Long-Term Care Insurance Act

A Municipality, in the following cases, pay an Exceptional Allowance for Community-Based Long-Term Care Service to an Insured Person Requiring Long-Term Care:

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

when the Municipality determines it necessary in a case when an Insured Person Requiring Long-Term Care has a domicile on an isolated island or other area where it is significantly difficult to secure Designated Community-Based Service (except for Admission to a Community-Based Facility for Preventive Daily Long-Term Care of the Elderly Covered by Public Aid; the same applies hereinafter in this item) and in a location that qualifies with standards as determined by the Minister of Health, Labour, and Welfare, and an Insured Person receives Community-Based Service other than Designated Community-Based Service (except for Admission to a Community-Based Facility for Preventive Daily Long-Term Care of the Elderly Covered by Public Aid) or an equivalent service to said services;

when provided by a Cabinet Order.

The amount of an Exceptional Allowance for Community-Based Long-Term Care Service is to be specified by a Municipality based on the amount equivalent to 90 percent of the amount of expenses calculated, for said Community-Based Service or equivalent service, by the standards determined by the Minister of Health, Labour and Welfare under each item of paragraph (2) of the preceding Article (when said calculated amount exceeds the amount of the actual expenses required for said Community-Based Service or equivalent service (excluding, with regard to the expenses required for Community-Based Outpatient Day Long-Term Care, outpatient long-term care for a Dementia patient, Multifunctional Long-Term Care in a Small Group Home, Communal Daily Long-Term Care for a Dementia Patient, Daily Life Long-Term Care for a Person Admitted to a Community-Based Specified Facility, Daily Life Long-Term Care for a Person Admitted to a Community-Based Facility for the Elderly Covered by Public Aid Requiring Long-Term Care, and combined service, and services equivalent to these, the expenses necessary to provide meals, residence and other expenses necessary for daily life as determined by Order of the Ministry of Health, Labour and Welfare), said amount is to be the amount of the actual expenses required for said Community-Based Service or equivalent service), or the amount specified by the Municipality pursuant to the provisions of paragraph (4) of the same Article (in the case of an Exceptional Allowance for Community-Based Long-Term Care Service (limited to that pertaining to Specified Community-Based Service) for an Insured Person Requiring Long-Term Care to Whom the Domicile Exception Applies who received Designated Community-Based Service from a Designated Community-Based Service Provider for which the mayor of the Municipality Where the Facility Is Located made the designation in the main clause of paragraph (1) of the same Article, or another person specified by Order of the Ministry of Health, Labour and Welfare, the Municipality Where the Facility Is Located).

The mayor of a Municipality, when he or she determines the necessity of payment of an Exceptional Allowance for Community-Based Long-Term Care Service, orders a person that has been in charge of said Community-Based Service pertaining to said payment or in charge of an equivalent service (herein referred to as "Person, etc., in Charge of Community-Based Service, etc." in this paragraph) to report, submit or present record books and documents, appear, or direct its personnel to question the relevant person or enter the Business Office of the provider of said Person, etc., in Charge of Community-Based Service, etc., pertaining to said payment in order to inspect said equipment, record books and documents, and other items.

The provisions of Article 24, paragraph (3) apply mutatis mutandis to questions or inspections as prescribed in the preceding paragraph, and the provisions of paragraph (4) of the same Article apply mutatis mutandis to the authority granted as prescribed in the preceding paragraph.

The total sum of allowances that are paid monthly for In-Home Service pertaining to one classification of In-Home Service, etc., that an Insured In-Home Person Requiring Long-Term Care during the period determined by Ordinance of Ministry of Health, Labour, and Welfare for each classification of In-Home Service, etc. (which means with regard to In-Home Service (including equivalent services; hereinafter the same applies in this Article) and Community-Based Service (including equivalent services except for Admission to a Community-Based Facility for Preventive Daily Long-Term Care of the Elderly Covered by Public Aid; the same applies hereinafter in this Article) by categories of two or more types as determined by the Minister of Health, Labour, and Welfare, considering the inter-substitution by each type of category; the same applies hereinafter) may not exceed the amount equivalent to 90 percent of the amount calculated pursuant to the provisions of Order of the Ministry of Health, Labour, and Welfare based on the base amount of maximum payment for each category of Allowance for In-Home Long-Term Care Service, etc. The total sum of allowance is the total amount of Allowance for In-Home Long-Term Care Service or Exceptional Allowance for In-Home Long-Term Care Service, or the total amount of Allowance for Community-Based Long-Term Care Service to be paid for Community-Based Service or the total amount of Exceptional Allowance for Community-Based Long-Term Care Service.

