Published: 2007
Key Benefits:
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-
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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
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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)
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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
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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
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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
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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.
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(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
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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
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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
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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
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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.
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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
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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;
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(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:
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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
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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
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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
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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
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(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-
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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
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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);
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(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
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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
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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.
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(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
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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.
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(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
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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.
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(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
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"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
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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
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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.
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(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
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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,
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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.
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(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
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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
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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);
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(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
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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),
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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).
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(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.
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(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
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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
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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
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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.
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(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
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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.
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(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").
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(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.
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(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.
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(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:
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(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
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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
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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
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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
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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
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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).
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(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.
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(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
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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,
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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
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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-
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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
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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
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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
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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)
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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
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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-
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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
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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
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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
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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);
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(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
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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.
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(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
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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
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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
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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
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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
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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
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"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
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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.
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(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
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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
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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
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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;
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(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
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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
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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
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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
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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.
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(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
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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
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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
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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).
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(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
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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
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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
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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.
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(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.
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(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
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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
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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).
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(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
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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,
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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
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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
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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.)
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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
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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
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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
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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;
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(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
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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.)
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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,
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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
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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
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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
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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
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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.
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(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.
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(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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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.
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(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
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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.
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(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
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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,
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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)
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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
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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."
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(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
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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
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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
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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
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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
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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.
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(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
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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
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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:
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(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
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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;
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(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
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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
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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
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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
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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)
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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.
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(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)
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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
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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
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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.
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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.
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(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).
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