Living support expenses for inpatients are paid to an insured person undergoing special long-term hospitalization who, pursuant to Order of the Ministry of Health, Labour and Welfare, has received from a hospital or clinic that the person selected from those listed in the items of Article 63, paragraph (3) confirmation of being an insured person by electronic eligibility confirmation, etc., for expenses required for living support that the person received along with benefits for medical treatment listed in Article 63, paragraph (1), item (v).
The amount of living support expenses for inpatients is the amount obtained by deducting the amount specified by the Minister of Health, Labor and Welfare taking into consideration an amount equivalent to the amount of base cost for meal expenses prescribed in Article 51-3, paragraph (2), item (i) of the Long-Term Care Insurance Act and the amount of base cost for residence expenses prescribed in item (ii) of the same paragraph with regard to the status of food expenses for an average household budget and fuel, lighting and water charges as well as expenses required for living support at hospitals and clinics from the amount calculated based on standards specified by the Minister of Health, Labour and Welfare taking into account the average amount of expenses required for the living support (when the calculated amount exceeds the amount of expenses actually incurred in the living support, the amount of expenses actually incurred in the living support) (for a person specified by Order of the Ministry of Health, Labor and Welfare in consideration of income status, extent of symptoms, contents of medical treatment, and other circumstances, a separately determined amount; hereinafter referred to as "standard co-payment for living support").
入院時生活療養費の額は、当該生活療養につき生活療養に要する平均的な費用の額を勘案して厚生労働大臣が定める基準により算定した費用の額（その額が現に当該生活療養に要した費用の額を超えるときは、当該現に生活療養に要した費用の額）から、平均的な家計における食費及び光熱水費の状況並びに病院及び診療所における生活療養に要する費用について介護保険法第五十一条の三第二項第一号に規定する食費の基準費用額及び同項第二号に規定する居住費の基準費用額に相当する費用の額を勘案して厚生労働大臣が定める額（所得の状況、病状の程度、治療の内容その他の事情をしん酌して厚生労働省令で定める者については、別に定める額。以下「生活療養標準負担額」という。）を控除した額とする。
When intending to specify the standards referred to in the preceding paragraph, the Minister of Health, Labour, and Welfare is to consult with the Central Social Insurance Medical Council.
厚生労働大臣は、前項の基準を定めようとするときは、中央社会保険医療協議会に諮問するものとする。
If the circumstances to be taken into consideration have changed significantly since the Minister of Health, Labour, and Welfare determined the amount of standard co-payment for living support, the minister must promptly revise the amount.
厚生労働大臣は、生活療養標準負担額を定めた後に勘案又はしん酌すべき事項に係る事情が著しく変動したときは、速やかにその額を改定しなければならない。
The provisions of Article 64, Article 70, paragraph (1), Article 72, paragraph (1), Article 73, Article 76, paragraphs (3) through (6), Article 78, Article 84, paragraph (1), and paragraphs (5) through (8) of the preceding Article apply mutatis mutandis to payment of living support received at or from a hospital or clinic listed in the items of Article 63, paragraph (3) and living support expenses for inpatients associated with the living support.
第六十四条、第七十条第一項、第七十二条第一項、第七十三条、第七十六条第三項から第六項まで、第七十八条、第八十四条第一項及び前条第五項から第八項までの規定は、第六十三条第三項各号に掲げる病院又は診療所から受けた生活療養及びこれに伴う入院時生活療養費の支給について準用する。
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(Benefits for Medical Treatment)
hospitalization or visiting a clinic, and care and other nursing involved in medical treatment provided there.
