term Care Support Provider, etc." in this

Article), or to a Long-Term Care Support Specialist as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare.

(6) A Designated In-Home Long-Term Care Support Provider, etc., entrusted

pursuant to the provisions of the preceding paragraph shall direct a Long-Term

Care Support Specialist or other person as determined by an Ordinance of the

Ministry of Health, Labour, and Welfare to perform an investigation pertaining

to said entrustment.

(7) A Designated In-Home Long-Term Care Support Provider, etc., entrusted

pursuant to the provisions of paragraph (5) (in cases when said person is a

juridical person, its Officers; the same shall apply in the following paragraph),

its personnel (including a Long-Term Care Support Specialist as prescribed in

the preceding paragraph or other person as determined by an Ordinance of the

Ministry of Health, Labour, and Welfare; the same shall apply in the following

paragraph), a Long-Term Care Support Specialist or other person that was in

said position shall not divulge any personal confidential information learned

from said entrusted operations without a justifiable reason.

(8) A Designated In-Home Long-Term Care Support Provider, etc., entrusted

pursuant to the provisions of paragraph (5), its personnel, or a Long-Term Care

Support Specialist that engages in said entrusted operations shall be deemed

as personnel who engage in public service pursuant to the provisions of laws

and regulations with regard to the application of the Penal Code and other

penal provisions.

(9) A Renewal of Certification of Needed Long-Term Care pertaining to an

application as set forth in paragraph (3) shall be effective retroactively on the

date following the date of expiry of the Effective Period of Certification of

Needed Long-Term Care pertaining to said renewal application.

(10) The provisions of paragraph (1) shall apply mutatis mutandis to a Renewal

of Certification of Needed Long-Term Care. In this case, the phrase "period as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare" in

the same paragraph shall be deemed to be replaced with "period as determined

by an Ordinance of the Ministry of Health, Labour, and Welfare from the date

following the expiry of the Effective Period."

(Certification of Change of Category of Condition of Need for Long-Term Care)

31

Article 29 (1) An Insured Person that was issued a Certification of Needed Long-

Term Care, when it is determined that the degree of necessity of care qualifies

for a Category of Condition of Need for Long-Term Care other than the

Category of Condition of Need for Long-Term Care pertaining to the

Certification of Needed Long-Term Care which is currently issued, may apply

to a Municipality for a Certification of Change of Category of Condition of Need

for Long-Term Care, pursuant to the provisions of an Ordinance of the

Ministry of Health, Labour, and Welfare.

(2) The provisions of Article 27 and the preceding Article, paragraphs (5) to (8)

shall apply mutatis mutandis to an application as prescribed in the preceding

paragraph and to a Certification of Change of Category of Condition of Need for

Long-Term Care pertaining to said application. In this case, the necessary

technical replacement of the terms of these provisions shall be provided by a

Cabinet Order.

Article 30 (1) A Municipality, when it is determined that an Insured Person that

was issued a Certification of Needed Long-Term Care, qualifies for a Category

of Condition of Need for Long-Term Care other than the Category of Condition

of Need for Long-Term Care pertaining to said Certification of Needed Long-

Term Care due to a lowering of the degree of necessity of long-term care, may

certify a change of Category of Condition of Need for Long-Term Care. In this

case, the Municipality shall request the Insured Person pertaining to said

change of certification to submit said Certificate of Insured Person, shall enter

the Category of Condition of Need for Long-Term Care pertaining to said

change of certification and the opinion of the Certification Committee pursuant

to the provisions of the second sentence of Article 27, paragraph (5) as applied

mutatis mutandis pursuant to the following paragraph (limited to those

changes pertaining to matters listed in item (ii) of the same paragraph), and

then return said Certificate of Insured Person to the Insured Person.

(2) The provisions of Article 27, paragraphs (2) to (6), the first sentence of

paragraph (7), and Article 28, paragraphs (5) to (8) shall apply mutatis

mutandis to a Certification of Change of Category of Condition of Need for

Long-Term Care as prescribed in the preceding paragraph. In this case, the

necessary technical replacement of the terms of these provisions shall be

provided by a Cabinet Order.

(Rescission of Certification of Needed Long-Term Care)

Article 31 (1) When an Insured Person that was issued a Certification of Needed

Long-Term Care is subject to any of the following items, a Municipality may

rescind said Certification of Needed Long-Term Care. In this case, pursuant to

the provisions of an Ordinance of the Ministry of Health, Labour, and Welfare,

32

the Municipality shall request the Insured Person pertaining to said rescission

to submit said Certificate of Insured Person, delete the entry of matters listed

in each item of Article 27, paragraph (7), and return the Certificate of Insured

Person to the Insured Person:

(i) when the Municipality determines that the Insured Person fails to or no

longer qualifies as a Person Requiring Long-Term Care;

(ii) when the Insured Person fails to comply with an investigation pursuant to

the provisions of Article 27, paragraph (2) as applied mutatis mutandis

pursuant to the preceding Article, paragraph (2) and the following paragraph

(in a case when said investigation is entrusted pursuant to the provisions of

Article 28, paragraph (5) as applied mutatis mutandis pursuant to Article 24-

2, paragraph (1), item (ii), the preceding Article, paragraph (2), or the

following paragraph, including an investigation pertaining to said

entrustment) without a justifiable reason, or when the Insured Person fails

to act in compliance with an order for diagnosis pursuant to the provisions of

the proviso of Article 27, paragraph (3) as applied mutatis mutandis

pursuant to the preceding Article, paragraph (2), and the following

paragraph.

(2) The provisions of Article 27, paragraphs (2) to (4), the first sentence of

paragraph (5), paragraph (6), the first sentence of paragraph (7), and Article 28,

paragraphs (5) to (8) shall apply mutatis mutandis to a rescission of a

Certification of Needed Long-Term Care pursuant to the provisions of the

preceding paragraph, item (i). In this case, the necessary technical replacement

of the terms of these provisions shall be provided by a Cabinet Order.

(Certification of Needed Support)

Article 32 (1) An Insured Person that intends to receive a Certification of

Needed Support shall submit to a Municipality an application with a

Certificate of Insured Person pursuant to the provisions of an Ordinance of the

Ministry of Health, Labour, and Welfare. In this case, said Insured Person may,

pursuant to the provisions of an Ordinance of the Ministry of Health, Labour,

and Welfare, have a Designated In-Home Long-Term Care Support Provider,

etc., as prescribed in Article 46, paragraph (1), a Community-Based Facility for

the Elderly Covered by Public Aid Requiring Long-Term Care or a Facility

Covered by Long-Term Care Insurance as determined by an Ordinance of the

Ministry of Health, Labour, and Welfare, or a community general support

center as prescribed in Article 115-39, paragraph (1), perform the procedures of

said application on behalf of the Insured Person.

(2) The provisions of Article 27, paragraphs (2) and (3) shall apply mutatis

mutandis to an investigation pertaining to an application as prescribed in the

preceding paragraph, opinions of an attending physician of the Insured Person

33

pertaining to an application as set forth in the same paragraph, and an order

for diagnosis to said Insured Person.

(3) A Municipality shall notify the Certification Committee of the result of an

investigation as set forth in Article 27, paragraph (2) as applied mutatis

mutandis pursuant to the preceding paragraph (in a case when the

investigation is entrusted pursuant to the provisions of Article 24-2, paragraph

(1), item (ii), including an investigation pertaining to said entrustment), the

opinion of an attending physician as set forth in Article 27, paragraph (2) as

applied mutatis mutandis pursuant to the preceding paragraph, the result of a

diagnosis of a designated physician or its personnel who is a physician, or

other matters specified by an Ordinance of the Ministry of Health, Labour, and

Welfare, and request an examination and judgment pertaining to matters as

prescribed in each said item according to the category of Insured Person listed

in the following items with regard to the Insured Person pertaining to an

application as set forth in paragraph (1):

(i) Primary Insured Person: those who qualify for a Needed Support Condition

and Category of Needed Support Condition for which said condition qualifies;

(ii) Secondary Insured Person: those who qualify for a Needed Support

Condition, a Category of Needed Support Condition for which said condition

qualifies, and the physical or mental problem(s) that is the cause of said

Needed Support Condition as caused by a Specified Disease.

(4) A Certification Committee, when being requested to perform an examination

and judgment pursuant to the provisions of the preceding paragraph, shall act

in compliance with standards as determined by the Minister of Health, Labour,

and Welfare, examine and judge matters as prescribed in each item of the same

paragraph of an Insured Person pertaining to said examination and judgment,

and notify the Municipality of said result. In this case, a Certification

Committee, when it determines necessary, may state opinions to the

Municipality regarding the following matters:

(i) matters of necessary medical care for or support pertaining to domestic

home duties for the reduction or prevention of deterioration of a Needed

Support Condition of said Insured Person;

(ii) matters that said Insured Person shall heed to appropriately and effectively

use Designated Preventive Long-Term Care Service as prescribed in Article

53, paragraph (1) or a Designated Community-Based Preventive Service of

Long-Term Care as prescribed in Article 54-2, paragraph (1).

(5) The provisions of Article 27, paragraph (6) shall apply mutatis mutandis to an

examination and judgment as prescribed in the first sentence of the preceding

paragraph.

(6) A Municipality, when providing Certification of Needed Support based on the

results of an examination and judgment of a Certification Committee that is

34

notified pursuant to the provisions of the first sentence of paragraph (4), shall

notify the Insured Person pertaining to said Certification of Needed Support of

said result. In this case, a Municipality shall enter the following items on the

Certificate of Insured Person of said Insured Person and return the Certificate

of Insured Person to the Insured Person:

(i) said Category of Needed Support Condition;

(ii) opinions of the Certification Committee pertaining to matters listed in

paragraph (4), item (ii).

(7) A Certification of Needed Support shall become effective retroactively on the

date that said application was submitted.

(8) A Municipality, when it is determined that the Insured Person predating the

application as set forth in paragraph (1) fails to qualify the Person Requiring

Support based on the results of an examination and judgment of a Certification

Committee that is notified pursuant to the provisions of the first sentence of

paragraph (4), shall notify said Insured Person pertaining of the results,

indicating the reasons, and return the Certificate of Insured Person to said

Insured Person.

(9) The provisions of Article 27, paragraph (10) to (12) shall apply mutatis

mutandis to an application as set forth in paragraph (1) and the action for said

application.

(Renewal of Certification of Needed Support)

Article 33 (1) A Certification of Needed Support shall be effective according to

the Category of Needed Support Condition during the period as determined by

an Ordinance of the Ministry of Health, Labour, and Welfare (herein referred

to as "Effective Period" in this Article).

(2) An Insured Person that has been issued a Certification of Needed Support,

when he or she is expected to be in a Needed Support Condition after the

expiry of the Effective Period, may apply to the Municipality for application of

renewal of said Certification of Needed Support (herein referred to as "Renewal

of Certification of Needed Support") pursuant to the provisions of an Ordinance

of the Ministry of Health, Labour, and Welfare.

(3) In a case when an Insured Person that may apply for the application as set

forth in the preceding paragraph was not able to apply for said application

prior to expiry of the Effective Period of Certification of Needed Support

pertaining to said application due to a disaster or other compelling reason, said

Insured Person may apply for a Renewal of Certification of Needed Support

within one month from the date on which said reasons are no longer valid.

(4) The provisions of the preceding Article (except for paragraph (7)) and Article

28, paragraphs (5) to (8) shall apply mutatis mutandis to an application as

prescribed in the preceding two paragraphs and a Renewal of Certification of

35

Needed Support pertaining to said application. In this case, the necessary

technical replacement of the terms of these provisions shall be provided by a

Cabinet Order.

(5) A Renewal of Certification of Needed Support pertaining to an application as

set forth in paragraph (3) shall be effective retroactively on the date following

the date of expiry of the Effective Period of Certification of Needed Support

pertaining to said application.

(6) The provisions of paragraph (1) shall apply mutatis mutandis to a Renewal of

Certification of Needed Support. In this case, the phrase "period as determined

by an Ordinance of the Ministry of Health, Labour, and Welfare" in the same

paragraph shall be deemed to be replaced with "period as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare from the date

following the expiry of the Effective Period."

(Certification of Change of Category of Needed Support Condition)

Article 33-2 (1) An Insured Person that has been issued a Certification of

Needed Support, when it is determined that the degree of Needed Support

Condition qualifies for a Category of Needed Support Condition other than the

Category of Needed Support Condition pertaining to said Certification of

Needed Support that is issued currently, may apply to the Municipality for a

certification of change of Category of Needed Support Condition, pursuant to

the provisions of an Ordinance of the Ministry of Health, Labour, and Welfare.

(2) The provisions of Article 28, paragraph (5) to paragraph (8), and Article 33

shall apply mutatis mutandis to an application as prescribed in the preceding

paragraph and change of Category of Needed Support Condition pertaining to

said application. In this case, the necessary technical replacement of terms for

these provisions shall be provided by a Cabinet Order.

Article 33-3 (1) A Municipality, when it is determined that an Insured Person

that has been issued a Certification of Needed Support qualifies for a Category

of Needed Support Condition other than the Category of Needed Support

Condition pertaining to said Certification of Needed Support due to a lowering

of the degree of Needed Support Condition, may certify a change of Category of

Needed Support Condition. In this case, the Municipality shall request the

Insured Person pertaining to said change of certification to submit said

Certificate of Insured Person, shall enter the Category of Needed Support

Condition pertaining to said change of certification and the opinion of the

Certification Committee pursuant to the provisions of the second sentence of

Article 32, paragraph (4) as applied mutatis mutandis pursuant to the

following paragraph (limited to those pertaining to matters listed in item (ii) of

the same paragraph), and then return the Certificate of Insured Person to the

36

Insured Person.

(2) The provisions of Article 28, paragraph (5) to paragraph (8), Article 32,

paragraph (2) to paragraph (5), and the first sentence of paragraph (6), shall

apply mutatis mutandis to a certification of Change of Category of Needed

Support Condition as prescribed in the preceding paragraph. In this case, the

necessary technical replacement of terms of these provisions shall be provided

by a Cabinet Order.

(Rescission of Certification of Needed Support)

Article 34 (1) When an Insured Person to whom has been issued a Certification

of Needed Support is subject to any of the following items, a Municipality may

rescind said Certification of Needed Support. In this case, the Municipality,

pursuant to the provisions of an Ordinance of the Ministry of Health, Labour,

and Welfare, shall request the Insured Person pertaining to said rescission to

submit said Certificate of Insured Person, delete the entry of matters listed in

the each item of Article 32, paragraph (6), and return the Certificate of Insured

Person to the Insured Person. These items are:

(i) when it is determined that the Insured Person fails to qualify as a Person

Requiring Support;

(ii) when the Insured Person fails to qualify after an investigation pursuant to

the provisions of Article 27, paragraph (2) as applied mutatis mutandis

pursuant to the provisions of Article 32, paragraph (2) as applied mutatis

mutandis pursuant to the preceding Article, paragraph (2) or the following

paragraph (in a case when said investigation is entrusted pursuant to the

provisions of Article 28, paragraph (5) as applied mutatis mutandis pursuant

to the provisions of Article 24-2, paragraph (1), item (ii) or paragraph (2) of

the preceding Article or the following paragraph, including an investigation

pertaining to said entrustment) without a justifiable reason, or when the

Insured Person fails to act in compliance with an order for diagnosis

pursuant to the provisions of the proviso of Article 27, paragraph (3) as

applied mutatis mutandis pursuant to provisions of Article 33, paragraph (2)

as applied mutatis mutandis pursuant to the following paragraph.

(2) The provisions of Article 28, paragraph (5) to paragraph (8), Article 32,

paragraph (2), paragraph (3), the first sentence of paragraph (4), paragraph (5),

and the first sentence of paragraph (6) shall apply mutatis mutandis to a

rescission of Certification of Needed Support pursuant to the provisions of the

preceding paragraph, item (i). In this case, the necessary technical replacement

of terms for these provisions shall be provided by a Cabinet Order.

(Exception for Procedures of Certification of Needed Long-Term Care, etc.)

Article 35 (1) A Certification Committee, when it is determined that an Insured

37

Person that is the subject of a request for investigation or judgment pursuant

to the provisions of Article 27, paragraph (4) (including a case when applied

mutatis mutandis pursuant to Article 28, paragraph (4)) qualifies as a Person

Requiring Support, although it is determined that said Insured Person fails to

qualify as a Person Requiring Long-Term Care, may notify said result to the

Municipality, notwithstanding the provisions of Article 27, paragraph (5)

(including a case when applied mutatis mutandis pursuant to Article 28,

paragraph (4)).

(2) A Municipality, when a notification was issued pursuant to the provisions of

the preceding paragraph, may deem that the Insured Person pertaining to said

notification has submitted an application as set forth in Article 32, paragraph

(1), the Municipality requested the Certification Committee to conduct an

examination or issue a judgment pursuant to the provisions of paragraph (3) of

the same Article and the Municipality received a notification by the

Certification Committee pursuant to the provisions of paragraph (4) of the

same Article, and may issue the Insured Person a Certification of Needed

Support. In this case, the Municipality shall notify said Insured Person that a

Certification of Needed Support is provided, enter the matters listed in each

item of paragraph (6) of the same Article on the Certificate of Insured Person

of said Insured Person, and return the Certificate of Insured Person to the

Insured Person.

(3) A Certification Committee, when it is determined that an Insured Person that

is the subject of a requested examination or judgment pursuant to the

provisions of Article 32, paragraph (3) (including the case it is applied mutatis

mutandis pursuant to Article 33, paragraph (4)) qualifies as a Person

Requiring Long-Term Care, may notify said result to the Municipality,

notwithstanding the provision of Article 32, paragraph (4) (including a case

applied mutatis mutandis pursuant to Article 33, paragraph (4)).

(4) A Municipality, when a notification is issued pursuant to the provisions of the

preceding paragraph, may deem that the Insured Person pertaining to said

notification submitted an application as set forth in Article 27, paragraph (1),

the Municipality requested the Certification Committee for a judgment or to

conduct an examination pursuant to the provisions of paragraph (4) of the

same Article, and the Municipality is provided a notification of the

Certification Committee pursuant to the provisions of paragraph (5) of the

same Article, and may issue the Insured Person a Certification of Needed

Long-Term Care. In this case, the Municipality shall notify said Insured

Person that a Certification of Needed Long-Term Care is provided, enter the

matters listed in each item of paragraph (7) of the same Article on the

Certificate of Insured Person of said Insured Person, and return the Certificate

of Insured Person to the Insured Person.

38

(5) A Certification Committee, when it is determined that an Insured Person that

is the subject of a requested examination or judgment pursuant to the

provisions of Article 27, paragraph (4) as applied mutatis mutandis pursuant

to Article 31, paragraph (2) is certified as a Person Requiring Support although

said Insured Person fails to qualify as a Person Requiring Long-Term Care,

may notify said result to the Municipality, notwithstanding the provision of

Article 27, paragraph (5) as applied mutatis mutandis pursuant to Article 31,

paragraph (2).

(6) A Municipality, when a notification is issued pursuant to the provisions of the

preceding paragraph, may deem that the Insured Person pertaining to said

notification submitted an application as set forth in Article 32, paragraph (1),

the Municipality requested the Certification Committee for an examination or

judgment pursuant to the provisions of paragraph (3) of the same Article, and

the Municipality received a notification of the Certification Committee

pursuant to the provisions of paragraph (4) of the same Article, and may issue

said Insured Person a Certification of Needed Support. In this case, the

Municipality shall, pursuant to the provisions of an Ordinance of the Ministry

of Health, Labour, and Welfare, request to Insured Person pertaining to said

notification to submit such Insured Person's Certificate of Insured Person,

enter the matters listed in each item of paragraph (6) of the same Article, and

return the Certificate of Insured Person to the Insured Person.

(Certification of Needed Long-Term Care and Certification of Needed Support

after Relocation of Domicile)

Article 36 A Municipality, in a case when a person that is issued a Certification

of Needed Long-Term Care or a Certification of Needed Support by another

Municipality becomes an Insured Person of Long-Term Care Insurance of said

Municipality and when said Insured Person submits an application for a

Certification of Needed Long-Term Care or a Certification of Needed Support

attached with the documents that are issued by said Municipality and the

other Municipality and proves matters pertaining to said Certification of

Needed Long-Term Care or Certification of Needed Support within fourteen

(14) days from the date on which said qualification was obtained, may provide

a Certification of Needed Long-Term Care or a Certification of Needed Support

according to the matters entered on said documents, notwithstanding the

provisions of Article 27, paragraph (4) and the first sentence of paragraph (7),

or Article 32, paragraph (3) and the first sentence of paragraph (6), and

without awaiting an examination or judgment of a Certification Committee.

(Specification of Type of Service Covered by Long-Term Care Benefits, etc.)

Article 37 (1) A Municipality, when providing a Certification of Needed Long-

39

Term Care; a Renewal of Certification of Needed Long-Term Care; a

Certification of Change of Category of Condition of Need for Long-Term Care

pursuant to the provisions of Article 27, paragraph (7) or Article 30, paragraph

(1) as applied mutatis mutandis pursuant to Article 29, paragraph (2); a

Certification of Needed Support; a Renewal of Certification of Needed Support;

a Certification of Change of Category of Needed Support Condition pursuant to

the provisions of Article 32, paragraph (6) or Article 33-3, paragraph (1) as

applied mutatis mutandis pursuant to Article 33-2, paragraph (2); (hereinafter

simply referred to as "Certification" in this paragraph) may specify the type of

services to be performed for an Insured Person pertaining to said Certification,

including In-Home Service pertaining to Allowance for In-Home Long-Term

Care Service or Exceptional Allowance for In-Home Long-Term Care Service,

Community-Based Service pertaining to Allowance for Community-Based Long-

Term Care Service or Exceptional Allowance for Community-Based Long-Term

Care Service, Facility Service pertaining to Allowance for Long-Term Care

Facility Service or Exceptional Allowance for Long-Term Care Facility Service,

Preventive Long-Term Care Service pertaining to Allowance for Preventive

Long-Term Care Service or Exceptional Allowance for Preventive Service of

Long-Term Care, or Community-Based Service for Preventive Long-Term Care

pertaining to Allowance for Community-Based Preventive Long-Term Care

Service, or Exceptional Allowance for Community-Based Preventive Service of

Long-Term Care, based on the opinion of the Certification Committee

pertaining to the matter listed in Article 27, paragraph (5), item (i) (including

a case it is applied mutatis mutandis pursuant to Article 28, paragraph (4),

Article 29, paragraph (2), or Article 30, paragraph (2)) or Article 32, paragraph

(4), item (i) (including a case it is applied mutatis mutandis pursuant to Article

33, paragraph (4), or Article 33-2, paragraph (2)). In this case, the Municipality

shall enter on the Certificate of Insured Person of said Insured Person the type

of services pertaining to said specification including In-Home Service,

Community-Based Service, Facility Service, Preventive Long-Term Care

Service, or Community-Based Service for Preventive Long-Term Care together

with an entry pursuant to the provisions of Article 27, paragraph (7) second

sentence (including a case it is applied mutatis mutandis pursuant to Article

28, paragraph (4) or Article 29, paragraph (2)), Article 30, paragraph (1),

second sentence, Article 35, paragraph (4), second sentence, or Article 32,

paragraph (6) second sentence (including a case it is applied mutatis mutandis

pursuant to Article 33, paragraph (4) or Article 33-2, paragraph (2)), Article

33-3, paragraph (1) second sentence, Article 35, paragraph (2), second sentence,

or paragraph (6), second sentence.

(2) An Insured Person specified pursuant to the provisions of the preceding

paragraph, first sentence, may apply for a change of type of services pertaining

40

to said specification including In-Home Service, Community-Based Service,

Facility Service, Preventive Long-Term Care Service, or Community-Based

Service for Preventive Long-Term Care.

(3) The application as prescribed in the preceding paragraph shall be submitted

with the Certificate of Insured Person, pursuant to the provisions of an

Ordinance of the Ministry of Health, Labour, and Welfare.

(4) In a case when the application as set forth in paragraph (2) is submitted, a

Municipality, pursuant to the provisions of an Ordinance of the Ministry of

Health, Labour, and Welfare, when it hears the opinion of the Certification

Committee and determines it necessary, may change the type of services

pertaining to said specification including In-Home Service, Community-Based

Service, Facility Service, Preventive Long-Term Care Service, or Community-

Based Service for Preventive Long-Term Care.

(5) When a Municipality, with regard to an Insured Person pertaining to the

application as set forth in paragraph (2), has changed the type of services

pertaining to the specification pursuant to the provisions of paragraph (1), first

sentence, including In-Home Service, Community-Based Service, Facility

Service, Preventive Long-Term Care Service, or Community-Based Service for

Preventive Long-Term Care pursuant to the provisions of the preceding

paragraph, it shall notify said Insured Person of said result, enter the type of

services, including In-Home Service, Community-Based Service, Facility

Service, Preventive Long-Term Care Service, or Community-Based Service for

Preventive Long-Term Care after amending the Certificate of Insured Person of

said Insured Person, and return the Certificate of Insured Person to the

Insured Person.

(Assistance, etc., of Prefectures)

Article 38 (1) A prefecture, with regard to affairs pursuant to the provisions of

Article 27 to Article 35 and the preceding Article that a Municipality performs,

may cooperate regarding technical matters at public aid office (those offices

regarding public aid provided by the Social Welfare Act (Act No. 45 of 1951)) or

a health center, and provide other necessary assistance to a Municipality.

(2) Pursuant to the provisions of Article 252-14, paragraph (1) of the Local

Autonomy Act, a Prefectural Certification Committee of Needed Long-Term

Care shall be established by entrustment from a Municipality, in order for the

prefecture to perform examinations and judgments (operations that a

Certification Committee performs pursuant to the provisions of Article 27 to

Article 35 and the preceding Article; the same shall apply hereinafter in this

Article).

(3) The provisions of Article 15 and Article 17 shall apply mutatis mutandis to a

Prefectural Certification Committee of Needed Long-Term Care as prescribed

41

in the preceding paragraph. In this case, the phrase "mayor of a Municipality

("ward mayor" for special city wards; the same shall apply hereinafter)" in

Article 15 shall be deemed to be replaced with "prefectural governor."

(4) With regard to a Municipality that entrusts examinations and judgments to a

prefecture, in a case of applying the provisions of Article 27 (including a case

applied mutatis mutandis pursuant to Article 28, paragraph (4), Article 29,

paragraph (2), Article 30, paragraph (2), Article 31, paragraph (2) or Article 32,

paragraph (5)), Article 30, Article 32 (including a case applied mutatis

mutandis pursuant to Article 33, paragraph (4), Article 33-2, paragraph (2),

Article 33-3, paragraph (2), or Article 34, paragraph (2)), Article 33-3 or Article

35 to the preceding Article, the term "Certification Committee" shall be deemed

to be replaced with "Prefectural Certification Committee of Needed Long-Term

Care."

(Delegation to an Ordinance of the Ministry of Health, Labour, and Welfare)

Article 39 In addition to those matters provided by this Section, an application

for Certification of Needed Long-Term Care and Certification of Needed

Support, and other procedures necessary matters shall be as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare.

Section 3 Long-Term Care Benefits

(Types of Long-Term Care Benefits)

Article 40 A Long-Term Care Benefit shall be any of the insurance benefits

listed below:

(i) payment of an Allowance for In-Home Long-Term Care Service;

(ii) payment of an Exceptional Allowance for In-Home Long-Term Care Service;

(iii) payment of an Allowance for Community-Based Long-Term Care Service;

(iv) payment of an Exceptional Allowance for Community-Based Long-Term

Care Service;

(v) payment of an Allowance for Purchasing Equipment for In-Home Long-

Term Care Covered by Public Aid;

(vi) payment of an Allowance for Home Modification for In-Home Long-Term

Care;

(vii) payment of an Allowance for In-Home Long-Term Care Service Plan;

(viii) payment of an Exceptional Allowance for an In-Home Long-Term Care

Service Plan;

(ix) payment of an Allowance for Long-Term Care Facility Service;

(x) payment of an Exceptional Allowance for Long-Term Care Facility Service;

(xi) payment of an Allowance for High-Cost Long-Term Care Service;

(xii) payment of an Allowance for Long-Term Care Service to a Person

42

Admitted to a Specified Facility;

(xiii) payment of an Exceptional Allowance for Long-Term Care Service to a

Person Admitted to a Specified Facility.

(Payment of an Allowance for In-Home Long-Term Care Service)

Article 41 (1) A Municipality, when an Insured Person that receives long-term

care at his or her home (herein referred to as "Insured In-Home Person

Requiring Long-Term Care") among persons who have obtained a Certification

of Needed Long-Term Care (herein referred to as "Insured Person Requiring

Long-Term Care") receives from a person designated by prefectural governor

(hereinafter referred to as "Designated In-Home Service Provider") an In-Home

Service provided by an appointed provider that performs In-Home Service

Business pertaining to said specification (herein referred to as "Designated In-

Home Service"), shall pay an Allowance for In-Home Long-Term Care Service

to said Insured In-Home Person Requiring Long-Term Care regarding expenses

required for said Designated In-Home Service (except for expenses required for

purchase of Specified Equipment Covered by Public Aid, and excluding the

expenses necessary to provide meals, residence, and other expenses as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare as

necessary for daily life with regard to the expenses required for Outpatient

Day Long-Term Care, Outpatient Rehabilitation, a Short-Term Admission for

Daily Life Long-Term Care, Short-Term Admission for Recuperation, and Daily

Life Long-Term Care Admitted to a Specified Facility; the same shall apply

hereinafter in this Act), however, provided that this provision shall not apply

to a case when said Insured In-Home Person Requiring Long-Term Care is

specified pursuant to the provisions of Article 37, paragraph (1) and the Person

receives In-Home Service other than the type pertaining to said specification.

(2) An Allowance for In-Home Long-Term Care Service, pursuant to the

provisions of an Ordinance of the Ministry of Health, Labour, and Welfare,

shall be paid only when a Municipality determines that it is necessary.

(3) An Insured In-Home Person Requiring Long-Term Care who intends to

receive Designated In-Home Service pursuant to the provisions of an

Ordinance of the Ministry of Health, Labour, and Welfare shall present a

Certificate of Insured Person to the Designated In-Home Service Provider that

said Insured Person selects and will receive said Designated In-Home Service.

(4) The amount of Allowance for In-Home Long-Term Care Service shall be the

amount provided by each of the following items according to the category of In-

Home Service listed in the said items:

(i) the amount equivalent to 90 percent of the expenses calculated based on the

standards provided by the Minister of Health, Labour, and Welfare (but shall

be the actual expenses required for Designated In-Home Service in a case

43

when the standard amount exceeds the actual expenses required for said

Designated In-Home Service) by considering the average expenses required

for said Designated In-Home Service calculated by considering the content of

Designated In-Home Service pertaining to the type of said In-Home Service,

the area where the provider that performs said Designated In-Home Service

business is located, etc. (with regard to the expenses necessary for

Outpatient Day Long-Term Care and Outpatient Rehabilitation, excluding

the expenses necessary to provide meals, residence, and other necessary

expenses for daily life as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare), according to by the type of In-Home Service

including Home-Visit Long-Term Care, Home-Visit Bathing Long-Term Care,

Home-Visit Nursing, Home-Visit Rehabilitation, Guidance for Management

of In-Home Medical Long-Term Care, Outpatient Day Long-Term Care,

Outpatient Rehabilitation, and Rental Service of Equipment for Long-Term

Care Covered by Public Aid;

(ii) the amount equivalent to 90 percent of the expenses calculated based on

the standards provided by the Minister of Health, Labour, and Welfare (but

shall be the actual expenses required for Designated In-Home Service in a

case when the standard amount exceeds the actual expenses required for

said Designated In-Home Service) by considering the average expenses

required for said Designated In-Home Service calculated by considering the

Category of Needed Support Condition, , the area where the provider that

performs said Designated In-Home Service Business pertaining to the type of

said In-Home Service is located, etc. (excluding the expenses necessary to

provide meals, residence, and other necessary expenses for daily life as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare),

according to by the type of In-Home Service including a Short-Term

Admission for Daily Life Long-Term Care, Short-Term Admission for

Recuperation, and Daily Life Long-Term Care Admitted to a Specified

Facility.

(5) The Minister of Health, Labour, and Welfare, when it intends to determine

the standards as prescribed in the items of the preceding paragraph, shall hear

the opinion of the Social Security Council in advance.

(6) When an Insured In-Home Person Requiring Long-Term Care is provided

Designated In-Home Service (limited to a case when said Insured In-Home

Person Requiring Long-Term Care has notified the Municipality to receive

Designated In-Home Long-Term Care Support pursuant to the provisions of

Article 46, paragraph (4) in advance, that said Designated In-Home Service is

subject to said Designated In-Home Long-Term Care Support and other cases

as determined by an Ordinance of the Ministry of Health, Labour, and Welfare)

by a Designated In-Home Service Provider, the Municipality may pay expenses

44

required for said Designated In-Home Service that said Insured In-Home

Person Requiring Long-Term Care should pay to said Designated In-Home

Service Provider on behalf of said Insured In-Home Person Requiring Long-

Term Care to said Designated In-Home Service Provider within the specified

limit of the amount that shall be paid to said Insured In-Home Person

Requiring Long-Term Care as Allowance for In-Home Long-Term Care Service.

(7) When the payment pursuant to the provisions of the preceding paragraph is

paid, it shall be deemed as an Allowance for In-Home Long-Term Care Service

that has been paid to an Insured In-Home Person Requiring Long-Term Care.

(8) A Designated In-Home Service Provider, when accepting payment of the

expenses required for providing the Designated In-Home Service and other

services, shall deliver a receipt to the Insured In-Home Person Requiring Long-

Term Care who made said payment, pursuant to the provisions of an

Ordinance of the Ministry of Health, Labour, and Welfare.

(9) A Municipality, when a Designated In-Home Service Provider requests an

Allowance for In-Home Long-Term Care Service, shall pay said allowance after

conducting an examination according to standards provided by the Minister of

Health, Labour, and Welfare as prescribed in the each item of paragraph (4)

and the standards of facilities and management of Designated In-Home Service

Business as prescribed in Article 74, paragraph (2) (limited to the part

regarding the handling of Designated In-Home Service).

(10) A Municipality may entrust an examination and payment affairs prescribed

in the preceding paragraph to an Association.

(11) An Association that undertakes entrustment pursuant to the provisions of

the preceding paragraph, after obtaining the consent of the Municipality that

delegated said entrustment and pursuant to the provisions of an Ordinance of

the Ministry of Health, Labour, and Welfare, may entrust a part of the affairs

that are under said entrustment to a not-for-profit juridical person that

qualifies with requirements as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare.

(12) In addition to the provisions of the preceding paragraph, necessary matters

for payment of an Allowance for In-Home Long-Term Care Service and a

request for an Allowance for In-Home Long-Term Care Service by a Designated

In-Home Service Provider shall be as prescribed by an Ordinance of the

Ministry of Health, Labour, and Welfare.

(Payment of an Exceptional Allowance for In-Home Long-Term Care Service)

Article 42 (1) A Municipality shall pay an Exceptional Allowance for In-Home

Long-Term Care Service to an Insured In-Home Person Requiring Long-Term

Care in the following cases:

(i) when a Municipality determines it necessary in a case when an Insured In-

45

Home Person Requiring Long-Term Care receives Designated In-Home

Service prior to the date said Certification of Needed Long-Term Care

becomes effective due to an emergency or other compelling reason;

(ii) when a Municipality determines it necessary in a case when an Insured In-

Home Person Requiring Long-Term Care receives In-Home Service other

than Designated In-Home Service or service equivalent to said services

(limited to those services provided by a provider that performs a business

that is judged to satisfy standards as determined by an Ordinance of the

Ministry of Health, Labour, and Welfare among the standards provided by

the Ordinance of the Ministry of Health, Labour, and Welfare as set forth in

Article 74, paragraph (1) pertaining to Designated In-Home Service Business,

the number of employees as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare as prescribed in the same paragraph, and

standards for equipment and the management of the Designated In-Home

Service Business as prescribed in paragraph (2) of the same Article; herein

referred to as "In-Home Service Applicable to Standards" in the following

item);

(iii) when a Municipality determines it necessary in a case when an Insured In-

Home Person Requiring Long-Term Care who is domiciled on an isolated

island or other area where it is significantly difficult to secure Designated

In-Home Service and In-Home Service Applicable to Standards and is in a

location that qualifies with the standards as determined by the Minister of

Health, Labour, and Welfare, receives In-Home Service other than

Designated In-Home Service or In-Home Service Applicable to Standards, or

services equivalent to those services;

(iv) when provided by a Cabinet Order.

(2) The amount of Exceptional Allowance for In-Home Long-Term Care Service

shall be specified by a Municipality with regard to said In-Home Service or

services equivalent to said service based on an amount equivalent to 90 percent

of the expenses calculated by standards determined by the Minister of Health,

Labour, and Welfare as prescribed in each item of the preceding Article,

paragraph (4) (but shall be the actual expenses required for said In-Home

Service or service equivalent to said services when said calculated standard

amount exceeds the actual expenses required for said In-Home Service or

service equivalent to said services (except for purchases of Specified Equipment

Covered by Public Aid; with regard to expenses necessary for Outpatient Day

Long-Term Care, Outpatient Rehabilitation, Short-Term Admission for Daily

Life Long-Term Care, Short-Term Admission for Recuperation, Daily Life

Long-Term Care Admitted to a Specified Facility, excluding expenses necessary

to provide meals, residence, other expenses, other expenses necessary for daily

life as determined by an Ordinance of the Ministry of Health, Labour, and

46

Welfare)).

(3) A Municipality, when it determines the necessity for payment of an

Exceptional Allowance for In-Home Long-Term Care Service, may order a

person that has been in charge of the In-Home Service pertaining to said

payment or equivalent service (herein referred to as "Person, etc., in Charge of

In-Home Service, etc." in this paragraph) to report, submit, or present record

books and documents, appear before, or direct its personnel to question the

relevant person and enter the Business Office of the service provider of said

Person, etc., in Charge of In-Home Service, etc., pertaining to said payment in

order to inspect said equipment, record books and documents, and other items.

(4) The provisions of Article 24, paragraph (3) shall apply mutatis mutandis to

questions and inspections as prescribed in the preceding paragraph and the

provisions of paragraph (4) of the same Article shall apply mutatis mutandis to

the authority granted as prescribed in the preceding paragraph.

(Payment of an Allowance for Community-Based Long-Term Care Service)

Article 42-2 (1) A Municipality, when an Insured Person Requiring Long-Term

Care received from a person designated by the mayor of said Municipality

(herein referred to as "Designated Community-Based Service Provider") a

Community-Based Service from a provider that performs Community-Based

Service Business pertaining to said designation (herein referred to as

"Designated Community-Based Service"), shall pay to said Insured Person

Requiring Long-Term Care an Allowance for Community-Based Long-Term

Care Service with regard to the expenses required for said Designated

Community-Based Service (except for expenses necessary to provide meals,

residence, and other expenses as determined by an Ordinance of the Ministry

of Health, Labour, and Welfare as necessary for daily life with regard to the

expenses required for Outpatient Long-Term Care for a Dementia Patient,

Multifunctional Long-Term Care in a Small Group Home, Communal Daily

Long-Term Care for a Dementia Patient, Daily Life Long-Term Care for a

Person Admitted to a Community-Based Specified Facility, and Admission to a

Community-Based Facility for Preventive Daily Long-Term Care of the Elderly

Covered by Public Aid; hereinafter the same shall apply in this Article),

however, provided that this provision shall not apply when said Insured Person

Requiring Long-Term Care receives Community-Based Service other than the

type pertaining to said designation in a case said Insured Person is issued a

designation pursuant to the provision of Article 37, paragraph (1).

(2) The amount of Allowance for Community-Based Long-Term Care Service shall

be the amount provided by each item of following, according to the category of

Community-Based Service listed in said item:

(i) Home-Visit at Night for Long-Term Care and Outpatient Long-Term Care

47

for a Dementia Patient: the amount equivalent to 90 percent of the expenses

calculated based on the standards determined by the Minister of Health,

Labour, and Welfare (but shall be the actual expenses required for said

Designated Community-Based Service in a case such calculated amount

exceeds the actual expenses required for said Designated Community-Based

Service) by considering the average expenses required for said Designated

Community-Based Service calculated by considering the content of the

Designated Community-Based Service pertaining to the type of said

Community-Based Service, the area where the provider that performs said

Designated Community-Based Service Business is located, etc. (except for

expenses necessary to provide meals, residence, and other necessary

expenses for daily life as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare with regard to the expenses necessary for

Outpatient Long-Term Care for a Dementia Patient), according to by the type

of Community-Based Service;

(ii) Multifunctional Long-Term Care in a Small Group Home, Communal Daily

Long-Term Care for a Dementia Patient, Daily Life Long-Term Care for a

Person Admitted to a Community-Based Specified Facility, and Admission to

a Community-Based Facility for Preventive Daily Long-Term Care of the

Elderly Covered by Public Aid: the amount equivalent to 90 percent of the

expenses calculated based on standards determined by the Minister of

Health, Labour, and Welfare (which shall be the actual expenses required for

said Designated Community-Based Service in a case said standard amount

exceeds the actual expenses required for said Designated Community-Based

Service) by considering the average expenses required for said Designated

Community-Based Service calculated by considering the Category of

Condition of Need for Long-Term Care and the area where the provider that

performs said Designated Community-Based Service Business is located, etc.

(excluding the expenses necessary to provide meals, residence, and other

necessary expenses for daily life as determined by an Ordinance of the

Ministry of Health, Labour, and Welfare), according to the type of

Community-Based Service.

(3) The Minister of Health, Labour, and Welfare, when providing standards for

each item of the preceding paragraph, shall hear the opinion of the Social

Security Committee in advance.

(4) A Municipality, notwithstanding the provision of each item of paragraph (2),

may determine the amount for the Allowance for Community-Based Long-Term

Care Service in said Municipality, in lieu of the amount of Allowance for

Community-Based Long-Term Care Service prescribed in the same paragraph

and same item, the amount of which shall not exceed the amount of said

Allowance for Community-Based Long-Term Care Service prescribed in the

48

same paragraph and same item.

(5) A Municipality, when it intends to determine the amount of Allowance for

Community-Based Long-Term Care Service in said Municipality as prescribed

in the preceding paragraph, shall reflect the opinions of Insured Persons of

Long-Term Care Insurance undertaken by said Municipality and take

necessary measures in order to promote the use of knowledge of persons with

relevant knowledge and experience, in advance.

(6) When an Insured Person Requiring Long-Term Care receives Designated

Community-Based Service from a Designated Community-Based Service

Provider (limited to a case when said Insured Person Requiring Long-Term

Care notifies the Municipality regarding the receiving of Designated In-Home

Long-Term Care Support pursuant to the provision of Article 46, paragraph (4)

in advance, and a case when said Designated Community-Based Service is

subject to said Designated In-Home Long-Term Care Support, or other cases as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare),

the Municipality may pay the expenses required for said Designated

Community-Based Service that are to be paid to said Designated Community-

Based Service Provider by said Insured Person Requiring Long-Term Care on

behalf of said Insured Person Requiring Long-Term Care within the limit of the

amount to be paid to said Insured Person Requiring Long-Term Care as an

Allowance for Community-Based Long-Term Care Service.

(7) When the payment as prescribed in the preceding paragraph is paid, it shall

be deemed that an Allowance for Community-Based Long-Term Care Service is

paid to Insured Person Requiring Long-Term Care.

(8) A Municipality, when a Designated Community-Based Service Provider

requests payment for Allowance for Designated Community-Based Service,

shall pay said amount after conducting an examination according to the

amount specified by the Municipality pursuant to the provisions of the

standards determined by the Ministry of Health, Labour, and Welfare as set

forth in each item of paragraph (2) and pursuant to the provision of paragraph

(4), and according to the standards pertaining to facilities and management of

Designated Community-Based Service Business as prescribed by Article 78-4,

paragraph (2) or paragraph (4) (limited to the part regarding the handling of

Designated Community-Based Service).

(9) The provisions of Article 41, paragraph (2), paragraph (3), paragraph (10),

and paragraph (11) shall apply mutatis mutandis to the payment of an

Allowance for Designated Community-Based Service and the provisions of

paragraph (8) of the same Article shall apply mutatis mutandis to a Designated

Community-Based Service Provider. In this case, the necessary technical

replacement of terms in these provisions shall be provided by a Cabinet Order.

(10) In addition to the provisions as prescribed in each of the preceding items,

49

necessary matters for payment of an Allowance for Designated Community-

Based Service and a request by a Designated Community-Based Service

Provider for an Allowance for Designated Community-Based Service shall be as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare.

(Payment of an Exceptional Allowance for Community-Based Long-Term Care

Service)

Article 42-3 (1) A Municipality shall, in the following cases, pay an Exceptional

Allowance for Community-Based Long-Term Care Service to an Insured Person

Requiring Long-Term Care:

(i) when the Municipality determines it necessary in a case when an Insured

Person Requiring Long-Term Care receives a Designated Community-Based

Service prior to the date said Certification of Needed Long-Term Care

becomes effective due to an emergency or other compelling reason;

(ii) when the Municipality determines it necessary in a case when an Insured

Person Requiring Long-Term Care has a domicile on an isolated island or

other area where it is significantly difficult to secure Designated

Community-Based Service (except for Admission to a Community-Based

Facility for Preventive Daily Long-Term Care of the Elderly Covered by

Public Aid; the same shall apply hereinafter in this item) and in a location

that qualifies with standards as determined by the Minister of Health,

Labour, and Welfare, and an Insured Person receives Community-Based

Service other than Designated Community-Based Service (except for

Admission to a Community-Based Facility for Preventive Daily Long-Term

Care of the Elderly Covered by Public Aid) or an equivalent service to said

services;

(iii) when provided by a Cabinet Order.

(2) The amount of an Exceptional Allowance for Community-Based Long-Term

Care Service shall be provided by a Municipality based on the amount

equivalent to 90 percent of the expenses calculated by standards determined by

the Minister of Health, Labour, and Welfare as prescribed for each item of the

preceding Article, paragraph (2) regarding said Community-Based Service or

equivalent service (except when said calculated standard amount exceeds the

actual expenses required for said Community-Based Service or equivalent

service (excluding the expenses necessary to provide meals, residence, and

other expenses as determined by an Ordinance of the Ministry of Health,

Labour, and Welfare as necessary for daily life with regard to the expenses

required for Outpatient Long-Term Care for a Dementia Patient,

Multifunctional Long-Term Care in a Small Group Home, Communal Daily

Long-Term Care for a Dementia Patient, Daily Life Long-Term Care for a

Person Admitted to a Community-Based Specified Facility, Admission to a

50

Community-Based Facility for Preventive Daily Long-Term Care of the Elderly

Covered by Public Aid, and equivalent services), said amount shall be the

actual expenses required for said Community-Based Service or equivalent

service), or the amount specified by the Municipality pursuant to the provision

of paragraph (4) of the same Article.

(3) The mayor of a Municipality, when he or she determines the necessity of

payment of an Exceptional Allowance for Community-Based Long-Term Care

Service, shall order a person that has been in charge of said Community-Based

Service pertaining to said payment or in charge of an equivalent service

(herein referred to as "Person, etc., in Charge of Community-Based Service,

etc." in this paragraph) to report, submit or present record books and

documents, appear, or direct its personnel to question the relevant person or

enter the Business Office of the provider of said Person, etc., in Charge of

Community-Based Service, etc., pertaining to said payment in order to inspect

said equipment, record books and documents, and other items.

(4) The provisions of Article 24, paragraph (3) shall apply mutatis mutandis to

questions or inspections as prescribed in the preceding paragraph, and the

provisions of paragraph (4) of the same Article shall apply mutatis mutandis to

the authority granted as prescribed in the preceding paragraph.

(Maximum Amount of Payment Pertaining to an Allowance for In-Home Long-

Term Care Service, etc.)

Article 43 (1) The total sum of allowances that are paid monthly for In-Home

Service pertaining to one classification of In-Home Service, etc., that an

Insured In-Home Person Requiring Long-Term Care during the period

determined by Ordinance of Ministry of Health, Labour, and Welfare for each

classification of In-Home Service, etc. (which means with regard to In-Home

Service (including equivalent services; hereinafter the same shall apply in this

Article) and Community-Based Service (including equivalent services except

for Admission to a Community-Based Facility for Preventive Daily Long-Term

Care of the Elderly Covered by Public Aid; the same shall apply hereinafter in

this Article) by categories of two or more types as determined by the Minister

of Health, Labour, and Welfare, considering the inter-substitution by each type

of category; the same shall apply hereinafter) shall not exceed the amount

equivalent to 90 percent of the amount calculated pursuant to the provisions of

an Ordinance of the Ministry of Health, Labour, and Welfare based on the base

amount of maximum payment for each category of Allowance for In-Home

Long-Term Care Service, etc. The total sum of allowance is the total amount of

Allowance for In-Home Long-Term Care Service or Exceptional Allowance for

In-Home Long-Term Care Service, or the total amount of Allowance for

Community-Based Long-Term Care Service to be paid for Community-Based

51

Service or the total amount of Exceptional Allowance for Community-Based

Long-Term Care Service.

(2) The base amount of maximum payment by classification of Allowance for In-

Home Long-Term Care Service, etc., as prescribed in the preceding paragraph

shall be an amount determined by the Minister of Health, Labour, and Welfare

by classification of In-Home Service, etc., and by considering the standard use,

according to the categories of Condition of Need for Long-Term Care, of In-

Home Service pertaining to the category of said In-Home Service and

Community-Based Service, etc., during the period as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare as prescribed in the

same paragraph, and standards, etc., provided by the Minister of Health,

Labour, and Welfare as set forth in each item of Article 41, paragraph (4) and

each item of Article 42-2, paragraph (2) pertaining to said In-Home Service and

Community-Based Service.

(3) A Municipality, notwithstanding the provisions of the preceding paragraph

and pursuant to the provisions of a municipal ordinance, in lieu of the base

amount of maximum payment for the categories of allowances for In-Home

Long-Term Care, etc., as prescribed in paragraph (1), may determine an

amount exceeding said base amount as the base amount of maximum payment

for the categories of allowances for In-Home Long-Term Care, etc., in said

Municipality.

(4) A Municipality, with regard to the total sum of the total amount of allowances

for In-Home Long-Term Care and exceptional allowances for In-Home Long-

Term Care that are paid by each type of In-Home Service and the total amount

of allowances for Community-Based Service and exceptional allowances for

Community-Based Service that are paid by each type of Community-Based

Service when said allowances are paid monthly to an Insured In-Home Person

Requiring Long-Term Care by the type of In-Home Service and Community-

Based Service (limited to those types that are included in categories of In-

Home Service, etc., and that are determined by the Minister of Health, Labour,

and Welfare) during the period as determined by an Ordinance of the Ministry

of Health, Labour, and Welfare, may determine that said total sum shall not

exceed 90 percent of the calculated standard amount pursuant to the

provisions of an Ordinance of the Ministry of Health, Labour, and Welfare

based on base amount of maximum payment for the categories of allowances

for In-Home Long-Term Care, etc.

(5) The base amount of maximum payment for the categories of allowances for In-

Home Long-Term Care, etc., as set forth in the preceding paragraph shall be

the amount specified by a municipal ordinance within the limit of the base

amount of maximum payment for the categories of allowances for In-Home

Long-Term Care, etc., prescribed in paragraph (1) pertaining to the categories

52

of In-Home Service, etc., including said In-Home Service and Community-

Based Service (with regard to the Municipality that provides a municipal

ordinance pursuant to the provisions of paragraph (3), the base amount shall

be the amount for which measures pursuant to the provisions of said municipal

ordinance are undertaken) by considering each type of In-Home Service and

Community-Based Service for its standard use according to the categories of

Condition of Need for Long-Term Care of said In-Home Service and

Community-Based Service during the period as determined by an Ordinance of

the Ministry of Health, Labour, and Welfare as prescribed in the preceding

paragraph and of standards, etc., provided by the Minister of Health, Labour,

and Welfare as set forth in each item of Article 41, paragraph (4) and each item

of Article 42-2, paragraph (2) pertaining to said In-Home Service and

Community-Based Service.

(6) In a case when the total sum as prescribed in paragraph (1) exceeds the

amount equivalent to 90 percent of the calculated amount as prescribed in the

same paragraph for payment of allowances for In-Home Long-Term Care,

Exceptional Allowance for In-Home Long-Term Care Service, Allowance for

Community-Based Long-Term Care Service, or Exceptional Allowance for

Community-Based Long-Term Care Service, or in a case when the total sum as

prescribed in paragraph (4) exceeds the amount equivalent to 90 percent of the

calculated amount as prescribed in the same paragraph, the amount of

allowances of said In-Home Long-Term Care, Exceptional Allowance for In-

Home Long-Term Care Service, Allowance for Community-Based Long-Term

Care Service, or Exceptional Allowance for Community-Based Long-Term Care

Service shall be the amount calculated pursuant to the provisions of a Cabinet

Order, notwithstanding the provisions of each item of Article 41, paragraph (4),

Article 42, paragraph (2), each item of Article 42-2, paragraph (2) or paragraph

(4), or paragraph (2) of the preceding Article.

(Payment of an Allowance for Purchasing Equipment for In-Home Long-Term

Care Covered by Public Aid)

Article 44 (1) A Municipality, when an Insured In-Home Person Requiring Long-

Term Care purchases from a Designated In-Home Service Provider pertaining

to the Sale of Specified Equipment Covered by Public Aid an article of the

Specified Equipment Covered by Public Aid that is sold by a provider that

performs an In-Home Service pertaining to said designation, shall pay to said

Insured In-Home Person Requiring Long-Term Care an Allowance for

purchasing Equipment for In-Home Long-Term Care Covered by Public Aid.

(2) An Allowance for purchasing Equipment for In-Home Long-Term Care

Covered by Public Aid shall be paid pursuant to the provisions of an Ordinance

of the Ministry of Health, Labour, and Welfare and limited to when the

53

Municipality determines it necessary.

(3) The amount of Allowance for purchasing Equipment for In-Home Long-Term

Care Covered by Public Aid shall be the amount equivalent to 90 percent of the

actual expenses required for the purchase of said Specified Equipment Covered

by Public Aid.

(4) The total Allowance for purchasing Equipment for In-Home Long-Term Care

Covered by Public Aid that is paid monthly for Specified Equipment Covered by

Public Aid purchased by an Insured In-Home Person Requiring Long-Term

Care during the period as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare shall not exceed the amount equivalent to 90

percent of the amount calculated pursuant to the provision of an Ordinance of

the Ministry of Health, Labour, and Welfare based on the base amount of

maximum payment for Allowance for purchasing Equipment for In-Home Long-

Term Care Covered by Public Aid.

(5) The base amount of maximum payment for Allowance for purchasing

Equipment for In-Home Long-Term Care Covered by Public Aid as prescribed

in the preceding paragraph shall be an amount provided by the Minister of

Health, Labour, and Welfare as prescribed in the same paragraph after

considering the average expenses required for the purchase of said Specified

Equipment Covered by Public Aid during the period as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare.

(6) A Municipality, notwithstanding the provisions of the preceding paragraph, in

lieu of the base amount of maximum payment for Allowance for purchasing

Equipment for In-Home Long-Term Care Covered by Public Aid as set forth in

paragraph (4), may determine an amount that exceeds said base amount as the

base amount of maximum payment for Allowance for purchasing Equipment for

In-Home Long-Term Care Covered by Public Aid in said Municipality.

(7) In a case when the total sum as prescribed in paragraph (4) exceeds the

amount equivalent to 90 percent of the calculated amount as prescribed in the

same paragraph for payment of an Allowance for purchasing Equipment for In-

Home Long-Term Care Covered by Public Aid, the amount of said Allowance

for purchasing Equipment for In-Home Long-Term Care Covered by Public Aid

shall be the amount calculated pursuant to the provisions of a Cabinet Order,

notwithstanding the provision of paragraph (3).

(Payment of an Allowance for Home Modification for In-Home Long-Term Care)

Article 45 (1) A Municipality, when an Insured In-Home Person Requiring Long-

Term Care implements a type of modification determined by the Minister of

Health, Labour, and Welfare, such as installing handrails or other fixtures

(herein referred to as "Home Modification"), shall pay an Allowance for Home

Modification for In-Home Long-Term Care to said Insured In-Home Person

54

Requiring Long-Term Care.

(2) An Allowance for Home Modification for In-Home Long-Term Care shall be

paid pursuant to the provisions of an Ordinance of the Ministry of Health,

Labour, and Welfare limited to a case when the Municipality determines it

necessary.

(3) The amount of Allowance for Home Modification for In-Home Long-Term Care

shall be the amount equivalent to 90 percent of the actual expenses required

for said Home Modification.

(4) The total amount of Allowance for Home Modification for In-Home Long-Term

Care that is paid for a single type of modifying house for in-home care

undertaken by an Insured In-Home Person Requiring Long-Term Care shall

not exceed the amount equivalent to 90 percent of the amount calculated

pursuant to the provisions of an Ordinance of the Ministry of Health, Labour,

and Welfare based on the base amount of maximum payment for Allowance for

Home Modification for In-Home Long-Term Care.

(5) The base amount of maximum payment for Allowance for Home Modification

for In-Home Long-Term Care as prescribed in the preceding paragraph shall be

the amount specified by the Minister of Health, Labour, and Welfare by type of

Home Modification after considering the average expenses required.

(6) A Municipality, notwithstanding the provision of the preceding paragraph,

pursuant to the provisions of a municipal ordinance, and in lieu of the base

amount of maximum payment for Allowance for Home Modification for In-

Home Long-Term Care as set forth in paragraph (4), may determine an amount

that exceeds said base amount as the base amount of maximum payment for

Allowance for Home Modification for In-Home Long-Term Care in said

Municipality.

(7) In a case when the total amount as prescribed in paragraph (4) exceeds the

amount equivalent to 90 percent of the calculated amount as prescribed in the

same paragraph due to payment of said Allowance for Home Modification for

In-Home Long-Term Care, the amount of said Allowance for Home Modification

for In-Home Long-Term Care shall be the amount calculated pursuant to the

provisions of a Cabinet Order, notwithstanding the provision of paragraph (3).

(8) A Municipality, when it determines the necessity for payment of an Allowance

for Home Modification for In-Home Long-Term Care, may order a person that

implements or implemented the Home Modification pertaining to said payment

(herein referred to as "Person, etc., that Implements the Home Modification" in

this paragraph) to report, submit or present record books and documents,

appear, or direct its personnel to question said relevant Person or enter the

Business Office of the provider of said Person, etc., that Implements the Home

Modification in order to inspect said books, documents, and other items.

