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This text is not in force yetIt by 11 December 2028, on a day set by — at the latest in 2 years
Read the text in force →高齢者の医療の確保に関する法律
Chapter IV Late-Stage Elderly Medical Care System (Articles 116 to 122)
The law as Act Partially Amending the Medical Care Act, etc. (Act No. 87 of 2025) leaves it, with the words it changes marked.
The main text is read a page at a time: a chapter to a page, and a long chapter in runs of articles. The whole main text, and the supplementary provisions and appended tables this amendment changes. Those it leaves untouched are on the page for the text in force.
A prefecture, in order to contribute to the financial stability of medical care for the elderly, is to establish a financial stability fund to cover the expenses necessary for the following projects:
都道府県は、後期高齢者医療の財政の安定化に資するため財政安定化基金を設け、次に掲げる事業に必要な費用に充てるものとする。
a project to provide a Association of Medical Care Systems for the Elderly Aged 75 and older whose actual amount of insurance premiums received is expected to fall short of the estimated amount of insurance premiums received and whose amount of revenue subject to a fund project is expected to fall short of the amount of expenses subject to a fund project with an amount calculated pursuant to the provisions of Cabinet Order based on an amount equivalent to half of the amount listed in (a) below (if the amount listed in (a) below exceeds the amount listed in (b) below, the amount listed in (b) below) by taking into consideration the status of receipt of insurance premiums, etc. in the municipality that organizes the Association of Medical Care Systems for the Elderly Aged 75 and older, pursuant to the provisions of Cabinet Order:
実績保険料収納額が予定保険料収納額に不足すると見込まれ、かつ、基金事業対象収入額が基金事業対象費用額に不足すると見込まれる後期高齢者医療広域連合に対し、政令で定めるところにより、イに掲げる額（イに掲げる額がロに掲げる額を超えるときは、ロに掲げる額）の二分の一に相当する額を基礎として、当該後期高齢者医療広域連合を組織する市町村における保険料の収納状況等を勘案して政令で定めるところにより算定した額を交付する事業
the amount of insurance premiums actually received that is expected to be less than the amount of insurance premiums scheduled to be received;
実績保険料収納額が予定保険料収納額に不足すると見込まれる額
the amount by which the Amount of Revenue Covered by the Fund Project is expected to be short of the Amount of Cost Covered by the Fund Project;
基金事業対象収入額が基金事業対象費用額に不足すると見込まれる額
a project to provide a Association of Medical Care Systems for the Elderly Aged 75 and older whose total of the Revenue Subject to a Fund Project and the Amount Delivered by a Fund Project is expected to fall short of the Amount of Expenses Subject to a Fund Project with a loan, pursuant to the provisions of Cabinet Order, in an amount not exceeding the amount calculated pursuant to the provisions of Cabinet Order, based on the expected shortfall, by taking into consideration the status of collection of insurance premiums, etc. in the Municipality that organizes the Association of Medical Care Systems for the Elderly Aged 75 and older.
