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 In-Home Persons Requiring Support receives any of the following Designated Preventive Long-Term Care Service (hereinafter referred to as "Specified Preventive Long-Term Care Service" in this Article and paragraph (1) of the following Article), pays to said Insured In-Home Person Requiring Support (hereinafter referred to as a "Specified Person Admitted to a Facility" in this Article and paragraph (1) of the following Article) an Allowance for Preventive Long-Term Care Service to a Person Admitted to a Specified Facility for the expenses required to provide meals and the expenses required for stay at a Designated Provider of Preventive Long-Term Care Service that provides said Specified Preventive Long-Term Care Service (hereinafter referred to as a "Specified Provider of Preventive Long-Term Care Service" 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 Preventive Long-Term Care Service other than the type pertaining to said designation:

Short-Term Admission for Daily Preventive Long-Term Care;

Short-Term Admission for Recuperation for Preventive Long-Term Care.

The amount of Allowance for Long-Term Care Preventive Service of a Person Admitted to a Specified Facility is to be the total of the amount as prescribed in item (i) and the amount as prescribed in item (ii):

the amount remaining 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 (herein referred to as "Maximum Allowance for Meal Expense" in this Article and paragraph (2) of the following Article) 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 Long-Term Care Preventive Service Specified Provider (in a case when said amount exceeds the actual expenses of providing said meals, this amount is to be the amount of the actual expenses of providing said meals, herein referred to as "Base Cost for Meal Expense" in this Article and paragraph (2) of the following Article);

the amount remaining after the amount determined by the Minister of Health, Labour, and Welfare after considering the income status of the Special Insured Person Admitted to the Facility and other circumstances (herein referred to as "Maximum Allowance for Room and Board Expense") is deducted from the amount determined by the Minister of Health, Labour, and Welfare after considering the average expenses necessary for a stay in the Long-Term Care Preventive Service Specified Provider, the status of said facility, and other circumstances (in a case when said amount exceeds the actual expenses for said stay, this amount is to be the amount of the actual expenses for said stay; herein referred to as "Base Costs for Room and Board" in this Article and paragraph (2) of the following Article).

The Minister of Health, Labour, and Welfare, when the expenses necessary of providing meals and for a stay incurred by a Long-Term Care Preventive Service Specified Provider and other circumstances have changed significantly after the Base Cost for Meal Expense or the Maximum Allowance for Meal Expense, or the Base Costs for Room and Board or the Maximum Allowance for Stay Expense were determined, must revise those amount immediately.

When a Specified Person Admitted to a Facility receives Specified Preventive Service of Long-Term Care from a Long-Term Care Preventive Service Specified Provider, a Municipality may pay the expenses required to provide meals and residence that said Specified Person Admitted to a Facility should pay to said Long-Term Care Preventive Service Specified Provider, within the limit of amount to be paid to said Specified Person Admitted to a Facility as an Allowance for Long-Term Care Preventive Service of a Person Admitted to a Specified Facility to said Long-Term Care Preventive Service Specified Provider on behalf of said Specified Person Admitted to a Facility.

When the allowance is paid pursuant to the provisions of the preceding paragraph, it is to be deemed that an Allowance for Long-Term Care Preventive Service of 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 Specified Person Admitted to a Facility pays to a Long-Term Care Preventive Service Specified Provider the amount exceeding the Base Cost for Meal Expense or the Base Costs for Room and Board (with regard to a Specified Person Admitted to a Facility that was deemed to be paid an Allowance for Long-Term Care Preventive Service of a Person Admitted to a Specified Facility pursuant to the provisions of the preceding paragraph, the Maximum Allowance for Meal Expense or the Maximum Allowance for Stay Expense) as the expenses necessary of providing meals or for stay, does not pay the Allowance for Long-Term Care Preventive Service of a Person Admitted to a Specified Facility.

