Health Insurance Act

A physician or midwife engaged in delivery care covered by health insurance at a delivery-handling medical institution providing services covered by health insurance or designated birthing center must be a physician providing health insurance treatment (limited to a physician) or a midwife registered by the Minister of Health, Labour and Welfare (hereinafter referred to as a "registered midwife").

The provisions of Article 70, paragraphs (1) and (2) apply mutatis mutandis to delivery-handling medical institutions providing services covered by health insurance, the provisions of Article 70-2, paragraph (2) apply mutatis mutandis to administrators of delivery-handling medical institutions providing services covered by health insurance, and the provisions of Article 72 apply mutatis mutandis to physicians providing health insurance treatment (limited to physicians) who are engaged in delivery care at delivery-handling medical institutions providing services covered by health insurance, respectively.

A designation referred to in Article 98-2, paragraph (1), item (i) is provided upon an application by the establisher of a birthing center, as specified by Cabinet Order.

If an application referred to in the preceding paragraph is filed and falls under any of the following items, the Minister of Health, Labour and Welfare may decline to make the designation referred to in Article 98-2, paragraph (1), item (i):

the birthing center pertaining to the application has had its designation referred to in Article 98-2, paragraph (1), item (i) pertaining to designated birthing centers rescinded pursuant to the provisions of this Act and five years have not elapsed from the date of the rescission;

the birthing center pertaining to the application has received repeated guidance due to a likelihood of inappropriate content of delivery care with respect to insurance benefits pursuant to Article 98-19, paragraph (1) (including when applied mutatis mutandis to Article 98-24, paragraph (2), Article 112-2, paragraph (3), and Article 149);

the establisher or administrator of the birthing center pertaining to the application has been sentenced to a fine pursuant to the provisions of this Act or other laws concerning citizens' health and medical care which are specified by Cabinet Order, and the execution of the sentence has not yet been completed or the execution of the sentence still applies;

the establisher or administrator of the birthing center pertaining to the application has been sentenced to imprisonment or a heavier punishment, and the execution of the sentence has not yet been completed or the execution of the sentence still applies;

the establisher or administrator of the birthing center pertaining to the application is a person who, with regard to social insurance premiums, has received, by the day before the day on which the application was filed, a disposition of delinquency pursuant to the provisions of the social insurance laws, and has continued, without justifiable grounds, for three months or more from the date on which the person received the disposition, to be delinquent in all social insurance premiums the due dates of which came on or after the date on which the person received the disposition; or

beyond what is provided for in the preceding items, the birthing center pertaining to the application is deemed significantly inappropriate as a designated birthing center.

If the Minister of Health, Labour and Welfare determines not to make the designation referred to in Article 98-2, paragraph (1), item (i) pertaining to a designated birthing center, the Minister must undergo discussion at the relevant local social insurance medical council.

A designation referred to in Article 98-2, paragraph (1), item (i) expires when six years have elapsed after the day of designation.

With regard to a designated birthing center that is specified by Order of the Ministry of Health, Labour and Welfare, unless otherwise notified during the period from six months before the expiration date of the designation pursuant to the provisions of the preceding paragraph until three months before that date, the application referred to in Article 98-6, paragraph (1) is deemed to have been made.

In the case where a birthing center is one established by a midwife and only the midwife who is the establisher engages in delivery care, if the registration under Article 98-4 is made for that midwife, the designation referred to in Article 98-2, paragraph (1), item (i) is deemed to have been made for that birthing center; provided, however, that this does not apply if that birthing center falls under the requirements prescribed in Article 98-6, paragraph (2) and the Minister of Health, Labour and Welfare finds it inappropriate to deem that the designation referred to in the same item has been made.

In addition to putting registered midwives who are engaged in delivery care at the designated birthing center in charge of delivery care pursuant to Order of the Ministry of Health, Labour and Welfare referred to in Article 98-13, paragraph (1), a designated birthing center must be responsible for delivery care pertaining to delivery expenses pursuant to Order of the Ministry of Health, Labour and Welfare.

Beyond the provisions of the preceding paragraph (including when applied mutatis mutandis to Article 98-24, paragraph (2), Article 112-2, paragraph (3), and Article 149), a designated birthing center is to be responsible for delivery care pertaining to delivery expenses pursuant to medical insurance laws other than this act.

An administrator of a designated birthing center must be a person who satisfies all of the following requirements:

being a registered midwife; and

being a person who meets the requirements specified by Order of the Ministry of Health, Labour and Welfare, such as having experience of engaging in delivery care as a registered midwife at a delivery-handling medical institution providing services covered by health insurance or a designated birthing center for three or more years.

An administrator of a designated birthing center must, pursuant to Order of the Ministry of Health, Labour and Welfare, in order to ensure the efficient provision of appropriate delivery care, supervise the midwives and other employees working at the designated birthing center and exercise necessary care in the management and operation of the designated birthing center.

The registration under Article 98-4 is made upon application by a midwife.

