This Act comes into effect on April 1, 2018; provided, however, that the provisions set forth in the following items come into effect as of the days specified respectively in those items.

After the promulgation of this Act, from the perspective of building a sustainable medical insurance system, the government is to review the appropriateness of the expenses required for medical care, the scope of insurance benefits of medical insurance, the manner of bearing the expenses required for medical care in accordance with the ability of participants, etc. to bear them, and other matters, and take necessary measures based on the results.

①The national government is to establish, promptly on or after the item (ii) Effective Date, the national plan for the optimization of medical expenses under the Act on Assurance of Medical Care for Elderly People as amended by Article 9 (hereinafter referred to as the "item (ii) Amended Elderly Medical Care Assurance Act") (hereinafter referred to as the "new national plan").

②The national plan for the optimization of medical expenses under the Act on Assurance of Medical Care for Elderly People as it stood before the amendment by Article 9 (referred to as the "item (ii) Pre-amendment Elderly Medical Care Assurance Act" in paragraph (2) of the following Article) (referred to as the "former national plan" in the following paragraph) is deemed to be the new national plan until the new national plan is established.

③With regard to the former national plan deemed to be the new national plan pursuant to the provisions of the preceding paragraph, the provisions of Article 8 (excluding paragraphs (2) and (3)), Article 11, paragraphs (6) through (8), Article 12, paragraphs (3) and (4), Article 14 and Article 15 of the item (ii) Amended Elderly Medical Care Assurance Act do not apply, and the provisions then in force continue to govern. In this case, the day before the day on which the new national plan is established is deemed to be the last day of the period of the former national plan.

④With regard to the application of the provisions of Article 8, paragraph (1) of the item (ii) Amended Elderly Medical Care Assurance Act to the new national plan first established on or after the item (ii) Effective Date, the phrase "every six years (hereinafter referred to as the 'national plan for the optimization of medical expenses') with six years as one period" in that paragraph is deemed to be replaced with "(hereinafter referred to as the 'national plan for the optimization of medical expenses') with the plan period ending on March 31, 2024".

①Prefectures are to establish, promptly on or after the item (ii) Effective Date, the prefectural plan for the optimization of medical expenses under the item (ii) Amended Elderly Medical Care Assurance Act (hereinafter referred to as the "new prefectural plan").

②The prefectural plan for the optimization of medical expenses under the item (ii) Pre-amendment Elderly Medical Care Assurance Act (referred to as the "former prefectural plan" in the following paragraph) is deemed to be the new prefectural plan until the new prefectural plan is established.

③With regard to the former prefectural plan deemed to be the new prefectural plan pursuant to the provisions of the preceding paragraph, the provisions of Article 9, Article 11, paragraphs (1) through (5), Article 12, paragraphs (1) and (2), Article 13, paragraph (1) and Article 15 of the item (ii) Amended Elderly Medical Care Assurance Act do not apply, and the provisions then in force continue to govern. In this case, the day before the day on which the new prefectural plan is established is deemed to be the last day of the period of the former prefectural plan.

④With regard to the application of the provisions of Article 9, paragraph (1) of the item (ii) Amended Elderly Medical Care Assurance Act to the new prefectural plan first established on or after the item (ii) Effective Date, the phrase "every six years, with six years as one period," in that paragraph is deemed to be replaced with "with the plan period ending on March 31, 2024,".

①The Minister of Health, Labour and Welfare may, for the purpose of preparing the new national plan, consult with the heads of the relevant administrative organs, even before the item (ii) Effective Date, in the same manner as under the provisions of Article 8, paragraph (6) of the item (ii) Amended Elderly Medical Care Assurance Act.

②A prefecture may, for the purpose of preparing the new prefectural plan, consult with the relevant municipalities (or, for a prefecture in which the Council of Insurers under Article 157-2, paragraph (1) of the Act on Assurance of Medical Care for Elderly People has been organized, the relevant municipalities and that Council of Insurers), even before the item (ii) Effective Date, in the same manner as under the provisions of Article 9, paragraph (7) of the item (ii) Amended Elderly Medical Care Assurance Act.

①With regard to the estimated young-old subsidy, the estimated young-old payment and the estimated aid for the old-old pertaining to the Insurers (meaning the Insurers prescribed in Article 7, paragraph (2) of the Act on Assurance of Medical Care for Elderly People as it stood before the amendment by the provisions of Article 10 (hereinafter referred to in this Article and Article 30 of the Supplementary Provisions as the "item (iii) Pre-amendment Elderly Medical Care Assurance Act"), and excluding Insurers of employee insurance, etc. (meaning Insurers of employee insurance, etc. prescribed in Article 10, paragraph (1) of the Supplementary Provisions of the item (iii) Pre-amendment National Health Insurance Act; the same applies in the following Article); the same applies hereinafter in this Article) for each fiscal year up to and including fiscal year 2016, and the fixed young-old subsidy, the fixed young-old payment and the fixed aid for the old-old pertaining to the Insurers for each fiscal year up to and including fiscal year 2014, the provisions then in force continue to govern.

②The amount of the fixed young-old subsidy pertaining to the Insurers for each of fiscal year 2015 and fiscal year 2016 is, notwithstanding Article 35, paragraph (1) of the item (iii) amended Elderly Medical Care Assurance Act, the amount calculated pursuant to the provisions of Article 35, paragraph (1) of the item (iii) Pre-amendment Elderly Medical Care Assurance Act.

③The amount of the fixed young-old payment pertaining to the Insurers for each of fiscal year 2015 and fiscal year 2016 is, notwithstanding Article 39, paragraph (1) of the item (iii) amended Elderly Medical Care Assurance Act, the amount calculated pursuant to the provisions of Article 39, paragraph (1) of the item (iii) Pre-amendment Elderly Medical Care Assurance Act.

④The amount of the fixed aid for the old-old pertaining to the Insurers for each of fiscal year 2015 and fiscal year 2016 is, notwithstanding Article 121, paragraph (1), item (ii) of the item (iii) amended Elderly Medical Care Assurance Act, the amount calculated pursuant to the provisions of Article 121, paragraph (1) of the item (iii) Pre-amendment Elderly Medical Care Assurance Act.

With regard to the estimated young-old subsidy, the estimated young-old payment and the estimated aid for the old-old pertaining to Insurers of employee insurance, etc. for each fiscal year up to and including fiscal year 2016, and the fixed young-old subsidy, the fixed young-old payment and the fixed aid for the old-old pertaining to Insurers of employee insurance, etc. for each fiscal year up to and including fiscal year 2014, the provisions then in force continue to govern.

With regard to the estimated young-old subsidy, the estimated young-old payment and the estimated aid for the old-old pertaining to municipalities for each fiscal year up to and including fiscal year 2017, and the fixed young-old subsidy, the fixed young-old payment and the fixed aid for the old-old pertaining to municipalities for each fiscal year up to and including fiscal year 2015, the provisions then in force continue to govern.