The base amount of maximum payment by classification of Allowance for In-Home Long-Term Care Service, etc., as prescribed in the preceding paragraph is to be an amount determined by the Minister of Health, Labour, and Welfare by classification of In-Home Service, etc., and by considering the standard use, according to the categories of Condition of Need for Long-Term Care, of In-Home Service pertaining to the category of said In-Home Service and Community-Based Service, etc., during the period as determined by Order of the Ministry of Health, Labour, and Welfare as prescribed in the same paragraph, and standards, etc., provided by the Minister of Health, Labour, and Welfare as set forth in each item of Article 41, paragraph (4) and each item of Article 42-2, paragraph (2) pertaining to said In-Home Service and Community-Based Service.

A Municipality, notwithstanding the provisions of the preceding paragraph and pursuant to the provisions of a municipal ordinance, in lieu of the base amount of maximum payment for the categories of allowances for In-Home Long-Term Care, etc., as prescribed in paragraph (1), may determine an amount exceeding said base amount as the base amount of maximum payment for the categories of allowances for In-Home Long-Term Care, etc., in said Municipality.

A Municipality, with regard to the total sum of the total amount of allowances for In-Home Long-Term Care and exceptional allowances for In-Home Long-Term Care that are paid by each type of In-Home Service and the total amount of allowances for Community-Based Service and exceptional allowances for Community-Based Service that are paid by each type of Community-Based Service when said allowances are paid monthly to an Insured In-Home Person Requiring Long-Term Care by the type of In-Home Service and Community-Based Service (limited to those types that are included in categories of In-Home Service, etc., and that are determined by the Minister of Health, Labour, and Welfare) during the period as determined by Order of the Ministry of Health, Labour, and Welfare, may determine that said total sum may not exceed 90 percent of the calculated standard amount pursuant to the provisions of Order of the Ministry of Health, Labour, and Welfare based on base amount of maximum payment for the categories of allowances for In-Home Long-Term Care, etc.

The base amount of maximum payment for the categories of allowances for In-Home Long-Term Care, etc., as set forth in the preceding paragraph is to be the amount specified by a municipal ordinance within the limit of the base amount of maximum payment for the categories of allowances for In-Home Long-Term Care, etc., prescribed in paragraph (1) pertaining to the categories of In-Home Service, etc., including said In-Home Service and Community-Based Service (with regard to the Municipality that provides a municipal ordinance pursuant to the provisions of paragraph (3), the base amount is to be the amount for which measures pursuant to the provisions of said municipal ordinance are undertaken) by considering each type of In-Home Service and Community-Based Service for its standard use according to the categories of Condition of Need for Long-Term Care of said In-Home Service and Community-Based Service during the period as determined by Order of the Ministry of Health, Labour, and Welfare as prescribed in the preceding paragraph and of standards, etc., provided by the Minister of Health, Labour, and Welfare as set forth in each item of Article 41, paragraph (4) and each item of Article 42-2, paragraph (2) pertaining to said In-Home Service and Community-Based Service.

In the case where, by payment of an Allowance for In-Home Long-Term Care Service, an Exceptional Allowance for In-Home Long-Term Care Service, an Allowance for Community-Based Long-Term Care Service or an Exceptional Allowance for Community-Based Long-Term Care Service, the total amount prescribed in paragraph (1) exceeds the amount equivalent to 90 percent prescribed in the same paragraph, or the total amount prescribed in paragraph (4) exceeds the amount equivalent to 90 percent prescribed in the same paragraph, the amount of said 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 or Exceptional Allowance for Community-Based Long-Term Care Service is to be the amount calculated pursuant to the provisions of a Cabinet Order, notwithstanding the provisions of each item of Article 41, paragraph (4), Article 42, paragraph (3), each item of Article 42-2, paragraph (2), Article 42-2, paragraph (4), or paragraph (2) of the preceding Article.

A Municipality, when an Insured In-Home Person Requiring Long-Term Care purchases from a Designated In-Home Service Provider pertaining to the Sale of Specified Equipment Covered by Public Aid an article of the Specified Equipment Covered by Public Aid that is sold by a provider that performs an In-Home Service pertaining to said designation, pays to said Insured In-Home Person Requiring Long-Term Care an Allowance for purchasing Equipment for In-Home Long-Term Care Covered by Public Aid.

An Allowance for purchasing Equipment for In-Home Long-Term Care Covered by Public Aid is to be paid pursuant to the provisions of Order of the Ministry of Health, Labour, and Welfare and limited to when the Municipality determines it necessary.

