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Article 49-2Amount of Allowance for In-Home Long-Term Care Service, etc. for an Insured Person Requiring Long-Term Care with Income at or above a Certain Level

第四十九条の二(一定以上の所得を有する要介護被保険者に係る居宅介護サービス費等の額)

In the case of applying the provisions specified in the items below to the Long-Term Care Benefit listed in each of those items that is received by an Insured Person Requiring Long-Term Care who is a Primary Insured Person and whose amount of income calculated as specified by Cabinet Order is the amount specified by Cabinet Order or more (excluding an Insured Person Requiring Long-Term Care prescribed in the following paragraph), the term "90 percent" in those provisions is deemed to be replaced with "80 percent".

第一号被保険者であって政令で定めるところにより算定した所得の額が政令で定める額以上である要介護被保険者(次項に規定する要介護被保険者を除く。)が受ける次の各号に掲げる介護給付について当該各号に定める規定を適用する場合においては、これらの規定中「百分の九十」とあるのは、「百分の八十」とする。

payment of an Allowance for In-Home Long-Term Care Service:Article 41, paragraph (4), item (i) and item (ii), and Article 43, paragraph (1), paragraph (4) and paragraph (6);

居宅介護サービス費の支給 第四十一条第四項第一号及び第二号並びに第四十三条第一項、第四項及び第六項

payment of an Exceptional Allowance for In-Home Long-Term Care Service:Article 42, paragraph (3), and Article 43, paragraph (1), paragraph (4) and paragraph (6);

特例居宅介護サービス費の支給 第四十二条第三項並びに第四十三条第一項、第四項及び第六項

payment of an Allowance for Community-Based Long-Term Care Service:each item of Article 42-2, paragraph (2), and Article 43, paragraph (1), paragraph (4) and paragraph (6);

地域密着型介護サービス費の支給 第四十二条の二第二項各号並びに第四十三条第一項、第四項及び第六項

payment of an Exceptional Allowance for Community-Based Long-Term Care Service:Article 42-3, paragraph (2) and Article 43, paragraph (1), paragraph (4), and paragraph (6);

特例地域密着型介護サービス費の支給 第四十二条の三第二項並びに第四十三条第一項、第四項及び第六項

payment of an Allowance for Long-Term Care Facility Service:Article 48, paragraph (2);

施設介護サービス費の支給 第四十八条第二項

payment of an Exceptional Allowance for Long-Term Care Facility Service:paragraph (2) of the preceding Article;

特例施設介護サービス費の支給 前条第二項

payment of an Allowance for Purchasing Equipment for In-Home Long-Term Care Covered by Public Aid:Article 44, paragraph (3), paragraph (4), and paragraph (7);

居宅介護福祉用具購入費の支給 第四十四条第三項、第四項及び第七項

payment of an Allowance for Home Modification for In-Home Long-Term Care:Article 45, paragraph (3), paragraph (4) and paragraph (7).

居宅介護住宅改修費の支給 第四十五条第三項、第四項及び第七項

In the case of applying the provisions specified in the items of the preceding paragraph to the Long-Term Care Benefit listed in those items that is received by an Insured Person Requiring Long-Term Care who is a Primary Insured Person and whose amount of income calculated as specified by Cabinet Order is the amount specified by Cabinet Order, which exceeds the amount specified by Cabinet Order in the preceding paragraph, or more, the term "90 percent" in those provisions is deemed to be replaced with "70 percent".

第一号被保険者であって政令で定めるところにより算定した所得の額が前項の政令で定める額を超える政令で定める額以上である要介護被保険者が受ける同項各号に掲げる介護給付について当該各号に定める規定を適用する場合においては、これらの規定中「百分の九十」とあるのは、「百分の七十」とする。

Article 50Exceptions to the Amount of Allowance for In-Home Long-Term Care Service

第五十条(居宅介護サービス費等の額の特例)

In a case when a Municipality applies the provisions prescribed in the items of paragraph (1) of the preceding Article to a Long-Term Care Benefit listed in said items received by an Insured Person Requiring Long-Term Care for whom the Municipality has found it difficult to pay the necessary expenses for In-Home Service (including equivalent services; the same applies hereinafter in this Article), Community-Based Service (including equivalent services; the same applies hereinafter in this Article), Facility Service, or Home Modification due to disaster or other special circumstances as determined by Order of the Ministry of Health, Labour and Welfare (excluding a case when the provisions are applied as replaced pursuant to the provisions of that Article), the term "90 percent" in the referenced provisions is deemed to be replaced with "the percentage determined by the Municipality within the range exceeding 90 percent and 100 percent or less".

市町村が、災害その他の厚生労働省令で定める特別の事情があることにより、居宅サービス(これに相当するサービスを含む。以下この条において同じ。)、地域密着型サービス(これに相当するサービスを含む。以下この条において同じ。)若しくは施設サービス又は住宅改修に必要な費用を負担することが困難であると認めた要介護被保険者が受ける前条第一項各号に掲げる介護給付について当該各号に定める規定を適用する場合(同条の規定により読み替えて適用する場合を除く。)においては、これらの規定中「百分の九十」とあるのは、「百分の九十を超え百分の百以下の範囲内において市町村が定めた割合」とする。

In a case when a Municipality applies the provisions prescribed in the items of paragraph (1) of the preceding Article to a Long-Term Care Benefit listed in said items received by an Insured Person Requiring Long-Term Care for whom the Municipality has found it difficult to pay the necessary expenses for In-Home Service, Community-Based Service, Facility Service, or Home Modification due to disaster or other special circumstances as determined by Order of the Ministry of Health, Labour and Welfare (limited to a case when the provisions are applied as replaced pursuant to the provisions of that paragraph), the term "80 percent" in the referenced provisions applied as replaced pursuant to the provisions of that paragraph is deemed to be replaced with "the percentage determined by the Municipality within the range exceeding 80 percent and 100 percent or less".

