Act on Assurance of Medical Care for Elderly People

The NHI federation and designated corporations, in order to ensure the stability of the operation of Old-old Medical Care, in addition to conducting research and study on health services for the elderly conducted by an Association of Medical Care Systems for the Elderly Aged 75 and older, the services prescribed in Article 125, paragraph (5), services for the optimization of expenses required for old-old medical care benefit, and other services (hereinafter referred to as "health services for the elderly, etc." in this Article), and liaison and coordination among the Associations in relation to the implementation of health services for the elderly, etc. (in the case of the NHI federation, including between an Association and a municipality entrusted by that Association pursuant to the provisions of the first sentence of Article 125-2, paragraph (1), and among municipalities so entrusted), must endeavor to dispatch persons with specialized technology or knowledge, provide information, analyze and evaluate the status of implementation of health services for the elderly, etc., and provide other necessary assistance in relation to health services for the elderly, etc.

The national government and local governments must endeavor to give advice, provide information, and take other measures necessary to promote the services provided by NHI federations and designated corporations pursuant to the provisions of the preceding Article.

A prefecture is to provide a Association of Medical Care Systems for the Elderly Aged 75 and older or a municipality with necessary advice and appropriate assistance so that the operation of the medical insurance system for the elderly is carried out soundly and smoothly.

If a Association of Medical Care Systems for the Elderly Aged 75 and older intends to provide the benefits set forth in Article 56, item (iii) or in other cases specified by Cabinet Order, it must consult with the prefectural governor in advance.

The Minister of Health, Labour and Welfare or the prefectural governor may, when they find it necessary for the enforcement of this Act with regard to a Association of Medical Care Systems for the Elderly Aged 75 and older or a municipality, collect reports on the status of its services and assets, or have the relevant officials inspect the status on site.

If the Minister of Health, Labour and Welfare or the prefectural governor finds it necessary for the calculation of the amount of young-old payments, etc., aid for the old-old, etc., and contributions for administrative expenses related to childbirth, the Minister of Health, Labour and Welfare or the prefectural governor may collect reports on the services from Insurers (or prefectures in the case of National Health Insurance) or have the relevant officials inspect the situation on site.

The provisions of Article 16-10, paragraph (2) apply mutatis mutandis to the inspection pursuant to the provisions of the preceding two paragraphs, and the provisions of paragraph (3) of the same Article apply mutatis mutandis to the authority pursuant to the provisions of the preceding two paragraphs.

An Association of Medical Care Systems for the Elderly Aged 75 and older or the NHI federation must, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, report the status of services pertaining to Old-old Medical Care (in the case of an Association, including the status of services reported by a Municipality pursuant to the provisions of the following paragraph to the head of the Association (in the case of an Association that has a board of directors in place of a head pursuant to the provisions of Article 287-3, paragraph (2) of the Local Autonomy Act as applied mutatis mutandis pursuant to Article 291-13 of that Act, the board of directors; the same applies in the following paragraph)) to the Prefectural Governor.

A Municipality, pursuant to the provisions of an Order of the Ministry of Health, Labour and Welfare, must report the status of its services pertaining to Old-Old Healthcare to the head of an Association of Medical Care Systems for the Elderly Aged 75 and older.

The mayor of a municipality (including the head of a special ward and, in the case of a designated city under Article 252-19, paragraph (1) of the Local Autonomy Act, a ward head or a general ward head) may, pursuant to the provisions of the Municipal Ordinance of the municipality, certify free of charge, to an Association of Medical Care Systems for the Elderly Aged 75 and older or a person who receives old-old medical care benefit, matters concerning the family register of the insured or a person who was insured.

If the Association of Medical Care Systems for the Elderly Aged 75 and older finds it necessary in relation to eligibility as an insured, a medical care benefit for the old-old, and insurance premiums, it may order the insured, the spouse of the insured, or the householder or any other member or former member of the household to which the insured belongs to submit or present a document or any other item, or may have its official ask them questions.

A Municipality, when it finds it necessary in relation to the collection of insurance premiums, may order the insured, the spouse of the insured, or the householder or any other member or former member of the household to which the insured belongs to submit or present a document or any other article, or may have its personnel question such person.

The provisions of Article 16-10, paragraph (2) apply mutatis mutandis to questions pursuant to the provisions of the preceding two paragraphs, and the provisions of paragraph (3) of the same Article apply mutatis mutandis to the authority granted pursuant to the provisions of the preceding two paragraphs.

When an Association of Medical Care Systems for the Elderly Aged 75 and older finds it necessary in relation to the qualifications of insured, old-old medical care benefit, and insurance premiums, it may request a Municipality or other public agencies or Pension Insurers to provide access to necessary documents or to provide necessary materials, or may request banks, trust companies, other institutions, employers of the insured, or other relevant persons to make a report, with regard to the matters necessary to confirm that the grounds on which the insured received old-old medical care benefit arose from the act of a third party, the status of assets or income of the insured, the spouse of the insured, or the head of the household to which the insured belongs or other members of that household, or the status of payment of an Old Age, etc., pension benefit prescribed in Article 107, paragraph (2) to the insured.

If a Association of Medical Care Systems for the Elderly Aged 75 and older finds it necessary in relation to eligibility as an insured, it may request other Association of Medical Care Systems for the Elderly Aged 75 and older and insurers (or municipalities in the case of national health insurance programs) to provide necessary materials, including the names and addresses of the insured and subscribers of medical care for the elderly provided by other Association of Medical Care Systems for the Elderly Aged 75 and older (or the insured domiciled within the area of the relevant municipality in the case of national health insurance programs), and the name and location of the applicable place of business as prescribed in Article 3, paragraph (3) of the Health Insurance Act.

A Municipality, when it finds it necessary in relation to the collection of insurance premiums, may request public agencies or Pension Insurers to provide access to necessary documents or to provide necessary materials, or may request a report from banks, trust companies, other institutions, employers of the insured, or other relevant persons, with regard to the status of assets or income of the insured, the spouses of the insured, or the head of the household or other members of the household to which the insured belongs, or the status of payment of an Old Age, etc., pension benefit as prescribed by the Article 107, paragraph (2) to the insured.