Long-Term Care Insurance Act

In the case of applying the provisions specified in the items below to the Long-Term Care Benefit listed in each of those items that is received by an Insured Person Requiring Long-Term Care who is a Primary Insured Person and whose amount of income calculated as specified by Cabinet Order is the amount specified by Cabinet Order or more (excluding an Insured Person Requiring Long-Term Care prescribed in the following paragraph), the term "90 percent" in those provisions is deemed to be replaced with "80 percent".

payment of an Allowance for In-Home Long-Term Care Service:Article 41, paragraph (4), item (i) and item (ii), and Article 43, paragraph (1), paragraph (4) and paragraph (6);

payment of an Exceptional Allowance for In-Home Long-Term Care Service:Article 42, paragraph (3), and Article 43, paragraph (1), paragraph (4) and paragraph (6);

payment of an Allowance for Community-Based Long-Term Care Service:each item of Article 42-2, paragraph (2), and Article 43, paragraph (1), paragraph (4) and paragraph (6);

payment of an Exceptional Allowance for Community-Based Long-Term Care Service:Article 42-3, paragraph (2) and Article 43, paragraph (1), paragraph (4), and paragraph (6);

payment of an Allowance for Long-Term Care Facility Service:Article 48, paragraph (2);

payment of an Exceptional Allowance for Long-Term Care Facility Service:paragraph (2) of the preceding Article;

payment of an Allowance for Purchasing Equipment for In-Home Long-Term Care Covered by Public Aid:Article 44, paragraph (3), paragraph (4), and paragraph (7);

payment of an Allowance for Home Modification for In-Home Long-Term Care:Article 45, paragraph (3), paragraph (4) and paragraph (7).

In the case of applying the provisions specified in the items of the preceding paragraph to the Long-Term Care Benefit listed in those items that is received by an Insured Person Requiring Long-Term Care who is a Primary Insured Person and whose amount of income calculated as specified by Cabinet Order is the amount specified by Cabinet Order, which exceeds the amount specified by Cabinet Order in the preceding paragraph, or more, the term "90 percent" in those provisions is deemed to be replaced with "70 percent".

In a case when a Municipality applies the provisions prescribed in the items of paragraph (1) of the preceding Article to a Long-Term Care Benefit listed in said items received by an Insured Person Requiring Long-Term Care for whom the Municipality has found it difficult to pay the necessary expenses for In-Home Service (including equivalent services; the same applies hereinafter in this Article), Community-Based Service (including equivalent services; the same applies hereinafter in this Article), Facility Service, or Home Modification due to disaster or other special circumstances as determined by Order of the Ministry of Health, Labour and Welfare (excluding a case when the provisions are applied as replaced pursuant to the provisions of that Article), the term "90 percent" in the referenced provisions is deemed to be replaced with "the percentage determined by the Municipality within the range exceeding 90 percent and 100 percent or less".

In a case when a Municipality applies the provisions prescribed in the items of paragraph (1) of the preceding Article to a Long-Term Care Benefit listed in said items received by an Insured Person Requiring Long-Term Care for whom the Municipality has found it difficult to pay the necessary expenses for In-Home Service, Community-Based Service, Facility Service, or Home Modification due to disaster or other special circumstances as determined by Order of the Ministry of Health, Labour and Welfare (limited to a case when the provisions are applied as replaced pursuant to the provisions of that paragraph), the term "80 percent" in the referenced provisions applied as replaced pursuant to the provisions of that paragraph is deemed to be replaced with "the percentage determined by the Municipality within the range exceeding 80 percent and 100 percent or less".

In a case when a Municipality applies the provisions prescribed in the items of paragraph (1) of the preceding Article to a Long-Term Care Benefit listed in said items received by an Insured Person Requiring Long-Term Care for whom the Municipality has found it difficult to pay the necessary expenses for In-Home Service, Community-Based Service, Facility Service, or Home Modification due to disaster or other special circumstances as determined by Order of the Ministry of Health, Labour and Welfare (limited to a case when the provisions are applied as replaced pursuant to the provisions of paragraph (2) of that Article), the term "70 percent" in the referenced provisions applied as replaced pursuant to the provisions of paragraph (2) of that Article is deemed to be replaced with "the percentage determined by the Municipality within the range exceeding 70 percent and 100 percent or less".