(9) The provisions of Article 24, paragraph (3) shall apply mutatis mutandis to

55

questions and inspections as prescribed in the preceding paragraph and the

provisions of paragraph (4) of the same Article shall apply mutatis mutandis to

the authority granted as prescribed in the preceding paragraph.

(Payment of an Allowance for In-Home Long-Term Care Service Plan)

Article 46 (1) A Municipality, when an Insured In-Home Person Requiring Long-

Term Care receives Designated In-Home Long-Term Care Support from a

person designated by the prefectural governor (herein referred to as

"Designated In-Home Long-Term Care Support Provider") provided by the

provider that performs a Designated In-Home Long-Term Care Support

Business pertaining to said designation (herein referred to as "Designated In-

Home Long-Term Care Support"), may pay to said Insured In-Home Person

Requiring Long-Term Care the Allowance for In-Home Long-Term Care Service

Plan for the expenses required for said Designated In-Home Long-Term Care

Support.

(2) The amount of Allowance for In-Home Long-Term Care Service Plan shall be

the amount of expenses calculated by standards as prescribed by the Minister

of Health, Labour, and Welfare after considering the average expenses

necessary for the Designated In-Home Long-Term Care Support, calculated

after considering the area, etc., where the provider that performs the

Designated In-Home Long-Term Care Support Business is located (in a case

when said calculated amount exceeds the actual expenses necessary for the

Designated In-Home Long-Term Care Support, the amount of Allowance for In-

Home Long-Term Care Service Plan shall be the actual expenses necessary for

said Designated In-Home Long-Term Care Support.)

(3) The Minister of Health, Labour, and Welfare, when intending to specify

standards as prescribed in the preceding paragraph, shall hear the opinions of

the Social Security Council in advance.

(4) When an Insured In-Home Person Requiring Long-Term Care receives

Designated In-Home Long-Term Care Support from a Designated In-Home

Long-Term Care Support Provider (limited to a case when said Insured In-

Home Person Requiring Long-Term Care has notified the Municipality in

advance to receive said Designated In-Home Long-Term Care Support

pursuant to the provisions of an Ordinance of the Ministry of Health, Labour,

and Welfare), the Municipality may pay to said Designated In-Home Long-

Term Care Support Provider on behalf of said Insured In-Home Person

Requiring Long-Term Care the expenses required for said Designated In-Home

Long-Term Care Support that said Insured In-Home Person Requiring Long-

Term Care should pay to said Designated In-Home Long-Term Care Support

Provider.

(5) When the payment pursuant to the provisions of the preceding paragraph is

56

paid, it shall be deemed that an Allowance for In-Home Long-Term Care

Service Plan is paid to the Insured In-Home Person Requiring Long-Term Care.

(6) A Municipality, when requested to pay an Allowance for In-Home Long-Term

Care Service Plan by a Designated In-Home Long-Term Care Support Provider,

shall conduct an examination according to standards provided by the Minister

of Health, Labour, and Welfare as set forth in the paragraph (2) and the

standards of business management of a Designated In-Home Long-Term Care

Support Provider as prescribed in Article 81, paragraph (2) (limited to the part

regarding the handling of Designated In-Home Long-Term Care Support).

(7) The provisions of Article 41, paragraph (2), paragraph (3), paragraph (10) and

paragraph (11) shall apply mutatis mutandis to the payment of an Allowance

for In-Home Long-Term Care Service Plan and the provisions of paragraph (8)

of the same Article shall apply mutatis mutandis to the Designated In-Home

Long-Term Care Support Provider. In this case, the necessary technical

replacement of terms in these provisions shall be provided by a Cabinet Order.

(8) In addition to the provisions of each preceding paragraph, other necessary

matters for the payment of Allowance for In-Home Long-Term Care Service

Plan and for requesting an Allowance for In-Home Long-Term Care Service

Plan from a Designated In-Home Long-Term Care Support Provider shall be as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare.

(Payment of an Exceptional Allowance for In-Home Long-Term Care Service

Plan)

Article 47 (1) A Municipality shall, in the following cases, pay an Allowance for

an Exceptional Allowance for In-Home Long-Term Care Service Plan to an

Insured In-Home Person Requiring Long-Term Care:

(i) when the Municipality determines it necessary in a case when an Insured

In-Home Person Requiring Long-Term Care receives In-Home Long-Term

Care Support other than Designated In-Home Long-Term Care Support or an

equivalent service (limited to those services provided by a provider

performing business that is determined to satisfy the standards as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare

among the number of employees as determined by an Ordinance of the

Ministry of Health, Labour, and Welfare as set forth in Article 81, paragraph

(1) pertaining to Designated In-Home Long-Term Care Support Business and

the standards of management of a Designated In-Home Long-Term Care

Support Business as prescribed in paragraph (2) of the same Article;

hereinafter referred to as "In-Home Long-Term Care Support Applicable to

Standards" in the following item);

(ii) when the Municipality determines it necessary in a case when an Insured

In-Home Person Requiring Long-Term Care who is domiciled on an isolated

57

island or other area where it is significantly difficult to secure Designated

In-Home Long-Term Care Support or In-Home Long-Term Care Support

Applicable to Standards and in a location that qualifies pursuant to

standards as determined by the Minister of Health, Labour, and Welfare

receives In-Home Long-Term Care other than Designated In-Home Long-

Term Care Support and Designated In-Home Long-Term Care Support that

qualifies with standards or service equivalent to those services;

(iii) when provided by a Cabinet Order.

(2) The amount of Allowance for an Exceptional Allowance for In-Home Long-

Term Care Service Plan shall be specified by the Municipality based on the

expenses calculated by standards determined by the Minister of Health,

Labour, and Welfare as set forth in paragraph (2) of the preceding Article for

said Designated In-Home Long-Term Care Support or equivalent service (in a

case said calculated amount exceeds the amount of actual expenses of said

Designated In-Home Long-Term Care Support or equivalent service, the base

amount shall be the actual expenses required for said Designated In-Home

Long-Term Care Support or equivalent service).

(3) A Municipality, when it determines the necessity for payment of an

Exceptional Allowance for In-Home Long-Term Care Service Plan, may order a

person that has been in charge of the Designated In-Home Long-Term Care

Support pertaining to said payment or equivalent service (herein referred to as

"Person, etc., in Charge of Designated In-Home Long-Term Care Support" in

this paragraph) to report, submit, or present record books and documents,

appear, or direct its personnel to question the relevant person and to enter the

Business Office of the provider of said Person, etc., in Charge of Designated In-

Home Long-Term Care Support pertaining to said payment in order to inspect

said books, documents, and other items.

(4) The provisions of Article 24, paragraph (3) shall apply mutatis mutandis to

questions and inspections pursuant to the provisions of the preceding

paragraph and the provisions of paragraph (4) of the same Article shall apply

mutatis mutandis to the authority granted pursuant to the provisions of the

preceding paragraph.

(Payment of an Allowance for Long-Term Care Facility Service)

Article 48 (1) A Municipality, when an Insured Person Requiring Long-Term

Care receives the following Facility Service (herein referred to as "Designated

Facility Service, etc."), shall pay to said Insured Person Requiring Long-Term

Care an Allowance for Long-Term Care Facility Service of the expenses

required for said Designated Facility Service, etc. (excluding the expenses

necessary to provide meals, residence, and other necessary expenses for daily

life as determined by an Ordinance of the Ministry of Health, Labour, and

58

Welfare; the same shall herein apply in this Article), however, provided that

this provision shall not apply to a case that said Insured Person Requiring

Long-Term Care who is designated pursuant to the provision of Article 37,

paragraph (1), received Facility Service other than the type pertaining to said

designation:

(i) Facility Service for Long-Term Care Covered by Public Aid (herein referred

to as "Designated Facility Service for Long-Term Care Covered by Public

Aid") provided by a Facility Covered by Public Aid Providing Long-Term Care

to the Elderly that is designated by said prefectural governor (herein

referred to as "Designated Facility Covered by Public Aid Providing Long-

Term Care to the Elderly");

(ii) Long-Term Care Health Facility Service;

(iii) Sanatorium Long-Term Care Service (herein referred to as "Designated

Sanatorium Service for Long-Term Care") provided by a Sanatorium Medical

Facility for the Elderly Requiring Long-Term Care that is designated as such

by the prefectural governor (herein referred to as "Designated Medical Long-

Term Care Sanatorium").

(2) The amount of allowance for Long-Term Care Facility Service shall be 90

percent of the amount of expenses calculated by type of Facility Service with

standards as prescribed by the Minister of Health, Labour, and Welfare after

considering the average expenses (excluding the expenses necessary to provide

meals, residence, and other necessary expenses for daily life as determined by

an Ordinance of the Ministry of Health, Labour, and Welfare; the same shall

apply hereinafter in this Article) necessary for the Designated Facility Service,

etc., that are calculated by considering the categories of Condition of Need for

Long-Term Care, the area where the Facility Covered by Long-Term Care

Insurance that provides the Designated Facility Service, etc., pertaining to the

type of said Facility Service is located, etc. (in a case when said calculated

amount exceeds the actual expenses necessary for the Designated Facility

Service, etc., the amount of Allowance for Long-Term Care Facility Service

shall be the actual expenses necessary for said Designated Facility Service,

etc.).

(3) The Minister of Health, Labour, and Welfare, when intending to specify

standards as prescribed in the preceding paragraph, shall hear the opinion of

the Social Security Council in advance.

(4) When an Insured Person Requiring Long-Term Care receives Designated

Facility Service, etc., from a Facility Covered by Long-Term Care Insurance,

the Municipality may pay to said Facility Covered by Long-Term Care

Insurance on behalf of said Insured In-Home Person Requiring Long-Term

Care the expenses required for said Designated Facility Service, etc., that said

Insured Person Requiring Long-Term Care should pay to said Facility Covered

59

by Long-Term Care Insurance as an Allowance for Long-Term Care Facility

Service within the maximum amount to be paid to said Facility Providing

Insured Health Benefits of Long-Term Care.

(5) When a payment pursuant to the provisions of the preceding paragraph is

paid, it shall be deemed that an Allowance for Long-Term Care Facility Service

is paid to said Insured Person Requiring Long-Term Care.

(6) A Municipality, when a Facility Covered by Long-Term Care Insurance

requests an Allowance for Long-Term Care Facility Service, shall pay said

allowance after conducting an examination according to the standards

determined by the Minister of Health, Labour, and Welfare as set forth in

paragraph (2), the standards concerning facilities and management of a

Designated Facility Covered by Public Aid Providing Long-Term Care to the

Elderly as prescribed in Article 88, paragraph (2) (limited to the part

concerning the handling of Designated Facility Service for Long-Term Care

Covered by Public Aid), the standards concerning facilities and management of

a Long-Term Care Health Facility as prescribed in Article 97, paragraph (3)

(limited to the part concerning the handling of a Long-Term Care Health

Facility Service), and standards concerning facilities and management of a

Designated Medical Long-Term Care Sanatorium as prescribed in Article 110,

paragraph (2) (limited to the part concerning the handling of a Designated

Sanatorium Service for Long-Term Care).

(7) The provisions of Article 41, paragraph (2), paragraph (3), paragraph (10),

and paragraph (11) shall apply mutatis mutandis to payment of an Allowance

for Long-Term Care Facility Service, and the provisions of paragraph (8) of the

same Article shall apply mutatis mutandis to a Facility Covered by Long-Term

Care Insurance. In this case, the necessary technical replacement of terms in

these provisions shall be provided by a Cabinet Order.

(8) In addition to the provisions as prescribed in the preceding paragraph, other

necessary matters for payment of an Allowance for Long-Term Care Facility

Service and a request for an Allowance for Long-Term Care Facility Service of

a Facility Covered by Long-Term Care Insurance shall be as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare.

(Payment of an Exceptional Allowance for Long-Term Care Facility Service)

Article 49 (1) A Municipality shall, in the following cases, pay to an Insured

Person Requiring Long-Term Care an Exceptional Allowance for Long-Term

Care Facility Service:

(i) when the Municipality determines it necessary in a case when an Insured

Person Requiring Long-Term Care receives Designated Facility Service, etc.,

prior to the date said Certification of Needed Long-Term Care becomes

effective due to an emergency or other compelling reason;

60

(ii) when provided by a Cabinet Order.

(2) The amount of Exceptional Allowance for Long-Term Care Facility Service

shall be specified by the Municipality based on 90 percent of the amount

equivalent to the expenses calculated with regard to said Facility Service

according to the standards as prescribed by the Minister of Health, Labour,

and Welfare (in a case when said calculated expenses exceed the actual

expenses required for said Facility Service (excluding the expenses necessary

to provide meals, residence, and other necessary expenses for daily life as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare),

the base amount shall be the actual expenses required for said Facility Service).

(3) The mayor of a Municipality, when he or she determines the necessity for

payment of an Exceptional Allowance for Long-Term Care Facility Service, may

order a person that has been in charge of the Facility Service pertaining to said

payment or equivalent service (herein referred to as "Person, etc., in Charge of

Facility Service" in this paragraph) to report, submit or present record books

and documents, appear, or direct its personnel to question the relevant person

or enter the Business Office of the provider of said Person, etc., in Charge of

Facility Service pertaining to said payment in order to inspect said equipment,

books, documents, and other items.

(4) The provisions of Article 24, paragraph (3) shall apply mutatis mutandis to

questions and inspections pursuant to the provisions of the preceding

paragraph and the provisions of paragraph (4) of the same Article shall apply

mutatis mutandis to the authority granted pursuant to the provisions of the

preceding paragraph.

(Exceptions to the Amount of Allowance for In-Home Long-Term Care Service,

etc.)

Article 50 In a case when a Municipality applies the provisions as prescribed in

the following items to a Long-Term Care Benefit as listed in said items

received by an Insured Person Requiring Long-Term Care for whom it is

deemed difficult to pay the necessary expenses for In-Home Service (including

equivalent services), Community-Based Service (including equivalent services),

Facility Service, or a Home Modification due to disaster or other special reason

as determined by an Ordinance of the Ministry of Health, Labour, and Welfare,

the term "90 percent" in the referenced provisions shall be deemed to be

replaced with "the percentage determined by the Municipality within the range

of more than 90 percent to 100 percent or less":

(i) payment of an Allowance for In-Home Long-Term Care Service: Article 41,

paragraph (4) item (i) and item (ii), and Article 43, paragraph (1), paragraph

(4) and paragraph (6);

(ii) payment of an Exceptional Allowance for In-Home Long-Term Care Service:

61

Article 42, paragraph (2), Article 43, paragraph (1), paragraph (4) and

paragraph (6);

(iii) payment of an Allowance for Community-Based Long-Term Care Service:

Article 42-2, paragraph (2), item (i) and item (ii), and Article 43, paragraph

(1), paragraph (4) and paragraph (6);

(iv) payment of an Exceptional Allowance for Community-Based Long-Term

Care Service: Article 42-3, paragraph (2), and Article 43, paragraph (1),

paragraph (4), and paragraph (6);

(v) payment of an Allowance for Long-Term Care Facility Service: Article 48,

paragraph (2);

(vi) payment of an Exceptional Allowance for Long-Term Care Facility Service:

paragraph (2) of the preceding Article;

(vii) payment of an Allowance for purchasing Equipment for In-Home Long-

Term Care Covered by Public Aid: Article 44, paragraph (3), paragraph (4),

and paragraph (7);

(viii) payment for Allowance for Home Modification for In-Home Long-Term

Care: Article 45, paragraph (3), paragraph (4), and paragraph (7).

(Payment of an Allowance for High-Cost Long-Term Care Service)

Article 51 (1) When the amount that is obtained by deducting the amount

calculated pursuant to the provisions of a Cabinet Order as the total amount of

expenses required for each of In-Home Service (including equivalent service),

Community-Based Service (including equivalent service), or Facility Service

that an Insured Person Requiring Long-Term Care receives as the total

amount of allowances for In-Home Long-Term Care, Exceptional Allowance for

In-Home Long-Term Care Service, Allowance for Community-Based Long-Term

Care Service, Exceptional Allowance for Community-Based Long-Term Care

Service, Allowance for Long-Term Care Facility Service, and Exceptional

Allowance for Long-Term Care Facility Service from the expenses that are

actually paid for said calculated expenses is extremely large, a Municipality

shall pay an Allowance for High-Cost Long-Term Care Service to said Insured

Person Requiring Long-Term Care.

(2) In addition to the provisions as set forth in the preceding paragraph,

requirements for payment of an Allowance for High-Cost Long-Term Care

Service, the amount of said allowance, and other matters necessary for the

payment of an Allowance for High-Cost Long-Term Care Service shall be

provided by a Cabinet Order after considering the impact on said household

budget due to the burden of the expenses necessary for In-Home Service,

Community-Based Service, or Facility Service.

(Payment of an Allowance for Long-Term Care Service to a Person Admitted to

62

a Specified Facility)

Article 51-2 (1) A Municipality, when a person as determined by an Ordinance of

the Ministry of Health, Labour, and Welfare due to an extenuating income

condition or other circumstances among those who are an Insured Person

Requiring Long-Term Care, receives Designated Facility Service, etc.,

Designated Community-Based Service, or Designated In-Home Service (herein

referred to as "Specified Long-Term Care Service" in this Article and the

following Article, paragraph (1)) as listed below, shall pay to said Insured

Person Requiring Long-Term Care (herein referred to as "Specified Person

Admitted to a Facility" in this Article and the following Article, paragraph (1))

an Allowance for Long-Term Care Service to a Person Admitted to a Specified

Facility for the expenses required to provide meals and residence or stay

(hereinafter referred to as "Residence, etc.") at a Facility Covered by Long-

Term Care Insurance, Designated Community-Based Service Provider, or

Designated In-Home Service Provider that provides said Specified Long-Term

Care Service (herein referred to as "Specified Facility, etc., for Insured Long-

Term Care" in this Article), however, provided that this provision shall not

apply when said Specified Person Admitted to a Facility that is issued a

designation pursuant to the provisions of Article 37, paragraph (1) receives

Specified Long-Term Care Service other than the type pertaining to said

designation:

(i) Designated Facility Service for Long-Term Care Covered by Public Aid;

(ii) Long-Term Care Health Facility Service;

(iii) Designated Sanatorium Service for Long-Term Care;

(iv) Admission to a Community-Based Facility for Preventive Daily Long-Term

Care of the Elderly Covered by Public Aid;

(v) Short-Term Admission for Daily Life Long-Term Care;

(vi) Short-Term Admission for Recuperation.

(2) The amount of the Allowance for Long-Term Care Service to a Person

Admitted to a Specified Facility shall be the total sum of the amount as

prescribed in item (i) and the amount as prescribed in item (ii) below:

(i) the amount after the amount determined by the Minister of Health, Labour,

and Welfare after considering the status of food expenses for an average

household budget, the income status of the Specified Person Admitted to a

Facility, and other circumstances (hereinafter referred to as "Maximum

Allowance for Meal Expense" in this Article and the following Article,

paragraph (2)) is deducted from the amount of expenses determined by the

Minister of Health, Labour, and Welfare after considering the average

expenses required to provide meals at a Specified Facility, etc., for Insured

Long-Term Care (in a case when said amount exceeds the actual expenses of

providing said meals, the amount shall be the actual expenses of providing

63

said meals; herein referred to as "Base Cost for Meal Expenses" in this

Article and in the following Article, paragraph (2));

(ii) the amount after the amount provided by the Minister of Health, Labour,

and Welfare after considering the income status of the Specified Person

Admitted to a Facility and other circumstances (herein referred to as

"Maximum Allowance for Residence Expenses") is deducted from the amount

provided by the Minister of Health, Labour, and Welfare after considering

the average expenses necessary for Residence, etc., at a Specified Facility,

etc., for Insured Long-Term Care, the status of such facility, and other

circumstances (in a case when such amount exceeds the actual expenses for

said Residence, etc., the amount shall be the actual expenses for said

Residence, etc.; herein referred to as "Base Costs for Residence" in this

Article and the following Article, paragraph (2)).

(3) When the expenses necessary of providing meals, Residence, etc., at a

Specified Facility, etc., for Insured Long-Term Care, and other circumstances

have changed significantly from the Base Cost for Meal Expense or Maximum

Allowance for Meal Expense, or Base Costs for Residence or Maximum

Allowance for Residence Expenses after the Minister of Health, Labour, and

Welfare has issued a determination of these expenses, the Minister shall revise

those amounts immediately.

(4) When a Specified Person Admitted to a Facility receives Specified Long-Term

Care Service from a Specified Facility, etc., for Insured Long-Term Care, a

Municipality may pay the expenses required for providing meals and Residence,

etc., that said Specified Person Admitted to a Facility should pay to said

Specified Facility, etc., for Insured Long-Term Care, within the limit of the

amount to be paid to said Specified Person Admitted to a Facility as an

Allowance for Long-Term Care Service to a Person Admitted to a Specified

Facility on behalf of said Specified Person Admitted to a Facility to said

Specified Facility, etc., for Insured Long-Term Care

(5) When the payment pursuant to the provisions of the preceding paragraph is

paid, it shall be deemed that an Allowance for Long-Term Care Service to a

Person Admitted to a Specified Facility is paid to the Specified Person

Admitted to a Facility.

(6) A Municipality, notwithstanding the provisions of paragraph (1) in a case

when a Specified Person Admitted to a Facility paid to a Specified Facility, etc.,

for Insured Long-Term Care, an amount exceeding the Base Cost for Meal

Expense or the Base Costs for Residence (with regard to a Specified Person

Admitted to a Facility, one who is deemed to be paid an Allowance for Long-

Term Care Service to a Person Admitted to a Specified Facility pursuant to the

provisions of the preceding paragraph, Maximum Allowance for Meal Expense,

or Maximum Allowance for Residence Expenses) as the expenses necessary for

64

providing meals or for Residence, etc., shall not pay an Allowance for Long-

Term Care Service to a Person Admitted to a Specified Facility.

(7) A Municipality, when a Specified Facility, etc., for Insured Long-Term Care,

requests an Allowance for Long-Term Care Service to a Person Admitted to a

Specified Facility, shall pay said allowance after conducting an examination

according to the provisions of paragraph (1), paragraph (2) and the preceding

paragraph.

(8) The provisions of Article 41, paragraph (3), paragraph (10), and paragraph

(11) shall apply mutatis mutandis to the payment of an Allowance for Long-

Term Care Service to a Person Admitted to a Specified Facility and the

provisions of paragraph (8) of the same Article shall apply mutatis mutandis to

a Specified Facility, etc., for Insured Long-Term Care in this case, the

necessary technical replacement of terms in these provisions shall be provided

by a Cabinet Order.

(9) In addition to the provisions as prescribed in the preceding paragraphs, the

other necessary matters the payment of an Allowance for Long-Term Care

Service to a Person Admitted to a Specified Facility and a request for an

Allowance for Long-Term Care Service to a Person Admitted to a Specified

Facility by a Specified Facility, etc., for Insured Long-Term Care, shall be as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare.

(Payment of an Exceptional Allowance for Long-Term Care Service to a Person

Admitted to a Specified Facility)

Article 51-3 (1) A Municipality shall, in the following cases, pay an Exceptional

Allowance for Long-Term Care Service to a Person Admitted to a Specified

Facility to a Specified Person Admitted to a Facility:

(i) when the Municipality determines it necessary in a case when a Specified

Person Admitted to a Facility receives Specified Long-Term Care Service

prior to the date said Certification of Needed Long-Term Care becomes

effective due to an emergency or other compelling reason;

(ii) when provided by a Cabinet Order.

(2) The amount of an Exceptional Allowance for Long-Term Care Service to a

Person Admitted to a Specified Facility shall be determined by a Municipality

based on the total sum of the amounts remaining after the amount of Base Cost

for Meal Expense is deducted from the Maximum Allowance for Meal Expense

with regard to the expense required to provide said meal and the amount of

Base Costs for Residence is deducted from the amount of Maximum Allowance

for Residence Expenses with regard to the expense required for said Residence,

etc..

Section 4 Prevention Benefits

65

(Type of Prevention Benefits)

Article 52 A prevention benefit shall be an insurance benefit listed in the

following:

(i) payment of a Preventive Long-Term Care Service Allowance;

(ii) payment of an Exceptional Allowance for Preventive Service of Long-Term

Care;

(iii) payment of an Allowance for Community-Based Preventive Long-Term

Care Service;

(iv) payment of an Exceptional Allowance for Community-Based Preventive

Service of Long-Term Care;

(v) payment of an Allowance for Purchasing Equipment for Preventive Long-

Term Care Covered by Public Aid;

(vi) payment of an Allowance for Preventive Long-Term Care Home

Modification;

(vii) payment of an Allowance for Preventive Long-Term Care Service Plan;

(viii) payment of an Exceptional Allowance for a Preventive Service Plan of

Long-term care;

(ix) payment of an Allowance for High-Cost Preventive Long-Term Care

Service;

(x) payment of an Allowance for Preventive Long-Term Care Service to a

Person Admitted to a Specified Facility;

(xi) payment of an Exceptional Allowance for Preventive Long-Term Care

Service to a Person Admitted to a Specified Facility.

(Payment of an Allowance for Preventive Long-Term Care Service)

Article 53 (1) A Municipality, when a person that receives support in his or her

home is an Insured Person that has been issued a Certification of Needed

Support (herein referred to as "Insured In-Home Person Requiring Support")

receives from a person designated by a prefectural governor (herein referred to

as "Designated Provider of a Preventive Service to Long-Term Care") a

Preventive Service of Long-Term Care provided by a provider that performs

Preventive Service of Long-Term Care Business pertaining to said designation

(herein referred to as "Designated Preventive Service of Long-Term Care")

(limited to a case when said Insured In-Home Person Requiring Support has

notified a Municipality in advance pursuant to the provisions of Article 58,

paragraph (4) concerning the receipt of a Designated Support for Prevention of

Long-Term Care as prescribed in paragraph (1) of the same Article, when said

Designated Preventive Service of Long-Term Care is subject to said Designated

Support for Prevention of Long-Term Care or when provided by an Ordinance

of the Ministry of Health, Labour, and Welfare), shall pay to said Insured In-

66

Home Person Requiring Support an Allowance for Preventive Long-Term Care

Service for the expenses required for said Designated Preventive Service of

Long-Term Care (except for the expenses required to purchase Specified

Equipment for Preventive Long-Term Care Covered by Public Aid, excluding

the expenses necessary to provide meals, residence, and other necessary

expenses for daily life as determined by an Ordinance of the Ministry of Health,

Labour, and Welfare with regard to the expenses required for Outpatient

Preventive Long-Term Care, Outpatient Rehabilitation for Preventive Long-

Term Care, a Short-Term Admission for Daily Preventive Long-Term Care, and

Short-Term Admission for Recuperation for Preventive Long-Term Care, Daily

Preventive Long-Term Care Admitted to a Specified Facility), provided

however, that this provision shall not apply to a case when said Insured In-

Home Person Requiring Support that has been designated pursuant to the

provisions of Article 37, paragraph (1) receives Preventive Service of Long-

Term Care other than the type pertaining to said designation.

(2) The amount of Allowance for Preventive Long-Term Care Service shall be

according to the categories of Preventive Service of Long-Term Care listed in

each item of the following and the amount as prescribed in said items:

(i) Home-Visit Service for Preventive Long-Term Care, Home-Visit Bathing

Long-Term Care for Preventive Service of Long-Term Care, Home-Visit

Nursing for Preventive Service of Long-Term Care, Home-Visit

Rehabilitation Service for Preventive Long-Term Care, Management and

Guidance for In-Home Medical Service for Preventive Long-Term Care,

Outpatient Preventive Long-Term Care, Outpatient Rehabilitation for

Preventive Long-Term Care, and Rental Service of Preventive Long-Term

Care Covered by Public Aid Equipment: the amount equivalent to 90 percent

of the amount calculated by the type of Preventive Service of Long-Term

Care and after considering the average expenses necessary for said

Designated Preventive Service of Long-Term Care that is calculated after

considering the content of the Designated Preventive Service of Long-Term

Care pertaining to the type of said Preventive Service of Long-Term Care,

the area where the provider that performs said Designated Preventive

Service of Long-Term Care Business is located, etc. (excluding the expenses

necessary to provide meals and other expenses as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare as necessary for

daily life with regard to the expenses necessary for Outpatient Preventive

Long-Term Care and Outpatient Rehabilitation for Preventive Long-Term

Care), based on the standards provided by the Minister of Health, Labour,

and Welfare (when said calculated amount exceeds the actual expenses

required for said Designated Preventive Service of Long-Term Care, said

amount shall be the actual expenses that are required for said Designated

67

Preventive Service of Long-Term Care);

(ii) Short-Term Admission for Daily Preventive Long-Term Care, Short-Term

Admission for Recuperation for Preventive Long-Term Care, and Daily

Preventive Long-Term Care Admitted to a Specified Facility: the amount

equivalent to 90 percent of the amount calculated by the type of Preventive

Service of Long-Term Care and after considering the average expenses

necessary for said Designated Preventive Service of Long-Term Care that is

calculated after considering the categories of Needed Support Condition, the

area where the provider that performs said Designated Preventive Service of

Long-Term Care Business is located, etc., pertaining the type of said

Preventive Service of Long-Term Care (excluding the expenses necessary to

provide meals, residence, and other expenses as determined by an Ordinance

of the Ministry of Health, Labour, and Welfare as necessary for daily life),

based on the standards provided by the Minister of Health, Labour, and

Welfare (when said calculated amount exceeds the actual expenses required

for said Designated Preventive Service of Long-Term Care, said amount shall

be the actual expenses required for said Designated Preventive Service of

Long-Term Care).

(3) The Minister of Health, Labour, and Welfare, when it intends to determine

the standards as prescribed in the items of the preceding paragraph, shall hear

the opinion of the Social Security Council in advance.

(4) When an Insured In-Home Person Requiring Support receives Designated

Preventive Service of Long-Term Care from a Designated Provider of a

Preventive Service to Long-Term Care, a Municipality may pay the expenses

required for said Designated Preventive Service of Long-Term Care that said

Insured In-Home Person Requiring Support should pay to said Designated

Provider of a Preventive Service to Long-Term Care to said Designated

Provider of a Preventive Service to Long-Term Care on behalf of said Insured

In-Home Person Requiring Support within the limit of the amount to be paid to

said Insured In-Home Person Requiring Support as an Allowance for

Preventive Long-Term Care Service.

(5) When the payment pursuant to the provisions of the preceding paragraph is

paid, it shall be deemed that an Allowance for Preventive Long-Term Care

Service is paid to said Insured In-Home Person Requiring Support.

(6) A Municipality, when a Designated Provider of a Preventive Service to Long-

Term Care requests an Allowance for Preventive Long-Term Care Service,

shall pay after conducting an examination according to standards provided by

the Minister of Health, Labour, and Welfare as set forth in each item of

paragraph (2), standards concerning effective support methods for prevention

of long-term care pertaining to the Designated Preventive Service of Long-

Term Care as prescribed in Article 115-4, paragraph (4), and standards

68

concerning facilities and management of a Designated Preventive Service to

Long-Term Care Business (limited to the part concerning the handling of

Designated Preventive Service of Long-Term Care).

(7) The provisions of Article 41, paragraph (2), paragraph (3), paragraph (10),

and paragraph (11) shall apply mutatis mutandis to payment of an Allowance

for Preventive Long-Term Care Service and the provisions of paragraph (8) of

the same Article shall apply mutatis mutandis to a Designated Provider of a

Preventive Service to Long-Term Care. In this case, the necessary technical

replacement of terms in these provisions shall be provided by a Cabinet Order.

(8) In addition to those matters as prescribed in each of the preceding

paragraphs, other necessary matters for payment of an Allowance for

Preventive Long-Term Care Service and for the request of an Allowance for

Preventive Long-Term Care Service by a Designated Provider of a Preventive

Service to Long-Term Care shall be provided by an Ordinance of the Ministry

of Health, Labour, and Welfare.

(Payment of an Exceptional Allowance for Preventive Service of Long-Term

Care)

Article 54 (1) A Municipality, in the following cases, shall pay an Exceptional

Allowance for Preventive Service of Long-Term Care to an Insured In-Home

Person Requiring Support:

(i) when a Municipality determines it necessary in a case when an Insured

Person Requiring Support receives Designated Preventive Service of Long-

Term Care prior to the date said Certification of Needed Support becomes

effective due to an emergency or other compelling reason;

(ii) when a Municipality determines it necessary in a case when an Insured

Person Requiring Support receives Preventive Service of Long-Term Care

other than Designated Preventive Service of Long-Term Care or equivalent

service (limited to those provided by a provider that performs business that

has been determined to satisfy the standards for Preventive Service of Long-

Term Care among standards provided by an Ordinance of the Ministry of

Health, Labour, and Welfare as set forth in Article 115-4, paragraph (1)

pertaining to a Designated Provider of a Preventive Service to Long-Term

Care and standards concerning the number of employees provided by an

Ordinance of the Ministry of Health, Labour, and Welfare as set forth in the

same paragraph that concern effective support methods for Prevention of

Long-Term Care pertaining to a Designated Preventive Service of Long-Term

Care as prescribed in paragraph (2) of the same Article and concerning

facilities and management of Designated Preventive Service to Long-Term

Care Business; herein referred to as "Preventive Long-Term Care Service

Applicable to Standards" in the following item);

69

(iii) when a Municipality determines it necessary in a case when an Insured In-

Home Person Requiring Support who is domiciled on an isolated island or

other location where it is significantly difficult to secure Designated

Preventive Service of Long-Term Care and Preventive Long-Term Care

Service Applicable to Standards and is in a location that is subject to

standards as determined by an Ordinance of the Minister of Health, Labour,

and Welfare receives Preventive Service of Long-Term Care other than

Designated Preventive Service of Long-Term Care and Preventive Long-Term

Care Service Applicable to Standards or equivalent services;

(iv) when provided by a Cabinet Order.

(2) The amount of Exceptional Allowance for Preventive Service of Long-Term

Care shall be determined by a Municipality based on the amount equivalent to

90 percent of the amount of expenses calculated based on standards provided

by the Minister of Health, Labour, and Welfare as set forth in each item of

paragraph(2) of the preceding Article pertaining to said Preventive Service of

Long-Term Care or equivalent service (when the calculated amount exceeds the

actual expenses required for said Preventive Service of Long-Term Care or

equivalent service (except for the expenses required to purchase Specified

Equipment for Preventive Long-Term Care Covered by Public Aid and

excluding the expenses necessary to provide meals, residence, and other

expenses as determined by an Ordinance of the Ministry of Health, Labour,

and Welfare as necessary for daily life with regard to the expenses required for

Outpatient Preventive Long-Term Care, Outpatient Rehabilitation for

Preventive Long-Term Care, a Short-Term Admission for Daily Preventive

Long-Term Care, Short-Term Admission for Recuperation for Preventive Long-

Term Care and Daily Preventive Long-Term Care Admitted to a Specified

Facility), said calculated amount shall be the actual expenses required for said

Preventive Service of Long-Term Care or equivalent service).

(3) The mayor of a Municipality, when he or she determines the necessity of

payment of an Exceptional Allowance for Preventive Service of Long-Term

Care, may order a person that has been in charge of the Preventive Service of

Long-Term Care pertaining to said payment or equivalent service (herein

referred to as "Person, etc., in Charge of Providing Preventive Long-Term Care

Service" in this paragraph) to report, submit, or present record books and

documents, appear, or direct personnel to question the relevant Person or enter

the Business Office of the provider of said Person, etc., in Charge of said

Preventive Service of Long-Term Care pertaining to said payment in order to

inspect said equipment, record books and documents, and other items.

(4) The provisions of Article 24, paragraph (3) shall apply mutatis mutandis to

questions and inspections pursuant to the provisions of the preceding

paragraph, and the provisions of paragraph (4) of the same Article shall apply

70

mutatis mutandis to the authority granted pursuant to the provisions of the

preceding paragraph.

(Payment of an Allowance for Community-Based Preventive Long-Term Care

Service)

Article 54-2 (1) A Municipality, when an Insured In-Home Person Requiring

Support receives from a person designated by the mayor of said Municipality

(herein referred to as "Designated Provider of Community-Based Preventive

Service of Long-Term Care") the Community-Based Preventive Service of Long-

Term Care (herein referred to as "Designated Community-Based Preventive

Service of Long-Term Care") provided by a provider that performs Community-

Based Preventive Long-Term Care Business pertaining to said designation

(limited to a case said Insured In-Home Person Requiring Support has notified

the Municipality pursuant to the provisions of Article 58, paragraph (4) to

receive a Designated Support for Prevention of Long-Term Care as prescribed

in paragraph (1) of the same Article when said Designated Community-Based

Preventive Service of Long-Term Care is subject to said Designated Support for

Prevention of Long-Term Care and other matters as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare), shall pay to said

Insured In-Home Person Requiring Support the Allowance for Community-

Based Preventive Long-Term Care Service for the expenses required for said

Community-Based Service for Preventive Long-Term Care (excluding the

expenses necessary to provide meals and other expenses as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare as necessary for

daily life; the same shall apply hereinafter in this Article), however, provided

that this provision shall not apply to a case when said Insured In-Home Person

Requiring Support that has been designated pursuant to the provisions of

Article 37, paragraph (1), receives a Community-Based Service for Preventive

Long-Term Care other than the type pertaining to said designation.

(2) The amount of Allowance for Community-Based Preventive Long-Term Care

Service shall be according to the categories of Community-Based Service for

Preventive Long-Term Care listed in the following items and the amount as

prescribed in said item:

(i) Preventive Long-Term Care for a Dementia Outpatient: the amount

equivalent to 90 percent of the amount calculated after considering the

amount of average expenses (excluding the expenses necessary to provide

meals and other expenses as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare as necessary for daily life) that is calculated

after considering the content of the Designated Community-Based Preventive

Service of Long-Term Care pertaining to Preventive Long-Term Care for a

Dementia Outpatient, the area where the provider that performs said

71

Designated Community-Based Preventive Service of Long-Term Care is

located, etc., necessary for said Designated Community-Based Preventive

Service of Long-Term Care based on the standards provided by the Minister

of Health, Labour, and Welfare (when said calculated amount exceeds the

actual amount required for said Designated Community-Based Preventive

Service of Long-Term Care, the amount of allowance shall be the actual

expenses required for said Designated Community-Based Preventive Service

of Long-Term Care);

(ii) Multifunctional Preventive Long-Term Care in a Small Group Home, and

Preventive Long-Term Care for a Dementia Patient in Communal Living: the

amount equivalent to 90 percent of the amount calculated according to type

of Community-Based Preventive Service of Long-Term Care, after

considering the average expenses (excluding the expenses necessary to

provide meals and other expenses as determined by an Ordinance of the

Ministry of Health, Labour, and Welfare as necessary for daily life) that is

calculated after considering the categories of Needed Support Condition, the

location of the provider that performs the Designated Community-Based

Preventive Service of Long-Term Care Business pertaining to the type of said

Community-Based Preventive Service of Long-Term Care, etc., necessary for

said Community-Based Preventive Service of Long-Term Care, based on the

standards provided by the Minister of Health, Labour, and Welfare (when

said calculated amount exceeds the actual expense required for said

Designated Community-Based Preventive Service of Long-Term Care, the

allowance shall be the actual amount required for said Designated

Community-Based Preventive Service of Long-Term Care).

(3) The Minister of Health, Labour, and Welfare shall, when it intends to provide

standards as prescribed in each item of the preceding paragraph, hear opinions

of Social Security Council in advance.

(4) A Municipality, notwithstanding the provisions of each item of paragraph (2),

on behalf of the amount of Allowance for Community-Based Preventive Long-

Term Care Service as prescribed in the same paragraph and same item, may

determine that the amount for the allowance of Community-Based Preventive

Service of Long-Term Care in said Municipality is an amount that shall not

exceed the calculated amount of Allowance for said Community-Based

Preventive Service of Long-Term Care.

(5) A Municipality, when it intends to determine the amount of Allowance for

Community-Based Preventive Long-Term Care Service in said Municipality as

prescribed in the preceding paragraph, shall reflect the opinions of Insured

Persons of Long-Term Care Insurance undertaken by said Municipality and

other relevant persons, and take necessary measures in order to promote the

use of knowledge of persons with relevant knowledge and experience, in

72

advance.

(6) When an Insured In-Home Person Requiring Support receives Designated

Preventive Service of Long-Term Care from a Designated Provider of

Community-Based Preventive Service of Long-Term Care, a Municipality may

pay the expense required for said Designated Preventive Service of Long-Term

Care that said Insured In-Home Person Requiring Support should pay to said

Designated Provider of a Preventive Service to Long-Term Care, to said

Designated Provider of a Preventive Service to Long-Term Care on behalf of

said Insured In-Home Person Requiring Support within the limit of the amount

to be paid to said Insured In-Home Person Requiring Support as an Allowance

for Preventive Long-Term Care Service.

(7) When the cost is paid pursuant to the provisions of the preceding paragraph,

it shall be deemed that an Allowance for Community-Based Preventive Long-

Term Care Service is paid to said Insured In-Home Person Requiring Support.

(8) A Municipality shall, when a Designated Provider of Community-Based

Service for Preventive Long-Term Care requests an Allowance for Community-

Based Preventive Long-Term Care Service, pay said allowance after conducting

an examination according to standards provided by the Minister of Health,

Labour, and Welfare as set forth in each item of paragraph (2) or the amount

determined by the Municipality pursuant to the provisions of paragraph (4),

the standards concerning effective support methods for Prevention of Long-

Term Care pertaining to a Designated Community-Based Preventive Service of

Long-Term Care as prescribed in Article 115-13, paragraph (2) or paragraph (4),

and standards concerning facilities and management of a Designated

Community-Based Service for Preventive Long-Term Care Business (limited to

the part concerning the handling of Designated Community-Based Preventive

Service of Long-Term Care).

(9) The provisions of Article 41, paragraph (2), paragraph (3), paragraph (10) and

paragraph (11) shall apply mutatis mutandis to the payment of an Allowance

for Community-Based Preventive Long-Term Care Service and the provisions

of paragraph (8) of the same Article shall apply mutatis mutandis to a

Designated Service Provider of Community-Based Preventive Approach in

Long-Term Care. In this case, the necessary technical replacement of terms in

these provisions shall be provided by a Cabinet Order.

(10) In addition to the provisions as prescribed in the items of the preceding

paragraph, other necessary matters payment of an Allowance for Community-

Based Preventive Long-Term Care Service and for requests of Allowance for

Community-Based Preventive Long-Term Care Service by a Designated

Provider of Community-Based Service for Preventive Long-Term Care shall be

provided by an Ordinance of the Ministry of Health, Labour, and Welfare.

73

(Payment of an Exceptional Allowance for Community-Based Preventive

Service of Long-Term Care)

Article 54-3 (1) A Municipality shall, in the following cases, pay an Exceptional

Allowance for Community-Based Preventive Service of Long-Term Care to an

Insured In-Home Person Requiring Support:

(i) when a Municipality determines it necessary in a case when an Insured

Person Requiring Support receives Designated Community-Based Preventive

Service of Long-Term Care prior to the date said Certification of Needed

Support becomes effective due to an emergency or other compelling reason;

(ii) when a Municipality determines it necessary in a case when an Insured In-

Home Person Requiring Support that is domiciled on an isolated island or

other location where it is significantly difficult to secure Designated

Community-Based Preventive Service of Long-Term Care and where it is

defined by standards provided by an the Minister of Health, Labour, and

Welfare, receives Community-Based Preventive Service of Long-Term Care

other than Designated Community-Based Preventive Service of Long-Term

Care or equivalent services;

(iii) when provided by a Cabinet Order.

(2) The amount of an Exceptional Allowance for Community-Based Preventive

Service of Long-Term Care shall be provided by a Municipality based on the

amount equivalent to 90 percent of the amount of expenses calculated, with

regard to said Community-Based Preventive Service of Long-Term Care or

equivalent service, based on standards provided by the Minister of Health,

Labour, and Welfare as set forth in each item of paragraph (2) of the preceding

Article (when said calculated amount exceeds the amount of actual expenses

required for said Community-Based Preventive Service of Long-Term Care or

equivalent service (excluding the expenses necessary to provide meals and

other necessary expenses as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare as necessary for daily life), the allowance shall be

the actual amount of expenses required for said Community-Based Preventive

Service of Long-Term Care or equivalent service), or based on the amount

provided by a Municipality pursuant to the provisions of paragraph (4) of the

same Article.

(3) The mayor of a Municipality, when he or she determines the necessary for

payment of an Exceptional Allowance for Community-Based Preventive Service

of Long-Term Care, may order a person that has been in charge of the

Community-Based Preventive Service of Long-Term Care pertaining to said

payment or equivalent service (hereinafter referred to as "Person, etc., in

Charge of Community-Based Preventive Long-Term Care, etc." in this

paragraph) to report, submit or present record books and documents, appear,

or direct its personnel to question the relevant person or enter the Business

74

Office of the provider of said Person, etc., in Charge of said Community-Based

Preventive Service of Long-Term Care pertaining to said payment in order to

inspect said equipment, record books and documents, and other items.

(4) The provisions of Article 24, paragraph (3) shall apply mutatis mutandis to

questions and inspections pursuant to the provisions of the preceding

paragraph, and the provisions of paragraph (4) of the same Article shall apply

mutatis mutandis to the authority granted pursuant to the provisions of the

preceding paragraph.

(Maximum Payment pertaining to an Allowance for Preventive Long-Term

Care Service, etc.)

Article 55 (1) Total sum of the total amounts of the Allowance for Preventive

Long-Term Care Service and Exceptional Allowance for Preventive Service of

Long-Term Care that are paid for Preventive Service of Long-Term Care, and

the Allowance for Community-Based Preventive Long-Term Care Service and

Exceptional Allowance for Community-Based Preventive Service of Long-Term

Care that are paid for Designated Provider of Community-Based Service for

Preventive Long-Term Care, as pertaining to a single category of Preventive

Service of Long-Term Care, etc., that an In-Home Person Requiring Support

receives monthly by category of Preventive Service of Long-Term Care, etc.

(which means categories of two or more types as determined by the Minister of

Health, Labour, and Welfare, with regard to Preventive Service of Long-Term

Care (including equivalent services; the same shall apply hereinafter in this

Article) and Community-Based Preventive Service of Long-Term Care

(including equivalent services; the same shall apply hereinafter in this Article),

after considering the inter-substitution by type; the same shall apply

hereinafter in this Article) during the period provided by an Ordinance of the

Ministry of Health, Labour, and Welfare, shall not exceed the amount

equivalent to 90 percent of the amount calculated pursuant to the provisions of

an Ordinance of the Ministry of Health, Labour, and Welfare based on the base

amount of maximum benefit for the payment categories of Preventive Service

of Long-Term Care, etc.

(2) The base amount of maximum benefit for the payment categories of Allowance

for Preventive Long-Term Care Service, etc., as set forth in the preceding

paragraph shall be the amount determined by the Minister of Health, Labour,

and Welfare by category of Preventive Service of Long-Term Care, etc., after

considering the types of standard use that are according to the categories of

Needed Support Condition, of Preventive Service of Long-Term Care, and of

Community-Based Preventive Service of Long-Term Care pertaining to the

categories of said Preventive Service of Long-Term Care, etc., during the period

as determined by an Ordinance of the Ministry of Health, Labour, and Welfare

75

as prescribed in the same paragraph, standards provided by the Minister of

Health, Labour, and Welfare as set forth in each item of Article 53, paragraph

(2) and each item of Article 54-2, paragraph (2) pertaining to said Preventive

Service of Long-Term Care and Community-Based Preventive Service of Long-

Term Care.

(3) A Municipality, notwithstanding the provisions of the preceding paragraph

and pursuant to the provisions of a municipal ordinance, in lieu of the base

amount of the maximum benefit by payment category of Preventive Service of

Long-Term Care, etc., as set forth in paragraph (1), may determine that an

amount exceeding said base amount as the base amount of maximum benefit by

payment category of Preventive Service of Long-Term Care in said

Municipality.

(4) A Municipality may stipulate that the total sum of the total amounts of

Allowance for Preventive Long-Term Care Service and Exceptional Allowance

for Preventive Service of Long-Term Care that are paid for single type of

Preventive Service of Long-Term Care and the total amount of Allowance for

Community-Based Preventive Long-Term Care Service and Exceptional

Allowance for Community-Based Preventive Service of Long-Term Care that

are paid for single type of Community-Based Preventive Service of Long-Term

Care as allowances that were paid monthly to an In-Home Person Requiring

Support by type of Preventive Service of Long-Term Care and Community-

Based Preventive Service of Long-Term Care (limited to those types included in

categories of Preventive Service of Long-Term Care, etc., and provided by the

Minister of Health, Labour, and Welfare; the same shall apply in the following

paragraph) during the period as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare shall not exceed the amount equivalent to 90

percent of the amount calculated pursuant to the provisions of an Ordinance of

the Ministry of Health, Labour, and Welfare based on the base amount of

maximum benefit by payment type of Preventive Service of Long-Term Care,

etc.

(5) The base amount of maximum benefit by payment type of Preventive Service

of Long-Term Care, etc., as set forth in the preceding paragraph shall be the

amount that a Municipality stipulates by ordinance, by type of Preventive

Service of Long-Term Care and Community-Based Preventive Service of Long-

Term Care, after considering the type of standard use that is according to each

Category of Needed Support Condition, of said Preventive Service of Long-

Term Care and Community-Based Preventive Service of Long-Term Care

during the period as determined by an Ordinance of the Ministry of Health,

Labour, and Welfare as prescribed in the same paragraph, standards

determined by the Minister of Health, Labour, and Welfare as set forth in each

item of Article 53, paragraph (2) and each item of Article 54-2, paragraph (2)

76

pertaining to said Preventive Service of Long-Term Care and Community-

Based Preventive Service of Long-Term Care, etc., within the base amount of

maximum benefit by payment category of Preventive Service of Long-Term

Care, etc., as set forth in paragraph (1) pertaining to the categories of

Preventive Service of Long-Term Care, etc., that include said Preventive

Service of Long-Term Care and Community-Based Preventive Service of Long-

Term Care (said base amount, with regard to the Municipality that provides an

ordinance pursuant to the provisions of paragraph (3), shall be the amount by

which measures pursuant to the provisions of said municipal ordinance are

undertaken).

(6) In a case when the total amount as prescribed in paragraph (1) exceeds the

amount equivalent to 90 percent of the amount as prescribed in the same

paragraph or when the total amount as prescribed in paragraph (4) exceeds the

amount equivalent to 90 percent of the amount as prescribed in the same

paragraph by payment of an Allowance for Preventive Long-Term Care Service

or Exceptional Allowance for Preventive Service of Long-Term Care, or an

Allowance for Community-Based Preventive Long-Term Care Service or an

Exceptional Allowance for Community-Based Preventive Service of Long-Term

Care, the amount of said Allowance for Preventive Long-Term Care Service or

Exceptional Allowance for Preventive Service of Long-Term Care, or Allowance

for Community-Based Preventive Long-Term Care Service or Exceptional

Allowance for Community-Based Preventive Service of Long-Term Care shall

be the amount calculated pursuant to the provisions of a Cabinet Order,

notwithstanding the provisions of each item of Article 53, paragraph (2),

Article 54, paragraph (2), each item of Article 54-2, paragraph (2) or paragraph

(4), or paragraph (2) of the preceding Article.

(Payment of an Allowance for Purchasing Equipment for Preventive Long-Term

Care Covered by Public Aid)

Article 56 (1) A Municipality, when an Insured In-Home Person Requiring

Support purchases from a Designated Provider of a Preventive Service to Long-

Term Care pertaining to the Sale of Specified Equipment for Preventive Long-

Term Care Covered by Public Aid, Specified Equipment for Preventive Long-

Term Care Covered by Public Aid that is sold by a Provider that performs

Preventive Service of Long-Term Care Business pertaining to said designation,

shall pay an Allowance for Purchasing Equipment for Preventive Long-Term

Care Covered by Public Aid to said Insured In-Home Person Requiring Support.

(2) An Allowance for Purchasing Equipment for Preventive Long-Term Care

Covered by Public Aid shall be paid pursuant to the provisions of an Ordinance

of the Ministry of Health, Labour, and Welfare only when a Municipality

determines it necessary.

77

(3) The amount of Allowance for Purchasing Equipment for Preventive Long-

Term Care Covered by Public Aid shall be the amount equivalent to 90 percent

of the actual expenses required to purchase said Specified Equipment for

Preventive Long-Term Care Covered by Public Aid.

(4) The total amount of Allowance for Purchasing Equipment for Preventive

Long-Term Care Covered by Public Aid that is paid monthly for Specified

Equipment for Preventive Long-Term Care Covered by Public Aid that an

Insured In-Home Person Requiring Support purchases during the period as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare

shall not exceed the amount equivalent to 90 percent of the amount calculated

pursuant to the provisions of an Ordinance of the Ministry of Health, Labour,

and Welfare based on the base amount of maximum payment of the Allowance

for Purchasing Equipment for Preventive Long-Term Care Covered by Public

Aid .

(5) The base amount of maximum payment of the Allowance for Purchasing

Equipment for Preventive Long-Term Care Covered by Public Aid as set forth

in the preceding paragraph shall be the amount determined by the Minister of

Health, Labour, and Welfare after considering the expenses normally required

to purchase Specified Equipment for Preventive Long-Term Care Covered by

Public Aid during the period as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare as set forth in the same paragraph.

(6) A Municipality, notwithstanding the provisions of the preceding paragraph

and pursuant to the provisions of a municipal ordinance, in lieu of the base

amount of maximum payment of the Allowance for Purchasing Equipment for

Preventive Long-Term Care Covered by Public Aid as set forth in paragraph (4),

may stipulate an amount that exceeds said base amount as the base amount of

maximum payment for the Allowance for Purchasing Equipment for Preventive

Long-Term Care Covered by Public Aid in said Municipality.

(7) In a case when the total amount as prescribed in paragraph (4) exceeds the

amount equivalent to 90 percent of the amount as prescribed in the same

paragraph due to payment of an Allowance for Purchasing Equipment for

Preventive Long-Term Care Covered by Public Aid , the amount of said

Allowance for Purchasing Equipment for Preventive Long-Term Care Covered

by Public Aid shall be the amount calculated pursuant to the provisions of a

Cabinet Order, notwithstanding the provisions of paragraph (3).

(Payment of Allowance for Preventive Long-Term Care Home Modification)

Article 57 (1) A Municipality shall, when an Insured In-Home Person Requiring

Support modifies his or her home, pay Allowance for Preventive Long-Term

Care Home Modification to said Insured In-Home Person Requiring Support.

(2) Allowance for Preventive Long-Term Care Home Modification shall, pursuant

78

to the provisions of an Ordinance of the Ministry of Health, Labour, and

Welfare, be paid only when a Municipality determines it necessary.

(3) The amount of Allowance for Preventive Long-Term Care Home Modification

shall be the amount equivalent to 90 percent of the actual expenses required

for said Home Modification.

(4) The total amount of Allowance for Preventive Long-Term Care Home

Modification that should be paid for one type of Home Modification that an

Insured In-Home Person Requiring Support undertakes shall not exceed the

amount equivalent to 90 percent of the amount calculated pursuant to the

provisions of an Ordinance of the Ministry of Health, Labour, and Welfare

based on the base amount of maximum payment as an Allowance for

Preventive Long-Term Care Home Modification.

(5) The based amount of maximum payment as an Allowance for Preventive

Long-Term Care Home Modification as set forth in the preceding paragraph

shall be the amount determined by the Minister of Health, Labour, and

Welfare by type of Home Modification care after considering the expenses

normally required.

(6) A Municipality, notwithstanding the provisions of the preceding paragraph

and pursuant to the provisions of a municipal ordinance, in lieu of the base

amount of maximum payment as an Allowance for Preventive Long-Term Care

Home Modification as set forth in paragraph (4), may stipulate an amount that

exceeds said base amount as the base amount of maximum payment as an

Allowance for Preventive Long-Term Care Home Modification in said

Municipality.

(7) In a case when the total amount as prescribed by paragraph (4) exceeds the

amount equivalent to 90 percent of the amount as prescribed in the same

paragraph due to payment of an Allowance for Preventive Long-Term Care

Home Modification, the amount of said Allowance for Preventive Long-Term

Care Home Modification shall be the amount calculated pursuant to the

provisions of a Cabinet Order, notwithstanding the provisions of paragraph (3).

(8) The mayor of a Municipality, when he or she determines the necessity of the

payment of an Allowance for Preventive Long-Term Care Home Modification,

may order a person that modifies the home or equivalent service pertaining to

said payment (herein referred to as "Person, etc., that Modifies a Home" in this

paragraph") to report, submit or present record books and documents, appear,

or direct its personnel to question the relevant Person or enter the Business

Office of the provider of said Person, etc., that Modifies a Home pertaining to

said payment in order to inspect such facilities, record books and documents,

and other items.

(9) The provisions of Article 24, paragraph (3) shall apply mutatis mutandis to

questions and inspections as prescribed in the provisions of the preceding

79

paragraph and the provisions of paragraph (4) of the same Article shall apply

mutatis mutandis to the authority granted as prescribed in the provisions of

the preceding paragraph.

(Payment of an Allowance for Preventive Long-Term Care Service Plan)

Article 58 (1) A Municipality, when an Insured In-Home Person Requiring

Support receives from a person designated by the mayor of said Municipality

(herein referred to as "Designated Provider of Preventive Support of Long-

Term Care"), the Preventive Long-Term Care Support provided by a provider

that performs the Preventive Long-Term Care Support Business pertaining to

said designation (herein referred to as "Designated Support for Prevention of

Long-Term Care"), shall pay to said Insured In-Home Person Requiring

Support an Allowance for Preventive Long-Term Care Service Plan for the

expenses required for said Designated Support for Prevention of Long-Term

Care.

(2) The amount of the Allowance for Preventive Long-Term Care Service Plan

shall be the amount of expenses calculated by standards as prescribed by the

Minister of Health, Labour, and Welfare after considering the average

expenses necessary for Designated Support for Prevention of Long-Term Care

that is calculated after considering the area, etc., where a provider that

performs the Designated Support for Prevention of Long-Term Care Business is

located (in a case when said calculated amount exceeds the actual expenses

necessary for said Designated Support for Prevention of Long-Term Care, the

allowance shall be the actual expenses necessary for said Designated Support

for Prevention of Long-Term Care).

(3) The Minister of Health, Labour, and Welfare, when it intends to provide

standards as prescribed in the items of the preceding paragraph, shall hear

opinions of the Social Security Council in advance.

