Article 46Payment of an Allowance for In-Home Long-Term Care Service Plan
第四十六条(居宅介護サービス計画費の支給)
A Municipality, when an Insured In-Home Person Requiring Long-Term Care has received, from a person designated by the mayor of said Municipality or the mayor of another Municipality (hereinafter referred to as a "Designated In-Home Long-Term Care Support Provider"), In-Home Long-Term Care Support provided by a Business Office conducting the In-Home Long-Term Care Support Business pertaining to said designation (hereinafter referred to as "Designated In-Home Long-Term Care Support"), pays to said Insured In-Home Person Requiring Long-Term Care an Allowance for In-Home Long-Term Care Service Plan for the expenses required for said Designated In-Home Long-Term Care Support.
The amount of Allowance for In-Home Long-Term Care Service Plan is to be the amount of expenses calculated by standards as prescribed by the Minister of Health, Labour, and Welfare after considering the average expenses necessary for the Designated In-Home Long-Term Care Support, calculated after considering the area, etc., where the provider that performs the Designated In-Home Long-Term Care Support Business is located (in a case when said calculated amount exceeds the actual expenses necessary for the Designated In-Home Long-Term Care Support, the amount of Allowance for In-Home Long-Term Care Service Plan is to be the actual expenses necessary for said Designated In-Home Long-Term Care Support.)
居宅介護サービス計画費の額は、指定居宅介護支援の事業を行う事業所の所在する地域等を勘案して算定される指定居宅介護支援に要する平均的な費用の額を勘案して厚生労働大臣が定める基準により算定した費用の額(その額が現に当該指定居宅介護支援に要した費用の額を超えるときは、当該現に指定居宅介護支援に要した費用の額とする。)とする。
The Minister of Health, Labour, and Welfare, when intending to specify standards as prescribed in the preceding paragraph, must hear the opinions of the Social Security Council in advance.
厚生労働大臣は、前項の基準を定めようとするときは、あらかじめ社会保障審議会の意見を聴かなければならない。
When an Insured In-Home Person Requiring Long-Term Care receives Designated In-Home Long-Term Care Support from a Designated In-Home Long-Term Care Support Provider (limited to a case when said Insured In-Home Person Requiring Long-Term Care has notified the Municipality in advance to receive said Designated In-Home Long-Term Care Support pursuant to the provisions of Order of the Ministry of Health, Labour, and Welfare), the Municipality may pay to said Designated In-Home Long-Term Care Support Provider on behalf of said Insured In-Home Person Requiring Long-Term Care the expenses required for said Designated In-Home Long-Term Care Support that said Insured In-Home Person Requiring Long-Term Care should pay to said Designated In-Home Long-Term Care Support Provider.
居宅要介護被保険者が指定居宅介護支援事業者から指定居宅介護支援を受けたとき(当該居宅要介護被保険者が、厚生労働省令で定めるところにより、当該指定居宅介護支援を受けることにつきあらかじめ市町村に届け出ている場合に限る。)は、市町村は、当該居宅要介護被保険者が当該指定居宅介護支援事業者に支払うべき当該指定居宅介護支援に要した費用について、居宅介護サービス計画費として当該居宅要介護被保険者に対し支給すべき額の限度において、当該居宅要介護被保険者に代わり、当該指定居宅介護支援事業者に支払うことができる。
When the payment pursuant to the provisions of the preceding paragraph is paid, it is to be deemed that an Allowance for In-Home Long-Term Care Service Plan is paid to the Insured In-Home Person Requiring Long-Term Care.
A Municipality, when requested to pay an Allowance for In-Home Long-Term Care Service Plan by a Designated In-Home Long-Term Care Support Provider, conducts an examination according to standards provided by the Minister of Health, Labour, and Welfare as set forth in the paragraph (2) and the standards of business management of a Designated In-Home Long-Term Care Support Provider as prescribed in Article 81, paragraph (2) (limited to the part regarding the handling of Designated In-Home Long-Term Care Support).
市町村は、指定居宅介護支援事業者から居宅介護サービス計画費の請求があったときは、第二項の厚生労働大臣が定める基準及び第八十一条第二項に規定する指定居宅介護支援の事業の運営に関する基準(指定居宅介護支援の取扱いに関する部分に限る。)に照らして審査した上、支払うものとする。
The provisions of Article 41, paragraph (2), paragraph (3), paragraph (10) and paragraph (11) apply mutatis mutandis to the payment of an Allowance for In-Home Long-Term Care Service Plan and the provisions of paragraph (8) of the same Article apply mutatis mutandis to the Designated In-Home Long-Term Care Support Provider. In this case, the necessary technical replacement of terms in these provisions is specified by a Cabinet Order.
In addition to the provisions of each preceding paragraph, other necessary matters for the payment of Allowance for In-Home Long-Term Care Service Plan and for requesting an Allowance for In-Home Long-Term Care Service Plan from a Designated In-Home Long-Term Care Support Provider are prescribed by Order of the Ministry of Health, Labour, and Welfare.