When the amount obtained by deducting the total amount of the Allowance for In-Home Long-Term Care Service, Exceptional Allowance for In-Home Long-Term Care Service, Allowance for Community-Based Long-Term Care Service, Exceptional Allowance for Community-Based Long-Term Care Service, Allowance for Long-Term Care Facility Service, and Exceptional Allowance for Long-Term Care Facility Service paid for the expenses from the amount calculated as provided by Cabinet Order as the total amount of expenses required for In-Home Service (including equivalent services), Community-Based Service (including equivalent services), or Facility Service received by an Insured Person Requiring Long-Term Care (hereinafter referred to as "User Charge for Long-Term Care Service" in paragraph (1) of the following Article) is extremely large, a Municipality pays an Allowance for High-Cost Long-Term Care Service to said Insured Person Requiring Long-Term Care.

In addition to the provisions as set forth in the preceding paragraph, requirements for payment of an Allowance for High-Cost Long-Term Care Service, the amount of said allowance, and other matters necessary for the payment of an Allowance for High-Cost Long-Term Care Service are provided by a Cabinet Order after considering the impact on said household budget due to the burden of the expenses necessary for In-Home Service, Community-Based Service, or Facility Service.

A Municipality, when the total sum of the User Charge for Long-Term Care Service of an Insured Person Requiring Long-Term Care (in a case when an Allowance for High-Cost Long-Term Care Service under paragraph (1) of the preceding Article is paid, the amount obtained by deducting the amount equivalent to the amount of said allowance paid), the amount of the co-payment, etc. prescribed in Article 115, paragraph (1) of the Health Insurance Act pertaining to said Insured Person Requiring Long-Term Care (in a case when high-cost medical expenses under that paragraph are paid, the amount obtained by deducting the amount equivalent to the amount of said payment), and other amounts determined by Cabinet Order as amounts equivalent to these as prescribed in the Medical Insurance Acts or the Act on Assurance of Medical Care for Elderly People (Act No. 80 of 1982), is extremely large, pays an Allowance for High-Cost Medical and Long-Term Care Service Combined to said Insured Person Requiring Long-Term Care.

The provisions of paragraph (2) of the preceding Article apply mutatis mutandis to payment of an Allowance for High-Cost Medical and Long-Term Care Service Combined.

A Municipality, when a person specified by Order of the Ministry of Health, Labour and Welfare in consideration of the status of income and assets and other circumstances from among Insured Persons Requiring Long-Term Care receives any of the following Designated Facility Service, etc., Designated Community-Based Service, or Designated In-Home Service (hereinafter referred to as "Specified Long-Term Care Service" in this Article and paragraph (1) of the following Article), pays to said Insured Person Requiring Long-Term Care (hereinafter referred to as a "Specified Person Admitted to a Facility" in this Article and paragraph (1) of the following Article) an Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility for the expenses required to provide meals and the expenses required for residence or stay (hereinafter referred to as "Residence, etc.") at a Facility Covered by Long-Term Care Insurance, Designated Community-Based Service Provider, or Designated In-Home Service Provider that provides said Specified Long-Term Care Service (hereinafter referred to as "Specified Facility, etc., for Insured Long-Term Care" in this Article); provided, however, that this does not apply when said Specified Person Admitted to a Facility, in a case where he or she has been issued a designation pursuant to the provisions of Article 37, paragraph (1), receives Specified Long-Term Care Service other than the type pertaining to said designation:

Designated Facility Service for Long-Term Care Covered by Public Aid;

Long-Term Care Health Facility Service;

service at an integrated facility for medical and long-term care;

Admission to a Community-Based Facility for Preventive Daily Long-Term Care of the Elderly Covered by Public Aid;

Short-Term Admission for Daily Life Long-Term Care;

Short-Term Admission for Recuperation.

