Long-Term Care Insurance Act

A Municipality, when an Insured In-Home Person Requiring Support receives from a person designated by the mayor of said Municipality (including, with regard to a Specified Community-Based Service for Preventive Long-Term Care for an Insured In-Home Person Requiring Support who is an Insured Person to Whom the Domicile Exception Applies (herein referred to as "Insured In-Home Person Requiring Support to Whom the Domicile Exception Applies"), the Municipality Where the Facility Is Located) (herein referred to as "Designated Provider of Community-Based Service for Preventive Long-Term Care") the Community-Based Service for Preventive Long-Term Care (herein referred to as "Designated Community-Based Service for Preventive Long-Term Care") provided by a provider that performs Community-Based Preventive Long-Term Care Business pertaining to said designation (limited to a case when said Insured In-Home Person Requiring Support has notified the Municipality pursuant to the provisions of Article 58, paragraph (4) to receive a Designated Preventive Long-Term Care Support as prescribed in paragraph (1) of the same Article when said Designated Community-Based Service for Preventive Long-Term Care is subject to said Designated Preventive Long-Term Care Support and other matters as determined by Order of the Ministry of Health, Labour and Welfare), pays to said Insured In-Home Person Requiring Support the Allowance for Community-Based Preventive Long-Term Care Service for the expenses required for said Designated Community-Based Service for Preventive Long-Term Care (excluding the expenses necessary to provide meals and other expenses as determined by Order of the Ministry of Health, Labour and Welfare as necessary for daily life; the same applies hereinafter in this Article), however, this provision does not apply to a case when said Insured In-Home Person Requiring Support that has been designated pursuant to the provisions of Article 37, paragraph (1), receives a Community-Based Service for Preventive Long-Term Care other than the type pertaining to said designation.

The amount of Allowance for Community-Based Preventive Long-Term Care Service is to be according to the categories of Community-Based Service for Preventive Long-Term Care listed in the following items and the amount as prescribed in said item:

Preventive Long-Term Care for a Dementia Outpatient:the amount equivalent to 90 percent of the amount calculated after considering the amount of average expenses (excluding the expenses necessary to provide meals and other expenses as determined by Order of the Ministry of Health, Labour, and Welfare as necessary for daily life) that is calculated after considering the content of the Designated Community-Based Preventive Service of Long-Term Care pertaining to Preventive Long-Term Care for a Dementia Outpatient, the area where the provider that performs said Designated Community-Based Preventive Service of Long-Term Care is located, etc., necessary for said Designated Community-Based Preventive Service of Long-Term Care based on the standards provided by the Minister of Health, Labour, and Welfare (when said calculated amount exceeds the actual amount required for said Designated Community-Based Preventive Service of Long-Term Care, the amount of allowance is to be the actual expenses required for said Designated Community-Based Preventive Service of Long-Term Care);

Multifunctional Preventive Long-Term Care in a Small Group Home, and Preventive Long-Term Care for a Dementia Patient in Communal Living:the amount equivalent to 90 percent of the amount calculated according to type of Community-Based Preventive Service of Long-Term Care, after considering the average expenses (excluding the expenses necessary to provide meals and other expenses as determined by Order of the Ministry of Health, Labour, and Welfare as necessary for daily life) that is calculated after considering the categories of Needed Support Condition, the location of the provider that performs the Designated Community-Based Preventive Service of Long-Term Care Business pertaining to the type of said Community-Based Preventive Service of Long-Term Care, etc., necessary for said Community-Based Preventive Service of Long-Term Care, based on the standards provided by the Minister of Health, Labour, and Welfare (when said calculated amount exceeds the actual expense required for said Designated Community-Based Preventive Service of Long-Term Care, the allowance is to be the actual amount required for said Designated Community-Based Preventive Service of Long-Term Care).

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

A Municipality may, notwithstanding the provisions of each item of paragraph (2), set the amount determined by said Municipality (or, for the amount of an Allowance for Community-Based Preventive Long-Term Care Service (limited to that pertaining to a Specified Community-Based Service for Preventive Long-Term Care) for an Insured In-Home Person Requiring Support to Whom the Domicile Exception Applies who has received a Designated Community-Based Service for Preventive Long-Term Care from a Designated Provider of Community-Based Service for Preventive Long-Term Care designated by the mayor of the Municipality Where the Facility Is Located under the main clause of paragraph (1), the Municipality Where the Facility Is Located), within the limit of the amount calculated according to standards determined by the Minister of Health, Labour and Welfare after considering the type of Community-Based Service for Preventive Long-Term Care and other circumstances, in place of the amount of the Allowance for Community-Based Preventive Long-Term Care Service prescribed in each item of that paragraph, as the amount of the Allowance for Community-Based Preventive Long-Term Care Service in said Municipality.

A Municipality, when it intends to determine the amount of Allowance for Community-Based Preventive Long-Term Care Service in said Municipality as prescribed in the preceding paragraph, must reflect the opinions of Insured Persons of Long-Term Care Insurance undertaken by said Municipality and other relevant persons, and take necessary measures in order to promote the use of knowledge of persons with relevant knowledge and experience, in advance.

