Long-Term Care Insurance Act

An Insured Person that intends to receive a Certification of Needed Support, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, must submit to a Municipality a written application with the Certificate of Insured Person attached. In this case, said Insured Person may, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, have a Designated In-Home Long-Term Care Support Provider prescribed in Article 46, paragraph (1), a Community-Based Facility for the Elderly Covered by Public Aid Requiring Long-Term Care or a Facility Covered by Long-Term Care Insurance, as determined by Order of the Ministry of Health, Labour and Welfare, or a community general support center prescribed in Article 115-46, paragraph (1), perform the procedures pertaining to said application on behalf of the Insured Person.

The provisions of Article 27, paragraphs (2) and (3) apply mutatis mutandis to an investigation pertaining to an application as prescribed in the preceding paragraph, opinions of an attending physician of the Insured Person pertaining to an application as set forth in the same paragraph, and an order for diagnosis to said Insured Person.

A Municipality is to notify the Certification Committee of the result of an investigation as set forth in Article 27, paragraph (2) as applied mutatis mutandis pursuant to the preceding paragraph (in a case when the investigation is entrusted pursuant to the provisions of Article 24-2, paragraph (1), item (ii), including an investigation pertaining to said entrustment), the opinion of an attending physician as set forth in Article 27, paragraph (3) as applied mutatis mutandis pursuant to the preceding paragraph, the result of a diagnosis of a designated physician or its personnel who is a physician, or other matters specified by Order of the Ministry of Health, Labour, and Welfare, and request an examination and judgment pertaining to matters as prescribed in each said item according to the category of Insured Person listed in the following items with regard to the Insured Person pertaining to an application as set forth in paragraph (1):

Primary Insured Person:those who qualify for a Needed Support Condition and Category of Needed Support Condition for which said condition qualifies;

Secondary Insured Person:those who qualify for a Needed Support Condition, a Category of Needed Support Condition for which said condition qualifies, and the physical or mental problem(s) that is the cause of said Needed Support Condition as caused by a Specified Disease.

A Certification Committee, when being requested to perform an examination and judgment pursuant to the provisions of the preceding paragraph, is to act in compliance with standards as determined by the Minister of Health, Labour, and Welfare, examine and judge matters as prescribed in each item of the same paragraph of an Insured Person pertaining to said examination and judgment, and notify the Municipality of said result. In this case, a Certification Committee, when it determines necessary, may state opinions to the Municipality regarding the following matters:

matters of necessary medical care for or support pertaining to domestic home duties for the reduction or prevention of deterioration of a Needed Support Condition of said Insured Person;

matters that said Insured Person should give heed to regarding the appropriate and effective use, etc. of Designated Preventive Long-Term Care Service prescribed in Article 53, paragraph (1), Designated Community-Based Service for Preventive Long-Term Care prescribed in Article 54-2, paragraph (1), or a Specified Comprehensive Project for Long-Term Care Prevention and Daily Life Support.

The provisions of Article 27, paragraph (6) apply mutatis mutandis to an examination and judgment as prescribed in the first sentence of the preceding paragraph.

A Municipality, when providing Certification of Needed Support based on the results of an examination and judgment of a Certification Committee that is notified pursuant to the provisions of the first sentence of paragraph (4), is to notify the Insured Person pertaining to said Certification of Needed Support of said result. In this case, a Municipality shall enter the following items on the Certificate of Insured Person of said Insured Person and return the Certificate of Insured Person to the Insured Person:

said Category of Needed Support Condition;

opinions of the Certification Committee pertaining to matters listed in paragraph (4), item (ii).

A Certification of Needed Support becomes effective retroactively on the date that said application was submitted.

A Municipality, when it is determined that the Insured Person predating the application as set forth in paragraph (1) fails to qualify the Person Requiring Support based on the results of an examination and judgment of a Certification Committee that is notified pursuant to the provisions of the first sentence of paragraph (4), is to notify said Insured Person pertaining of the results, indicating the reasons, and return the Certificate of Insured Person to said Insured Person.

The provisions of Article 27, paragraph (10) to (12) apply mutatis mutandis to an application as set forth in paragraph (1) and the action for said application.

A Certification of Needed Support is effective according to the Category of Needed Support Condition during the period as determined by Order of the Ministry of Health, Labour, and Welfare (herein referred to as "Effective Period" in this Article).

An Insured Person that has been issued a Certification of Needed Support, when he or she is expected to be in a Needed Support Condition after the expiry of the Effective Period, may apply to the Municipality for application of renewal of said Certification of Needed Support (herein referred to as "Renewal of Certification of Needed Support") pursuant to the provisions of Order of the Ministry of Health, Labour, and Welfare.

