Long-Term Care Insurance Act

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

when the Municipality determines it necessary in a case when an Insured In-Home Person Requiring Long-Term Care receives In-Home Long-Term Care Support other than Designated In-Home Long-Term Care Support or an equivalent service that is provided by a Business Office conducting a business that is found to satisfy, among the number of employees specified by Municipal Ordinance as set forth in Article 81, paragraph (1) pertaining to the business of Designated In-Home Long-Term Care Support and the standards concerning the operation of the business of Designated In-Home Long-Term Care Support prescribed in paragraph (2) of the same Article (referred to as the "Standards for the Business of Designated In-Home Long-Term Care Support" in the following item), those specified by Municipal Ordinance (hereinafter referred to as "In-Home Long-Term Care Support Applicable to Standards" in this Article);

when the Municipality determines it necessary in a case when an Insured In-Home Person Requiring Long-Term Care receives In-Home Long-Term Care Support other than Designated In-Home Long-Term Care Support and In-Home Long-Term Care Support 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 and is found to satisfy those of the Standards for the Business of Designated In-Home Long-Term Care Support that are specified by Municipal Ordinance (hereinafter referred to as "In-Home Long-Term Care Support in a Specified Area" in this Article);

when the 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 Long-Term Care Support, In-Home Long-Term Care Support Applicable to Standards and In-Home Long-Term Care Support in a Specified Area, and which falls under the standards as determined by the Minister of Health, Labour and Welfare, receives In-Home Long-Term Care Support other than Designated In-Home Long-Term Care Support, In-Home Long-Term Care Support Applicable to Standards and In-Home Long-Term Care Support in a Specified Area, or service equivalent to those services;

when otherwise provided by a Cabinet Order.

A Municipality, in establishing the Municipal Ordinance pursuant to the provisions of item (i) of the preceding paragraph, is to establish the following matters in accordance with the standards determined by Order of the Ministry of Health, Labour and Welfare, and is to take into consideration the standards determined by Order of the Ministry of Health, Labour and Welfare for other matters:

standards pertaining to employees engaging in In-Home Long-Term Care Support Applicable to Standards and the number of such employees;

matters concerning the operation of the business of In-Home Long-Term Care Support 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.

A Municipality, in establishing a Municipal Ordinance pursuant to the provisions of paragraph (1), item (ii), 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 Article 42, paragraph (1), item (iii), the status of employees engaging in In-Home Long-Term Care Support and other circumstances; is to establish the matters listed in item (ii) in accordance with the standards specified by Order of the Ministry of Health, Labour and Welfare; 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 Long-Term Care Support in a Specified Area and the number of such employees;

matters concerning the operation of the business of In-Home Long-Term Care Support 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 amount of Exceptional Allowance for In-Home Long-Term Care Service Plan in the cases listed in paragraph (1), item (i), item (iii) or item (iv) is specified by the Municipality based on the expenses calculated by standards determined by the Minister of Health, Labour and Welfare as set forth in paragraph (2) of the preceding Article for said In-Home Long-Term Care Support or equivalent service (in a case said calculated amount exceeds the amount of actual expenses of said In-Home Long-Term Care Support or equivalent service, the base amount is to be the actual expenses required for said In-Home Long-Term Care Support or equivalent service).

The amount of Exceptional Allowance for In-Home Long-Term Care Service Plan in the case listed in paragraph (1), item (ii) is specified by the Municipality based on 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 In-Home Long-Term Care Support in a Specified Area, calculated by taking into consideration the area, etc., where the Business Offices conducting the business of In-Home Long-Term Care Support in a Specified Area are located (if that amount exceeds the actual expenses required for said In-Home Long-Term Care Support in a Specified Area, the amount of those actual expenses).

The Minister of Health, Labour and Welfare, when intending to determine the standards referred to in 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 Plan, may order a person that is or has been in charge of the In-Home Long-Term Care Support or equivalent service pertaining to said payment (herein referred to as "Person, etc., in Charge of In-Home Long-Term Care Support, 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 Long-Term Care Support, etc., pertaining to said payment and inspect the books, 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.

