Long-Term Care Insurance Act

A Municipality, when providing a Certification of Needed Long-Term Care; a Renewal of Certification of Needed Long-Term Care; a Certification of Change of Category of Condition of Need for Long-Term Care pursuant to the provisions of Article 27, paragraph (7) or Article 30, paragraph (1) as applied mutatis mutandis pursuant to Article 29, paragraph (2); a Certification of Needed Support; a Renewal of Certification of Needed Support; a Certification of Change of Category of Needed Support Condition pursuant to the provisions of Article 32, paragraph (6) or Article 33-3, paragraph (1) as applied mutatis mutandis pursuant to Article 33-2, paragraph (2); (hereinafter simply referred to as "Certification" in this paragraph) may specify the type of services to be performed for an Insured Person pertaining to said Certification, including In-Home Service pertaining to Allowance for In-Home Long-Term Care Service or Exceptional Allowance for In-Home Long-Term Care Service, Community-Based Service pertaining to Allowance for Community-Based Long-Term Care Service or Exceptional Allowance for Community-Based Long-Term Care Service, Facility Service pertaining to Allowance for Long-Term Care Facility Service or Exceptional Allowance for Long-Term Care Facility Service, Preventive Long-Term Care Service pertaining to Allowance for Preventive Long-Term Care Service or Exceptional Allowance for Preventive Service of Long-Term Care, or Community-Based Service for Preventive Long-Term Care pertaining to Allowance for Community-Based Preventive Long-Term Care Service, or Exceptional Allowance for Community-Based Preventive Service of Long-Term Care, based on the opinion of the Certification Committee pertaining to the matter listed in Article 27, paragraph (5), item (i) (including a case it is applied mutatis mutandis pursuant to Article 28, paragraph (4), Article 29, paragraph (2), or Article 30, paragraph (2)) or Article 32, paragraph (4), item (i) (including a case it is applied mutatis mutandis pursuant to Article 33, paragraph (4), Article 33-2, paragraph (2), or Article 33-3, paragraph (2)). In this case, the Municipality is to enter on the Certificate of Insured Person of said Insured Person the type of services pertaining to said specification including In-Home Service, Community-Based Service, Facility Service, Preventive Long-Term Care Service, or Community-Based Service for Preventive Long-Term Care together with an entry pursuant to the provisions of Article 27, paragraph (7) second sentence (including a case it is applied mutatis mutandis pursuant to Article 28, paragraph (4) or Article 29, paragraph (2)), Article 30, paragraph (1), second sentence, Article 35, paragraph (4), second sentence, or Article 32, paragraph (6) second sentence (including a case it is applied mutatis mutandis pursuant to Article 33, paragraph (4) or Article 33-2, paragraph (2)), Article 33-3, paragraph (1) second sentence, Article 35, paragraph (2), second sentence, or paragraph (6), second sentence.

An Insured Person specified pursuant to the provisions of the preceding paragraph, first sentence, may apply for a change of type of services pertaining to said specification including In-Home Service, Community-Based Service, Facility Service, Preventive Long-Term Care Service, or Community-Based Service for Preventive Long-Term Care.

The application as prescribed in the preceding paragraph is to be submitted with the Certificate of Insured Person, pursuant to the provisions of Order of the Ministry of Health, Labour, and Welfare.

In a case when the application as set forth in paragraph (2) is submitted, a Municipality, pursuant to the provisions of Order of the Ministry of Health, Labour, and Welfare, when it hears the opinion of the Certification Committee and determines it necessary, may change the type of services pertaining to said specification including In-Home Service, Community-Based Service, Facility Service, Preventive Long-Term Care Service, or Community-Based Service for Preventive Long-Term Care.

When a Municipality, with regard to an Insured Person pertaining to the application as set forth in paragraph (2), has changed the type of services pertaining to the specification pursuant to the provisions of paragraph (1), first sentence, including In-Home Service, Community-Based Service, Facility Service, Preventive Long-Term Care Service, or Community-Based Service for Preventive Long-Term Care pursuant to the provisions of the preceding paragraph, it is to notify said Insured Person of said result, enter the type of services, including In-Home Service, Community-Based Service, Facility Service, Preventive Long-Term Care Service, or Community-Based Service for Preventive Long-Term Care after amending the Certificate of Insured Person of said Insured Person, and return the Certificate of Insured Person to the Insured Person.

A prefecture, with regard to affairs pursuant to the provisions of Article 27 to Article 35 and the preceding Article that a Municipality performs, may cooperate regarding technical matters at public aid office (those offices regarding public aid provided by the Social Welfare Act (Act No. 45 of 1951)) or a health center, and provide other necessary assistance to a Municipality.