(4) When an Insured In-Home Person Requiring Support receives Designated

Support for Prevention of Long-Term Care from a Designated Provider of

Preventive Support of Long-Term Care (limited to a case when said Insured In-

Home Person Requiring Support has notified in advance the Municipality

pursuant to the provisions of an Ordinance of the Ministry of Health, Labour,

and Welfare of receipt of said Designated Support for Prevention of Long-Term

Care), a Municipality may pay the expenses required for said Designated

Support for Prevention of Long-Term Care that said Insured In-Home Person

Requiring Support should pay to said Designated Provider of Support for

Prevention of Long-Term Care, to said Designated Provider of Preventive

Support of Long-Term Care on behalf of said Insured In-Home Person

Requiring Support within the limit of the amount to be paid to said Insured In-

Home Person Requiring Support as an Allowance for Preventive Long-Term

80

Care Service Plan.

(5) When the expenses are paid pursuant to the provisions of the preceding

paragraph, it shall be deemed that an Allowance for Preventive Long-Term

Care Service Plan is paid to said Insured In-Home Person Requiring Support.

(6) A Municipality, when a Designated Provider of Preventive Support of Long-

Term Care requests an Allowance for Preventive Long-Term Care Service Plan,

shall pay said allowance after conducting an examination according to

standards determined by the Minister of Health, Labour, and Welfare as set

forth in each item of paragraph (2), standards concerning effective support

methods for Prevention of Long-Term Care pertaining to Designated Support

for Prevention of Long-Term Care as prescribed in Article 115-22, paragraph

(2), and standards concerning management of the Designated Support for

Prevention of Long-Term Care Business (limited to the part concerning the

handling of Designated Support for Prevention of Long-Term Care).

(7) The provisions of Article 41, paragraph (2), paragraph (3), paragraph (10),

and paragraph (11) shall apply mutatis mutandis to the payment of an

Allowance for Preventive Long-Term Care Service Plan and the provisions of

paragraph (8) of the same Article shall apply mutatis mutandis to a Designated

Provider of Preventive Support of Long-Term Care. In this case, the necessary

technical replacement of terms in these provisions shall be provided by a

Cabinet Order.

(8) In addition to those provisions as prescribed in each of the preceding

paragraphs, other necessary matters payment of an Allowance for Preventive

Long-Term Care Service Plan and the request of an Allowance for Preventive

Long-Term Care Service Plan by a Designated Provider of Preventive Support

of Long-Term Care shall be as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare.

(Payment of an Exceptional Allowance for Preventive Long-Term Care Service

Plan)

Article 59 (1) A Municipality shall, in the following cases, pay an Exceptional

Allowance for Preventive Long-Term Care Service Plan to an Insured In-Home

Person Requiring Support:

(i) when a Municipality determines it necessary in a case when an Insured

Person Requiring Support receives a Preventive Long-Term Care Support

other than a Designated Support for Prevention of Long-Term Care or

equivalent service (limited to services provided by a provider that performs

said business in a location that has been determined to satisfy the standards

provided by an Ordinance of the Ministry of Health, Labour, and Welfare,

among the standards as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare as set forth in Article 115-22, paragraph (1)

81

pertaining to a Designated Support for Prevention of Long-Term Care and

the number of employees as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare as set forth in the same paragraph, and

standards concerning effective support methods for Prevention of Long-Term

Care pertaining to Designated Support for Prevention of Long-Term Care as

prescribed in paragraph (2) of the same Article and standards concerning the

management of a business of Designated Support for Prevention of Long-

Term Care (herein referred to as "Preventive Long-Term Care Support

Applicable to Standards" in the items following);

(ii) when a Municipality determines it necessary in a case when an Insured In-

Home Person Requiring Support that is domiciled on an isolated island or

other location where it is significantly difficult to secure Designated Support

for Prevention of Long-Term Care, and Preventive Long-Term Care Support

Applicable to Standards, and where it is defined by standards as determined

by an Ordinance of the Minister of Health, Labour, and Welfare, receives

Preventive Long-Term Care Support or equivalent service other than

Designated Support for Prevention of Long-Term Care or Preventive Long-

Term Care Support Applicable to Standards;

(iii) when provided by a Cabinet Order.

(2) The amount of Exceptional Allowance for Preventive Long-Term Care Service

Plan shall be specified by a Municipality based on the expenses calculated by

standards determined by the Minister of Health, Labour, and Welfare as set

forth in paragraph (2) of the preceding Article for said Preventive Long-Term

Care Support or equivalent service (in a case said calculated amount exceeds

the amount of actual expenses of said Preventive Long-Term Care Support or

equivalent service, the base amount shall be the actual expenses required for

said Preventive Long-Term Care Support or equivalent service).

(3) The mayor of a Municipality, when he or she determines the necessity for the

payment of an Exceptional Allowance for Preventive Long-Term Care Service

Plan, may order a person that is or was in charge of the Preventive Long-Term

Care Support pertaining to said payment or equivalent service (herein referred

to as "Person, etc., in Charge of Preventive Long-Term Care Support, etc." in

this paragraph") to report, submit or present record books and documents,

appear, or direct its personnel to question the relevant Person or enter the

Business Office of the provider of said Person, etc., in Charge of Preventive

Long-Term Care Support, etc., pertaining to said payment in order to inspect

said record books and documents, and other items.

(4) The provisions of Article 24, paragraph (3) shall apply mutatis mutandis to

questions and inspections as prescribed in the preceding paragraph and the

provisions of paragraph (4) of the same Article shall apply mutatis mutandis to

the authority granted as prescribed in the preceding paragraph.

82

(Exceptions to the Amount of Allowance for Preventive Long-Term Care

Service, etc.)

Article 60 In a case when a Municipality applies provisions as prescribed in the

following items to a prevention benefit listed in the said items that an Insured

Person Requiring Support receives, for whom it is deemed to be difficult to pay

necessary expenses for Preventive Long-Term Care Service (including

equivalent services), Community-Based Service for Preventive Long-Term Care

(including equivalent services), or Home Modification due to a disaster or other

special reasons as determined by an Ordinance of the Ministry of Health,

Labour, and Welfare, the term "90 percent" in these provisions shall be deemed

to be replaced with "the percentage provided by a Municipality within the

range of more than 90 percent to 100 percent or less":

(i) payment of an Allowance for Preventive Service of Long-Term Care of the

Age: Article 53, paragraph (2), item (i), and item (ii), and Article 55,

paragraph (1), paragraph (4), and paragraph (6);

(ii) payment of an Exceptional Allowance for Preventive Service of Long-Term

Care: Article 54, paragraph (2) and Article 55, paragraph (1), paragraph (4),

and paragraph (6);

(iii) payment of an Allowance for Community-Based Preventive Service of

Long-Term Care: Article 54-2, paragraph (2), item (i) and item (ii), and

Article 55, paragraph (1), paragraph (4), and paragraph (6);

(iv) payment of an Exceptional Allowance for Community-Based Preventive

Service of Long-Term Care: Article 54-3, paragraph (2), and Article 55,

paragraph (1), paragraph (4), and paragraph (6);

(v) payment of an Allowance for Purchasing Equipment for Preventive Long-

Term Care Covered by Public Aid: Article 56, paragraph (3), paragraph (4)

and paragraph (7);

(vi) payment of an Allowance for Preventive Long-Term Care Home

Modification: Article 57, paragraph (3), paragraph (4), and paragraph (7).

(Payment of an Allowance for High-Cost Preventive Long-Term Care Service)

Article 61 (1) When the amount that is obtained by deducting from the amount

calculated pursuant to the provisions of a Cabinet Order as the total amount of

each expense required for Preventive Long-Term Care Service (including

equivalent service), or Community-Based Service for Preventive Long-Term

Care (including equivalent service) that an Insured In-Home Person Requiring

Support receives, the total amount of Allowance for Preventive Long-Term

Care Service, Exceptional Allowance for Preventive Service of Long-Term Care,

Community-Based Preventive Service of Long-Term Care, and Exceptional

Allowance for Community-Based Preventive Service of Long-Term Care that

83

are actually paid for the said expenses is significantly large, a Municipality

shall pay an Allowance for High-Cost Preventive Long-Term Care Service to

said Insured In-Home Person Requiring Support.

(2) In addition to the provisions as set forth in the preceding paragraph,

requirements for payment of an Allowance for High-Cost Preventive Long-

Term Care Service, the amount of said allowance, and other matters necessary

for payment of an Allowance for High-Cost Preventive Long-Term Care Service

shall be provided by a Cabinet Order after considering the impact on the

household budget from the burden of the expenses necessary for Preventive

Long-Term Care Service or Community-Based Service for Preventive Long-

Term Care.

(Payment of an Allowance for Preventive Long-Term Care Service to a Person

Admitted to a Specified Facility)

Article 61-2 (1) A Municipality, when a person as determined by an Ordinance of

the Ministry of Health, Labour, and Welfare due to the extenuating income

status and other circumstances among those who are an Insured In-Home

Person Requiring Support receives Designated Preventive Long-Term Care

Service (herein referred to as "Specified Preventive Service of Long-Term Care"

in this Article and the following Article paragraph (1)) as listed below, shall

pay to said Insured In-Home Person Requiring Support (herein referred to as

"Specified Person Admitted to a Facility" in this Article and the following

Article paragraph (1)) the Allowance for Preventive Long-Term Care Service to

a Person Admitted to a Specified Facility for the expenses required to provide

meals and residence by a Designated Provider of Preventive Long-Term Care

Service that provides said Specified Preventive Service of Long-Term Care

(herein referred to as "Long-Term Care Preventive Service Specified Provider"

in this Article), however, provided that this provision shall not apply to when

said Specified Person Admitted to a Facility who is assigned a designation

pursuant to the provisions of Article 37, paragraph (1) receives Specified

Preventive Service of Long-Term Care other than the type pertaining to said

designation:

(i) Short-Term Admission for Daily Preventive Long-Term Care;

(ii) Short-Term Admission for Recuperation for Preventive Long-Term Care.

(2) The amount of Allowance for Long-Term Care Preventive Service of a Person

Admitted to a Specified Facility shall be the total of the amount as prescribed

in item (i) and the amount as prescribed in item (ii):

(i) the amount remaining after the amount determined by the Minister of

Health, Labour, and Welfare after considering the status of food expenses for

an average household budget, the income status of the Specified Person

Admitted to a Facility, and other circumstances (herein referred to as

84

"Maximum Allowance for Meal Expense" in this Article and paragraph (2) of

the following Article) is deducted from the amount of expenses determined by

the Minister of Health, Labour, and Welfare after considering the average

expenses required to provide meals at a Long-Term Care Preventive Service

Specified Provider (in a case when said amount exceeds the actual expenses

of providing said meals, this amount shall be the amount of the actual

expenses of providing said meals, herein referred to as "Base Cost for Meal

Expense" in this Article and paragraph (2) of the following Article);

(ii) the amount remaining after the amount determined by the Minister of

Health, Labour, and Welfare after considering the income status of the

Special Insured Person Admitted to the Facility and other circumstances

(herein referred to as "Maximum Allowance for Room and Board Expense" is

deducted from the amount determined by the Ministry of Health, Labour,

and Welfare after considering the average expenses necessary for a stay in

the Long-Term Care Preventive Service Specified Provider, the status of said

facility, and other circumstances (in a case when said amount exceeds the

actual expenses for said stay, this amount shall be the amount of the actual

expenses for said stay; herein referred to as "Base Costs for Room and Board"

in this Article and paragraph (2) of the following Article).

(3) The Ministry of Health, Labour, and Welfare, when the expenses necessary of

providing meals and for a stay incurred by a Long-Term Care Preventive

Service Specified Provider and other circumstances have changed significantly

after the Base Cost for Meal Expense or the Maximum Allowance for Meal

Expense, or the Base Costs for Room and Board or the Maximum Allowance for

Stay Expense were determined, shall revise those amount immediately.

(4) When a Specified Person Admitted to a Facility receives Specified Preventive

Service of Long-Term Care from a Long-Term Care Preventive Service

Specified Provider, a Municipality may pay the expenses required to provide

meals and residence that said Specified Person Admitted to a Facility should

pay to said Long-Term Care Preventive Service Specified Provider, within the

limit of amount to be paid to said Specified Person Admitted to a Facility as an

Allowance for Long-Term Care Preventive Service of a Person Admitted to a

Specified Facility to said Long-Term Care Preventive Service Specified

Provider on behalf of said Specified Person Admitted to a Facility.

(5) When the allowance is paid pursuant to the provisions of the preceding

paragraph, it shall be deemed that an Allowance for Long-Term Care

Preventive Service of a Person Admitted to a Specified Facility is paid to the

Specified Person Admitted to a Facility.

(6) A Municipality, notwithstanding the provisions of paragraph (1) in a case

when Specified Person Admitted to a Facility pays to a Long-Term Care

Preventive Service Specified Provider the amount exceeding the Base Cost for

85

Meal Expense or the Base Costs for Room and Board (with regard to a

Specified Person Admitted to a Facility that was deemed to be paid an

Allowance for Long-Term Care Preventive Service of a Person Admitted to a

Specified Facility pursuant to the provisions of the preceding paragraph, the

Maximum Allowance for Meal Expense or the Maximum Allowance for Stay

Expense) as the expenses necessary of providing meals or for stay, shall not

pay the Allowance for Long-Term Care Preventive Service of a Person

Admitted to a Specified Facility.

(7) A Municipality, when a Long-Term Care Preventive Service Specified

Provider requests an Allowance for Long-Term Care Preventive Service of a

Person Admitted to a Specified Facility provided to a Specified Person

Admitted to a Facility, shall pay said allowance after conducting an

examination according to provisions of paragraph (1), paragraph (2) and the

preceding paragraph.

(8) The provisions of Article 41, paragraph (3), paragraph (10), and paragraph

(11) shall apply mutatis mutandis to payment of an Allowance for Long-Term

Care Preventive Service of a Person Admitted to a Specified Facility and the

provisions of paragraph (8) of the same Article shall apply mutatis mutandis to

a Long-Term Care Preventive Service Specified Provider. In this case, the

necessary technical replacement of terms in these provisions shall be provided

by a Cabinet Order.

(9) In addition to those matters as prescribed in each preceding paragraph, other

necessary matters payment of an Allowance for Long-Term Care Preventive

Service of a Person Admitted to a Specified Facility and for the request of an

Allowance for Long-Term Care Preventive Service of a Person Admitted to a

Specified Facility by a Long-Term Care Preventive Service Specified Provider

shall be as determined by an Ordinance of the Ministry of Health, Labour, and

Welfare.

(Payment of an Exceptional Allowance for Long-Term Care Preventive Service

of a Person Admitted to a Specified Facility)

Article 61-3 (1) A Municipality shall, in the following cases, pay an Exceptional

Allowance for Long-Term Care Preventive Service of a Person Admitted to a

Specified Facility to a Specified Person Admitted to a Facility:

(i) when a Municipality determines it necessary in a case when Specified

Person Admitted to a Facility receives Specified Preventive Service of Long-

Term Care prior to the date said Certification of Needed Support becomes

effective due to an emergency or other compelling reason;

(ii) when provided by a Cabinet Order.

(2) The amount of Exceptional Allowance for Long-Term Care Preventive Service

of a Person Admitted to a Specified Facility to a Specified Person Admitted to a

86

Facility shall be provided by a Municipality based on the total sum of the

amount with regard to the expenses required of providing said meals that is

the result of deducting the Base Allowance for Food Expense from the

Maximum Cost for Food Expense, and the amount with regard to the expenses

required for said stay that is the result of deduction of the Base Allowance for

Stay from the Maximum Cost for Stay.

Section 5 Municipal Special Benefits

Article 62 A Municipality may pay a Municipal Special Benefit pursuant to the

provisions of a municipal ordinance to an Insured Person Requiring Long-Term

Care or an Insured In-Home Person Requiring Support (herein referred to as

"Insured Person Requiring Long-Term Care, etc.") in addition to the insurance

benefits as set forth in the preceding two sections.

Section 6 Limitation of Insurance Benefits, etc.

(Limitation of Insurance Benefits)

Article 63 With regard to a person that is confined to penal institution, work

facility, or other facility mutatis mutandis as these, a Long-Term Care Benefit,

etc., pertaining to said period of confinement shall not be paid.

Article 64 With regard to the Condition of Need for Long-Term Care, etc., of an

Insured Person that caused the accident that caused a Condition of Need for

Long-Term Care, etc., or the cause of said condition, or who increased the

degree of Condition of Need for Long-Term Care, etc., by not obeying

instructions for the use of Service Covered by Long-Term Care Benefits, etc., or

for a Home Modification pertaining to an Allowance for Home Modification for

In-Home Long-Term Care or Allowance for Preventive Long-Term Care Home

Modification due to an intentional criminal act or gross negligence or without

justifiable reasons, a Municipality may not pay the whole or a part of a Long-

Term Care Benefit, etc., for which the reason for payment is said Condition of

Need for Long-Term Care, etc.

Article 65 A Municipality, when a person that receives a Long-Term Care

Benefit, etc., fails to respond to a request pursuant to the provisions of Article

23 (in a case when it is entrusted pursuant to the provisions of Article 24-2,

paragraph (1), item (i), including a request pertaining to said entrustment) or

refuses to answer without a justifiable reason, may not pay the whole or a part

of a Long-Term Care Benefit, etc.

87

(Change of Payment Method Pertaining to Person Delinquent in Payment of an

Insurance Premium)

Article 66 (1) A Municipality, in a case when an Insured Person Requiring Long-

Term Care, etc., that is a Primary Insured Person that is a person delinquent

in payment of an insurance premium (except for those who can receive a

medical allowance for general disease pursuant to the Act for Medical

Measures for the Victims of the Atomic Bomb (Act No. 117 of 1994) and other

benefits for medical care as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare) fails to pay said insurance premium from the

payment due date of said insurance premium until the expiry of the period as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare,

except for a case when it is determined that there is a special circumstance for

said delinquency of insurance premium payment such as a disaster or other

special circumstances provided by a Cabinet Order, shall request said Insured

Person Requiring Long-Term Care, etc., to submit the Certificate of Insured

Person, pursuant to the provisions of an Ordinance of the Ministry of Health,

Labour, and Welfare, and enter on said Certificate of Insured Person that the

provisions of Article 41, paragraph (6), Article 42-2, paragraph (6), Article 46,

paragraph (4), Article 48, paragraph (4), Article 51-2, paragraph (4), Article 53,

paragraph (4), Article 54-2, paragraph (6), Article 58, paragraph (4) and Article

61-2, paragraph (4) shall not apply (herein referred to as "Entry of Change of

Payment Method" in this Article and paragraph (3) of the following Article).

(2) A Municipality, although in a case when the period as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare as prescribed in the

preceding paragraph has not yet expired, except for a case it is determined that

said person delinquent in payment is due to special circumstances provided by

a Cabinet Order as prescribed in the same paragraph, may request the Insured

Person Requiring Long-Term Care, etc., as prescribed in the same paragraph to

submit the Certificate of Insured Person, and include the Entry of Change of

Payment Method on said Certificate of Insured Person.

(3) A Municipality, when an Insured Person Requiring Long-Term Care, etc., that

has received an Entry of Change of Payment Method pursuant to the

provisions of the preceding two paragraphs and has completed payment of said

delinquent insurance premium or when it is determined that the delinquent

payment amount pertaining to said Insured Person Requiring Long-Term Care,

etc., has decreased significantly or due to a disaster or other special

circumstances provided by a Cabinet Order, shall delete said Entry of Change

of Payment Method.

(4) With regard to the payment of an Allowance for In-Home Long-Term Care

Service, Allowance for Community-Based Long-Term Care Service, Allowance

for In-Home Long-Term Care Service Plan, Allowance for Long-Term Care

88

Facility Service, Allowance for Long-Term Care Service to a Person Admitted

to a Specified Facility, Allowance for Preventive Long-Term Care Service,

Allowance for Community-Based Preventive Long-Term Care Service,

Allowance for Preventive Long-Term Care Service Plan, and Allowance for

Preventive Long-Term Care Service to a Person Admitted to a Specified

Facility, pertaining to a Designated In-Home Service, Designated Community-

Based Service, Designated In-Home Long-Term Care Support, Designated

Facility Service, etc., Designated Preventive Long-Term Care Service,

Designated Community-Based Preventive Service of Long-Term Care, and

Designated Support for Prevention of Long-Term Care that an Insured Person

Requiring Long-Term Care, etc., who received an Entry of Change of Payment

Method pursuant to the provisions of paragraph (1) or paragraph (2), receives

during the period said Entry of Change of Payment Method remains on the

Certificate of Insured Person, the provisions of Article 41, paragraph (6),

Article 42-2, paragraph (6), Article 46, paragraph (4), Article 48, paragraph (4),

Article 51-2, paragraph (4), Article 53, paragraph (4), Article 54-2, paragraph

(6), Article 58, paragraph (4), and Article 61-2, paragraph (4) shall not apply.

(Temporary Suspension of Payment of Insurance Benefit)

Article 67 (1) A Municipality, when an Insured Person Requiring Long-Term

Care, etc., that is a Primary Insured Person that can receive an insurance

benefit becomes a person delinquent in the payment of an insurance premium

and fails to pay said insurance premium from the due date of payment of said

insurance premium until the period as determined by an Ordinance of the

Ministry of Health, Labour, and Welfare expires, shall temporarily suspend the

payment of the whole or a part of an insurance benefit, pursuant to the

provisions of an Ordinance of the Ministry of Health, Labour, and Welfare,

except for a case when it is determined that said delinquency of payment of an

insurance premium is due to a disaster or other special circumstance as

determined by a Cabinet Order.

(2) A Municipality, in a case when an Insured Person Requiring Long-Term Care,

etc., who is a Primary Insured Person that can receive an insurance benefit

becomes a person delinquent in the payment of an insurance premium

although the period as determined by an Ordinance of the Ministry of Health,

Labour, and Welfare as prescribed in the preceding paragraph has not yet

expired, except for a case when it is determined that said delinquency of an

insurance premium is due to a disaster or other special circumstance as

determined by a Cabinet Order as prescribed, may temporarily suspend the

whole or a part of an insurance benefit pursuant to the provisions of an

Ordinance of the Ministry of Health, Labour, and Welfare.

(3) A Municipality, in a case when an Insured Person Requiring Long-Term Care,

89

etc., that has received an Entry of Change of Payment Method pursuant to the

provisions of paragraph (1) or paragraph (2) of the preceding Article and whose

insurance benefit has been temporarily suspended in whole or in part pursuant

to the provisions of the preceding two paragraphs and who has not yet paid the

delinquent insurance premium, may notify in advance said Insured Person

Requiring Long-Term Care, etc., pursuant to the provisions of an Ordinance of

the Ministry of Health, Labour, and Welfare, and deduct the amount of

delinquent insurance premium of said Insured Person Requiring Long-Term

Care, etc., from the amount of insurance benefit pertaining to said temporary

suspension.

(Temporary Suspensions of Insurance Benefits to a Person that has not paid an

insurance premium, etc., as prescribed in the Medical Insurance Acts)

Article 68 (1) With regard to an Insured Person Requiring Long-Term Care, etc.,

that is a Secondary Insured Person that can receive an insurance benefit, in a

case when said Insured Person Requiring Long-Term Care, etc., has an

obligatory insurance premium pursuant to the provisions of the Medical

Insurance Acts (including national health insurance tax pursuant to the

provisions of the Local Tax Act (Act No. 226 of 1950)) or when there is a

remaining premium installments that was not paid by the deadline for

payment (herein referred to as "Unpaid Medical Insurance Premium, etc." in

this paragraph and the following paragraph), except for a case said Unpaid

Medical Insurance Premium, etc., is due to a disaster or other special

circumstance as determined by a Cabinet Order, a Municipality, pursuant to

the provisions of an Ordinance of the Ministry of Health, Labour, and Welfare,

may request said Insured Person Requiring Long-Term Care, etc., to submit

the Certificate of Insured Person and to enter on said Certificate of Insured

Person that the provisions of Article 41, paragraph (6), Article 42-2, paragraph

(6), Article 46, paragraph (4), Article 48, paragraph (4), Article 51-2, paragraph

(4), Article 53, paragraph (4), Article 54-2, paragraph (6), Article 58, paragraph

(4), and Article 61-2, paragraph (4) shall not apply and that the whole or a part

of the payment of an insurance benefit shall be suspended (herein referred to

as "Entry of Suspension of Insurance Benefit" in this Article).

(2) When an Insured Person Requiring Long-Term Care, etc., that has received

an Entry of Suspension of Insurance Benefit pursuant to the provisions of the

preceding paragraph completes payment of an Unpaid Medical Insurance

Premium, etc., or when it is determined that there is a significant decrease of

an Unpaid Medical Insurance Premium, etc., pertaining to said Insured Person

Requiring Long-Term Care, etc., or due to disaster or other special

circumstance as provided by a Cabinet Order, said Entry of Suspension of

Insurance Benefit shall be deleted.

90

(3) The provisions of Article 66, paragraph (4) shall apply mutatis mutandis to an

Insured Person Requiring Long-Term Care, etc., that has received an Entry of

Suspension of Insurance Benefit pursuant to the provisions of paragraph (1).

(4) With regard to an Insured Person Requiring Long-Term Care, etc., that has

received an Entry of Suspension of Insurance Benefit pursuant to the

provisions of paragraph (1), a Municipality shall temporarily suspend the

whole or a part of an insurance benefit.

(5) A Municipality, when the necessity is determined for an Entry of Suspension

of Insurance Benefit of an Insured Person Requiring Long-Term Care, etc., may

request the submission of information pursuant to the provisions of an

Ordinance of the Ministry of Health, Labour, and Welfare to a Medical Insurer

of said Insured Person Requiring Long-Term Care, etc., regarding insurance

premium collected pursuant to the provisions of the Medical Insurance Acts

pertaining to said Insured Person Requiring Long-Term Care, etc., the status

of an insurance premium (including national health insurance tax collected

pursuant to the provisions of the Local Tax Act) or installments premium

payments, and other matters as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare.

(Exception of Insurance Benefit in a Case of Extinction of Right to Collect an

Insurance Premium)

Article 69 (1) In a case when a Municipality issues a Certification of Needed

Long-Term Care, a Renewal of Certification of Care Need, or Certification of

Change of Condition of Need for Long-Term Care pursuant to the provisions of

Article 27, paragraph (7) or Article 30, paragraph (1) as applied mutatis

mutandis pursuant to Article 29, paragraph (2), a Certification of Needed

Support, a Renewal of Certification of Needed Support, or a Certification of

Change of Category of Needed Support Condition pursuant to the provisions of

Article 32, paragraph (6) or Article 33-3, paragraph (1) as applied mutatis

mutandis pursuant to Article 33-2, paragraph (2) (hereinafter referred to

simply as "Certification" in this paragraph) and there is a period when the

right to collect an insurance premium has extinguished (which means a period

calculated pursuant to the provisions of a Cabinet Order regarding the period

when the right to collect an insurance premium pertaining to said period has

been extinguished due to a legal proscription) with regard to an Insured Person

Requiring Long-Term Care, etc., that is the Primary Insured Person pertaining

to said Certification, a Municipality pursuant to the provisions of an Ordinance

of the Ministry of Health, Labour, and Welfare shall enter on the Certificate of

Insured Person of said Insured Person Requiring Long-Term Care, etc., in

addition to the entry pursuant to the provisions of Article 27, paragraph (7),

second sentence (including a case applied mutatis mutandis pursuant to Article

91

28, paragraph (4) and Article 29, paragraph (2)), Article 30, paragraph (1),

second sentence, Article 35, paragraph (4), second sentence, Article 32,

paragraph (6), second sentence (including a case applied mutatis mutandis

pursuant to Article 33, paragraph (4) or Article 33-2, paragraph (2)), Article

33-3, paragraph (1), second sentence, Article 35, paragraph (2), second

sentence, or paragraph (6) second sentence as pertaining to said Certification,

that the amount of Long-Term Care Benefit, etc., (except for payment of an

Allowance for In-Home Long-Term Care Service, Exceptional Allowance for an

In-Home Long-Term Care Service Plan, Allowance for Preventive Long-Term

Care Service Plan, Exceptional Allowance for a Preventive Service Plan of

Long-term care, Allowance for High-Cost Long-Term Care Service, Allowance

for High-Cost Preventive Long-Term Care Service, Allowance for Long-Term

Care Service to a Person Admitted to a Specified Facility, Exceptional

Allowance for Long-Term Care Service to a Person Admitted to a Specified

Facility, Allowance for Preventive Long-Term Care Service to a Person

Admitted to a Specified Facility, and Exceptional Allowance for Long-Term

Care Preventive Service of a Person Admitted to a Specified Facility) shall be

reduced and that the Allowance for High-Cost Long-Term Care Service,

Allowance for High-Cost Preventive Long-Term Care Service, Allowance for

Long-Term Care Service to a Person Admitted to a Specified Facility,

Exceptional Allowance for Long-Term Care Service to a Person Admitted to a

Specified Facility, Allowance for Preventive Long-Term Care Service to a

Person Admitted to a Specified Facility, and Exceptional Allowance for Long-

Term Care Preventive Service of a Person Admitted to a Specified Facility

shall not be paid, and the period that these measures are applicable (which

means a period that a Municipality determines pursuant to the provisions of a

Cabinet Order according to the period during which the right to collect an

insurance premium is extinguished; herein referred to as "Benefit Reduction

Period" in this Article) (hereinafter said entry is referred to as "Entry of

Benefit Reduction Amount, etc." in this Article), however, provided that this

provision shall not apply to a case when it is determined that said Insured

Person Requiring Long-Term Care, etc., suffers due to a disaster or other

special circumstance provided by a Cabinet Order.

(2) A Municipality, when it is determined that an Insured Person Requiring

Long-Term Care, etc., that has received an Entry of Benefit Reduction Amount,

etc., pursuant to the provisions of the preceding paragraph is subject to a

special circumstance as provided by a Cabinet Order as set forth in the proviso

of the same paragraph, and when the Benefit Reduction Period expires, shall

delete said Entry of Benefit Reduction Amount, etc.

(3) With regard to In-Home Service (including equivalent service; the same shall

apply in the following paragraph), Community-Based Service (including

92

equivalent service; the same shall apply in the following paragraph), Facility

Service, Preventive Long-Term Care Service (including equivalent service; the

same shall apply in the following paragraph), Community-Based Service for

Preventive Long-Term Care (including equivalent service; the same shall apply

in the following paragraph), and a Long-Term Care Benefit, etc., as listed in

the following items pertaining to a Home Modification that is used or

implemented by an Insured Person Requiring Long-Term Care, etc., that has

received an Entry of Benefit Reduction Amount, etc., pursuant to the

provisions of paragraph (1), from the first day of the month following the

month in which said Entry was entered until said Benefit Reduction Period

expires, when the provisions as prescribed in each said item shall apply to

these services and benefits, etc., the term "90 percent" in the listed provisions

shall be "70 percent":

(i) payment of an Allowance for In-Home Long-Term Care Service: Article 41,

paragraph (4), item (i) and item (ii), and Article 43, paragraph (1), paragraph

(4) and paragraph (6);

(ii) payment of an Exceptional Allowance for In-Home Long-Term Care Service:

Article 42, paragraph (2) and Article 43, paragraph (1), paragraph (4), and

paragraph (6);

(iii) payment of an Allowance for Community-Based Long-Term Care Service:

Article 42-2, paragraph (2), item (i) and item (ii), and Article 43, paragraph

(1), paragraph (4) and paragraph (6);

(iv) payment of an Exceptional Allowance for Community-Based Long-Term

Care Service: Article 42-3, paragraph (2) and Article 43, paragraph (1),

paragraph (4), and paragraph (6);

(v) payment of an Allowance for Long-Term Care Facility Service: Article 48,

paragraph (2);

(vi) payment of an Exceptional Allowance for Long-Term Care Facility Service:

Article 49, paragraph (2);

(vii) payment of an Allowance for Preventive Long-Term Care Service: Article

53, paragraph (2), item (i) and item (ii), and Article 55, paragraph (1),

paragraph (4), and paragraph (6);

(viii) payment of an Exceptional Allowance for Preventive Service of Long-

Term Care: Article 54, paragraph (2) and Article 55, paragraph (1),

paragraph (4), and paragraph (6);

(ix) payment of an Exceptional Allowance for Community-Based Preventive

Service of Long-Term Care: Article 54-2, paragraph (2), item (i) and item (ii),

and Article 55, paragraph (1), paragraph (4), and paragraph (6);

(x) payment of an Exceptional Allowance for Community-Based Preventive

Service of Long-Term Care: Article 54-3, paragraph (2) and Article 55,

paragraph (1), paragraph (4), and paragraph (6);

93

(xi) payment of an Allowance for Purchasing Equipment for In-Home Long-

Term Care Covered by Public Aid: Article 44, paragraph (3), paragraph (4),

and paragraph (7);

(xii) payment of an Allowance for Purchasing Equipment for Preventive Long-

Term Care Covered by Public Aid: Article 56, paragraph (3), paragraph (4),

and paragraph (7);

(xiii) payment of an Allowance for Home Modification for In-Home Long-Term

Care: Article 45, paragraph (3), paragraph (4) and paragraph (7);

(xiv) payment of an Allowance for Preventive Long-Term Care Home

Modification: Article 57, paragraph (3), paragraph (4) and paragraph (7).

(4) The provisions of Article 51, paragraph (1), Article 51-2, paragraph (1),

Article 51-3, paragraph (1), Article 61, paragraph (1), Article 61-2, paragraph

(1) and Article 61-3, paragraph (1) shall not apply to the allowance for

expenses provided to an Insured Person Requiring Long-Term Care, etc., that

has received an Entry of Benefit Reduction Amount, etc., pursuant to the

provisions of paragraph (1) from the first day of the month following the month

when said Entry is entered to when said Benefit Reduction Period expires

regarding the expenses that are necessary for In-Home Service, Community-

Based Service, Facility Service, Preventive Long-Term Care Service and

Community-Based Service for Preventive Long-Term Care.

Chapter V Long-Term Care Support Specialists, Providers, and Facilities

Section 1 Long-Term Care Support Specialists

Subsection 1 Registration, etc.

(Registration of Long-Term Care Support Specialists)

Article 69-2 (1) A person that possesses practical experience as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare, has passed an

examination undertaken pursuant to the provisions of an Ordinance of the

Ministry of Health, Labour, and Welfare as administered by a prefectural

governor (herein referred to as "Long-Term Care Support Specialist

Examination"), and has completed a training program provided pursuant to the

provisions of an Ordinance of the Ministry of Health, Labour, and Welfare as

administered by a prefectural governor (herein referred to as "Long-Term Care

Support Specialist Internship") shall be issued a registration by said

prefectural governor pursuant to the provisions of an Ordinance of the

Ministry of Health, Labour, and Welfare, however, provided that this provision

shall not apply to a person that corresponds to any of following items:

(i) an adult ward or a person under guardianship;

(ii) a person punished by imprisonment without compulsory labor or to a more

severe penalty and the execution of said penalty has not yet been completed

94

or has not yet expired;

(iii) a person punished by a fine pursuant to provisions of a Cabinet Order as

set forth in this Act or any another Act concerning national insurance,

medical service, or welfare, and has not yet completed the execution of said

punishment or remains subject to said punishment;

(iv) a person that has committed a wrongful act or a significantly unjustifiable

act concerning In-Home Service, etc. within five years prior to submitting an

application for registration;

(v) a person that was subject to a prohibition pursuant to the provisions of

Article 69-38, paragraph (3) whose registration was rescinded pursuant to

the provisions of Article 69-6, paragraph (1) during said prohibition period,

and said prohibition period has not yet expired;

(vi) a person that was subject to a rescinding of registration pursuant to the

provisions of Article 69-39 within five years from the date of said disposition

of the matter;

(vii) a person that applied for deletion of registration from the date of said

notification pursuant to the provisions of Article 15 of the Administrative

Procedures Act (Act No. 88 of 1993) pertaining to a deletion of registration

pursuant to the provisions of Article 69-39, and five years as not passed yet

from the date of said disposition of the matter.

(2) A registration as set forth in the preceding paragraph shall be implemented

by a prefectural governor by listing the name, date of birth, domicile, and other

matters as determined by an Ordinance of the Ministry of Health, Labour, and

Welfare, and the registration number and date on a registration list of Long-

Term Care Support Specialists.

(Transfer of Registration)

Article 69-3 When a person that is registered as set forth in paragraph (1) of the

preceding Article engages in or intends to engage in Designated In-Home Long-

Term Care Support Provider, other provider, or a facility as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare that located in a

prefecture other than the prefecture governed by a prefectural governor where

said person is registered, said person may apply for a transfer of registration to

the prefectural governor governing the location of the business of said provider

or the location of said facility via the prefectural governor who governs said

registration, however, provided that this provision shall not apply when said

person is punished by a prohibition pursuant to the provisions of Article 69-38,

paragraph (3) and said prohibition period has not completely expired.

(Notification of Change of Registration Matter)

Article 69-4 A person that is registered as set forth in Article 69-2, paragraph (1),

95

when his or her name or other matter as determined by an Ordinance of the

Ministry of Health, Labour, and Welfare pertaining to said registration has

changed, shall notify the prefectural governor without delay of said fact.

(Notification of Death, etc.)

Article 69-5 When a person that is registered as set forth in Article 69-2,

paragraph (1) becomes as defined by any of the following items, the person as

provided by said item shall provide notification of said fact to the prefectural

governor where said person is registered or the prefectural governor governing

the domicile of said person as provided in said item within thirty days from the

date (in a case of being defined by item (i), on the day) that said fact is known:

(i) when the registered person dies: the successor or executor of the estate of

said person;

(ii) when the registered person corresponds to Article 69-2, paragraph (1), item

(i): the guardian or curator of said person;

(iii) when the registered person corresponds to Article 69-2, paragraph (1), item

(ii) or item (iii): said registered person.

(Deletion of Registration Based on an Application, etc.)

Article 69-6 A prefectural governor shall, in a case defined by any of the

following items, delete the registration as set forth in Article 69-2, paragraph

(1):

(i) when the registered person applies for the deletion of registration;

(ii) when notified as set forth in the preceding Article;

(iii) when not notified as set forth in the preceding Article but a fact that

corresponds to any of the items of the same Article is known;

(iv) when a judgment of passing an examination is rescinded pursuant to the

provisions of Article 69-31.

(Delivery, etc., of Long-Term Care Support Specialist Certification)

Article 69-7 (1) A person that is registered as set forth in Article 69-2, paragraph

(1) may apply for delivery of a Long-Term Care Support Specialist Certification

to the prefectural governor.

(2) A person that intends to receive a Long-Term Care Support Specialist

Certification, shall undertake training provided by the prefectural governor

pursuant to the provisions of an Ordinance of the Ministry of Health, Labour,

and Welfare, provided however, that this provision shall not apply to a person

that intends to receive a Long-Term Care Support Specialist Certification

within the period as determined by an Ordinance of the Ministry of Health,

Labour, and Welfare from the date of registration as set forth in Article 69-2,

paragraph (1).

96

(3) The effective period of a Long-Term Care Support Specialist Certification

(except for Long-Term Care Support Specialist Certification delivered pursuant

to the provisions of paragraph (5)) shall be five years.

(4) When registration is transferred pursuant to the provisions of Article 69-3

after delivery of a Long-Term Care Support Specialist Certification, said prior

Long-Term Care Support Specialist Certification shall cease to be effective.

(5) In a case as prescribed in the preceding paragraph, when the delivery of a

Long-Term Care Support Specialist Certification is submitted for together with

change of registration, the prefectural governor who receives said application

shall deliver a Long-Term Care Support Specialist Certification that is

effective until the effective period expires of the Long-Term Care Support

Specialist Certification as set forth in the same paragraph.

(6) A Long-Term Care Support Specialist, when the registration as set forth in

Article 69-2, paragraph (1) is rescinded or the Long-Term Care Support

Specialist Certification ceases to be effective, shall return said Long-Term Care

Support Specialist Certification immediately to the prefectural governor that

delivered said Long-Term Care Support Specialist Certification.

(7) A Long-Term Care Support Specialist, when punished by a prohibition

pursuant to the provisions of Article 69-38, paragraph (3), shall immediately

submit the Long-Term Care Support Specialist Certification to the prefectural

governor that issued said certification.

(8) A prefectural governor who receives a Long-Term Care Support Specialist

Certification pursuant to the provisions of the preceding paragraph, when said

person that submitted the certification requests the return of said certification

in a case when the prohibition period as set forth in the same paragraph

expires, shall immediately return said Long-Term Care Support Specialist

Certification.

(Renewal of Effective Period of Long-Term Care Support Specialist

Certification)

Article 69-8 (1) The effective period of a Long-Term Care Support Specialist

Certification shall be renewable by the submission of an application.

(2) A person that intends to renew the effective period of a Long-Term Care

Support Specialist Certification shall undertake the training provided by a

prefectural governor pursuant to the provisions of an Ordinance of the

Ministry of Health, Labour, and Welfare (herein referred to as "Training for

Renewal"), provided however, that this provision shall not apply to a person

that currently engages in the business of a Long-Term Care Support Specialist

and has completed the training program designated by the prefectural

governor pursuant to the provisions of an Ordinance of the Ministry of Health,

Labour, and Welfare as an equivalent to a program of Training for Renewal.

97

(3) The provisions of paragraph (3) of the preceding Article shall apply mutatis

mutandis to the effective period of a renewed Long-Term Care Support

Specialist Certification.

(Presentation of Long-Term Care Support Specialist Certification)

Article 69-9 A Long-Term Care Support Specialist, when requested by a relevant

person, shall present his or her Long-Term Care Support Specialist

Certification prior to conducting said business.

(Delegation to an Ordinance of the Ministry of Health, Labour, and Welfare)

Article 69-10 In addition to the provisions in this Subsection, matters necessary

concerning a registration as set forth in Article 69-2, paragraph (1), said

transfer or a Long-Term Care Support Specialist Certification, shall be as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare.

Subsection 2 Registration of Organization that Prepares Registration

Examination Questions, and Appointment, etc., of Designated

Testing Agencies and Designated Training Agencies

(Registration of Organization that Prepares Registration Examination

Questions)

Article 69-11 (1) A prefectural governor may require a juridical person

registered with the Minister of Health, Labour, and Welfare (herein referred to

as "Organization that Prepares Registration Examination Questions") to

undertake affairs concerning the preparation of examination questions and the

establishment of criteria for passing (herein referred to as "Examination

Question Preparation Affairs") among the affairs concerning the

implementation of an Examination for Long-Term Care Support Specialist.

(2) A registration as set forth in the preceding paragraph shall be submitted by a

person that intends to implement Examination Question Preparation Affairs.

(3) A prefectural governor, when entrusting an Organization that Prepares

Registration Examination Questions with the Examination Question

Preparation Affairs pursuant to the provisions of paragraph (1), shall not

otherwise implement Examination Question Preparation Affairs.

(Reasons of Disqualification)

Article 69-12 A juridical person that corresponds to any of the following items

shall not be granted registration as set forth in paragraph (1) of the preceding

paragraph:

(i) a person punished pursuant to a provision of this Act and two years have

not elapsed from the date said execution of punishment is completed or

98

expired;

(ii) a person that registration is rescinded pursuant to the provisions of Article

69-2, paragraph (1) or paragraph (2) and two years have not elapsed from the

date of rescission;

(iii) a juridical person that has an Officer a person defined by item (i).

(Standard of Registration)

Article 69-13 The Minister of Health, Labour, and Welfare, when a person that

applies for registration pursuant to the provisions of Article 69-11, paragraph

(2) conforms to all requirements listed in the following items, shall issue the

registration as set forth in paragraph (1) of the same Article; in said case,

necessary procedures for registration shall be as determined by an Ordinance

of the Ministry of Health, Labour, and Welfare:

(i) with regard to the subjects listed in the upper column of the appended table,

the examination board listed in the lower column of the same table shall

prepare the examination questions and establish criteria for passing the

examination;

(ii) measures listed in the following sub-items shall be undertaken in order to

ensure the reliability of the examination:

(a) a full-time supervisor for Examination Question Preparation Affairs shall

be assigned;

(b) measures shall be undertaken in order to ensure the reliability of the

preparation of documents concerning management of Examination

Question Preparation Affairs (including maintaining the confidentiality of

the examination and matters concerning the criteria for passing said

examination) and other Examination Question Preparation Affairs as

determined by an Ordinance of the Ministry of Health, Labour, and

Welfare;

(c) a department dedicated to the management of Examination Question

Preparation Affairs shall be established according to the provisions for

documents as set forth in sub-item (b);

(iii) said person shall not be in a financial condition with liabilities in excess of

assets.

(Public Notice of Registration, etc.)

Article 69-14 (1) The Minister of Health, Labour, and Welfare, when registering

a person as set forth in Article 69-11, paragraph (1), issue public notice of the

name and location of the main Business Office of said person that is registered

and the date of said registration.

(2) An Organization that Prepares Registration Examination Questions, when it

intends to change its name or the location of its main Business Office, shall

99

provide notification two (2) weeks prior to the day of said change of said fact to

the Minister of Health, Labour, and Welfare and to the prefectural governor

who entrusted said Organization that Prepares Registration Examination

Questions to conduct Examination Question Preparation Affairs pursuant to

the provisions of Article 69-11, paragraph (1) (herein referred to as "Entrusting

Prefectural Governor").

(3) The Minister of Health, Labour, and Welfare, when a notification of said

change is received as set forth in the preceding paragraph, shall issue public

notice of said fact.

(Appointment and Dismissal of Officers)

Article 69-15 An Organization that Prepares Registration Examination

Questions, when it appoints or dismisses an Officer, shall notify without delay

the Minister of Health, Labour, and Welfare of said fact.

(Appointment and Dismissal of Examination Board)

Article 69-16 An Organization that Prepares Registration Examination

Questions, when it appoints or dismisses an examination board as set forth in

Article 69-13, paragraph (1), shall notify without delay the Minister of Health,

Labour, and Welfare of said fact.

(Confidentiality Obligations, etc.)

Article 69-17 (1) An Officer or other personnel of an Organization that Prepares

Registration Examination Questions (including an examination board as set

forth in Article 69-13, paragraph (1); the same shall apply in the following

paragraph) or a person that held this occupation shall not divulge any

confidential information that said person learns concerning any Examination

Question Preparation Affairs.

(2) An Officer or other personnel of an Organization that Prepares Registration

Examination Questions who engages in Examination Question Preparation

Affairs shall be deemed as personnel that engage in public service pursuant to

the provisions of laws and regulations with regard to application of the Penal

Code and other penal provisions.

(Rules for Examination Question Preparation Affairs)

Article 69-18 (1) An Organization that Prepares Registration Examination

Questions, prior to commencing Examination Question Preparation Affairs,

shall stipulate Rules of Examination Question Preparation Affairs with regard

to matters pertaining to the conduct of Examination Question Preparation

Affairs as determined by an Ordinance of the Ministry of Health, Labour, and

Welfare, and obtain the approval of the Minister of Health, Labour, and

100

Welfare; the same shall apply when said rules are changed.

(2) The Minister of Health, Labour, and Welfare, when it is determined that the

Rules of Examination Question Preparation Affairs that are approved pursuant

to the provisions of the preceding paragraph have become inappropriate for the

proper and assured conduct of Examination Question Preparation Affairs, shall

order an Organization that Prepares Registration Examination Questions to

change said rules.

(Maintenance and Inspection of Financial Statements, etc.)

Article 69-19 (1) An Organization that Prepares Registration Examination

Questions, within three months from the end of every fiscal year, shall prepare

a schedule of inventories, a Statement of Financial Position, Statement of

Operations, Cash Flow Statement, and business report of such fiscal year

(including an electromagnetic record (a record in an electronic format, a

magnetic format, or any other format not recognizable to human perception

that is used for information processing by a computer; the same shall apply

herein this Article) when said electromagnetic record is prepared in lieu of said

financial statements, etc.; herein referred to as "Financial Statements, etc." in

the following paragraph, and Article 211-2) and maintain said Financial

Statements, etc., in the Business Office of the Organization that Prepares

Registration Examination Questions for five years.

(2) A person that intends to undertake the Examination for Long-Term Care

Support Specialist or other interested person may request any time within the

business hours of an Organization that Prepares Registration Examination

Questions the items listed below, however, provided that said person shall pay

the expenses specified by and pay to the Organization that Prepares

Registration Examination Questions as requested, as set forth in item (ii) and

item (iv):

(i) when the Financial Statements, etc., are prepared on paper, a request of

inspection or copy of said documents;

(ii) a request of transcripts or extracts of the documents as set forth in the

preceding paragraph;

(iii) when the Financial Statements, etc., are prepared as an electromagnetic

record, request inspection or copy of matters recorded in said electromagnetic

record and a display shown of the same by a method as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare;

(iv) a request to provide matters in an electromagnetic record as set forth in

the preceding paragraph by a method as determined by an Ordinance of the

Ministry of Health, Labour, and Welfare, or to deliver the documents stated

by said matters.

101

(Maintenance of Records, etc.)

Article 69-20 An Organization that Prepares Registration Examination

Questions, pursuant to the provisions of an Ordinance of the Ministry of

Health, Labour, and Welfare, shall keep and maintain records of all matters

concerning Examination Question Preparation Affairs as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare, and ensure said

matters are recorded.

(Order for Conformity)

Article 69-21 The Minister of Health, Labour, and Welfare, when it is

determined that an Organization that Prepares Registration Examination

Questions is not conforming with any of the items of Article 69-13, may order

said Organization that Prepares Registration Examination Questions to take

the necessary measures to conform with these provisions.

(Reports and Inspections)

Article 69-22 (1) The Minister of Health, Labour, and Welfare, when it is

determined to be necessary to ensure the proper conduct of Examination

Question Preparation Affairs, may request an Organization that Prepares

Registration Examination Questions to provide necessary reports concerning

the status of Examination Question Preparation Affairs, direct said personnel

to answer the questions of a relevant person, enter the Business Office of an

Organization that Prepares Registration Examination Questions in order to

inspect record books and documents, and other items.

(2) An Entrusting Prefectural Governor, when it is determined to be necessary to

ensure the proper conduct of Examination Question Preparation Affairs that

said prefectural governor entrusted, may request an Organization that

Prepares Registration Examination Questions to provide necessary reports

concerning the status of Examination Question Preparation Affairs, direct its

personnel to ask questions to the relevant Persons, enter the Business Office of

an Organization that Prepares Registration Examination Questions in order to

inspect record books and documents, and other items.

(3) The provisions of Article 24, paragraph (3) shall apply mutatis mutandis to

questions and inspections pursuant to the provisions of the preceding two

paragraphs and the provisions of paragraph (4) of the same Article shall apply

mutatis mutandis to the authority granted pursuant to the provisions of the

preceding two paragraphs.

(Discontinuance and Abolishment of Examination Question Preparation

Affairs)

Article 69-23 (1) An Organization that Prepares Registration Examination

102

Questions shall not discontinue or abolish the whole or a part of the

Examination Question Preparation Affairs without the approval of the

Minister of Health, Labour, and Welfare.

(2) The Minister of Health, Labour, and Welfare, when granting an approval

pursuant to the provisions of the preceding paragraph, shall hear the opinions

of relevant Entrusting Prefectural Governor.

(3) The Minister of Health, Labour, and Welfare, when granting an approval

pursuant to the provisions of paragraph (1), shall issue public notice of and

provide notification of said fact to the relevant Entrusting Prefectural

Governor.

(Rescission of Registration, etc.)

Article 69-24 (1) The Minister of Health, Labour, and Welfare, when an

Organization that Prepares Registration Examination Questions becomes as

defined by Article 69-12, item (i) or item (iii), shall rescind the registration of

said Organization that Prepares Registration Examination Questions.

(2) The Minister of Health, Labour, and Welfare, when an Organization that

Prepares Registration Examination Questions corresponds to any of the

following items, may rescind the registration of said Organization that

Prepares Registration Examination Questions, or specify a period of

suspension for the whole or a part of any Examination Question Preparation

Affairs:

(i) when the registration as set forth in Article 69-11, paragraph (1) is

performed by wrongful means;

(ii) when said Organization violates a provision of Article 69-14, paragraph (2),

Article 69-15, Article 69-16, Article 69-19, paragraph (1), Article 69-20 or

paragraph (1) of the preceding Article;

(iii) when said Organization refuses a request pursuant to the provisions of

Article 69-19, paragraph (2) without a justifiable reason;

(iv) when said Organization conducts Examination Question Preparation

Affairs without conforming to the Rules of Examination Question

Preparation Affairs that are approved pursuant to the provisions of Article

69-18, paragraph (1);

(v) when said Organization violates an order as set forth in Article 69-18,

paragraph (2) or Article 69-21.

(3) The Minister of Health, Labour, and Welfare, when rescinding a registration

pursuant to the provisions of the preceding two paragraphs and ordering a

suspension of the whole or a part of Examination Question Preparation Affairs

pursuant to the provisions of the preceding paragraph, shall issue public notice

of the relevant Entrusting Prefectural Governor and publicly give notice of said

fact.

103

(Implementation of Examination Question Preparation Affairs by an

Entrusting Prefectural Governor)

Article 69-25 (1) When an Organization that Prepares Registration Examination

Questions discontinues the whole or a part of Examination Question

Preparation Affairs pursuant to the provisions of Article 69-23, paragraph (1),

or when the Minister of Health, Labour, and Welfare orders an Organization

that Prepares Registration Examination Questions pursuant to the provisions

of paragraph (2) of the preceding Article to suspend the whole or a part of

Examination Question Preparation Affairs, or when it has become difficult for

an Organization that Prepares Registration Examination Questions to conduct

the whole or a part of Examination Question Preparation Affairs due to a

disaster or other reasons, the Entrusting Prefectural Governor, when the

Minister of Health, Labour, and Welfare determines it necessary, shall conduct

the whole or a part of said Examination Question Preparation Affairs

notwithstanding the provisions of Article 69-11, paragraph (3).

(2) The Minister of Health, Labour, and Welfare, when an Entrusting Prefectural

Governor is conducting the Examination Question Preparation Affairs

pursuant to the provisions of the preceding paragraph and when the reason is

no longer valid for an Entrusting Prefectural Governor to conduct the

Examination Question Preparation Affairs pursuant to the provisions of the

same paragraph, shall provide notice of said fact immediately to said

Entrusting Prefectural Governor.

(Fee Pertaining to Examination Question Preparation Affairs)

Article 69-26 An Entrusting Prefectural Governor, in a case when collecting a

fee pertaining to Examination Question Preparation Affairs based on the

provisions of Article 227 of the Local Autonomy Act, may direct a person that

intends to undertake an Examination for Long-Term Care Support Specialist

pertaining to Examination Question Preparation Affairs provided by an

Organization that Prepares Registration Examination Questions pursuant to

the provisions of Article 69-11, paragraph (1) and pursuant to the provisions of

a prefectural ordinance, to pay said fee to said Organization that Prepares

Registration Examination Questions as income.

(Appointment of Designated Testing Agency)

Article 69-27 (1) A prefectural governor may designate a person (herein referred

to as "Designated Testing Agency") to operate affairs concerning

implementation of an Examination for Long-Term Care Support Specialist

(except for Examination Question Preparation Affairs; herein referred to as

"Examination Affairs").

104

(2) The provisions of the preceding Article shall apply mutatis mutandis to a fee

pertaining to Examination Affairs provided by a Designated Testing Agency.

(Confidentiality Obligations, etc.)

Article 69-28 (1) A Designated Testing Agency (in a case when said person is a

juridical person, an Officer of said person; the same shall apply in the following

paragraph) or its personnel, or a person that held this occupation shall not

divulge any confidential information that was learned pertaining to

Examination Affairs.

(2) A Designated Testing Agency which engages in Examination Affairs or its

personnel shall be deemed as personnel that engage in public service pursuant

to the provisions of laws and regulations, with regard to application of the

Penal Code or other penal provisions.

(Supervisory Orders, etc.)

Article 69-29 A prefectural governor, when it is determined that it is necessary

for ensuring the proper conduct of Examination Affairs, may give necessary

orders for supervision concerning Examination Affairs to a Designated Testing

Agency.

(Reports and Inspections)

Article 69-30 (1) A prefectural governor, when it is determined that it is

necessary for ensuring proper conduct of Examination Affairs, may request a

Designated Testing Agency to submit the necessary reports concerning the

status of Examination Affairs, direct its personnel to ask questions of the

relevant person, enter the Business Office of a Designated Testing Agency in

order to inspect said facility, record books and documents, and other items.

(2) The provisions of Article 24, paragraph (3) shall apply mutatis mutandis to

questions and inspections, and the provisions of paragraph (4) of the same

Article shall apply mutatis mutandis to the authority granted pursuant to the

provisions of the preceding paragraph.

(Rescission of Passing an Examination, etc.)

Article 69-31 (1) A prefectural governor may rescind an application to take an

examination or a judgment of passing an examination for a person that

completed or intends to complete an Examination for Long-Term Care Support

Specialist by wrongful means, or is prohibited from taking said Examination

for Long-Term Care Support Specialist.

(2) A Designated Testing Agency may exercise the authority as prescribed in the

preceding paragraph of the prefectural governor who issued said designation to

said Designated Testing Agency.

105

(Delegation to a Cabinet Order)

Article 69-32 In addition to the provisions specified in Article 69-27 through the

preceding Article, other necessary matters concerning a Designated Testing

Agency shall be provided by a Cabinet Order.

(Appointment of Designated Training Agencies)

Article 69-33 (1) A prefectural governor may designate a person (herein referred

to as "Designated Training Agency") to conduct affairs concerning the

implementation of a Long-Term Care Support Specialist Internship and

Training for Renewal (herein referred to as "Training Affairs").

(2) The provisions of Article 69-27, paragraph (2), Article 69-29, and Article 69-30

shall apply mutatis mutandis to a Designated Training Agency. In this case,

the terms "Designated Testing Agency" and "Examination Affairs" in these

provisions shall be deemed to be replaced with "Designated Training Agency"

and "Training Affairs," respectively.

(3) In addition to the provisions of the preceding two paragraphs, other necessary

matters concerning a Designated Training Agency shall be provided by a

Cabinet Order.

Subsection 3 Obligations, etc.

(Obligations of a Long-Term Care Support Specialist)

Article 69-34 (1) A Long-Term Care Support Specialist shall operate said

business correctly and faithfully with respect to the personality of an Insured

Person Requiring Long-Term Care, etc., that is under the responsibility of said

Specialist, always from the viewpoint of said Insured Person Requiring Long-

Term Care, etc., in order to prevent placing inappropriate or false emphasis on

a specific type, or a specific provider or facility that provides In-Home Service,

Community-Based Service, Facility Service, Preventive Long-Term Care

Service, or Community-Based Service for Preventive Long-Term Care that is

provided to said Insured Person Requiring Long-Term Care, etc.