A Municipality, when an Insured Person Requiring Long-Term Care receives the following Facility Service (herein referred to as "Designated Facility Service, etc."), pays to said Insured Person Requiring Long-Term Care an Allowance for Long-Term Care Facility Service of the expenses required for said Designated Facility Service, etc. (excluding the expenses necessary to provide meals, residence, and other necessary expenses for daily life as determined by Order of the Ministry of Health, Labour, and Welfare; the same applies in this Article), however, provided that this provision does not apply to a case that said Insured Person Requiring Long-Term Care who is designated pursuant to the provisions of Article 37, paragraph (1), received Facility Service other than the type pertaining to said designation:

Facility Service for Long-Term Care Covered by Public Aid (herein referred to as "Designated Facility Service for Long-Term Care Covered by Public Aid") provided by a Facility Covered by Public Aid Providing Long-Term Care to the Elderly that is designated by said prefectural governor (herein referred to as "Designated Facility Covered by Public Aid Providing Long-Term Care to the Elderly");

Long-Term Care Health Facility Service (excluding Long-Term Care Health Facility Service in a Specified Area prescribed in paragraph (1), item (iii) of the following Article);

service at an integrated facility for medical and long-term care (excluding Service at an Integrated Facility for Medical and Long-Term Care in a Specified Area prescribed in paragraph (1), item (iv) of the following Article);

The amount of allowance for Long-Term Care Facility Service is to be 90 percent of the amount of expenses calculated by type of Facility Service with standards as prescribed by the Minister of Health, Labour, and Welfare after considering the average expenses (excluding the expenses necessary to provide meals, residence, and other necessary expenses for daily life as determined by Order of the Ministry of Health, Labour, and Welfare; the same applies hereinafter in this Article) necessary for the Designated Facility Service, etc., that are calculated by considering the categories of Condition of Need for Long-Term Care, the area where the Facility Covered by Long-Term Care Insurance that provides the Designated Facility Service, etc., pertaining to the type of said Facility Service is located, etc. (in a case when said calculated amount exceeds the actual expenses necessary for the Designated Facility Service, etc., the amount of Allowance for Long-Term Care Facility Service is to be the actual expenses necessary for said Designated Facility Service, etc.).

The Minister of Health, Labour, and Welfare, when intending to specify standards as prescribed in the preceding paragraph, must hear the opinion of the Social Security Council in advance.

When an Insured Person Requiring Long-Term Care receives Designated Facility Service, etc., from a Facility Covered by Long-Term Care Insurance, the Municipality may pay to said Facility Covered by Long-Term Care Insurance on behalf of said Insured In-Home Person Requiring Long-Term Care the expenses required for said Designated Facility Service, etc., that said Insured Person Requiring Long-Term Care should pay to said Facility Covered by Long-Term Care Insurance as an Allowance for Long-Term Care Facility Service within the maximum amount to be paid to said Facility Providing Insured Health Benefits of Long-Term Care.

When a payment pursuant to the provisions of the preceding paragraph is paid, it is to be deemed that an Allowance for Long-Term Care Facility Service is paid to said Insured Person Requiring Long-Term Care.

A Municipality, when a Facility Covered by Long-Term Care Insurance requests an Allowance for Long-Term Care Facility Service, pays said allowance after conducting an examination according to the standards determined by the Minister of Health, Labour and Welfare as set forth in paragraph (2) and the standards concerning facilities and management of a Designated Facility Covered by Public Aid Providing Long-Term Care to the Elderly prescribed in Article 88, paragraph (2) (limited to the part concerning the handling of Designated Facility Service for Long-Term Care Covered by Public Aid), the standards concerning facilities and management of a Long-Term Care Health Facility prescribed in Article 97, paragraph (3) (limited to the part concerning the handling of Long-Term Care Health Facility Service), or the standards concerning facilities and management of an integrated facility for medical and long-term care prescribed in Article 111, paragraph (3) (limited to the part concerning the handling of service at an integrated facility for medical and long-term care).

The provisions of Article 41, paragraph (2), paragraph (3), paragraph (10), and paragraph (11) apply mutatis mutandis to payment of an Allowance for Long-Term Care Facility Service, and the provisions of paragraph (8) of the same Article apply mutatis mutandis to a Facility Covered by Long-Term Care Insurance. 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 for payment of an Allowance for Long-Term Care Facility Service and a request for an Allowance for Long-Term Care Facility Service of a Facility Covered by Long-Term Care Insurance are determined by Order of the Ministry of Health, Labour, and Welfare.