Pursuant to the provisions of Article 252-14, paragraph (1) of the Local Autonomy Act, a Prefectural Certification Committee of Needed Long-Term Care is to be established by entrustment from a Municipality, in order for the prefecture to perform examinations and judgments (operations that a Certification Committee performs pursuant to the provisions of Article 27 to Article 35 and the preceding Article; the same shall apply hereinafter in this Article).

The provisions of Article 15 and Article 17 apply mutatis mutandis to a Prefectural Certification Committee of Needed Long-Term Care as prescribed in the preceding paragraph. In this case, the phrase "mayor of a Municipality ("ward mayor" for special city wards; the same applies hereinafter)" in Article 15 is deemed to be replaced with "prefectural governor."

With regard to a Municipality that entrusts examinations and judgments to a prefecture, in a case of applying the provisions of Article 27 (including a case applied mutatis mutandis pursuant to Article 28, paragraph (4), Article 29, paragraph (2), Article 30, paragraph (2), Article 31, paragraph (2) or Article 32, paragraph (5)), Article 30, Article 32 (including a case applied mutatis mutandis pursuant to Article 33, paragraph (4), Article 33-2, paragraph (2), Article 33-3, paragraph (2), or Article 34, paragraph (2)), Article 33-3 or Article 35 to the preceding Article, the term "Certification Committee" is deemed to be replaced with "Prefectural Certification Committee of Needed Long-Term Care."

In addition to those matters provided by this Section, an application for Certification of Needed Long-Term Care and Certification of Needed Support, and other procedures necessary matters are specified by Order of the Ministry of Health, Labour, and Welfare.

A Long-Term Care Benefit is to be any of the insurance benefits listed below:

payment of an Allowance for In-Home Long-Term Care Service;

payment of an Exceptional Allowance for In-Home Long-Term Care Service;

payment of an Allowance for Community-Based Long-Term Care Service;

payment of an Exceptional Allowance for Community-Based Long-Term Care Service;

payment of an Allowance for Purchasing Equipment for In-Home Long-Term Care Covered by Public Aid;

payment of an Allowance for Home Modification for In-Home Long-Term Care;

payment of an Allowance for In-Home Long-Term Care Service Plan;

payment of an Exceptional Allowance for an In-Home Long-Term Care Service Plan;

payment of an Allowance for Long-Term Care Facility Service;

payment of an Exceptional Allowance for Long-Term Care Facility Service;

payment of an Allowance for High-Cost Long-Term Care Service;

payment of an Allowance for High-Cost Medical and Long-Term Care Service Combined;

payment of an Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility;

payment of an Exceptional Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility.

A Municipality, when an Insured Person that receives long-term care at his or her home (herein referred to as "Insured In-Home Person Requiring Long-Term Care") among persons who have obtained a Certification of Needed Long-Term Care (herein referred to as "Insured Person Requiring Long-Term Care") receives from a person designated by prefectural governor (hereinafter referred to as "Designated In-Home Service Provider") an In-Home Service provided by an appointed provider that performs In-Home Service Business pertaining to said specification (herein referred to as "Designated In-Home Service"), pays an Allowance for In-Home Long-Term Care Service to said Insured In-Home Person Requiring Long-Term Care regarding expenses required for said Designated In-Home Service (except for expenses required for purchase of Specified Equipment Covered by Public Aid, and excluding the expenses necessary to provide meals, residence, and other expenses as determined by Order of the Ministry of Health, Labour, and Welfare as necessary for daily life with regard to the expenses required for Outpatient Day Long-Term Care, Outpatient Rehabilitation, a Short-Term Admission for Daily Life Long-Term Care, Short-Term Admission for Recuperation, and Daily Life Long-Term Care Admitted to a Specified Facility; the same applies hereinafter in this Act), however, provided that this provision does not apply to a case when said Insured In-Home Person Requiring Long-Term Care is specified pursuant to the provisions of Article 37, paragraph (1) and the Person receives In-Home Service other than the type pertaining to said specification.

An Allowance for In-Home Long-Term Care Service, pursuant to the provisions of Order of the Ministry of Health, Labour, and Welfare, are to be paid only when a Municipality determines that it is necessary.

An Insured In-Home Person Requiring Long-Term Care who intends to receive Designated In-Home Service pursuant to the provisions of Order of the Ministry of Health, Labour, and Welfare is to present a Certificate of Insured Person to the Designated In-Home Service Provider that said Insured Person selects and will receive said Designated In-Home Service.