基金事業対象収入額及び基金事業交付額の合計額が、基金事業対象費用額に不足すると見込まれる後期高齢者医療広域連合に対し、政令で定めるところにより、当該不足すると見込まれる額を基礎として、当該後期高齢者医療広域連合を組織する市町村における保険料の収納状況等を勘案して政令で定めるところにより算定した額の範囲内の額を貸し付ける事業
Among the terms used in the preceding paragraph, the meanings of those set forth in the following items are as prescribed respectively in those items:
前項における用語のうち次の各号に掲げるものの意義は、当該各号に定めるところによる。
the estimated amount of insurance premiums received: the amount calculated pursuant to the provisions of Cabinet Order as the amount to be allocated to the amount of expenses incurred in providing benefits for medical treatment, etc., the amount of expenses required for payment of the Fiscal Stability Fund contributions, the contributions and childbirth support payments pursuant to the provisions of paragraph (2) of the following Article, the physician allowance contributions, etc., the contribution for securing medical care in the early phase of an epidemic, etc., and the children and child-rearing support levy, and the amount of expenses required for redemption of borrowings from the prefecture pursuant to the provisions of item (ii) of the preceding paragraph (hereinafter referred to as "Borrowings for Fund Project" in this paragraph), out of the total amount of insurance premiums that are expected to be received, during the specified period (meaning every two-fiscal-year period from fiscal year 2008, which is the first year; the same applies hereinafter in this paragraph), by the municipalities that organize the Association of Medical Care Systems for the Elderly Aged 75 and older in that Association;
予定保険料収納額 後期高齢者医療広域連合において特定期間（平成二十年度を初年度とする同年度以降の二年度ごとの期間をいう。以下この項において同じ。）中に当該後期高齢者医療広域連合を組織する市町村において収納が見込まれた保険料の額の合計額のうち、療養の給付等に要する費用の額、財政安定化基金拠出金、次条第二項の規定による拠出金及び出産支援金、医師手当拠出金等、流行初期医療確保拠出金等並びに子ども・子育て支援納付金の納付に要する費用の額並びに前項第二号の規定による都道府県からの借入金（以下この項において「基金事業借入金」という。）の償還に要する費用の額に充てるものとして政令で定めるところにより算定した額
the actual amount of insurance premiums received: the amount calculated pursuant to the provisions of Cabinet Order as the amount to be allocated to the sum total of the amount obtained by deducting the amount equivalent to the co-payment for the benefits from the amount of expenses spent on benefits for medical treatment and the amount of expenses spent on payment of dietary treatment expenses for inpatients, living support expenses for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, special medical expenses, transport expenses, high-cost medical expenses and sizable medical and nursing expenses (hereinafter referred to as the "amount of costs spent on benefits for medical treatment, etc." in this paragraph), the amount of expenses spent on payment of the Fiscal Stability Fund contributions, the contributions and childbirth support payments pursuant to the provisions of paragraph (2) of the following Article, the physician allowance contributions, etc., the contribution for securing medical care in the early phase of an epidemic, etc., and the children and child-rearing support levy, and the amount of expenses spent on redemption of Borrowings for Fund Project, out of the total amount of insurance premiums received during the specified period by the municipalities that organize the Association of Medical Care Systems for the Elderly Aged 75 and older;
実績保険料収納額 後期高齢者医療広域連合を組織する市町村において特定期間中に収納した保険料の額の合計額のうち、療養の給付に要した費用の額から当該給付に係る一部負担金に相当する額を控除した額並びに入院時食事療養費、入院時生活療養費、保険外併用療養費、療養費、訪問看護療養費、特別療養費、移送費、高額療養費及び高額介護合算療養費の支給に要した費用の額の合計額（以下この項において「療養の給付等に要した費用の額」という。）、財政安定化基金拠出金、次条第二項の規定による拠出金及び出産支援金、医師手当拠出金等、流行初期医療確保拠出金等並びに子ども・子育て支援納付金の納付に要した費用の額並びに基金事業借入金の償還に要した費用の額に充てるものとして政令で定めるところにより算定した額
the amount of revenue subject to fund projects: the amount calculated pursuant to the provisions of Cabinet Order as the amount to be allocated to the amount of costs spent on benefits for medical treatment, etc., the amount of expenses spent on payment of the Fiscal Stability Fund contributions, the contributions and childbirth support payments pursuant to the provisions of paragraph (2) of the following Article, the physician allowance contributions, etc., the contribution for securing medical care in the early phase of an epidemic, etc., and the children and child-rearing support levy, and the amount of expenses spent on redemption of Borrowings for Fund Project, out of the total of the amounts received during the specified period in the special account for old-old medical care of the Association of Medical Care Systems for the Elderly Aged 75 and older (excluding the amount of grants for fund business set forth in item (v) and the amount of Borrowings for Fund Project);