(2) A Long-Term Care Support Specialist shall perform the business of Long-

Term Care Support Specialist according to standards as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare.

(Prohibition on Use of Name, etc.)

Article 69-35 A Long-Term Care Support Specialist shall not permit others to

wrongfully use the Long-Term Care Support Specialist Certification or the

business name of said Long-Term Care Support Specialist.

106

(Prohibition of Acts to Damage Impartiality)

Article 69-36 A Long-Term Care Support Specialist shall not commit any act

that may impair the impartiality of or confidence placed in said Long-Term

Care Support Specialist.

(Confidentiality Obligations, etc.)

Article 69-37 A Long-Term Care Support Specialist shall not divulge any

confidential information of an individual person that is learned pertaining to

said business without a justifiable basis. The same provision shall apply after

said person ceases to be a Long-Term Care Support Specialist.

(Reporting, etc.)

Article 69-38 (1) A prefectural governor, when it is determined that it is

necessary for ensuring proper execution of the business of a Long-Term Care

Support Specialist, may request necessary reports of said business from a

registered Long-Term Care Support Specialist and a Long-Term Care Support

Specialist that operates within the area governed by said prefectural governor.

(2) A prefectural governor, when it is determined that a registered Long-Term

Care Support Specialist or a Long-Term Care Support Specialist that operates

within the area governed by said prefectural governor violates the provisions of

Article 69-34, may provide necessary instructions to said Long-Term Care

Support Specialist and order said Specialist to undertake the training

designated by said prefectural governor.

(3) A prefectural governor, in a case that a registered Long-Term Care Support

Specialist or a Long-Term Care Support Specialist that operates within the

area governed by said prefectural governor disobeys instructions or orders

pursuant to the provisions of the preceding paragraph, may prohibit said Long-

Term Care Support Specialist from operating as a Long-Term Care Support

Specialist by specifying a period that is less than one (1) year.

(4) A prefectural governor, when he or she executes an action pursuant to the

provisions of the preceding two paragraphs to a Long-Term Care Support

Specialist who is registered in an area governed by a different prefectural

governor, shall notify without delay the prefectural governor that is governing

the area where said Long-Term Care Support Specialist is registered of said

fact.

(Deletion and Rescission of Registration)

Article 69-39 (1) A prefectural governor, when a Long-Term Care Support

Specialist that is registered in an area governed by said prefectural governor

corresponds to any of the following items, shall delete and rescind said

registration:

107

(i) when a Specialist corresponds to any provision of Article 69-2, paragraph (1),

item (i) to item (iii);

(ii) when a Specialist is registered as set forth in Article 69-2, paragraph (1) by

a wrongful means;

(iii) when the Long-Term Care Support Specialist Certification is issued by a

wrongful means;

(iv) when a Specialist violates a prohibition of business ordered pursuant to the

provisions of paragraph (3) of the preceding Article.

(2) A prefectural governor, in a case when a registered Long-Term Care Support

Specialist corresponds to any of the following items, may delete and rescind

said registration:

(i) when a Specialist violates a provision listed from Article 69-34 to Article 69-

37;

(ii) when a Specialist is requested to report pursuant to the provisions of

paragraph (1) of the preceding Article, but does not report or submits a false

report;

(iii) when a Specialist violates an instruction or order pursuant to the

provisions of paragraph (2) of the preceding Article and said circumstances

are considered serious.

(3) When a person is registered as set forth in Article 69-2, paragraph (1) that

has not been issued a Long-Term Care Support Specialist Certification as

defined by any of the following items, the prefectural governor that provides

said registration shall delete said registration:

(i) when said person corresponds to any provision of Article 69-2, paragraph (1),

item (i) to item (iii);

(ii) when said person is registered as set forth in Article 69-2, paragraph (1) by

wrongful means;

(iii) when said person operates a business as a Long-Term Care Support

Specialist.

Section 2 Designated In-Home Service Providers

(Appointment as service provider of a Designated In-Home Service Provider)

Article 70 (1) An appointment as service provider as set forth in the main clause

of Article 41, paragraph (1) shall be provided pursuant to the provisions of an

Ordinance of the Ministry of Health, Labour, and Welfare, by the submission of

an application of a person that operates an In-Home Service Business, and by

type of In-Home Service and provider that operates said In-Home Service

Business pertaining to the type of said In-Home Service (hereinafter referred

to simply as "Business Office" in this Section).

(2) A prefectural governor, in a case of an application to provide service as set

108

forth in the preceding paragraph when defined by any provision of item (i) to

item (iii), item (v) to item (vii), or item (ix) to item (x) (with regard to an

application of appointment as service provider pertaining to Guidance for

Management of In-Home Medical Long-Term Care provided by a Hospital, etc.,

Home-Visit Nursing provided by a hospital or a clinic, Home-Visit

Rehabilitation, Outpatient Rehabilitation, or Short-Term Admission for

Recuperation, item (ii) to item (xi)), shall not provide the appointment as

service provider as set forth in the main clause of Article 41, paragraph (1):

(i) when the applicant is not a juridical person;

(ii) when the knowledge, skill, and number of personnel of the Business Office

pertaining to said application do not meet standards as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare as set forth in

Article 74, paragraph (1) and for the number of employees as determined by

an Ordinance of the Ministry of Health, Labour, and Welfare as provided in

the same paragraph;

(iii) when it is determined that the applicant cannot perform a proper In-Home

Service Business in accordance with standards pertaining to facilities and

management of a Designated In-Home Service Business as prescribed in

Article 74, paragraph (2);

(iv) a person punished by imprisonment without compulsory labor and the

execution of said penalty has not yet been completed or has not yet expired;

(v) when the applicant is punished by a fine pursuant to the provisions of this

Act or any other Act pertaining to medical service or the welfare of citizens

as provided by a Cabinet Order and the execution of said penalty has not yet

been completed or has not yet expired;

(vi) when the applicant has been rescinded for an appointment as service

provider pursuant to the provisions of Article 77, paragraph (1) or Article

115-29, paragraph (6) and five years have not elapsed from the date of said

rescission (in a case when a person that has been rescinded for said

appointment as service provider is a juridical person, including a person that

is or was an Officer of said juridical person (which means an employee,

director, or executive Officer that executes the business, or a person in an

equivalent position and includes an employee, director, or executive Officer

that executes business for a juridical person, or a person that shall be

deemed to have the equivalent or higher ascendency of position to these

persons; the same shall apply in Section 5), a person that manages said

Business Office, or other personnel as provided by a Cabinet Order (herein

referred to as "Officers, etc.") within sixty days prior to the date of

notification pursuant to the provisions of Article 15 of the Administrative

Procedures Act pertaining to said rescission and five years have not elapsed

from the date of said rescission, and in a case when a person that has been

109

rescinded for said appointment as service provider, is a Hospital, etc., that is

not a juridical person, including a person that is or was a manager of said

Hospital, etc., within sixty days prior to the date of said rescission and five

years have not elapsed from the date of said rescission;

(vii) when the applicant who provided notification of abolishment of business

pursuant to the provisions of Article 75 from the date of notification

pursuant to the provisions of Article 15 of the Administrative Procedures Act

pertaining to rescission of appointment as service provider pursuant to the

provisions of Article 77, paragraph (1) or Article 115-29, paragraph (6) until

the date when the appointment as service provider is rescinded or when it is

determined not to rescind the appointment as service provider (except for a

person that has a reasonable basis for said abolishment of business) and five

years have not elapsed from the date of said notification;

(viii) in a case when abolishment of business pursuant to the provisions of

Article 75 was duly provided by notification during the period pursuant to

the provisions of the preceding item, when the applicant who was an Officer,

etc., of a juridical person (except for a juridical person that has a reasonable

basis for said abolishment of business) pertaining to said notification or a

manager of a Hospital, etc., that is not a juridical person pertaining to said

notification (except for a juridical person that has a reasonable basis for said

abolishment of business) within sixty days before the notification as set forth

in the same item, and five years have not elapsed from the date of said

notification;

(ix) when the applicant performed a wrongful or significantly unjustifiable act

pertaining to In-Home Service, etc., within five years prior to an application

of appointment as service provider;

(x) when the applicant is a juridical person and any said Officer, etc.,

corresponds to any of the provisions of item (iv) to the preceding item;

(xi) when the applicant is a Hospital, etc., which is not a juridical person and a

manager of said Provider corresponds to any provision of item (iv) to item (ix).

(3) In a case of an application as set forth in paragraph (1) for Daily Life Care of

a Patient Admitted to a Specialized Long-Term Care Specified Facility (which

means Daily Life Long-Term Care Admitted to a Specified Facility provided to

a Person Requiring Long-Term Care who is admitted to a Specialized Long-

Term Care Specified Facility; the same shall apply hereinafter), a prefectural

governor, when the total sum of the capacity of users of Daily Life Care of a

Patient Admitted to a Specialized Long-Term Care Specified Facility and the

total capacity of users of Daily Life Long-Term Care for a Person Admitted to a

Community-Based Specified Facility in the area including the location of the

Business Office pertaining to said application has reached or is it determined

to exceed due to the appointment as service provider of said business

110

pertaining to said application the total sum of the total capacity of users of

Daily Life Care of a Patient Admitted to a Specialized Long-Term Care

Specified Facility and the total capacity of users of Daily Life Long-Term Care

for a Person Admitted to a Community-Based Specified Facility in the area as

prescribed by a Prefectural Insured Long-Term Care Support Project Plan

provided by said prefecture pursuant to the provisions of paragraph (1) of the

same Article, or when it is determined that said application may interfere with

the accomplishment of said Prefectural Insured Long-Term Care Support

Project Plan, may determine not to execute the appointment as service

provider as set forth in the main clause of Article 41, paragraph (1).

(4) In a case of an application as set forth in paragraph (1) for Daily Life

Activities of a Long-Term Care Patient Admitted to a Combined Specified

Facility (which means Daily Life Long-Term Care Admitted to a Specified

Facility provided for a Person Requiring Long-Term Care who is a resident in a

Specified Facility other than a Specialized Long-Term Care Specified Facility;

the same shall apply herein), a prefectural governor, when the total of assumed

capacity of users of Daily Life Activities of a Long-Term Care Patient Admitted

to a Combined Specified Facility (which means a capacity calculated pursuant

to the provisions of an Ordinance of the Ministry of Health, Labour, and

Welfare) in the area including the location of the Business Office pertaining to

said application (which means an area provided by said prefecture pursuant to

the provisions of Article 118, paragraph (2), item (i)) has been reached or is it

determined that said capacity will be exceeded by the appointment as service

provider pertaining to said application the total of prospective capacity of

necessary users of Daily Life Activities of a Long-Term Care Patient Admitted

to a Combined Specified Facility (which means a capacity calculated pursuant

to the provisions of an Ordinance of the Ministry of Health, Labour, and

Welfare) in said area provided by a Prefectural Insured Long-Term Care

Support Project Plan provided by said prefecture pursuant to the provisions of

paragraph (1) of the same Article, or when it is determined that said

application may interfere with the accomplishment of said Prefectural Insured

Long-Term Care Support Project Plan, may determine not to execute an

appointment as service provider as set forth in the main clause of Article 41,

paragraph (1).

(5) A prefectural governor, when he or she intends to determine an appointment

as service provider as set forth in the main clause of Article 41, paragraph (1)

(limited to Daily Life Long-Term Care Admitted to a Specified Facility or other

In-Home Service as determined by an Ordinance of the Ministry of Health,

Labour, and Welfare), shall provide notice of matters as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare to the mayor of the

relevant Municipality, specify a reasonable period, and request opinions from

111

the perspective of coordination with the Municipal Insured Long-Term Care

Service Plan as prescribed in Article 117, paragraph (1) of said relevant

Municipality.

(Renewal of Appointment as service provider)

Article 70-2 (1) An appointment as service provider as set forth in the main

clause of Article 41, paragraph (1), if it is not renewed within a period of six

years, shall cease to be effective when said period expires.

(2) In a case of an application of renewal as set forth in the preceding paragraph,

when the disposition of said application does not occur prior to the expiry of

the period as set forth in the same paragraph (herein referred to as "Effective

Period of Designation as Service Provider" in this Article), the prior

appointment as service provider shall remain effective after expiry of the

Effective Period of Designation as Service Provider until a determination is

reached regarding said application.

(3) In a case as set forth in the preceding paragraph, when the appointment as

service provider is renewed, said Effective Period of Designation as Service

Provider shall be from the date following the date of expiry of the prior

Effective Period of Designation as Service Provider.

(4) The provisions of the preceding Article shall apply mutatis mutandis to a

renewal of appointment as service provider as set forth in paragraph (1).

(Exception of a Designated In-Home Service Provider)

Article 71 (1) With regard to a Hospital, etc., when a medical facility that

provides insured services or pharmacy that provides insured services is

appointed pursuant to the provisions of Article 63, paragraph (3), item (i) of

the Health Insurance Act (including when it is determined that appointment as

service provider as set forth in the same item was provided pursuant to the

provisions of Article 69 of the same Act), it shall be deemed that the organizer

of said Hospital, etc., was provided an appointment as service provider as set

forth in the main clause of Article 41, paragraph (1) pertaining to In-Home

Service provided by said Hospital, etc., (with regard to a hospital or a clinic,

limited to Guidance for Management of In-Home Medical Long-Term Care and

other types of In-Home Service as determined by an Ordinance of the Ministry

of Health, Labour, and Welfare, and with regard to a pharmacy, limited to

Guidance for Management of In-Home Medical Long-Term Care) at the time of

said appointment as service provider, provided however, that this provision

shall not apply when the organizer of the Hospital, etc., offers a different

notification pursuant to the provisions of an Ordinance of the Ministry of

Health, Labour, and Welfare or when the appointment as service provider as

set forth in the main clause of Article 41, paragraph (1) is rescinded pursuant

112

to the provisions of Article 77, paragraph(1) or Article 115-29, paragraph (6)

prior to said appointment as service provider.

(2) An appointment as service provider as set forth in the main clause of Article

41, paragraph (1) pertaining to a person that was deemed as a Designated In-

Home Service Provider pursuant to the provisions of the preceding paragraph,

when appointment as service provider of a medical facility that provides

insured services or pharmacy that provides insured services is rescinded

pursuant to the provisions of Article 80 of the Health Insurance Act with

regard to said Hospital, etc., pertaining to said appointment as service provider,

shall cease to be effective.

Article 72 (1) With regard to a Long-Term Care Health Facility or Sanatorium

Medical Facility for the Elderly Requiring Long-Term Care when it is approved

as set forth in Article 94, paragraph (1) or appointed as set forth in Article 48,

paragraph (1), item (iii), it shall be deemed that the organizer of said Long-

Term Care Health Facility or Sanatorium Medical Facility for the Elderly

Requiring Long-Term Care shall be appointed as set forth in the main clause of

Article 41, paragraph (1) pertaining to In-Home Service (limited to Short-Term

Admission for Recuperation or a type of In-Home Service as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare) provided by said

Long-Term Care Health Facility or Sanatorium Medical Facility for the Elderly

Requiring Long-Term Care at the time of said approval or appointment as

service provider, however, provided that this provision shall not apply when

the organizer of said Long-Term Care Health Facility or Sanatorium Medical

Facility for the Elderly Requiring Long-Term Care offers a different

notification pursuant to the provisions of an Ordinance of the Ministry of

Health, Labour, and Welfare.

(2) The appointment as service provider as set forth in the main clause of Article

41, paragraph (1) pertaining to a person that is deemed as a Designated In-

Home Service Provider pursuant to the provisions of the preceding paragraph,

shall cease to be effective when, with regard to a Long-Term Care Health

Facility or a Sanatorium Medical Facility for the Elderly Requiring Long-Term

Care pertaining to said appointment as service provider, when the approval

ceases to be effective pursuant to the provisions of Article 94-2, paragraph (1),

when the approval is rescinded pursuant to the provisions of Article 104,

paragraph (1) or Article 115-29, paragraph (6), when the appointment as

service provider ceased to be effective pursuant to the provisions of Article 170-

2, paragraph (1), or when the appointment as service provider is rescinded

pursuant to the provisions of Article 114, paragraph (1) or Article 115-29,

paragraph(6).

113

(Standards of Designated In-Home Service Business)

Article 73 (1) A Designated In-Home Service Provider shall act in compliance

with the standards concerning facilities and management of a Designated In-

Home Service Business as prescribed in paragraph (2) of the following Article,

offer appropriate Designated In-Home Service according to the mental and

physical condition, etc., of a Person Requiring Long-Term Care, and always

engage in offering said services from the viewpoint of the person that receives

Designated In-Home Service by implementing a self-evaluation of the quality

of the Provider's own Designated In-Home Service and other measures.

(2) A Designated In-Home Service Provider, when an opinion as listed in Article

27, paragraph (7), item (ii) (including a case applied mutatis mutandis

pursuant to Article 28, paragraph (4) or Article 29, paragraph (2)) or Article 32,

paragraph (6), item (ii) (including a case applied mutatis mutandis pursuant to

Article 33, paragraph (4) or Article 33-2, paragraph (2)), or an opinion as

prescribed in the second sentence of Article 30, paragraph (1) or in the second

sentence of Article 33-3, paragraph (1) (herein referred to as "Opinion of the

Certification Committee") is entered on the Certificate of Insured Person that

is presented by an Insured Person that intends to receive Designated In-Home

Service, shall engage in offering said Designated In-Home Service of said

Insured Person in consideration of said Opinion of the Certification Committee.

Article 74 (1) A Designated In-Home Service Provider shall employ the number

of employees engaging in said Designated In-Home Service as determined by

an Ordinance of the Ministry of Health, Labour, and Welfare in accordance

with standards as determined by an Ordinance of the Ministry of Health,

Labour, and Welfare, by each Business Office pertaining to said appointment

as service provider.

(2) In addition to the provisions as prescribed in the preceding paragraph,

standards concerning facilities and management of a Designated In-Home

Service Business shall be determined by the Minister of Health, Labour, and

Welfare.

(3) The Minister of Health, Labour, and Welfare, when providing standards

concerning facilities and management of a Designated In-Home Service

Business as prescribed in the preceding paragraph (limited to the part

concerning the handling of Designated In-Home Service), shall hear the

opinion of the Social Security Council in advance.

(4) A Designated In-Home Service Provider shall respect the personality of a

Person Requiring Long-Term Care, act in compliance with this Act or an Order

based on this Act, and faithfully executes said duty on behalf of the Person

Requiring Long-Term Care.

114

(Notification of Change, etc.)

Article 75 A Designated In-Home Service Provider, when the name or location of

the Business Office pertaining to said appointment as service provider or other

matters as determined by an Ordinance of the Ministry of Health, Labour, and

Welfare change, or when said Designated In-Home Service Business is

abolished, suspended, or recommenced, shall provide notification of said fact to

the prefectural governor within ten days pursuant to the provisions of an

Ordinance of the Ministry of Health, Labour, and Welfare.

(Reporting, etc.)

Article 76 (1) A prefectural governor or mayor of a Municipality, when it is

determined to be necessary concerning the payment of an allowance for In-

Home Long-Term Care, shall order a Designated In-Home Service Provider, a

person that is or was a Designated In-Home Service Provider, or a person that

is or was an employee or Officer pertaining to said appointment as service

provider (herein referred to as a "Person, etc., that was a Designated In-Home

Service Provider" in this paragraph) to report, submit or present record books

and documents, request a Designated In-Home Service Provider, an employee

of the Business Office pertaining to said appointment as service provider, or a

Person that is or was a Designated In-Home Service Provider, etc., to appear,

to direct its personnel to ask questions to a relevant person, or enter the

Business Office pertaining to said appointment as service provider of said

Designated In-Home Service Provider in order to inspect said facilities, record

books and documents, or other items.

(2) The provisions of Article 24, paragraph (3) shall apply mutatis mutandis to

questions and inspections pursuant to the provisions of the preceding

paragraph, and the provisions of paragraph (4) of the same Article shall apply

mutatis mutandis to the authority granted pursuant to the provisions of the

preceding paragraph.

(Recommendations, Orders, etc.)

Article 76-2 (1) A prefectural governor, when a Designated In-Home Service

Provider fails to meet the standards as determined by an Ordinance of the

Ministry of Health, Labour, and Welfare as set forth in the Article 74,

paragraph (1) or the fixed minimum number of employees as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare as set forth in the

same paragraph with regard to knowledge, skill, or number of employees of the

Business Office pertaining to said appointment as service provider, or when it

is determined that said Designated In-Home Service Provider does not operate

an appropriate Designated In-Home Service in accordance with the standards

concerning Facilities and Management of a Designated In-Home Service

115

Business provided by paragraph (2) of the same Article, may specify a due date

and recommend to said Designated In-Home Service Provider to act in

compliance with the standards as determined by an Ordinance of the Ministry

of Health, Labour, and Welfare as set forth in paragraph (1) of the same Article,

to employ the number of employees as determined by an Ordinance of the

Ministry of Health, Labour, and Welfare as set forth in the same paragraph,

and to act in compliance with the standards concerning Facilities and

Management of a Designated In-Home Service Business as prescribed by

paragraph (2) of the same Article.

(2) A prefectural governor, in a case of providing a recommendation pursuant to

the provisions of the preceding paragraph, may provide public notice of the fact

that said Designated In-Home Service Provider that was issued said

recommendation did not act in compliance with said recommendation within

the due date as set forth in the same paragraph.

(3) When said Designated In-Home Service Provider that was issued a

recommendation pursuant to the provisions of paragraph (1) does not

implement any measures pertaining to said recommendation without a

justifiable cause, a prefectural governor may specify a due date and order said

Designated In-Home Service Provider to implement measures pertaining to

said recommendation.

(4) A prefectural governor, when issuing an order pursuant to the provisions of

the preceding paragraph, shall issue public notice of said fact.

(5) With regard to a Designated In-Home Service Provider who provided

Designated In-Home Service pertaining to an insurance benefit, a Municipality,

when it is determined that said Designated In-Home Service Provider does not

operate an appropriate Designated In-Home Service Business in accordance

with standards concerning Facilities and Management of a Designated In-

Home Service Business as prescribed in Article 74, paragraph (2), shall provide

notification of said fact to the prefectural governor that governs the location of

the Business Office pertaining to said appointment as service provider.

(Rescission of Appointment as service provider, etc.)

Article 77 (1) A prefectural governor, in a case that corresponds to any of the

following items, may rescind the appointment as service provider as set forth

in the main clause of Article 41, paragraph (1) pertaining to said Designated

In-Home Service Provider or suspend the whole or a part of the effect of said

appointment as service provider by specifying a due date:

(i) when a Designated In-Home Service Provider corresponds to any provision

of Article 70, paragraph (2), item (iv), item (v), item (x), or item (xi);

(ii) when a Designated In-Home Service Provider becomes unable to meet the

standards as determined by an Ordinance of the Ministry of Health, Labour,

116

and Welfare as set forth in Article 74, paragraph (1) or the fixed minimum

number of employees as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare as set forth in the same paragraph with regard

to knowledge, skill, or number of employees of the Business Office pertaining

to said appointment as service provider;

(iii) when a Designated In-Home Service Provider becomes unable to operate

an appropriate Designated In-Home Service Business in accordance with

standards concerning Facilities and Management of a Designated In-Home

Service Business as prescribed in Article 74, paragraph (2);

(iv) when it is determined that a Designated In-Home Service Provider violates

an obligation as prescribed in Article 74, paragraph (4);

(v) when an Allowance for In-Home Long-Term Care Service is wrongly

requested;

(vi) when a Designated In-Home Service Provider is ordered to report, submit

or present record books and documents pursuant to the provisions of Article

76, paragraph (1), but disobeys said order or submits a false report;

(vii) when a Designated In-Home Service Provider or an employee of the

Business Office pertaining to said appointment as service provider is

requested to appear pursuant to the provisions of Article 76, paragraph (1),

fails to respond or fails to reply to questions pursuant to the provisions of the

same paragraph or submits a false reply, or refuses, interrupts, or interferes

with an inspection pursuant to the provisions of the same paragraph,

however, provided that this provision shall not apply when an employee of

the Business Office pertaining to said appointment as service provider

performs said act but said Designated In-Home Service Provider is faithfully

providing reasonable care and supervision in order to prevent said act of said

employee;

(viii) when a Designated In-Home Service Provider is appointed to provide

service as set forth in the main clause of Article 41, paragraph (1) by

wrongful means;

(ix) in addition to the cases listed in the preceding items, when a Designated

In-Home Service Provider violates this Act, another Act concerning citizens'

health and medical care or public aid that are provided by a Cabinet Order,

or an order or disposition of a matter based on these Acts;

(x) in addition to the cases listed in the preceding items, when a Designated In-

Home Service Provider performs a wrongful or significantly unjustifiable act

concerning In-Home Service, etc.;

(xi) in a case when a Designated In-Home Service Provider is a juridical person,

when any said Officer, etc., performs a wrongful or significantly unjustifiable

act concerning In-Home Service, etc., within five years and the appointment

as service provider is rescinded or the whole or a part of the effect of the

117

appointment as service provider is suspended due to said act;

(xii) in a case when a Designated In-Home Service Provider is a Hospital, etc.,

that is not a juridical person, when a manager of said Provider performs a

wrongful or significantly unjustifiable act concerning In-Home Service, etc.,

within five years and the appointment as service provider is rescinded or the

whole or a part of the effect of the appointment as service provider is

suspended due to said act.

(2) A Municipality, when it is determined that a Designated In-Home Service

Provider that provides Designated In-Home Service pertaining to an insurance

benefit corresponds to any provision of the items in the preceding paragraph,

shall provide notification of said fact to the prefectural governor that governs

the location of the Business Office pertaining to said appointment as service

provider.

(Public Notice)

Article 78 A prefectural governor shall, in the following cases, provide public

notice of the said fact:

(i) when an appointment as service provider as set forth in the main clause of

Article 41, paragraph (1) is determined;

(ii) when there is a notification pursuant to the provisions of Article 75 (except

for change of matters as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare as set forth in the same Article and matters

pertaining to abolishment or recommencement of business provided by the

same Article);

(iii) when an appointment as service provider as set forth in the main clause of

Article 41, paragraph (1) is rescinded, or the effect of the whole or a part of

an appointment as service provider is suspended pursuant to the provisions

of paragraph (1) of the preceding Article or Article 115-29, paragraph (6).

Section 3 Designated Community-Based Service Providers

(Appointment as service provider of Designated Community-Based Service

Providers)

Article 78-2 (1) An appointment as service provider as set forth in the main

clause of Article 42-2, paragraph (1) shall be provided, pursuant to the

provisions of an Ordinance of the Ministry of Health, Labour, and Welfare,

based on the application of a person that provides community-based service

(with regard to a business to provide Admission to a Community-Based Facility

for Preventive Daily Long-Term Care of the Elderly Covered by Public Aid, an

organizer of an Intensive Care Home for the Elderly as prescribed in Article

20-5 of the Public Aid for the Aged Act for which capacity of users are twenty-

118

nine (29) or less), by type of Community-Based Service and Business Office of

Community-Based Service Business pertaining to the type of said Community-

Based Service (herein referred to as "Business Office" in this Section), and

shall have an effect on the payment of an Allowance for Community-Based

Long-Term Care Service or an Exceptional Allowance for Community-Based

Long-Term Care Service to an Insured Person by Long-Term Care Insurance

provided by a Municipality of which a mayor provided said appointment as

service provider.

(2) The mayor of a Municipality shall, when providing an appointment as service

provider as set forth in the main clause of Article 42-2, paragraph (1), provide

notification of said fact to the prefectural governor in advance pursuant to the

provisions of an Ordinance of the Ministry of Health, Labour, and Welfare.

(3) A prefectural governor, in a case when a mayor of a Municipality provides

notification as set forth in the preceding paragraph regarding Daily Life Long-

Term Care for a Person Admitted to a Community-Based Specified Facility,

and when it is determined that the total sum of the total number of maximum

users of Daily Life Care of a Patient Admitted to a Specialized Long-Term Care

Specified Facility and the total number of maximum users of Daily Life Long-

Term Care for a Person Admitted to a Community-Based Specified Facility in

the area (which shall be an area provided by said prefecture pursuant to the

provisions of Article 118, paragraph (2) item (i)) including the location of the

Business Office pertaining to said application has been reached or is it

determined that said total number of maximum users will be exceeded by the

appointment as service provider pertaining to said application to provide

service of Daily Life Care of a Patient Admitted to a Specialized Long-Term

Care Specified Facility and the total number of the necessary number of users

of Daily Life Long-Term Care for a Person Admitted to a Community-Based

Specified Facility in said area provided by Prefectural Insured Long-Term Care

Support Project Plan that is provided by said prefecture pursuant to the

provisions of paragraph (1) of the same Article, or when it is determined that it

will be likely to cause a problem with accomplishment of a Prefectural Insured

Long-Term Care Support Project Plan, may provide necessary advice or

recommendations to said mayor of the Municipality.

(4) The mayor of a Municipality, in a case of an application to provide service as

set forth in paragraph (1) and when it corresponds to any of the following items,

shall not provide an appointment as service provider as set forth in the main

clause of Article 42-2, paragraph (1):

(i) when said applicant is not a juridical person;

(ii) when the knowledge, skill, or number personnel of the Business Office

pertaining to said application do not meet the standards as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare as set forth in

119

Article 78-4, paragraph (1) and number of employees as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare of the same

paragraph, or standards concerning employees engaged in Designated

Community-Based Service as prescribed in paragraph (4) of the same Article;

(iii) when it is determined that said applicant cannot perform proper

Community-Based Service Business in accordance with standards pertaining

to Facilities and Management of a Designated Community-Based Service as

prescribed in Article 78-4, paragraph (2) or paragraph (4);

(iv) when the Business Office pertaining to said application is located outside

the area of said Municipality and the consent of the mayor of the

Municipality of said location have not yet been obtained;

(v) when said applicant is punished by a fine pursuant to the provisions of this

Act, or as provided by a Cabinet Order, concerning citizens' health and

medical care or public aid and the execution of said penalty has not yet been

completed or has not yet expired;

(vi) when said applicant has been rescinded for an appointment as service

provider pursuant to the provisions of Article 78-9 (except for item (ii) to

item (v)) and five years have not elapsed from the date of said rescission;

(vii) when said applicant provides notification of an abolishment of business

pursuant to the provisions of Article 78-5 (except for a person that has a

reasonable basis for abolishment of said business), or declined an

appointment as service provider pursuant to the provisions of Article 78-7

(except for a person that has a reasonable basis to decline said appointment

as service provider) from the date of notification pursuant to the provisions

of Article 15 of the Administrative Procedures Act pertaining to rescission of

appointment as service provider pursuant to the provisions of Article 78-9

(except for item (i) to (v), and five years have not elapsed from the date of

said notification;

(viii) when said applicant performs a wrongful or significantly unjustifiable act

concerning In-Home Service within five years prior to the application of

appointment as service provider;

(ix) when any Officer, etc., of said applicant corresponds to any of the

following:

(a) a person punished by imprisonment without compulsory labor and the

execution of said penalty has not yet been completed or has not yet

expired;

(b) a person that corresponds to item (v) or the preceding item;

(c) a person that is or was an Officer, etc., of a juridical person which

appointment as service provider is rescinded pursuant to the provisions of

Article 78-9 (except for item (ii) to item (v)) within sixty days prior to the

date of notification pursuant to the provisions of Article 15 of the

120

Administrative Procedures Act pertaining to said rescission and five years

have not elapsed from the date of said rescission;

(d) a person that is or was an Officer, etc., of a juridical person that provided

notification of an abolishment of business pursuant to the provisions of

Article 78-5 (except for a juridical person that has a reasonable basis for

said abolishment of business), or a juridical person that declined an

appointment as service provider pursuant to the provisions of Article 78-7

(except for a juridical person that has a reasonable basis for said decline of

appointment as service provider) within the period provided by item (vii)

and within sixty days prior to the date of notification as set forth in the

same item and five years have not elapsed from the date of said

notification or decline of appointment as service provider.

(5) The mayor of a Municipality, in a case when an application as set forth in

paragraph (1) is filed and when it corresponds to any of the following items,

may not provide an appointment as service provider as set forth in the main

clause of Article 42-2, paragraph (1):

(i) when an applicant has rescinded an appointment as service provider

pursuant to the provisions of Article 78-9, item (ii) to item (v) and five years

have not elapsed from the date of said rescission;

(ii) when an applicant provides notification of abolishment of business

pursuant to the provisions of Article 78-5 (except for a person that has a

reasonable basis for said abolishment of business) or declined an

appointment as service provider pursuant to the provisions of Article 78-7

(except for a person that has a reasonable basis for said decline of

appointment as service provider) from the date of notification pursuant to

the provisions of Article 15 of the Administrative Procedures Act pertaining

to rescission of appointment as service provider pursuant to the provisions of

Article 78-9, item (ii) to item (v) and five years have not elapsed from the

date of said notification or decline of appointment as service provider;

(iii) when any Officer, etc., of an applicant corresponds to any of the following:

(a) a person that is or was an Officer, etc., of a juridical person that

appointment as service provider is rescinded pursuant to the provisions of

Article 78-9, item (ii) to item (v) within sixty days prior to the date of

rescission pursuant to the provisions of Article 15 of the Administrative

Procedures Act pertaining to said rescission and five years have not

elapsed from the date of said rescission;

(b) a person that is or was an Officer, etc., of a juridical person that provides

notification of abolishment of business pursuant to the provisions of Article

78-5 (except for a juridical person that has a reasonable basis for said

abolishment of business) within the period provided by the preceding item,

or a juridical person that declined an appointment as service provider

121

pursuant to the provisions of Article 78-7 (except for a juridical person that

has a reasonable basis for said decline of appointment as service provider)

within the period provided by the preceding item, within sixty days prior to

the date of notification as set forth in the same item, and five years have

not elapsed from the date of said notification or said decline of

appointment as service provider;

(iv) in a case when an appointment as service provider as set forth in

paragraph (1) was filed for Communal Daily Long-Term Care for a Dementia

Patient, Daily Life Long-Term Care for a Person Admitted to a Community-

Based Specified Facility, or Admission to a Community-Based Facility for

Preventive Daily Long-Term Care of the Elderly Covered by Public Aid, when

it is determined that the total capacity of users of said Community-Based

Service in said Municipality or in the area including the location of the

Business Office pertaining to said application (which means an area provided

by said Municipality pursuant to the provisions of Article 117, paragraph (2),

item (i); herein referred to as "Daily Activities Area" in this item) has been

reached or is it determined that said total number will be exceeded by the

appointment as service provider pertaining to said application for the total

capacity of necessary users for said Community-Based Service in said

Municipality or said Daily Activities Area provided by Municipal Insured

Long-Term Care Service Plan provided by said Municipality pursuant to the

provisions of paragraph (1) of the same Article, or when it is determined that

it is likely to cause problems with the accomplishment of said Municipal

Insured Long-Term Care Service Plan.

(6) The mayor of a Municipality, when he or she intends to provide an

appointment as service provider as set forth in the main clause of Article 42-2,

paragraph (1), or, he or she determines not to provide an appointment as

service provider as set forth in the main clause of paragraph (1) of the same

Article pursuant to the provisions of item (iv) of the preceding paragraph, shall

take necessary measures in advance in order to reflect the opinions of Insured

Persons of Long-Term Care Insurance provided by said Municipality or other

relevant persons.

(7) The mayor of a Municipality, when providing an appointment as service

provider as set forth in the main clause of Article 42-2, paragraph (1), may add

a provision that is determined to be necessary for ensuring the appropriate

conduct of said business.

(Standards of Designated Community-Based Service Business)

Article 78-3 (1) A Designated Community-Based Service Provider shall act in

compliance with the standards concerning Facilities and Management of a

Designated Community-Based Service Business as prescribed in paragraph (2)

122

or paragraph (4) of the following Article, offer appropriate Designated

Community-Based Service according to the mental and physical condition, etc.,

of a Person Requiring Long-Term Care, and always engage in offering said

services from the viewpoint of the person that receives Designated Community-

Based Service by implementing a self-evaluation of the quality of the

Provider's own Designated Community-Based Service and other measures.

(2) A Designated Community-Based Service Provider, when an Opinion of the

Certification Committee is entered on the Certificate of Insured Person that is

presented by an Insured Person that intends to receive Designated

Community-Based Service, shall engage in offering said Designated

Community-Based Service of said Insured Person in consideration of said

Opinion of the Certification Committee.

Article 78-4 (1) A Designated Community-Based Service Provider shall employ

the number of employees that engage in said Designated Community-Based

Service as determined by an Ordinance of the Ministry of Health, Labour, and

Welfare in accordance with the standards as determined by an Ordinance of

the Ministry of Health, Labour, and Welfare in each Business Office pertaining

to said appointment as service provider.

(2) In addition to the provisions in the preceding paragraph, standards

concerning Facilities and Management of a Designated Community-Based

Service Business shall be determined by the Minister of Health, Labour, and

Welfare.

(3) The Minister of Health, Labour, and Welfare, when intending to provide

standards concerning Facilities and Management of a Designated Community-

Based Service Business pursuant to the provisions of the preceding paragraph

(limited to the part concerning the handling of Designated Community-Based

Service), shall hear the opinion of the Social Security Council in advance.

(4) A Municipality, notwithstanding the provisions of paragraph (1) and

paragraph (2) and within the scope as determined by an Ordinance of the

Ministry of Health, Labour, and Welfare, in lieu of standards provided by these

provisions, may provide standards concerning employees that engage in

Designated Community-Based Service in said Municipality and standards

concerning Facilities and Management of a Designated Community-Based

Service Business.

(5) A Municipality, when it intends to provide standards concerning employees

that engage in Designated Community-Based Service in said Municipality as

set forth in the preceding paragraph and standards concerning Facilities and

Management of a Designated Community-Based Service Business, shall reflect

the opinions of Insured Persons of Long-Term Care Insurance provided by said

Municipality and take necessary measures in order to promote the use of

123

knowledge of persons with relevant knowledge and experience.

(6) A Designated Community-Based Service Provider shall respect the

personality of a Person Requiring Long-Term Care, act in compliance with this

Act or an Order based on this Act, and faithfully perform said duty for a Person

Requiring Long-Term Care.

(Notification of Change, etc.)

Article 78-5 A Designated Community-Based Service Provider, when the name

or location of an Business Office pertaining to an appointment as service

provider or other matters as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare are changed, or when said Designated

Community-Based Service Business (except for Admission to a Community-

Based Facility for Preventive Daily Long-Term Care of the Elderly Covered by

Public Aid) is abolished, suspended, or recommenced, shall provide notification

of said fact to the mayor of the Municipality within ten days pursuant to the

provisions of an Ordinance of the Ministry of Health, Labour, and Welfare.

(Reporting, etc.)

Article 78-6 (1) The mayor of a Municipality, when it is determined to be

necessary concerning payment of an Allowance for Community-Based Long-

Term Care Service, shall order a Designated Community-Based Service

Provider, a person that is or was a Designated Community-Based Service

Provider, or a person that is or was an employee or an Officer pertaining to

said appointment as service provider (herein referred to as a "Person that was

a Designated Community-Based Service Provider, etc." in this paragraph) to

report, submit or present record books and documents, request a Designated

Community-Based Service Provider, an employee of the Business Office

pertaining to said appointment as service provider or a Person that was a

Designated Community-Based Service Provider, etc., to appear, direct its

personnel to ask questions to the relevant Person, or enter the Business Office

pertaining to said appointment as service provider of said Designated

Community-Based Service Provider in order to inspect said facilities, record

books and documents, or other items.

(2) The provisions of Article 24, paragraph (3) shall apply mutatis mutandis to

questions and inspections pursuant to the provisions of the preceding

paragraph, and the provisions of paragraph (4) of the same Article shall apply

mutatis mutandis to the authority granted pursuant to the provisions of the

preceding paragraph.

(Decline of an Appointment as service provider)

Article 78-7 A person that performs the business of Admission to a Community-

124

Based Facility for Preventive Daily Long-Term Care of the Elderly Covered by

Public Aid under appointment as set forth in Article 42-2, paragraph (1), main

clause may decline said appointment as service provider by providing a period

of one month or longer of said prior notice.

(Recommendations, Orders, etc.)

Article 78-8 (1) The mayor of a Municipality, when it is determined that a

Designated Community-Based Service Provider does not act in compliance with

the provision provided when providing said appointment as service provider

pursuant to the provisions of Article 78-2, paragraph (7), that does not meet

the standards as determined by an Ordinance of the Ministry of Health,

Labour, and Welfare as set forth in the Article 78-4, paragraph (1) or fixed

number as determined by an Ordinance of the Ministry of Health, Labour, and

Welfare as set forth in the same paragraph, or standards concerning employees

that engage in Designated Community-Based Service provided by paragraph

(4) of the same Article, with regard to knowledge, skill, or number of employee

of the Business Office pertaining to said appointment as service provider, or

when it is determined that said Designated Community-Based Service Provider

does not operate an appropriate Designated Community-Based Service in

accordance with the standards concerning Facilities and Management of a

Designated Community-Based Service Business provided by paragraph (2) or

paragraph (4) of the same Article, may specify a due date and recommend to

said Designated Community-Based Service Provider to act in compliance with

the provisions provided when determining said appointment as service

provider pursuant to the provisions of Article 78-2, paragraph (7), to comply

with the standards as determined by an Ordinance of the Ministry of Health,

Labour, and Welfare as set forth in Article 78-4, paragraph (1), to employ the

number of employees as determined by an Ordinance of the Ministry of Health,

Labour, and Welfare as set forth in the same paragraph, to comply with

standards concerning employees that engage in Designated Community-Based

Service as prescribed in paragraph (4) of the same Article, and to comply with

standards concerning Facilities and Management of a Designated Community-

Based Service Business as prescribed by paragraph (2) or paragraph (4) of the

same Article.

(2) The mayor of a Municipality, in a case of providing a recommendation

pursuant to the provisions of the preceding paragraph, may provide public

notice of the fact that said Designated Community-Based Service Provider that

was issued said recommendation did not act in compliance with said

recommendation within the due date as set forth in the same paragraph.

(3) The mayor of a Municipality, when a Designated Community-Based Service

Provider that was issued a recommendation pursuant to the provisions of

125

paragraph (1) does not implement the measures pertaining to said

recommendation without justifiable reasons may specify a due date and order

said Designated Community-Based Service Provider to implement measures

pertaining to said recommendation.

(4) The mayor of a Municipality, when issuing an order pursuant to the

provisions of the preceding paragraph, shall issue public notice of the said fact.

(Rescission of Appointment as service provider, etc.)

Article 78-9 A mayor of a Municipality, in a case that corresponds to any of the

following items, may rescind an appointment as service provider as set forth in

the main clause of Article 42, paragraph (1) pertaining to said Designated

Community-Based Service Provider or suspend the whole or a part of the effect

of said appointment as service provider by specifying a due date for

compliance:

(i) when a Designated Community-Based Service Provider corresponds to any

provision of Article 78-2, paragraph (4), item (iv), item (v), or item (ix);

(ii) when a Designated Community-Based Service Provider corresponds to any

provision of Article 78-2, paragraph (5), item (iii);

(iii) when it is determined that a Designated Community-Based Service

Provider is in violation of a provision determined when granting said

appointment as service provider pursuant to the provisions of the provisions

of Article 78-2, paragraph (7);

(iv) when a Designated Community-Based Service Provider becomes unable to

meet the standards as determined by an Ordinance of the Ministry of Health,

Labour, and Welfare as set forth in Article 78-4, paragraph (1), employ the

fixed minimum number of employees as determined by an Ordinance of the

Ministry of Health, Labour, and Welfare as set forth in the same paragraph,

or standards concerning employees that engage in Designated Community-

Based Service as prescribed in paragraph (4) of the same Article, with regard

to knowledge, skill, or number of employees of the Business Office pertaining

to said appointment as service provider;

(v) when a Designated Community-Based Service Provider becomes unable to

operate an appropriate Designated Community-Based Service Business in

accordance with standards concerning Facilities and Management of a

Designated Community-Based Service Business as prescribed in Article 78-4,

paragraph (2) or paragraph (4);

(vi) when it is determined that a Designated Community-Based Service

Provider violates an obligation as prescribed in Article 78-4, paragraph (6);

(vii) when a Designated Community-Based Service Provider (limited to a

Provider that provides Admission to a Community-Based Facility for

Preventive Daily Long-Term Care of the Elderly Covered by Public Aid) is

126

entrusted with an investigation pursuant to the provisions of Article 28,

paragraph (5) (including a case applied mutatis mutandis pursuant to Article

29, paragraph (2), Article 30, paragraph (2), Article 31, paragraph (2), Article

33, paragraph (4), Article 33-2, paragraph (2), Article 33-3, paragraph (2),

and Article 34, paragraph (2); the same shall apply to Article 84, Article 92,

Article 104 and Article 114), and submits a false report regarding the result

of said investigation;

(viii) when an Allowance for Community-Based Long-Term Care Service is

wrongly requested;

(ix) when a Designated Community-Based Service Provider is ordered to report,

submit, or present record books and documents pursuant to the provisions of

Article 78-6, paragraph (1), but disobeys said order or submits a false report;

(x) when a Designated Community-Based Service Provider or an employee of

the Business Office pertaining to said appointment as service provider is

requested to appear pursuant to the provisions of Article 78-6, paragraph (1),

but does not respond or does not reply to questions pursuant to the

provisions of the same paragraph or submits a false reply, or refuses,

interrupts, or interferes with an inspection pursuant to the provisions of the

same paragraph, however, provided that this provision shall not apply when

an employee of the Business Office pertaining to said appointment as service

provider performed said act and said Designated Community-Based Service

Provider was faithfully providing reasonable care and supervision in order to

prevent said act of said employee;

(xi) when a Designated Community-Based Service Provider is appointed to

provide service as set forth in the main clause of Article 42-2, paragraph (1)

by wrongful means;

(xii) in addition to the cases listed in the preceding items, when a Designated

Community-Based Service Provider violates this Act, another Act concerning

citizens' health and medical care or public aid as determined by a Cabinet

Order, or other Order or the disposition of a matter based on these Acts;

(xiii) in addition to the cases listed in the preceding items, when a Designated

Community-Based Service Provider performs a wrongful or significantly

unjustifiable act concerning In-Home Service, etc.;

(xiv) when any Officer, etc., of a Designated Community-Based Service

Provider performs a wrongful or significantly unjustifiable act concerning In-

Home Service, etc., within five years and the appointment as service provider

is rescinded or the whole or a part of the effect of the appointment as service

provider is suspended due to said act.

(Public Notice)

Article 78-10 A mayor of a Municipality, in the following cases, shall provide

127

notification of said fact to the prefectural governor and issue public notice of

the said fact without delay:

(i) when an appointment as service provider as set forth in the main clause of

Article 42-2, paragraph (1) is determined;

(ii) when there is a notification pursuant to the provisions of Article 78-5

(except for change of matters as determined by an Ordinance of the Ministry

of Health, Labour, and Welfare as set forth in the same Article and matters

pertaining to abolishment or recommencement of business provided by the

same Article);

(iii) when the appointment as service provider as set forth in the main clause of

Article 42-2, paragraph (1) is declined pursuant to the provisions of Article

78-7;

(iv) when an appointment as service provider as set forth in the main clause of

Article 42-2, paragraph (1) is rescinded, or the effect of the whole or a part of

an appointment as service provider is suspended.

(Mutatis Mutandis Application)

Article 78-11 The provisions of Article 70-2 shall apply mutatis mutandis to the

main clause of Article 42-2, paragraph (1). In this case, the necessary technical

replacement of terms shall be provided by a Cabinet Order.

Section 4 Designated In-Home Long-Term Care Support Providers

(Appointment as service provider of Designated In-Home Long-Term Care

Support Providers)

Article 79 (1) An appointment as service provider as set forth in Article 46,

paragraph (1) shall be determined pursuant to the provisions of an Ordinance

of the Ministry of Health, Labour, and Welfare, by the application of a Person

that operates an In-Home Long-Term Care Support Business, and by type of

In-Home Service and provider that operates In-Home Long-Term Care Support

Business pertaining to the type of said In-Home Service (hereinafter referred

to simply as "Business Office" in this Section).

(2) A prefectural governor, in a case of an application as set forth in the

preceding paragraph, when it corresponds to any of the following items, shall

not provide appointment as service provider as set forth in Article 46,

paragraph (1):

(i) when the applicant is not a juridical person;

(ii) when the number of Long-Term Care Support Specialist s pertaining to said

application does not meet the fixed minimum number of employees as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare

as set forth in Article 81, paragraph (1);

128

(iii) when it is determined that the applicant cannot perform proper In-Home

Long-Term Care Support Business in accordance with standards pertaining

to Management of a Designated In-Home Long-Term Care Support Business

as prescribed in Article 81, paragraph (2);

(iv) when the applicant is punished by a fine pursuant to the provisions of this

Act or another Act pertaining to citizens' health and medical care and public

aid as determined by a Cabinet Order and the execution of said penalty has

not yet been completed or has not yet expired;

(v) when the applicant has rescinded appointment as service provider pursuant

to the provisions of Article 84, paragraph (1) or Article 115-29, paragraph (6)

and five years have not elapsed from the date of said rescission;

(vi) when the applicant provides notification of abolishment of business

pursuant to the provisions of Article 82 from the date of notification

pursuant to the provisions of Article 15 of the Administrative Procedures Act

pertaining to rescission of appointment as service provider pursuant to the

provisions of Article 84, paragraph (1) or Article 115-29, paragraph (6) to the

date when the appointment as service provider is rescinded or when it is

determined not to rescind the appointment as service provider (except for a

person that has a reasonable basis for said abolishment of business) and five

years have not elapsed yet from the date of said notification;

(vii) when the applicant performs a wrongful or significantly unjustifiable act

pertaining to In-Home Service, etc., within five years prior to said

application of appointment as service provider;

(viii) when any Officer, etc., of the applicant corresponds to any of the following

items:

(a) a person punished by imprisonment without compulsory labor and the

execution of said penalty has not yet been completed or has not yet

expired;

(b) a person that corresponds to item (iv) or the preceding item;

(c) a person that is or was an Officer, etc., of a juridical person that

appointment as service provider is rescinded pursuant to the provisions of

Article 84, paragraph (1) or Article 115-29, paragraph (6) within sixty days

prior to the date of notification pursuant to the provisions of Article 15 of

the Administrative Procedures Act pertaining to said rescission and five

years have not elapsed from the date of said rescission;

(d) a person that is or was an Officer, etc., of a juridical person that provided

notification of an abolishment of business pursuant to the provisions of

Article 82 (except for a juridical person that has a reasonable basis for said

abolishment of business), within the period provided by item (vi), within

sixty days prior to the date of notification as set forth in the same item and

five years have not elapsed from the date of said notification or decline of

129

appointment as service provider.

(Renewal of Appointment as service provider)

Article 79-2 (1) An appointment as service provider as set forth in Article 46,

paragraph (1), if it is not renewed within a period of six years, shall cease to be

effective when said period expires.

(2) In a case of application for renewal as set forth in the preceding paragraph,

when a final determination of the application does not occur prior to the expiry

of the period as set forth in the same paragraph (herein referred to as

"Effective Period of Designation as Service Provider" in this Article), the prior

appointment as service provider shall remain effective after expiry of the

Effective Period of Designation as Service Provider until a determination is

reached regarding said application.

(3) In a case as set forth in the preceding paragraph, when the appointment as

service provider is renewed, said Effective Period of Designation as Service

Provider shall be from the date following the date of expiry of the prior

Effective Period of Designation as Service Provider.

(4) The provisions of the preceding Article shall apply mutatis mutandis to a

renewal of appointment as service provider as set forth in paragraph (1).

(Standards of Designated In-Home Long-Term Care Support Business)

Article 80 (1) A Designated In-Home Long-Term Care Support Provider shall act

in compliance with the standards concerning Management of a Designated In-

Home Long-Term Care Support Business as prescribed in paragraph (2) of the

following Article, offer appropriate Designated In-Home Long-Term Care

Support according to the mental and physical condition, etc., of a Person

Requiring Long-Term Care, and always engage in offering said services from

the viewpoint of the person that receives Designated Community-Based Service

by implementing self-evaluation of the quality of the Provider's own

Designated Community-Based Service and other measures.

(2) A Designated In-Home Long-Term Care Support Provider, when an Opinion of

the Certification Committee is entered on the Certificate of Insured Person

that is presented by an Insured Person that intends to receive Designated In-

Home Long-Term Care Support, shall engage in offering said Designated

Community-Based Service of said Insured Person in consideration of said

Opinion of the Certification Committee.

Article 81 (1) A Designated In-Home Long-Term Care Support Provider shall

employ the number of Long-Term Care Support Specialist s as determined by

an Ordinance of the Ministry of Health, Labour, and Welfare by each Business

Office pertaining to said appointment as service provider.

130

(2) In addition to the provisions in the preceding paragraph, standards

concerning Facilities and Management of a Designated In-Home Long-Term

Care Support Business shall be determined by the Minister of Health, Labour,

and Welfare.

(3) The Minister of Health, Labour, and Welfare, when intending to provide

standards concerning Management of a Designated In-Home Long-Term Care

Support Business pursuant to the provisions of the preceding paragraph

(limited to the part concerning the handling of Designated In-Home Long-Term

Care Support), shall hear the opinion of the Social Security Council in advance.

(4) A Designated In-Home Long-Term Care Support Provider shall respect the

personality of a Person Requiring Long-Term Care, act in compliance with this

Act or an Order based on this Act, and faithfully perform said duty for a Person

Requiring Long-Term Care.

(Notification of Change, etc.)

Article 82 A Designated In-Home Long-Term Care Support Provider, when the

name or location of an Business Office pertaining to said appointment as

service provider or other matters as determined by an Ordinance of the

Ministry of Health, Labour, and Welfare are changed, or when said Designated

In-Home Long-Term Care Support Business is abolished, suspended, or

recommenced, shall provide notification of said fact to the mayor of the

Municipality within ten days pursuant to the provisions of an Ordinance of the

Ministry of Health, Labour, and Welfare.

(Reporting, etc.)

Article 83 (1) A prefectural governor or mayor of a Municipality, when it is

determined to be necessary, shall order a Designated In-Home Long-Term Care

Support Provider, a Person that is or was a Designated In-Home Long-Term

Care Support Provider, etc., or a person that is or was an employee or an

Officer, etc., pertaining to said appointment as service provider (herein

referred to as a "Person that is or was a Designated In-Home Long-Term Care

Support Provider, etc., etc." in this paragraph) to report, submit, or present

record books and documents, request a Designated In-Home Long-Term Care

Support Provider, an employee of the Business Office pertaining to said

appointment as service provider or a Person that is or was a Designated In-

Home Long-Term Care Support Provider, etc., etc., to appear, direct its

personnel to ask questions to the relevant Person, or enter the Business Office

pertaining to said appointment as service provider of said Designated

Community-Based Service Provider in order to inspect said record books and

documents, or other items.

(2) The provisions of Article 24, paragraph (3) shall apply mutatis mutandis to

131

questions and inspections pursuant to the provisions of the preceding

paragraph, and the provisions of paragraph (4) of the same Article shall apply

mutatis mutandis to the authority granted pursuant to the provisions of the

preceding paragraph.

(Recommendations, Orders, etc.)

Article 83-2 (1) A prefectural governor, when it is determined that a Designated

In-Home Long-Term Care Support Provider does not meet the fixed minimum

number of employees as determined by an Ordinance of the Ministry of Health,

Labour, and Welfare as set forth in Article 81, paragraph (1) with regard to the

number of Long-Term Care Support Specialist s of an Business Office

pertaining to said appointment as service provider, or does not operate an

appropriate Designated In-Home Long-Term Care Support Business in

accordance with standards concerning Management of a Designated In-Home

Long-Term Care Support Business as prescribed in paragraph (2) of the same

Article, may specify a due date and recommend to said Designated In-Home

Long-Term Care Support Provider to employ the fixed minimum number of

employees of Long-Term Care Support Specialist s as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare as set forth in

paragraph (1) of the same Article and to comply with the standards concerning

management of a Designated In-Home Long-Term Care Support Business

provided by paragraph (2) of the same Article.

(2) A prefectural governor, in a case of providing a recommendation pursuant to

the provisions of the preceding paragraph, may provide public notice of the fact

that said Designated In-Home Long-Term Care Support Provider that is issued

said recommendation did not act in compliance with said recommendation

within the due date as set forth in the same paragraph.

(3) A prefectural governor, when a Designated In-Home Long-Term Care Support

Provider that is issued a recommendation pursuant to the provisions of

paragraph (1) does not implement the measures pertaining to said

recommendation without a justifiable reason, may specify a due date and order

said Designated In-Home Long-Term Care Support Provider to implement

measures pertaining to said recommendation.

(4) A prefectural governor, when issuing an order pursuant to the provisions of

the preceding paragraph, shall issue public notice of the said fact.

(5) With regard to a Designated In-Home Long-Term Care Support Provider that

performs Designated In-Home Long-Term Care Support pertaining to an

insurance benefit, a Municipality, when it is determined that said Designated

In-Home Long-Term Care Support Provider does not operate an appropriate

Designated In-Home Long-Term Care Support Business in accordance with

standards concerning Management of a Designated In-Home Long-Term Care

132

Support Business as prescribed in Article 81, paragraph (2), shall provide

notification of said fact to the prefectural governor that governs the location of

the Business Office pertaining to said appointment as service provider.

(Rescission of Appointment as service provider, etc.)