前各項に規定するもののほか、居宅介護サービス計画費の支給及び指定居宅介護支援事業者の居宅介護サービス計画費の請求に関して必要な事項は、厚生労働省令で定める。
Article 47Payment of an Exceptional Allowance for In-Home Long-Term Care Service Plan
第四十七条(特例居宅介護サービス計画費の支給)
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 (limited to those 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, those specified by the Municipal Ordinance of said Municipality; hereinafter referred to as "In-Home Long-Term Care Support Applicable to Standards" in the following item and the following paragraph);
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 or In-Home Long-Term Care Support Applicable to Standards and in a location that qualifies pursuant to standards as determined by the Minister of Health, Labour, and Welfare receives In-Home Long-Term Care other than Designated In-Home Long-Term Care Support and Designated In-Home Long-Term Care Support that qualifies with standards or service equivalent to those services;
指定居宅介護支援及び基準該当居宅介護支援の確保が著しく困難である離島その他の地域であって厚生労働大臣が定める基準に該当するものに住所を有する居宅要介護被保険者が、指定居宅介護支援及び基準該当居宅介護支援以外の居宅介護支援又はこれに相当するサービスを受けた場合において、必要があると認めるとき。
when provided by a Cabinet Order.
その他政令で定めるとき。
A Municipality, in establishing the Municipal Ordinance set forth in 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;
基準該当居宅介護支援に従事する従業者に係る基準及び当該従業者の員数
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.
基準該当居宅介護支援の事業の運営に関する事項であって、利用する要介護者のサービスの適切な利用、適切な処遇及び安全の確保並びに秘密の保持等に密接に関連するものとして厚生労働省令で定めるもの
The amount of Allowance for an Exceptional Allowance for In-Home Long-Term Care Service Plan 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 Designated In-Home Long-Term Care Support or equivalent service (in a case said calculated amount exceeds the amount of actual expenses of said Designated In-Home Long-Term Care Support or equivalent service, the base amount is to be the actual expenses required for said Designated In-Home Long-Term Care Support or equivalent service).
A Municipality, when it determines the necessity for payment of an Exceptional Allowance for In-Home Long-Term Care Service Plan, may order a person that has been in charge of the Designated In-Home Long-Term Care Support pertaining to said payment or equivalent service (herein referred to as "Person, etc., in Charge of Designated In-Home Long-Term Care Support" in this paragraph) to report, submit, or present record books and documents, appear, or direct its personnel to question the relevant person and to enter the Business Office of the provider of said Person, etc., in Charge of Designated In-Home Long-Term Care Support pertaining to said payment in order to inspect said books, documents, and other items.
市町村長は、特例居宅介護サービス計画費の支給に関して必要があると認めるときは、当該支給に係る居宅介護支援若しくはこれに相当するサービスを担当する者若しくは担当した者(以下この項において「居宅介護支援等を担当する者等」という。)に対し、報告若しくは帳簿書類の提出若しくは提示を命じ、若しくは出頭を求め、又は当該職員に関係者に対して質問させ、若しくは当該居宅介護支援等を担当する者等の当該支給に係る事業所に立ち入り、その帳簿書類その他の物件を検査させることができる。
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.
Article 48Payment of an Allowance for Long-Term Care Facility Service
第四十八条(施設介護サービス費の支給)
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");
都道府県知事が指定する介護老人福祉施設(以下「指定介護老人福祉施設」という。)により行われる介護福祉施設サービス(以下「指定介護福祉施設サービス」という。)
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.
厚生労働大臣は、前項の基準を定めようとするときは、あらかじめ社会保障審議会の意見を聴かなければならない。
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).
市町村は、介護保険施設から施設介護サービス費の請求があったときは、第二項の厚生労働大臣が定める基準及び第八十八条第二項に規定する指定介護老人福祉施設の設備及び運営に関する基準(指定介護福祉施設サービスの取扱いに関する部分に限る。)、第九十七条第三項に規定する介護老人保健施設の設備及び運営に関する基準(介護保健施設サービスの取扱いに関する部分に限る。)又は第百十一条第三項に規定する介護医療院の設備及び運営に関する基準(介護医療院サービスの取扱いに関する部分に限る。)に照らして審査した上、支払うものとする。
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.
Article 49Payment of an Exceptional Allowance for Long-Term Care Facility Service
第四十九条(特例施設介護サービス費の支給)
A Municipality, in the following cases, pay to an Insured Person Requiring Long-Term Care an Exceptional Allowance for Long-Term Care Facility Service:
when the Municipality determines it necessary in a case when an Insured Person Requiring Long-Term Care receives Designated Facility Service, etc., prior to the date said Certification of Needed Long-Term Care becomes effective due to an emergency or other compelling reason;
when provided by a Cabinet Order.
その他政令で定めるとき。
The amount of Exceptional Allowance for Long-Term Care Facility Service is to be specified by the Municipality based on 90 percent of the amount equivalent to the expenses calculated with regard to said Facility Service according to the standards as prescribed by the Minister of Health, Labour, and Welfare (in a case when said calculated expenses exceed the actual expenses required for said Facility Service (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 base amount is to be the actual expenses required for said Facility Service).
The mayor of a Municipality, when he or she determines the necessity for payment of an Exceptional Allowance for Long-Term Care Facility Service, may order a person that has been in charge of the Facility Service pertaining to said payment or equivalent service (herein referred to as "Person, etc., in Charge of Facility Service" 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 Facility Service pertaining to said payment in order to inspect said equipment, books, documents, and other items.
市町村長は、特例施設介護サービス費の支給に関して必要があると認めるときは、当該支給に係る施設サービスを担当する者若しくは担当した者(以下この項において「施設サービスを担当する者等」という。)に対し、報告若しくは帳簿書類の提出若しくは提示を命じ、若しくは出頭を求め、又は当該職員に関係者に対して質問させ、若しくは当該施設サービスを担当する者等の当該支給に係る施設に立ち入り、その設備若しくは帳簿書類その他の物件を検査させることができる。
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.