基金事業対象収入額 後期高齢者医療広域連合の後期高齢者医療に関する特別会計において特定期間中に収入した金額（第五号の基金事業交付額及び基金事業借入金の額を除く。）の合計額のうち、療養の給付等に要した費用の額、財政安定化基金拠出金、次条第二項の規定による拠出金及び出産支援金、医師手当拠出金等、流行初期医療確保拠出金等並びに子ども・子育て支援納付金の納付に要した費用の額並びに基金事業借入金の償還に要した費用の額に充てるものとして政令で定めるところにより算定した額
the amount of expenses subject to fund projects: the amount calculated pursuant to the provisions of Cabinet Order as the sum total of the amount of costs spent on benefits for medical treatment, etc., the amount of expenses spent on payment of the Fiscal Stability Fund contributions, the contributions and childbirth support payments pursuant to the provisions of paragraph (2) of the following Article, the physician allowance contributions, etc., the contribution for securing medical care in the early phase of an epidemic, etc., and the children and child-rearing support levy, and the amount of expenses spent on redemption of Borrowings for Fund Project, during the specified period at the Association of Medical Care Systems for the Elderly Aged 75 and older;
基金事業対象費用額 後期高齢者医療広域連合において特定期間中に療養の給付等に要した費用の額、財政安定化基金拠出金、次条第二項の規定による拠出金及び出産支援金、医師手当拠出金等、流行初期医療確保拠出金等並びに子ども・子育て支援納付金の納付に要した費用の額並びに基金事業借入金の償還に要した費用の額の合計額として政令で定めるところにより算定した額
the amount of grants for fund business:the amount that a Association of Medical Care Systems for the Elderly Aged 75 and older has received pursuant to the provisions of item (i) of the preceding paragraph during the specified period.
基金事業交付額 後期高齢者医療広域連合が特定期間中に前項第一号の規定により交付を受けた額
A prefecture, pursuant to the provisions of Cabinet Order, is to collect Fiscal Stability Fund contributions from the Association of Medical Care Systems for the Elderly Aged 75 and older in order to allocate them to the Fiscal Stability Fund.
都道府県は、財政安定化基金に充てるため、政令で定めるところにより、後期高齢者医療広域連合から財政安定化基金拠出金を徴収するものとする。
The Association of Medical Care Systems for the Elderly Aged 75 and older is obliged to pay the Fiscal Stability Fund contribution pursuant to the provisions of the preceding paragraph.
後期高齢者医療広域連合は、前項の規定による財政安定化基金拠出金を納付する義務を負う。
A prefecture, pursuant to the provisions of Cabinet Order, must transfer an amount equivalent to three times the total amount of Fiscal Stability Fund contributions collected from the Association of Medical Care Systems for the Elderly Aged 75 and older pursuant to the provisions of paragraph (3) to the Fiscal Stability Fund.
都道府県は、政令で定めるところにより、第三項の規定により後期高齢者医療広域連合から徴収した財政安定化基金拠出金の総額の三倍に相当する額を財政安定化基金に繰り入れなければならない。
Pursuant to the provisions of Cabinet Order, the national government bears an amount equivalent to one third of the amount transferred by a prefecture pursuant to the provisions of the preceding paragraph.
国は、政令で定めるところにより、前項の規定により都道府県が繰り入れた額の三分の一に相当する額を負担する。
All revenues arising from the Fiscal Stability Fund must be appropriated to the Fiscal Stability Fund.
財政安定化基金から生ずる収入は、全て財政安定化基金に充てなければならない。
A designated corporation, pursuant to the provisions of Cabinet Order, in order to mitigate the impact of the occurrence of benefits related to extremely expensive medical care on the finances of medical care for the elderly, is to implement a project to provide Association of Medical Care Systems for the Elderly Aged 75 and older with grants related to benefits related to extremely expensive medical care pertaining to insured (hereinafter referred to as a "special joint high medical care cost project").
指定法人は、政令で定めるところにより、著しく高額な医療に関する給付の発生が後期高齢者医療の財政に与える影響を緩和するため、後期高齢者医療広域連合に対して被保険者に係る著しく高額な医療に関する給付に係る交付金を交付する事業（以下「特別高額医療費共同事業」という。）を行うものとする。
Designated Corporations, pursuant to the provisions of Cabinet Order, collect contributions from the Association of Medical Care Systems for the Elderly Aged 75 and older to cover the expenses required for the Special high medical care cost Joint Enterprise.
