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Read the text in force →介護保険法
Chapter IV Insurance Benefits (Articles 49 to 51-2)
The law as Act Partially Amending the Social Welfare Act, etc. (Act No. 51 of 2026) leaves it, with the words it changes marked.
The main text is read a page at a time: a chapter to a page, and a long chapter in runs of articles. The whole main text, and the supplementary provisions and appended tables this amendment changes. Those it leaves untouched are on the page for the text in force.
A Municipality, in the following cases, paypays to an Insured Person Requiring Long-Term Care, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, an Exceptional Allowance for Long-Term Care Facility Service:
市町村は、次に掲げる場合には、要介護被保険者に対し、厚生労働省令で定めるところにより、特例施設介護サービス費を支給する。
when the Municipality determines it necessary in a case when an Insured Person Requiring Long-Term Care receives Designated Facility Service, etc., prior to the date said Certification of Needed Long-Term Care becomes effective due to an emergency or other compelling reason;
要介護被保険者が、当該要介護認定の効力が生じた日前に、緊急その他やむを得ない理由により指定施設サービス等を受けた場合において、必要があると認めるとき。
when the Municipality determines it necessary in a case when an Insured Person Requiring Long-Term Care receives Facility Service for Long-Term Care Covered by Public Aid (hereinafter referred to as "Facility Service for Long-Term Care Covered by Public Aid in a Specified Area" in this Article) provided by a Cabinet Order.Facility Covered by Public Aid Providing Long-Term Care to the Elderly, other than a Designated Facility Covered by Public Aid Providing Long-Term Care to the Elderly, that is located in a Specified Area and is found to satisfy, among the number of employees specified by Prefectural Ordinance as set forth in Article 88, paragraph (1) pertaining to a Designated Facility Covered by Public Aid Providing Long-Term Care to the Elderly and the standards concerning facilities and management of a Designated Facility Covered by Public Aid Providing Long-Term Care to the Elderly prescribed in paragraph (2) of the same Article, those specified by Prefectural Ordinance (hereinafter referred to as "Facility Covered by Public Aid Providing Long-Term Care to the Elderly in a Specified Area" in the following paragraph);
その他政令で定要介護被保険者が、指定介護老人福祉施設以外の介護老人福祉施設であって、特定地域に所在し、かつ、指定介護老人福祉施設に係る第八十八条第一項の都道府県の条例で定める員数及び同条第二項に規定する指定介護老人福祉施設の設備及び運営に関する基準のうち都道府県の条例で定めるものを満たすと認められるもの（次項において「特定地域介護老人福祉施設」という。）により行われる介護福祉施設サービス（以下この条において「特定地域介護福祉施設サービス」という。）を受けた場合において、必要があると認めるとき。
when the Municipality determines it necessary in a case when an Insured Person Requiring Long-Term Care receives Long-Term Care Health Facility Service provided by a Long-Term Care Health Facility located in a Specified Area (limited to one pertaining to a person that has received the notification under Article 94, paragraph (5); hereinafter referred to as "Long-Term Care Health Facility Service in a Specified Area" in paragraph (4));
要介護被保険者が、特定地域に所在する介護老人保健施設（第九十四条第五項の規定による通知を受けた者に係るものに限る。）により行われる介護保健施設サービス（第四項において「特定地域介護保健施設サービス」という。）を受けた場合において、必要があると認めるとき。
when the Municipality determines it necessary in a case when an Insured Person Requiring Long-Term Care receives service at an integrated facility for medical and long-term care provided by an integrated facility for medical and long-term care located in a Specified Area (limited to one pertaining to a person that has received the notification under Article 107, paragraph (5); hereinafter referred to as "Service at an Integrated Facility for Medical and Long-Term Care in a Specified Area" in paragraph (4));
要介護被保険者が、特定地域に所在する介護医療院（第百七条第五項の規定による通知を受けた者に係るものに限る。）により行われる介護医療院サービス（第四項において「特定地域介護医療院サービス」という。）を受けた場合において、必要があると認めるとき。
when otherwise provided by a Cabinet Order.