A Municipality, when a Long-Term Care Preventive Service Specified Provider requests an Allowance for Long-Term Care Preventive Service of a Person Admitted to a Specified Facility provided to a Specified Person Admitted to a Facility, pays said allowance after conducting an examination according to 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 payment of an Allowance for Long-Term Care Preventive Service of a Person Admitted to a Specified Facility and the provisions of paragraph (8) of the same Article apply mutatis mutandis to a Long-Term Care Preventive Service Specified Provider. 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 preceding paragraph, other necessary matters payment of an Allowance for Long-Term Care Preventive Service of a Person Admitted to a Specified Facility and for the request of an Allowance for Long-Term Care Preventive Service of a Person Admitted to a Specified Facility by a Long-Term Care Preventive Service Specified Provider 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 Preventive Service of a Person Admitted to a Specified Facility to a Specified Person Admitted to a Facility:

when a Municipality determines it necessary in a case when Specified Person Admitted to a Facility receives Specified Preventive Service of Long-Term Care prior to the date said Certification of Needed Support becomes effective due to an emergency or other compelling reason;

when otherwise specified by Cabinet Order.

The amount of Exceptional Allowance for Long-Term Care Preventive Service of a Person Admitted to a Specified Facility to a Specified Person Admitted to a Facility is established by a Municipality based on the total sum of the amount with regard to the expenses required of providing said meals that is the result of deducting the Base Allowance for Food Expense from the Maximum Cost for Food Expense, and the amount with regard to the expenses required for said stay that is the result of deduction of the Base Allowance for Stay from the Maximum Cost for Stay.

A Municipality may pay a Municipal Special Benefit pursuant to the provisions of a municipal ordinance to an Insured Person Requiring Long-Term Care or an Insured In-Home Person Requiring Support (herein referred to as "Insured Person Requiring Long-Term Care, etc.") in addition to the insurance benefits as set forth in the preceding two sections.

With regard to a person that is confined to penal institution, work facility, or other facility mutatis mutandis as these, a Long-Term Care Benefit, etc., pertaining to said period of confinement is not paid.

With regard to the Condition of Need for Long-Term Care, etc., of an Insured Person that caused the accident that caused a Condition of Need for Long-Term Care, etc., or the cause of said condition, or who increased the degree of Condition of Need for Long-Term Care, etc., by not obeying instructions for the use of Service Covered by Long-Term Care Benefits, etc., or for a Home Modification pertaining to an Allowance for Home Modification for In-Home Long-Term Care or Allowance for Preventive Long-Term Care Home Modification due to an intentional criminal act or gross negligence or without justifiable reasons, a Municipality may not pay the whole or a part of a Long-Term Care Benefit, etc., for which the reason for payment is said Condition of Need for Long-Term Care, etc.

A Municipality, when a person that receives a Long-Term Care Benefit, etc., fails to respond to a request pursuant to the provisions of Article 23 (in a case when it is entrusted pursuant to the provisions of Article 24-2, paragraph (1), item (i), including a request pertaining to said entrustment) or refuses to answer without a justifiable reason, may not pay the whole or a part of a Long-Term Care Benefit, etc.

A Municipality, in a case when an Insured Person Requiring Long-Term Care, etc. who is a Primary Insured Person delinquent in payment of an insurance premium (excluding those who can receive payment of a medical allowance for general disease pursuant to the Atomic Bomb Survivors' Assistance Act (Act No. 117 of 1994) and other benefits for medical care as determined by Order of the Ministry of Health, Labour and Welfare) fails to pay said insurance premium from the payment due date of said insurance premium until the expiry of the period as determined by Order of the Ministry of Health, Labour and Welfare, except for a case when it is found that there is a special circumstance for said delinquency of insurance premium payment such as a disaster or other circumstances provided by a Cabinet Order, is to request said Insured Person Requiring Long-Term Care, etc. to submit the Certificate of Insured Person, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, and to enter on said Certificate of Insured Person that the provisions of Article 41, paragraph (6), Article 42-2, paragraph (6), Article 46, paragraph (4), Article 48, paragraph (4), Article 51-3, paragraph (4), Article 53, paragraph (4), Article 54-2, paragraph (6), Article 58, paragraph (4) and Article 61-3, paragraph (4) do not apply (hereinafter referred to as "Entry of Change of Payment Method" in this Article and paragraph (3) of the following Article).