病院又は診療所への入院及びその療養に伴う世話その他の看護
Open this provision(Benefits for Medical Treatment)
A person who intends to receive benefits under paragraph (1) is, pursuant to Order of the Ministry of Health, Labour and Welfare, to receive confirmation that the person is an insured person from a…
第一項の給付を受けようとする者は、厚生労働省令で定めるところにより、次に掲げる病院若しくは診療所又は薬局のうち、自己の選定するものから、電子資格確認その他厚生労働省令で定める方法（以下「電子資格確認等」という。）により、被保険者であることの確認を受け、同項の給付を受けるものとする。
Open this provision(Physicians Providing Health Insurance Treatment or Pharmacists Filling Health Insurance Prescriptions)
A physician or dentist engaged in medical treatment covered by health insurance at a medical institution providing services covered by health insurance or a pharmacist engaged in prescription covered…
保険医療機関において健康保険の診療に従事する医師若しくは歯科医師又は保険薬局において健康保険の調剤に従事する薬剤師は、厚生労働大臣の登録を受けた医師若しくは歯科医師（以下「保険医」と総称する。）又は薬剤師（以下「保険薬剤師」という。）でなければならない。
Open this provision(Responsibilities of Medical Institutions Providing Services Covered by Health Insurance or Pharmacies Providing Services Covered by Health Insurance)
A medical institution providing services covered by health insurance or a pharmacy providing services covered by health insurance must put physicians providing health insurance treatment who are…
保険医療機関又は保険薬局は、当該保険医療機関において診療に従事する保険医又は当該保険薬局において調剤に従事する保険薬剤師に、第七十二条第一項の厚生労働省令で定めるところにより、診療又は調剤に当たらせるほか、厚生労働省令で定めるところにより、療養の給付を担当しなければならない。
Open this provision(Responsibilities of Physicians Providing Health Insurance Treatment or Pharmacists Filling Health Insurance Prescriptions)
A physician providing health insurance treatment at a medical institution providing services covered by health insurance or a pharmacist filling health insurance prescriptions at a pharmacy providing…
保険医療機関において診療に従事する保険医又は保険薬局において調剤に従事する保険薬剤師は、厚生労働省令で定めるところにより、健康保険の診療又は調剤に当たらなければならない。
Open this provision(Guidance by the Minister of Health, Labour and Welfare)
A medical institution providing services covered by health insurance or a pharmacy providing services covered by health insurance, and the physician providing health insurance treatment or the…
保険医療機関及び保険薬局は療養の給付に関し、保険医及び保険薬剤師は健康保険の診療又は調剤に関し、厚生労働大臣の指導を受けなければならない。
Open this provision(Expenses for Benefits for Medical Treatment)
An insurer may, with the authorization of the Minister of Health, Labour and Welfare, specify otherwise in a contract with a medical institution providing services covered by health insurance or…
保険者は、厚生労働大臣の認可を受けて、保険医療機関又は保険薬局との契約により、当該保険医療機関又は保険薬局において行われる療養の給付に関する第一項の療養の給付に要する費用の額につき、前項の規定により算定される額の範囲内において、別段の定めをすることができる。
Open this provision(Expenses for Benefits for Medical Treatment)
When receiving a claim for expenses incurred in providing medical services from a medical institution providing services covered by health insurance or pharmacy providing services covered by health…
保険者は、保険医療機関又は保険薬局から療養の給付に関する費用の請求があったときは、第七十条第一項及び第七十二条第一項の厚生労働省令並びに前二項の定めに照らして審査の上、支払うものとする。
Open this provision(Expenses for Benefits for Medical Treatment)
An insurer may delegate affairs concerning the examination and payment pursuant to the provisions of the preceding paragraph to the Medical Information Infrastructure and Medical Fee Examination and…
保険者は、前項の規定による審査及び支払に関する事務を医療情報基盤・診療報酬審査支払機構法（昭和二十三年法律第百二十九号）による医療情報基盤・診療報酬審査支払機構（以下「基盤機構」という。）又は国民健康保険法第四十五条第五項に規定する国民健康保険団体連合会（以下「国保連合会」という。）に委託することができる。
Open this provision(Expenses for Benefits for Medical Treatment)
Beyond what is provided for in the preceding paragraphs, necessary matters concerning claims for expenses incurred in providing medical services at a medical institution providing services covered by…
前各項に定めるもののほか、保険医療機関又は保険薬局の療養の給付に関する費用の請求に関して必要な事項は、厚生労働省令で定める。
Open this provision(Reports by Medical Institutions Providing Services Covered by Health Insurance or Pharmacies Providing Services Covered by Health Insurance)
When the Minister of Health, Labour and Welfare finds it necessary in relation to benefits for medical treatment, the minister or governor may order a medical institution providing services covered…
厚生労働大臣は、療養の給付に関して必要があると認めるときは、保険医療機関若しくは保険薬局若しくは保険医療機関若しくは保険薬局の開設者若しくは管理者、保険医、保険薬剤師その他の従業者であった者（以下この項において「開設者であった者等」という。）に対し報告若しくは診療録その他の帳簿書類の提出若しくは提示を命じ…
Open this provision(Benefits for Medical Treatment at Hospitals Designated by Insurers)
Rules on benefits for medical treatment, and on medical care and prescription services covered by health insurance and provided by hospitals, clinics, and pharmacies listed in Article 63…
第六十三条第三項第二号及び第三号に掲げる病院若しくは診療所又は薬局において行われる療養の給付及び健康保険の診療又は調剤に関する準則については、第七十条第一項及び第七十二条第一項の厚生労働省令の例による。
Open this provision(Living Support Expenses for Inpatients)
The amount of living support expenses for inpatients is the amount obtained by deducting the amount specified by the Minister of Health, Labor and Welfare taking into consideration an amount…
入院時生活療養費の額は、当該生活療養につき生活療養に要する平均的な費用の額を勘案して厚生労働大臣が定める基準により算定した費用の額（その額が現に当該生活療養に要した費用の額を超えるときは、当該現に生活療養に要した費用の額）から…
Open this provision(Dietary Treatment Expenses for Inpatients)
When an insured person (excluding insured persons undergoing special long-term hospitalization; the same applies hereinafter in this Article) has received dietary treatment at or from a hospital or…
被保険者（特定長期入院被保険者を除く。以下この条において同じ。）が第六十三条第三項第一号又は第二号に掲げる病院又は診療所から食事療養を受けたときは、保険者は、その被保険者が当該病院又は診療所に支払うべき食事療養に要した費用について、入院時食事療養費として被保険者に対し支給すべき額の限度において、被保険者に代わり…
Open this provision(Dietary Treatment Expenses for Inpatients)
When a payment pursuant to the provisions of the preceding paragraph is paid, it is deemed that the relevant dietary treatment expenses for inpatients are paid to the insured person.
