Long-Term Care Insurance Act

A Long-Term Care Health Facility is not a hospital or a clinic as used in the Medical Care Act; provided, however, that the terms "hospital" and "clinic" in provisions of laws and regulations other than the same Act and orders based on it (excluding the provisions of the Health Insurance Act, the National Health Insurance Act and other laws and regulations that are specified by Cabinet Order) include a Long-Term Care Health Facility (excluding, in the provisions of laws and regulations specified by Cabinet Order, those specified by Cabinet Order).

A person that intends to establish an integrated facility for medical and long-term care must obtain approval of the prefectural governor pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare.

When a person that has established an integrated facility for medical and long-term care intends to change the capacity of residents of said integrated facility for medical and long-term care or other particulars specified by Order of the Ministry of Health, Labour and Welfare, the same applies as in the preceding paragraph.

A prefectural governor, in a case when the application of approval as set forth in the preceding two paragraphs is filed and when it corresponds to any of the following items (with regard to the application as set forth in the preceding paragraph, item (ii) or item (iii)), may not provide approval as set forth in the preceding two paragraphs:

when a person that intends to establish said integrated facility for medical and long-term care is not a local government, a medical juridical person, a social welfare juridical person, or other person as determined by the Minister of Health, Labour and Welfare;

when said integrated facility for medical and long-term care does not have the medical care rooms, consultation rooms, treatment rooms and functional training rooms prescribed in Article 111, paragraph (1), and the facilities specified by Prefectural Ordinance, or the personnel specified by Order of the Ministry of Health, Labour and Welfare and by Prefectural Ordinance as set forth in paragraph (2) of the same Article;

when it is determined that proper management of an integrated facility for medical and long-term care cannot be conducted in accordance with the standards pertaining to facilities and management of an integrated facility for medical and long-term care as prescribed in Article 111, paragraph (3);

when the applicant is punished by imprisonment or a severer punishment and execution of said punishment has not yet been completed or has not yet expired;

when the applicant is punished by a fine pursuant to the provisions of this Act or another Act pertaining to health and medical care or public aid for citizens as determined by a Cabinet Order and execution of said penalty has not yet been completed or has not yet expired;

when the applicant is punished by a fine pursuant to the provisions of laws concerning labor specified by Cabinet Order and execution of said penalty has not yet been completed or has not yet expired;

when the applicant, with regard to insurance premiums, etc., was subject, by the day before the day of making said application, to a disposition of delinquency based on the provisions of the Act that provides for the obligation of payment, and has continued, for a period of three months or more from the day of receiving said disposition without a justifiable reason, to be delinquent in all of the insurance premiums, etc. whose due dates arrived on or after the day of receiving said disposition;

when the applicant has had approval rescinded pursuant to the provisions of Article 114-6, paragraph (1) or Article 115-35, paragraph (6) and five years have not elapsed from the date of said rescission (including, in the case where the person whose approval was rescinded is a juridical person, a person who was an Officer of said juridical person or a manager of the integrated facility for medical and long-term care that said juridical person established within sixty days prior to the date of notification pursuant to the provisions of Article 15 of the Administrative Procedure Act pertaining to said disposition of rescission and for whom five years have not elapsed from the date of said rescission, and including, in the case where the person whose approval was rescinded is a person who is not a juridical person among the persons specified by the Minister of Health, Labour and Welfare in item (i), a person who was a manager of the integrated facility for medical and long-term care established by said person within sixty days prior to the date of said notification and for whom five years have not elapsed from the date of said rescission). However, this does not apply where the rescission of the approval falls under a rescission of the approval of an integrated facility for medical and long-term care that is specified by Order of the Ministry of Health, Labour and Welfare as one found appropriate not to be treated as the rescission of approval prescribed in the main clause of this item, in consideration of the fact that constituted the ground for the disposition of rescission of the approval, the status of efforts toward the establishment of an operational control system by the establisher of said integrated facility for medical and long-term care to prevent the occurrence of said fact, and other matters concerning the degree of responsibility that the establisher of said integrated facility for medical and long-term care had in relation to said fact;