In the case where an application under the preceding paragraph is filed, the Minister of Health, Labour and Welfare may refuse to make the registration under Article 98-4 if any of the following items applies.

the applicant is a person whose registration under Article 98-4 has been revoked pursuant to the provisions of this Act and for whom five years have not elapsed from the date of the revocation;

the applicant has been sentenced to a fine pursuant to the provisions of this Act or other laws concerning citizens' health and medical care which are specified by Cabinet Order, and the execution of the sentence has not been completed or the applicant has not ceased to be subject to execution;

the applicant has been sentenced to imprisonment or a more severe penalty and the execution of the sentence has not been completed or the execution of the sentence still applies; or

beyond what is provided for in the preceding three items, the applicant is deemed significantly inappropriate as a registered midwife.

If the Minister of Health, Labour and Welfare determines not to make the registration under Article 98-4, the Minister must undergo discussion at the local social insurance medical council.

In addition to what is prescribed in paragraph (1) or (2), necessary matters concerning the registration under Article 98-4 are specified by Cabinet Order.

A registered midwife engaged in delivery care at a delivery-handling medical institution providing services covered by health insurance or a designated birthing center must, pursuant to Order of the Ministry of Health, Labour and Welfare, provide delivery care under health insurance.

A registered midwife engaged in delivery care at a delivery-handling medical institution providing services covered by health insurance or a designated birthing center is to, in addition to what is provided pursuant to the preceding paragraph (including when applied mutatis mutandis pursuant to Article 98-24, paragraph (2), Article 112-2, paragraph (3) and Article 149), provide delivery care under the medical insurance laws other than this act.

A designated birthing center may decline its designation by giving notice not less than one month in advance.

A registered midwife may request deregistration by giving notice not less than one month in advance.

The Minister of Health, Labour and Welfare may rescind the designation under Article 98-2, paragraph (1), item (i) pertaining to the relevant designated birthing center in the case where any of the following items applies.

a registered midwife engaged in delivery care at the designated birthing center has violated the provisions of Article 98-13, paragraph (1) (including when applied mutatis mutandis pursuant to Article 98-24, paragraph (2), Article 112-2, paragraph (3) and Article 149) (except if the designated birthing center had made efforts to provide reasonable care and supervision so as to prevent the violation);

the administrator of the designated birthing center has violated the provisions of Article 98-11, paragraph (2) (except if the administrator had made efforts to provide reasonable care and supervision as the administrator of the designated birthing center so as to prevent the violation);

beyond what is provided for in the preceding two items, the designated birthing center has violated the provisions of Article 98-10, paragraph (1) (including when applied mutatis mutandis pursuant to Article 98-24, paragraph (2), Article 112-2, paragraph (3) and Article 149);

there has been fraud in a claim relating to payment pursuant to the provisions of Article 98-2, paragraph (3) (including when applied mutatis mutandis pursuant to Article 98-24, paragraph (2), Article 112-2, paragraph (3) and Article 149) or Article 101, paragraph (2) (including when applied mutatis mutandis pursuant to Article 106, paragraph (2), Article 114, paragraph (2) and Article 149);

the designated birthing center is ordered to make a report, or to submit or present medical records, birth records or other books and documents pursuant to the provisions of Article 98-20, paragraph (1) (including when applied mutatis mutandis pursuant to Article 98-24, paragraph (2), Article 112-2, paragraph (3) and Article 149; the same applies in the following item) but fails to comply with the order or submits a false report;

the establisher or an employee of the designated birthing center has been requested to appear pursuant to the provisions of Article 98-20, paragraph (1) but failed to comply, failed to answer questions pursuant to the provisions of the same paragraph, answered untruthfully, or refused, obstructed, or evaded an inspection pursuant to the same paragraph (except if, where an employee of the designated birthing center did that act, the designated birthing center had made efforts to provide reasonable care and supervision so as to prevent that act);

the establisher of the designated birthing center has violated an order pursuant to the provisions of Article 98-23, paragraph (3) (including when applied mutatis mutandis pursuant to Article 98-24, paragraph (2), Article 106, paragraph (2), Article 112-2, paragraph (3), Article 114, paragraph (2) and Article 149);

in relation to delivery care pertaining to delivery expenses under the medical insurance laws other than this act, there has been a ground corresponding to any of the preceding items;

the establisher or administrator of the designated birthing center has come to fall under the category of a person who has been sentenced to a fine pursuant to the provisions of this Act or other laws concerning citizens' health and medical care which are specified by Cabinet Order, and for whom the execution of the sentence has not been completed or who has not ceased to be subject to execution; or

the establisher or administrator of the designated birthing center has come to fall under the category of a person who has been sentenced to imprisonment or a more severe penalty, and for whom the execution of the sentence has not been completed or who has not ceased to be subject to execution.

beyond what is provided for in the preceding items, the establisher of the designated birthing center has violated the provisions of this Act or other laws concerning citizens' health and medical care which are specified by Cabinet Order, or an order or disposition based thereon.