Article 42-2Payment of an Allowance for Community-Based Long-Term Care Service

①A Municipality, when an Insured Person Requiring Long-Term Care has received, from a person designated by the mayor of said Municipality (including the Municipality Where the Facility Is Located in the case of Specified Community-Based Service for an Insured Person Requiring Long-Term Care who is an Insured Person to Whom the Domicile Exception Applies (hereinafter referred to as an "Insured Person Requiring Long-Term Care to Whom the Domicile Exception Applies")) (hereinafter referred to as a "Designated Community-Based Service Provider"), Community-Based Service provided by a Business Office conducting the Community-Based Service Business pertaining to said designation (hereinafter referred to as "Designated Community-Based Service"), pays to said Insured Person Requiring Long-Term Care an Allowance for Community-Based Long-Term Care Service with regard to the expenses required for said Designated Community-Based Service (excluding, with regard to the expenses required for Community-Based Outpatient Day Long-Term Care, outpatient long-term care for a Dementia patient, Multifunctional Long-Term Care in a Small Group Home, Communal Daily Long-Term Care for a Dementia Patient, Daily Life Long-Term Care for a Person Admitted to a Community-Based Specified Facility, and Daily Life Long-Term Care for a Person Admitted to a Community-Based Facility for the Elderly Covered by Public Aid Requiring Long-Term Care, the expenses necessary to provide meals, residence and other expenses necessary for daily life as determined by Order of the Ministry of Health, Labour and Welfare; the same applies hereinafter in this Article); provided, however, that this does not apply when said Insured Person Requiring Long-Term Care, in a case where he or she has been issued a designation pursuant to the provisions of Article 37, paragraph (1), receives Community-Based Service other than the type pertaining to said designation.

②The amount of Allowance for Community-Based Long-Term Care Service is to be the amount provided by each item of following, according to the category of Community-Based Service listed in said item:

③The Minister of Health, Labour, and Welfare, when providing standards for each item of the preceding paragraph, must hear the opinion of the Social Security Committee in advance.

④A Municipality may, notwithstanding the provisions of each item of paragraph (2), within the limit of the amount calculated in accordance with the standards determined by the Minister of Health, Labour and Welfare in consideration of the type of Community-Based Service and other circumstances, make an amount determined by the Municipality (in the case of the amount of an Allowance for Community-Based Long-Term Care Service (limited to that pertaining to Specified Community-Based Service) for an Insured Person Requiring Long-Term Care to Whom the Domicile Exception Applies who received Designated Community-Based Service from a Designated Community-Based Service Provider for which the mayor of the Municipality Where the Facility Is Located made the designation in the main clause of paragraph (1), the Municipality Where the Facility Is Located) the amount of the Allowance for Community-Based Long-Term Care Service in that Municipality, in lieu of the amount of the Allowance for Community-Based Long-Term Care Service specified in the items of that paragraph.

⑤A Municipality, when it intends to determine the amount of Allowance for Community-Based Long-Term Care Service in said Municipality as prescribed in the preceding paragraph, shall reflect the opinions of Insured Persons of Long-Term Care Insurance undertaken by said Municipality and take necessary measures in order to promote the use of knowledge of persons with relevant knowledge and experience, in advance.

⑥When an Insured Person Requiring Long-Term Care receives Designated Community-Based Service from a Designated Community-Based Service Provider (limited to a case when said Insured Person Requiring Long-Term Care notifies the Municipality regarding the receiving of Designated In-Home Long-Term Care Support pursuant to the provisions of Article 46, paragraph (4) in advance, and a case when said Designated Community-Based Service is subject to said Designated In-Home Long-Term Care Support, or other cases as determined by Order of the Ministry of Health, Labour, and Welfare), the Municipality may pay the expenses required for said Designated Community-Based Service that are to be paid to said Designated Community-Based Service Provider by said Insured Person Requiring Long-Term Care on behalf of said Insured Person Requiring Long-Term Care within the limit of the amount to be paid to said Insured Person Requiring Long-Term Care as an Allowance for Community-Based Long-Term Care Service.

⑦When the payment as prescribed in the preceding paragraph is paid, it is to be deemed that an Allowance for Community-Based Long-Term Care Service is paid to Insured Person Requiring Long-Term Care.

⑧A Municipality, when it receives a claim for an Allowance for Community-Based Long-Term Care Service from a Designated Community-Based Service Provider, is to pay it after examining the claim in light of the standards determined by the Minister of Health, Labour and Welfare under each item of paragraph (2) or the amount determined by the Municipality pursuant to the provisions of paragraph (4) (in the case of a claim for an Allowance for Community-Based Long-Term Care Service (limited to that pertaining to Specified Community-Based Service) for an Insured Person Requiring Long-Term Care to Whom the Domicile Exception Applies who received Designated Community-Based Service from a Designated Community-Based Service Provider for which the mayor of the Municipality Where the Facility Is Located made the designation in the main clause of paragraph (1), the Municipality Where the Facility Is Located), and the standards concerning facilities and management of a Designated Community-Based Service Business (limited to the part concerning the handling of Designated Community-Based Service) determined by the Municipality pursuant to the provisions of Article 78-4, paragraph (2) or (5) (in the case of a claim for an Allowance for Community-Based Long-Term Care Service (limited to that pertaining to Specified Community-Based Service) for an Insured Person Requiring Long-Term Care to Whom the Domicile Exception Applies who received Designated Community-Based Service from a Designated Community-Based Service Provider for which the mayor of the Municipality Where the Facility Is Located made the designation in the main clause of paragraph (1), the Municipality Where the Facility Is Located).

⑩In addition to the provisions as prescribed in each of the preceding paragraphs, necessary matters for payment of an Allowance for Designated Community-Based Service and a request by a Designated Community-Based Service Provider for an Allowance for Designated Community-Based Service is as determined by Order of the Ministry of Health, Labour, and Welfare.