Long-Term Care Insurance Act

The Minister of Health, Labour and Welfare is to publish the guidelines necessary for the appropriate and effective implementation of the Comprehensive Project for Long-Term Care Prevention and Daily Life Support conducted by Municipalities.

A Municipality is to endeavor to periodically conduct investigation, analysis, and evaluation of the implementation status of the Comprehensive Project for Long-Term Care Prevention and Daily Life Support, and to endeavor to take necessary measures based on the results.

A Municipality may conduct the category 1 project (limited, for the category 1 Preventive Long-Term Care Support project, to that pertaining to Insured In-Home Persons Requiring Support) by paying a category 1 project payment to an Insured In-Home Person Requiring Support, etc. for the expenses required for the category 1 project, in the case where said Insured In-Home Person Requiring Support, etc. has used the category 1 project provided by a Business Office conducting the category 1 project pertaining to the designation of a person designated by the head of said Municipality (hereinafter referred to as a "Designated Provider").

The amount of the category 1 project payment under the preceding paragraph (hereinafter referred to as "category 1 project payment") is to be the amount calculated, as provided by Order of the Ministry of Health, Labour and Welfare, in consideration of the amount of the expenses required for the category 1 project.

When an Insured In-Home Person Requiring Support, etc. has used the category 1 project provided by a Business Office conducting the category 1 project pertaining to the designation of a Designated Provider, the Municipality may, on behalf of said Insured In-Home Person Requiring Support, etc., pay to said Designated Provider the expenses required for said category 1 project that said Insured In-Home Person Requiring Support, etc. is to pay to said Designated Provider, up to the amount to be paid to said Insured In-Home Person Requiring Support, etc. as the category 1 project payment.

When payment has been made pursuant to the provisions of the preceding paragraph, the category 1 project payment is deemed to have been paid to the Insured In-Home Person Requiring Support, etc.

A Municipality, when a Designated Provider requests the category 1 project payment, is to make payment after conducting an examination as provided by Order of the Ministry of Health, Labour and Welfare.

A Municipality may entrust an examination and payment affairs prescribed in the preceding paragraph to an Association.

An Association that undertakes entrustment pursuant to the provisions of the preceding paragraph, after obtaining the consent of the Municipality that delegated said entrustment and pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, may entrust a part of the affairs that are under said entrustment to a not-for-profit juridical person that qualifies with requirements as determined by Order of the Ministry of Health, Labour and Welfare.

Taxes and other public charges may not be imposed using money received as a category 1 project payment as the basis.

The designation under Article 115-45-3, paragraph (1) (except in Article 115-45-7, paragraph (1); hereinafter referred to as "Designation as Designated Provider" in this Chapter) is to be given, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, upon application by a person that conducts category 1 projects, for each type of said project and each Business Office that conducts the category 1 project pertaining to said type of project.

A mayor of a Municipality, in the case where an application under the preceding paragraph is filed and the applicant is found to be unable to appropriately conduct category 1 projects in accordance with the standards specified by Order of the Ministry of Health, Labour and Welfare, must not grant the Designation as Designated Provider.

A Designation as Designated Provider, if it is not renewed at each period specified by Order of the Ministry of Health, Labour and Welfare, ceases to be effective when said period expires.

In a case of application of renewal as set forth in the preceding paragraph, when a final determination of the application does not occur prior to the expiry of the period as set forth in the same paragraph (hereinafter referred to as "Effective Period" in this Article), the prior Designation as Designated Provider remains in force after expiry of the Effective Period until a determination is reached regarding said application.

In a case as set forth in the preceding paragraph, when the Designation as Designated Provider is renewed, said Effective Period is to be counted from the date following the date of expiry of the prior Effective Period.

The provisions of the preceding Article apply mutatis mutandis to the renewal of the Designation as Designated Provider.