when the applicant is a person that submitted a notification of abolition pursuant to the provisions of Article 113, paragraph (2) during the period from the date of notification pursuant to the provisions of Article 15 of the Administrative Procedure Act pertaining to a disposition of rescission of the approval pursuant to the provisions of Article 114-6, paragraph (1) or Article 115-35, paragraph (6) to the date on which said disposition is made or the date on which a decision not to make a disposition is made (excluding a person that has a reasonable basis for said abolition), and five years have not elapsed from the date of said notification;

when the applicant is a person that submitted a notification of abolition pursuant to the provisions of Article 113, paragraph (2) during the period from the date on which an inspection pursuant to the provisions of Article 114-2, paragraph (1) was conducted to the expected hearing decision date (meaning, where the prefectural governor has, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, notified said applicant of a specific date within 10 days from the date on which said inspection was conducted as the date on which a decision is expected to be made, based on the result of said inspection, as to whether or not to hold a hearing pertaining to a disposition of rescission of the approval pursuant to the provisions of Article 114-6, paragraph (1), said specific date) (excluding a person that has a reasonable basis for said abolition), and five years have not elapsed from the date of said notification;

in the case where a notification of abolition pursuant to the provisions of Article 113, paragraph (2) has been submitted within the period prescribed in item (ix), when the applicant is a person that was, within sixty days prior to the date of notification set forth in the same item, an Officer of the juridical person pertaining to said notification (excluding a juridical person that has a reasonable basis for said abolition) or a manager of the integrated facility for medical and long-term care that said juridical person established, or a manager of an integrated facility for medical and long-term care established by a person who is not a juridical person among the persons specified by the Minister of Health, Labour and Welfare in item (i) pertaining to said notification (excluding a person that has a reasonable basis for said abolition), and five years have not elapsed from the date of said notification;

when the applicant is a person that performed a wrongful or significantly unjustifiable act pertaining to In-Home Service, etc., within five years prior to an application for approval;

when the applicant is a juridical person and any of its Officers, etc. is a person who corresponds to any of the provisions of item (iv) through the preceding item;

when the applicant is a person who is not a juridical person among the persons specified by the Minister of Health, Labour and Welfare in item (i), and among the person who manages the Business Office of the applicant and the other employees specified by Cabinet Order there is a person who corresponds to any of the provisions of item (iv) through item (xii);

A prefectural governor may decline to give the approval set forth in paragraph (1) to a person who intends to establish an integrated facility for medical and long-term care for the purpose of profit.

In a case when an application for the approval set forth in paragraph (1) or the approval set forth in paragraph (2) (limited to those pertaining to an increase in the maximum number of persons who may be admitted to the facility; hereinafter the same applies in this paragraph and the following paragraph) is filed, the prefectural governor, when it is determined that the total number of the maximum number of persons who may be admitted to integrated facilities for medical and long-term care in the area (which means an area specified by said prefecture pursuant to the provisions of Article 118, paragraph (2), item (i)) including the location of the facility pertaining to said application has already reached the total number of the required number of persons who may be admitted to integrated facilities for medical and long-term care in the area as prescribed in the Prefectural Insured Long-Term Care Support Project Plan specified by said prefecture pursuant to the provisions of paragraph (1) of the same Article, or will exceed said total number by the establishment of the facility pertaining to said application or the increase in the maximum number of persons who may be admitted to the facility, or when it is determined that it is likely to cause problems with the accomplishment of said Prefectural Insured Long-Term Care Support Project Plan, may decline to give the approval set forth in paragraph (1) or the approval set forth in paragraph (2).

A prefectural governor, when he or she intends to give the approval set forth in paragraph (1) or the approval set forth in paragraph (2), must provide notice of matters specified by Order of the Ministry of Health, Labour and Welfare to the mayor of the relevant Municipality, specify a reasonable period, and request opinions from the perspective of coordination with the Municipal Insured Long-Term Care Service Plan as prescribed in Article 117, paragraph (1) of said relevant Municipality.

Approval as set forth in paragraph (1) of the preceding Article, if it is not renewed within a period of six years, ceases to be effective when said period expires.