指定法人は、特別高額医療費共同事業に要する費用に充てるため、政令で定めるところにより、後期高齢者医療広域連合から拠出金を徴収する。
A Association of Medical Care Systems for the Elderly Aged 75 and older is liable to pay contributions pursuant to the provisions of the preceding paragraph.
後期高齢者医療広域連合は、前項の規定による拠出金を納付する義務を負う。
The Organization collects aid for the old-old and contributions for administrative expenses related to the old-old (hereinafter referred to as "aid for the old-old, etc.") from Insurers (in the case of National Health Insurance, the prefecture; the same applies hereinafter in this Section) each fiscal year in order to cover the expenses required for the services listed in Article 139, paragraph (1), item (ii).
機構は、第百三十九条第一項第二号に掲げる業務に要する費用に充てるため、年度ごとに、保険者（国民健康保険にあつては、都道府県。以下この節において同じ。）から、後期高齢者支援金及び後期高齢者関係事務費拠出金（以下「後期高齢者支援金等」という。）を徴収する。
Insurers are liable to pay Medical Care Assistance for the Elderly Aged 75 and over money, etc.
保険者は、後期高齢者支援金等を納付する義務を負う。
The amount of aid for the old-old to be collected from each Insurer pursuant to the provisions of paragraph (1) of the preceding Article is to be the estimated amount of aid for the old-old for the relevant fiscal year; provided, however, that when the estimated amount of aid for the old-old for the fiscal year before the previous fiscal year exceeds the fixed amount of aid for the old-old for that fiscal year, it is to be the amount obtained by deducting from the estimated amount of aid for the old-old for the relevant fiscal year the sum total of the excess amount and the old-old aid adjustment amount pertaining to the excess amount, and when the estimated amount of aid for the old-old for the fiscal year before the previous fiscal year is less than the fixed amount of aid for the old-old for that fiscal year, it is to be the amount obtained by adding to the estimated amount of aid for the old-old for the relevant fiscal year the sum total of the shortfall and the old-old aid adjustment amount pertaining to the shortfall.
前条第一項の規定により各保険者から徴収する後期高齢者支援金の額は、当該年度の概算後期高齢者支援金の額とする。ただし、前々年度の概算後期高齢者支援金の額が同年度の確定後期高齢者支援金の額を超えるときは、当該年度の概算後期高齢者支援金の額からその超える額とその超える額に係る後期高齢者調整金額との合計額を控除して得た額とするものとし、前々年度の概算後期高齢者支援金の額が同年度の確定後期高齢者支援金の額に満たないときは、当該年度の概算後期高齢者支援金の額にその満たない額とその満たない額に係る後期高齢者調整金額との合計額を加算して得た額とする。
The amount of adjustment for late-stage elderly as prescribed in the preceding paragraph is the amount calculated for each of the Insurers pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare by taking into consideration the interest arising from any excess or deficiency between the estimated amount of Medical Care Assistance for the Elderly Aged 75 and over and the amount of final Medical Care Assistance for the Elderly Aged 75 and over pertaining to all Insurers in the fiscal year before the previous fiscal year and any other circumstances.