Article 84 (1) A prefectural governor, in a case that corresponds to any of the

following items, may rescind the appointment as service provider as set forth

in Article 46, paragraph (1) pertaining to said Designated In-Home Long-Term

Care Support Provider or suspend the whole or a part of the effect of said

appointment as service provider by specifying the due date for compliance:

(i) when a Designated In-Home Long-Term Care Support Provider corresponds

to any provision of Article 79, paragraph (2), item (iv), or item (viii);

(ii) when a Designated In-Home Long-Term Care Support Provider becomes

unable to meet the fixed minimum number of employees of Long-Term Care

Support Specialist s as determined by an Ordinance of the Ministry of Health,

Labour, and Welfare as set forth in Article 81, paragraph (1) with regard to

the number of Long-Term Care Support Specialist s of the Business Office

pertaining to said appointment as service provider;

(iii) when a Designated In-Home Long-Term Care Support Provider becomes

unable to operate an appropriate Designated In-Home Long-Term Care

Support Business in accordance with standards concerning Management of a

Designated In-Home Long-Term Care Support Business as prescribed in

Article 81, paragraph (2);

(iv) when it is determined that a Designated In-Home Long-Term Care Support

Provider violates an obligation as prescribed in Article 81, paragraph (4);

(v) when a Designated In-Home Long-Term Care Support Provider is entrusted

with an investigation pursuant to the provisions of Article 28, paragraph (5),

and submits a false report regarding the result of said investigation;

(vi) when an Allowance for In-Home Long-Term Care Service Plan is wrongly

requested;

(vii) when a Designated In-Home Long-Term Care Support Provider is ordered

to report, submit or present record books and documents pursuant to the

provisions of Article 83, paragraph (1), but disobeys said order or submits a

false report;

(viii) when a Designated In-Home Long-Term Care Support Provider or an

employee of the Business Office pertaining to said appointment as service

provider is requested to appear pursuant to the provisions of Article 83,

paragraph (1), but does not respond or does not reply to questions pursuant

to the provisions of the same paragraph or submits a false reply, or refuses,

interrupts, or interferes with an inspection pursuant to the provisions of the

same paragraph, however, provided that this provision shall not apply when

133

an employee of the Business Office pertaining to said appointment as service

provider performed said act and said Designated In-Home Long-Term Care

Support Provider was faithfully providing reasonable care and supervision in

order to prevent said act of said employee;

(ix) when a Designated In-Home Long-Term Care Support Provider is

appointed to provide service as set forth in the main clause of Article 46,

paragraph (1) by wrongful means;

(x) in addition to the cases listed in the preceding items, when a Designated In-

Home Long-Term Care Support Provider violates this Act, another Act

concerning citizens' health and medical care or public aid as determined by a

Cabinet Order, or an Order or disposition of a matter based on these Acts;

(xi) in addition to the cases listed in the preceding items, when a Designated

In-Home Long-Term Care Support Provider performs a wrongful or

significantly unjustifiable act concerning In-Home Service, etc.;

(xii) when any Officer, etc., of a Designated In-Home Long-Term Care Support

Provider performs a wrongful or significantly unjustifiable act concerning In-

Home Service, etc., within five years and the appointment as service provider

is rescinded or the whole or a part of the effect of the appointment as service

provider is suspended due to said act.

(2) With regard to a Designated In-Home Long-Term Care Support Provider of

Designated In-Home Long-Term Care Support pertaining to an insurance

benefit or the implementation of an entrusted investigation pursuant to the

provisions of Article 28, paragraph (5), a Municipality, when it is determined

said Provider corresponds to any provision of the items in the preceding

paragraph, shall provide notification of said fact to the prefectural governor

that governs the location of the Business Office pertaining to said appointment

as service provider.

(Public Notice)

Article 85 A prefectural governor, in the following cases, shall provide public

notice of the fact as prescribed in each of the following items:

(i) when an appointment as service provider as set forth in the main clause of

Article 46, paragraph (1) is determined;

(ii) when there is a notification pursuant to the provisions of Article 82 (except

for change of matters as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare as set forth in the same Article and matters

pertaining to abolishment or recommencement of business provided by the

same Article);

(iii) when an appointment as service provider as set forth in Article 46,

paragraph (1) is rescinded pursuant to the provisions of paragraph (1) of the

preceding Article or Article 115-29, paragraph (6), or the effect of the whole

134

or a part of an appointment as service provider is suspended.

Section 5 Facilities Covered by Long-Term Care Insurance

Subsection 1 Designated Facilities Covered by Public Aid Providing

Long-Term Care to the Elderly

(Appointment as Service Provider of a Designated Facility Covered by Public

Aid Providing Long-Term Care to the Elderly)

Article 86 (1) The appointment as a service provider as set forth in Article 48,

paragraph (1), item (i) shall be provided, pursuant to the provisions of an

Ordinance of the Ministry of Health, Labour, and Welfare, to an application

filed by an organizer of an Intensive Care Home for the Elderly as prescribed

in Article 20-5 of the Public Aid for the Aged Act with an admission capacity of

said facility that is thirty (30) or more.

(2) A prefectural governor, in a case of an application as set forth in the

preceding paragraph, when said Intensive Care Home for the Elderly

corresponds to any of the following items, shall not provide appointment as

service provider as set forth in the main clause of Article 48, paragraph (1),

item (i):

(i) when it does not employ personnel as provided by Article 88, paragraph (1);

(ii) when it is determined that said Intensive Care Home for the Elderly cannot

properly manage a Facility Covered by Public Aid Providing Long-Term Care

to the Elderly in accordance with standards pertaining to facilities and

management of a Designated Facility Covered by Public Aid Providing Long-

Term Care to the Elderly as prescribed in Article 88, paragraph (2);

(iii) when the organizer of said Intensive Care Home for the Elderly was

punished by a fine pursuant to the provisions of this Act, provided by a

Cabinet Order, concerning citizens' health and medical care or public aid and

execution of said penalty has not yet been completed or has not yet expired;

(iv) when an organizer of said Intensive Care Home for the Elderly is rescinded

as the appointed service provider pursuant to the provisions of Article 92,

paragraph (1) or Article 115-29, paragraph (6) and five years have not

elapsed from the date of said rescission;

(v) when an organizer of said Intensive Care Home for the Elderly declined an

appointment as service provider of business pursuant to the provisions of

article 91 (except for a person that has a reasonable basis for abolishment of

said business) from the date of notification pursuant to the provisions of

Article 15 of the Administrative Procedures Act pertaining to rescission of

appointment as service provider pursuant to the provisions of Article 92,

paragraph (1) or Article 115-29, paragraph (6) to the date of said rescission

or the date it is determined that said termination of appointment will not be

135

accepted, and five years have not elapsed from the date of said notification or

decline of appointment as service provider;

(vi) when an organizer of said Intensive Care Home for the Elderly performs a

wrongful or significantly unjustifiable act concerning In-Home Service, etc.,

within five years prior to an application of appointment as service provider;

(vii) when any Officer, etc., or the chairperson of an organizer of said Intensive

Care Home for the Elderly corresponds to any of the following:

(a) a person punished by imprisonment without compulsory labor and

execution of said penalty has not yet been completed or has not yet

expired;

(b) a person that corresponds to item (iii) or the preceding item;

(c) a person that is or was an Officer, etc., of an organizer or the chairperson

of the board of an Intensive Care Home for the Elderly for which

appointment as service provider is rescinded pursuant to the provisions of

Article 92, paragraph (1) or Article 115-29, paragraph (6) within sixty days

prior to the date of notification pursuant to the provisions of Article 15 of

the Administrative Procedures Act pertaining to said rescission and f ive

years have not elapsed from the date of said rescission;

(d) a person that is or was an Officer, etc., of an organizer or the chairperson

of the board of an Intensive Care Home for the Elderly that declined an

appointment as service provider pursuant to the provisions of Article 91

within the period provided by item (v) (except for an Intensive Care Home

for the Elderly which has a reasonable basis for said decline of

appointment as service provider) within sixty days prior to the date of

notification as set forth in the same item and five years have not elapsed

from the date of said decline of appointment as service provider.

(3) A prefectural governor, when he or she intends to provide appointment as

service provider as set forth in Article 48, paragraph (1), item (i), shall provide

notice of matters as determined by an Ordinance of the Ministry of Health,

Labour, and Welfare to the mayor of the relevant Municipality, specify a

reasonable period, and request opinions from the perspective of coordination

with the Municipal Insured Long-Term Care Service Plan as prescribed in

Article 117, paragraph (1) of said relevant Municipality.

(Renewal of Appointment as Service Provider)

Article 86-2 (1) Appointment as service provider as set forth in Article 48,

paragraph (1), item (i), if it is not renewed within a period of six years, shall

cease to be effective when said period expires.

(2) In a case of application of renewal as set forth in the preceding paragraph,

when a final determination of the application does not occur prior to the expiry

of the period as set forth in the same paragraph (herein referred to as

136

"Effective Period of Designation as Service Provider" in this Act), the prior

appointment as service provider shall remain effective after expiry of the

Effective Period of Designation as Service Provider until a determination is

reached regarding said application.

(3) In a case as set forth in the preceding paragraph, when the appointment as

service provider is renewed, said Effective Period of Designation as Service

Provider shall be from the date following the date of expiry of the prior

Effective Period of Designation as Service Provider.

(4) The provisions of the preceding Article shall apply mutatis mutandis to

renewal of appointment as service provider as set forth in paragraph (1).

(Standards of a Designated Facility Covered by Public Aid Providing Long-

Term Care to the Elderly)

Article 87 (1) An organizer of a Designated Facility Covered by Public Aid

Providing Long-Term Care to the Elderly shall act in compliance with the

standards concerning facilities and management of a Designated Facility

Covered by Public Aid Providing Long-Term Care to the Elderly as prescribed

in paragraph (2) of the following Article, offer an appropriate Designated

Facility Covered by Public Aid Providing Long-Term Care to the Elderly

according to the mental and physical condition, etc., of a Person Requiring

Long-Term Care, and always engage in offering said services from the

viewpoint of the person that receives Designated Facility Covered by Public

Aid Providing Long-Term Care to the Elderly by implementing self-evaluation

of the quality of the Provider's own Designated Facility Covered by Public Aid

Providing Long-Term Care to the Elderly and other measures.

(2) A organizer of a Designated Facility Service for Long-Term Care Covered by

Public Aid, when an Opinion of the Certification Committee is entered on the

Certificate of Insured Person that is presented by an Insured Person that

intends to receive Designated Facility Service for Long-Term Care Covered by

Public Aid, shall engage in offering said Designated Facility Covered by Public

Aid Providing Long-Term Care to the Elderly of said Insured Person in

consideration of said Opinion of the Certification Committee.

Article 88 (1) Designated Facility Covered by Public Aid Providing Long-Term

Care to the Elderly shall employ the number of Long-Term Care Support

Specialist or other employees that engage in said Designated Facility Service

for Long-Term Care Covered by Public Aid, as determined by an Ordinance of

the Ministry of Health, Labour, and Welfare.

(2) In addition to the provisions as prescribed in the preceding paragraph,

standards concerning facilities and management of a Designated Facility

Covered by Public Aid Providing Long-Term Care to the Elderly shall be

137

provided by the Minister of Health, Labour, and Welfare.

(3) The Minister of Health, Labour, and Welfare shall, when providing standards

concerning facilities and management of a Designated Facility Covered by

Public Aid Providing Long-Term Care to the Elderly prescribed in the

preceding paragraph (limited to the part concerning the handling of

Designated Facility Service for Long-Term Care Covered by Public Aid), hear

the opinion of the Social Security Council in advance.

(4) An organizer of a Designated Facility Covered by Public Aid Providing Long-

Term Care to the Elderly shall respect the personality of a Person Requiring

Long-Term Care, act in compliance with this Act or an Order based on this Act,

and faithfully perform said duty for a Person Requiring Long-Term Care.

(Notification of Change)

Article 89 A organizer of a Designated Facility Covered by Public Aid Providing

Long-Term Care to the Elderly shall, when the domicile of an organizer or

other matters as determined by an Ordinance of the Ministry of Health, Labour,

and Welfare are changed, provide notification of said fact to the prefectural

governor within ten days pursuant to the provisions of an Ordinance of the

Ministry of Health, Labour, and Welfare.

(Reporting, etc.)

Article 90 (1) A prefectural governor or mayor of a Municipality, when it is

determined to be necessary, shall order a Designated Facility Covered by

Public Aid Providing Long-Term Care to the Elderly, a person that is or was an

organizer, the chairperson, or other employee of a Designated Facility Covered

by Public Aid Providing Long-Term Care to the Elderly (hereinafter referred to

as a "Person that is or was a Organizer of a Designated Facility Covered by

Public Aid Providing Long-Term Care to the Elderly, etc." in this paragraph) to

report, submit or present record books and documents, request a person that is

or was an organizer, the chairperson, or an employee of a Designated Facility

Covered by Public Aid Providing Long-Term Care to the Elderly, etc., to appear,

to direct personnel to ask questions to the relevant Person, or enter the

Business Office pertaining to said appointment as service provider of said

Designated Facility Covered by Public Aid Providing Long-Term Care to the

Elderly in order to inspect said facility, record books and documents, or other

items.

(2) The provisions of Article 24, paragraph (3) shall apply mutatis mutandis to

questions and inspections pursuant to the provisions of the preceding

paragraph, and the provisions of paragraph (4) of the same Article shall apply

mutatis mutandis to the authority granted pursuant to the provisions of the

preceding paragraph.

138

(Decline of Appointment as Service Provider)

Article 91 A Designated Facility Covered by Public Aid Providing Long-Term

Care to the Elderly may decline an appointment as service provider by offering

one month or more of prior notice.

(Recommendation, Order, etc.)

Article 91-2 (1) A prefectural governor, when a Designated Facility Covered by

Public Aid Providing Long-Term Care to the Elderly does not meet the fixed

minimum number of employees as determined by an Ordinance of the Ministry

of Health, Labour, and Welfare as set forth in Article 88 paragraph (1), with

regard to the number of employees that engage in Designated Facility Service

for Long-Term Care Covered by Public Aid provided by said Designated

Facility Covered by Public Aid Providing Long-Term Care to the Elderly, or

when it is determined that said Designated Facility Covered by Public Aid

Providing Long-Term Care to the Elderly does not operate an appropriate

Designated Facility Covered by Public Aid Providing Long-Term Care to the

Elderly in accordance with the standards concerning facilities and

management of a Designated Facility Covered by Public Aid Providing Long-

Term Care to the Elderly as prescribed in paragraph (2) of the same Article,

may specify a due date and recommend to an organizer of said Designated

Facility Covered by Public Aid Providing Long-Term Care to the Elderly to

employ the number of employees as determined by an Ordinance of the

Ministry of Health, Labour, and Welfare as set forth in paragraph (1) of the

same Article, or to act in compliance with standards concerning facilities and

management of a Designated Facility Covered by Public Aid Providing Long-

Term Care to the Elderly as prescribed by paragraph (2) of the same Article.

(2) A prefectural governor, in a case of providing a recommendation pursuant to

the provisions of the preceding paragraph, may provide public notice of the fact

that the organizer of said Designated Facility Covered by Public Aid Providing

Long-Term Care to the Elderly that was issued said recommendation did not

act in compliance with said recommendation within the due date as set forth in

the same paragraph.

(3) A prefectural governor, when an organizer of a Designated Facility Covered

by Public Aid Providing Long-Term Care to the Elderly that was issued a

recommendation pursuant to the provisions of paragraph (1) does not

implement the measures pertaining to said recommendation without a

justifiable basis, may order to an organizer of said Designated Facility Covered

by Public Aid Providing Long-Term Care to the Elderly to implement measures

pertaining to said recommendation within a period specified by a due date.

(4) A prefectural governor, when issuing an order pursuant to the provisions of

139

the preceding paragraph, shall issue public notice of the said fact.

(5) With regard to a Designated Facility Covered by Public Aid Providing Long-

Term Care to the Elderly that provided Designated Facility Service for Long-

Term Care Covered by Public Aid pertaining to an Insurance Benefit, a

Municipality, when it is determined that said Designated Facility Covered by

Public Aid Providing Long-Term Care to the Elderly does not operate an

appropriate Designated Facility Covered by Public Aid Providing Long-Term

Care to the Elderly in accordance with standards concerning facilities and

management of a Designated Facility Covered by Public Aid Providing Long-

Term Care to the Elderly as prescribed in Article 88, paragraph (2), shall

provide notification of said fact to the prefectural governor that governs the

location of said Designated Facility Covered by Public Aid Providing Long-

Term Care to the Elderly.

(Rescission of Appointment as Service Provider, etc.)

Article 92 (1) A prefectural governor, in a case that corresponds to any of the

following items, may rescind the appointment as service provider as set forth

in the main clause of Article 48, paragraph (1), item (i) pertaining to said

Designated Facility Covered by Public Aid Providing Long-Term Care to the

Elderly or suspend the whole or a part of the effect of said appointment as

service provider by specifying the due date for compliance:

(i) when a Designated Facility Covered by Public Aid Providing Long-Term

Care to the Elderly corresponds to any provision of Article 86, paragraph (2),

item (iii) or item (vii);

(ii) when a Designated Facility Covered by Public Aid Providing Long-Term

Care to the Elderly becomes unable to meet the fixed minimum number of

employees as determined by an Ordinance of the Ministry of Health, Labour,

and Welfare as set forth in Article 88, paragraph (1), with regard to the

number of employees that engage in Designated Facility Service for Long-

Term Care Covered by Public Aid provided by said Designated Facility;

(iii) when a Designated Facility Covered by Public Aid Providing Long-Term

Care to the Elderly becomes unable to operate an appropriate Designated

Facility Covered by Public Aid Providing Long-Term Care to the Elderly in

accordance with standards concerning facilities and management of a

Designated Facility Covered by Public Aid Providing Long-Term Care to the

Elderly as prescribed in Article 88, paragraph (2);

(iv) when it is determined that an organizer of a Designated Facility Covered

by Public Aid Providing Long-Term Care to the Elderly violates an obligation

as prescribed in Article 88, paragraph (4);

(v) when a Designated Facility Covered by Public Aid Providing Long-Term

Care to the Elderly is entrusted with an investigation pursuant to the

140

provisions of Article 28, paragraph (5), and submits a false report regarding

the result of said investigation;

(vi) when an Allowance for Long-Term Care Facility Service is wrongly

requested;

(vii) when a Designated Facility Covered by Public Aid Providing Long-Term

Care to the Elderly is ordered to report, submit or present record books and

documents pursuant to the provisions of Article 90, paragraph (1), but

disobeys said order or submits a false report;

(viii) when the organizer, the chairperson, or an employee of a Designated

Facility Covered by Public Aid Providing Long-Term Care to the Elderly is

requested to appear pursuant to the provisions of Article 90, paragraph (1),

but does not respond or does not reply to questions pursuant to the

provisions of the same paragraph or submits a false reply, or refuses,

interrupts, or interferes with an inspection pursuant to the provisions of the

same paragraph, however, provided that this provision shall not apply when

an employee of said Designated Facility Covered by Public Aid Providing

Long-Term Care to the Elderly performed said act and an organizer or the

chairperson of said Designated Facility Covered by Public Aid Providing

Long-Term Care to the Elderly was faithfully providing reasonable care and

supervision in order to prevent said act of said employee;

(ix) when an organizer of a Designated Facility Covered by Public Aid

Providing Long-Term Care to the Elderly is appointed to provide service as

set forth in the main clause of Article 48, paragraph (1) by wrongful means;

(x) in addition to the cases listed in the preceding items, when an organizer of

a Designated Facility Covered by Public Aid Providing Long-Term Care to

the Elderly violates this Act, another Act concerning citizens' health and

medical care and public aid as provided by a Cabinet Order, or an Order or

disposition of a matter based on these Acts;

(xi) in addition to the cases listed in the preceding items, when an organizer of

a Designated Facility Covered by Public Aid Providing Long-Term Care to

the Elderly performs a wrongful or significantly unjustifiable act concerning

In-Home Service, etc.;

(xii) when any Officers or chairperson of the organizer of a Designated Facility

Covered by Public Aid Providing Long-Term Care to the Elderly performs a

wrongful or significantly unjustifiable act concerning In-Home Service, etc.,

within five years and the appointment as service provider is rescinded or the

whole or a part of the effect of the appointment as service provider is

suspended due to said act.

(2) With regard to a Designated Facility Covered by Public Aid Providing Long-

Term Care to the Elderly that provided Designated Facility Service for Long-

Term Care Covered by Public Aid pertaining to an Insurance Benefit or the

141

implementation of an entrusted investigation pursuant to the provisions of

Article 28, paragraph (5), a Municipality, when it determines said Designated

Facility Service for Long-Term Care Covered by Public Aid corresponds to any

provision of the items in the preceding paragraph, shall provide notification of

said fact to the prefectural governor that governs the location of said

Designated Facility Covered by Public Aid Providing Long-Term Care to the

Elderly.

(Public Notice)

Article 93 A prefectural governor, in the following cases, shall issue public notice

of the said fact:

(i) when an appointment as service provider as set forth in the main clause of

Article 48, paragraph (1), item (i) is determined;

(ii) when the appointment as service provider as set forth in Article 48,

paragraph (1), item (i) is declined pursuant to the provisions of Article 91;

(iii) when an appointment as service provider as set forth in Article 48,

paragraph (1), item (i) is rescinded pursuant to the provisions of paragraph

(1) of the preceding Article or Article 115-29, paragraph (6), or the effect of

the whole or a part of an appointment as service provider is suspended.

Subsection 2 Long-Term Care Health Facilities

(Approval for Establishment)

Article 94 (1) A person that intends to establish a Long-Term Care Health

Facility shall obtain approval of the prefectural governor pursuant to the

provisions of an Ordinance of the Ministry of Health, Labour, and Welfare.

(2) The provisions of the preceding paragraph shall apply to when a person that

established a Long-Term Care Health Facility (hereinafter referred to as a

"Organizer of a Long-Term Care Health Facility"), intends to change the fixed

limit of the number of persons who may be admitted to said Long-Term Care

Health Facility and other matters as determined by an Ordinance of the

Ministry of Health, Labour, and Welfare.

(3) A prefectural governor, in a case when the application of approval as set forth

in the preceding two paragraphs is filed and when it corresponds to any of the

following items (with regard to the application as set forth in the preceding

paragraph, item (ii) or item (iii)), may not provide approval as set forth in the

preceding two paragraphs:

(i) when a person that intends to establish said Long-Term Care Health

Facility is not a local government, a medical juridical person, a social welfare

juridical person, or other person as determined by an Ordinance of the

Minister of Health, Labour, and Welfare;

142

(ii) when said Long-Term Care Health Facility does not possess a facility as

prescribed in Article 97, paragraph (1) or the number of personnel as

prescribed in paragraph (2) of the same Article;

(iii) when it is determined that the Long-Term Care Health Facility cannot

properly manage the Long-Term Care Health Facility in accordance with

standards pertaining to facilities and management as prescribed in Article

97, paragraph (3);

(iv) when the applicant is punished by imprisonment without compulsory labor

or to a more severe penalty, and said execution of the penalty has not been

completed or has not yet expired;

(v) when the applicant is punished by a fine pursuant to the provisions of this

Act or another Act pertaining to health and medical care or public aid for

citizens as determined by a Cabinet Order and execution of said penalty has

not yet been completed or has not yet expired;

(vi) when the applicant has been rescinded approval pursuant to the provisions

of Article 104, paragraph (1) or Article 115-29, paragraph (6) and five years

have not elapsed from the date of said rescission (in a case when a person

that has been rescinded for said appointment as service provider is a

juridical person, including a person that is or was an Officer of said juridical

person or who managed the established Long-Term Care Health Facility

(hereinafter referred to as "Manager of a Long-Term Care Health Facility")

and within sixty days prior to the date of notification pursuant to the

provisions of Article 15 of the Administrative Procedures Act pertaining to

said rescission and five years have not elapsed from the date of said

rescission, and in a case when a person that has been rescinded said

approval, is a person as determined by an Ordinance of the Minister of

Health, Labour, and Welfare, but not a juridical person, including a person

that is or was a Manager of a Long-Term Care Health Facility, which was

established by said person, within sixty days prior to the date of said

notification and five years have not elapsed from the date of said rescission;

(vii) when the applicant who provided notification of abolishment pursuant to

the provisions of Article 9, paragraph (1) of the Medical Care Act as applied

mutatis mutandis pursuant to Article 105 from the date of notification

pursuant to the provisions of Article 15 of the Administrative Procedures Act

pertaining to rescission of approval pursuant to the provisions of Article 104,

paragraph (1) or Article 115-29, paragraph (6) to the date when said approval

is rescinded or when it is determined not to rescind the approval (except for a

person that has a reasonable basis for said abolishment) and five years have

not elapsed from the date of said notification;

(viii) in a case when abolishment pursuant to the provisions of Article 9,

paragraph (1) of the Medical Treatment Act as applied mutatis mutandis

143

pursuant to Article 105 within the period as prescribed in the preceding

paragraph was duly provided by notification, when the applicant was an

Officer of a juridical person pertaining to said notification (except for a

juridical person that has a reasonable basis for said abolishment) or an

established Manager of a Long-Term Care Health Facility, within sixty days

prior to the date of notification as set forth in the same item, or is not a

Manager of a Long-Term Care Health Facility established by a non-juridical

person among those who are provided by the Minister of Health, Labour, and

Welfare as set forth in item (i) pertaining to said notification (except for a

juridical person that has a reasonable basis for said abolishment) and five

years have not elapsed from the date of said notification;

(ix) when the applicant performs a wrongful or significantly unjustifiable act

pertaining to In-Home Service, etc., within five years prior to an application

of appointment as service provider;

(x) when the applicant is a juridical person and any said Officer, etc.,

corresponds to any provision of item (iv) in the preceding item;

(xi) when the applicant is not a juridical person among those who are provided

by the Minister of Health, Labour, and Welfare as set forth in item (i), and

any person that manages said Business Office and other employees provided

by a Cabinet Order are defined by item (iv) to item (ix).

(4) A prefectural governor may not provide approval as set forth in item (i) to a

person that intends to establish a Long-Term Care Health Facility for the

purpose of profit;

(5) In a case when an approval as set forth in paragraph (1) and an approval as

set forth in paragraph (2) (limited to those pertaining to increase of the

maximum number of persons who may be admitted to the facility; hereinafter

the same shall apply in this paragraph and the following paragraph) is applied,

the prefectural governor, when it is determined that total number of maximum

number of persons who may be admitted to Long-Term Care Health Facility in

the area (which means an area provided by said prefecture pursuant to the

provisions of Article 118, paragraph (2), item (i)) including the location of

facility pertaining to said application has already reached the total number of

necessary number of persons who may be admitted to the Long-Term Care

Health Facility in the area as prescribed by the Prefectural Insured Long-Term

Care Support Project Plan provided by said prefecture pursuant to the

provisions of paragraph (1) of the same Article, or will exceed said total

number by establishment of the facility pertaining to said application or

increase the maximum number of persons who may be admitted to the facility,

or when it is determined that it is likely to cause problems with

accomplishment of said Prefectural Insured Long-Term Care Support Project

Plan, may not provide an approval as set forth in paragraph (1) or an approval

144

as set forth in paragraph (2).

(6) A prefectural governor, when he or she intends to provide an approval as set

forth in paragraph (1) or an approval as set forth in paragraph (2), shall

provide notice of matters as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare to the mayor of the relevant Municipality, specify

a reasonable period, and request opinions from the perspective of coordination

with the Municipal Insured Long-Term Care Service Plan as prescribed in

Article 117, paragraph (1) of said relevant Municipality.

(Renewal of Approval)

Article 94-2 (1) Approval as set forth in paragraph (1) of the preceding Article, if

it is not renewed within a period of six years, shall cease to be effective when

said period expires.

(2) In a case of approval of renewal as set forth in the preceding paragraph, when

a final determination of the application does not occur prior to the expiry of the

period as set forth in the same paragraph (hereinafter referred to as "Effective

Period of Approval" in this Article), the prior appointment as service provider

shall remain effective after expiry of the Effective Period of Approval until a

determination is reached regarding said application.

(3) In a case as set forth in the preceding paragraph, when the approval is

renewed, said Effective Period of Approval shall be from the date following the

date of expiry of the prior Effective Period of Approval.

(4) The provisions of the preceding Article shall apply mutatis mutandis to

renewal of appointment as service provider as set forth in paragraph (1).

(Management of a Long-Term Care Health Facility)

Article 95 (1) An Organizer of a Long-Term Care Health Facility shall employ

physicians approved by the prefectural governor to manage said Long-Term

Care Health Facility.

(2) Notwithstanding the provisions of the preceding paragraph, an Organizer of a

Long-Term Care Health Facility may obtain approval of the prefectural

governor and direct a person other than a physician to manage said Long-Term

Care Health Facility.

(Standards of a Long-Term Care Health Facility)

Article 96 (1) A Organizer of a Long-Term Care Health Facility shall act in

compliance with the standards concerning facilities and management of a

Long-Term Care Health Facility as prescribed in paragraph (3) of the following

Article, offer appropriate Long-Term Care Health Facility Service according to

the mental and physical condition, etc., of a Person Requiring Long-Term Care,

and always engage in offering said services from the viewpoint of the person

145

that receives Long-Term Care Health Facility Service by implementing self-

evaluation of the quality of the Provider's own Long-Term Care Health Facility

Service and other measures.

(2) A Organizer of a Long-Term Care Health Facility, when an Opinion of the

Certification Committee is entered on the Certificate of Insured Person that is

presented by an Insured Person that intends to receive Long-Term Care Health

Facility Service, shall engage in offering said Long-Term Care Health Facility

Service of said Insured Person in consideration of said Opinion of the

Certification Committee.

Article 97 (1) A Long-Term Care Health Facility shall possess, pursuant to the

provisions of an Ordinance of the Ministry of Health, Labour, and Welfare, a

medical care room, consultation room, functional training room, lounge and

other facilities as determined by an Ordinance of the Ministry of Health,

Labour, and Welfare.

(2) A Long-Term Care Health Facility shall employ the fixed minimum number,

as determined by an Ordinance of the Ministry of Health, Labour, and Welfare,

of physicians, nurses, Long-Term Care Support Specialists, and employees that

engage in long-term care or other operations.

(3) In addition to the provisions as prescribed in the preceding two paragraphs,

standards concerning facilities and management of a Long-Term Care Health

Facility shall be provided by the Minister of Health, Labour, and Welfare.

(4) The Minister of Health, Labour, and Welfare, when providing standards

concerning facilities and management of a Long-Term Care Health Facility as

prescribed in the preceding paragraph (limited to the part concerning the

handling of a Long-Term Care Health Facility Service), shall hear the opinion

of the Social Security Council in advance.

(5) An Organizer of a Long-Term Care Health Facility shall respect the

personality of a Person Requiring Long-Term Care, act in compliance with this

Act or an Order based on this Act, and faithfully perform said duty for a Person

Requiring Long-Term Care.

(Restraint of Advertisement)

Article 98 (1) With regard to a Long-Term Care Health Facility, regardless of

documents or any other methods, no person shall advertise the Facility, except

for the following matters:

(i) matters that display the name, telephone number, and location of a Long-

Term Care Health Facility;

(ii) names of physicians and nurses who are employed at the Long-Term Care

Health Facility;

(iii) in addition to matters listed in the preceding two items, matters as

146

determined by an Ordinance of the Minister of Health, Labour, and Welfare;

(iv) other matters approved by the prefectural governor.

(2) The Minister of Health, Labour, and Welfare, with regard to method of

advertisement of matters listed in the preceding three items, pursuant to the

provisions of an Ordinance of the Ministry of Health, Labour, and Welfare, may

specify necessary matters.

(Notification of Change)

Article 99 A Organizer of a Long-Term Care Health Facility, except for matters

pertaining to approval pursuant to the provisions of Article 94, paragraph (2),

when the domicile of a Organizer of said Long-Term Care Health Facility or

other matters as determined by an Ordinance of the Ministry of Health, Labour,

and Welfare are changed, shall provide notification of said fact to the

prefectural governor within ten days pursuant to the provisions of an

Ordinance of the Ministry of Health, Labour, and Welfare.

(Reporting, etc.)

Article 100 (1) A prefectural governor or mayor of a Municipality, when it is

determined to be necessary, shall order a person that is or was an organizer of

a Long-Term Care Health Facility, a manager of a Long-Term Care Health

Facility, physician and other employee (herein referred to as a "Organizer of a

Long-Term Care Health Facility, etc.") to report, submit or present medical

records or record books and documents, request a Organizer of a Long-Term

Care Health Facility, etc., to appear, to direct personnel to ask questions of a

Organizer of a Long-Term Care Health Facility, etc., or enter Long-Term Care

Health Facility in order to inspect said facilities, record books and documents,

or other items.

(2) The provisions of Article 24, paragraph (3) shall apply mutatis mutandis to

questions and inspections pursuant to the provisions of the preceding

paragraph, and the provisions of paragraph (4) of the same Article shall apply

mutatis mutandis to the authority granted pursuant to the provisions of the

preceding paragraph.

(3) Pursuant to the provisions of paragraph (1), the mayor of the Municipality

that ordered a Organizer of a Long-Term Care Health Facility, etc., to report,

submit, or present records, or appear, to direct personnel to ask questions of a

Organizer of a Long-Term Care Health Facility, etc., or enter the Long-Term

Care Health Facility for inspection, when it is determined that it is necessary

to terminate said Long-Term Care Health Facility pursuant to the provisions of

the following Article, Article 102, Article 103, paragraph (3), or Article 104,

paragraph (1), shall provide notification of said fact to the prefectural governor

indicating said reasons.

147

(Restriction on Use of Facility)

Article 101 A prefectural governor, when a Long-Term Care Health Facility does

not possess the facilities as prescribed in Article 97, paragraph (1) or does not

conform with the standards concerning facilities and management of a Long-

Term Care Health Facility as prescribed in paragraph (3) of the same Article

(limited to the part concerning said Facility) to a Organizer of a Long-Term

Care Health Facility, may restrict or prohibit the use of the whole or a part of

said facility within a period limited by a due date, or order to repair or modify

said facility within the period limited by a due date.

(Order to Change)

Article 102 (1) A prefectural governor, when it is determined that a Manager of

a Long-Term Care Health Facility is inappropriate as a Manager of a Long-

Term Care Health Facility, may order the Organizer of said Long-Term Care

Health Facility to change the Manager of the Long-Term Care Health Facility

within a period limited by a due date.

(2) The Minister of Health, Labour, and Welfare, with regard to the affairs

pertaining to the authority of a prefectural governor as prescribed in the

preceding paragraph, when it determines the urgent necessity to ensure life

and the physical safety of a person that may be admitted to a Long-Term Care

Health Facility, may order the prefectural governor to conduct the affairs as

set forth in the same paragraph.

(Recommendation, Order, etc., of Business Operations)

Article 103 (1) A prefectural governor, when it is determined that a Long-Term

Care Health Facility does not meet the fixed minimum numbers as prescribed

in an Ordinance of the Ministry of Health, Labour, and Welfare as set forth in

Article 97, paragraph (2) with regard to the number of employees that engage

in said business and that the Facility does not meet the standards concerning

facilities and management of a Long-Term Care Health Facility as prescribed

in paragraph (3) of the same Article (limited to the part concerning

management; the same shall apply hereinafter in this Article), may recommend

to the Organizer of said Long-Term Care Health Facility to employ the fixed

minimum number of employees as prescribed in an Ordinance of the Ministry

of Health, Labour, and Welfare as set forth in Article 97, paragraph (2) within

the period limited by a due date, and to comply with the standards concerning

facilities and management of a Long-Term Care Health Facility as prescribed

in paragraph (3) of the same Article.

(2) A prefectural governor, in a case of providing a recommendation pursuant to

the provisions of the preceding paragraph, may provide public notice of the fact

148

that the Organizer of said Long-Term Care Health Facility that is issued said

recommendation did not act in compliance with said recommendation within

the due date as set forth in the same paragraph.

(3) A prefectural governor, when a Organizer of a Long-Term Care Health

Facility that was issued a recommendation pursuant to the provisions of

paragraph (1) does not implement the measures pertaining to said

recommendation without a justifiable basis, may order the Organizer of said

Long-Term Care Health Facility to implement measures pertaining to said

recommendation within a period specified by a due date or to suspend said

operation for a period of time.

(4) A prefectural governor, when issuing an order pursuant to the provisions of

the preceding paragraph, shall issue public notice of said fact.

(5) With regard to a Long-Term Care Health Facility that provides Long-Term

Care Health Facility Service pertaining to an Insurance Benefit, a

Municipality, when it is determined that said Long-Term Care Health Facility

does not conform with standards concerning facilities and management of a

Long-Term Care Health Facility as prescribed in Article 97, paragraph (3),

shall provide notification of said fact to the prefectural governor that governs

the location of said Long-Term Care Health Facility.

(Rescission of Approval, etc.)

Article 104 (1) A prefectural governor, in a case that corresponds to any of the

following items, may rescind the approval as set forth in Article 94, paragraph

(1) pertaining to said Long-Term Care Health Facility or suspend the whole or

a part of the effect of said appointment as service provider within the period

limited by a due date:

(i) when a Organizer of a Long-Term Care Health Facility does not commence

said operation for six months or more after obtaining approval as set forth in

Article 94, paragraph (1) without a reasonable basis;

(ii) when a Long-Term Care Health Facility corresponds to any provision of

Article 94, paragraph (3), item (iv), item (v), item (x), or item (ix);

(iii) when it is determined that an Organizer of a Long-Term Care Health

Facility violates an obligation as prescribed in Article 97, paragraph (5);

(iv) when an Organizer of a Long-Term Care Health Facility committed a crime

or act of dishonesty concerning medical business;

(v) when a Long-Term Care Health Facility is entrusted with an investigation

pursuant to the provisions of Article 28, paragraph (5) and submits a false

report regarding the result of said investigation;

(vi) when an Allowance for Long-term care Facility Service is wrongly

requested;

(vii) when an Organizer, etc., of a Long-Term Care Health Facility is ordered to

149

report, submit or present medical records or record books and documents

pursuant to the provisions of Article 100, paragraph (1), but disobeys said

order or submits a false report;

(viii) when an Organizer, etc., of a Long-Term Care Health Facility is

requested to appear pursuant to the provisions of Article 100, paragraph (1)

but does not respond or does not reply to questions pursuant to the

provisions of the same paragraph or submits a false reply, or refuses,

interrupts, or interferes with an inspection pursuant to the provisions of the

same paragraph, however, provided that this provision shall not apply when

an employee of said Long-Term Care Health Facility performed said act and

the Organizer of the Long-Term Care Health Facility or said Manager of a

Long-Term Care Health Facility was faithfully providing reasonable care and

supervision in order to prevent said act of said employee;

(ix) in addition to the cases listed in the preceding items, when an Organizer of

a Long-Term Care Health Facility violates this Act, another Act concerning

citizens' health and medical care and public aid as provided by a Cabinet

Order, or an Order or disposition of a matter based on these Acts;

(x) in addition to the cases listed in the preceding items, when an Organizer of

a Long-Term Care Health Facility performs a wrongful or significantly

unjustifiable act concerning In-Home Service, etc.;

(xi) in a case when an Organizer of a Long-Term Care Health Facility is a

juridical person, when any of said Officer, etc., or said Manager of a Long-

Term Care Health Facility performs a wrongful or significantly unjustifiable

act concerning In-Home Service, etc., within five years and the appointment

as service provider is rescinded or the whole or a part of the effect of the

appointment as service provider is suspended due to said act;

(xii) in a case when a Organizer of a Long-Term Care Health Facility is not a

juridical person among those provided by the Ministry of Health, Labour,

and Welfare as set forth in Article 94, paragraph (3), item (i), a manager of

said Provider performs a wrongful or significantly unjustifiable act

concerning In-Home Service, etc., within five years and the appointment as

service provider is rescinded or the whole or a part of the effect of the

appointment as service provider is suspended due to said act.

(2) With regard to a Long-Term Care Health Facility that conducts an entrusted

investigation or provided Long-Term Care Health Facility Service pertaining to

an Insurance Benefit pursuant to the provisions of Article 28, paragraph (5), a

Municipality, when it determines said Long-Term Care Health Facility

corresponds to any provision of the items in the preceding paragraph, shall

provide notification of said fact to the prefectural governor that governs the

location of said Long-Term Care Health Facility.

(3) The Minister of Health, Labour, and Welfare, with regard to the affair that

150

belongs to the authority of the prefectural governor as prescribed in paragraph

(1), when it determines the urgent necessity to secure life and the physical

safety of a person that may be admitted to the Long-Term Care Health Facility,

may order the prefectural governor to conduct the affairs as set forth in the

same paragraph.

(Mutatis Mutandis Application of the Medical Care Act)

Article 105 The provisions of Article 8-2, paragraph (2) and Article 9 of the

Medical Care Act shall apply mutatis mutandis to an Organizer of a Long-Term

Care Health Facility and the provisions of Article 15, paragraph (1) and

paragraph (3) of the same Act shall apply mutatis mutandis to a Manager of a

Long-Term Care Health Facility, and the provisions of Article 30 of the same

Act shall apply mutatis mutandis to the disposition of a matter based on the

provisions of Article 101 to the preceding Article. In this case, necessary

technical replacement of the terms of these provisions shall be provided by a

Cabinet Order.

(Relationship, etc., with the Medical Care Act)

Article 106 A Long-Term Care Health Facility shall not be a hospital or a clinic

as used in the Medical Care Act, however, provided that the terms "hospital"

and "clinic" in the Medical Care Act and provisions of laws and regulations

other than orders based on the Medical Care Act (except for the Health

Insurance Act, National Health Insurance Act and provisions provided by a

Cabinet Order as set forth in other laws and regulations) shall include a Long-

Term Care Health Facility (in the provisions of laws and regulations provided

by a Cabinet Order, except for those provided by a Cabinet Order).

Subsection 3 Designated Medical Long-Term Care Sanatoriums

(Appointment as Service Provider of a Designated Medical Long-Term Care

Sanatorium)

Article 107 (1) Appointment as service provider as set forth in Article 48,

paragraph (1), item (iii) shall be provided, pursuant to the provisions of an

Ordinance of the Ministry of Health, Labour, and Welfare, to a hospital or a

clinic that possesses Sanatorium Ward, etc., (hereinafter referred to as

"Sanatorium Ward Hospital, etc." in this Article) for which Organizer

submitted for said appointment as service provider.

(2) The application as set forth in the preceding paragraph shall be implemented

by specifying the maximum number of persons who may be admitted to the

Sanatorium Ward, etc., pertaining to an appointment as service provider as set

forth in Article 48, paragraph (1), item (iii).

151

(3) A prefectural governor, in a case of an application as set forth in paragraph

(1), when said Sanatorium Ward Hospital, etc., corresponds to any of the

following items, shall not provide appointment as service provider as set forth

in Article 48, paragraph (1), item (iii):

(i) when it does not employ the personnel provided by Article 110, paragraph

(1);

(ii) when it is determined that said Sanatorium Ward Hospital, etc., cannot

properly manage the Sanatorium Medical Care Facilities for the Elderly

Requiring Care in accordance with standards pertaining to management of a

Designated Medical Long-Term Care Sanatorium as prescribed in Article 110,

paragraph (2);

(iii) when a Organizer of said Sanatorium Ward Hospital, etc., is punished by

imprisonment without compulsory labor or to a more severe penalty and said

execution of the penalty has not been completed or has not yet expired;

(iv) when a Organizer of said Sanatorium Ward Hospital, etc., is punished by a

fine pursuant to the provisions of this Act or another Act pertaining to health

and medical care or public aid for citizens as determined by a Cabinet Order

and execution of said penalty has not yet been completed or has not yet

expired;

(v) when an organizer of said Sanatorium Ward Hospital, etc., rescinds its

appointment as service provider pursuant to the provisions of Article 114,

paragraph (1) or Article 115-29, paragraph (6) and five years have not

elapsed from the date of said rescission (in a case when a person that

rescinds said appointment as service provider is a juridical person, including

an Officer of said juridical person or a manager of the established

Sanatorium Ward Hospital, etc., within sixty days prior to the date of

notification pursuant to the provisions of Article 15 of the Administrative

Procedures Act pertaining to said rescission and five years have not elapsed

from the date of said rescission, and in a case that a person that rescinds

said appointment as service provider is not a juridical person, including a

person that is or was a manager of said Sanatorium Ward Hospital, etc.,

within sixty days prior to said notification and five years have not elapsed

from the date of said rescission);

(vi) when an organizer of said Sanatorium Ward Hospital, etc., is a person that

declined an appointment as service provider pursuant to the provisions of

Article 113 from the date of notification pursuant to the provisions of Article

15 of the Administrative Procedures Act pertaining to the rescission of

appointment as service provider pursuant to the provisions of Article 114,

paragraph (1) or Article 115-29, paragraph (6) to the date when said

appointment as service provider is rescinded or when it is determined not to

rescind the approval (except for a person that has a reasonable basis for said

152

abolishment) and five years have not elapsed from the date of said decline of

appointment as service provider;

(vii) in a case when a decline of appointment as service provider pursuant to

the provisions of Article 113 is duly provided by notification within the

period provided in the preceding paragraph, when an Organizer of said

Sanatorium Ward Hospital, etc., is or was an Officer of a juridical person

pertaining to said decline of appointment (except for a juridical person that

has a reasonable basis for said abolishment) or a manager of the established

Sanatorium Ward Hospital, etc., or is or was a Manager of a Sanatorium

Ward Hospital, etc., that is not a juridical person pertaining to decline of

said appointment as service provider (except for a person that has a

reasonable basis for said abolishment) within sixty days prior to the date of

notification as set forth in the same item, and five years have not elapsed

from the date of said decline of appointment as service provider;

(viii) when an Organizer of said Sanatorium Ward Hospital, etc., performs a

wrongful or significantly unjustifiable act pertaining to In-Home Service, etc.,

within five years prior to an application of appointment as service provider;

(ix) when an Organizer of said Sanatorium Ward Hospital, etc., is a juridical

person and any Officer, etc., or managers of said Sanatorium Ward Hospital,

etc., corresponds to any provision of item (iii) to the preceding item;

(x) when an Organizer of said Sanatorium Ward Hospital, etc., is a Sanatorium

Ward Hospital, etc., which is not juridical person, and a manager of said

provider is defined by item (iii) to item (viii).

(4) In a case when an application as set forth in paragraph (1) is submitted, the

prefectural governor, when it is determined that the total capacity of persons

who may be admitted to the Sanatorium Ward, etc., of a Designated Medical

Long-Term Care Sanatorium in the area (which means an area provided by

said prefecture pursuant to the provisions of Article 118, paragraph (2), item

(i)) including the location of the Facility pertaining to said application has

reached the total necessary capacity of persons who may be admitted to the

Sanatorium Ward, etc., of the Designated Medical Long-Term Care Sanatorium

in the area as prescribed in the Prefectural Insured Long-Term Care Support

Project Plan provided by said prefecture pursuant to the provisions of

paragraph (1) of the same Article, or will exceed said total number by said

appointment as service provider of the facility pertaining to said application, or

when it is determined that it is likely to cause problems with the

accomplishment of said Prefectural Insured Long-Term Care Support Project

Plan, may determine not to provide an appointment as service provider as set

forth in Article 48, paragraph (1), item (iii).

(5) A prefectural governor, when he or she intends to provide an appointment as

service provider as set forth in Article 48, paragraph (1), item (iii), shall

153

provide notice of matters as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare to the mayor of the relevant Municipality, specify

a reasonable period, and request opinions from the perspective of coordination

with the Municipal Insured Long-Term Care Service Plan as prescribed in

Article 117, paragraph (1) of said relevant Municipality.

(Renewal of Appointment as Service Provider)

Article 107-2 (1) An appointment as service provider as set forth in Article 48,

paragraph (1), item (iii), if it is not renewed within a period of six years, shall

cease to be effective when said period expires.

(2) In a case of application of renewal as set forth in the preceding paragraph,

when a final determination of the application does not occur prior to the expiry

of the period as set forth in the same paragraph (hereinafter referred to as

"Effective Period of Designation as Service Provider" in this Article), the prior

appointment as service provider shall remain effective after expiry of the

Effective Period of Designation as Service Provider until a determination is

reached regarding said application.

(3) In a case as set forth in the preceding paragraph, when the appointment as

service provider is renewed, said Effective Period of Designation as Service

Provider shall be from the date following the date of expiry of the prior

Effective Period of Designation as Service Provider.

(4) The provisions of the preceding Article shall apply mutatis mutandis to a

renewal of appointment as service provider as set forth in paragraph (1).

(Change of Appointment as Service Provider)

Article 108 (1) A organizer of a Designated Medical Long-Term Care Sanatorium

may, when intending to increase the capacity of Sanatorium Ward, etc.,

pertaining to an appointment as service provider pursuant to Article 48,

paragraph (1), item (iii), shall apply in advance for a change of appointment as

service provider as set forth in the same item pertaining to said Designated

Medical Long-Term Care Sanatorium, pursuant to the provisions of an

Ordinance of the Ministry of Health, Labour, and Welfare.

(2) The provisions of Article 107, paragraph (4) shall apply mutatis mutandis to a

case when the change of appointment as service provider as set forth in the

preceding paragraph is submitted. In this case the phrase "not to provide an

appointment as service provider" in paragraph (4) of the same Article shall be

deemed to be replaced with "to refuse the change of appointment as service

provider."

(Standards of a Designated Medical Long-Term Care Sanatorium)

Article 109 (1) A organizer of a Designated Medical Long-Term Care Sanatorium

154

shall act in compliance with the standards concerning facilities and

management of a Designated Medical Long-Term Care Sanatorium as

prescribed in paragraph (2) of the following Article, offer appropriate

Designated Sanatorium Service for Long-Term Care according to the mental

and physical condition, etc., of a Person Requiring Long-Term Care, and

always engage in offering said services from the viewpoint of the person that

receives Designated Sanatorium Service for Long-Term Care by implementing

self-evaluation of the quality of the organizer's own Designated Sanatorium

Service for Long-Term Care and other measures.

(2) A organizer of a Designated Medical Long-Term Care Sanatorium shall, when

an opinion is entered on the Certificate of Insured Person that is presented by

an Insured Person that intends to receive Designated Sanatorium Service for

Long-Term Care, engage in offering said Designated Sanatorium Service for

Long-Term Care of said Insured Person in consideration of said Opinion of the

Certification Committee.

Article 110 (1) A Designated Medical Long-Term Care Sanatorium shall employ

the number of Long-Term Care Support Specialists or other employees that

engage in said Designated Sanatorium Service for Long-Term Care, as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare.

(2) In addition to the provisions as prescribed in the preceding paragraph,

standards concerning facilities and management of a Designated Medical Long-

Term Care Sanatorium shall be provided by the Minister of Health, Labour,

and Welfare.

(3) The Minister of Health, Labour, and Welfare, when providing standards

concerning facilities and management of a Designated Medical Long-Term Care

Sanatorium as prescribed in the preceding paragraph (limited to the part

concerning the handling of Designated Sanatorium Service for Long-Term

Care), shall hear the opinion of the Social Security Council in advance.

(4) An organizer of a Designated Medical Long-Term Care Sanatorium shall

respect the personality of a Person Requiring Long-Term Care, act in

compliance with this Act or an Order based on this Act, and faithfully perform

said duty for a Person Requiring Long-Term Care.

(Notification of Change)

Article 111 A organizer of a Designated Medical Long-Term Care Sanatorium,

when the domicile of the organizer or other matters as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare have changed, shall

provide notification of said fact to the prefectural governor within ten days

pursuant to the provisions of an Ordinance of the Ministry of Health, Labour,

and Welfare.

155

(Reporting, etc.)

Article 112 (1) A prefectural governor or mayor of a Municipality, when it is

determined to be necessary, shall order a Designated Medical Long-Term Care

Sanatorium, a person that is or was an organizer, a manager, a physician, or

other employee of the Designated Medical Long-Term Care Sanatorium

(hereinafter referred to as a "person that is an organizer, etc." in this

paragraph) to report, submit or present medical records and other record books

and documents, request a person that is an organizer, etc., of the Designated

Medical Long-Term Care Sanatorium to appear, to direct personnel to ask

questions to the relevant person, or enter said Designated Medical Long-Term

Care Sanatorium in order to inspect said medical records, record books and

documents, or other items.

(2) The provisions of Article 24, paragraph (3) shall apply mutatis mutandis to

questions and inspections pursuant to the provisions of the preceding

paragraph, and the provisions of paragraph (4) of the same Article shall apply

mutatis mutandis to the authority granted pursuant to the provisions of the

preceding paragraph.

(Decline of Appointment as Service Provider)

Article 113 A Designated Medical Long-Term Care Sanatorium may decline said

appointment as service provider by offering one month or more of prior notice.

(Recommendation, Order, etc.)

Article 113-2 (1) A prefectural governor, when a Designated Medical Long-Term

Care Sanatorium does not meet the fixed minimum number of employees as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare as

set forth in Article 110, paragraph (1), with regard to the number of employees

that engage in Designated Sanatorium Service for Long-Term Care provided by

said Designated Medical Long-Term Care Sanatorium, or when it is

determined that said Designated Medical Long-Term Care Sanatorium does

not operate an appropriate Designated Medical Long-Term Care Sanatorium in

accordance with the standards concerning facilities and management of

Designated Medical Long-Term Care Sanatorium as prescribed in paragraph

(2) of the same Article, may specify a due date and recommend to an organizer

of said Designated Medical Long-Term Care Sanatorium to employ the number

of employees as determined by an Ordinance of the Ministry of Health, Labour,

and Welfare as set forth in the paragraph (1) of the same Article, or to act in

compliance with standards concerning facilities and management of

Designated Medical Long-Term Care Sanatorium as prescribed by paragraph

(2) of the same Article.

156

(2) A prefectural governor, in a case of providing a recommendation pursuant to

the provisions of the preceding paragraph, may provide public notice of the fact

that an organizer of said Designated Medical Long-Term Care Sanatorium,

that is issued said recommendation, did not act in compliance with said

recommendation within the due date as set forth in the same paragraph.

(3) A prefectural governor, when an organizer of a Designated Medical Long-

Term Care Sanatorium that is issued a recommendation pursuant to the

provisions of paragraph (1) does not implement the measures pertaining to said

recommendation without a justifiable basis, may order an organizer of said

Designated Medical Long-Term Care Sanatorium to implement measures

pertaining to said recommendation within a period specified by a due date.

(4) A prefectural governor, when issuing an order pursuant to the provisions of

the preceding paragraph, shall issue public notice of said fact.

(5) With regard to a Designated Medical Long-Term Care Sanatorium that

provides Designated Sanatorium Service for Long-Term Care pertaining to an

Insurance Benefit, a Municipality, when it is determined that said Designated

Medical Long-Term Care Sanatorium does not operate an appropriate

Designated Medical Long-Term Care Sanatorium in accordance with standards

concerning facilities and management of a Designated Medical Long-Term Care

Sanatorium as prescribed in Article 110, paragraph (2), shall provide

notification of said fact to the prefectural governor that governs the location of

said Designated Medical Long-Term Care Sanatorium.

(Rescission of Appointment as Service Provider, etc.)

Article 114 (1) A prefectural governor, in a case that corresponds to any of the

following items, may rescind the appointment as service provider as set forth

in the main clause of Article 48, paragraph (1), item (iii) pertaining to said

Designated Medical Long-Term Care Sanatorium or suspend the whole or a

part of the effect of said appointment as service provider by specifying the due

date for compliance:

(i) when a Designated Medical Long-Term Care Sanatorium corresponds to any

provision of Article 107, paragraph (3), item (iii), item (iv), item (ix) or item

(x);

(ii) when a Designated Medical Long-Term Care Sanatorium becomes unable to

meet the fixed minimum number of employees as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare as set forth in

Article 110, paragraph (1), with regard to the number of employees that

engage in Designated Sanatorium Service for Long-Term Care provided by

said Designated Medical Long-Term Care Sanatorium;

(iii) when a Designated Medical Long-Term Care Sanatorium becomes unable

to operate an appropriate Designated Medical Long-Term Care Sanatorium

157

in accordance with standards concerning facilities and management of a

Designated Medical Long-Term Care Sanatorium as prescribed in Article 110,

paragraph (2);

(iv) when it is determined that an organizer of a Designated Medical Long-

Term Care Sanatorium violates an obligation as prescribed in Article 110,

paragraph (4);

(v) when a Designated Medical Long-Term Care Sanatorium is entrusted with

an investigation pursuant to the provisions of Article 28, paragraph (5), and

submits a false report regarding the result of said investigation;

(vi) when an Allowance for Long-Term Care Facility Service is wrongly

requested;

(vii) when a Designated Medical Long-Term Care Sanatorium is ordered to

report, submit or present medical records and other record books and

documents pursuant to the provisions of Article 112, paragraph (1), but

disobeys said order or submits a false report;

(viii) when an organizer, a manager, a physician, or other employee of a

Designated Medical Long-Term Care Sanatorium is requested to appear

pursuant to the provisions of Article 112, paragraph (1), but does not respond

or does not reply to questions pursuant to the provisions of the same

paragraph or submits a false reply, or refuses, interrupts, or interferes with

an inspection pursuant to the provisions of the same paragraph, however,

provided that this provision shall not apply when an employee of said

Designated Medical Long-Term Care Sanatorium performed said act and an

organizer or a manager of said Designated Medical Long-Term Care

Sanatorium was faithfully providing reasonable care and supervision in

order to prevent said act of said employee;

(ix) when an organizer of a Designated Medical Long-Term Care Sanatorium is

appointed to provide service as set forth in Article 48, paragraph (1), item

(iii) by wrongful means;

(x) in addition to the cases listed in the preceding items, when an organizer of

a Designated Medical Long-Term Care Sanatorium violates this Act, another

Act concerning citizens' health and medical care and public aid as provided

by a Cabinet Order, or an Order or disposition of a matter based on these

Acts;

(xi) in addition to the cases listed in the preceding items, when an organizer of

a Designated Medical Long-Term Care Sanatorium performs a wrongful or

significantly unjustifiable act concerning In-Home Service, etc.;

(xii) in a case when an organizer of a Designated Medical Long-Term Care

Sanatorium is a juridical person, when any said Officer or manager of said

Designated Medical Long-Term Care Sanatorium performs a wrongful or

significantly unjustifiable act concerning In-Home Service, etc., within five

158

years and the appointment as service provider is rescinded or the whole or a

part of the effect of the appointment as service provider is suspended due to

said act;

(xiii) in a case when an organizer of a Designated Medical Long-Term Care

Sanatorium is not a juridical person, when a manager of said Provider

performs a wrongful or significantly unjustifiable act concerning In-Home

Service, etc., within five years and the appointment as service provider is

rescinded or the whole or a part of the effect of the appointment as service

provider is suspended due to said act.

(2) With regard to a Designated Medical Long-Term Care Sanatorium that

conducts an entrusted investigation pursuant to the provisions of Article 28,

paragraph (5), a Municipality, when it determines said Designated Medical

Long-Term Care Sanatorium corresponds to any provision of the items in the

preceding paragraph, shall provide notification of said fact to the prefectural

governor that governs the location of said Designated Medical Long-Term Care

Sanatorium.

(Public Notice)

Article 115 A prefectural governor, in the following cases, shall issue public

notice of said fact:

(i) when an appointment as service provider as set forth in the main clause of

Article 48, paragraph (1), item (i) is determined;

(ii) when an appointment as service provider as set forth in Article 48,

paragraph (1), item (iii) is declined pursuant to the provisions of Article 113;

(iii) when an appointment as service provider as set forth in Article 48,

paragraph (1), item (iii) is rescinded pursuant to the provisions of paragraph

(1) of the preceding Article or Article 115-29, paragraph (6), or the effect of

the whole or a part of an appointment as service provider is suspended.

