Long-Term Care Insurance Act

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

when a Municipality determines it necessary in a case when an Insured Person Requiring Support receives Designated 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 receives Preventive Long-Term Care Service other than Designated Preventive Long-Term Care Service or equivalent service 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 115-4, paragraph (1) pertaining to the business of Designated Preventive Long-Term Care Service, the number of employees specified by Prefectural Ordinance as set forth in the same paragraph, and, among the standards concerning effective methods of support for Prevention of Long-Term Care pertaining to Designated Preventive Long-Term Care Service and the standards concerning facilities and management of the business of Designated Preventive Long-Term Care Service prescribed in paragraph (2) of the same Article (herein referred to as "Standards for the Business of Designated Preventive Long-Term Care Service" in the following item), those specified by Prefectural Ordinance (herein referred to as "Preventive Long-Term Care Service Applicable to Standards" in this Article);

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

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

the floor area of residence rooms pertaining to the business of Preventive Long-Term Care Service Applicable to Standards;

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

the number of maximum users pertaining to the business of Preventive Long-Term Care 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 Article 42, paragraph (1), item (iii), the status of employees engaging in Preventive Long-Term Care 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 Preventive Long-Term Care Service in a Specified Area and the number of such employees;

the floor area of residence rooms pertaining to the business of Preventive Long-Term Care Service in a Specified Area;

matters concerning the operation of the business of Preventive Long-Term Care Service in a Specified Area that are closely related to ensuring the appropriate use of services, appropriate treatment and safety of Persons Requiring Support 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 Preventive Long-Term Care Service in a Specified Area.

The amount of Exceptional Allowance for Preventive Long-Term Care Service in the cases listed in paragraph (1), item (i), item (ii), item (iv) or item (v) is to be determined by a Municipality based on the amount equivalent to 90 percent of the amount of expenses calculated 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 pertaining to said Preventive Long-Term Care Service or equivalent service (when the calculated amount exceeds the actual expenses required for said Preventive Long-Term Care Service or equivalent service (except for the expenses required to purchase Specified Equipment for Preventive Long-Term Care Covered by Public Aid and excluding the expenses necessary to provide meals, residence, and other expenses as determined by Order of the Ministry of Health, Labour and Welfare as necessary for daily life with regard to the expenses required for Outpatient Rehabilitation for Preventive Long-Term Care, Short-Term Admission for Daily Preventive Long-Term Care, Short-Term Admission for Recuperation for Preventive Long-Term Care and Daily Preventive Long-Term Care Admitted to a Specified Facility, and services equivalent to these), said calculated amount is to be the actual expenses required for said Preventive Long-Term Care Service or equivalent service).

The amount of Exceptional Allowance for Preventive 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 Preventive Long-Term Care Service in a Specified Area listed in those items.

Preventive Long-Term Care Service in a Specified Area that falls under the Preventive Long-Term Care Service listed in paragraph (2), item (i) of the preceding Article or services equivalent thereto: for each type of that Preventive Long-Term Care 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 Preventive Long-Term Care Service in a Specified Area that falls under that Preventive Long-Term Care Service (excluding, with regard to the expenses required for Outpatient Rehabilitation for Preventive Long-Term Care, 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 Preventive Long-Term Care Service in a Specified Area that falls under that Preventive Long-Term Care Service, the Category of Needed Support Condition, and the area, etc., where the Business Offices conducting the business of that Preventive Long-Term Care Service in a Specified Area are located (if that amount exceeds the actual expenses required for the Preventive Long-Term Care Service in a Specified Area that falls under that Preventive Long-Term Care Service or services equivalent thereto (excluding, with regard to the expenses required for Outpatient Rehabilitation for Preventive Long-Term Care 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 Preventive Long-Term Care Service in a Specified Area)

Preventive Long-Term Care Service in a Specified Area that falls under the Preventive Long-Term Care Service listed in paragraph (2), item (ii) of the preceding Article or services equivalent thereto: for each type of that Preventive Long-Term Care 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 Preventive Long-Term Care Service in a Specified Area that falls under that Preventive Long-Term Care 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 Needed Support Condition and the area, etc., where the Business Offices conducting the business of the Preventive Long-Term Care Service in a Specified Area that falls under that Preventive Long-Term Care Service are located (if that amount exceeds the actual expenses required for the Preventive Long-Term Care Service in a Specified Area that falls under that Preventive Long-Term Care 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 Preventive Long-Term Care 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 he or she determines it necessary for the payment of an Exceptional Allowance for Preventive Long-Term Care Service, may order a person that is or has been in charge of the Preventive Long-Term Care Service or equivalent service pertaining to said payment (herein referred to as "Person, etc., in Charge of Providing Preventive Long-Term Care Service" in this paragraph) to report, to submit or present record books and documents, or to appear, or may direct personnel to question the relevant persons or to enter the Business Office of said Person, etc., in Charge of Providing Preventive Long-Term Care Service 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.