前項に規定する後期高齢者調整金額は、前々年度におけるすべての保険者に係る概算後期高齢者支援金の額と確定後期高齢者支援金の額との過不足額につき生ずる利子その他の事情を勘案して厚生労働省令で定めるところにより各保険者ごとに算定される額とする。
The estimated amount of Medical Care Assistance for the Elderly Aged 75 and over referred to in paragraph (1) of the preceding Article is the amount specified in the relevant of the following items for the category of insurers set forth in that item:
前条第一項の概算後期高齢者支援金の額は、次の各号に掲げる保険者の区分に応じ、当該各号に定める額とする。
Insurers of employee insurance, etc.: the amount obtained by multiplying the amount obtained by multiplying the amount obtained by dividing the total of the estimated amountssum totals of the amounts subject to insurance payment set forth in (a) and (b) of all Associations of Medical Care Systems for the Elderly Aged 75 and older in the relevant fiscal year by the estimated total number of participants pertaining to all Insurers in the same fiscal year, calculated as specified by Order of the Ministry of Health, Labour and Welfare, by the estimated number of participants pertaining to all Insurers of employee insurance, etc. in the same fiscal year, calculated as specified by Order of the Ministry of Health, Labour and Welfare, by the rate obtained by dividing the amount set forth in (ac) by the amount set forth in (bd) for the same fiscal year and the estimated old-old aid adjustment rate;
被用者保険等保険者 当該年度における全ての後期高齢者医療広域連合の保険納付対象額の見込イ及びロに掲げる額の合計額の総額を厚生労働省令で定めるところにより算定した同年度における全ての保険者に係る加入者の見込総数で除して得た額に、厚生労働省令で定めるところにより算定した同年度における全ての被用者保険等保険者に係る加入者数の見込数を乗じて得た額に、同年度におけるイハに掲げる額をロニに掲げる額で除して得た率及び概算後期高齢者支援金調整率を乗じて得た額
the estimated amount of the Total Amount of Standard Fees pertainingamount subject to the Insurer of employee insurance, etc. payment;
当該被用者保険等保険者に係る標準報酬総保険納付対象額の見込額
the sum estimated amount of the estimated amountssum total of the total amount of standardized remunerations pertaining obtained by multiplying the physician allowance contribution amount subject to all Insurers of employee insurance, etc.sharing by the rate obtained by deducting the contribution rate for the old-old set forth in Article 100, paragraph (2) and 50 percent from 1, and the amount obtained by multiplying the amount of specified physician allowance contribution by the rate obtained by deducting the contribution rate for the old-old set forth in that paragraph from 1;
全ての被用者保険等保険者に係る標準報酬総額の見込負担対象手当拠出金額に一から第百条第二項の後期高齢者負担率及び百分の五十を控除して得た率を乗じて得た額並びに特定医師手当拠出金の額に一から同項の後期高齢者負担率を控除して得た率を乗じて得た額の合計額の見込額
the estimated total standard remuneration pertaining to the relevant insurer of employee insurance, etc.;
当該被用者保険等保険者に係る標準報酬総額の見込額
the sum total of the estimated total standard remuneration pertaining to all Insurers of employee insurance, etc.;
全ての被用者保険等保険者に係る標準報酬総額の見込額の合計額
Insurers other than Insurers of employee insurance, etc.: the amount obtained by multiplying the amount obtained by multiplying the amount obtained by dividing the total of the estimated amountssum totals of the amounts subject to insurance paymentset forth in (a) and (b) of the preceding item of all Associations of Medical Care Systems for the Elderly Aged 75 and older in the relevant fiscal year by the estimated total number of participants pertaining to all Insurers in the same fiscal year, calculated as specified by Order of the Ministry of Health, Labour and Welfare, by the estimated number of participants pertaining to the relevant Insurer in the same fiscal year, calculated as specified by Order of the Ministry of Health, Labour and Welfare, by the estimated old-old aid adjustment rate.
被用者保険等保険者以外の保険者 当該年度における全ての後期高齢者医療広域連合の保険納付対象額の見込前号イ及びロに掲げる額の合計額の総額を厚生労働省令で定めるところにより算定した同年度における全ての保険者に係る加入者の見込総数で除して得た額に、厚生労働省令で定めるところにより算定した同年度における当該保険者に係る加入者の見込数を乗じて得た額に、概算後期高齢者支援金調整率を乗じて得た額
The estimated Medical Care Assistance for the Elderly Aged 75 and over adjustment rate referred to in the items of the preceding paragraph is calculated pursuant to the provisions of Cabinet Order within the range of 90 percent to 110 percent by taking into consideration the degree of achievement of the particulars set forth in Article 18, paragraph (2), item (ii) and Article 19, paragraph (2), item (ii), the expected number of subscribers pertaining to the insurers, and other factors.