Section 6 Designated Providers of a Preventive Service to Long-Term

Care

(Appointment as Designated Provider of Preventive Long-Term Care Service)

Article 115-2 (1) An appointment as service provider as set forth in the main

clause of Article 53, paragraph (1) shall be provided pursuant to the provisions

of an Ordinance of the Ministry of Health, Labour, and Welfare by the

application of a person performing Preventive Long-Term Care Service

Business, for each type of Preventive Long-Term Care Service, and Business

Office that operates a business of Preventive Long-Term Care Service

pertaining to said Preventive Long-Term Care Service (hereinafter referred to

as "Business Office" in this Section).

159

(2) A prefectural governor, in a case of an application as set forth in the

preceding paragraph, when the application corresponds to any provision of

item (i) to item (iii), item (v) to item (vii), item (ix) or item (x) (in a case of

application for appointment as a service provider pertaining to Management

and Guidance for In-Home Medical Service for Preventive Long-Term Care

provided by a Hospital, etc., or Home-Visit Nursing Service for Preventive

Long-Term Care, Home-Visit Rehabilitation Service for Preventive Long-Term

Care, Outpatient Rehabilitation for Preventive Long-Term Care provided by a

clinic, or Short-Term Admission for Recuperation for Preventive Long-Term

Care, item (ii) to item (xi)), shall not provide an appointment as service

provider as set forth in the main clause of Article 53, paragraph (1):

(i) when the applicant is not a juridical person;

(ii) when knowledge, skill, and the number of employees of the Business Office

pertaining to said application does not meet the standards as determined by

an Ordinance of the Ministry of Health, Labour, and Welfare as set forth in

Article 115, paragraph (4), item (i) or the fixed minimum number of

employees as determined by an Ordinance of the Ministry of Health, Labour,

and Welfare;

(iii) when it is determined that the applicant cannot perform appropriate

business of Preventive Long-Term Care Service in accordance with standards

concerning effective methods of support for Preventive Long-Term Care

Service pertaining to Designated Preventive Service of Long-Term Care and

the standards concerning facilities and management of Designated

Preventive Service of Long-Term Care as prescribed in Article 115,

paragraph (4), item (ii);

(iv) when the applicant is punished by imprisonment without compulsory labor

or to a more severe penalty and said execution of the penalty has not been

completed or has not yet expired;

(v) when the applicant is punished by a fine pursuant to the provisions of this

Act or another Act pertaining to health and medical care or public aid for

citizens as determined by a Cabinet Order and execution of said penalty has

not yet been completed or has not yet expired;

(vi) when an approval of the applicant has been rescinded pursuant to the

provisions of Article 105-8, paragraph (1) or Article 115-29, paragraph (6)

and five years have not elapsed from the date of said rescission (in a case

when a person that has been rescinded for said appointment as service

provider is a juridical person, including a person that is or was an Officer,

etc., of said juridical person within sixty days prior to the date of notification

pursuant to the provisions of Article 15 of the Administrative Procedures Act

pertaining to said rescission and five years have not elapsed from the date o f

said rescission, and in a case when a person that has been rescinded said

160

approval, is a Hospital, etc., that is not a juridical person, including a person

that is or was a manager of said Hospital, etc., within sixty days prior to the

date of said notification and five years have not elapsed from the date of said

rescission);

(vii) when the applicant who provided notification of abolishment of business

pursuant to the provisions of Article 115-5 from the date of notification

pursuant to the provisions of Article 15 of the Administrative Procedures Act

pertaining to rescission of appointment as service provider pursuant to the

provisions of Article 115-8, paragraph (1) or Article 115-29, paragraph (6) to

the date when the appointment as service provider is rescinded or when it is

determined not to rescind the appointment as service provider (except for a

person that has a reasonable basis for said abolishment of business) and five

years have not elapsed from the date of said notification;

(viii) in a case when abolishment of business pursuant to the provisions of

Article 115-5 was duly provided by notification during the period pursuant to

the provisions of the preceding paragraph, when the applicant who was an

Officer, etc., of a juridical person pertaining to said notification (except for a

juridical person that has a reasonable basis for said abolishment of business)

or a manager of Hospital, etc., which is not a juridical person pertaining to

said notification (except for a juridical person, within sixty days prior to the

date of notification as set forth in the same item, that has a reasonable basis

for said abolishment of business) and five years have not elapsed from the

date of said notification;

(ix) when the applicant performs a wrongful or significantly unjustifiable act

pertaining to In-Home Service, etc., within five years prior to an application

of appointment as service provider;

(x) when the applicant is a juridical person and any said Officer, etc.,

corresponds to any provision of item (iv) to the preceding item;

(xi) when the applicant is a Hospital, etc., which is not a juridical person and a

manager of said Provider corresponds to any provision of item (iv) to item (ix).

(Standards of the business of Designated Preventive Service of Long-Term

Care)

Article 115-3 (1) A Designated Provider of Preventive Service of Long-Term Care

shall act in compliance with the standards concerning effective methods of

support for Preventive Long-Term Care Service pertaining to Designated

Preventive Service of Long-Term Care as prescribed in paragraph (2) of the

following Article and standards concerning facilities and management of a

business of Designated Preventive Service of Long-Term Care, offer

appropriate Designated Preventive Service of Long-Term Care according to the

mental and physical condition, etc., of a Person Requiring Long-Term Care,

161

and always engage in offering said services from the viewpoint of the person

that receives Designated Preventive Service of Long-Term Care by

implementing self-evaluation of the quality of the Provider's own Designated

Preventive Service of Long-Term Care and other measures.

(2) A Designated Provider of Preventive Long-Term Care Service, when an

Opinion of the Certification Committee is entered on the Certificate of Insured

Person that is presented by an Insured Person that intends to receive

Designated Preventive Service of Long-Term Care, shall engage in offering said

Designated Preventive Service of Long-Term Care of said Insured Person in

consideration of said Opinion of the Certification Committee.

Article 115-4 (1) A Designated Provider of Preventive Long-Term Care Service

shall employ in the Business Office pertaining to said appointment as service

provider, the fixed minimum number of employees that engage in said

Designated Preventive Service of Long-Term Care, as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare in accordance with

the standards as determined by an Ordinance of the Ministry of Health,

Labour, and Welfare.

(2) In addition to the provisions in the preceding paragraph, standards

concerning effective support methods for Preventive Long-Term Care Service

pertaining to Designated Preventive Service of Long-Term Care and standards

concerning facilities and management of the business of Designated Preventive

Service of Long-Term Care shall be provided by the Minister of Health, Labour,

and Welfare.

(3) The Minister of Health, Labour, and Welfare, when intending to provide

standards concerning effective support methods for Preventive Long-Term Care

Service pertaining to Designated Preventive Service of Long-Term Care

standards concerning facilities and management of a business of Designated

Preventive Service of Long-Term Care as prescribed in the preceding

paragraph (limited to the part concerning the handling of Designated

Preventive Service of Long-Term Care), shall hear the opinion of the Social

Security Council in advance.

(4) A Designated Provider of Preventive Long-Term Care Service shall respect

the personality of a Person Requiring Long-Term Care, act in compliance with

this Act or an Order based on this Act, and faithfully perform said duty for a

Person Requiring Long-Term Care.

(Notification of Change, etc.)

Article 115-5 A Designated Provider of Preventive Long-Term Care Service,

when the name or location of the Business Office pertaining to said

appointment as service provider or other matters as determined by an

162

Ordinance of the Ministry of Health, Labour, and Welfare are changed, or

when the business of said Designated Preventive Service of Long-Term Care is

abolished, suspended, or recommenced, shall provide notification of said fact to

the mayor of the Municipality within ten days pursuant to the provisions of an

Ordinance of the Ministry of Health, Labour, and Welfare.

(Reporting, etc.)

Article 115-6 (1) A mayor of a Municipality, when it is determined to be

necessary concerning payment of an allowance for Preventive Long-Term Care

Service, shall order a Designated Provider of Preventive Long-Term Care

Service, a person that is or was a Designated Provider of Preventive Long-

Term Care Service, or a person that is or was an employee of the Business

Office pertaining to said appointment as service provider (hereinafter referred

to as a "Person that is or was a Designated Provider of Preventive Long-Term

Care Service, etc." in this paragraph) to report, submit or present record books

and documents, request to said Designated Provider of Preventive Long-Term

Care Service, an employee of the Business Office pertaining to said

appointment as service provider, or a Person that is or was a Designated

Provider of Preventive Long-Term Care Service, etc., to appear, to direct

personnel to ask questions to the relevant Person, or enter the Business Office

pertaining to said appointment as service provider of said Designated Provider

of Preventive Long-Term Care Service in order to inspect said facility, record

books and documents, or other items.

(2) The provisions of Article 24, paragraph (3) shall apply mutatis mutandis to

questions and inspections pursuant to the provisions of the preceding

paragraph, and the provisions of paragraph (4) of the same Article shall apply

mutatis mutandis to the authority granted pursuant to the provisions of the

preceding paragraph.

(Recommendation, Order, etc.)

Article 115-7 (1) A prefectural governor, when it is determined that a

Designated Provider of Preventive Long-Term Care Service does not meet the

standards as determined by an Ordinance of the Ministry of Health, Labour,

and Welfare as set forth in Article 115-4, paragraph (1) or the fixed minimum

number of employees as determined by an Ordinance of the Ministry of Health,

Labour, and Welfare as set forth in the same paragraph, with regard to

knowledge, skill, or number of employees of the Business Office pertaining to

said appointment as service provider, or does not operate an appropriate

business of Designated Preventive Service of Long-Term Care in accordance

with standards concerning effective support methods for Preventive Long-Term

Care Service pertaining to Designated Preventive Service of Long-Term Care

163

or standards concerning facilities and management of the business of

Designated Preventive Service of Long-Term Care as prescribed in paragraph

(2) of the same Article, may specify a due date and recommend to said

Designated Provider of Preventive Long-Term Care Service to comply with the

standards as determined by an Ordinance of the Ministry of Health, Labour,

and Welfare as set forth in paragraph (1) of the same Article, to employ the

fixed minimum number of employees as determined by an Ordinance of the

Ministry of Health, Labour, and Welfare as set forth in the same paragraph, to

comply with standards concerning effective support methods for Preventive

Long-Term Care Service pertaining to Designated Preventive Service of Long-

Term Care or standards concerning facilities and management of the business

of Designated Preventive Service of Long-Term Care, and to comply with

standards concerning facilities and management of a Designated Preventive

Long-Term Care Service as prescribed in paragraph (2) of the same Article.

(2) A prefectural governor may, in a case of providing a recommendation

pursuant to the provisions of the preceding paragraph, provide public notice of

the fact that said Designated Provider of Preventive Long-Term Care Service

that is issued said recommendation did not act in compliance with said

recommendation within the due date as set forth in the same paragraph.

(3) A prefectural governor, when the Designated Provider of Preventive Long-

Term Care Service that is issued a recommendation pursuant to the provisions

of paragraph (1) does not implement the measures pertaining to said

recommendation without a justifiable basis, may specify a due date and order

said Designated Provider of Preventive Long-Term Care Service to implement

measures pertaining to said recommendation.

(4) A prefectural governor, when issuing an order pursuant to the provisions of

the preceding paragraph, shall issue public notice of said fact.

(5) With regard to a Designated Provider of Preventive Long-Term Care Service

that provides Designated Preventive Service of Long-Term Care pertaining to

an Insurance Benefit, a Municipality, when it is determined that said

Designated Provider of Preventive Long-Term Care Service does not operate an

appropriate business of Designated Preventive Service of Long-Term Care in

accordance with standards concerning effective support methods for Preventive

Long-Term Care Service pertaining to Designated Preventive Service of Long-

Term Care or standards concerning facilities and management of the business

of Designated Preventive Service of Long-Term Care as prescribed in Article

115-4, paragraph (2), shall provide notification of said fact to the prefectural

governor that governs the location of the Business Office pertaining to said

appointment as service provider.

(Rescission of Appointment as Service Provider, etc.)

164

Article 115-8 (1) A prefectural governor, in a case that corresponds to any of the

following items, may rescind the appointment as service provider as set forth

in the main clause of Article 53, paragraph (1) pertaining to said Designated

Provider of Preventive Long-Term Care Service or suspend the whole or a part

of the effect of said appointment as service provider within the period specified

by a due date:

(i) when a Designated Provider of Preventive Long-Term Care Service

corresponds to any provision of Article 115-2, paragraph (2), item (iv), item

(v), item (x) or item (xi);

(ii) when a Designated Provider of Preventive Long-Term Care Service becomes

unable to meet standards as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare or the fixed minimum number of employees as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare

as set forth in Article 115-4, paragraph (1), with regard to knowledge, skill

and number of employees of the Business Office pertaining to said

appointment as service provider;

(iii) when a Designated Provider of Preventive Long-Term Care Service

becomes unable to operate an appropriate business of Designated Preventive

Service of Long-Term Care in accordance with standards concerning effective

support methods for Preventive Long-Term Care Service pertaining to

Designated Preventive Service of Long-Term Care or standards concerning

facilities and management of the business of Designated Preventive Service

of Long-Term Care as prescribed in Article 115-4, paragraph (2);

(iv) when it is determined that an organizer of Designated Provider of

Preventive Long-Term Care Service violates an obligation as prescribed in

Article 115-4, paragraph (4), item (iv);

(v) when an allowance for Preventive Long-Term Care Service is wrongly

requested;

(vi) when a Designated Provider of Preventive Long-Term Care Service is

ordered to report, submit or present record books and documents pursuant to

the provisions of Article 115-6, paragraph (1), but disobeys said order or

submits a false report;

(vii) when a Designated Provider of Preventive Long-Term Care Service or an

employee of the location of a Business Office pertaining to said appointment

as service provider is requested to appear pursuant to the provisions of

Article 115-6, paragraph (1) but does not respond or does not reply to

questions pursuant to the provisions of the same paragraph or submits a

false reply, or refuses, interrupts, or interferes with an inspection pursuant

to the provisions of the same paragraph, however, provided that this

provision shall not apply when an employee of the Business Office pertaining

to said appointment as service provider performed said act and said

165

Designated Provider of Preventive Long-Term Care Service was faithfully

providing reasonable care and supervision in order to prevent said act of said

employee;

(viii) when a Designated Provider of Preventive Long-Term Care Service is

appointed to provide service as set forth in the main clause of Article 53,

paragraph (1) by wrongful means;

(ix) in addition to the cases listed in the preceding items, when a Designated

Provider of Preventive Long-Term Care Service violates this Act, another Act

concerning citizens' health and medical care and public aid as provided by a

Cabinet Order, or an Order or disposition of a matter based on these Acts;

(x) in addition to the cases listed in the preceding items, when a Designated

Provider of Preventive Long-Term Care Service performs a wrongful or

significantly unjustifiable act concerning In-Home Service, etc.;

(xi) in a case when a Designated Provider of Preventive Long-Term Care

Service is a juridical person, when any said Officer, etc., performs a wrongful

or significantly unjustifiable act concerning In-Home Service, etc., within

five years and the appointment as service provider is rescinded or the whole

or a part of the effect of the appointment as service provider is suspended

due to said act;

(xii) in a case when a Designated Provider of Preventive Long-Term Care

Service is a Hospital, etc., which is not a juridical person, a manager of said

Provider performs a wrongful or significantly unjustifiable act concerning In-

Home Service, etc., within five years and the appointment as service provider

is rescinded or the whole or a part of the effect of the appointment as service

provider is suspended due to said act.

(2) With regard to a Designated Provider of Preventive Long-Term Care Service

that provides Designated Preventive Service of Long-Term Care pertaining to

an Insurance Benefit, a Municipality shall, when it determines said Designated

Provider of Preventive Long-Term Care Service corresponds to any provision of

the items in the preceding paragraph, provide notification of said fact to the

prefectural governor that governs the location of Business Office pertaining to

said appointment.

(Public Notice)

Article 115-9 A prefectural governor, in the following cases, shall issue public

notice of said fact:

(i) when an appointment as service provider as set forth in the main clause of

Article 53, paragraph (1) is determined;

(ii) when there is a notification pursuant to the provisions of Article 115-5

(except for those pertaining to change of matters as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare in the same Article

166

and suspension or recommencement of business as prescribed in the same

Article);

(iii) when an appointment as service provider as set forth in the main clause of

Article 53, paragraph (1) is rescinded pursuant to the provisions of

paragraph (1) of the preceding Article or Article 115-29, paragraph (6), or the

effect of the whole or a part of an appointment as service provider is

suspended.

(Mutatis Mutandis Application)

Article 115-10 The provisions of Article 70-2 to Article 72 shall apply mutatis

mutandis to appointment as service provider as set forth in the main clause of

Article 53, paragraph (1). In this case, necessary technical replacement of

terms shall be provided by a Cabinet Order.

Section 7 Designated Providers of Community-Based Preventive Service

of Long-Term Care

(Appointment as Service Provider of Designated Provider of Community-Based

Preventive Service of Long-Term Care)

Article 115-11 (1) An appointment as service provider as set forth in the main

clause of Article 54-2, paragraph (1) shall be provided, pursuant to the

provisions of an Ordinance of the Ministry of Health, Labour, and Welfare, by

application of a person that performs a Community-Based Service for

Preventive Long-Term Care Business, for each type of Community-Based

Preventive Service of Long-Term Care Service and Business Office that

performs a Community-Based Service of Preventive Long-Term Care Business

pertaining to the type of said Community-Based Preventive Long-Term Care

Service (hereinafter referred to as "Business Office" in this Section), and shall

have effect with regard to payment of an allowance for Community-Based

Preventive Long-Term Care Service and an exceptional allowance for

Community-Based Service of Preventive Long-Term Care Service to an Insured

Person by Long-Term Care Insurance provided by a Municipality, for which the

mayor of the Municipality that provides said appointment as service provider,

is chairperson.

(2) A mayor of a Municipality, in a case of an application as set forth in the

preceding paragraph, when the application corresponds to any of the following

items, shall not provide appointment as service provider as set forth in the

main clause of Article 54-2, paragraph (1):

(i) when the applicant is not a juridical person;

(ii) when knowledge, skill and number of employees of the Business Office

pertaining to said application does not meet the standards as determined by

167

an Ordinance of the Ministry of Health, Labour, and Welfare as set forth in

Article 115-13, paragraph (1) and the fixed minimum number of employees as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare

of standards concerning employees that engage in Designated Community-

Based Preventive Service of Long-Term Care as prescribed in paragraph (4)

of the same Article;

(iii) when it is determined that the applicant cannot perform appropriate

Community-Based Service of Preventive Long-Term Care Business in

accordance with standards concerning effective support methods for

Preventive Long-Term Care Service pertaining to Designated Community-

Based Preventive Service of Long-Term Care and the standards concerning

facilities and management of the business of Designated Community-Based

Preventive Service of Long-Term Care as prescribed in Article 115-13,

paragraph (2) or paragraph (4);

(iv) when the Business Office pertaining to said application is located outside

the area of said Municipality and the consent of the mayor of the

Municipality of said location has not yet obtained;

(v) when an applicant is punished by a fine pursuant to the provisions of this

Act, as provided by a Cabinet Order, concerning citizens' health and medical

care or public aid and execution of said penalty has not yet been completed or

has not yet expired;

(vi) when an applicant is rescinded as the appointed service provider pursuant

to the provisions of Article 115-17 (except for item (ii) to item (v)) and five

years have not elapsed from the date of said rescission;

(vii) when an applicant provides notification of abolishment of business

pursuant to the provisions of Article 115-14 (except for a person that has a

reasonable basis for abolishment of said business) from the date of

notification pursuant to the provisions of Article 15 of the Administrative

Procedures Act pertaining to rescission of appointment as service provider

pursuant to the provisions of Article 115-17 (except for item (ii) to item (v))

to the date of said rescission or the date it is determined that said

termination of appointment will not be accepted, and five years have not

elapsed from the date of said notification or decline of appointment as service

provider;

(viii) when an applicant performs a wrongful or significantly unjustifiable act

concerning In-Home Service, etc. within five years prior to an application of

appointment as service provider;

(ix) when any Officer, etc., of the applicant corresponds to any of the following:

(a) a person punished by imprisonment without compulsory labor and

execution of said penalty has not yet been completed or has not yet

expired;

168

(b) a person that corresponds to item (v) or the preceding item;

(c) a person that is or was an Officer, etc. of a juridical person that

appointment as service provider is rescinded pursuant to the provisions of

Article 115-17 (except for item (ii) to item (v)) within sixty days prior to the

date of notification pursuant to the provisions of Article 15 of the

Administrative Procedures Act pertaining to said rescission and five years

have not elapsed from the date of said rescission;

(d) a person that is or was an Officer, etc., of a juridical person that provided

notification of an abolishment of business pursuant to the provisions of

Article 115-14 (except for a juridical person that has a reasonable basis for

said abolishment of business) within the period provided by item (vii),

within sixty days prior to the date of notification as set forth in the same

item and five years have not elapsed from the date of said notification or

decline of appointment as service provider.

(3) A mayor of a Municipality, in a case when an application as set forth in

paragraph (1) is filed and the application corresponds to any of the following

items, may determine not to provide an appointment as service provider as set

forth in the main clause of Article 54-2, paragraph (1):

(i) when an applicant has been rescinded the appointment as service provider

pursuant to the provisions of Article 115-17 item (ii) to item (v) and five

years have not elapsed from the date of said rescission;

(ii) when an applicant provides notification of abolishment of business

pursuant to the provisions of Article 115-14 (except for a person that has a

reasonable basis for said abolishment of business) from the date of

notification pursuant to the provisions of Article 15 of the Administrative

Procedures Act pertaining to rescission of appointment as service provider

pursuant to the provisions of Article 115-17, item (ii) to item (v) to the date

of said rescission or the date it is determined that said termination of

appointment will not be accepted, and five years have not elapsed from the

date of said notification or decline of appointment as service provider;

(iii) when any Officer, etc., of an applicant corresponds to any of the following:

(a) a person that is or was an Officer, etc., of a juridical person that

appointment as service provider is rescinded pursuant to the provisions of

Article 115-17 item (ii) to item (v), within sixty days prior to the date of

notification pursuant to the provisions of Article 15 of the Administrative

Procedures Act pertaining to said rescission and five years have not

elapsed from the date of said rescission;

(b) a person that is or was an Officer, etc., of a juridical person that has

provides notification of abolishment of business pursuant to the provisions

of Article 115-14 (except for a juridical person that has a reasonable basis

for said abolishment of business) within the period provided by the

169

preceding item, within sixty days prior to the date of notification as set

forth in the same item, and five years have not elapsed from the date of

said notification or said decline of appointment as service provider.

(4) A mayor of a Municipality, when intending to designate an appointment as

service provider as set forth in the main clause of Article 54-2, paragraph (1),

shall take necessary measures in advance in order to reflect opinions of

Insured Persons by Long-Term Care Insurance provided by said Municipality

or other relevant persons.

(5) A mayor of a Municipality, when providing an appointment as service

provider as set forth in the main clause of Article 54-2, paragraph (1), may add

a provision that is determined to be necessary for ensuring appropriate

operation of said business.

(Standards of a Designated Community-Based Preventive Service of Long-

Term Care Business)

Article 115-12 (1) A Designated Provider of Community-Based Service for

Preventive Long-Term Care shall act in compliance with the standards

concerning effective support methods for Prevention of Long-Term Care

pertaining to a Designated Provider of Provider of Community-Based Service

for Preventive Long-Term Care and standards concerning facilities and

management of the business of Designated Community-Based Preventive

Service of Long-Term Care as prescribed in paragraph (2) and paragraph (4) of

the following Article, offer appropriate Designated Community-Based

Preventive Service of Long-Term Care according to the mental and physical

condition, etc., of a Person Requiring Long-Term Care, and always engage in

offering said services from the viewpoint of the person that receives Designated

Community-Based Preventive Service of Long-Term Care by implementing self-

evaluation of the quality of the Provider's own Designated Community-Based

Preventive Service of Long-Term Care and other measures.

(2) A Designated Provider of Community-Based Service for Preventive Long-

Term Care, when an Opinion of the Certification Committee is entered on the

Certificate of Insured Person that is presented by an Insured Person that

intends to receive Designated Community-Based Preventive Service of Long-

Term Care, shall engage in offering said Designated Community-Based

Preventive Service of Long-Term Care of said Insured Person in consideration

of said Opinion of the Certification Committee.

Article 115-13 (1) A Designated Provider of Community-Based Service for

Preventive Long-Term Care shall employ the fixed minimum number of

employees that engage in said Designated Community-Based Preventive

Service of Long-Term Care, as determined by an Ordinance of the Ministry of

170

Health, Labour, and Welfare in accordance with the standards as determined

by an Ordinance of the Ministry of Health, Labour, and Welfare, by each place

of business pertaining to said appointment as service provider.

(2) In addition to the provisions in the preceding paragraph, standards

concerning effective support methods for Prevention of Long-Term Care

pertaining to a Designated Provider of Community-Based Service for

Preventive Long-Term Care and standards concerning facilities and

management of the business of Designated Community-Based Preventive

Service of Long-Term Care shall be provided by the Ministry of Health, Labour,

and Welfare.

(3) The Minister of Health, Labour, and Welfare, when intending to provide

standards concerning effective support methods for Prevention of Long-Term

Care pertaining to a Designated Provider of Community-Based Service for

Preventive Long-Term Care and standards concerning facilities and

management of the business of Designated Community-Based Preventive

Service of Long-Term Care as prescribed in the preceding paragraph (limited to

the part concerning the handling of Designated Community-Based Preventive

Service of Long-Term Care), shall hear the opinion of the Social Security

Council in advance.

(4) A Municipality, notwithstanding the provisions of paragraph (1) and

paragraph (2), within the scope as determined by an Ordinance of the Ministry

of Health, Labour, and Welfare, in lieu of standards provided by these

provisions, may provide standards concerning employees that engage in

Designated Community-Based Preventive Service of Long-Term Care and

standards concerning effective support methods for Prevention of Long-Term

Care pertaining to a Designated Provider of Community-Based Service for

Preventive Long-Term Care, and standards concerning facilities and

management of the business of Designated Community-Based Preventive

Service of Long-Term Care in said Municipality.

(5) A Municipality, when it intends to promulgate standards concerning

employees that engage in Designated Community-Based Preventive Service of

Long-Term Care, standards concerning effective support methods for

Prevention of Long-Term Care pertaining to a Designated Provider of

Community-Based Service for Preventive Long-Term Care, and standards

concerning facilities and management of the business of Designated

Community-Based Preventive Service of Long-Term Care in said Municipality

as set forth in the preceding paragraph, shall reflect opinions of Insured

Persons by Long-Term Care Insurance provided by said Municipality and take

necessary measures in order to promote to use knowledge of persons with

relevant knowledge and experience.

(6) A Designated Provider of Community-Based Service for Preventive Long-

171

Term Care shall respect the personality of a Person Requiring Long-Term Care,

act in compliance with this Act or an Order based on this Act, and faithfully

perform said duty for a Person Requiring Long-Term Care.

(Notification of Change, etc.)

Article 115-14 A Designated Provider of Community-Based Service for

Preventive Long-Term Care Service, when the name or location of the Business

Office pertaining to said appointment as service provider or other matters as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare

are changed, or when the business of said Designated Community-Based

Preventive Service of Long-Term Care is abolished, suspended, or

recommenced, shall provide notification of said fact to the mayor of the

Municipality within ten days pursuant to the provisions of an Ordinance of the

Ministry of Health, Labour, and Welfare.

(Reporting, etc.)

Article 115-15 (1) A mayor of a Municipality, when it is determined to be

necessary concerning payment of an Allowance for Community-Based

Preventive Service of Long-Term Care, shall order a Designated Provider of

Community-Based Service for Preventive Long-Term Care, a person that is or

was a Designated Provider of Community-Based Service for Preventive Long-

Term Care, or a person that is or was an employee of the Business Office

pertaining to said appointment as service provider (hereinafter referred to as a

"Person that is or was a Designated Provider of Community-Based Service for

Preventive Long-Term Care, etc." in this paragraph) to report, submit or

present record books and documents, as requested to the Designated Provider

of Community-Based Service for Preventive Long-Term Care, an employee of

the Business Office pertaining to said appointment as service provider or a

Person that is or was a Designated Provider of Community-Based Service for

Preventive Long-Term Care, etc., to appear, to direct personnel to ask

questions to the relevant Person, or enter the Business Office pertaining to

said appointment as service provider of said Designated Provider of

Community-Based Service for Preventive Long-Term Care in order to inspect

said facilities, record books and documents, or other items.

(2) The provisions of Article 24, paragraph (3) shall apply mutatis mutandis to

questions and inspections pursuant to the provisions of the preceding

paragraph, and the provisions of paragraph (4) of the same Article shall apply

mutatis mutandis to the authority granted pursuant to the provisions of the

preceding paragraph.

(Recommendations, Orders, etc.)

172

Article 115-16 (1) A mayor of a Municipality, when it is determined that a

Designated Provider of Community-Based Service for Preventive Long-Term

Care does not act in compliance with the provision provided when providing

said appointment as service provider pursuant to the provisions of Article 115-

11, paragraph (5), does not meet the standards as determined by an Ordinance

of the Ministry of Health, Labour, and Welfare as set forth in Article 115-13,

paragraph (1) or the fixed minimum number of employees as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare as set forth in the

same paragraph or standards concerning employees that engage in Designated

Community-Based Preventive Service of Long-Term Care provided by

paragraph (4) of the same Article, with regard to knowledge, skill, or number of

employees of the Business Office pertaining to said appointment as service

provider, or when it is determined that said Community-Based Preventive

Long-Term Care Service does not operate an appropriate Designated

Community-Based Preventive Service of Long-Term Care in accordance with

standards concerning effective support methods for Prevention of Long-Term

Care pertaining to a Designated Provider of Community-Based Service for

Preventive Long-Term Care and standards concerning facilities and

management of the business of Designated Community-Based Preventive

Service of Long-Term Care as prescribed in paragraph (2) or paragraph (4) of

the same Article, may specify a due date and recommend to said Designated

Provider of Community-Based Service for Preventive Long-Term Care to act in

compliance with the provisions provided when determining said appointment

as service provider pursuant to the provisions of Article 115-11, paragraph (5),

to comply with the standards as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare as set forth in Article 115-13, paragraph (1), to

employ the number of employees as determined by an Ordinance of the

Ministry of Health, Labour, and Welfare as set forth in the same paragraph, to

comply with standards concerning employees that engage in Designated

Community-Based Preventive Service of Long-Term Care as prescribed in

paragraph (4) of the same Article, and to comply with standards concerning

effective support methods for Prevention of Long-Term Care pertaining to a

Designated Provider of Community-Based Service for Preventive Long-Term

Care and standards concerning facilities and management of the business of

Designated Community-Based Preventive Service of Long-Term Care as

prescribed by paragraph (2) and paragraph (4) of the same Article.

(2) A mayor of a Municipality, in a case of providing a recommendation pursuant

to the provisions of the preceding paragraph, may provide public notice of the

fact that said Designated Provider of Community-Based Service for Preventive

Long-Term Care that is issued said recommendation did not act in compliance

with said recommendation within the due date as set forth in the same

173

paragraph.

(3) A mayor of a Municipality, when the Designated Provider of Community-

Based Service for Preventive Long-Term Care that is issued a recommendation

pursuant to the provisions of paragraph (1) does not implement the measures

pertaining to said recommendation without a justifiable basis, may specify a

due date and order said Designated Provider of Community-Based Service for

Preventive Long-Term Care to implement measures pertaining to said

recommendation.

(4) A mayor of a Municipality, when issuing an order pursuant to the provisions

of the preceding paragraph, shall issue public notice of the said fact.

(Rescission of Appointment as Service Provider, etc.)

Article 115-17 A mayor of a Municipality, in a case that corresponds to any of

the following items, may rescind the appointment as service provider as set

forth in the main clause of Article 54-2, paragraph (1) pertaining to said

Designated Provider of Community-Based Service for Preventive Long-Term

Care or suspend the whole or a part of the effect of said appointment as service

provider for a period as specified within the period specified by a due date:

(i) when a Designated Provider of Community-Based Service for Preventive

Long-Term Care corresponds to any provision of Article 115-12, paragraph

(2), item (v) or item (ix);

(ii) when a Designated Provider of Community-Based Service for Preventive

Long-Term Care corresponds to any provision of Article 115-11, paragraph

(3), item (iii);

(iii) when it is determined that a Designated Provider of Community-Based

Service for Preventive Long-Term Care is in violation of a provision

determined when granting said appointment as service provider pursuant to

the provisions of the provisions of Article 115-11, paragraph (5);

(iv) when a Designated Provider of Community-Based Service for Preventive

Long-Term Care becomes unable to meet the standards as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare as set forth in

Article 115-13, paragraph (1), the fixed minimum number of employees as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare

as set forth in the same paragraph, or standards concerning employees that

engage in Designated Community-Based Preventive Service of Long-Term

Care as prescribed in paragraph (4) of the same Article, with regard to

knowledge, skill, or number of employees of the Business Office pertaining to

said appointment as service provider;

(v) when a Designated Provider of Community-Based Service for Preventive

Long-Term Care becomes unable to operate an appropriate business of

Designated Community-Based Preventive Service of Long-Term Care in

174

accordance with standards concerning effective support methods for

Prevention of Long-Term Care pertaining to a Designated Provider of

Community-Based Service for Preventive Long-Term Care and standards

concerning facilities and management of the business of Designated

Community-Based Preventive Service of Long-Term Care as prescribed in

Article 115-13, paragraph (2) or paragraph (4);

(vi) when it is determined that a Designated Provider of Community-Based

Service for Preventive Long-Term Care violates an obligation as prescribed

in Article 115-13, paragraph (6);

(vii) when an allowance for Community-Based Preventive Long-Term Care

Service is wrongly requested;

(viii) when a Designated Provider of Community-Based Service for Preventive

Long-Term Care is ordered to report, submit or present record books and

documents pursuant to the provisions of Article 115-15, paragraph (1), but

disobeys said order or submits a false report;

(ix) when a Designated Provider of Community-Based Service for Preventive

Long-Term Care or an employee of the Business Office pertaining to said

appointment as service provider is requested to appear pursuant to the

provisions of Article 115-15, paragraph (1), but does not respond or does not

reply to questions pursuant to the provisions of the same paragraph or

submits a false reply, or refuses, interrupts, or interferes with an inspection

pursuant to the provisions of the same paragraph, however, provided that

this provision shall not apply when an employee of the Business Office

pertaining to said appointment as service provider performed said act and

said Designated Provider of Community-Based Service for Preventive Long-

Term Care was faithfully providing reasonable care and supervision in order

to prevent said act of said employee;

(x) when a Designated Provider of Community-Based Service for Preventive

Long-Term Care is appointed to provide service as set forth in the main

clause of Article 54-2, paragraph (1) by wrongful means;

(xi) in addition to the cases listed in the preceding items, when a Designated

Provider of Community-Based Service for Preventive Long-Term Care

violates this Act, another Act concerning citizens' health and medical care

and public aid as provided by a Cabinet Order, or an Order or disposition of a

matter based on these Acts;

(xii) in addition to the cases listed in the preceding items, when a Designated

Provider of Community-Based Service for Preventive Long-Term Care

performs a wrongful or significantly unjustifiable act concerning In-Home

Service, etc.;

(xiii) when any Officer, etc., of a Designated Provider of Community-Based

Service for Preventive Long-Term Care performs a wrongful or significantly

175

unjustifiable act concerning In-Home Service, etc., within five years and the

appointment as service provider is rescinded or the whole or a part of the

effect of the appointment as service provider is suspended due to said act.

(Public Notice)

Article 115-18 A mayor of a Municipality, in the following cases, shall provide

notification of said fact to the prefectural governor and issue public notice of

said fact without delay:

(i) when an appointment as service provider as set forth in the main clause of

Article 54-2, paragraph (1) is determined;

(ii) when there is a notification pursuant to the provisions of Article 115-14

(except for change of matters as determined by an Ordinance of the Ministry

of Health, Labour, and Welfare as set forth in the same Article and matters

pertaining to suspension and recommencement of business provided by the

same Article);

(iii) when an appointment as service provider as set forth in the main clause of

Article 54-2, paragraph (1) is rescinded, or the effect of the whole or a part of

an appointment as service provider is suspended.

(Mutatis Mutandis Application)

Article 115-19 The provisions of Article 70-2 shall apply mutatis mutandis to

appointment as service provider as set forth in the main clause of Article 54-2,

paragraph (1). In this case, necessary technical replacement of terms shall be

provided by a Cabinet Order.

Section 8 Designated Providers of Support for Prevention of Long-Term

Care

(Appointment as Designated Service Provider of Preventive Support of Long-

Term Care)

Article 115-20 (1) An appointment as service provider as set forth in Article 58,

paragraph (1) shall be provided, pursuant to the provisions of an Ordinance of

the Ministry of Health, Labour, and Welfare by an application by institution

personnel of a community general support center as prescribed in Article 115-

39, paragraph (1) from each place of business that performs Preventive

Support of Long-Term Care Business (hereinafter referred to as "Business

Office" in this Section), and shall have effect with regard to payment of an

Allowance for Preventive Long-Term Care Service Plan and an Exceptional

Allowance for Preventive Long-Term Care Service Plan to an Insured Person

by Long-Term Care Insurance provided by a Municipality, for which the mayor

of the Municipality that provides said appointment as service provider, is

176

chairperson.

(2) A mayor of a Municipality, in a case of an application as set forth in the

preceding paragraph, when it corresponds to any of the following items, shall

not provide appointment as service provider as set forth in the main clause of

Article 58, paragraph (1):

(i) when the applicant is not a juridical person;

(ii) when knowledge, skill and the number of employees of the Business Office

pertaining to said application does not meet the standards as determined by

an Ordinance of the Ministry of Health, Labour, and Welfare as set forth in

Article 115-22, paragraph (1) and the fixed minimum number of employees as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare

as prescribed in the same paragraph;

(iii) when it is determined that the applicant cannot perform appropriate

business of Prevention Support for Long-Term Care in accordance with

standards concerning effective support methods for Prevention of Long-Term

Care pertaining to Designated Support for Prevention of Long-Term Care

and standards concerning management of the business of Designated

Support for Prevention of Long-Term Care as prescribed in Article 115-22,

paragraph (2);

(iv) when an applicant is punished by a fine pursuant to the provisions of this

Act as provided by a Cabinet Order, concerning citizens' health and medical

care and public aid and execution of said penalty has not yet been completed

or has not yet expired;

(v) when an applicant is rescinded as the appointed service provider pursuant

to the provisions of Article 115-26 and five years have not elapsed from the

date of said rescission;

(vi) when an applicant provides notification of abolishment of business

pursuant to the provisions of Article 115-23 (except for a person that has a

reasonable basis for abolishment of said business) from the date of

notification pursuant to the provisions of Article 15 of the Administrative

Procedures Act pertaining to rescission of appointment as service provider

pursuant to the provisions of Article 115-26 to the date of said rescission or

the date it is determined that said termination of appointment will not be

accepted, and five years have not elapsed from the date of said notification or

decline of appointment as service provider;

(vii) when an applicant performs a wrongful or significantly unjustifiable act

concerning In-Home, etc. Service within five years prior to an application of

appointment as service provider;

(viii) when any Officer, etc., of the applicant corresponds to any of the

following:

(a) a person punished by imprisonment without compulsory labor and

177

execution of said penalty has not yet been completed or has not yet

expired;

(b) a person that corresponds to item (iv) or the preceding item;

(c) a person that is or was an Officer, etc., of a juridical person that

appointment as service provider is rescinded pursuant to the provisions of

Article 115-26, within sixty days prior to the date of notification pursuant

to the provisions of Article 15 of the Administrative Procedures Act

pertaining to said rescission and five years have not elapsed from the date

of said rescission;

(d) a person that is or was an Officer, etc., of a juridical person that provided

notification of an abolishment of business pursuant to the provisions of

Article 115-23 (except for a juridical person that has a reasonable basis for

said abolishment of business) within the period provided by item (vi),

within sixty days prior to the date of notification as set forth in the same

item and five years have not elapsed from the date of said notification or

decline of appointment as service provider.

(3) A mayor of a Municipality, when intending to designate an appointment as

service provider as set forth in the main clause of Article 58, paragraph (1),

shall take necessary measures in advance in order to reflect the opinion of

relevant persons and those of Insured Persons by Long-Term Care Insurance

provided by said Municipality.

(Standards of the Business of Designated Support for Prevention of Long-Term

Care)

Article 115-21 (1) A Designated Provider of Support for Prevention of Long-Term

Care shall act in compliance with the standards concerning effective support

methods for Prevention of Long-Term Care pertaining to Designated Support

for Prevention of Long-Term Care and standards concerning management of

the business of Designated Support for Prevention of Long-Term Care as

prescribed in paragraph (2) of the following Article, offer appropriate

Designated Support for Prevention of Long-Term Care according to the mental

and physical condition, etc., of a Person Requiring Long-Term Care, and

always engage in offering said services from the viewpoint of the person that

receives Designated Support for Prevention of Long-Term Care by

implementing self-evaluation of the quality of the Provider's own Designated

Support for Prevention of Long-Term Care and other measures.

(2) A Designated Provider of Support for Prevention of Long-Term Care, when an

Opinion of the Certification Committee is entered on the Certificate of Insured

Person that is presented by an Insured Person that intends to receive

Designated Support for Prevention of Long-Term Care, shall engage in offering

said Designated Support for Prevention of Long-Term Care of said Insured

178

Person in consideration of said Opinion of the Certification Committee.

(3) A Designated Provider of Support for Prevention of Long-Term Care,

pursuant to the provisions of an Ordinance of the Ministry of Health, Labour,

and Welfare, may entrust a part of Designated Support for Prevention of Long-

Term Care to a person as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare.

Article 115-22 (1) A Designated Provider of Support for Prevention of Long-Term

Care shall employ the fixed minimum number of employees that engage in said

Designated Support for Prevention of Long-Term Care, as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare in accordance with

the standards as determined by an Ordinance of the Ministry of Health,

Labour, and Welfare, at each place of business pertaining to said appointment

as service provider.

(2) In addition to the provisions in the preceding paragraph, standards

concerning effective support methods for Prevention of Long-Term Care

pertaining to Designated Support for Prevention of Long-Term Care and

standards concerning management of the business of Designated Support for

Prevention of Long-Term Care shall be provided by the Minister of Health,

Labour, and Welfare.

(3) The Minister of Health, Labour, and Welfare, when intending to provide

standards concerning effective support methods for Prevention of Long-Term

Care pertaining to Designated Support for Prevention of Long-Term Care and

standards concerning management of the business of Designated Support for

Prevention of Long-Term Care as prescribed in the preceding paragraph

(limited to the part concerning the handling of Designated Support for

Prevention of Long-Term Care), shall hear the opinion of the Social Security

Council in advance.

(4) A Designated Provider of Support for Prevention of Long-Term Care shall

respect the personality of a Person Requiring Long-Term Care, act in

compliance with this Act or an Order based on this Act, and faithfully perform

said duty for a Person Requiring Long-Term Care.

(Notification of Change, etc.)

Article 115-23 A Designated Provider of Support for Prevention of Long-Term

Care, when the name or location of the Business Office pertaining to said

appointment as service provider or other matters as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare are changed, or

when the business of said Designated Support for Prevention of Long-Term

Care is abolished, suspended, or recommenced, shall provide notification of

said fact to the mayor of the Municipality within ten days pursuant to the

179

provisions of an Ordinance of the Ministry of Health, Labour, and Welfare.

(Reporting, etc.)

Article 115-24 (1) A mayor of a Municipality, when it is determined to be

necessary, shall order a Designated Provider of Support for Prevention of Long-

Term Care, a person that is or was a Designated Provider of Support for

Prevention of Long-Term Care, or an employee of the Business Office

pertaining to said appointment as service provider (hereinafter referred to as a

"Person that is or was a Designated Support Provider for Prevention of Long-

Term Care, etc." in this paragraph) to report, submit or present record books

and documents, request to said Designated Provider of Support for Prevention

of Long-Term Care, an employee of the Business Office pertaining to said

appointment as service provider, or a Person that is or was a Designated

Support Provider for Prevention of Long-Term Care, etc., to appear, to direct

personnel to ask questions to the relevant Person, or enter the Business Office

pertaining to said appointment as service provider of said Designated Provider

of Support for Prevention of Long-Term Care in order to inspect said facility,

record books and documents, or other items.

(2) The provisions of Article 24, paragraph (3) shall apply mutatis mutandis to

questions and inspections pursuant to the provisions of the preceding

paragraph, and the provisions of paragraph (4) of the same Article shall apply

mutatis mutandis to the authority granted pursuant to the provisions of the

preceding paragraph.

(Recommendation, Order, etc.)

Article 115-25 (1) A mayor of a Municipality, when it is determined that a

Designated Provider of Support for Prevention of Long-Term Care does not

meet the standards as determined by an Ordinance of the Ministry of Health,

Labour, and Welfare as set forth in the Article 115-22, paragraph (1) or fixed

minimum number of employees as determined by an Ordinance of the Ministry

of Health, Labour, and Welfare as set forth in the same paragraph with regard

to knowledge, skill, or employee of the Business Office pertaining to said

appointment as service provider, or does not operate an appropriate business of

Designated Support for Prevention of Long-Term Care in accordance with

standards concerning effective support methods for Prevention of Long-Term

Care pertaining to Designated Support for Prevention of Long-Term Care and

standards concerning management of the business of Designated Support for

Prevention of Long-Term Care prescribed in paragraph (2) of the same Article,

may specify a due date and recommend to said Designated Provider of Support

for Prevention of Long-Term Care to comply with the standards as determined

by an Ordinance of the Ministry of Health, Labour, and Welfare as set forth in

180

paragraph (1) of the same Article, to employ the fixed minimum number of

employees as determined by an Ordinance of the Ministry of Health, Labour,

and Welfare as set forth in the same paragraph, to comply with standards

concerning effective support methods for Prevention of Long-Term Care

pertaining to Designated Support for Prevention of Long-Term Care and

standards concerning management of the business of Designated Support for

Prevention of Long-Term Care as prescribed in paragraph (2) of the same

Article.

(2) A mayor of a Municipality, in a case of providing a recommendation pursuant

to the provisions of the preceding paragraph, may provide public notice of the

fact that said Designated Provider of Support for Prevention of Long-Term

Care that is issued said recommendation did not act in compliance with said

recommendation within the due date as set forth in the same paragraph.

(3) A mayor of a Municipality, when the Designated Provider of Support for

Prevention of Long-Term Care that is issued a recommendation pursuant to

the provisions of paragraph (1) does not implement the measures pertaining to

said recommendation without a justifiable basis, may specify a due date and

order said Designated Provider of Support for Prevention of Long-Term Care to

implement measures pertaining to said recommendation.

(4) A mayor of a Municipality, when issuing an order pursuant to the provisions

of the preceding paragraph, shall issue public notice of said fact.

(Rescission of Appointment as Service Provider, etc.)

Article 115-26 A mayor of a Municipality, in a case that corresponds to any of

the following items, may rescind the appointment as service provider as set

forth in Article 58, paragraph (1) pertaining to said Designated Provider of

Support for Prevention of Long-Term Care or suspend the whole or a part of

the effect of said appointment as service provider within the period specified by

a due date:

(i) when a Designated Provider of Support for Prevention of Long-Term Care

corresponds to any provision of Article 115-20, paragraph (2), item (iv) or

item (viii);

(ii) when a Designated Provider of Support for Prevention of Long-Term Care

becomes unable to meet standards as determined by an Ordinance of the

Ministry of Health, Labour, and Welfare or the fixed minimum number of

employees as determined by an Ordinance of the Ministry of Health, Labour,

and Welfare as set forth in Article 115-22, paragraph (1) with regard to

knowledge, skill and number of employees of the Business Office pertaining

to said appointment as service provider;

(iii) when a Designated Provider of Support for Prevention of Long-Term Care

becomes unable to operate an appropriate business of Designated Support for

181

Prevention of Long-Term Care in accordance with standards concerning

effective support methods for Prevention of Long-Term Care pertaining to

Designated Support for Prevention of Long-Term Care and standards

concerning management of the business of Designated Support for

Prevention of Long-Term Care as prescribed in Article 115-22, paragraph (2);

(iv) when it is determined that an organizer of a Designated Provider of

Preventive Support for Long-Term Care violates an obligation as prescribed

in Article 115-22, paragraph (4);

(v) when an Allowance for Preventive Long-Term Care Service Plan is wrongly

requested;

(vi) when a Designated Provider of Support for Prevention of Long-Term Care

is ordered to report, submit or present record books and documents pursuant

to the provisions of Article 115-24, paragraph (1), but disobeys said order or

submits a false report;

(vii) when a Designated Provider of Support for Prevention of Long-Term Care

or an employee of the Business Office pertaining to said appointment as

service provider is requested to appear pursuant to the provisions of Article

115-24, paragraph (1) but does not respond or does not reply to questions

pursuant to the provisions of the same paragraph or submits a false reply, or

refuses, interrupts, or interferes with an inspection pursuant to the

provisions of the same paragraph, however, provided that this provision shall

not apply when an employee of the Business Office pertaining to said

appointment as service provider performed said act and said Designated

Provider of Support for Prevention of Long-Term Care was faithfully

providing reasonable care and supervision in order to prevent said act of said

employee;

(viii) when a Designated Provider of Support for Prevention of Long-Term Care

is appointed to provide service as set forth in Article 58, paragraph (1) by

wrongful means;

(ix) in addition to the cases listed in the preceding items, when a Designated

Provider of Support for Prevention of Long-Term Care violates this Act,

another Act concerning citizens' health and medical care and public aid as

provided by a Cabinet Order, or an Order or disposition of a matter based on

these Acts;

(x) in addition to the cases listed in the preceding items, when a Designated

Provider of Support for Prevention of Long-Term Care performs a wrongful

or significantly unjustifiable act concerning In-Home Service, etc.;

(xi) when any Officer, etc., of a Designated Provider of Support for Prevention

of Long-Term Care performs a wrongful or significantly unjustifiable act

concerning In-Home Service, etc., within five years and the appointment as

service provider is rescinded or the whole or a part of the effect of the

182

appointment as service provider is suspended due to said act.

(Public Notice)

Article 115-27 A mayor of a Municipality, in the following cases, shall issue

public notice of the said fact:

(i) when an appointment as service provider as set forth in Article 58,

paragraph (1) is determined;

(ii) when there is a notification pursuant to the provisions of Article 115-23

(except for those pertaining to change of matters as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare in the same Article

and suspension or recommencement of business as prescribed in the same

Article);

(iii) when an appointment as service provider as set forth in Article 58,

paragraph (1) is rescinded pursuant to the provisions of the preceding Article,

or the effect of the whole or a part of an appointment as service provider is

suspended.

(Mutatis Mutandis Application)

Article 115-28 The provisions of Article 70-2 shall apply mutatis mutandis to

appointment as service provider as set forth in Article 58, paragraph (1). In

this case, necessary technical replacement of terms shall be provided by a

Cabinet Order;

Section 9 Publication of Long-Term Care Service Information

(Report and Public Notice of Long-Term Care Service Information)

Article 115-29 (1) An Organizer of a Designated In-Home Service Provider,

Designated Community-Based Service Provider, Designated In-Home Long-

Term Care Support Provider, Designated Provider of Preventive Long-Term

Care Service, Designated Provider of Community-Based Service for Preventive

Long-Term Care, Designated Provider of Support for Prevention of Long-Term

Care, Designated Facility Covered by Public Aid Providing Long-Term Care to

the Elderly, Long-Term Care Health Facility, and Designated Medical Long-

Term Care Sanatorium (herein referred to as "Long-Term Care Service

Provider"), when said institution personnel obtain an appointment as service

provider of Designated In-Home Service Provider, Designated Community-

Based Service Provider, Designated In-Home Long-Term Care Support

Provider, Designated Facility Covered by Public Aid Providing Long-Term Care

to the Elderly, Designated Medical Long-Term Care Sanatorium, Designated

Provider of Preventive Long-Term Care Service, Designated Provider of

Community-Based Service for Preventive Long-Term Care, and Designated

183

Provider of Support for Prevention of Long-Term Care and an approval of a

Long-Term Care Health Facility, and intends to commence offering Home-Visit

Long-Term Care, Home-Visit Bathing Long-Term Care and other services as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare, or

when it is as determined by an Ordinance of the Ministry of Health, Labour,

and Welfare, (herein "Long-Term Care Service") pursuant to the provisions of a

Cabinet Order, shall report long-term care information pertaining to Long-

Term Care Service to be offered (which means contents of Long-Term Care

Service and information concerning the management status of the provider or

facility that offers Long-Term Care Service, those which are as determined by

an Ordinance of the Ministry of Health, Labour, and Welfare as necessary to be

provided public notice in order for an Insured Person Requiring Long-Term

Care, etc., that uses or intends to use Long-term care to secure an opportunity

to use said Long-Term Care Service appropriately and efficiently, the same

shall apply herein) to the prefectural governor that governs the location of the

Business Office or a facility which provides said Long-Term Care Service.

(2) A prefectural governor, when a report is received pursuant to the provisions

of the preceding paragraph, shall investigate the Long-Term Care Service

Provider of said report, regarding those items as determined by an Ordinance

of the Ministry of Health, Labour, and Welfare among Long-Term Care Service

information.

(3) A prefectural governor, after an investigation pursuant to the provisions of

the preceding paragraph is completed, shall issue public notice of those items

as determined by an Ordinance of the Ministry of Health, Labour, and Welfare

among contents of the report pursuant to the provisions of paragraph (1) and

the results of the investigation pursuant to the provisions of the preceding

paragraph.

(4) A prefectural governor, when a Long-Term Care Service Provider does not

report pursuant to the provisions of paragraph (1) or reports falsely, or does

not permit the investigation pursuant to the provisions of paragraph (2) or

interrupted the investigation, may specify a due date and order said Long-

Term Care Service Provider to provide said report, correct the contents of said

report, or permit such investigation.

(5) A prefectural governor, when the disposition of a matter is determined

pursuant to the provisions of the preceding paragraph, pertaining to a

Designated Community-based Service Provider, Designated Provider of

Community-Based Service for Preventive Long-Term Care, and Designated

Provider of Support for Prevention of Long-Term Care, shall provide

notification of such fact to the mayor of the Municipality that provided

appointment as service provider to said Designated Community-Based Service

Provider, Designated Provider of Community-Based Service for Preventive

184

Long-Term Care, or Designated Provider of Support for Prevention of Long-

Term Care.

(6) A prefectural governor, when institution personnel of a Designated In-Home

Service Provider, Designated In-Home Long-Term Care Support Provider,

Designated Provider of Preventive Long-Term Care Service, Designated

Facility Covered by Public Aid Providing Long-Term Care to the Elderly, Long-

Term Care Health Facility, or Designated Medical Long-Term Care

Sanatorium do not act in compliance with an order pursuant to the provisions

of paragraph (4), may rescind the appointment as service provider of said

Designated In-Home Service Provider, Designated In-Home Long-Term Care

Support Provider, Designated Provider of Preventive Long-Term Care Service,

Designated Facility Covered by Public Aid Providing Long-Term Care to the

Elderly, and Designated Medical Long-Term Care Sanatorium or an approval

for a Long-Term Care Health Facility, or suspend the whole or a part of the

effect of said appointment as service provider or approval within the period

specified by a due date.

(7) A prefectural governor, in a case when a Designated Community-Based

Service Provider, Designated Provider of Community-Based Preventive Service

for Long-Term Care, or Designated Provider of Support for Prevention of Long-

Term Care does not act in compliance with an order pursuant to the provisions

of paragraph (4), shall rescind appointment as service provider of said

Designated Community-Based Service Provider, Designated Provider of

Community-Based Preventive Service for Long-Term Care, or Designated

Provider of Support for Prevention of Long-Term Care, or when he or she

determines appropriate, suspend the whole or a part of its effect within the

period specified by a due date, and shall provide notification of said effect

indicating said reasons to the mayor of the Municipality that provided said

appointment as service provider.

(Appointment of Designated Investigative Agency)

Article 115-30 (1) A prefectural governor may assign a person that the

prefectural governor appoints (hereinafter referred to as "Designated

Investigative Agency") to conduct affairs pertaining to an investigation as set

forth in paragraph (2) of the preceding Article (hereinafter referred to as

"Investigation Affairs").

(2) Appointment as service provider as set forth in the preceding paragraph shall

be provided by said prefectural governor in each prefecture, by application of a

person that intends to obtain said appointment as service provider.

(3) A prefecture, in a case when collection fees pertaining to Investigation Affairs

based on the provisions of Article 227 of the Local Autonomy Act, may have

said person that accepts the investigation as set forth in paragraph (2) in the

185

preceding Article provided by a Designated Investigative Agency pursuant to

the provisions of paragraph (1) pay said fee to said Designated Investigative

Agency pursuant to the provisions of a prefectural ordinance and determine

said fee as income of said Designated Investigative Agency.

(Investigator)

Article 115-31 (1) A Designated Investigative Agency shall, when implementing

Investigation Affairs, act in compliance with the method as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare and assign

investigator to Investigation Affairs.

(2) Investigator shall be selected from those who possess expert knowledge and

skill concerning Investigation Affairs and meet the requirements provided by a

Cabinet Order.

(Confidentiality Obligations, etc.)

Article 115-32 (1) A Designated Investigative Agency (in a case when said

person is a juridical person, said Officer; the same shall apply in the following

paragraph), said personnel, or a person that was in these occupation shall not

divulge any confidential information that said person learned concerning

Investigation Affairs.

(2) A Designated Investigative Agency and said personnel who engage in

Investigation Affairs shall be deemed as personnel that engages in public

service pursuant to the provisions of laws and regulations with regard to

application of the Penal Code and other penal provisions.

(Maintenance of Books, etc.)

Article 115-33 A Designated Investigative Agency, pursuant to the provisions of

an Ordinance of the Ministry of Health, Labour, and Welfare, shall keep and

maintain books where matters concerning Investigation Affairs and as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare

are recorded.

(Reporting, etc.)

Article 115-34 (1) A prefectural governor, when it is determined to be necessary

for ensuring fair and appropriate conduct of Investigation Affairs, may request

a Designated Investigative Agency to report concerning Investigation Affairs,

direct personnel to ask questions to a relevant person, or enter the Business

Office of said Designated Investigative Agency in order to inspect said facilities,

record books and documents, or other items.