In a case of application for renewal as set forth in the preceding paragraph, when a final determination of the application does not occur prior to the expiry of the period as set forth in the same paragraph (hereinafter referred to as "Effective Period of Approval" in this Article), the prior approval remains in force after expiry of the Effective Period of Approval until a determination is reached regarding said application.

In a case as set forth in the preceding paragraph, when the approval is renewed, said Effective Period of Approval is to be from the date following the date of expiry of the prior Effective Period of Approval.

The provisions of the preceding Article apply mutatis mutandis to renewal of approval as set forth in paragraph (1).

An establisher of an integrated facility for medical and long-term care must have a physician approved by the prefectural governor manage said integrated facility for medical and long-term care.

Notwithstanding the provisions of the preceding paragraph, an establisher of an integrated facility for medical and long-term care may obtain approval of the prefectural governor and have a person other than a physician manage said integrated facility for medical and long-term care.

An establisher of an integrated facility for medical and long-term care must endeavor to provide appropriate service at an integrated facility for medical and long-term care, in accordance with the standards concerning facilities and management of an integrated facility for medical and long-term care as prescribed in paragraph (3) of the following Article, according to the mental and physical condition, etc., of a Person Requiring Long-Term Care, and to always provide said service from the viewpoint of the person that receives service at an integrated facility for medical and long-term care, by implementing self-evaluation of the quality of the service at an integrated facility for medical and long-term care that the establisher provides and by other measures.

An establisher of an integrated facility for medical and long-term care, when an Opinion of the Certification Committee is entered on the certificate of insured person that is presented by an Insured Person that intends to receive service at an integrated facility for medical and long-term care, must endeavor to provide said service at an integrated facility for medical and long-term care to said Insured Person in consideration of said Opinion of the Certification Committee.

An integrated facility for medical and long-term care must have medical care rooms, consultation rooms, treatment rooms and functional training rooms pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, as well as facilities specified by Prefectural Ordinance.

An integrated facility for medical and long-term care must have physicians and nurses in the number specified by Order of the Ministry of Health, Labour and Welfare, as well as Long-Term Care Support Specialists and employees that engage in care and other duties in the number specified by Prefectural Ordinance.

In addition to what is prescribed in the preceding two paragraphs, the standards concerning facilities and management of an integrated facility for medical and long-term care are specified by Prefectural Ordinance.

A prefecture, in establishing the Prefectural Ordinance set forth in the preceding three paragraphs, is to establish the following matters in accordance with the standards specified by Order of the Ministry of Health, Labour and Welfare, and is to take into consideration the standards specified by Order of the Ministry of Health, Labour and Welfare for other matters:

Long-Term Care Support Specialists and employees that engage in care and other duties, and their number;

matters concerning the management of an integrated facility for medical and long-term care that are specified by Order of the Ministry of Health, Labour and Welfare as being closely related to the appropriate use of services by Persons Requiring Long-Term Care who are admitted, appropriate treatment, ensuring of safety, and maintaining of confidentiality.

The Minister of Health, Labour and Welfare, when intending to provide the standards specified by Order of the Ministry of Health, Labour and Welfare as prescribed in the preceding paragraph (limited to the part pertaining to the handling of service at an integrated facility for medical and long-term care), must hear the opinion of the Social Security Council in advance.

An establisher of an integrated facility for medical and long-term care, when it has submitted a notification of abolition or suspension pursuant to the provisions of Article 113, paragraph (2), must provide convenience, such as coordination with the establishers of other integrated facilities for medical and long-term care and other persons concerned, to persons who were receiving said service at an integrated facility for medical and long-term care on the day before the date of said notification and who wish to continue to be provided with service equivalent to said service at an integrated facility for medical and long-term care on or after the date of said abolition or suspension, so that necessary In-Home Service, etc. is continuously provided.

An establisher of an integrated facility for medical and long-term care must respect the personality of a Person Requiring Long-Term Care, act in compliance with this Act or an order based on this Act, and faithfully perform its duties for a Person Requiring Long-Term Care.