The amount of the Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility is to be the total sum of the amount as prescribed in item (i) and the amount as prescribed in item (ii) below:

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, the income status of the Specified Person Admitted to a Facility, and other circumstances (hereinafter referred to as "Maximum Allowance for Meal Expense" in this Article and the following Article, paragraph (2)) is deducted from the amount of expenses determined by the Minister of Health, Labour, and Welfare after considering the average expenses required to provide meals at a Specified Facility, etc., for Insured Long-Term Care (in a case when said amount exceeds the actual expenses of providing said meals, the amount is the actual expenses of providing said meals; herein referred to as "Base Cost for Meal Expenses" in this Article and in the following Article, paragraph (2));

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 (herein referred to as "Maximum Allowance for Residence Expenses") is deducted from the amount provided by the Minister of Health, Labour, and Welfare after considering the average expenses necessary for Residence, etc., at a Specified Facility, etc., for Insured Long-Term Care, the status of such facility, and other circumstances (in a case when such amount exceeds the actual expenses for said Residence, etc., the amount is the actual expenses for said Residence, etc.; herein referred to as "Base Costs for Residence" in this Article and the following Article, paragraph (2)).

When the expenses necessary of providing meals, Residence, etc., at a Specified Facility, etc., for Insured Long-Term Care, and other circumstances have changed significantly from the Base Cost for Meal Expense or Maximum Allowance for Meal Expense, or Base Costs for Residence or Maximum Allowance for Residence Expenses after the Minister of Health, Labour, and Welfare has issued a determination of these expenses, the Minister must revise those amounts immediately.

When a Specified Person Admitted to a Facility receives Specified Long-Term Care Service from a Specified Facility, etc., for Insured Long-Term Care, a Municipality may pay the expenses required for providing meals and Residence, etc., that said Specified Person Admitted to a Facility should pay to said Specified Facility, etc., for Insured Long-Term Care, within the limit of the amount to be paid to said Specified Person Admitted to a Facility as an Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility on behalf of said Specified Person Admitted to a Facility to said Specified Facility, etc., for Insured Long-Term Care

When the payment pursuant to the provisions of the preceding paragraph is paid, it is to be deemed that an Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility is paid to the Specified Person Admitted to a Facility.

A Municipality, notwithstanding the provisions of paragraph (1) in a case when a Specified Person Admitted to a Facility paid to a Specified Facility, etc., for Insured Long-Term Care, an amount exceeding the Base Cost for Meal Expense or the Base Costs for Residence (with regard to a Specified Person Admitted to a Facility, one who is deemed to be paid an Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility pursuant to the provisions of the preceding paragraph, Maximum Allowance for Meal Expense, or Maximum Allowance for Residence Expenses) as the expenses necessary for providing meals or for Residence, etc., does not pay an Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility.

A Municipality, when a Specified Facility, etc., for Insured Long-Term Care, requests an Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility, pays said allowance after conducting an examination according to the provisions of paragraph (1), paragraph (2) and the preceding paragraph.

The provisions of Article 41, paragraph (3), paragraph (10), and paragraph (11) apply mutatis mutandis to the payment of an Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility and the provisions of paragraph (8) of the same Article apply mutatis mutandis to a Specified Facility, etc., for Insured Long-Term Care in this case, the necessary technical replacement of terms in these provisions is provided by a Cabinet Order.

In addition to the provisions as prescribed in the preceding paragraphs, the other necessary matters the payment of an Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility and a request for an Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility by a Specified Facility, etc., for Insured Long-Term Care, are prescribed by Order of the Ministry of Health, Labour, and Welfare.

A Municipality, in the following cases, pay an Exceptional Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility to a Specified Person Admitted to a Facility:

when the Municipality determines it necessary in a case when a Specified Person Admitted to a Facility receives Specified Long-Term Care Service prior to the date said Certification of Needed Long-Term Care becomes effective due to an emergency or other compelling reason;

when otherwise specified by Cabinet Order.

The amount of an Exceptional Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility is established by a Municipality based on the total sum of the amounts remaining after the amount of Base Cost for Meal Expense is deducted from the Maximum Allowance for Meal Expense with regard to the expense required to provide said meal and the amount of Base Costs for Residence is deducted from the amount of Maximum Allowance for Residence Expenses with regard to the expense required for said Residence, etc..