In a case when an Insured Person that may apply for the application as set forth in the preceding paragraph was not able to apply for said application prior to expiry of the Effective Period of Certification of Needed Support pertaining to said application due to a disaster or other compelling reason, said Insured Person may apply for a Renewal of Certification of Needed Support within one month from the date on which said reasons are no longer valid.

The provisions of the preceding Article (except for paragraph (7)) and Article 28, paragraphs (5) to (8) apply mutatis mutandis to an application as prescribed in the preceding two paragraphs and a Renewal of Certification of Needed Support pertaining to said application. In this case, the necessary technical replacement of the terms of these provisions is specified by a Cabinet Order.

A Renewal of Certification of Needed Support pertaining to an application as set forth in paragraph (3) becomes effective retroactively on the date following the date of expiry of the Effective Period of Certification of Needed Support pertaining to said application.

The provisions of paragraph (1) apply mutatis mutandis to a Renewal of Certification of Needed Support. In this case, the phrase "period as determined by Order of the Ministry of Health, Labour, and Welfare" in the same paragraph is deemed to be replaced with "period as determined by Order of the Ministry of Health, Labour, and Welfare from the date following the expiry of the Effective Period."

An Insured Person that has been issued a Certification of Needed Support, when it is determined that the degree of Needed Support Condition qualifies for a Category of Needed Support Condition other than the Category of Needed Support Condition pertaining to said Certification of Needed Support that is issued currently, may apply to the Municipality for a certification of change of Category of Needed Support Condition, pursuant to the provisions of Order of the Ministry of Health, Labour, and Welfare.

The provisions of Article 28, paragraph (5) to paragraph (8), and Article 32 apply mutatis mutandis to an application as prescribed in the preceding paragraph and change of Category of Needed Support Condition pertaining to said application. In this case, the necessary technical replacement of terms for these provisions is specified by a Cabinet Order.

A Municipality, when it is determined that an Insured Person that has been issued a Certification of Needed Support qualifies for a Category of Needed Support Condition other than the Category of Needed Support Condition pertaining to said Certification of Needed Support due to a lowering of the degree of Needed Support Condition, may certify a change of Category of Needed Support Condition. In this case, the Municipality is to request the Insured Person pertaining to said change of certification to submit said Certificate of Insured Person, shall enter the Category of Needed Support Condition pertaining to said change of certification and the opinion of the Certification Committee pursuant to the provisions of the second sentence of Article 32, paragraph (4) as applied mutatis mutandis pursuant to the following paragraph (limited to those pertaining to matters listed in item (ii) of the same paragraph), and then return the Certificate of Insured Person to the Insured Person.

The provisions of Article 28, paragraph (5) to paragraph (8), Article 32, paragraph (2) to paragraph (5), and the first sentence of paragraph (6), apply mutatis mutandis to a certification of Change of Category of Needed Support Condition as prescribed in the preceding paragraph. In this case, the necessary technical replacement of terms of these provisions is specified by a Cabinet Order.

When an Insured Person to whom has been issued a Certification of Needed Support is subject to any of the following items, a Municipality may rescind said Certification of Needed Support. In this case, the Municipality, pursuant to the provisions of Order of the Ministry of Health, Labour, and Welfare, is to request the Insured Person pertaining to said rescission to submit said Certificate of Insured Person, delete the entry of matters listed in the each item of Article 32, paragraph (6), and return the Certificate of Insured Person to the Insured Person. These items are:

when it is determined that the Insured Person fails to qualify as a Person Requiring Support;

when the Insured Person fails to qualify after an investigation pursuant to the provisions of Article 27, paragraph (2) as applied mutatis mutandis pursuant to the provisions of Article 32, paragraph (2) as applied mutatis mutandis pursuant to the preceding Article, paragraph (2) or the following paragraph (in a case when said investigation is entrusted pursuant to the provisions of Article 28, paragraph (5) as applied mutatis mutandis pursuant to the provisions of Article 24-2, paragraph (1), item (ii) or paragraph (2) of the preceding Article or the following paragraph, including an investigation pertaining to said entrustment) without a justifiable reason, or when the Insured Person fails to act in compliance with an order for diagnosis pursuant to the provisions of the proviso of Article 27, paragraph (3) as applied mutatis mutandis pursuant to the provisions of Article 32, paragraph (2) as applied mutatis mutandis pursuant to the following paragraph.

The provisions of Article 28, paragraph (5) to paragraph (8), Article 32, paragraph (2), paragraph (3), the first sentence of paragraph (4), paragraph (5), and the first sentence of paragraph (6) apply mutatis mutandis to a rescission of Certification of Needed Support pursuant to the provisions of the preceding paragraph, item (i). In this case, the necessary technical replacement of terms for these provisions is specified by a Cabinet Order.