A mayor of a Municipality, when it is determined to be necessary concerning payment of a category 1 project payment, may order a Designated Provider, a person that was a Designated Provider, or a person that was an employee of the Business Office pertaining to said designation under Article 115-45-3, paragraph (1) (hereinafter referred to as "Person, etc., that Was a Designated Provider" in this paragraph) to report or to submit or present record books and documents, request a Designated Provider, an employee of the Business Office pertaining to said designation, or a Person, etc., that Was a Designated Provider to appear, direct its personnel to ask questions of a relevant person, or enter the Business Office pertaining to said designation of said Designated Provider, an office, or other place related to the category 1 project conducted by said Designated Provider in order to inspect the facilities, record books and documents, or other items.

The provisions of Article 24, paragraph (3) apply mutatis mutandis to questions and 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, respectively.

A mayor of a Municipality, when finding that a Designated Provider is not conducting category 1 projects in accordance with the standards specified by Order of the Ministry of Health, Labour and Welfare under Article 115-45, paragraph (1), item (i), (a) through (d) or Article 115-45-5, paragraph (2), may specify a due date and recommend to said Designated Provider that it conduct category 1 projects in accordance with those standards specified by Order of the Ministry of Health, Labour and Welfare.

A mayor of a Municipality, in a case of providing a recommendation pursuant to the provisions of the preceding paragraph, may provide public notice of the fact that said Designated Provider that is issued said recommendation did not act in compliance with said recommendation within the due date as set forth in the same paragraph.

A mayor of a Municipality, when a Designated Provider that is issued a recommendation pursuant to the provisions of paragraph (1) does not implement the measures pertaining to said recommendation without a justifiable basis, may specify a due date and order said Designated Provider to implement the measures pertaining to said recommendation.

The mayor of a Municipality, when issuing an order pursuant to the provisions of the preceding paragraph, must issue public notice of the said fact.

A mayor of a Municipality, in the case where any of the following items applies, may rescind the Designation as Designated Provider pertaining to said Designated Provider, or specify a period and suspend the effect of all or part of the Designation as Designated Provider of that provider:

when a Designated Provider becomes unable to conduct category 1 projects in accordance with the standards specified by Order of the Ministry of Health, Labour and Welfare under Article 115-45, paragraph (1), item (i), (a) through (d) or Article 115-45-5, paragraph (2);

when a category 1 project payment is wrongly claimed;

when a Designated Provider is ordered to report, or to submit or present record books and documents pursuant to the provisions of Article 115-45-7, paragraph (1), but disobeys said order or submits a false report;

when a Designated Provider or an employee of the Business Office pertaining to said Designation as Designated Provider is requested to appear pursuant to the provisions of Article 115-45-7, paragraph (1) but does not respond or does not reply to questions pursuant to the provisions of the same paragraph or submits a false reply, or refuses, interrupts, or interferes with an inspection pursuant to the provisions of the same paragraph, however, provided that this provision does not apply when an employee of the Business Office pertaining to said Designation as Designated Provider performed said act and said Designated Provider was faithfully providing reasonable care and supervision in order to prevent said act of said employee;

when a Designated Provider has received the Designation as Designated Provider by wrongful means;

in addition to the cases listed in the preceding items, when a Designated Provider violates this Act, another Act concerning citizens' health and medical care or public aid that is specified by Cabinet Order, or an order or disposition based on these Acts;

in addition to the cases listed in the preceding items, when a Designated Provider performs a wrongful or significantly unjustifiable act concerning Community Support Projects or In-Home Service, etc.

A Municipality may conduct coordination among relevant persons necessary for the smooth implementation of the Comprehensive Project for Long-Term Care Prevention and Daily Life Support and the projects listed in the items of Article 115-45, paragraph (2).

Relevant persons of the Comprehensive Project for Long-Term Care Prevention and Daily Life Support and the projects listed in the items of Article 115-45, paragraph (2) conducted by a Municipality must endeavor to cooperate with said projects.

A prefecture is to endeavor to provide information and other support to Municipalities with regard to the Comprehensive Project for Long-Term Care Prevention and Daily Life Support and the projects listed in the items of Article 115-45, paragraph (2) conducted by Municipalities.

In addition to the provisions of Article 115-45 through the preceding Article, other necessary matters concerning implementation of a Community Support Project are prescribed by a Cabinet Order.