A Municipality, although in a case when the period as determined by Order of the Ministry of Health, Labour, and Welfare as prescribed in the preceding paragraph has not yet expired, except for a case it is determined that said person delinquent in payment is due to special circumstances provided by a Cabinet Order as prescribed in the same paragraph, may request the Insured Person Requiring Long-Term Care, etc., as prescribed in the same paragraph to submit the Certificate of Insured Person, and include the Entry of Change of Payment Method on said Certificate of Insured Person.

A Municipality, when an Insured Person Requiring Long-Term Care, etc., that has received an Entry of Change of Payment Method pursuant to the provisions of the preceding two paragraphs and has completed payment of said delinquent insurance premium or when it is determined that the delinquent payment amount pertaining to said Insured Person Requiring Long-Term Care, etc., has decreased significantly or due to a disaster or other special circumstances provided by a Cabinet Order, is to delete said Entry of Change of Payment Method.

With regard to the payment of an Allowance for In-Home Long-Term Care Service, Allowance for Community-Based Long-Term Care Service, Allowance for In-Home Long-Term Care Service Plan, Allowance for Long-Term Care Facility Service, Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility, Allowance for Preventive Long-Term Care Service, Allowance for Community-Based Preventive Long-Term Care Service, Allowance for Preventive Long-Term Care Service Plan, and Allowance for Preventive Long-Term Care Service to a Person Admitted to a Specified Facility, pertaining to Designated In-Home Service, Designated Community-Based Service, Designated In-Home Long-Term Care Support, Designated Facility Service, etc., Designated Preventive Long-Term Care Service, Designated Community-Based Service for Preventive Long-Term Care, and Designated Preventive Long-Term Care Support that an Insured Person Requiring Long-Term Care, etc. who received an Entry of Change of Payment Method pursuant to the provisions of paragraph (1) or paragraph (2) receives during the period said Entry of Change of Payment Method remains, the provisions of Article 41, paragraph (6), Article 42-2, paragraph (6), Article 46, paragraph (4), Article 48, paragraph (4), Article 51-3, paragraph (4), Article 53, paragraph (4), Article 54-2, paragraph (6), Article 58, paragraph (4), and Article 61-3, paragraph (4) do not apply.

A Municipality, when an Insured Person Requiring Long-Term Care, etc., that is a Primary Insured Person that can receive an insurance benefit becomes a person delinquent in the payment of an insurance premium and fails to pay said insurance premium from the due date of payment of said insurance premium until the period as determined by Order of the Ministry of Health, Labour, and Welfare expires, is to temporarily suspend the payment of the whole or a part of an insurance benefit, pursuant to the provisions of Order of the Ministry of Health, Labour, and Welfare, except for a case when it is determined that said delinquency of payment of an insurance premium is due to a disaster or other special circumstance as determined by a Cabinet Order.

A Municipality, in a case when an Insured Person Requiring Long-Term Care, etc., who is a Primary Insured Person that can receive an insurance benefit becomes a person delinquent in the payment of an insurance premium although the period as determined by Order of the Ministry of Health, Labour, and Welfare as prescribed in the preceding paragraph has not yet expired, except for a case when it is determined that said delinquency of an insurance premium is due to a disaster or other special circumstance as determined by a Cabinet Order as prescribed, may temporarily suspend the whole or a part of an insurance benefit pursuant to the provisions of Order of the Ministry of Health, Labour, and Welfare.

A Municipality, in a case when an Insured Person Requiring Long-Term Care, etc., that has received an Entry of Change of Payment Method pursuant to the provisions of paragraph (1) or paragraph (2) of the preceding Article and whose insurance benefit has been temporarily suspended in whole or in part pursuant to the provisions of the preceding two paragraphs and who has not yet paid the delinquent insurance premium, may notify in advance said Insured Person Requiring Long-Term Care, etc., pursuant to the provisions of Order of the Ministry of Health, Labour, and Welfare, and deduct the amount of delinquent insurance premium of said Insured Person Requiring Long-Term Care, etc., from the amount of insurance benefit pertaining to said temporary suspension.