A Certification Committee, when it is determined that an Insured Person that is the subject of a request for investigation or judgment pursuant to the provisions of Article 27, paragraph (4) (including a case when applied mutatis mutandis pursuant to Article 28, paragraph (4)) qualifies as a Person Requiring Support, although it is determined that said Insured Person fails to qualify as a Person Requiring Long-Term Care, may notify said result to the Municipality, notwithstanding the provisions of Article 27, paragraph (5) (including a case when applied mutatis mutandis pursuant to Article 28, paragraph (4)).

A Municipality, when a notification was issued pursuant to the provisions of the preceding paragraph, may deem that the Insured Person pertaining to said notification has submitted an application as set forth in Article 32, paragraph (1), the Municipality requested the Certification Committee to conduct an examination or issue a judgment pursuant to the provisions of paragraph (3) of the same Article and the Municipality received a notification by the Certification Committee pursuant to the provisions of paragraph (4) of the same Article, and may issue the Insured Person a Certification of Needed Support. In this case, the Municipality is to notify said Insured Person that a Certification of Needed Support is provided, enter the matters listed in each item of paragraph (6) of the same Article on the Certificate of Insured Person of said Insured Person, and return the Certificate of Insured Person to the Insured Person.

A Certification Committee, when it is determined that an Insured Person that is the subject of a requested examination or judgment pursuant to the provisions of Article 32, paragraph (3) (including the case it is applied mutatis mutandis pursuant to Article 33, paragraph (4)) qualifies as a Person Requiring Long-Term Care, may notify said result to the Municipality, notwithstanding the provision of Article 32, paragraph (4) (including a case applied mutatis mutandis pursuant to Article 33, paragraph (4)).

A Municipality, when a notification is issued pursuant to the provisions of the preceding paragraph, may deem that the Insured Person pertaining to said notification submitted an application as set forth in Article 27, paragraph (1), the Municipality requested the Certification Committee for a judgment or to conduct an examination pursuant to the provisions of paragraph (4) of the same Article, and the Municipality is provided a notification of the Certification Committee pursuant to the provisions of paragraph (5) of the same Article, and may issue the Insured Person a Certification of Needed Long-Term Care. In this case, the Municipality is to notify said Insured Person that a Certification of Needed Long-Term Care is provided, enter the matters listed in each item of paragraph (7) of the same Article on the Certificate of Insured Person of said Insured Person, and return the Certificate of Insured Person to the Insured Person.

A Certification Committee, when it is determined that an Insured Person that is the subject of a requested examination or judgment pursuant to the provisions of Article 27, paragraph (4) as applied mutatis mutandis pursuant to Article 31, paragraph (2) is certified as a Person Requiring Support although said Insured Person fails to qualify as a Person Requiring Long-Term Care, may notify said result to the Municipality, notwithstanding the provision of Article 27, paragraph (5) as applied mutatis mutandis pursuant to Article 31, paragraph (2).

A Municipality, when a notification is issued pursuant to the provisions of the preceding paragraph, may deem that the Insured Person pertaining to said notification submitted an application as set forth in Article 32, paragraph (1), the Municipality requested the Certification Committee for an examination or judgment pursuant to the provisions of paragraph (3) of the same Article, and the Municipality received a notification of the Certification Committee pursuant to the provisions of paragraph (4) of the same Article, and may issue said Insured Person a Certification of Needed Support. In this case, the Municipality, pursuant to the provisions of Order of the Ministry of Health, Labour, and Welfare, is to request to Insured Person pertaining to said notification to submit such Insured Person's Certificate of Insured Person, enter the matters listed in each item of paragraph (6) of the same Article, and return the Certificate of Insured Person to the Insured Person.

A Municipality, in a case when a person that is issued a Certification of Needed Long-Term Care or a Certification of Needed Support by another Municipality becomes an Insured Person of Long-Term Care Insurance of said Municipality and when said Insured Person submits an application for a Certification of Needed Long-Term Care or a Certification of Needed Support attached with the documents that are issued by said Municipality and the other Municipality and proves matters pertaining to said Certification of Needed Long-Term Care or Certification of Needed Support within fourteen (14) days from the date on which said qualification was obtained, may provide a Certification of Needed Long-Term Care or a Certification of Needed Support according to the matters entered on said documents, notwithstanding the provisions of Article 27, paragraph (4) and the first sentence of paragraph (7), or Article 32, paragraph (3) and the first sentence of paragraph (6), and without awaiting an examination or judgment of a Certification Committee.