When an insured person receives, from a person designated by the Minister of Health, Labour and Welfare (hereinafter referred to as a "designated home-nursing provider"), care for medical treatment or necessary assistance with medical treatment provided at the home of a person who is in a condition of continuing to receive medical treatment at home due to sickness or injury (limited to a person whom the attending physician finds to conform to the standards specified by Order of the Ministry of Health, Labour and Welfare as to the degree of necessity for treatment) by a nurse or other person specified by Order of the Ministry of Health, Labour and Welfare (excluding that provided by a medical institution providing services covered by health insurance, etc., or a long-term care health facility prescribed in Article 8, paragraph (28) of the Long-Term Care Insurance Act or a long-term care medical institution prescribed in paragraph (29) of that Article; hereinafter referred to as "home-nursing") that is provided by an office operating the home-nursing business pertaining to that designation (meaning the business of providing home-nursing) (hereinafter referred to as "designated home nursing"), medical expenses for home-nursing are paid to the insured person for the expenses required for that designated home nursing.
被保険者が、厚生労働大臣が指定する者（以下「指定訪問看護事業者」という。）から当該指定に係る訪問看護事業（疾病又は負傷により、居宅において継続して療養を受ける状態にある者（主治の医師がその治療の必要の程度につき厚生労働省令で定める基準に適合していると認めたものに限る。）に対し、その者の居宅において看護師その他厚生労働省令で定める者が行う療養上の世話又は必要な診療の補助（保険医療機関等又は介護保険法第八条第二十八項に規定する介護老人保健施設若しくは同条第二十九項に規定する介護医療院によるものを除く。以下「訪問看護」という。）を行う事業をいう。）を行う事業所により行われる訪問看護（以下「指定訪問看護」という。）を受けたときは、その指定訪問看護に要した費用について、訪問看護療養費を支給する。
The medical expenses for home-nursing referred to in the preceding paragraph are paid only if the insurer finds it necessary pursuant to Order of the Ministry of Health, Labour and Welfare.
前項の訪問看護療養費は、厚生労働省令で定めるところにより、保険者が必要と認める場合に限り、支給するものとする。
A person who intends to receive designated home nursing is to, as specified by Order of the Ministry of Health, Labour and Welfare, receive confirmation of being an insured person by electronic eligibility confirmation, etc. from the designated home-nursing provider that the person selects, and receive that designated home nursing.
The amount of expenses for home nursing is calculated by deducting, from the amount specified by the Minister of Health, Labour and Welfare for the home nursing taking into account the average expenses required for home-nursing, the amount obtained by multiplying the specified amount by the applicable ratio specified in an item of Article 74, paragraph (1) (if any of the measures listed in the items of Article 75-2, paragraph (1) need to be taken with respect to the co-payment referred to in the same paragraph for benefits for medical treatment, the amount calculated as if the relevant measures were taken), in accordance with the classifications listed in the items of the same paragraph.
訪問看護療養費の額は、当該指定訪問看護につき指定訪問看護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ところにより算定した費用の額から、その額に第七十四条第一項各号に掲げる場合の区分に応じ、同項各号に定める割合を乗じて得た額（療養の給付に係る同項の一部負担金について第七十五条の二第一項各号の措置が採られるべきときは、当該措置が採られたものとした場合の額）を控除した額とする。
When intending to specify the matters 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、前項の定めをしようとするときは、中央社会保険医療協議会に諮問するものとする。
When an insured person has received designated home-nursing from a designated home-nursing provider, the insurer may, on behalf of the relevant insured person, pay to the designated home-nursing provider expenses incurred in the designated home-nursing payable by the insured person to the designated home-nursing provider, within the limit of the amount payable to the insured person as medical expenses for home-nursing.
When a payment pursuant to the provisions of the preceding paragraph is made, it is deemed that medical expenses for home-nursing are paid to the insured person.
The provisions of Article 75 apply mutatis mutandis to the payment of the amount calculated by deducting, from the amount of expenses calculated pursuant to the provisions of paragraph (4) in the case referred to in paragraph (6), the amount payable as medical expenses for home-nursing with respect to expenses incurred in the relevant designated home-nursing.
Upon acceptance of the payment of expenses incurred in designated home-nursing, the designated home-nursing provider must issue a receipt therefor to the insured person who made the payment, pursuant to Order of the Ministry of Health, Labour and Welfare.
When requested to pay medical expenses for home-nursing expenses by a designated home-nursing provider, an insurer is to conduct an examination in light of the matters prescribed in paragraph (4) and standards for operations in home-nursing prescribed in Article 92, paragraph (2) (limited to the part regarding the handling of designated home-nursing).
An insurer may delegate affairs concerning the examination and payment pursuant to the provisions of the preceding paragraph to the Infrastructure Organization or an NHI federation.
No designated home-nursing is to be included in any of the types of medical treatment listed in the items of Article 63, paragraph (1).