その他政令で定めるとき。
The amount of Exceptional Allowance for Long-Term Care Facility Service A prefecture, in establishing a Prefectural Ordinance pursuant to the provisions of paragraph (1), item (ii), is to be specified by the Municipality based on 90 percent ofestablish the matters listed in item (i) in accordance with the amount equivalent to standards specified by Order of the expenses calculated with regard to said Facility Service according to Ministry of Health, Labour and Welfare, taking into consideration the status of population decline in areas that fall under the standards as prescribedspecified by Order of the MinisterMinistry of Health, Labour, and Welfare (in a case when said calculated expenses exceedprescribed in Article 42, paragraph (1), item (iii), the actual expenses required for saidstatus of employees engaging in Facility Service (excluding the expenses necessary to provide meals, residence,for Long-Term Care Covered by Public Aid and other necessary expenses for daily life as determined circumstances; is to establish the matters listed in items (ii) and (iii) in accordance with the standards specified by Order of the Ministry of Health, Labour, and Welfare), ; and is to take into consideration the base amount is to bestandards specified by Order of the actual expenses required for said Facility Service)Ministry of Health, Labour and Welfare for other matters.
特例施設介護サービス費の額は、当該施設サービスに都道府県が前項第二号の規定により条例を定めるに当たっては、第一号に掲げる事項について前条第二項のは第四十二条第一項第三号に規定する厚生労働大臣が省令で定める基準により算定した費用の額（その額が現に当該該当する地域における人口の減少の状況、介護福祉施設サービスに要した費用（食事の提供に要する費用、居住に要する費用従事する従業者の状況その他の日常生活に要する費用と事情を勘案して厚生労働省令で定める費用を除く。）の額を超えるときは、当該現に施設サービスに要した費用の額とする。）の百分の九十に相当する額を基準として、市町村が定め基準に従い定めるものとし、第二号及び第三号に掲げる事項については厚生労働省令で定める基準に従い定めるものとし、その他の事項については厚生労働省令で定める基準を参酌するものとする。
employees engaging in Facility Service for Long-Term Care Covered by Public Aid in a Specified Area and the number of such employees;
特定地域介護福祉施設サービスに従事する従業者及びその員数
the floor area of residence rooms pertaining to a Facility Covered by Public Aid Providing Long-Term Care to the Elderly in a Specified Area;
特定地域介護老人福祉施設に係る居室の床面積
matters concerning the operation of a Facility Covered by Public Aid Providing Long-Term Care to the Elderly in a Specified Area that are closely related to ensuring the appropriate use of services, appropriate treatment and safety of Persons Requiring Long-Term Care who are admitted, and maintaining confidentiality, and that are specified by Order of the Ministry of Health, Labour and Welfare.
特定地域介護老人福祉施設の運営に関する事項であって、入所する要介護者のサービスの適切な利用、適切な処遇及び安全の確保並びに秘密の保持に密接に関連するものとして厚生労働省令で定めるもの
The mayoramount of a Municipality, when he or she determines Exceptional Allowance for Long-Term Care Facility Service in the necessity for payment of an Exceptional Allowance for Long-Term Care Facility Service, may order a person that has been in chargecases listed in paragraph (1), item (i) or item (v) is to be specified by the Municipality based on 90 percent of the amount equivalent to the expenses calculated with regard to said Facility Service pertainingaccording to said payment or equivalent service (herein referred to the standards determined by the Minister of Health, Labour and Welfare as "Person, etc.,set forth in Charge paragraph (2) of Facility Service" the preceding Article (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 a case when said calculated expenses exceed the actual expenses required for said Facility Service (excluding the expenses necessary to provide meals, residence, and other necessary expenses for daily life as determined by Order of the Ministry of Facility Service pertaining to said payment in orderHealth, Labour and Welfare), the base amount is to inspect said equipment, books, documents, and other itemsbe the actual expenses required for said Facility Service).
市町村長は、第一項第一号又は第五号に掲げる場合における特例施設介護サービス費の支給に関して必要があると認めるとき額は、当該支給に係る施設サービスを担当する者若しくは担当した者（以下この項において「について前条第二項の厚生労働大臣が定める基準により算定した費用の額（その額が現に当該施設サービスを担当する者等」という。）に対し、報告若しくは帳簿書類の提出若しくは提示を命じ、若しくは出頭を求め、又は当該職員に関係者に対して質問させ、若しくは当該に要した費用（食事の提供に要する費用、居住に要する費用その他の日常生活に要する費用として厚生労働省令で定める費用を除く。）の額を超えるときは、当該現に施設サービスを担当する者等の当該支給に係る施設に立ち入り、その設備若しくは帳簿書類その他の物件を検査させることができに要した費用の額とする。）の百分の九十に相当する額を基準として、市町村が定める。
The provisionsamount of Article 24, Exceptional Allowance for Long-Term Care Facility Service in the cases listed in paragraph (3) apply mutatis mutandis 1), items (ii) through (iv) is to questions be specified by the Municipality, for each Facility Service for Long-Term Care Covered by Public Aid in a Specified Area, Long-Term Care Health Facility Service in a Specified Area or Service at an Integrated Facility for Medical and inspections pursuant Long-Term Care in a Specified Area, based on 90 percent of the amount of expenses calculated according to the provisions standards determined by the Minister of Health, Labour and Welfare after taking into consideration the preceding paragraph average expenses required for the Facility Service (excluding the expenses required for the provision of meals, the expenses required for residence, and other expenses required for daily life as specified by Order of the provisionsMinistry of paragraph (4) Health, Labour and Welfare), which average expenses are calculated by taking into consideration the Category of Condition of Need for Long-Term Care and the same Article apply mutatis mutandis area, etc., where the Long-Term Care Insurance Facility in a Specified Area pertaining to those Facility Services is located (if that amount exceeds the authority granted pursuant toactual expenses required for the provisions Facility Service (excluding the expenses required for the provision of meals, the preceding paragraphexpenses required for residence, and other expenses required for daily life as specified by Order of the Ministry of Health, Labour and Welfare), the amount of those actual expenses required for the Facility Service).