When an Insured In-Home Person Requiring Support receives Designated Preventive Service of Long-Term Care from a Designated Provider of Community-Based Preventive Service of Long-Term Care, a Municipality may pay the expense required for said Designated Preventive Service of Long-Term Care that said Insured In-Home Person Requiring Support should pay to said Designated Provider of a Preventive Service to Long-Term Care, to said Designated Provider of a Preventive Service to 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.

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

A Municipality, when a Designated Provider of Community-Based Service for Preventive Long-Term Care requests an Allowance for Community-Based Preventive Long-Term Care Service, is to pay said allowance after conducting an examination according to the standards provided by the Minister of Health, Labour and Welfare as set forth in each item of paragraph (2) or the amount determined by the Municipality (or, for a request for an Allowance for Community-Based Preventive Long-Term Care Service (limited to that pertaining to a Specified Community-Based Service for Preventive Long-Term Care) for an Insured In-Home Person Requiring Support to Whom the Domicile Exception Applies who has received a Designated Community-Based Service for Preventive Long-Term Care from a Designated Provider of Community-Based Service for Preventive Long-Term Care designated by the mayor of the Municipality Where the Facility Is Located under the main clause of paragraph (1), the Municipality Where the Facility Is Located) pursuant to the provisions of paragraph (4), and the standards concerning effective support methods for Prevention of Long-Term Care pertaining to a Designated Community-Based Service for Preventive Long-Term Care and the standards concerning the facilities and management of the business of Designated Community-Based Service for Preventive Long-Term Care (limited to the part concerning the handling of Designated Community-Based Service for Preventive Long-Term Care) that are determined by the Municipality (or, for a request for an Allowance for Community-Based Preventive Long-Term Care Service (limited to that pertaining to a Specified Community-Based Service for Preventive Long-Term Care) for an Insured In-Home Person Requiring Support to Whom the Domicile Exception Applies who has received a Designated Community-Based Service for Preventive Long-Term Care from a Designated Provider of Community-Based Service for Preventive Long-Term Care designated by the mayor of the Municipality Where the Facility Is Located under the main clause of paragraph (1), the Municipality Where the Facility Is Located) pursuant to the provisions of Article 115-14, paragraph (2) or paragraph (5).

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

In addition to the provisions as prescribed in the preceding paragraphs, other necessary matters payment of an Allowance for Community-Based Preventive Long-Term Care Service and for requests of Allowance for Community-Based Preventive Long-Term Care Service by a Designated Provider of Community-Based Service for Preventive Long-Term Care is to be provided by Order of the Ministry of Health, Labour, and Welfare.

A Municipality, in the following cases, pay an Exceptional Allowance for Community-Based Preventive Service of Long-Term Care to an Insured In-Home Person Requiring Support:

when a Municipality determines it necessary in a case when an Insured Person Requiring Support receives Designated Community-Based 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 a Municipality determines it necessary in a case when an Insured In-Home Person Requiring Support that is domiciled on an isolated island or other location where it is significantly difficult to secure Designated Community-Based Preventive Service of Long-Term Care and where it is defined by standards provided by the Minister of Health, Labour, and Welfare, receives Community-Based Preventive Service of Long-Term Care other than Designated Community-Based Preventive Service of Long-Term Care or equivalent services;

when provided by a Cabinet Order.

The amount of an Exceptional Allowance for Community-Based Preventive Long-Term Care Service is to be provided by a Municipality based on the amount equivalent to 90 percent of the amount of expenses calculated, with regard to said Community-Based Service for Preventive Long-Term Care or equivalent service, based on standards provided by the Minister of Health, Labour and Welfare as set forth in each item of paragraph (2) of the preceding Article (when said calculated amount exceeds the amount of actual expenses required for said Community-Based Service for Preventive Long-Term Care or equivalent service (excluding the expenses necessary to provide meals and other necessary expenses as determined by Order of the Ministry of Health, Labour and Welfare as necessary for daily life), the allowance is to be the actual amount of expenses required for said Community-Based Service for Preventive Long-Term Care or equivalent service), or based on the amount provided by a Municipality (or, for the amount of an Exceptional Allowance for Community-Based Preventive Long-Term Care Service (limited to that pertaining to a Specified Community-Based Service for Preventive Long-Term Care) for an Insured In-Home Person Requiring Support to Whom the Domicile Exception Applies who has received a Designated Community-Based Service for Preventive Long-Term Care from a Designated Provider of Community-Based Service for Preventive Long-Term Care designated by the mayor of the Municipality Where the Facility Is Located under the main clause of paragraph (1) of the same Article, or another person determined by Order of the Ministry of Health, Labour and Welfare, the Municipality Where the Facility Is Located) pursuant to the provisions of paragraph (4) of the same Article.

The mayor of a Municipality, when he or she determines the necessary for payment of an Exceptional Allowance for Community-Based Preventive Service of Long-Term Care, may order a person that has been in charge of the Community-Based Preventive Service of Long-Term Care pertaining to said payment or equivalent service (hereinafter referred to as "Person, etc., in Charge of Community-Based Preventive Long-Term Care, etc." 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., in Charge of said Community-Based Preventive Service of Long-Term Care pertaining to said payment in order to inspect said equipment, record books and documents, and 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.