Beyond what is provided for in the provisions of the preceding paragraphs, necessary matters concerning requests for medical expenses for home-nursing by a designated home-nursing provider are specified by Order of the Ministry of Health, Labour and Welfare.
Read this with the articles around it
(Benefits for Medical Treatment)
With regard to sickness and injury of insured persons, benefits for medical treatment are paid as listed below:
被保険者の疾病又は負傷に関しては、次に掲げる療養の給付を行う。
Open this provision(Amount of Co-Payment)
A person who receives benefits for medical treatment from a medical institution providing services covered by health insurance or a pharmacy providing services covered by health insurance pursuant to…
第六十三条第三項の規定により保険医療機関又は保険薬局から療養の給付を受ける者は、その給付を受ける際、次の各号に掲げる場合の区分に応じ、当該給付につき第七十六条第二項又は第三項の規定により算定した額に当該各号に定める割合を乗じて得た額を、一部負担金として、当該保険医療機関又は保険薬局に支払わなければならない。
Open this provisionWhen co-payment is made pursuant to the provisions of paragraph (1) of the preceding Article, if the amount of co-payment referred to in the same paragraph is a figure with less than five…
前条第一項の規定により一部負担金を支払う場合においては、同項の一部負担金の額に五円未満の端数があるときは、これを切り捨て、五円以上十円未満の端数があるときは、これを十円に切り上げるものとする。
Open this provision(Special Provisions for the Amount of Co-payment)
An insurer may take any of the following measures with respect to an insured person who is in a disaster or other special circumstances specified by Order of the Ministry of Health…
保険者は、災害その他の厚生労働省令で定める特別の事情がある被保険者であって、保険医療機関又は保険薬局に第七十四条第一項の規定による一部負担金を支払うことが困難であると認められるものに対し、次の措置を採ることができる。
Open this provision(Medical Expenses for Home-Nursing)
When an insured person receives, from a person designated by the Minister of Health, Labour and Welfare (hereinafter referred to as a "designated home-nursing provider")…
被保険者が、厚生労働大臣が指定する者（以下「指定訪問看護事業者」という。）から当該指定に係る訪問看護事業（疾病又は負傷により、居宅において継続して療養を受ける状態にある者（主治の医師がその治療の必要の程度につき厚生労働省令で定める基準に適合していると認めたものに限る。）に対し、その者の居宅において看護師その他厚生労働…
Open this provision(Medical Expenses for Home-Nursing)
When requested to pay medical expenses for home-nursing expenses by a designated home-nursing provider, an insurer is to conduct an examination in light of the matters prescribed in paragraph (4) and…
保険者は、指定訪問看護事業者から訪問看護療養費の請求があったときは、第四項の定め及び第九十二条第二項に規定する指定訪問看護の事業の運営に関する基準（指定訪問看護の取扱いに関する部分に限る。）に照らして審査の上、支払うものとする。
Open this provision(Medical Expenses for Home-Nursing)
An insurer may delegate affairs concerning the examination and payment pursuant to the provisions of the preceding paragraph to the Infrastructure Organization or an NHI federation.
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基盤機構又は国保連合会に委託することができる。
Open this provision(Medical Expenses for Home-Nursing)
No designated home-nursing is to be included in any of the types of medical treatment listed in the items of Article 63, paragraph (1).
指定訪問看護は、第六十三条第一項各号に掲げる療養に含まれないものとする。
Open this provision(Medical Expenses for Home-Nursing)
The medical expenses for home-nursing referred to in the preceding paragraph are paid only if the insurer finds it necessary pursuant to Order of the Ministry of Health, Labour and Welfare.
前項の訪問看護療養費は、厚生労働省令で定めるところにより、保険者が必要と認める場合に限り、支給するものとする。
Open this provision(Medical Expenses for Home-Nursing)
A person who intends to receive designated home nursing is to, as specified by Order of the Ministry of Health, Labour and Welfare, receive confirmation of being an insured person by electronic…
指定訪問看護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、自己の選定する指定訪問看護事業者から、電子資格確認等により、被保険者であることの確認を受け、当該指定訪問看護を受けるものとする。
Open this provision(Medical Expenses for Home-Nursing)
The amount of expenses for home nursing is calculated by deducting, from the amount specified by the Minister of Health, Labour and Welfare for the home nursing taking into account the average…
訪問看護療養費の額は、当該指定訪問看護につき指定訪問看護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ところにより算定した費用の額から、その額に第七十四条第一項各号に掲げる場合の区分に応じ…
Open this provision(Medical Expenses for Home-Nursing)
When intending to specify the matters 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、前項の定めをしようとするときは、中央社会保険医療協議会に諮問するものとする。
Open this provision(Medical Expenses for Home-Nursing)
When an insured person has received designated home-nursing from a designated home-nursing provider, the insurer may, on behalf of the relevant insured person…
被保険者が指定訪問看護事業者から指定訪問看護を受けたときは、保険者は、その被保険者が当該指定訪問看護事業者に支払うべき当該指定訪問看護に要した費用について、訪問看護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、当該指定訪問看護事業者に支払うことができる。
Open this provision(Medical Expenses for Home-Nursing)
When a payment pursuant to the provisions of the preceding paragraph is made, it is deemed that medical expenses for home-nursing are paid to the insured person.
