Long-Term Care Insurance Act

In order to conduct the examination of invoices for Long-Term Care Benefit expenses and invoices for Comprehensive Project for Long-Term Care Prevention and Daily Life Support expenses based on the entrustment pursuant to the provisions of Article 41, paragraph (10) (including a case applied mutatis mutandis pursuant to Article 42-2, paragraph (9), Article 46, paragraph (7), Article 48, paragraph (7), Article 51-3, paragraph (8), Article 53, paragraph (7), Article 54-2, paragraph (9), Article 58, paragraph (7) and Article 61-3, paragraph (8)), and Article 115-45-3, paragraph (6) and Article 115-47, paragraph (7), an examination committee for Long-Term Care Benefit expenses, etc. (hereinafter referred to as "examination committee for Long-Term Care Benefit expenses, etc.") is to be established by an Association.

An examination committee for Long-Term Care Benefit expenses, etc. is to be comprised of committee members that represent Persons in Charge of Service Covered by Long-Term Care Benefits, etc. (which means persons in charge of 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, or Designated Preventive Long-Term Care Support; the same applies in paragraph (3) and paragraphs (1) and (2) of the following Article) or Persons in Charge of Comprehensive Project for Long-Term Care Prevention and Daily Life Support (which means persons in charge of a category 1 project at a Designated Provider or persons in charge of the Comprehensive Project for Long-Term Care Prevention and Daily Life Support at a trustee; the same applies in paragraph (3) and paragraph (2) of the following Article), committee members that represent Municipalities, and committee members that represent the public interest, with each group having the same number of committee members, as prescribed by the constitution.

Committee members are commissioned by an Association.

The commission as set forth in the preceding paragraph, with regard to committee members who represent Persons in Charge of Service Covered by Long-Term Care Benefits, etc. or Persons in Charge of Comprehensive Project for Long-Term Care Prevention and Daily Life Support, and committee members who represent Municipalities, must be conducted by the nomination of concerned organizations, respectively.

An examination committee for Long-Term Care Benefit expenses, etc., when it is determined necessary for the examination of invoices for Long-Term Care Benefit expenses, after obtaining the approval of the prefectural governor, may request said Designated In-Home Service Provider, Designated Provider of Preventive Long-Term Care Service, or Facility Covered by Long-Term Care Insurance to report, or to submit or present record books and documents, or may request an Establisher or manager, or the head, of said Designated In-Home Service Provider, Designated Provider of Preventive Long-Term Care Service, or Facility Covered by Long-Term Care Insurance, or a Person in Charge of Service Covered by Long-Term Care Benefits, etc. at a Business Office pertaining to the business of said Designated In-Home Service or the business of Designated Preventive Long-Term Care Service or at a Facility Covered by Long-Term Care Insurance, to appear or provide an explanation.

An examination committee for Long-Term Care Benefit expenses, etc., when it is determined necessary for the examination of invoices for Long-Term Care Benefit expenses or invoices for Comprehensive Project for Long-Term Care Prevention and Daily Life Support expenses, after obtaining the approval of the mayor of the Municipality, may request said Designated Community-Based Service Provider, Designated In-Home Long-Term Care Support Provider, Designated Provider of Community-Based Service for Preventive Long-Term Care, Designated Preventive Long-Term Care Support Provider, Designated Provider, or trustee to report, or to submit or present record books and documents, or may request said Designated Community-Based Service Provider, Designated In-Home Long-Term Care Support Provider, Designated Provider of Community-Based Service for Preventive Long-Term Care, Designated Preventive Long-Term Care Support Provider, Designated Provider, or trustee, or a Person in Charge of Service Covered by Long-Term Care Benefits, etc. at a Business Office pertaining to the business of said Designated Community-Based Service, the Designated In-Home Long-Term Care Support Business, the business of Designated Community-Based Service for Preventive Long-Term Care, or the business of Designated Preventive Long-Term Care Support, or a Person in Charge of Comprehensive Project for Long-Term Care Prevention and Daily Life Support at a Designated Provider or trustee, to appear or provide an explanation.

An Association must pay the travel expenses, a daily allowance, and accommodation charges of a person that appears before an examination committee for Long-Term Care Benefit expenses, etc. pursuant to the provisions of the preceding two paragraphs, however, provided that this provision does not apply to those who appear pursuant to a request for appearance due to a defective or improper entry of an invoice for Long-Term Care Benefit expenses, an invoice for Comprehensive Project for Long-Term Care Prevention and Daily Life Support expenses, or the record books and documents that are submitted by said Designated In-Home Service Provider, Designated Provider of Preventive Long-Term Care Service, Facility Covered by Long-Term Care Insurance, Designated Community-Based Service Provider, Designated In-Home Long-Term Care Support Provider, Designated Provider of Community-Based Service for Preventive Long-Term Care, or Designated Preventive Long-Term Care Support Provider, or Designated Provider or trustee.

In addition to those matters as provided in this Chapter, necessary matters for an examination committee for Long-Term Care Benefit expenses, etc. are determined by Order of the Ministry of Health, Labour and Welfare.