Long-Term Care Insurance Act

A Municipality pays an Exceptional Allowance for In-Home Long-Term Care Service to an Insured In-Home Person Requiring Long-Term Care, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, in the following cases:

when a Municipality determines it necessary in a case when an Insured In-Home Person Requiring Long-Term Care receives Designated In-Home Service prior to the date said Certification of Needed Long-Term Care becomes effective due to an emergency or other compelling reason;

when a Municipality determines it necessary in a case when an Insured In-Home Person Requiring Long-Term Care receives In-Home Service other than Designated In-Home Service or service equivalent to said services that is provided by a Business Office conducting a business that is found to satisfy the standards specified by Prefectural Ordinance as set forth in Article 74, paragraph (1) pertaining to the business of Designated In-Home Service, the number of employees specified by Prefectural Ordinance as set forth in the same paragraph, and, among the standards concerning facilities and management of the business of Designated In-Home Service prescribed in paragraph (2) of the same Article (referred to as the "Standards for the Business of Designated In-Home Service" in the following item), those specified by Prefectural Ordinance (hereinafter referred to as "In-Home Service Applicable to Standards" in this Article);

when a Municipality determines it necessary in a case when an Insured In-Home Person Requiring Long-Term Care receives In-Home Service other than Designated In-Home Service and In-Home Service Applicable to Standards, or any service equivalent thereto, that is provided by a Business Office conducting a business that is located in a Specified Area (meaning an area designated by a prefecture as one that falls under the standards specified by Order of the Ministry of Health, Labour and Welfare, such as population decline; the same applies hereinafter) and is found to satisfy those of the Standards for the Business of Designated In-Home Service that are specified by Prefectural Ordinance (hereinafter referred to as "In-Home Service in a Specified Area" in this Article);

when a Municipality determines it necessary in a case when an Insured In-Home Person Requiring Long-Term Care who is domiciled on an isolated island or other area where it is significantly difficult to secure Designated In-Home Service, In-Home Service Applicable to Standards and In-Home Service in a Specified Area, and which falls under the standards as determined by the Minister of Health, Labour and Welfare, receives In-Home Service other than Designated In-Home Service, In-Home Service Applicable to Standards and In-Home Service in a Specified Area, or services equivalent to those services;

when otherwise provided by a Cabinet Order.

A prefecture, in establishing the Prefectural Ordinance pursuant to the provisions of item (ii) of the preceding paragraph, is to establish the matters listed in items (i) through (iii) in accordance with the standards specified by Order of the Ministry of Health, Labour and Welfare, is to establish the matters listed in item (iv) using the standards specified by Order of the Ministry of Health, Labour and Welfare as the standard, and is to take into consideration the standards specified by Order of the Ministry of Health, Labour and Welfare for other matters.

standards pertaining to employees engaging in In-Home Service Applicable to Standards and the number of such employees;

the floor area of residence rooms pertaining to the business of In-Home Service Applicable to Standards;

matters concerning the operation of the business of In-Home Service Applicable to Standards that are closely related to ensuring the appropriate use of services, appropriate treatment and safety of Persons Requiring Long-Term Care who use them, and maintaining confidentiality, etc., and that are specified by Order of the Ministry of Health, Labour and Welfare;

the maximum number of users pertaining to the business of In-Home Service Applicable to Standards.

A prefecture, in establishing a Prefectural Ordinance pursuant to the provisions of paragraph (1), item (iii), is to establish the matters listed in item (i) in accordance with the standards specified by Order of the Ministry of Health, Labour and Welfare, taking into consideration the status of population decline in areas that fall under the standards specified by Order of the Ministry of Health, Labour and Welfare prescribed in item (iii) of that paragraph, the status of employees engaging in In-Home Service and other circumstances; is to establish the matters listed in items (ii) and (iii) in accordance with the standards specified by Order of the Ministry of Health, Labour and Welfare; is to establish the matters listed in item (iv) using the standards specified by Order of the Ministry of Health, Labour and Welfare as the standard; and is to take into consideration the standards specified by Order of the Ministry of Health, Labour and Welfare for other matters.

standards pertaining to employees engaging in In-Home Service in a Specified Area and the number of such employees;

the floor area of residence rooms pertaining to the business of In-Home Service in a Specified Area;

matters concerning the operation of the business of In-Home Service in a Specified Area that are closely related to ensuring the appropriate use of services, appropriate treatment and safety of Persons Requiring Long-Term Care who use them, and maintaining confidentiality, etc., and that are specified by Order of the Ministry of Health, Labour and Welfare;

the maximum number of users pertaining to the business of In-Home Service in a Specified Area.