第二十四条第三項の規定は前項の規定による質問又は検査について、同条第四項の規定は前項の規定による権限について準用す一項第二号から第四号までに掲げる場合における特例施設介護サービス費の額は、特定地域介護福祉施設サービス、特定地域介護保健施設サービス又は特定地域介護医療院サービスごとに、要介護状態区分、これらの施設サービスに係る特定地域介護保険施設の所在する地域等を勘案して算定される当該施設サービスに要する平均的な費用（食事の提供に要する費用、居住に要する費用その他の日常生活に要する費用として厚生労働省令で定める費用を除く。）の額を勘案して厚生労働大臣が定める基準により算定した費用の額（その額が現に当該施設サービスに要した費用（食事の提供に要する費用、居住に要する費用その他の日常生活に要する費用として厚生労働省令で定める費用を除く。）の額を超えるときは、当該現に施設サービスに要した費用の額とする。）の百分の九十に相当する額を基準として、市町村が定める。
The Minister of Health, Labour and Welfare, when intending to determine the standards referred to in the preceding paragraph, must hear the opinion of the Social Security Council in advance.
厚生労働大臣は、前項の基準を定めようとするときは、あらかじめ社会保障審議会の意見を聴かなければならない。
The mayor of a Municipality, when he or she determines it necessary for the payment of an Exceptional Allowance for Long-Term Care Facility Service, may order a person that is or has been in charge of the Facility Service pertaining to said payment (herein referred to as "Person, etc., in Charge of Facility Service" in this paragraph) to report, to submit or present record books and documents, or to appear, or may direct its personnel to question the relevant persons or to enter the facility of said Person, etc., in Charge of Facility Service pertaining to said payment and inspect the equipment, books, documents, and other items.
市町村長は、特例施設介護サービス費の支給に関して必要があると認めるときは、当該支給に係る施設サービスを担当する者若しくは担当した者（以下この項において「施設サービスを担当する者等」という。）に対し、報告若しくは帳簿書類の提出若しくは提示を命じ、若しくは出頭を求め、又は当該職員に関係者に対して質問させ、若しくは当該施設サービスを担当する者等の当該支給に係る施設に立ち入り、その設備若しくは帳簿書類その他の物件を検査させることができる。
The provisions of Article 24, paragraph (3) apply mutatis mutandis to questions or inspections pursuant to the provisions of the preceding paragraph, and the provisions of paragraph (4) of the same Article apply mutatis mutandis to the authority granted pursuant to the provisions of the preceding paragraph.
第二十四条第三項の規定は前項の規定による質問又は検査について、同条第四項の規定は前項の規定による権限について準用する。
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".
第一号被保険者であって政令で定めるところにより算定した所得の額が政令で定める額以上である要介護被保険者（次項に規定する要介護被保険者を除く。）が受ける次の各号に掲げる介護給付について当該各号に定める規定を適用する場合においては、これらの規定中「百分の九十」とあるのは、「百分の八十」とする。
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);
居宅介護サービス費の支給 第四十一条第四項第一号及び第二号並びに第四十三条第一項、第四項及び第六項
payment of an Exceptional Allowance for In-Home Long-Term Care Service:Article 42, paragraph (34), and paragraph (5), item (i) and item (ii), and Article 43, paragraph (1), paragraph (4) and paragraph (6);
特例居宅介護サービス費の支給 第四十二条第三項四項並びに第五項第一号及び第二号並びに第四十三条第一項、第四項及び第六項
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);
地域密着型介護サービス費の支給 第四十二条の二第二項各号並びに第四十三条第一項、第四項及び第六項
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);
特例地域密着型介護サービス費の支給 第四十二条の三第二項並びに第四十三条第一項、第四項及び第六項
payment of an Allowance for Long-Term Care Facility Service:Article 48, paragraph (2);
施設介護サービス費の支給 第四十八条第二項
payment of an Exceptional Allowance for Long-Term Care Facility Service:paragraph (23) and paragraph (4) of the preceding Article;
特例施設介護サービス費の支給 前条第二三項及び第四項
payment of an Allowance for Purchasing Equipment for In-Home Long-Term Care Covered by Public Aid:Article 44, paragraph (3), paragraph (45), and paragraph (78);
居宅介護福祉用具購入費の支給 第四十四条第三項、第四五項及び第七八項
payment of an Allowance for Home Modification for In-Home Long-Term Care:Article 45, paragraph (3), paragraph (4) and paragraph (7).