前項の規定による支払があったときは、被保険者に対し入院時食事療養費の支給があったものとみなす。
Open this provision(Dietary Treatment Expenses for Inpatients)
When an insured person receives dietary treatment from a hospital or clinic listed in Article 63, paragraph (3), item (iii), if the insurer exempts the insured person from payment of an amount…
被保険者が第六十三条第三項第三号に掲げる病院又は診療所から食事療養を受けた場合において、保険者がその被保険者の支払うべき食事療養に要した費用のうち入院時食事療養費として被保険者に支給すべき額に相当する額の支払を免除したときは、入院時食事療養費の支給があったものとみなす。
Open this provision(Dietary Treatment Expenses for Inpatients)
Upon acceptance of a payment of expenses incurred for dietary treatment, the hospital or clinic listed in the items of Article 63, paragraph (3) must issue a receipt therefor to the relevant insured…
第六十三条第三項各号に掲げる病院又は診療所は、食事療養に要した費用につき、その支払を受ける際、当該支払をした被保険者に対し、厚生労働省令で定めるところにより、領収証を交付しなければならない。
Open this provision(Payment of an Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility)
the amount after the amount determined by the Minister of Health, Labour, and Welfare after considering the status of food expenses for an average household budget…
特定介護保険施設等における食事の提供に要する平均的な費用の額を勘案して厚生労働大臣が定める費用の額（その額が現に当該食事の提供に要した費用の額を超えるときは、当該現に食事の提供に要した費用の額とする。以下この条及び次条第二項において「食費の基準費用額」という。）から…
Open this provision(Payment of an Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility)
the amount after the amount provided by the Minister of Health, Labour, and Welfare after considering the income status of the Specified Person Admitted to a Facility and other circumstances…
特定介護保険施設等における居住等に要する平均的な費用の額及び施設の状況その他の事情を勘案して厚生労働大臣が定める費用の額（その額が現に当該居住等に要した費用の額を超えるときは、当該現に居住等に要した費用の額とする。以下この条及び次条第二項において「居住費の基準費用額」という。）から…
Open this provisioninsured person
「被保険者」
A person employed at an applicable place of business (適用事業所), or an insured person with optional and continued coverage (任意継続被保険者); the persons listed in the items of Article 3, paragraph (1) — among them some temporary, seasonal and short-time workers and persons insured under late-stage elderly medical care (後期高齢者医療) — cannot be insured persons, except as specially-insured day laborers (日雇特例被保険者).
Defined inArticle 3, paragraph (1)· applies throughout the law
insured person undergoing special long-term hospitalization
「特定長期入院被保険者」
An insured person who, when receiving inpatient care in a long-term care bed (療養病床) with the care and nursing that go with it, is in or past the month after the month in which they reach 65.
Short name set inArticle 63, paragraph (2), item (i)
living support
「生活療養」
Meals, and a suitable care environment as to temperature, lighting and water supply, provided together with inpatient care (Article 63, paragraph (1), item (v)) to an insured person undergoing special long-term hospitalization (特定長期入院被保険者).
Short name set inArticle 63, paragraph (2), item (ii)
electronic eligibility confirmation, etc.machine translation
「電子資格確認等」
Electronic eligibility confirmation (電子資格確認) or another method a Ministry of Health, Labour and Welfare Order (厚生労働省令) sets, by which a person seeking medical treatment benefits (療養の給付) is confirmed as an insured person by the hospital, clinic or pharmacy of their choice among those listed in Article 63, paragraph (3).
Short name set inArticle 63, paragraph (3)
standard co-payment for living support
「生活療養標準負担額」
The amount the Minister of Health, Labour and Welfare sets, taking account of average household spending on food, heating, lighting and water and of the base costs of meals and accommodation under Article 51-3, paragraph (2) of the Long-Term Care Insurance Act, which is deducted from the cost of living support (生活療養) to give the living support expenses for inpatients (入院時生活療養費); a different amount applies to people a Ministry of Health, Labour and Welfare Order (厚生労働省令) specifies in view of their income, condition, treatment and other circumstances.
Short name set inArticle 85-2, paragraph (2)