The amount of Allowance for purchasing Equipment for In-Home Long-Term Care Covered by Public Aid is to be the amount equivalent to 90 percent of the actual expenses required for the purchase of said Specified Equipment Covered by Public Aid.

The total Allowance for purchasing Equipment for In-Home Long-Term Care Covered by Public Aid that is paid monthly for Specified Equipment Covered by Public Aid purchased by an Insured In-Home Person Requiring Long-Term Care during the period as determined by Order of the Ministry of Health, Labour, and Welfare may not exceed the amount equivalent to 90 percent of the amount calculated pursuant to the provision of Order of the Ministry of Health, Labour, and Welfare based on the base amount of maximum payment for Allowance for purchasing Equipment for In-Home Long-Term Care Covered by Public Aid.

The base amount of maximum payment for Allowance for purchasing Equipment for In-Home Long-Term Care Covered by Public Aid as prescribed in the preceding paragraph is to be an amount provided by the Minister of Health, Labour, and Welfare as prescribed in the same paragraph after considering the average expenses required for the purchase of said Specified Equipment Covered by Public Aid during the period as determined by Order of the Ministry of Health, Labour, and Welfare.

A Municipality, notwithstanding the provisions of the preceding paragraph, in lieu of the base amount of maximum payment for Allowance for purchasing Equipment for In-Home Long-Term Care Covered by Public Aid as set forth in paragraph (4), may determine an amount that exceeds said base amount as the base amount of maximum payment for Allowance for purchasing Equipment for In-Home Long-Term Care Covered by Public Aid in said Municipality.

In a case when the total sum as prescribed in paragraph (4) exceeds the amount equivalent to 90 percent of the calculated amount as prescribed in the same paragraph for payment of an Allowance for purchasing Equipment for In-Home Long-Term Care Covered by Public Aid, the amount of said Allowance for purchasing Equipment for In-Home Long-Term Care Covered by Public Aid is to be the amount calculated pursuant to the provisions of a Cabinet Order, notwithstanding the provision of paragraph (3).

A Municipality, when an Insured In-Home Person Requiring Long-Term Care implements a type of modification determined by the Minister of Health, Labour, and Welfare, such as installing handrails or other fixtures (herein referred to as "Home Modification"), pays an Allowance for Home Modification for In-Home Long-Term Care to said Insured In-Home Person Requiring Long-Term Care.

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

The amount of Allowance for Home Modification for In-Home Long-Term Care is to be the amount equivalent to 90 percent of the actual expenses required for said Home Modification.

The total amount of Allowance for Home Modification for In-Home Long-Term Care that is paid for a single type of modifying house for in-home care undertaken by an Insured In-Home Person Requiring Long-Term Care may not exceed the amount equivalent to 90 percent of the amount calculated pursuant to the provisions of Order of the Ministry of Health, Labour, and Welfare based on the base amount of maximum payment for Allowance for Home Modification for In-Home Long-Term Care.

The base amount of maximum payment for Allowance for Home Modification for In-Home Long-Term Care as prescribed in the preceding paragraph is to be the amount specified by the Minister of Health, Labour, and Welfare by type of Home Modification after considering the average expenses required.

A Municipality, notwithstanding the provision of the preceding paragraph, pursuant to the provisions of a municipal ordinance, and in lieu of the base amount of maximum payment for Allowance for Home Modification for In-Home Long-Term Care as set forth in paragraph (4), may determine an amount that exceeds said base amount as the base amount of maximum payment for Allowance for Home Modification for In-Home Long-Term Care in said Municipality.

In a case when the total amount as prescribed in paragraph (4) exceeds the amount equivalent to 90 percent of the calculated amount as prescribed in the same paragraph due to payment of said Allowance for Home Modification for In-Home Long-Term Care, the amount of said Allowance for Home Modification for In-Home Long-Term Care is to be the amount calculated pursuant to the provisions of a Cabinet Order, notwithstanding the provision of paragraph (3).

A Municipality, when it determines the necessity for payment of an Allowance for Home Modification for In-Home Long-Term Care, may order a person that implements or implemented the Home Modification pertaining to said payment (herein referred to as "Person, etc., that Implements the Home Modification" in this paragraph) to report, submit or present record books and documents, appear, or direct its personnel to question said relevant Person or enter the Business Office of the provider of said Person, etc., that Implements the Home Modification in order to inspect said books, documents, and other items.

The provisions of Article 24, paragraph (3) apply mutatis mutandis to questions and inspections as prescribed in the preceding paragraph and the provisions of paragraph (4) of the same Article apply mutatis mutandis to the authority granted as prescribed in the preceding paragraph.