居宅介護住宅改修費の支給 第四十五条第三項、第四項及び第七項
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".
第一号被保険者であって政令で定めるところにより算定した所得の額が前項の政令で定める額を超える政令で定める額以上である要介護被保険者が受ける同項各号に掲げる介護給付について当該各号に定める規定を適用する場合においては、これらの規定中「百分の九十」とあるのは、「百分の七十」とする。
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".
市町村が、災害その他の厚生労働省令で定める特別の事情があることにより、居宅サービス（これに相当するサービスを含む。以下この条において同じ。）、地域密着型サービス（これに相当するサービスを含む。以下この条において同じ。）若しくは施設サービス又は住宅改修に必要な費用を負担することが困難であると認めた要介護被保険者が受ける前条第一項各号に掲げる介護給付について当該各号に定める規定を適用する場合（同条の規定により読み替えて適用する場合を除く。）においては、これらの規定中「百分の九十」とあるのは、「百分の九十を超え百分の百以下の範囲内において市町村が定めた割合」とする。
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".
市町村が、災害その他の厚生労働省令で定める特別の事情があることにより、居宅サービス、地域密着型サービス若しくは施設サービス又は住宅改修に必要な費用を負担することが困難であると認めた要介護被保険者が受ける前条第一項各号に掲げる介護給付について当該各号に定める規定を適用する場合（同項の規定により読み替えて適用する場合に限る。）においては、同項の規定により読み替えて適用するこれらの規定中「百分の八十」とあるのは、「百分の八十を超え百分の百以下の範囲内において市町村が定めた割合」とする。
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".
市町村が、災害その他の厚生労働省令で定める特別の事情があることにより、居宅サービス、地域密着型サービス若しくは施設サービス又は住宅改修に必要な費用を負担することが困難であると認めた要介護被保険者が受ける前条第一項各号に掲げる介護給付について当該各号に定める規定を適用する場合（同条第二項の規定により読み替えて適用する場合に限る。）においては、同条第二項の規定により読み替えて適用するこれらの規定中「百分の七十」とあるのは、「百分の七十を超え百分の百以下の範囲内において市町村が定めた割合」とする。
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.
市町村は、要介護被保険者が受けた居宅サービス（これに相当するサービスを含む。）、地域密着型サービス（これに相当するサービスを含む。）又は施設サービスに要した費用の合計額として政令で定めるところにより算定した額から、当該費用につき支給された居宅介護サービス費、特例居宅介護サービス費、地域密着型介護サービス費、特例地域密着型介護サービス費、施設介護サービス費及び特例施設介護サービス費の合計額を控除して得た額（次条第一項において「介護サービス利用者負担額」という。）が、著しく高額であるときは、当該要介護被保険者に対し、高額介護サービス費を支給する。
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.
前項に規定するもののほか、高額介護サービス費の支給要件、支給額その他高額介護サービス費の支給に関して必要な事項は、居宅サービス、地域密着型サービス又は施設サービスに必要な費用の負担の家計に与える影響を考慮して、政令で定める。
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.
市町村は、要介護被保険者の介護サービス利用者負担額（前条第一項の高額介護サービス費が支給される場合にあっては、当該支給額に相当する額を控除して得た額）及び当該要介護被保険者に係る健康保険法第百十五条第一項に規定する一部負担金等の額（同項の高額療養費が支給される場合にあっては、当該支給額に相当する額を控除して得た額）その他の医療保険各法又は高齢者の医療の確保に関する法律（昭和五十七年法律第八十号）に規定するこれに相当する額として政令で定める額の合計額が、著しく高額であるときは、当該要介護被保険者に対し、高額医療合算介護サービス費を支給する。
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.
前条第二項の規定は、高額医療合算介護サービス費の支給について準用する。