Act on Assurance of Medical Care for Elderly People

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:

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:

the amount of insurance premiums actually received that is expected to be less than the amount of insurance premiums scheduled to be received;

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;

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.

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:

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;

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;

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);

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;

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.

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.

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.

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.

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.

All revenues arising from the Fiscal Stability Fund must be appropriated to the Fiscal Stability Fund.

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").

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.

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.

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).

Insurers are liable to pay Medical Care Assistance for the Elderly Aged 75 and over money, etc.

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.

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.

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:

Insurers of employee insurance, etc.: the amount obtained by multiplying the amount obtained by multiplying the amount obtained by dividing the total of the sum totals of the amounts 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 (c) by the amount set forth in (d) for the same fiscal year and the estimated old-old aid adjustment rate;

the estimated amount of the amount subject to insurance payment;

the estimated amount of the sum total of the amount obtained by multiplying the physician allowance contribution amount subject to 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;

the estimated total standard remuneration pertaining to the relevant insurer of employee insurance, etc.;

the sum total of the estimated total standard remuneration pertaining to all Insurers of employee insurance, etc.;

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 sum totals of the amounts set 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.

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.

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:

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;

the total amount of standard compensation pertaining to the Insurer of employee insurance, etc.;

the sum of the Total Amount of Standard Fees pertaining to all Insurers of employee insurance, etc.;

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.

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.

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.