Long-Term Care Insurance Act

Total sum of the total amounts of the Allowance for Preventive Long-Term Care Service and Exceptional Allowance for Preventive Service of Long-Term Care that are paid for Preventive Service of Long-Term Care, and the Allowance for Community-Based Preventive Long-Term Care Service and Exceptional Allowance for Community-Based Preventive Service of Long-Term Care that are paid for Designated Provider of Community-Based Service for Preventive Long-Term Care, as pertaining to a single category of Preventive Service of Long-Term Care, etc., that an In-Home Person Requiring Support receives monthly by category of Preventive Service of Long-Term Care, etc. (which means categories of two or more types as determined by the Minister of Health, Labour, and Welfare, with regard to Preventive Service of Long-Term Care (including equivalent services; the same applies hereinafter in this Article) and Community-Based Preventive Service of Long-Term Care (including equivalent services; the same applies hereinafter in this Article), after considering the inter-substitution by type; the same applies hereinafter in this Article) during the period provided 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 provisions of Order of the Ministry of Health, Labour, and Welfare based on the base amount of maximum benefit for the payment categories of Preventive Service of Long-Term Care, etc.

The base amount of maximum benefit for the payment categories of Allowance for Preventive Long-Term Care Service, etc., as set forth in the preceding paragraph is to be the amount determined by the Minister of Health, Labour, and Welfare by category of Preventive Service of Long-Term Care, etc., after considering the types of standard use that are according to the categories of Needed Support Condition, of Preventive Service of Long-Term Care, and of Community-Based Preventive Service of Long-Term Care pertaining to the categories of said Preventive Service of Long-Term Care, etc., during the period as determined by Order of the Ministry of Health, Labour, and Welfare as prescribed in the same paragraph, standards provided by the Minister of Health, Labour, and Welfare as set forth in each item of Article 53, paragraph (2) and each item of Article 54-2, paragraph (2) pertaining to said Preventive Service of Long-Term Care and Community-Based Preventive Service of Long-Term Care.

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 the maximum benefit by payment category of Preventive Service of Long-Term Care, etc., as set forth in paragraph (1), may determine that an amount exceeding said base amount as the base amount of maximum benefit by payment category of Preventive Service of Long-Term Care in said Municipality.

A Municipality may stipulate that the total sum of the total amounts of Allowance for Preventive Long-Term Care Service and Exceptional Allowance for Preventive Service of Long-Term Care that are paid for single type of Preventive Service of Long-Term Care and the total amount of Allowance for Community-Based Preventive Long-Term Care Service and Exceptional Allowance for Community-Based Preventive Service of Long-Term Care that are paid for single type of Community-Based Preventive Service of Long-Term Care as allowances that were paid monthly to an In-Home Person Requiring Support by type of Preventive Service of Long-Term Care and Community-Based Preventive Service of Long-Term Care (limited to those types included in categories of Preventive Service of Long-Term Care, etc., and provided by the Minister of Health, Labour, and Welfare; the same applies in the following paragraph) 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 provisions of Order of the Ministry of Health, Labour, and Welfare based on the base amount of maximum benefit by payment type of Preventive Service of Long-Term Care, etc.

The base amount of maximum benefit by payment type of Preventive Service of Long-Term Care, etc., as set forth in the preceding paragraph is to be the amount that a Municipality stipulates by ordinance, by type of Preventive Service of Long-Term Care and Community-Based Preventive Service of Long-Term Care, after considering the type of standard use that is according to each Category of Needed Support Condition, of said Preventive Service of Long-Term Care and Community-Based Preventive Service of Long-Term Care during the period as determined by Order of the Ministry of Health, Labour, and Welfare as prescribed in the same paragraph, standards determined by the Minister of Health, Labour, and Welfare as set forth in each item of Article 53, paragraph (2) and each item of Article 54-2, paragraph (2) pertaining to said Preventive Service of Long-Term Care and Community-Based Preventive Service of Long-Term Care, etc., within the base amount of maximum benefit by payment category of Preventive Service of Long-Term Care, etc., as set forth in paragraph (1) pertaining to the categories of Preventive Service of Long-Term Care, etc., that include said Preventive Service of Long-Term Care and Community-Based Preventive Service of Long-Term Care (said base amount, with regard to the Municipality that provides Order pursuant to the provisions of paragraph (3), is to be the amount by which measures pursuant to the provisions of said municipal ordinance are undertaken).

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

An Allowance for Purchasing Equipment for Preventive 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 only when a Municipality determines it necessary.

A Municipality, when an Insured In-Home Person Requiring Support modifies his or her home, pay Allowance for Preventive Long-Term Care Home Modification to said Insured In-Home Person Requiring Support.

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

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

The total amount of Allowance for Preventive Long-Term Care Home Modification that should be paid for one type of Home Modification that an Insured In-Home Person Requiring Support undertakes 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 as an Allowance for Preventive Long-Term Care Home Modification.

The based amount of maximum payment as an Allowance for Preventive Long-Term Care Home Modification as set forth in the preceding paragraph is to be the amount determined by the Minister of Health, Labour, and Welfare by type of Home Modification care after considering the expenses normally required.

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 as an Allowance for Preventive Long-Term Care Home Modification as set forth in paragraph (4), may stipulate an amount that exceeds said base amount as the base amount of maximum payment as an Allowance for Preventive Long-Term Care Home Modification in said Municipality.

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

The mayor of a Municipality, when he or she determines the necessity of the payment of an Allowance for Preventive Long-Term Care Home Modification, may order a person that modifies the home or equivalent service pertaining to said payment (herein referred to as "Person, etc., that Modifies a Home" 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., that Modifies a Home pertaining to said payment in order to inspect such facilities, record books and documents, and other items.

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

A Municipality, when an Insured In-Home Person Requiring Support receives from a person designated by the mayor of said Municipality (or, for Preventive Long-Term Care Support for an Insured In-Home Person Requiring Support to Whom the Domicile Exception Applies, the Municipality Where the Facility Is Located) (herein referred to as "Designated Preventive Long-Term Care Support Provider") the Preventive Long-Term Care Support provided by a provider that performs the Preventive Long-Term Care Support Business pertaining to said designation (herein referred to as "Designated Preventive Long-Term Care Support"), pays to said Insured In-Home Person Requiring Support an Allowance for Preventive Long-Term Care Service Plan for the expenses required for said Designated Preventive Long-Term Care Support.

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

When an Insured In-Home Person Requiring Support receives Designated Support for Prevention of Long-Term Care from a Designated Provider of Preventive Support of Long-Term Care (limited to a case when said Insured In-Home Person Requiring Support has notified in advance the Municipality pursuant to the provisions of Order of the Ministry of Health, Labour, and Welfare of receipt of said Designated Support for Prevention of Long-Term Care), a Municipality may pay the expenses required for said Designated Support for Prevention of Long-Term Care that said Insured In-Home Person Requiring Support should pay to said Designated Provider of Support for Prevention of Long-Term Care, to said Designated Provider of Preventive Support of 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 Plan.

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

A Municipality, when a Designated Preventive Long-Term Care Support Provider requests an Allowance for Preventive Long-Term Care Service Plan, is to pay said allowance after conducting an examination according to standards determined by the Minister of Health, Labour and Welfare as set forth in paragraph (2), standards concerning effective support methods for Prevention of Long-Term Care pertaining to Designated Preventive Long-Term Care Support as prescribed in Article 115-24, paragraph (2), and standards concerning the management of the business of Designated Preventive Long-Term Care Support (limited to the part concerning the handling of Designated Preventive Long-Term Care Support).

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

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