Article 48Payment of an Allowance for Long-Term Care Facility Service

①A 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:

②The 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.).

③The 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.

④When 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.

⑤When 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.

⑥A 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).

⑦The 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.

⑧In 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.