(2) The provisions of Article 24, paragraph (3) shall apply mutatis mutandis to

questions and inspections pursuant to the provisions of the preceding

186

paragraph, and the provisions of paragraph (4) of the same Article shall apply

mutatis mutandis to the authority granted pursuant to the provisions of the

preceding paragraph.

(Suspension, Abolition, etc., of Business)

Article 115-35 A Designated Investigative Agency shall not suspend or abolish

the whole or a part of Investigation Affairs without obtaining approval from

prefectural governor.

(Appointment of Designated Public Information Center)

Article 115-36 (1) A prefectural governor may appoint a person (hereinafter

referred to as "Designated Public Information Center") the whole or a part of

those Investigation Affairs, as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare, concerning acceptance of reports of Long-Term

Care Service information and appointment as service provider as a Designated

Investigative Agency (hereinafter referred to as "Public Information Business

Office").

(2) Appointment as service provider as set forth in the preceding paragraph shall

be provided in each prefectural area, by an application of a person that intends

to obtain said appointment as service provider, by the governor of said

prefecture.

(3) The provisions of Article 115-30, paragraph (3) and Article 115-32 to the

preceding Article shall apply mutatis mutandis to a Designated Public

Information Center. In this case, the terms "Investigation Affairs," "Designated

Investigative Agency," and "personnel (including an investigator; the same

shall apply in the same paragraph)" in these provisions shall be deemed to be

replaced with "Public Information Business Office," "Designated Public

Information Center," and "personnel" respectively, and the necessary technical

replacement of terms shall be provided by a Cabinet Order.

(Delegation to a Cabinet Order)

Article 115-37 In addition to those matters provided in this Section, other

necessary matters concerning a Designated Investigative Agency and

Designated Public Information Center shall be provided by a Cabinet Order.

Chapter VI Community Support Projects, etc.

(Community Support Projects)

Article 115-38 (1) A Municipality shall prevent an Insured Person from being in

a Condition of Need for Long-Term Care, and shall implement the following

projects as Community Support Projects in order to support said persons to be

187

able to live an independent daily life in each area, as much as possible,

although said person becomes in a Condition of Need for Long-Term Care, etc.:

(i) a project necessary for preventing an Insured Person (limited to a Primary

Insured Person) from becoming in a Condition of Need for Long-Term Care,

etc., reduction of a Condition of Need for Long-Term Care, etc., or prevention

of deterioration (except for business of Preventive Long-Term Care Service

and Community-Based Preventive Long-Term Care Business);

(ii) a project to provide necessary assistance for providing businesses listed in

the preceding item and other appropriate business comprehensively and

effectively, in order to prevent an Insured Person from being in a Condition

of Need for Long-Term Care, etc., according to the mental and physical

condition, surroundings, and other conditions of said person, and based on a

said selection;

(iii) a project to understand the mental and physical conditions of an Insured

Person, the actual living status in his or her home, and other necessary

actual conditions, to provide comprehensive information concerning health

and medical care, public health, social public aid service and other relevant

measures, to coordinate with relevant facilities, and to provide

comprehensive support in order to improve health and medical care of

Insured Person and to promote public aid service;

(iv) a project to provide the necessary assistance for prevention of abuse of an

Insured Person, a business for early detection of said abuse and other

advocacy for an Insured Person;

(v) a project to provide comprehensive and continuous support, through review

of the In-Home Service Plan and Facility Service Plan for an Insured Person,

said Person's mental and physical condition, use status of services subject to

Long-Term Care Benefit and periodical consultation with people possessing

expert knowledge concerning health and medical care and public aid, in order

for said Insured Person to live said daily life independently in the community.

(2) A Municipality, in addition to the projects listed in the items of the preceding

paragraph, may implement the following projects as Community Support

Projects:

(i) a project to appropriate allowances necessary for Long-Term Care Benefit,

etc.;

(ii) a project necessary for supporting the guidance of long-term care method

and for supporting personnel that are actually providing care to the Insured

Persons Requiring Long-Term Care;

(iii) a project necessary for stabilization of management of Long-Term Care

Insurance business and for supporting an Insured Person for an independent

daily life in the community.

(3) A Community Support Project shall be implemented by taking into

188

consideration the current conditions of business concerning Preventive Long-

Term Care Service in said Municipality, the business conditions of Long-Term

Care Insurance and other conditions within the scope of amounts provided by a

Cabinet Order.

(4) A Municipality may request a fee to user of a Community Support Project

pursuant to the provisions of an Ordinance of the Ministry of Health, Labour,

and Welfare.

(5) The Ministry of Health, Labour, and Welfare shall provide public notice of

guidelines necessary for promoting appropriate and effective implementation of

a project implemented by a Municipality pursuant to the provisions of

paragraph (1), item (i).

(6) In addition to the provisions of the items in the preceding paragraph, other

necessary matters concerning implementation of a Community Support Project

shall be provided by a Cabinet Order.

(Community General Support Center)

Article 115-39 (1) A community general support center aims to provide

comprehensive support for improvement of health and medical care and

promotion of the public of local residents through implementation of projects

listed in paragraph (1), item (ii) to item (v) of the preceding paragraph

(hereinafter "Comprehensive Support Project") and other projects as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare,

and provide assistance necessary for maintaining mental and physical health

and for stabilization of the lives of local residents.

(2) A Municipality may establish a community general support center.

(3) A person that is entrusted with the implementation of a project as set forth in

paragraph (1) of the following Article, may provide notice of matters as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare to

the mayor of the Municipality in advance and establish a community general

support center pursuant to the provisions of an Ordinance of the Ministry of

Health, Labour, and Welfare, in order to implement a Comprehensive Support

Project and other projects as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare as set forth in paragraph (1).

(4) Institution personnel of a community general support center shall comply

with standards as determined by an Ordinance of the Ministry of Health,

Labour, and Welfare as necessary for the implementation of a Comprehensive

Support Project.

(5) Institution personnel of a community general support center (in a case when

the institution personnel refers to a juridical person, said Officers) or the

personnel or a person that were in said occupation shall not divulge any

confidential information that said person learned concerning said business

189

without justifiable reasons.

(6) The provisions of Article 69-14 shall apply mutatis mutandis to a community

general support center. In this case, the necessary technical replacement of

terms shall be provided by a Cabinet Order.

(7) In addition to the provisions as prescribed in each of the preceding paragraph,

other necessary matters concerning a community general support center shall

be provided by a Cabinet Order.

(Entrustment of Implementation)

Article 115-40 (1) A Municipality may entrust implementation of a

Comprehensive Support Project to the institution personnel of a Long-Term

Care Support Center as prescribed in Article 20-7, paragraph (1) of the Public

Aid for the Aged Act and other persons as determined by an Ordinance of the

Ministry of Health, Labour, and Welfare.

(2) Entrustment pursuant to the provisions of the preceding paragraph shall be

implemented for all Comprehensive Support Projects collectively.

(3) The provisions of paragraph (5) of the preceding Article shall apply mutatis

mutandis to a person that accepted an entrustment as set forth in paragraph

(1).

(4) A Municipality may entrust implementation of the whole or a part of project

listed in Article 115-38, paragraph (1), item (i) and each item listed in

paragraph (2) to the institution personnel of a Long-Term Care Support Center

as prescribed in Article 20-7, paragraph (1) of the Public Aid for the Aged Act

and other person that said Municipality determines appropriate.

(Health Care and Public Aid Projects)

Article 115-41 A Municipality may implement, in addition to Community

Support Projects, a project necessary for supporting a person that actually

provides care for an Insured Person Requiring Long-Term Care, a project

necessary for preventing an Insured Person from being in a Condition of Need

for Long-Term Care, etc., a project of Designated In-Home Service or

Designated In-Home Long-Term Care Support, a project necessary for

management of a Facility Covered by Long-Term Care Insurance and other

Insurance Benefits, a project necessary for the loan of funds for Services

Subject to Long-Term Care Benefits, etc., that an Insured Person utilizes, and

other projects.

Chapter VII Insured Long-Term Care Service Plans

(Basic Guidelines)

Article 116 (1) The Minister of Health, Labour, and Welfare shall provide basic

190

guidelines for ensuring the efficient implementation of Insurance Benefits

pertaining to Long-Term Care Projects Covered by Insurance (hereinafter

referred to as "Basic Guidelines").

(2) Basic Guidelines shall provide matters as listed in the following:

(i) basic matters for ensuring a system to provide Services Subject to Long-

Term Care Benefits, etc., and concerning implementation of a Community

Support Project;

(ii) for matters that concern the Municipal Insured Long-Term Care Service

Plan as set forth in paragraph (1) of the following Article, standards to be

considered when determining the prospective service amounts by type of

Service Covered by Long-Term Care Benefits, etc., as set forth in paragraph

(2), item (i) of the same Article, and matters concerning preparation of a

Prefectural Insured Long-Term Care Service Plan as set forth in Article 118,

paragraph (1);

(iii) matters necessary for ensuring the efficient implementation of Insurance

Benefits pertaining to an Insured Long-Term Care Project.

(3) The Minister of Health, Labour, and Welfare shall provide Basic Guidelines,

and when changing said guidelines, shall consult with the Minister of Public

Management, Home Affairs, Posts and Telecommunications and other

chairpersons of related administrative organizations.

(4) The Minister of Health, Labour, and Welfare shall provide Basic Guidelines

and shall, when providing said Guidelines, provide public notice of said

Guidelines without delay.

(Municipal Insured Long-Term Care Service Plan)

Article 117 (1) A Municipality shall, for Basic Guidelines, provide a plan

concerning the efficient implementation of Insurance Benefits pertaining to an

Insured Long-Term Care Project that is implemented by said Municipality by

specifying three years as one project term (hereinafter referred to as

"Municipal Insured Long-Term Care Service Plan").

(2) A Municipal Insured Long-Term Care Service Plan shall provide the matters

listed as follows:

(i) the total of the necessary fixed number of persons that utilize Communal

Daily Long-Term Care for A Dementia Patient, Daily Life Long-Term Care

for A Person Admitted to A Community-Based Specified Facility, and

Admission to A Community-Based Facility for Preventive Daily Long-Term

Care of the Elderly Covered by Public Aid, said prospective numbers by type

of Service Covered by Long-Term Care Benefits, etc., and measures to secure

said prospective numbers for each fiscal year by each area that is specified

by said Municipality by comprehensively taking into consideration

geographical conditions, population, transportation, other social conditions,

191

status of facility conditions for providing Service Covered by Long-Term Care

Benefits, etc., and other conditions within the area where said residents live

their daily life;

(ii) amount of cost necessary for a Community Support Project, prospective

quantities of a Community Support Project, and measures for ensuring said

prospective quantities;

(iii) matters concerning a project for ensuring cooperation among organizations

that are a Designated In-Home Service Provider, Designated Community-

Based Service Provider, and Designated In-Home Long-Term Care Support

Provider and concerning other projects for promoting the efficient provision

of Service Covered by Long-Term Care Benefits, etc., (limited to those

pertaining to Long-Term Care Benefits);

(iv) matters concerning a project for ensuring cooperation among organizations

that are a Designated Provider of Preventive Long-Term Care Service,

Designated Provider of Community-Based Service for Preventive Long-Term

Care, and Designated Provider of Support for Prevention of Long-Term Care

and other projects for promoting the efficient provision of Service Covered by

Long-Term Care Benefits, etc., (limited to those pertaining to Prevention

Benefits) and efficient implementation of a Community Support Project;

(v) matters that a Municipality determines are necessary for promoting

efficient implementation of Insurance Benefits pertaining to an Insured

Long-Term Care Project.

(3) A Municipal Insured Long-Term Care Service Plan shall be prepared by

taking into consideration the number of Insured Persons Requiring Long-Term

Care, etc., in the area of said Municipality, the intentions of a Person

Requiring Long-Term Care concerning use of the Service Covered by Long-

Term Care Benefits, etc., and other conditions.

(4) A Municipal Insured Long-Term Care Service Plan shall be prepared in

conjunction with a Municipal Welfare Plan for the Elderly as prescribed in

Article 20-8, paragraph (1) of the Public Aid for the Aged Act and a Municipal

Health Plan for the Elderly as prescribed in Article 46-18, paragraph (1) of the

Health and Medical Services Act for the Aged (Act No. 80 of 1982).

(5) A Municipal Insured Long-Term Care Service Plan shall maintain harmony

and balance with a Municipal Community Welfare Plan as prescribed in Article

107 of the Social Welfare Act and plans pursuant to the provisions of other

Acts, and those that provide matters concerning health, medical care, or

welfare of an Insured Person Requiring Long-Term Care, etc.

(6) A Municipality, when providing or changing a Municipal Insured Long-Term

Care Service Plan, shall undertake the necessary measures in advance in order

to reflect the opinions of Insured Persons.

(7) A Municipality, when providing or changing a Municipal Insured Long-Term

192

Care Service Plan, shall hear opinions of the prefecture in advance.

(8) A Municipality, when providing or changing a Municipal Insured Long-Term

Care Service Plan, shall submit said Plan to the prefectural governor without

delay.

(Prefectural Insured Long-Term Care Service Plan)

Article 118 (1) A prefecture, with regard to Basic Guidelines, shall provide a

plan concerning efficient implementation of Insurance Benefits pertaining to

an Insured Long-Term Care Project by specifying three years as one term

(hereinafter referred to as "Prefectural Insured Long-Term Care Service Plan").

(2) A Prefectural Insured Long-Term Care Service Plan shall provide the matters

listed as follows:

(i) the total necessary capacity of persons to utilize Daily Life Care of A Patient

Admitted to A Specialized Long-Term Care Specified Facility, Daily Life

Long-Term Care for A Person Admitted to A Community-Based Specified

Facility, and Admission to A Community-Based Facility for Preventive Daily

Long-Term Care of the Elderly Covered by Public Aid in each fiscal year by

each area provided by said prefecture, the total necessary capacity of persons

that may be admitted to a facility by type of Facility Covered by Long-Term

Care Insurance (with regard to a Designated Medical Long-Term Care

Sanatorium, the total necessary capacity of persons for admission to a

facility pertaining to Sanatorium Ward, etc., of said Designated Medical

Long-Term Care Sanatorium) and prospective quantity of other Service

Covered by Long-Term Care Benefits, etc.;

(ii) matters concerning a project to promote improvement of the living

environment at a Facility Covered by Long-Term Care Insurance and other

facilities that are to provide Service Covered by Long-Term Care Benefits,

etc;

(iii) matters concerning publication of Long-Term Care Service information;

(iv) matters concerning a Long-Term Care Support Specialist and other Service

Covered by Long-Term Care Benefits, etc., ensuring adequate personnel

qualified to engage in Community Support Projects, and business

contributing to the improvement of quality;

(v) matters concerning a project ensuring cooperation among organizations that

are a Facility Covered by Long-Term Care Insurance and other projects for

promoting the efficient provision of Service Covered by Long-Term Care

Benefits, etc.;

(vi) other matters that a prefecture determines necessary for supporting

efficient implementation of Insurance Benefits pertaining to Long-Term Care

Projects Covered by Insurance.

(3) A Prefectural Insured Long-Term Care Service Plan, in addition to matters

193

listed in each item of the preceding paragraph, may provide the total necessary

capacity of persons who utilize Daily Life Activities of A Long-Term Care

Patient Admitted to A Combined Specified Facility in each fiscal year by area

specified by said prefecture pursuant to the provisions of item (i) of the same

paragraph;

(4) A Prefectural Insured Long-Term Care Service Plan shall be prepared in

conjunction with a Prefectural Welfare Plan for Elderly as prescribed in Article

20-9, paragraph (1) of the Public Aid for the Aged Act and Prefectural Health

Plan for Elderly as prescribed in Article 46-19, paragraph (1) of Health and

Medical Services Act for the Aged.

(5) A Prefectural Insured Long-Term Care Service Plan shall maintain a

harmonious balance with a medical care plan as prescribed in Article 30-4,

paragraph (1) of the Medical Care Act, a Prefectural Community Welfare

Support Plan as prescribed in Article 108 of Social Welfare Act and plan

pursuant to the provisions of other Acts and those provides matters concerning

health, medical care, and welfare of an Insured Person Requiring Long-Term

Care, etc.

(6) A prefecture shall, when providing or changing a Prefectural Insured Long-

Term Care Service Plan, submit said plan to the Minister of Health, Labour,

and Welfare without delay.

(Advice, etc., of a Prefectural Governor)

Article 119 (1) A prefectural governor may provide necessary advice to a

Municipality regarding technical matters for preparation of a Municipal

Insured Long-Term Care Service Plan.

(2) The Ministry of Health, Labour, and Welfare may provide necessary advice to

a prefecture regarding technical matters for preparation of a Prefectural

Insured Long-Term Care Service Plan.

(Assistance of the National Government)

Article 120 The national government, when a Municipality or a prefecture

intends to implement projects as prescribed in a Municipal Insured Long-Term

Care Service Plan or a Prefectural Insured Long-Term Care Service Plan, shall

endeavor to provide necessary information, advice, and other assistance for the

efficient implementation of said projects.

Chapter VIII Expenses, etc.

Section 1 Imposition of Expenses

(Costs Imposed upon the National Government)

Article 121 (1) The national government, pursuant to the provisions of a Cabinet

194

Order, shall be subject to defray the costs incurred by a Municipality for the

amount equivalent to the percentage as prescribed in each of the following

items for the amount of expenses necessary for Long-Term Care Benefits and

Prevention Benefits, according to the categories of allowance listed in said

items:

(i) costs necessary for Long-Term Care Benefits (except for those listed in the

following item) and Prevention Benefits (except for those listed in the same

item): 20 percent of the necessary costs;

(ii) costs necessary for Long-Term Care Benefits (limited to those pertaining to

a Facility Covered by Long-Term Care Insurance and Daily Life Long-Term

Care for A Person Admitted to A Community-Based Specified Facility) and

Prevention Benefits (limited to those pertaining to Daily Preventive Long-

Term Care Admitted to A Specified Facility): 15 percent of the necessary

costs.

(2) With regard to application of the provisions of the preceding paragraph to a

Municipality that provides an ordinance based on the provisions of Article 43,

paragraph (3), Article 44, paragraph (6), Article 45, paragraph (6), Article 55,

paragraph (3), Article 56, paragraph (6), or Article 57, paragraph (6), measures

pursuant to the provisions of said ordinance shall not be implemented to those

amount of costs necessary for Long-Term Care Benefits and Prevention

Benefits as prescribed in the same paragraph, and said amount of costs shall

be equivalent to the amount of expenses necessary for said Long-Term Care

Benefit and Prevention Benefit, which are calculated pursuant to the

provisions of a Cabinet Order;

(Adjusting Subsidies, etc.)

Article 122 (1) The national government shall provide Adjusting Subsidies to a

Municipality pursuant to the provisions of a Cabinet Order, in order to adjust

the finances of Long-Term Care Insurance by taking into consideration the

distribution by age group of Primary Insured Persons, distribution of income of

Primary Insured Persons, etc.;

(2) The total amount of Adjusting Subsidies pursuant to the provisions of the

preceding paragraph shall be the amount equivalent to 5 percent of the total

amount of costs necessary for Long-Term Care Benefits and Prevention

Benefits as prescribed in paragraph (1) of the preceding paragraph for each

Municipality (in a case when the provisions of paragraph (2) of the same

Article apply, the amount calculated by applying the provisions of the same

paragraph; the same shall apply in the following paragraph).

(3) The total amount of Adjusting Subsidies to be granted as a portion of each

fiscal year shall be the amount equivalent to 5 percent of the total prospective

amount of costs necessary for Long-Term Care Benefits and Prevention

195

Benefits as prescribed in paragraph (1) of the preceding paragraph in each

Municipality in said fiscal year, plus the amount of Adjusting Subsidies for the

fiscal year prior to the year previous to said fiscal year that have not yet been

provided, or the amount equivalent to 5 percent of said total prospective

amount, minus an amount that is the portion provided that exceeded the

amount to be provided in prior fiscal years of the year previous to said fiscal

year.

Article 122-2 (1) The national government, pursuant to the provisions of a

Cabinet Order, shall provide an amount equivalent to 25 percent of costs

necessary for a Community Support Project (limited to projects listed in Article

115-38, paragraph (1), item (i); hereinafter referred to as "Long-Term Care

Prevention Project") to a Municipality.

(2) The national government, pursuant to the provisions of a Cabinet Order, shall

grant an amount equivalent to 50 percent of the amount (hereinafter referred

to as "Economic Assistance to A Comprehensive Support Business, etc.") that is

obtained by multiplying the percentage that is the result of the sum of the cost

payment percentage of the Secondary Insured Person group as set forth in

Article 125, paragraph (1) and 50 percent, by the amount of expenses necessary

for a Community Support Project (except for Long-Term Care Prevention

Project) to a Municipality.

(Cost Impositions, etc., upon a Prefecture)

Article 123 (1) A prefecture, pursuant to the provisions of an Ordinance of the

Ministry of Health, Labour, and Welfare, shall be subject to defray to a

Municipality the amount equivalent to the portion as prescribed in each of the

following items for the amount of expenses necessary for Long-Term Care

Benefits and Prevention Benefits, according to the categories of costs listed in

each said item:

(i) costs necessary for Long-Term Care Benefits (except for those listed in the

following item) and Prevention Benefits (except for those listed in the same

item): 12.5 percent of the necessary costs;

(ii) costs necessary for Long-Term Care Benefits (limited to those pertaining to

a Facility Covered by Long-Term Care Insurance and Living Care for the

Elderly Admitted to a Special Facility for Preventive Long-Term Care

Service) and Prevention Benefits (limited to those pertaining to Daily

Preventive Long-Term Care Admitted to A Specified Facility): 17.5 percent of

the necessary costs.

(2) The provisions of Article 121, paragraph (2) shall apply mutatis mutandis to

the amount of expenses necessary for Long-Term Care Benefits and Prevention

Benefits as prescribed in the preceding paragraph.

196

(3) A prefecture, pursuant to the provisions of a Cabinet Order, shall provide an

amount equivalent to 12.5 percent of the costs necessary for a Long-Term Care

Prevention Project to a Municipality;

(4) A prefecture shall, pursuant to the provisions of a Cabinet Order, subsidize

an amount equivalent to 25 percent of Economic Assistance to A

Comprehensive Support Business, etc., to a Municipality.

(Costs Imposed on the General Fund of a Municipality)

Article 124 (1) A Municipality, pursuant to the provisions of a Cabinet Order,

shall bear an amount equivalent to 12.5 percent of the amount of expenses

necessary for Long-Term Care Benefits and Prevention Benefits by said

general fund.

(2) The provisions of Article 21, paragraph (2) shall apply mutatis mutandis to

the amount of expenses necessary for Long-Term Care Benefits and Prevention

Benefits as prescribed in the preceding paragraph.

(3) A Municipality, pursuant to the provisions of a Cabinet Order, shall bear the

cost of the amount equivalent to 12.5 percent of the amount of expenses

necessary for Long-Term Care Prevention Project by said general fund.

(4) A Municipality, pursuant to the provisions of a Cabinet Order, shall bear the

cost of the amount equivalent to 25 percent of Economic Assistance to A

Comprehensive Support Business, etc., by the general fund.

(Grant for Long-Term Care Benefit Expenses)

Article 125 (1) With regard to the amount (hereinafter referred to as "Amount

Subject to Medical Insurance Premium Payment" in this Chapter) that is

obtained by multiplying the payment percentage of the Secondary Insured

Person group to the amount of expense necessary for Long-Term Care Benefits

and Prevention Benefits among the expenses that are imposed upon a special

account pertaining to Municipal Long-Term Care Insurance, pursuant to the

provisions of a Cabinet Order, a Grant for Long-Term Care Benefit Expenses

that is provided to a Municipality by the Social Insurance Medical Fee

Payment Fund (hereinafter referred to as "Payment Fund") pursuant to the

provisions of the Social Insurance Medical Fee Payment Fund Act (Act No. 129

of 1948) shall be allocated to said amount.

(2) The payment proportion of a Secondary Insured Person group as prescribed in

the preceding paragraph shall be established based on the percentage obtained

by multiplying 50 percent to the percentage of the total prospective number of

Secondary Insured Persons pertaining to all Municipalities to the total

prospective number of Insured Persons pertaining to all Municipalities and

shall be specified by a Cabinet Order by taking into consideration the changes

of said proportion every three years.

197

(3) The provisions of Article 121, paragraph (2) shall apply mutatis mutandis to

the amount of expenses necessary for Long-Term Care Benefits and Prevention

Benefits as prescribed in paragraph (1).

(4) The payment that is collected by the Payment Fund pursuant to the

provisions of Article 150, paragraph (1) shall be allocated to the Grant for

Long-Term Care Benefit Expenses as set forth in paragraph (1).

(Grants for Supporting Community Support Projects)

Article 126 (1) With regard to the amount that is obtained by multiplying the

payment proportion of the Secondary Insured Person group as set forth in

paragraph (1) of the preceding Article to the amount of expenses necessary for

a Long-Term Care Prevention Project among the expenses that are imposed on

a special account pertaining to Municipal Long-Term Care Insurance

(hereinafter referred to as "Amount Subject to Medical Insurance Premium

Payment for Long-Term Care Prevention Project" in this Chapter), pursuant to

the provisions of a Cabinet Order, the Grants for Supporting Community

Support Projects that the Payment Fund provides to a Municipality, shall be

allocated to said amount.

(2) Payments that are collected by the Payment Fund pursuant to the provisions

of Article 150, paragraph (1) shall be allocated to Grants for Supporting

Community Support Projects as set forth in the preceding paragraph.

(Assistance by National Government)

Article 127 The national government, in addition to those items as prescribed in

Article 121, Article 122, and Article 122-2, may assist with a portion of the

expenses necessary for an Insured Long-Term Care Project within the budget.

(Assistance by a Prefecture)

Article 128 A prefecture, in addition to those items as prescribed in Article 123,

may assist with a portion of the expenses necessary for an Insured Long-Term

Care Project.

(Insurance Premiums)

Article 129 (1) A Municipality shall collect insurance premiums in order to

allocate these amounts to the disbursements necessary for an Insured Long-

Term Care Project (including the disbursements necessary for payment of a

Fiscal Stability Fund contribution).

(2) Insurance premiums as prescribed in the preceding paragraph shall be

imposed upon a Primary Insured Person with the amount of an insurance

premium calculated by the rate of an insurance premium that is calculated

pursuant to the provisions of an ordinance in accordance with the standards

198

provided by a Cabinet Order.

(3) The rate of an insurance premium as set forth in the preceding paragraph

shall be determined in order to be able to maintain fiscal balance of revenue

and expenses approximated through three years in consideration of the

estimated amount of disbursements necessary for Insurance Benefits

calculated based on the prospective volume, etc., of the Service Covered by

Long-Term Care Benefits, etc., as prescribed in a Municipal Insured Long-

Term Care Service Plan, the estimated amount of disbursements necessary for

payment of a Fiscal Stability Fund contribution, the approximate amount of

disbursements necessary for repayment of borrowings from a prefecture

pursuant to the provisions of Article 147, paragraph (1), item (ii), and

estimated amount of disbursements necessary for Community Support Projects

and Health Care and Welfare Projects, the distribution of income of the

Primary Insured Person group and said prospective amount, and the amount of

national treasury impositions, etc.

(4) A Municipality, notwithstanding the provisions of paragraph (1), shall not

collect an insurance premium from a Secondary Insured Person.

(Base Date for Assessment)

Article 130 The base date for assessment of an insurance premium shall be the

first date of said fiscal year.

(Insurance Premium Collection Method)

Article 131 With regard to the collection of an insurance premium as set forth in

Article 129, except for a case when the insurance premium is collected by a

method of special collection (which means having a person (hereinafter

referred to as "Pension Insurer") that pays an Old Age Basic Pension pursuant

to the provisions of the National Pension Act (Act No. 141 of 1959), other

benefits for a pension with the reason of payment, such as old age, retirement,

disability, or death that are provided by a Cabinet Order and based on the

same Act, Employees Pension Insurance Act (Act No. 115 of 1954), National

Public Service Mutual Aid Association Act, Local Public Service Mutual Aid

Association Act, and Private School Personnel Mutual Aid Association Act, and

other benefits as a pension with the reason of payment, such as old age,

retirement, disability, or death that are similar to those benefits as a pension

and are provided by a Cabinet Order (hereinafter referred to as "Old Age, etc.,

Pension Benefit"), collect insurance premiums and pay to the government said

insurance premiums to be collected; the same shall apply herein) pursuant to

the provisions of Article 135, the insurance premium shall be by a method of

ordinary collection (which means that a Municipality collects an insurance

premium by providing notification of the payment pursuant to the provisions of

199

Article 231 of the Local Autonomy Act to a Primary Insured Person that is

subject to an insurance premium, the householder of said family where said

Primary Insured Person resides, or the spouse of said Primary Insured Person

(including a person that has not submitted a notification of marriage, but is

under virtually the same circumstances in a marital relationship); the same

shall apply herein).

(Payment Obligation of an Insurance Premium Pertaining to General

Collection)

Article 132 (1) The Primary Insured Person, when a Municipality intends to

collect an insurance premium of said person by the method of general collection,

shall pay said insurance premium.

(2) A household, when a Municipality intends to collect an insurance premium of

a Primary Insured Person who resides with said family by the method of

general collection, shall be subject to the obligation of payment of said

insurance premium jointly and severally.

(3) A spouse, when a Municipality intends to collect an insurance premium of the

other spouse who is a Primary Insured Person by the method of general

collection, shall be subject to the obligation of payment of said insurance

premium jointly and severally.

(Due Date of an Insurance Premium Pertaining to General Collection)

Article 133 The due date of an insurance premium collected by the method of

general collection shall be specified by an ordinance of said Municipality.

(Notification of a Pension Insurer to a Municipality)

Article 134 (1) A Pension Insurer, by the due date as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare every year, shall

provide notice of the name, domicile and other matters, as determined by an

Ordinance of the Ministry of Health, Labour, and Welfare, of a person that has

received an Old Age, etc., Pension Benefit from said Pension Insurer as of April

1 of said year and is the age of 65 years or older (except for those persons listed

in the following) to the Municipality where said person is domiciled as of the

same date (in a case when said person is a Primary Insured Person of Long-

Term Care Insurance provided by another Municipality pursuant to the

provisions of Article 13, paragraph (1) or paragraph (2), notification of said fact

shall be provided to said other Municipality; the same shall apply from the

following item to item (vi) (except for item (iii)):

(i) a person for whom the total amount of said Old Age, etc., Pension Benefit to

be received during the period from June 1 of said year to May 31 of the

following year is less than the amount as of April 1 of said year as

200

determined by a Cabinet Order;

(ii) a person who has pledged the right to receive said Old Age, etc., Pension

Benefit as collateral pursuant to the provisions specified separately by the

Act or other special circumstances as determined by an Ordinance of the

Ministry of Health, Labour, and Welfare.

(2) A Pension Insurer shall provide notice of the name, domicile and other

circumstances as determined by an Ordinance of the Ministry of Health,

Labour, and Welfare of a person that is defined by any of the following items

from April 2 to June 1 of said year (including a person who is defined by item

(i) during the period from March 1 to April 1 of said year that has not yet

received the payment of an Old Age, etc., Pension Benefit from said Pension

Insurer as of April 1 of said year, and excluding a person whose prospective

amount of pension benefit that is calculated pursuant to the provisions of an

Ordinance of the Ministry of Health, Labour, and Welfare based on the total

amount of said Old Age, etc., Pension Benefit to be received during the period

from August 1 of said year to May 31 of the following year is less than the

amount determined by a Cabinet Order as of June 1 of said year, and a person

that corresponds to item (ii) of the preceding paragraph) by the due date as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare

every year to the Municipality where said person is domiciled as of June 1 of

said year:

(i) a person that has acquired the right to receive payment of said Old Age, etc.,

Pension Benefit from said Pension Insurer based on a ruling of the right to

receive an Old Age, etc., Pension Benefit and is the age of 65 years or older;

(ii) a person that has become the age of 65 years among those who receive

payment of an Old Age, etc., Pension Benefit from said Pension Insurer

(limited to a person who has the right to receive said Old Age, etc., Pension

Benefit continuously after the age of 65 years);

(iii) a person that submitted a notification of change of domicile to outside the

area of a Municipality to said Pension Insurer and is the age of 65 years or

older among those who receive an Old Age, etc., Pension Benefit from said

Pension Insurer.

(3) A Pension Insurer, by the date specified by an Ordinance of the Ministry of

Health, Labour, and Welfare shall provide notice every year of the name,

domicile, and other matters as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare of a person (except for a person whose prospective

amount of pension benefit is calculated pursuant to the provisions of an

Ordinance of the Ministry of Health, Labour, and Welfare based on total

amount of said Old Age, etc., Pension Benefit to be received during the period

October 1 of said year to May 31 of the following year that is less than the

amount specified by a Cabinet Order as of August 1 of said year and a person

201

that corresponds to paragraph (1), item (ii)) who corresponds to any items in

the preceding paragraph during the period from June 2 to August 1 of said year

to the Municipality where said person is domiciled as of August 1 of said year;

(4) A Pension Insurer, by the date specified by an Ordinance of the Ministry of

Health, Labour, and Welfare shall provide notice every year of the name,

domicile, and other matters as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare of a person (except for a person whose prospective

amount of pension benefit that is calculated pursuant to the provisions of an

Ordinance of the Ministry of Health, Labour, and Welfare based on the total

amount of said Old Age, etc., Pension Benefit to be received during the period

from December 1 of said year to May 31 of the following year is less than the

amount provided by a Cabinet Order as of October 1 of said year, and a person

that corresponds to paragraph (1), item (ii)) who corresponds to any provision

of the items of paragraph (2) during the period from August 2 to October 1 of

said year to the Municipality where said person is domiciled as of October 1 of

said year.

(5) A Pension Insurer, by the date specified by an Ordinance of the Ministry of

Health, Labour, and Welfare shall provide notice every year of the name,

domicile, and other matters as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare of a person (except for a person whose prospective

amount of pension benefit that is calculated pursuant to the provisions of an

Ordinance of the Ministry of Health, Labour, and Welfare based on the total

amount of said Old Age, etc., Pension Benefit to be received during the period

from February 1 to May 31 of said year is less than the amount provided by a

Cabinet Order as of December 1 of the previous year of said year, and a person

that corresponds to paragraph (1), item (ii)) who corresponds to any provision

of the items of paragraph (2) during the period from October 2 to December 1 of

the previous year of said year to the Municipality where said person is

domiciled as of December 1 of the previous year of said year.

(6) A Pension Insurer, by the date specified by an Ordinance of the Ministry of

Health, Labour, and Welfare shall provide notice of every year of the name,

domicile, and other matters as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare of a person (except for a person whose prospective

amount of pension benefit that is calculated pursuant to the provisions of an

Ordinance of the Ministry of Health, Labour, and Welfare based on the total

amount of said Old Age, etc., Pension Benefit to be received during the period

from April 1 to May 31 of said year is less than the amount determined by a

Cabinet Order as of February 1 of said year, and a person that corresponds to

paragraph (1), item (ii)) who corresponds to any items of paragraph (2) during

the period from December 2 of the previous year of said year to February 1 of

said year to the Municipality where said person is domiciled as of February 1

202

of said year.

(7) A Pension Insurer (except for the secretary of a Social Insurance Agency or a

Local Public Service Mutual Aid Association (including the National

Federation of Mutual Aid Associations for Municipal Personnel; the same shall

apply in the following paragraphs, Article 136, paragraph (3) and paragraph

(6), and Article 137, paragraph (2))), in a case when a notification is issued

pursuant to the provisions of the preceding paragraph, may obtain the consent

of the secretary of said Social Insurance Agency and issue all of said

notifications that are issued by said Pension Insurer, via the secretary of said

Social Insurance Agency.

(8) A Local Public Service Mutual Aid Association, in a case when a notification

is issued pursuant to the provisions of paragraph (1) to paragraph (6), shall

issue said notification via the Pension Fund Association for Local Government

Officials.

(9) The secretary of said Social Insurance Agency, when providing consent as set

forth in paragraph (7), shall issue a public notice of the Pension Insurer

pertaining to said consent (hereinafter referred to as "Specified Pension

Insurer" in Article 136).

(Special Collection of Insurance Premiums)

Article 135 (1) A Municipality, in a case when notification is issued pursuant to

the provisions of paragraph (1) of the preceding Article, shall collect all of an

insurance premium (in a case as determined by an Ordinance of the Ministry of

Health, Labour, and Welfare, a portion of said insurance premium) of said

fiscal year that is imposed upon a Primary Insured Person pertaining to said

notification (except a person for whom it is determined significantly difficult to

pay the insurance premium by the method of special collection due to disaster

or other special circumstances; the same shall apply in the following paragraph

and paragraph (3)) by the method of special collection, however, provided that

an insurance premium may not be collected by the method of special collection

in a Municipality that is determined inappropriate to implement special

collection due to a limited number of Primary Insured Persons pertaining to

said notification or other special circumstances.

(2) A Municipality (except for a Municipality as prescribed in the proviso of the

preceding paragraph; the same shall apply in the following paragraph), in a

case when notification is issued pursuant to the provisions of paragraph (2) or

paragraph (3) of the preceding Article, may collect a portion of an insurance

premium of said fiscal year that is imposed upon a Primary Insured Person

pertaining to said notification by the method of special collection.

(3) In a case when notification is issued pursuant to the provisions of paragraph

(2) or paragraph (3) of the preceding Article (except for a case when a portion of

203

an insurance premium of said fiscal year which is imposed upon a Primary

Insured Person pertaining to said notification is collected by the method of

special collection pursuant to the provisions of the preceding paragraph) or

when a notification is issued pursuant to the provisions of paragraph (4) to

paragraph (6) of the same Article, a Municipality, when an Old Age, etc.,

Pension Benefit pertaining to said notification is paid to the Primary Insured

Person pertaining to said notification during the period from the first day until

September 30 of the following fiscal year, shall collect the prospective amount

of an insurance premium that is divided by the number of payments (in a case

when there are special reasons to determine said amount is inappropriate, it

shall be the amount specified by a Municipality by taking into consideration

the status of income and other circumstances) for the amount of said insurance

premium pertaining to said payments by the method of special collection,

pursuant to the provisions of an Ordinance of the Ministry of Health, Labour,

and Welfare.

(4) The prospective amount of an insurance premium amount which is divided by

the number of payments as set forth in the preceding paragraph, with respect

to said Primary Insured Person, is the amount that shall be the amount

obtained by dividing the amount which is calculated pursuant to the provisions

of an Ordinance of the Ministry of Health, Labour, and Welfare based on said

insurance premium amount of said fiscal year by the number of payments of

said Old Age, etc., Pension Benefit during the period from the first day to

September 30 of the year following of said fiscal year (with regard to a Primary

Insured Person pertaining to a notification pursuant to the provisions of

paragraph (5) of the preceding Article, the date shall be June 1 of the same

fiscal year, and with regard to a Primary Insured Person pertaining to the

notification pursuant to the provisions of paragraph (6) of the same Article, the

date shall be August 1 of the same fiscal year).

(5) A Municipality, in a case when it intends to collect an insurance premium by

the method of special collection pursuant to the provisions of the main clause of

paragraph (1), paragraph (2), or paragraph (3), with regard to a Primary

Insured Person as prescribed in the main clause of paragraph (1), paragraph

(2), or paragraph (3) (hereinafter referred to as "Insured Person Subject to

Special Collection"), shall direct said Pension Insurer pertaining to said

Insured Person Subject to Special Collection (hereinafter referred to as a

"Person Under Obligation of Special Collection") to collect said insurance

premium.

(6) A Municipality, in a case when there are two or more Old Age, etc., Pension

Benefit plans pertaining to a notification pursuant to the provisions of

paragraph (1) to paragraph (6) of the preceding Article (hereinafter referred to

as "Pension Payment Subject to Special Collection") for the same Insured

204

Person Subject to Special Collection, shall direct an agent to collect the

insurance premium for each Pension Payment Subject to Special Collection,

pursuant to a Cabinet Order.

(Notification, etc., of Amount of Special Collection)

Article 136 (1) In a case when notification is issued pursuant to the provisions of

Article 134, paragraph (1), a Municipality, when it intends to collect an

insurance premium by the method of special collection pursuant to the

provisions of paragraph (1), paragraph (5), and paragraph (6) of the preceding

Article (limited to the part pertaining to paragraph (1) of the same Article),

shall notify the fact of collection of an insurance premium pertaining to an

Insured Person Subject to Special Collection, the insurance premium amount

divided by the number of payments pertaining to said Insured Person Subject

to Special Collection, and other matters as determined by an Ordinance of the

Ministry of Health, Labour, and Welfare to said Person Under Obligation of

Special Collection or to said Insured Person Subject to Special Collection.

(2) The amount of an insurance premium divided by the number of payments as

set forth in the preceding paragraph, pursuant to the provisions of an

Ordinance of the Ministry of Health, Labour, and Welfare, shall be the amount

obtained by dividing the amount that is obtained by deducting from the total

insurance premium amount to be collected during the period from April 1 to

September 30 of said year pursuant to the provisions of paragraph (3) of the

preceding Article, and Article 140, paragraph (1) and paragraph (2) the

insurance premium amount to be collected by the method of special collection

from said Insured Person Subject to Special Collection (hereinafter referred to

as "Insurance Premium Amount Subject to Special Collection"), by the number

of payments of said Insurance Premium Amount Subject to Special Collection

during the period from October 1 of said year to March 31 of the year following

said year.

(3) A notification issued to a Person Under Obligation of Special Collection

pursuant to the provisions of paragraph (1) (except for a notification pertaining

to the secretary of a Social Insurance Agency, a Specified Pension Insurer, or a

Local Public Service Mutual Aid Association) shall be issued by August 31 of

the year that includes the first day of said fiscal year.

(4) A notification issued to a Person Under Obligation of Special Collection

pursuant to the provisions of paragraph (1) (limited to a notification pertaining

to the secretary of a Social Insurance Agency) shall be issued by July 31 of the

year that includes the first day of said fiscal year.

(5) A notification to a Person Under Obligation of Special Collection pursuant to

the provisions of paragraph (1) (limited to notifications pertaining to a

Specified Pension Insurer) shall be issued by the secretary of a Social

205

Insurance Agency by July 31 of the year that includes the first day of said

fiscal year.

(6) A notification to a Person Under Obligation of Special Collection pursuant to

the provisions of paragraph (1) (limited to those pertaining to a Local Public

Service Mutual Aid Association) shall be issued by the Pension Fund

Association for Local Government Officials by July 31 of the year that includes

the first day of said fiscal year.

(Obligation, etc., of Payment of an Insurance Premium Amount Collected by

the Method of Special Collection)

Article 137 (1) A Person Under Obligation of Special Collection, in a case when

the Person receives a notification pursuant to the provisions of paragraph (1) of

the preceding Article, shall be under an obligation pursuant to the provisions

of an Ordinance of the Ministry of Health, Labour, and Welfare, to pay the

insurance premium amount divided by the number of payments as prescribed

in the same paragraph when the Person pays an Insurance Premium Amount

Subject to Special Collection during the period from October 1 of said year to

March 31 of the year following said year, and to pay said amount to said

Municipality by the 10th day of the month following the month that includes

said day of collection.

(2) A Local Public Service Mutual Aid Association, in a case of paying an

insurance premium to a Municipality pursuant to the provisions of the

preceding paragraph, shall pay the insurance premium via the Pension Fund

Association for Local Government Officials.

(3) A Person Under Obligation of Special Collection, in a case when paying to a

Municipality pursuant to the provisions of paragraph (1) the amount

equivalent to the insurance premium amount that has not been collected from

an Insured Person Subject to Special Collection, upon the payment of a Pension

Payment Subject to Special Collection, may deduct the equivalent amount to

said insurance premium amount that has not been collected from said Pension

Payment Subject to Special Collection to be paid to said Insured Person Subject

to Special Collection after a Person Under Obligation of Special Collection has

completed said payment.

(4) A Person Under Obligation of Special Collection, in a case when said Insured

Person Subject to Special Collection pertaining to an insurance premium that

said Person Under Obligation of Special Collection should collect pursuant to

the provisions of Article 135 has reasonable cause not to collect said Pension

Payment Subject to Special Collection from said Person Under Obligation of

Special Collection and in other cases as determined by an Ordinance of the

Ministry of Health, Labour, and Welfare, will have no obligation to collect and

pay the insurance premium amount that should be paid, after the month

206

following the month that includes the day that said reasonable cause is first

valid.

(5) In a case as prescribed in the preceding paragraph, a Person Under

Obligation of Special Collection, pursuant to the provisions of an Ordinance of

the Ministry of Health, Labour, and Welfare, shall provide notification of the

name of said Insured Person Subject to Special Collection that has become

unable to receive said Pension Payment Subject to Special Collection or other

person as prescribed in an Ordinance of the Ministry of Health, Labour, and

Welfare, and of the result of an insurance premium collection pertaining to

said Person Under Obligation of Special Collection and other necessary matters

to the Municipality that said insurance premium amount pertaining to special

collection is due to be paid.

(6) The provisions of Article 134, paragraph (7) to paragraph (9) shall apply

mutatis mutandis to a notification pursuant to the provisions of the preceding

paragraph.

(7) A Person Under Obligation of Special Collection, pursuant to the provisions of

an Ordinance of the Ministry of Health, Labour, and Welfare, shall provide

notice of the insurance premium amount divided by the number of payments

that shall be collected pursuant to the provisions of paragraph (1) to an

Insured Person Subject to Special Collection.

(Notification to Persons under Duty of Special Collection by a Municipality in

the Case of Loss of Status of Insured Person, etc.)

Article 138 (1) A Municipality, in a case when an Insured Person Subject to

Special Collection pertaining to said notification has lost status as an Insured

Person after notification of an insurance premium amount divided by the

number of payments to a Person Under Obligation of Special Collection

pursuant to the provisions of Article 136, paragraph (1) or other cases as

determined by an Ordinance of the Ministry of Health, Labour, and Welfare,

shall provide notification of said fact, pursuant to the provisions of an

Ordinance of the Ministry of Health, Labour, and Welfare, to said Person

Under Obligation of Special Collection and said Insured Person Subject to

Special Collection.

(2) The provisions of Article 136, paragraph (4) to paragraph (6) shall apply

mutatis mutandis to a notification to a Person Under Obligation of Special

Collection pursuant to the provisions of the preceding paragraph. In this case,

necessary technical replacement of the terms of these provisions shall be

provided by a Cabinet Order.

(3) A Person Under Obligation of Special Collection, in a case when said Person

received a notification pursuant to the provisions of paragraph (1), shall have

no obligation to collect and pay an Insurance Premium Amount Subject to

207

Special Collection after the date of said notification. In this case, a Person

Under Obligation of Special Collection shall provide notice of the result of an

insurance premium collection pertaining to an Insured Person Subject to

Special Collection pertaining to said notification and other necessary matters,

immediately to the Municipality which issued said notification.

(4) The provisions of Article 134, paragraph (7) to paragraph (9) shall apply

mutatis mutandis to a notification pursuant to the provisions of the preceding

paragraph.

(Transfer to Insurance Premium of an Amount Subject to Collection)

Article 139 (1) A Municipality, in a case when an insurance premium has not

been collected by the method of special collection as the result of a Primary

Insured Person that is not receiving a Pension Payment Subject to Special

Collection, etc., shall collect the insurance premium amount equivalent to the

amount that has become uncollected by the method of special collection, by a

general collection on each due date, when there are due dates as set forth in

Article 133 that will occur after the date that the insurance premium has

become uncollected by the method of special collection, or collect said amount

immediately when there is no other due date after the said date.

(2) In a case when the total amount of an insurance premium of a Primary

Insured Person that was paid by a Person Under Obligation of Special

Collection to said Municipality exceeds the amount of said insurance premium

of said Primary Insured Person that should be collected by the method of

special collection, (including a case there is no amount of said insurance

premium to be collected by the method of special collection), a Municipality

shall refund the amount of said insurance premium pertaining to said payment

in excess or collected in error (when said amount of said insurance premium

pertaining to a payment in excess or in error is caused by the death of said

Primary Insured Person, the amount shall be obtained by deducting the

amount calculated pursuant to the provisions of an Ordinance of the Ministry

of Health, Labour, and Welfare from the amount of said insurance premium

pertaining to said payment in excess or in error; hereinafter referred to as

"Amount Paid in Excess or in Error" in the following paragraph) to said

Primary Insured Person.

(3) A Municipality, in a case when an Amount Paid in Excess or in Error should

be refunded pursuant to the provisions of the preceding paragraph, when there

is an unpaid amount of insurance premium pertaining to said Primary Insured

Person or other levy pursuant to the provisions of this Act, notwithstanding

the provisions of the same paragraph, pursuant to the provisions of an

Ordinance of the Ministry of Health, Labour, and Welfare, may allocate said

Amount Paid in Excess or in Error to said insurance premium.

208

(Provisional Collection)

Article 140 (1) A Municipality, with regard to a Primary Insured Person that for

whom was collected the amount of an insurance premium divided by the

number of payments as prescribed in Article 136, paragraph (1) upon the

payment of a Pension Payment Subject to Special Collection during the period

from October 1 of the year that includes the first day of the year previous to

said fiscal year until March 31 of the year following said fiscal year, when an

Old Age, etc., Pension Benefit pertaining to said collection of said insurance

premium amount divided by the number of payments will be paid during the

period from the first day of said fiscal year until May 31 of the year that

includes the said first day, shall collect the amount equivalent to said amount

of said insurance premium divided by the number of payments, as the amount

of insurance premium pertaining to said payment, by the method of special

collection pursuant to the provisions of an Ordinance of the Ministry of Health,

Labour, and Welfare.

(2) A Municipality, with regard to a Primary Insured Person as prescribed in the

preceding paragraph, when an Old Age, etc., Pension Benefit as prescribed in

the same paragraph is paid during the period from June 1 to September 30 of

the year including the said first day of said fiscal year, shall collect as the

insurance premium amount pertaining to each payment, the amount

equivalent to the amount of said insurance premium pertaining to said

Primary Insured Person divided by the number of payments as prescribed in

the same paragraph (in a case of special circumstances in which it is

determined inappropriate to pay said amount, the amount shall be the amount

specified by said Municipality by taking into consideration the income status

and other circumstances) pursuant to the provisions of an Ordinance of the

Ministry of Health, Labour, and Welfare, by the method of special collection.

(3) The provisions of Article 136 to the preceding Article (except for Article 136,

paragraph (2)) shall apply mutatis mutandis to a special collection pursuant to

the provisions of the preceding two paragraphs. In this case, the necessary

technical replacement of the terms of these provisions shall be provided by a

Cabinet Order.

(4) With regard to a special collection pursuant to the provisions of paragraph (1),

it shall be deemed that there was a notification pursuant to the provisions of

Article 136, as applied mutatis mutandis to the preceding paragraph, and with

regard to a special collection pursuant to the provisions of paragraph (2), in a

case when the notification pursuant to the provisions of the same Article as

applied mutatis mutandis to the preceding paragraph is not issued by the due

date, it shall be deemed that there was a notification, pursuant to the

provisions of the same Article that prescribe that the amount equivalent to the

209

amount of said insurance premium divided by the number of payments as

prescribed in paragraph (2) shall be collected by the method of special

collection as the insurance premium amount pertaining to each payment of an

Old Age, etc., Pension Benefit as prescribed in paragraph (1).

(Notification to a Person under Obligation of Special Collection pertaining to

an Exception of Insured Person that is Staying at or in Residence of a

Facility Subject to Domicile Exception)

Article 141 (1) A Municipality, when an Insured Person Subject to Special

Collection of Long-Term Care Insurance provided by said Municipality

corresponds to an Insured Person to which are applicable Article 13, paragraph

(1) or paragraph (2), shall provide notice of said fact immediately to said

Person Under Obligation of Special Collection pertaining to said Insured

Person Subject to Special Collection.

(2) The provisions of Article 136, paragraph (4) to paragraph (6) shall apply

mutatis mutandis to a notification to a Person Under Obligation of Special

Collection pursuant to the provisions of the preceding paragraph. In this case,

the necessary technical replacement of the terms of these provisions shall be

provided by a Cabinet Order.

(Delegation to a Cabinet Order)

Article 141-2 In a case of issuance of the notification pursuant to the provisions

of Article 134, paragraph (2) to paragraph (6), when a Municipality intends to

collect an insurance premium by the method of special collection pursuant to

the provisions of Article 135, paragraph (2) to paragraph (6), notification of the

amount to be collected by said special collection, the obligation of payment of

an insurance premium amount which is collected by the method of said special

collection, and other procedures shall be determined by a Cabinet Order.

(Reduction and Exception, etc., of an Insurance Premium)

Article 142 A Municipality, pursuant to the provisions of an Ordinance of the

Ministry of Health, Labour, and Welfare, may reduce an insurance premium or

suspend said collection for a person in special circumstances.

(Mutatis Mutandis Application of the Local Tax Act)

Article 143 With regard to an insurance premium and other levies pursuant to

the provisions of this Act (except for a payment as prescribed in Article 150,

paragraph (1) and a delinquent charge as prescribed in Article 157, paragraph

(1)), provisions of Article 9, Article 13-2, Article 20, Article 20-2, and Article

20-4 of the Local Tax Act shall apply.

210

(Disposition of Delinquency)

Article 144 An Insurance Premium and other levies as prescribed in this Act

that a Municipality shall collect shall be revenue as prescribed in Article 231-3,

paragraph (3) of the Local Autonomy Act.

(Entrustment of Receipt of an Insurance Premium)

Article 144-2 A Municipality, with regard to the affairs of receipt of an insurance

premium that is collected by the method of general collection, may entrust said

collection to a private person, pursuant to the provisions of a Cabinet Order,

limited to a case when it is determined to contribute to secure the income and

to promote the convenience of said Primary Insured Person.

(Register of Insurance Premium Payments)

Article 145 A Municipality shall maintain a register of insurance premium

payments and record the name, domicile, payment status of said insurance

premium of a Primary Insured Person, and other matters as prescribed by an

Ordinance of the Ministry of Health, Labour, and Welfare pertaining to said

register.

(Delegation to Ordinance, etc.)

Article 146 In addition to the provisions as prescribed in this Section, matters

concerning imposition and collection, etc., of an insurance premium (except for

those matters concerning special collection) shall be specified by an ordinance

in accordance with standards determined by a Cabinet Order, and the

necessary matters concerning special collection shall be specified by a Cabinet

Order or ordinance in accordance with standards determined by a Cabinet

Order.

Section 2 Fiscal Stability Funds

(Fiscal Stability Funds)

Article 147 (1) A Municipality shall establish a Fiscal Stability Fund in order to

allocate necessary funding to a project contributing to the stabilization of the

finances of Long-Term Care Insurance as listed in the following:

(i) the amount of deficiency when the amount of insurance premiums actually

received are an amount that is less than the expected insurance premiums,

and for the deficit remaining when revenue subject to a fund project is an

amount that is less than the disbursements subject to said fund project,

pursuant to the provisions of a Cabinet Order, to allocate to a Municipality

the amount which is calculated pursuant to the provisions of a Cabinet Order

by taking into consideration the receipt status of insurance premiums of said

211

Municipality and other Municipalities based on the amount equivalent to 50

percent of the amount listed in sub-item (a) (when the amount listed in sub-

item (a) exceeds the amount listed in sub-item (b), the amount shall be the

amount listed in sub-item (b)):

(a) the amount of insurance premiums actually received that is forecast to be

less than the amount of expected insurance premiums;

(b) the amount of revenue subject to a fund project that is forecast to be

deficient with regard to the disbursements subject to said fund project;

(ii) to lend to a Municipality with regard to the total amount of revenue subject

to a fund project and grants to a fund project that is forecast to be deficient

with regard to the disbursements subject to said fund project, pursuant to

the provisions of a Cabinet Order, an amount within the amount which is

calculated pursuant to the provisions of a Cabinet Order, by taking into

consideration the receipt status of insurance premiums of said Municipality

and other Municipalities based on said amounts of deficiency.

(2) Terms used in the preceding paragraph that are listed in the following items

shall be defined pursuant to the provisions of each said item:

(i) expected insurance premiums: the amount which is calculated, pursuant to

the provisions of a Cabinet Order, to be allocated for the amount of funding

necessary to provide for Long-Term Care Benefits and Prevention Benefits,

the amount of funding necessary for Community Support Projects, the

amount of funding necessary for payment of Fiscal Stability Fund

contributions, and the amount of funding necessary for repayment of

borrowings from a prefecture pursuant to the provisions of paragraph (2) of

the preceding paragraph (hereinafter referred to as "Borrowings for Fund

Project" in this paragraph and in the following Article), from among the total

amount of insurance premiums which are expected to be received by a

Municipality as determined during the term of a Municipal Insured Long-

Term Care Service Plan (hereinafter referred to as "Plan Term") specified by

said Municipality;

(ii) insurance premiums actually received: the amount which is calculated

pursuant to the provisions of a Cabinet Order to be allocated for the amount

of funding necessary to provide for Long-Term Care Benefits and Prevention

Benefits, the amount of funding necessary for Community Support Projects,

the amount of funding necessary for payment of Fiscal Stability Fund

contributions, and the amount of funding necessary for repayment of

Borrowings for Fund Project from among the total amount of insurance

premiums actually received during said Plan Term of the Municipality;

(iii) revenue subject to a fund project: the amount which is calculated pursuant

to the provisions of a Cabinet Order to be allocated for the amount of funding

necessary to provide for Long-Term Care Benefits and Prevention Benefits,

212

the amount of funding necessary for Community Support Projects, the

amount of funding necessary for payment of Fiscal Stability Fund

contributions, and the amount of funding necessary for repayment of

Borrowings for Fund Project from among the total amount which is received

(excluding the amount of grants to a fund project and the amount of

Borrowings for Fund Project as set forth in item (v)) during said Plan Term

of a special account concerning Long-Term Care Insurance of the

Municipality,;

(iv) disbursements subject to fund project: the amount which is calculated

pursuant to the provisions of a Cabinet Order as the total of the amount of

disbursements necessary to provide Long-Term Care Benefits and Prevention

Benefits, the amount of disbursements necessary for Community Support

Projects, the amount of disbursements necessary for payment of Fiscal

Stability Funds contributions, and the amount of disbursements necessary

for repayment of Borrowings for Fund Project, of said Municipality during

said Plan Term;

(v) grants to a fund project: the amount that said Municipality receives during

said Plan Term pursuant to the provisions of item (i) of the preceding

paragraph.