The amount of Exceptional Allowance for In-Home Long-Term Care Service in the cases listed in paragraph (1), item (i), item (ii), item (iv) or item (v) is to be specified by a Municipality with regard to said In-Home Service or services equivalent to said service based on an amount equivalent to 90 percent of the expenses calculated by standards determined by the Minister of Health, Labour and Welfare as prescribed in each item of the preceding Article, paragraph (4) (but shall be the actual expenses required for said In-Home Service or service equivalent to said services when said calculated standard amount exceeds the actual expenses required for said In-Home Service or service equivalent to said services (except for purchases of Specified Equipment Covered by Public Aid; with regard to expenses necessary for Outpatient Day Long-Term Care, Outpatient Rehabilitation, Short-Term Admission for Daily Life Long-Term Care, Short-Term Admission for Recuperation, and daily life long-term care for a person admitted to a Specified Facility, and services equivalent thereto, excluding expenses necessary to provide meals, expenses necessary for residence, and other expenses necessary for daily life as determined by Order of the Ministry of Health, Labour and Welfare)).

The amount of Exceptional Allowance for In-Home Long-Term Care Service in the case listed in paragraph (1), item (iii) is to be specified by a Municipality, based on the amount provided in each of the following items according to the category of In-Home Service in a Specified Area listed in those items.

In-Home Service in a Specified Area that falls under the In-Home Service listed in paragraph (4), item (i) of the preceding Article or services equivalent thereto: for each type of that In-Home Service, the amount equivalent to 90 percent of the amount of expenses calculated according to the standards determined by the Minister of Health, Labour and Welfare after taking into consideration the average expenses required for the In-Home Service in a Specified Area that falls under that In-Home Service (excluding, with regard to the expenses required for Outpatient Day Long-Term Care and Outpatient Rehabilitation, the expenses required for the provision of meals and other expenses required for daily life as specified by Order of the Ministry of Health, Labour and Welfare), which average expenses are calculated by taking into consideration the content of the In-Home Service in a Specified Area that falls under that In-Home Service, the Category of Condition of Need for Long-Term Care, and the area, etc., where the Business Offices conducting the business of that In-Home Service in a Specified Area are located (if that amount exceeds the actual expenses required for the In-Home Service in a Specified Area that falls under that In-Home Service or services equivalent thereto (excluding, with regard to the expenses required for Outpatient Day Long-Term Care and Outpatient Rehabilitation and services equivalent thereto, the expenses required for the provision of meals and other expenses required for daily life as specified by Order of the Ministry of Health, Labour and Welfare), the amount of those actual expenses required for the In-Home Service in a Specified Area)

In-Home Service in a Specified Area that falls under the In-Home Service listed in paragraph (4), item (ii) of the preceding Article or services equivalent thereto: for each type of that In-Home Service, the amount equivalent to 90 percent of the amount of expenses calculated according to the standards determined by the Minister of Health, Labour and Welfare after taking into consideration the average expenses required for the In-Home Service in a Specified Area that falls under that In-Home Service (excluding the expenses required for the provision of meals, the expenses required for accommodation, and other expenses required for daily life as specified by Order of the Ministry of Health, Labour and Welfare), which average expenses are calculated by taking into consideration the Category of Condition of Need for Long-Term Care and the area, etc., where the Business Offices conducting the business of the In-Home Service in a Specified Area that falls under that In-Home Service are located (if that amount exceeds the actual expenses required for the In-Home Service in a Specified Area that falls under that In-Home Service or services equivalent thereto (excluding the expenses required for the provision of meals, the expenses required for accommodation, and other expenses required for daily life as specified by Order of the Ministry of Health, Labour and Welfare), the amount of those actual expenses required for the In-Home Service in a Specified Area)

The Minister of Health, Labour and Welfare, when intending to determine the standards set forth in each item of the preceding paragraph, must hear the opinion of the Social Security Council in advance.

The mayor of a Municipality, when the mayor determines it necessary for the payment of an Exceptional Allowance for In-Home Long-Term Care Service, may order a person that is or has been in charge of the In-Home Service or equivalent service pertaining to said payment (herein referred to as "Person, etc., in Charge of In-Home Service, etc." in this paragraph) to report, to submit or present record books and documents, or to appear, or may direct its personnel to question the relevant persons or to enter the Business Office of said Person, etc., in Charge of In-Home Service, etc., pertaining to said payment and inspect the equipment, record books and documents, and other items.

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