前項各号の概算後期高齢者支援金調整率は、第十八条第二項第二号及び第十九条第二項第二号に掲げる事項についての達成状況、保険者に係る加入者の見込数等を勘案し、百分の九十から百分の百十の範囲内で政令で定めるところにより算定する。
The amount of final Medical Care Assistance for the Elderly Aged 75 and over for Article 119, paragraph (1) is the amount specified in each of the following items in accordance with the category of insurers listed in the relevant item:
第百十九条第一項の確定後期高齢者支援金の額は、次の各号に掲げる保険者の区分に応じ、当該各号に定める額とする。
Insurers of employee insurance, etc.: the amount obtained by dividing the aggregate of the total amounts subject to insurance payment of all Associations of Medical Care Systems for the Elderly Aged 75 and older for the fiscal year before the previous fiscal year by the total number of participants for all Insurers in the same fiscal year calculated as specified by Order of the Ministry of Health, Labour and Welfare, multiplying the amount so obtained by the number of participants for all Insurers of employee insurance, etc. in the same fiscal year calculated as specified by Order of the Ministry of Health, Labour and Welfare, and further multiplying the amount so obtained by the rate obtained by dividing the amount set forth in (a) for the same fiscal year by the amount set forth in (b), and by the fixed old-old aid adjustment rate;
被用者保険等保険者 前々年度における全ての後期高齢者医療広域連合の保険納付対象総額の総額を厚生労働省令で定めるところにより算定した同年度における全ての保険者に係る加入者の総数で除して得た額に、厚生労働省令で定めるところにより算定した同年度における全ての被用者保険等保険者に係る加入者数を乗じて得た額に、同年度におけるイに掲げる額をロに掲げる額で除して得た率及び確定後期高齢者支援金調整率を乗じて得た額
the total amount of standard compensation pertaining to the Insurer of employee insurance, etc.;
当該被用者保険等保険者に係る標準報酬総額
the sum of the Total Amount of Standard Fees pertaining to all Insurers of employee insurance, etc.;
全ての被用者保険等保険者に係る標準報酬総額の合計額
Insurers other than Insurers of employee insurance, etc.: the amount obtained by multiplying the amount obtained by multiplying the amount obtained by dividing the total of the total amounts subject to insurance payment of all Associations of Medical Care Systems for the Elderly Aged 75 and older in the fiscal year before the previous fiscal year by the total number of participants pertaining to all Insurers in the same fiscal year, calculated as specified by Order of the Ministry of Health, Labour and Welfare, by the number of participants pertaining to the relevant Insurer in the same fiscal year, calculated as specified by Order of the Ministry of Health, Labour and Welfare, by the fixed old-old aid adjustment rate.
被用者保険等保険者以外の保険者 前々年度における全ての後期高齢者医療広域連合の保険納付対象総額の総額を厚生労働省令で定めるところにより算定した同年度における全ての保険者に係る加入者の総数で除して得た額に、厚生労働省令で定めるところにより算定した同年度における当該保険者に係る加入者の数を乗じて得た額に、確定後期高齢者支援金調整率を乗じて得た額
The fixed adjustment rate for the Medical Care Assistance for the Elderly Aged 75 and over referred to in the items of the preceding paragraph is calculated pursuant to the provisions of Cabinet Order within the range of 90 percent to 110 percent, in consideration of the degree of achievement of the particulars set forth in Article 18, paragraph (2), item (ii) and Article 19, paragraph (2), item (ii), the number of subscribers pertaining to insurers, and other factors.
前項各号の確定後期高齢者支援金調整率は、第十八条第二項第二号及び第十九条第二項第二号に掲げる事項についての達成状況、保険者に係る加入者の数等を勘案し、百分の九十から百分の百十の範囲内で政令で定めるところにより算定する。
The amount of contributions for administrative expenses related to the old-old to be collected from each Insurer pursuant to the provisions of Article 118, paragraph (1) is, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, the amount calculated pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, based on the estimated amount of expenses required for the handling of affairs concerning the services of the Organization set forth in Article 139, paragraph (1), item (ii) in the relevant fiscal year, in accordance with the estimated number of participants pertaining to each Insurer.
第百十八条第一項の規定により各保険者から徴収する後期高齢者関係事務費拠出金の額は、厚生労働省令で定めるところにより、当該年度における第百三十九条第一項第二号に掲げる機構の業務に関する事務の処理に要する費用の見込額を基礎として、各保険者に係る加入者の見込数に応じ、厚生労働省令で定めるところにより算定した額とする。