(3) A prefecture shall collect a Fiscal Stability Fund contribution from a

Municipality in order to allocate said contribution to said Fiscal Stability Fund,

pursuant to the provisions of a Cabinet Order.

(4) A Municipality shall be subject to the obligation to pay a Fiscal Stability

Fund contribution pursuant to the provisions of the preceding paragraph.

(5) A prefecture shall transfer the amount equivalent to three times the total

amount of Fiscal Stability Fund contribution collected from a Municipality

pursuant to the provisions of paragraph (3) to a Fiscal Stability Fund,

pursuant to the provisions of a Cabinet Order.

(6) The national government, pursuant to the provisions of a Cabinet Order, shall

defray an amount equivalent to one-third (1/3) of the amount which a

prefecture transfers pursuant to the provisions of the preceding paragraph.

(7) All revenue received by a Fiscal Stability Fund shall be allocated to said

Fiscal Stability Fund disbursements.

(8) The provisions of Article 121, paragraph (2) shall apply mutatis mutandis to

the amount of disbursements necessary to provide for Long-Term Care Benefits

and Prevention Benefits as prescribed in paragraph (2), item (i) and the

amount of disbursements required to provide for Long-Term Care Benefits and

Prevention Benefits as prescribed in item (ii) to item (iv) of the same

paragraph.

(Municipal Mutual Fiscal Stabilization Project)

213

Article 148 (1) A Municipality, in order to promote fiscal stabilization of Long-

Term Care Insurance, with regard to financial resources for the disbursements

necessary to provide for Long-Term Care Benefits and Prevention Benefits

(with regard to the disbursements necessary for said Long-Term Care Benefits

and Prevention Benefits pertaining to a Municipality that provides an

ordinance based on Article 43, paragraph (3), Article 44, paragraph (6), Article

45, paragraph (6), Article 55, paragraph (3), Article 56, paragraph (6), Article

57, paragraph (6), shall be the disbursements necessary for said Long-Term

Care Benefits and Prevention Benefits calculated pursuant to the provisions of

a Cabinet Order, as a Municipality may not undertake measures promulgated

by said ordinance; the same shall apply in the following paragraph), the

disbursements necessary for Community Support Projects, the disbursements

necessary for payment of Fiscal Stability Funds contribution, and the expense

necessary for repayment of Borrowings for Fund Project among those

disbursements to be imposed by a special account concerning said Long-Term

Care Insurance, pursuant to the provisions of a Cabinet Order, in cooperation

with other Municipalities based on an adjustment rate of insurance premiums,

may conduct a project to provide adjustments mutually among Municipalities

(hereinafter referred to as "Municipal Mutual Fiscal Stabilization Project" in

this Article and the following Article).

(2) The adjustment rate of insurance premiums as set forth in the preceding

paragraph, if each Municipality that participates in said Municipal Mutual

Fiscal Stabilization Project (hereinafter referred to as "Specified Municipality"

in this Article and paragraph (2) of the following Article) imposes upon each

Primary Insured Person an insurance premium according to the amount of

insurance premium that is calculated by using the rate of adjustment of

insurance premiums, shall be the total amount of insurance premiums received

during the project implementation period (which means a period that shall be

deemed to be three years that is provided by a Specified Municipality pursuant

to the provisions of the constitution referred to in the following paragraph as

one period to implement said Municipal Mutual Fiscal Stabilization Project;

the same shall apply hereinafter in this paragraph and paragraph (4)) for each

said Specified Municipality to be able to maintain a balance of the total

amount of the disbursements necessary to provide for Long-Term Care Benefits

and Prevention Benefits (except with regard to the disbursements necessary

for said Long-Term Care Benefits and Prevention Benefits, the amount

defrayed or granted to a general fund or Payment Fund by the national

government, a prefecture, or Municipality, pursuant to the provisions of Article

121, paragraph (1), Article 122, paragraph (1), Article 123, paragraph (1),

Article 124, paragraph (1) and Article 125, paragraph (1)), the disbursements

necessary for Community Support Projects (except with regard to the

214

disbursements necessary for said Community Support Projects, the amount

defrayed or granted to the general fund or Payment Fund by the national

government, a prefecture, or Municipality, pursuant to the provisions of Article

122-2, Article 123, paragraph (3) and paragraph (4), Article 124, paragraph (3)

and paragraph (4), and Article 126, paragraph (1)), the disbursements

necessary for payment of a Fiscal Stability Fund contribution, and the

disbursements necessary for repayment of Borrowings for Fund Project during

said project implementation period in said Municipality, and be determined by

said Specified Municipality in accordance with the standards provided by a

Cabinet Order.

(3) A Municipality, when it intends to implement a Municipal Mutual Fiscal

Stabilization Project, shall prescribe a constitution by deliberations held per a

resolution of said municipal council and provide notification of said fact to the

prefectural governor.

(4) The constitution as set forth in the preceding paragraph shall establish

provisions for the matters listed in the following:

(i) Specified Municipality;

(ii) adjustment rate of insurance premiums;

(iii) Project Implementation Period;

(iv) method of imposition and grant of financial resources pertaining to said

Municipal Mutual Fiscal Stabilization Project;

(v) in addition to the matters listed in each of the preceding items in this

paragraph, other necessary matters for implementation of said Municipal

Mutual Fiscal Stabilization Project.

(5) The provisions as set forth in paragraph (3) shall apply mutatis mutandis to a

change of said constitution as set forth in the same paragraph or when

rescinding said Municipal Mutual Fiscal Stabilization Project.

(6) In a case when a Specified Municipality, pursuant to the provisions of Article

129, paragraph (2), and provisions of paragraph (3) of the same Article, applies

a rate of insurance premium provided by said ordinance, the phrase

"approximate amount of the disbursements necessary for repayment" in the

same paragraph shall be deemed to be replaced with "approximate amount of

the disbursements necessary for repayment, the prospective amount of

disbursements imposed by said Municipal Mutual Fiscal Stabilization Project

as prescribed in Article 148, paragraph (1)," and the phrase "approximated

through three years in consideration of..., and the amount of national treasury

impositions, etc." shall be deemed to be replaced with "approximated during

the Project Implementation Period as prescribed in Article 148, paragraph (2)

in consideration of..., and the amount of national treasury impositions, etc.,

and prospective amount, etc., granted by said Municipal Mutual Fiscal

Stabilization Project as prescribed in the same paragraph."

215

(7) In a case when applying the provisions of paragraph (2) of the preceding

Article to a Specified Municipality, the phrase "and the amount of

disbursements necessary for repayment of borrowings from a prefecture

pursuant to the provisions of paragraph (2) of the preceding paragraph

(hereinafter referred to as "Borrowings for Fund Project")" in item (i) of the

same paragraph shall be deemed to be replaced with "the amount of

disbursements necessary for repayment of borrowings from a prefecture

pursuant to the provisions of paragraph (2) of the preceding paragraph

(hereinafter referred to as "Borrowings for Fund Project"), and the expense to

be imposed by a Municipal Insured Long-Term Care Service Plan (which means

a Municipal Insured Long-Term Care Service Plan as prescribed in paragraph

(1) of the following Article; hereinafter the same shall apply)," the phrase "and

the amount of disbursements required for repayment of Borrowings for Fund

Project" in item (ii) of the same paragraph shall be deemed to be replaced with

"the amount of disbursements required for repayment of Borrowings for Fund

Project, and the expense imposed by a Municipal Insured Long-Term Care

Service Plan," the phrase "revenue (except for the amount of grants for a fund

project and Borrowings for Fund Project as set forth in item (v))" in item (iii) of

the same Article shall be deemed to be replaced with "revenue (including the

amount granted by said Municipal Mutual Fiscal Stabilization Project, but

except for the amount of grants to a fund project and Borrowings for Fund

Project as set forth in item (v))," the phrase "and the amount of disbursements

necessary for repayment of Borrowings for Fund Project" shall be deemed to be

replaced with "..., the amount of disbursements required for repayment of

Borrowings for Fund Project and the amount imposed by said Municipal

Mutual Fiscal Stabilization Project," the phrase "and the amount of

disbursements necessary for repayment of Borrowings for Fund Project" in

item (iv) of the same paragraph shall be deemed to be replaced with "the

amount of disbursements required for repayment of Borrowings for Fund

Project and the amount imposed by said Municipal Mutual Fiscal Stabilization

Project."

(8) A Specified Municipality, pursuant to the provisions of an Ordinance of the

Ministry of Health, Labour, and Welfare, may entrust a portion of affairs

concerning imposition and grant of funds among a Municipal Mutual Fiscal

Stabilization Project to a not-for-profit juridical person in which said

Municipality is a contributing participant or a member and which is defined by

requirements as prescribed in an Ordinance of the Ministry of Health, Labour,

and Welfare;

Article 149 (1) A prefecture, according to the request of a Municipality which

intends to implement a Municipal Mutual Fiscal Stabilization Project, shall

216

conduct the necessary coordination among said Municipalities.

(2) A prefecture, according to the request of a Specified Municipality, may

provide necessary advice or information such as indicating standards for an

adjustment percentage of insurance premiums pertaining to said Municipal

Mutual Fiscal Stabilization Project.

Section 3 Levies for Medical Insurers

(Obligation of Collection of Payment and Obligation of Payment)

Article 150 (1) The Payment Fund, in order to allocate to the costs, expenses,

and disbursements necessary for operation as prescribed in Article 160,

paragraph (1), shall collect Long-Term Care Benefit Expense and supporting

payments of a Community Support Project (hereinafter referred to as "Levy")

from a medical care insurer for each fiscal year (which means from April 1 to

March 31 of the following year, in each year; hereinafter the same shall apply

in this Section and the following Chapter).

(2) A medical care insurer, in order to allocate to said Levy, pursuant to the

provisions of each Act related to medical insurance or the Local Tax Act, shall

be subject to an obligation to collect insurance premiums, installments

premium, or taxes for National Health Insurance and to pay said Levy.

(Amount of Levy)

Article 151 (1) The amount of Levy to be collected from each medical insurer

pursuant to the provisions of paragraph (1) of the preceding Article shall be the

amount of estimated Levy in said fiscal year, however, provided that when the

amount of estimated Levy of the year prior to the first preceding fiscal year

exceeds the fixed Levy of the year prior to the first preceding fiscal year, the

amount shall be the amount obtained by deducting the total amount of said

exceeding amount and the Adjustment amount pertaining to said exceeding

amount from the amount of estimated Levy of said year, and when the amount

of estimated Levy of the year prior to the first preceding fiscal year is deficient

with regard to the amount of fixed Levy of the year prior to the first preceding

fiscal year, the amount shall be the amount obtained by adding the amount of

estimated Levy of said year to the total amount of said amount of deficit and

the Adjustment amount pertaining to said amount of deficit.

(2) The Adjustment amount as set forth in the proviso of the preceding paragraph

shall be the amount calculated for each medical insurer by taking into

consideration the interest that is generated from the deficit or surplus amount

of the amounts of estimated Levy and fixed Levy pertaining to all medical

insurers in the year prior to the first preceding fiscal year and other

circumstances, pursuant to the provisions of an Ordinance of the Ministry of

217

Health, Labour, and Welfare.

(Estimated Levy)

Article 152 The amount of estimated Levy as set forth in paragraph (1) of the

preceding Article shall be the amount obtained by multiplying the prospective

number of Secondary Insured Persons pertaining to all said medical insurers in

said fiscal year that is calculated pursuant to the provisions of an Ordinance of

the Ministry of Health, Labour, and Welfare, by the amount obtained as a

result of dividing the total prospective amount of the Amount Subject to

Medical Insurance Premium Payment and Amount Subject to Medical

Insurance Premium Payment for Long-Term Care Prevention Project in all

Municipalities in said fiscal year by the total prospective number of Secondary

Insured Persons pertaining to all medical insurers in said fiscal year that is

calculated pursuant to the provisions of an Ordinance of the Ministry of Health,

Labour, and Welfare.

(Fixed Levy)

Article 153 The mount of fixed Levy as set forth in the proviso of Article 151,

paragraph (1), shall be the amount obtained by multiplying the number of

Secondary Insured Persons pertaining to said medical insurer in the year prior

to the first preceding fiscal year that is calculated pursuant to the provisions of

an Ordinance of the Ministry of Health, Labour, and Welfare, by the amount

obtained as a result of dividing the total amount of the Amount Subject to

Medical Insurance Premium Payment and Amount Subject to Medical

Insurance Premium Payment for Long-Term Care Prevention Project in all

Municipalities in the year prior to the first preceding fiscal year, by the total

number of Secondary Insured Persons pertaining to all medical insurers the

year prior to the first preceding fiscal year that is calculated pursuant to the

provisions of an Ordinance of the Ministry of Health, Labour, and Welfare.

(Exception of Amount of Levy in the Case of a Merger, Split, or Dissolution of a

Medical Insurer)

Article 154 Exceptions to the calculation of the amount of Levy pertaining to a

medical insurer that is incorporated by merger or split, a medical insurer

remaining after a merger or split, or a medical insurer that has succeeded to

the rights and obligations of a dissolved medical insurer, shall be determined

by a Cabinet Order.

(Determination, Notification, etc., of Amount of Levy)

Article 155 (1) The Payment Fund shall determine the amount of Levy to be paid

by each medical insurer for each fiscal year, and notify each said medical

218

insurer of the amount of Levy to be paid by said medical insurer, the method of

Levy, the due date of the Levy, and other necessary matters.

(2) When the amount of Levy is required to change after an amount is

determined for the Levy pursuant to the provisions of the preceding paragraph,

the Payment Fund shall change the amount of Levy to be paid by each said

medical insurer and notify each said medical insurer of the new amount of

Levy, as necessary.

(3) The Payment Fund, in a case when the amount of Levy paid by medical

insurers is deficit with regard to the amount of Levy after a change pursuant

to the provisions of the preceding paragraph, shall notify the method of Levy,

the due date of Levy, and other necessary matters for said amount of deficit

together with the notification pursuant to the provisions of the same paragraph.

In a case when said paid amount exceeds the revised amount of Levy after a

change pursuant to the provisions of the same paragraph, when there is unpaid

Levy and other levies of the Payment Fund pursuant to the provisions of this

Act, said excess amount shall be allocated to the unpaid Levy, and if there is

still an excess amount remaining, the amount shall be reimbursed, and in the

case that there are no unpaid levies, said excess amount shall be reimbursed.

(Demand for Levy and Disposition to Delinquency)

Article 156 (1) The Payment Fund, when a medical insurer does not pay the

Levy by the due date of said Levy, shall specify the due date and present a

demand for said Levy to said medical insurer.

(2) The Payment Fund, when presenting a demand pursuant to the provisions of

the preceding paragraph, shall deliver a demand note. In this case, the due

date to be specified by the demand note shall be a date more than ten days

after the date of issuance of said demand note.

(3) The Payment Fund, when a medical insurer that is presented a demand for

Levy pursuant to the provisions of paragraph (1) does not pay the full amount

of the Levy pertaining to said demand note or the delinquent charge pursuant

to the provisions of the following Article by said specified due date, shall

demand said collection from the Minister of Health, Labour, and Welfare or the

prefectural governor, pursuant to the provisions of a Cabinet Order.

(4) The Minister of Health, Labour, and Welfare or the prefectural governor,

when receiving a demand for collection pursuant to the provisions of the

preceding paragraph, may dispose of the demand as governed by the

disposition of a matter with regard to a failure to pay a national tax.

(Delinquent Charge)

Article 157 (1) When payment of the Levy is demanded pursuant to the

provisions of paragraph (1) of the preceding Article, the Payment Fund shall

219

collect a delinquent charge that is calculated by using the percentage of 14.5

percent per annum of the amount of Levy pertaining to said demand for the

number of days from the date following the due date of said Levy until the date

prior to the date of an attachment of property, however, provided that this

provision shall not apply when the amount of Levy pertaining to said demand

is less than 1,000 yen.

(2) In a case of the preceding paragraph, when a portion of the amount of Levy is

paid, the amount of Levy that is the principal amount for the calculation of the

delinquent charge pertaining to the period after the date of said payment shall

be the amount remaining after deducting the amount of said payment from the

amount of said Levy.

(3) In calculations of the delinquent charge, when the amount of Levy as set forth

in the preceding two paragraphs contains a fractional portion that is less than

1,000 yen, said fractional portion shall be rounded down to the nearest 1,000

yen increment.

(4) When the amount of delinquent charge calculated pursuant to the provisions

of the preceding three paragraphs contains a fractional portion that is less

than 100 yen, said fractional portion shall be rounded down to the nearest 100

yen increment.

(5) A delinquent charge shall not be collected when the case corresponds to any of

the following items, however, provided that in a case as set forth in item (iii),

said execution of judgment shall be suspended or limited to the portion of the

amount corresponding to the suspension period:

(i) when the Levy is paid in full by the due date specified in said demand note;

(ii) when the amount of delinquent charge is less than 100 yen;

(iii) when the disposition of the matter of said delinquency pertaining to Levy

is discontinued or suspended;

(iv) when it is determined that there are compelling reasons for not paying the

Levy.

(Grace Period of Levy)

Article 158 (1) The Payment Fund, when it is determined that payment is

significantly difficult for a medical insurer to pay the Levy due to compelling

reasons, pursuant to the provisions of an Ordinance of the Ministry of Health,

Labour, and Welfare, may suspend a portion of said Levy by specifying a period

within one year from the due date of said Levy based on the application of said

medical insurer, after obtaining the approval of the Minister of Health, Labour,

and Welfare,.

(2) The Payment Fund, when issuing a suspension pursuant to the provisions of

the preceding paragraph, shall provide notification of said fact, the amount of

Levy pertaining the suspension, the grace period, and other necessary matters

220

to said medical insurer.

(3) The Payment Fund, when issuing a suspension pursuant to the provisions of

paragraph (1), shall not present additional demands for payment of said Levy

pertaining to said suspension pursuant to the provisions of Article 156,

paragraph (1), and shall not present a demand for collection pursuant to the

provisions of paragraph (3) of the same Article.

(Notification)

Article 159 (1) A Municipality, pursuant to the provisions of an Ordinance of the

Ministry of Health, Labour, and Welfare, shall notify the Payment Fund of the

Amount Subject to Medical Insurance Premium Payment in each fiscal year

and other matters as determined by an Ordinance of the Ministry of Health,

Labour, and Welfare.

(2) A Municipality may entrust the affairs of said notification pursuant to the

provisions of the preceding paragraph to the Association.

Chapter IX Business Related to Insured Long-Term Care for Social

Insurance Medical Fee Payment Funds

(Operation of the Payment Fund)

Article 160 (1) The Payment Fund shall conduct operations listed in the

following items in order to accomplish the purposes as prescribed in Article 1

in addition to operations as prescribed in Article 15 of the Social Insurance

Medical Fee Payment Fund Act:

(i) to collect a Levy from a medical insurer;

(ii) to grant the Long-Term Care Benefit Expense as set forth in Article 125,

paragraph (1) to a Municipality;

(iii) to provide supporting grants for Community Support Projects as set forth

in Article 126, paragraph (1) to a Municipality;

(iv) to conduct operations incidental to the operations listed in the preceding

three items.

(2) Operations as prescribed in the preceding paragraph shall be referred to as

business related to insured long-term care.

(Entrustment of Operations)

Article 161 The Payment Fund, after obtaining the approval of the Minister of

Health, Labour, and Welfare, may entrust a portion of the business related to

insured long-term care to an organization to which a medical insurer belongs

and to those organizations specified by the Minister of Health, Labour, and

Welfare.

221

(Statement of Operating Procedures)

Article 162 (1) The Payment Fund, with respect to business related to insured

long-term care, shall prepare a statement of operating procedures and obtain

the approval of the Minister of Health, Labour, and Welfare prior to

commencement of said operations; the same shall apply when changing said

statement.

(2) Matters to be included in the statement of operating procedures as set forth

in the preceding paragraph shall be determined by an Ordinance of the

Ministry of Health, Labour, and Welfare.

(Reports, etc.)

Article 163 The Payment Fund may request a medical insurer to submit a report

every fiscal year of the number of medical insurance memberships (limited to

those persons of the age of 40 years or more and less than the age of 65 years)

and other matters as determined by an Ordinance of the Ministry of Health,

Labour, and Welfare, and when it is determined to be necessary for operations

listed in Article 160, paragraph (1), item (i), may request the submission of

documents and other items.

(Separate Accounting)

Article 164 The Payment Fund, with regard to the accounting procedures

pertaining to business related to insured long-term care, shall separate said

business from the accounting pertaining to other operations and conduct said

procedures by creating a special account and accounts.

(Approval of Budgets, etc.)

Article 165 The Payment Fund shall prepare a budget, business plan, and fund

plan for every fiscal year concerning business related to insured long-term care

and obtain the approval of the Minister of Health, Labour, and Welfare prior to

beginning of said fiscal year; the same shall apply when amending these items.

(Financial Statements, etc.)

Article 166 (1) The Payment Fund, with respect to business related to insured

long-term care, shall prepare an inventory of property, Statement of Financial

Position, and Statement of Operating Results (hereinafter referred to as

"Financial Statements" in this Article) for every fiscal year, and submit said

Financial Statements to the Minister of Health, Labour, and Welfare within

three months after the end of said fiscal year, and obtain the approval of said

Minister.

(2) The Payment Fund, when submitting Financial Statements to the Minister of

Health, Labour, and Welfare pursuant to the provisions of the preceding

222

paragraph, shall attach a business report of said fiscal year, financial results

that are prepared in accordance with categories of the budget, Financial

Statements, and a statement of opinion of an auditor concerning the financial

results, pursuant to the provisions of an Ordinance of the Minister of Health,

Labour, and Welfare.

(3) The Payment Fund, when it obtains the approval of the Minister of Health,

Labour, and Welfare pursuant to the provisions of paragraph (1), shall provide

public notice of the Financial Statements or a summary of the Financial

Statements published in an official gazette without delay, and maintain said

Financial Statements and supporting detailed statements, and the business

report, financial results, and statement of the auditor as set forth in the

preceding paragraph at each Business Office, and offer them for public perusal

for the period as determined by an Ordinance of the Ministry of Health, Labour,

and Welfare.

(Disposition of Surplus and Deficit)

Article 167 (1) The Payment Fund, with respect to business related to insured

long-term care, in the event that a surplus is recorded according the

calculation of surplus and deficit for every fiscal year, shall apply said surplus

to offset any remaining deficit carried forward from the previous fiscal year,

and, if there still remains a surplus, settle said surplus as a reserve fund.

(2) The Payment Fund, with respect to the business related to insured long-term

care, in the event that a deficit is incurred according to the calculation of

surplus and deficit for every fiscal year, shall settle said deficit by reducing the

reserve fund pursuant to the provisions of the preceding paragraph, and, if

there still remains a deficit, settle said deficit as an item to be carried forward

to the following fiscal year.

(3) The Payment Fund may allocate said reserve fund pursuant to the provisions

of paragraph (1) to the expenses necessary for operations listed in Article 160,

paragraph (1), item (ii) and item (iii), within the amount as prescribed by a

budget.

(Debt and Bonds)

Article 168 (1) The Payment Fund, with respect to business related to insured

long-term care, may borrow long-term debt, short-term debt, or issue bonds,

after obtaining the approval of the Minister of Health, Labour, and Welfare.

(2) Long-term debt and bonds pursuant to the provisions of the preceding

paragraph shall be repaid within two years.

(3) Short-term debt pursuant to the provisions of paragraph (1) shall be repaid

within said fiscal year, however, provided that when said short-term debt fails

to be repaid due to a lack of funds, only said lack of funds portion may be

223

refinanced, after obtaining the approval of the Minister of Health, Labour, and

Welfare.

(4) Short-term debt that is refinanced pursuant to the proviso of the preceding

paragraph shall be repaid within one year.

(5) The Payment Fund, in a case when issuing bonds pursuant to the provisions

of paragraph (1), may issue said bonds subject to a bond discount.

(6) A creditor holding bonds pursuant to the provisions of paragraph (1) shall

have the right to receive payment of the creditor's own claim in preference to

that of other creditors with regard to the property of the Payment Fund.

(7) The order of statutory lien as set forth in the preceding paragraph shall be in

the first subordinate position of priority to a general statutory lien pursuant to

the provisions of the Civil Code (Act No. 89 of 1896).

(8) The Payment Fund may entrust the whole or a portion of affairs concerning

issuance of bonds pursuant to the provisions of paragraph (1) to banks and

trust companies after obtaining the approval of the Minister of Health, Labour,

and Welfare.

(9) The provisions of Article 705, paragraph (1) and paragraph (2), and Article

709 of the Companies Act (Act No. 86 of 2005) shall apply mutatis mutandis to

banks and trust companies that are entrusted pursuant to the provisions of the

preceding paragraph.

(10) In addition to those items as prescribed in paragraph (1), paragraph (2), and

paragraph (5) through paragraph (9), other necessary matters concerning

bonds pursuant to the provisions of paragraph (1) shall be provided by a

Cabinet Order.

(Government Guarantee)

Article 169 The national government, notwithstanding the provisions of Article 3

of the Act Concerning Restrictions on Financial Assistance by the Government

to Corporations (Act No. 24 of 1946), when it determines necessary for efficient

payments by the Payment Fund of the grants for Long-Term Care Benefits

pursuant to the provisions of Article 125, paragraph (1) and supporting grants

for Community Support Projects pursuant to the provisions of Article 126,

paragraph (1), may provide guarantees within the scope of the period that is

determined to be necessary with regard to liabilities pertaining to long-term

debt, short-term debt, or bonds of the Payment Fund pursuant to the

provisions of the preceding paragraph.

(Investment of Surplus Funds)

Article 170 The Payment Fund shall not invest surplus funds in the course of

business pertaining to business related to insured long-term care, except by the

following methods:

224

(i) retention of national government bonds, local government bonds and other

securities specified by the Minister of Health, Labour, and Welfare;

(ii) as deposits in banks or other financial institutions specified by the Minister

of Health, Labour, and Welfare, or as postal deposits;

(iii) as a money trust in financial institutions (which means financial

institutions that obtain approval as set forth in Article 1, paragraph (1) of

the Act Concerning Additional Operations of Trust Business by Financial

Institutions, etc., (Act No. 43 of 1943)) that operate trust business.

(Consultation)

Article 170-2 The Minister of Health, Labour, and Welfare shall consult with the

Minister of Finance in advance, in the following cases:

(i) when intending to provide an approval as set forth in Article 168, paragraph

(1), paragraph (3), or paragraph (8);

(ii) when intending to provide an appointment as set forth in paragraph (1) or

paragraph (2) of the preceding Article.

(Delegation to an Ordinance of the Ministry of Health, Labour, and Welfare)

Article 171 In addition to those matters provided in this Chapter, the necessary

matters concerning finance and accounting of the Payment Fund pertaining to

business related to insured long-term care shall be determined by an

Ordinance of the Ministry of Health, Labour, and Welfare.

(Collection of Reports, etc.)

Article 172 (1) The Minister of Health, Labour, and Welfare or a prefectural

governor, with regard to a person that is entrusted by the Payment Fund or

pursuant to the provisions of Article 161 (hereinafter referred to as "Trustee"

in this paragraph and Article 207, paragraph (2)), when he or she determines it

necessary with respect to business related to insured long-term care, may

collect a report concerning the status of said operations or property, or direct

personnel to inspect said condition in practice, however, provided that with

regard to a Trustee, this provision shall apply as within the business of said

Trustee business.

(2) The provisions of Article 24, paragraph (3) shall apply mutatis mutandis to an

inspection pursuant to the provisions of the preceding paragraph, and the

provisions of paragraph (4) of the same Article shall apply mutatis mutandis to

the authority granted pursuant to the provisions of the preceding paragraph.

(3) A prefectural governor, with regard to the Payment Fund, when it is

determined necessary with respect to business related to insured long-term

care to conduct the disposition of a matter pursuant to the provisions of Article

29 of the Social Insurance Medical Fee Payment Fund Act, or when it is

225

determined necessary to execute an action for the president, the chairperson or

a director, or an inspector of the Payment Fund or business related to insured

long-term care, pursuant to the provisions of Article 11, paragraph (2) or

paragraph (3) of the same Act, shall provide notification of said fact to the

Minister of Health, Labour, and Welfare and provide the reasons thereof.

(Exception of Application of the Social Insurance Medical Fee Payment Fund

Act)

Article 173 Business related to insured long-term care shall, with regard to

application of the provisions of Article 32, paragraph (2) of the Social

Insurance Medical Fee Payment Fund Act, be deemed as operations as

prescribed in Article 15 of the same Act.

(Application for Examination)

Article 174 A person that is dissatisfied with the action executed by the

Payment Fund based on this Act may submit an application for examination

pursuant to the provisions of the Administrative Appeal Act (Act No. 160 of

1962) to the Minister of Health, Labour, and Welfare.

Article 175 [Article repealed, deleted]

Chapter X Business Related to a Long-Term Care Insurance Project from

the Federation of National Health Insurance Associations

(Operation of an Association)

Article 176 (1) An Association shall conduct the following business in addition to

the business pursuant to the provisions of the National Health Insurance Act:

(i) pursuant to the provisions of Article 41, paragraph (10) (including a case

applied mutatis mutandis pursuant to Article 42-2, paragraph (9), Article 46,

paragraph (7), Article 48, paragraph (7), Article 51-2, paragraph (8), Article

53, paragraph (7), Article 54-2, paragraph (9), Article 58, paragraph (7) and

Article 61-2, paragraph (8)), examination and payment concerning a demand

of Allowance for In-Home Long-Term Care Service, Allowance for

Community-Based Long-Term Care Service, Allowance for In-Home Long-

Term Care Service Plan, Allowance for Long-Term Care Facility Service,

Allowance for Long-Term Care Service to A Person Admitted to A Specified

Facility, Allowance for Preventive Long-Term Care Service, Allowance for

Community-Based Preventive Long-Term Care Service, Allowance for

Preventive Service Plan for Long-Term Care, and Allowance for Preventive

Long-Term Care Service to a Person Admitted to a Specified Facility that are

entrusted by a Municipality;

226

(ii) investigation of the improvement of quality of Designated In-Home Service,

Designated Community-Based Service, Designated In-Home Long-Term Care

Support, Designated Facility Service, etc., Designated Preventive Long-Term

Care Service, Designated Community-Based Preventive Long-Term Care

Service, and Designated Support for Prevention of Long-Term Care, and the

necessary instruction and advice to a Designated In-Home Service Provider,

Designated Community-Based Service Provider, Designated In-Home Long-

Term Care Support Provider, Long-Term Care Insurance Facility,

Designated Provider of Preventive Long-Term Care Service, Designated

Provider of Community-Based Preventive Service of Long-Term Care, and

Designated Provider of Support for Prevention of Long-Term Care.

(2) An Association, in addition to those operations listed in each item of the

preceding paragraph, may conduct the businesses listed in the following items,

in order to contribute to efficient operation of an Insured Long-Term Care

Project:

(i) affairs of collection or payment of compensation for damages to a third party

that is conducted based on the entrustment of a Municipality pursuant to the

provisions of Article 21, paragraph (3);

(ii) operation of the business of Designated In-Home Service, Designated

Community-Based Service, Designated In-Home Long-Term Care Support,

Designated Preventive Service of Long-Term Care, Designated Community-

Based Preventive Long-Term Care Service, and a Long-Term Care Insurance

Facility;

(iii) in addition to the operations listed in the preceding two paragraphs,

business that contributes to the efficient operation of an Insured Long-Term

Care Project.

(Exception of Voting Rights)

Article 177 With regard to business that an Association conducts pursuant to

the provisions of the preceding Article (hereinafter referred to as "Business

Relevant to A Long-Term Care Insurance Project"), notwithstanding the

provisions of Article 29 of the National Health Insurance Act as applied

mutatis mutandis pursuant to Article 86 of the same Act, a special provision

concerning voting rights shall be provided by the constitution.

(Separate Accounting)

Article 178 An Association, with regard to accounting procedures pertaining to

Business Related to A Long-Term Care Insurance Project, shall separate said

records from other accounting records.

Chapter XI Examination Committee for Long-Term Care Benefit Expense

227

(Examination Committee for Benefit Expense)

Article 179 In order to conduct the examination of invoices for Long-Term Care

Benefit Expense based on the entrustment pursuant to the provisions of Article

41, paragraph (10) (including a case applied mutatis mutandis pursuant to

Article 42-2, paragraph (9), Article 46, paragraph (7), Article 48, paragraph (7),

Article 51-2, paragraph (8), Article 53, paragraph (7), Article 54-2, paragraph

(9), Article 58, paragraph (7) and Article 61-2, paragraph (8)), an examination

committee for Long-Term Care Benefit Expense (hereinafter referred to as

"Examination Committee for Long-Term Care Benefit Expense") shall be

established by an Association.

(Organization of Examination Committee for Benefit Expense)

Article 180 (1) An Examination Committee for Benefit Expense shall be

comprised of groups of committee members, with each group having the same

number of committee members, to represent the following: committee members

that represent Municipalities; committee members that represent the public

interest; and committee members that represent persons that are in charge of

Service Covered by Long-Term Care Benefits, etc., (which means a person in

charge of Designated In-Home Service, Designated Community-Based Service,

Designated In-Home Long-Term Care Support, Designated Facility Service,

etc., Designated Preventive Service of Long-Term Care, Designated

Community-Based Preventive Long-Term Care Service, or Designated Support

for Prevention of Long-Term Care; the same shall apply in paragraph (3) and

paragraph (1) of the following Article) respectively, as prescribed by the

constitution.

(2) Committee members shall be commissioned by an Association.

(3) The commission as set forth in the preceding paragraph, with regard to

committee members who represent persons in charge of services subject to

Long-Term Care Benefit, etc., and committee members who represent

Municipalities, shall be conducted by the nomination of concerned

organizations, respectively.

(Authority of Examination Committee for Benefit Expense)

Article 181 (1) An Examination Committee for Benefit Expense, when it is

determined necessary for the examination of invoices for Long-Term Care

Benefit Expense, after obtaining the approval of the prefectural governor, may

request to report, submit or present record books and documents to said

Designated In-Home Service Provider, Designated In-Home Long-Term Care

Support Provider, Designated Provider of Preventive Long-Term Care Service,

or Long-Term Care Insurance Facility, or issue a request to appear or explain

228

to an organizer, manager, or said chairperson or director of said Designated In-

Home Service Provider, Designated In-Home Long-Term Care Support Provider,

Designated Provider of Preventive Long-Term Care Service, or Long-Term Care

Insurance Facility, or the location of a Business Office pertaining to the

business of said Designated In-Home Service, the business of Designated In-

Home Long-Term Care Support, the business of Designated Preventive Long-

Term Care Service, or a person in charge of Service Covered by Long-Term

Care Benefits, etc., of a Long-Term Care Insurance Facility.

(2) An Association shall pay the travel expenses, a daily allowance, and

accommodation charges of a person that appears before an Examination

Committee for Benefit Expense pursuant to the provisions of the preceding

paragraph, however, provided that this provision shall not apply to those who

appear pursuant to a request for appearance due to a defective or misleading

entry of an invoice for Long-Term Care Benefit Expense, or the record books

and documents that are submitted by said Designated In-Home Service

Provider, Designated In-Home Long-Term Care Support Provider, Designated

Provider of Preventive Long-Term Care Service, or Long-Term Care Insurance

Facility.

(3) The provisions of the preceding two paragraphs shall apply mutatis mutandis

to a Designated Community-Based Service Provider, Designated Provider of

Community-Based Preventive Service of Long-Term Care, or Designated

Provider of Support for Prevention of Long-Term Care, and the business of

Designated Community-Based Service, the business of Community-Based

Preventive Long-Term Care Service, and the business of Designated Support

for Prevention of Long-Term Care. In this case, the term "prefectural governor"

in paragraph (1) shall be deemed to be replaced with "mayor of the

Municipality."

(Delegation to an Ordinance of Ministry of Health, Labour, and Welfare)

Article 182 In addition to those matters as provided in this Chapter, necessary

matters for an Examination Committee for Benefit Expense shall be

determined by an Ordinance of the Ministry of Health, Labour, and Welfare.

Chapter XII Application for Examination

(Application for Examination)

Article 183 (1) A person that is dissatisfied with the action executed concerning

an Insurance Benefit (including the action pertaining to a request for issuance

of a Certificate of Insured Person and action concerning a Certification of

Needed Long-Term Care or Needed Support Certification) or an action

concerning an insurance premium and other levies pursuant to the provisions

229

of this Act (except for a Fiscal Stability Fund contribution, payment and

delinquent charge as prescribed in Article 157, paragraph (1)), may apply to a

Certification Committee for Long-Term Care Insurance for an examination.

(2) An application for examination as set forth in the preceding paragraph shall

be deemed as a judicial request with respect to interruption of a prescription.

(Establishment of Certification Committee for Long-Term Care Insurance)

Article 184 A Certification Committee for Long-Term Care Insurance

(hereinafter referred to as "Certification Committee for Insurance") shall be

organized in each prefecture.

(Organization)

Article 185 (1) A Certification Committee for Insurance shall be comprised of

groups of committee members as listed in each of following items and said fixed

number shall be the number provided by said each item:

(i) committee members who represent Insured Persons: three;

(ii) committee members who represent Municipalities: three;

(iii) committee members who represent the public interest: a fixed number

determined by ordinance in accordance with the standards provided by a

Cabinet Order.

(2) A committee member shall be appointed by the prefectural governor.

(3) A committee member shall be part-time.

(Terms of Committee Members)

Article 186 (1) The term of a committee member shall be three years, however,

provided that the term of a member filling a vacancy shall be for the duration

of the remaining term of said predecessor.

(2) A committee member may be reappointed.

(Chairperson)

Article 187 (1) A Certification Committee for Insurance shall have one

chairperson that is elected by the committee members, from among the

committee members representing the public interest.

(2) In the event that a chairperson becomes unable to serve, a member that has

been elected in accordance with the provisions as set forth in the preceding

paragraph shall perform the duties of the chairperson.

(Expert Investigator)

Article 188 (1) Expert investigators may be appointed to a Certification

Committee for Insurance in order for said expert to investigate special matters

concerning a case of an application for examination of action executed

230

concerning a Certification of Needed Long-Term Care or a Certification of

Needed Support.

(2) Expert investigators shall be appointed by a prefectural governor from among

persons with relevant knowledge and experience concerning the health,

medical care, or public aid of an Insured Person Requiring Long-Term Care, etc.

(3) Expert investigators shall be part-time.

(Council)

Article 189 (1) A Certification Committee for Insurance is a council consisting of

two (2) members, and selected for appointment to said Certification Committee

for Insurance from among the chairperson, all the members representing

Insured Persons and members representing Municipalities, and from among

the members representing the public interest except for the chairperson, and

shall administer the cases of application for examination (except for those

cases requiring action concerning Certification of Needed Long-Term Care or

Certification of Needed Support).

(2) A case of an application for examination regarding an action concerning

Certification of Needed Long-Term Care or Certification of Needed Support

shall be administered by a council consisting of three members selected for

appointment to the Certification Committee for Insurance from among

members representing the public interest.

Article 190 (1) A council as set forth in paragraph (1) of the preceding Article

shall not conduct a meeting nor make any decisions without the attendance of

a majority of members including one or more member representing Insured

Persons, a member representing Municipalities, and a member representing

the public interest respectively, and a council as set forth in paragraph (2)

shall not conduct a meeting nor make any decisions without the attendance of

all members that comprise said council.

(2) A decision of a council as set forth in paragraph (1) of the preceding Article

shall be determined by a majority of the members present, and in case of a tie

vote, matters shall be decided by the chairperson.

(3) A decision of a council as set forth in paragraph (2) of the preceding Article

shall be decided by a majority of the members who constitute said council.

(Jurisdictional Certification Committee for Insurance)

Article 191 (1) An application for examination shall be conducted by a

Certification Committee for Insurance of the prefecture that includes the area

of the Municipality that executed the action for said matter.

(2) In a case that a Certification Committee for Insurance lacks jurisdiction in

the matters of an application for examination, the Committee shall

231

immediately transfer said case to the competent Certification Committee for

Insurance and provide notification of said fact to said applicant of said

examination.

(3) When a case is transferred, it shall be deemed that said application for

examination was submitted originally to the Certification Committee for

Insurance that accepts said transfer.

(Term and Method of Application for Examination)

Article 192 An application for examination shall be requested with a document

or orally within sixty days from the day following the date when the applicant

learns that the action regarding a matter was executed, however, provided that

this provision shall not apply to a case when there is prima facie evidence to

prove that said application for examination was not submitted within said

period due to justifiable cause.

(Notification to Municipality)

Article 193 A Certification Committee for Insurance, when accepting an

application for examination, shall notify the Municipality that executed the

original action and other interested persons.

(Disposition for Proceedings)

Article 194 (1) A Certification Committee for Insurance, when it determines

necessary to conduct proceedings, may request reports or opinions of the

person requesting said examination or other relevant person, order to appear

and conduct hearings, or direct a physician or other person appointed by said

Certification Committee for Insurance (referred to as "Physician, etc." in the

following paragraph) to conduct a diagnosis or other investigations.

(2) A prefecture shall pay the travel expenses, a daily allowance, and

accommodation charges, or pay remuneration, pursuant to the provisions of a

Cabinet Order, to said relevant person that appears before said Certification

Committee for Insurance pursuant to the provisions of the preceding

paragraph or Physician, etc., that conducted said diagnosis or other

investigation.

(Delegation to a Cabinet Order)

Article 195 In addition to those items as prescribed in this Chapter or in the

Administrative Appeal Act, other necessary matters and procedures of an

application for examination and a Certification Committee for Insurance shall

be determined by a Cabinet Order.

(Relationship between Application for Examination and Litigation)

232

Article 196 An action of rescission or disposition of a matter as prescribed in

Article 183, paragraph (1) shall not be filed until a ruling with regard to the

application for examination pertaining to said disposition of a matter has been

determined.

Chapter XIII Miscellaneous Provisions

(Collection of Reports, etc.)

Article 197 (1) The Minister of Health, Labour, and Welfare or the prefectural

governor may, when it is determined necessary for an evaluation concerning

the effect of Insurance Benefits or other matter, request a Municipality to

submit a report concerning the performance of said project.

(2) The Minister of Health, Labour, and Welfare may request a prefectural

governor or the mayor of a Municipality, when it is determined to be necessary

with respect to the affairs to be conducted pursuant to the provisions of

Chapter V by said prefectural governor or mayor of said Municipality, to

submit a report, or may provide advice or recommendation.

(3) The Minister of Health, Labour, and Welfare or a prefectural governor, as

pertaining to a medical insurer, when he or she determines the necessity for a

calculation of an amount of payment, may collect reports concerning said

operation, or direct personnel to investigate said conditions in practice.

(4) The provisions of Article 24, paragraph (3) shall apply mutatis mutandis to an

inspection pursuant to the provisions of the preceding paragraph, and the

provisions of paragraph (4) of the same Article shall apply mutatis mutandis to

the authority granted pursuant to the provisions of the preceding paragraph.

Article 197-2 A mayor of a Municipality, pursuant to the provisions of a Cabinet

Order, shall report the performance of said business to the Minister of Health,

Labour, and Welfare.

(Supervision of Association)

Article 198 In a case when the provisions of Article 106 and Article 108 of the

National Health Insurance Act apply to an Association, the term "business" in

these provisions shall be deemed to be replaced with "business (including

Business Relevant to A Long-Term Care Insurance Project that is as prescribed

in Article 177 of the Long-Term Care Insurance Act (Act No.123 of 1997)."

(Order of Statutory Lien)

Article 199 An order of a statutory lien related to an insurance premium or other

levy pursuant to the provisions of this Act shall have priority subordinate to

national tax and local tax.

233

(Prescription)

Article 200 (1) The right to collect an insurance premium, payment, and other

levies pursuant to the provisions of this Act, to receive said refund, or to

receive an Insurance Benefit shall be extinguished by prescription, due to the

statute to limitations after two years have elapsed from the date of issuance.

(2) A demand for an insurance premium and other levies pursuant to the

provisions of this Act shall, notwithstanding the provisions of Article 153 of

Civil Code, have the effect of interruption of a prescription.

(Calculation of Periods)

Article 201 With regard to the calculation of periods as prescribed by this Act or

an Order based on this Act, said calculation shall apply mutatis mutandis to

the provisions concerning said periods as set forth in Civil Code.

(Investigation Concerning an Insured Person, etc.)

Article 202 (1) A Municipality, when it determines it necessary with respect to

qualification of an Insured Person, an Insurance Benefit, or an insurance

premium, may order an Insured Person, the spouse of a Primary Insured

Person, the householder of said family where said Primary Insured Person

resides, or other person who belongs or belonged to said family, to submit or

present documents and other items, or direct personnel to make inquiries.

(2) The provisions of Article 24, paragraph (3) shall apply mutatis mutandis to

questions pursuant to the provisions of the preceding paragraph, and the

provisions of paragraph (4) of the same Article shall apply mutatis mutandis to

the authority granted pursuant to the provisions of the preceding paragraph.

(Provision of Data, etc.)

Article 203 A Municipality, when it determines it necessary with regard to an

Insurance Benefit or an insurance premium, with respect to the property or

income condition of said Insured Person, the spouse of said Primary Insured

Person, the householder of said family where said Primary Insured Person

resides, or other person who belong to said family, or with regard to the

payment status of an Old Age, etc., Pension Benefit to an Insured Person, may

request the submission of necessary documents or to submit other materials of

a post office or other public agency, or the employer of said pension insurer, or

request the submission of a report from a bank, trust company, and other

institutions, or said employer of said Insured Person, or other relevant person.

(Execution of Affairs by the Minister of Health, Labour, and Welfare in an

Emergency)

234

Article 203-2 (1) Affairs that shall belong to the authority of a prefectural

governor or mayor of a Municipality pursuant to the provisions of Article 100,

paragraph(1), in a case when the Minister of Health, Labour, and Welfare

determines that there is an urgent need for protection of the safety of a

person's life or the physical condition of the body of a person who may be

admitted to a Long-Term Care Health Facility, shall be executed by the

Minister of Health, Labour, and Welfare, or a prefectural governor or mayor of

a Municipality. In this case, the provisions concerning a prefectural governor

in the provisions of this Act (limited to those pertaining to said Affairs) shall

apply to the Minister of Health, Labour, and Welfare as provisions concerning

the Minister of Health, Labour, and Welfare.

(2) In a case as set forth in the preceding paragraph, when the Minister of Health,

Labour, and Welfare, or a prefectural governor or mayor of a Municipality

execute said Affairs, said Affairs shall be performed under mutual and close

cooperation.

(Classification of Affairs)

Article 203-3 Affairs that are executed by a prefecture pursuant to the

provisions of Article 156, paragraph (4), Article 172, paragraph (1), and

paragraph (3), and Article 197, paragraph (3), item (i) shall be legally

delegated affairs, as prescribed in Article 2, paragraph (9), item (i) of the Local

Autonomy Act.

(Delegation of Authority)

Article 203-4 (1) The authority of the Minister of Health, Labour, and Welfare as

provided in this Act, pursuant to the provisions of an Ordinance of the Ministry

of Health, Labour, and Welfare, may be delegated to the chief of the relevant

Regional Bureau of Health and Welfare.

(2) The authority that is delegated to the chief of said Regional Bureau of Health

and Welfare pursuant to the provisions of the preceding paragraph, pursuant

to the provisions of an Ordinance of the Ministry of Health, Labour, and

Welfare, may be delegated to a branch manager of said Regional Bureau of

Health and Welfare

(Operative Provisions)

Article 204 Excluding the special provisions as provided in this Act, the

procedures for execution of this Act and other detailed regulations necessary

with regard to execution shall be determined by an Ordinance of the Ministry

of Health, Labour, and Welfare.

Chapter XIV Penalty Provisions

235

Article 205 (1) When a Certification Committee, Prefectural Certification

Committee of Needed Long-Term Care, or Examination Committee for Benefit

Expense, or member of a Certification Committee for Insurance, professional

investigator of a Certification Committee for Insurance, Association, Officer, or

personnel of a juridical person which is entrusted with affairs by an

Association concerning an examination or payment as prescribed in Article 41,

paragraph (9), Article 42-2, paragraph (8), Article 46, paragraph (6), Article 48,

paragraph (6), Article 51-2, paragraph (7), Article 53, paragraph (6), Article 54-

2, paragraph (8), Article 58, paragraph (6), or Article 61-2, paragraph (7),

pursuant to the provisions of Article 41, paragraph (11) (including a case

applied mutatis mutandis pursuant to Article 42-2, paragraph (9), Article 46,

paragraph (7), Article 48, paragraph (7), Article 51-2, paragraph (8), Article 53,

paragraph (7), Article 54-2, paragraph (9), Article 58, paragraph (7), and

Article 61-2, paragraph (8)), or a person that held said occupation divulges,

without justifiable cause, any business confidential information or personal

confidential information of a Designated In-Home Service Provider, Designated

Community-Based Service Provider, Designated In-Home Long-Term Care

Support Provider, an organizer of a Long-Term Care Insurance Facility,

Designated Provider of Preventive Long-Term Care Service, Designated

Provider of Community-Based Preventive Service of Long-Term Care,

Designated Provider of Support for Prevention of Long-Term Care or a person

that provided In-Home Service, etc., that said person has come to learn, shall

be imprisoned with compulsory labor for less than one year or fined an amount

not to exceed one million yen.

(2) Any person that violates the provisions of Article 24-2, paragraph (3), Article

28, paragraph (7) (including a case applied mutatis mutandis pursuant to

Article 29, paragraph (2), Article 30, paragraph (2), Article 31, paragraph (2),

Article 33, paragraph (4), Article 33-2, paragraph (2), Article 33-3, paragraph

(2) and Article 34, paragraph (2)), Article 69-17, paragraph (1), Article 69-28,

paragraph (1), Article 69-37, Article 115-32, paragraph (1) (including a case

applied mutatis mutandis pursuant to Article 115-36, paragraph (3)) or Article

115-39, paragraph (5) (including a case applied mutatis mutandis pursuant to

Article 115-40, paragraph (3), shall be imprisoned with compulsory labor for

less than one year or fined an amount not to exceed one million yen.

Article 205-2 Any person that violates an order pursuant to the provisions of

Article 69-24, paragraph (2) shall be imprisoned with compulsory labor for less

than one year or fined an amount not to exceed one million yen.

Article 206 In a case that corresponds to any item of the following, a person that

236

committed said violation shall be imprisoned with compulsory labor for less

than six months or fined an amount not to exceed 500,000 yen:

(i) when a person advertises matters other than those listed in each item of

Article 98, paragraph (1), advertised falsely with regard to the matter listed

in each item of the same Article, or the method of advertisement of matters

listed in item (iii) of the same Article violates the provisions pursuant to item

(ii) of the same Article;

(ii) when a person violates an order based on the provisions of Article 101 or

Article 102

Article 206-2 In a case defined by any item of the following, a person that

committed said violation shall be fined an amount not to exceed 500,000 yen:

(i) when a person fails to prepare a record book, fails to enter an entry in said

book, or entered a false entry in said book, or fails to maintain said book in

violation of the provisions of Article 69-20 or Article 115-33 (including a case

applied mutatis mutandis pursuant to Article 115-36, paragraph (3));

(ii) when a person fails to report pursuant to the provisions of Article 69-22,

paragraph (1) or paragraph (2), Article 69-30, paragraph (1) (including a case

applied mutatis mutandis pursuant to Article 69-33, paragraph (2)) or Article

115-34, paragraph (1) (including a case applied mutatis mutandis pursuant

to Article 115-36, paragraph (3)) or submits a false report, or fails to reply to

questions pursuant to these provisions or replies falsely, or refuses,

interrupts, or evades an inspection pursuant to these provisions;

(iii) when a person abolishes all Examination Question Preparation Affairs

without obtaining the approval pursuant to the provisions of Article 69-23,

paragraph (1), abolishes all Investigation Affairs without obtaining the

approval pursuant to the provisions of Article 115-35, or abolishes all Public

Information affairs without obtaining the approval pursuant to the

provisions of Article 115-35 as applied mutatis mutandis pursuant to Article

115-36, paragraph (3).

Article 207 (1) When corresponding to any one item of the following, an Officer,

liquidator, or personnel of a health insurance society, national health

insurance society, mutual aid association, or the Promotion and Mutual Aid

Corporation for Private Schools of Japan shall be fined an amount not to

exceed 300,000 yen:

(i) when a person fails to report or submit a document or other item pursuant

to the provisions of Article 163, or reports falsely or submits a document with

a false entry;

(ii) when a person fails to report pursuant to the provisions of Article 197,

paragraph (3), or submits a false report, or refuses, interrupts, or evades an

237

inspection pursuant to the provisions of the same paragraph.

(2) In a case when a person fails to report pursuant to the provisions of Article

172, paragraph (1) or submits a false report, or refuses, interrupts, or evades

an inspection pursuant to the provisions of the same paragraph, the Payment

Fund, Officer, or personnel of a Trustee that commits said violation shall be

fined an amount not to exceed 200,000 yen.

Article 208 When a person that receives Long-Term Care Benefit, etc., fails to

report pursuant to the provisions of Article 24, paragraph (2) or submits a false

report, or refuses, interrupts, or evades an inspection pursuant to the

provisions of the same paragraph, said person shall be fined an amount not to

exceed 300,000 yen.

Article 209 When corresponding to any item of the following, a person that

commits said violation shall be fined an amount not to exceed 300,000 yen:

(i) when a person violates the provisions of Article 95;

(ii) when a person fails to submit a report or does not submit record books and

documents, submits a false report or submits or presents false record books

or documents, pursuant to the provisions of Article 42, paragraph (3), Article

42-3, paragraph (3), Article 45, paragraph (8), Article 47, paragraph (3),

Article 49, paragraph (3), Article 54, paragraph (3), Article 54-3, paragraph

(3), Article 57, paragraph (8), Article 59, paragraph (3), Article 76, paragraph

(1), Article 78-6, paragraph (1), Article 83, paragraph (1), Article 90,

paragraph (1), Article 100, paragraph (1), Article 112, paragraph (1), Article

115-6, paragraph (1), Article 115-15, paragraph (1), or Article 115-24,

paragraph (1), or fails to reply or submits a false reply to questions pursuant

to these provisions or refuses, interrupts, or evades an inspection pursuant

to these provisions;

(iii) when a person violates the provisions of Article 8-2, paragraph (2) and

paragraph (9) of the Medical Care Act as applied mutatis mutandis pursuant

to Article 105 of this Act.

Article 210 A person that fails to appear, fails to submit a statement, fails to

submit a report or submits a false statement or report, or fails to perform a

diagnosis or other investigation in violation of the actions pursuant to the

provisions of Article 194, paragraph (1), shall be fined an amount not to exceed

200,000 yen, however, provided that this provision shall not apply to an

applicant of procedures of an examination conducted by a Certification

Committee for Insurance, a Municipality which is notified pursuant to the

provisions of Article 193, or other interested person.

238

Article 211 When a representative person of a juridical person, or an agent of a

juridical person or an individual, employee, or other worker commits a

violation as set forth in Article 205-2 to Article 206-2, or Article 209 with

regard to the business of said juridical person or an individual, not only the

offender shall be punished, but also said juridical person or said individual

shall be punished by the fine as prescribed in the respective Articles.

Article 211-2 When a person fails to keep Financial Statements, etc., fails to

enter the matters to be entered in Financial Statements, etc. , or submits a

false entry in violation of the provisions of Article 69-19, paragraph (1), or

refuses a demand pursuant to the provisions of any item of paragraph (2)

without justifiable cause, said person shall be punished by a fine of an amount

not to exceed 200,000 yen.

Article 212 When a person corresponds to one respective item of the following,

an Officer of the Payment Fund that commits said violation shall be punished

by a fine in an amount not to exceed 200,000 yen:

(i) in a case when said person is required to obtain the authorization or

approval of the Minister of Health, Labour, and Welfare pursuant to the

provisions of this Act, when said person fails to obtain said authorization or

approval;

(ii) when a person invests surplus funds of a business in violation of the

provisions of Article 170.

Article 213 (1) When a person that provides In-Home Service, etc., or a person

that employs said person fails to report or submit a report pursuant to the

provisions of Article 24, paragraph (1) or submits a false report, or fails to

reply or submits a false reply to the questions of said personnel pursuant to the

provisions of the same paragraph, said person shall be punished by a non-penal

fine in an amount not to exceed 100,000 yen.

(2) A person that violates the provisions of Article 69-7, paragraph (6) or

paragraph (7) shall be punished by a non-penal fine in an amount not to exceed

100,000 yen.

Article 214 (1) A Municipality, when a Primary Insured Person fails to provide a

notification pursuant to the provisions of the main clause of Article 12,

paragraph (1) (except for a case when the householder of said family of said

Primary Insured Person resides, fails to provide a notification pursuant to the

provisions of paragraph (2) of the same Article) or provides a false notification,

may enact a provision to punish said offender by a non-penal fine in an amount

not to exceed 100,000 yen.

239

(2) A Municipality may enact by ordinance a provision to punish by a non-penal

fine in an amount not to exceed 100,000 yen a person that fails to respond to a

request to submit a Certificate of Insured Person pursuant to the provisions of

the second sentence of Article 30, paragraph (1), second sentence of Article 31,

paragraph (1), Article 33-3, paragraph (1), second sentence of Article 34,

paragraph (1), second sentence of Article 35, paragraph (6), Article 66,

paragraph (1) or paragraph (2), or Article 68, paragraph (1).

(3) A Municipality, when an Insured Person, the spouse of said Primary Insured

Person, the householder of said family where said Primary Insured Person

resides, or other person that belongs or belonged to said family fails to act in

compliance with an order to submit or present documents or other items

pursuant to the provisions of Article 202, paragraph (1) or fails to reply or

submits a false reply to the questions asked by said personnel, may enact by

ordinance a provision to punish said person by non-penal fine in an amount not

to exceed 100,000 yen.

(4) A Municipality may enact by ordinance a provision to a person that was

exempted from the collection of an insurance premium and other levies

pursuant to the provisions of this Act (except for the payment and the

delinquent charge as prescribed in Article 157, paragraph (1)) to punish said

person by non-penal fine in an amount not to exceed the amount equivalent to

five times the amount that was exempted from said collection.

(5) The provisions of Article 255-3 of the Local Autonomy Act shall apply mutatis

mutandis to actions of non-penal fines pursuant to the provisions of the

respective preceding paragraphs.

Article 215 An Association, pursuant to the provisions of a constitution, may

collect a fine for default in an amount not to exceed 100,000 yen with respect to

the use of said facility (limited to Business Relevant to A Long-Term Care

Insurance Project).

240