The amount of Allowance for In-Home Long-Term Care Service is to be the amount provided by each of the following items according to the category of In-Home Service listed in the said items:

the amount equivalent to 90 percent of the expenses calculated based on the standards provided by the Minister of Health, Labour, and Welfare (the actual expenses required for Designated In-Home Service in a case when the standard amount exceeds the actual expenses required for said Designated In-Home Service) by considering the average expenses required for said Designated In-Home Service calculated by considering the content of Designated In-Home Service pertaining to the type of said In-Home Service, the area where the provider that performs said Designated In-Home Service business is located, etc. (with regard to the expenses necessary for Outpatient Day Long-Term Care and Outpatient Rehabilitation, excluding the expenses necessary to provide meals, residence, and other necessary expenses for daily life as determined by Order of the Ministry of Health, Labour, and Welfare), according to by the type of In-Home Service including Home-Visit Long-Term Care, Home-Visit Bathing Long-Term Care, Home-Visit Nursing, Home-Visit Rehabilitation, Guidance for Management of In-Home Medical Long-Term Care, Outpatient Day Long-Term Care, Outpatient Rehabilitation, and Rental Service of Equipment for Long-Term Care Covered by Public Aid;

the amount equivalent to 90 percent of the expenses calculated based on the standards provided by the Minister of Health, Labour, and Welfare (the actual expenses required for Designated In-Home Service in a case when the standard amount exceeds the actual expenses required for said Designated In-Home Service) by considering the average expenses required for said Designated In-Home Service calculated by considering the Category of Needed Support Condition, , the area where the provider that performs said Designated In-Home Service Business pertaining to the type of said In-Home Service is located, etc. (excluding the expenses necessary to provide meals, residence, and other necessary expenses for daily life as determined by Order of the Ministry of Health, Labour, and Welfare), according to by the type of In-Home Service including a Short-Term Admission for Daily Life Long-Term Care, Short-Term Admission for Recuperation, and Daily Life Long-Term Care Admitted to a Specified Facility.

The Minister of Health, Labour, and Welfare, when it intends to determine the standards as prescribed in the items of the preceding paragraph, must hear the opinion of the Social Security Council in advance.

When an Insured In-Home Person Requiring Long-Term Care is provided Designated In-Home Service (limited to a case when said Insured In-Home Person Requiring Long-Term Care has notified the Municipality to receive Designated In-Home Long-Term Care Support pursuant to the provisions of Article 46, paragraph (4) in advance, that said Designated In-Home Service is subject to said Designated In-Home Long-Term Care Support and other cases as determined by Order of the Ministry of Health, Labour, and Welfare) by a Designated In-Home Service Provider, the Municipality may pay expenses required for said Designated In-Home Service that said Insured In-Home Person Requiring Long-Term Care should pay to said Designated In-Home Service Provider on behalf of said Insured In-Home Person Requiring Long-Term Care to said Designated In-Home Service Provider within the specified limit of the amount that should be paid to said Insured In-Home Person Requiring Long-Term Care as Allowance for In-Home Long-Term Care Service.

When the payment pursuant to the provisions of the preceding paragraph is paid, it is to be deemed as an Allowance for In-Home Long-Term Care Service that has been paid to an Insured In-Home Person Requiring Long-Term Care.

A Designated In-Home Service Provider, when accepting payment of the expenses required for providing the Designated In-Home Service and other services, must deliver a receipt to the Insured In-Home Person Requiring Long-Term Care who made said payment, pursuant to the provisions of Order of the Ministry of Health, Labour, and Welfare.

A Municipality, when a Designated In-Home Service Provider requests an Allowance for In-Home Long-Term Care Service, is to pay said allowance after conducting an examination according to standards provided by the Minister of Health, Labour, and Welfare as prescribed in the each item of paragraph (4) and the standards of facilities and management of Designated In-Home Service Business as prescribed in Article 74, paragraph (2) (limited to the part regarding the handling of Designated In-Home Service).

A Municipality may entrust an examination and payment affairs prescribed in the preceding paragraph to an Association.

An Association that undertakes entrustment pursuant to the provisions of the preceding paragraph, after obtaining the consent of the Municipality that delegated said entrustment and pursuant to the provisions of Order of the Ministry of Health, Labour, and Welfare, may entrust a part of the affairs that are under said entrustment to a not-for-profit juridical person that qualifies with requirements as determined by Order of the Ministry of Health, Labour, and Welfare.

In addition to the provisions of the preceding paragraphs, necessary matters for payment of an Allowance for In-Home Long-Term Care Service and a request for an Allowance for In-Home Long-Term Care Service by a Designated In-Home Service Provider are prescribed by Order of the Ministry of Health, Labour, and Welfare.