Long-Term Care Insurance Act

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..

A prevention benefit is to an insurance benefit listed in the following:

payment of a Preventive Long-Term Care Service Allowance;

payment of an Exceptional Allowance for Preventive Service of Long-Term Care;

payment of an Allowance for Community-Based Preventive Long-Term Care Service;

payment of an Exceptional Allowance for Community-Based Preventive Service of Long-Term Care;

payment of an Allowance for Purchasing Equipment for Preventive Long-Term Care Covered by Public Aid;

payment of an Allowance for Preventive Long-Term Care Home Modification;

payment of an Allowance for Preventive Long-Term Care Service Plan;

payment of an Exceptional Allowance for a Preventive Service Plan of Long-term care;

payment of an Allowance for High-Cost Preventive Long-Term Care Service;

payment of an Allowance for High-Cost Medical and Preventive Long-Term Care Service Combined;

payment of an Allowance for Preventive Long-Term Care Service to a Person Admitted to a Specified Facility;

payment of an Exceptional Allowance for Preventive Long-Term Care Service to a Person Admitted to a Specified Facility.

A Municipality, when an Insured Person who has received a Certification of Needed Support and receives support at home (hereinafter referred to as an "Insured In-Home Person Requiring Support") has received, from a person designated by the prefectural governor (hereinafter referred to as a "Designated Provider of Preventive Long-Term Care Service"), Preventive Long-Term Care Service provided by a Business Office conducting the Preventive Long-Term Care Service Business pertaining to said designation (hereinafter referred to as "Designated Preventive Long-Term Care Service") (limited to a case when said Insured In-Home Person Requiring Support has notified a Municipality in advance, pursuant to the provisions of Article 58, paragraph (4), of receiving Designated Preventive Long-Term Care Support prescribed in paragraph (1) of the same Article and said Designated Preventive Long-Term Care Service is subject to said Designated Preventive Long-Term Care Support, or other cases specified by Order of the Ministry of Health, Labour and Welfare), pays to said Insured In-Home Person Requiring Support an Allowance for Preventive Long-Term Care Service for the expenses required for said Designated Preventive Long-Term Care Service (excluding the expenses required to purchase Specified Equipment for Preventive Long-Term Care Covered by Public Aid and, with regard to the expenses required for Outpatient Rehabilitation for Preventive Long-Term Care, Short-Term Admission for Daily Preventive Long-Term Care, Short-Term Admission for Recuperation for Preventive Long-Term Care, and Daily Preventive Long-Term Care Admitted to a Specified Facility, the expenses necessary to provide meals, stay and other expenses necessary for daily life as determined by Order of the Ministry of Health, Labour and Welfare; the same applies hereinafter in this Article); provided, however, that this does not apply when said Insured In-Home Person Requiring Support, in a case where he or she has been issued a designation pursuant to the provisions of Article 37, paragraph (1), receives Preventive Long-Term Care Service other than the type pertaining to said designation.

The amount of Allowance for Preventive Long-Term Care Service is to according to the categories of Preventive Service of Long-Term Care listed in each item of the following and the amount as prescribed in said items:

Home-Visit Bathing Service for Preventive Long-Term Care, Home-Visit Nursing Service for Preventive Long-Term Care, Home-Visit Rehabilitation Service for Preventive Long-Term Care, Management and Guidance for In-Home Medical Service for Preventive Long-Term Care, Outpatient Rehabilitation for Preventive Long-Term Care, and Equipment Rental for Preventive Long-Term Care Covered by Public Aid: for each type of these Preventive Long-Term Care Services, an amount equivalent to 90 percent of the amount of expenses calculated in accordance with the standards determined by the Minister of Health, Labour and Welfare (when said calculated amount exceeds the amount of expenses actually required for said Designated Preventive Long-Term Care Service, the amount of expenses actually required for said Designated Preventive Long-Term Care Service) in consideration of the average expenses required for said Designated Preventive Long-Term Care Service, calculated in consideration of the content of the Designated Preventive Long-Term Care Service pertaining to the type of said Preventive Long-Term Care Service, the area where the Business Office conducting said Designated Preventive Long-Term Care Service business is located, etc. (in the case of the expenses required for Outpatient Rehabilitation for Preventive Long-Term Care, excluding the expenses necessary to provide meals and other expenses necessary for daily life as determined by Order of the Ministry of Health, Labour and Welfare);

Short-Term Admission for Daily Preventive Long-Term Care, Short-Term Admission for Recuperation for Preventive Long-Term Care, and Daily Preventive Long-Term Care Admitted to a Specified Facility:the amount equivalent to 90 percent of the amount calculated by the type of Preventive Service of Long-Term Care and after considering the average expenses necessary for said Designated Preventive Service of Long-Term Care that is calculated after considering the categories of Needed Support Condition, the area where the provider that performs said Designated Preventive Service of Long-Term Care Business is located, etc., pertaining the type of said Preventive Service of Long-Term Care (excluding the expenses necessary to provide meals, residence, and other expenses as determined by Order of the Ministry of Health, Labour, and Welfare as necessary for daily life), based on the standards provided by the Minister of Health, Labour, and Welfare (when said calculated amount exceeds the actual expenses required for said Designated Preventive Service of Long-Term Care, said amount is to the actual expenses required for said Designated Preventive Service of Long-Term Care).

The Minister of Health, Labour, and Welfare, when it intends to determine the standards as prescribed in the items of the preceding paragraph, shmust hear the opinion of the Social Security Council in advance.

When an Insured In-Home Person Requiring Support receives Designated Preventive Service of Long-Term Care from a Designated Provider of a Preventive Service to Long-Term Care, a Municipality may pay the expenses required for said Designated Preventive Service of Long-Term Care that said Insured In-Home Person Requiring Support should pay to said Designated Provider of a Preventive Service to Long-Term Care to said Designated Provider of a Preventive Service to Long-Term Care on behalf of said Insured In-Home Person Requiring Support within the limit of the amount to be paid to said Insured In-Home Person Requiring Support as an Allowance for Preventive Long-Term Care Service.

When the payment pursuant to the provisions of the preceding paragraph is paid, it is to be deemed that an Allowance for Preventive Long-Term Care Service is paid to said Insured In-Home Person Requiring Support.

A Municipality, when a Designated Provider of a Preventive Service to Long-Term Care requests an Allowance for Preventive Long-Term Care Service, pays after conducting an examination according to standards provided by the Minister of Health, Labour, and Welfare as set forth in each item of paragraph (2), standards concerning effective support methods for prevention of long-term care pertaining to the Designated Preventive Service of Long-Term Care as prescribed in Article 115-4, paragraph (2), and standards concerning facilities and management of a Designated Preventive Service to Long-Term Care Business (limited to the part concerning the handling of Designated Preventive Service of Long-Term Care).

The provisions of Article 41, paragraph (2), paragraph (3), paragraph (10), and paragraph (11) apply mutatis mutandis to payment of an Allowance for Preventive Long-Term Care Service and the provisions of paragraph (8) of the same Article apply mutatis mutandis to a Designated Provider of a Preventive Service to Long-Term Care. In this case, the necessary technical replacement of terms in these provisions is specified by a Cabinet Order.

In addition to those matters as prescribed in each of the preceding paragraphs, other necessary matters for payment of an Allowance for Preventive Long-Term Care Service and for the request of an Allowance for Preventive Long-Term Care Service by a Designated Provider of a Preventive Service to Long-Term Care are prescribed by Order of the Ministry of Health, Labour, and Welfare.