前項の規定による支払があったときは、被保険者に対し訪問看護療養費の支給があったものとみなす。
Open this provision(Medical Expenses for Home-Nursing)
The provisions of Article 75 apply mutatis mutandis to the payment of the amount calculated by deducting, from the amount of expenses calculated pursuant to the provisions of paragraph (4) in the…
第七十五条の規定は、第六項の場合において第四項の規定により算定した費用の額から当該指定訪問看護に要した費用について訪問看護療養費として支給される額に相当する額を控除した額の支払について準用する。
Open this provision(Medical Expenses for Home-Nursing)
Upon acceptance of the payment of expenses incurred in designated home-nursing, the designated home-nursing provider must issue a receipt therefor to the insured person who made the payment…
指定訪問看護事業者は、指定訪問看護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(Standards for Operations in Designated Home-Nursing Services)
Beyond what is provided for in the preceding paragraph, standards for operations of a designated home-nursing business are provided for by the Minister of Health, Labour, and Welfare.
前項に規定するもののほか、指定訪問看護の事業の運営に関する基準は、厚生労働大臣が定める。
Open this provisionThe term "Long-Term Care Health Facility" as used in this Act means a facility which has obtained permission from the prefectural governor as set forth in Article 94…
この法律において「介護老人保健施設」とは、要介護者であって、主としてその心身の機能の維持回復を図り、居宅における生活を営むことができるようにするための支援が必要である者（その治療の必要の程度につき厚生労働省令で定めるものに限る。以下この項において単に「要介護者」という。）に対し、施設サービス計画に基づいて、看護…
Open this provisionThe term "integrated facility for medical and long-term care" as used in this Act means a facility which has obtained permission from the prefectural governor as set forth in Article 107…
この法律において「介護医療院」とは、要介護者であって、主として長期にわたり療養が必要である者（その治療の必要の程度につき厚生労働省令で定めるものに限る。以下この項において単に「要介護者」という。）に対し、施設サービス計画に基づいて、療養上の管理、看護…
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
medical institution providing services covered by health insurance, etc.machine translation
「保険医療機関等」
The hospitals, clinics and pharmacies listed in Article 63, paragraph (3) from which insured persons receive benefits for medical treatment (療養の給付): those designated by the Minister of Health, Labour and Welfare, those an insurer designates for the persons it insures, and those a health insurance society (健康保険組合) runs as insurer.
Defined inArticle 3, paragraph (13)
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)
NHI federationmachine translation
「国保連合会」
A federation of national health insurance associations (国民健康保険団体連合会) as provided in Article 45, paragraph (5) of the National Health Insurance Act, to which an insurer may entrust the review and payment of claims for medical fees from medical institutions and pharmacies providing services covered by health insurance.
Short name set inArticle 76, paragraph (5)
Infrastructure Organizationmachine translation
「基盤機構」
The Medical Information Infrastructure and Medical Fee Review and Payment Organization (医療情報基盤・診療報酬審査支払機構), established under Act No. 129 of 1948, to which an insurer may entrust the review and payment of claims for medical fees from medical institutions and pharmacies providing services covered by health insurance.
Short name set inArticle 76, paragraph (5)
designated home nursingmachine translation
「指定訪問看護」
Home-visit nursing (訪問看護) given by a designated home-nursing provider (指定訪問看護事業者) at its place of business covered by the designation, for which insured persons receive medical expenses for home-nursing (訪問看護療養費).
Short name set inArticle 88, paragraph (1)
designated home-nursing providermachine translation
「指定訪問看護事業者」
A provider the Minister of Health, Labour and Welfare has designated to run a home-visit nursing business: nursing care or help with medical treatment given at home by nurses and others a Ministry of Health, Labour and Welfare Order (厚生労働省令) names to people under continuing treatment at home for an illness or injury whom their doctor finds meet the Order's standard.
Short name set inArticle 88, paragraph (1)
home-nursingmachine translation
「訪問看護」
Care during treatment (療養上の世話) or necessary assistance with medical care that a nurse or another person a Ministry of Health, Labour and Welfare Order (厚生労働省令) specifies gives at home to someone who, because of illness or injury, is being treated at home on a continuing basis and whose attending physician finds they meet that Order's criteria for the need for treatment — but not such care given by a medical institution or pharmacy covered by health insurance (保険医療機関等), a long-term care health facility (介護老人保健施設) or an integrated facility for medical and long-term care (介護医療院).
Short name set inArticle 88, paragraph (1)