市町村が、災害その他の厚生労働省令で定める特別の事情があることにより、居宅サービス、地域密着型サービス若しくは施設サービス又は住宅改修に必要な費用を負担することが困難であると認めた要介護被保険者が受ける前条第一項各号に掲げる介護給付について当該各号に定める規定を適用する場合(同項の規定により読み替えて適用する場合に限る。)においては、同項の規定により読み替えて適用するこれらの規定中「百分の八十」とあるのは、「百分の八十を超え百分の百以下の範囲内において市町村が定めた割合」とする。

In a case when a Municipality applies the provisions prescribed in the items of paragraph (1) of the preceding Article to a Long-Term Care Benefit listed in said items received by an Insured Person Requiring Long-Term Care for whom the Municipality has found it difficult to pay the necessary expenses for In-Home Service, Community-Based Service, Facility Service, or Home Modification due to disaster or other special circumstances as determined by Order of the Ministry of Health, Labour and Welfare (limited to a case when the provisions are applied as replaced pursuant to the provisions of paragraph (2) of that Article), the term "70 percent" in the referenced provisions applied as replaced pursuant to the provisions of paragraph (2) of that Article is deemed to be replaced with "the percentage determined by the Municipality within the range exceeding 70 percent and 100 percent or less".

市町村が、災害その他の厚生労働省令で定める特別の事情があることにより、居宅サービス、地域密着型サービス若しくは施設サービス又は住宅改修に必要な費用を負担することが困難であると認めた要介護被保険者が受ける前条第一項各号に掲げる介護給付について当該各号に定める規定を適用する場合(同条第二項の規定により読み替えて適用する場合に限る。)においては、同条第二項の規定により読み替えて適用するこれらの規定中「百分の七十」とあるのは、「百分の七十を超え百分の百以下の範囲内において市町村が定めた割合」とする。

Article 51Payment of an Allowance for High-Cost Long-Term Care Service

第五十一条(高額介護サービス費の支給)

When the amount obtained by deducting the total amount of the Allowance for In-Home Long-Term Care Service, Exceptional Allowance for In-Home Long-Term Care Service, Allowance for Community-Based Long-Term Care Service, Exceptional Allowance for Community-Based Long-Term Care Service, Allowance for Long-Term Care Facility Service, and Exceptional Allowance for Long-Term Care Facility Service paid for the expenses from the amount calculated as provided by Cabinet Order as the total amount of expenses required for In-Home Service (including equivalent services), Community-Based Service (including equivalent services), or Facility Service received by an Insured Person Requiring Long-Term Care (hereinafter referred to as "User Charge for Long-Term Care Service" in paragraph (1) of the following Article) is extremely large, a Municipality pays an Allowance for High-Cost Long-Term Care Service to said Insured Person Requiring Long-Term Care.

市町村は、要介護被保険者が受けた居宅サービス(これに相当するサービスを含む。)、地域密着型サービス(これに相当するサービスを含む。)又は施設サービスに要した費用の合計額として政令で定めるところにより算定した額から、当該費用につき支給された居宅介護サービス費、特例居宅介護サービス費、地域密着型介護サービス費、特例地域密着型介護サービス費、施設介護サービス費及び特例施設介護サービス費の合計額を控除して得た額(次条第一項において「介護サービス利用者負担額」という。)が、著しく高額であるときは、当該要介護被保険者に対し、高額介護サービス費を支給する。

In addition to the provisions as set forth in the preceding paragraph, requirements for payment of an Allowance for High-Cost Long-Term Care Service, the amount of said allowance, and other matters necessary for the payment of an Allowance for High-Cost Long-Term Care Service are provided by a Cabinet Order after considering the impact on said household budget due to the burden of the expenses necessary for In-Home Service, Community-Based Service, or Facility Service.

前項に規定するもののほか、高額介護サービス費の支給要件、支給額その他高額介護サービス費の支給に関して必要な事項は、居宅サービス、地域密着型サービス又は施設サービスに必要な費用の負担の家計に与える影響を考慮して、政令で定める。

Article 51-2Payment of an Allowance for High-Cost Medical and Long-Term Care Service Combined

第五十一条の二(高額医療合算介護サービス費の支給)

A Municipality, when the total sum of the User Charge for Long-Term Care Service of an Insured Person Requiring Long-Term Care (in a case when an Allowance for High-Cost Long-Term Care Service under paragraph (1) of the preceding Article is paid, the amount obtained by deducting the amount equivalent to the amount of said allowance paid), the amount of the co-payment, etc. prescribed in Article 115, paragraph (1) of the Health Insurance Act pertaining to said Insured Person Requiring Long-Term Care (in a case when high-cost medical expenses under that paragraph are paid, the amount obtained by deducting the amount equivalent to the amount of said payment), and other amounts determined by Cabinet Order as amounts equivalent to these as prescribed in the Medical Insurance Acts or the Act on Assurance of Medical Care for Elderly People (Act No. 80 of 1982), is extremely large, pays an Allowance for High-Cost Medical and Long-Term Care Service Combined to said Insured Person Requiring Long-Term Care.

市町村は、要介護被保険者の介護サービス利用者負担額(前条第一項の高額介護サービス費が支給される場合にあっては、当該支給額に相当する額を控除して得た額)及び当該要介護被保険者に係る健康保険法第百十五条第一項に規定する一部負担金等の額(同項の高額療養費が支給される場合にあっては、当該支給額に相当する額を控除して得た額)その他の医療保険各法又は高齢者の医療の確保に関する法律(昭和五十七年法律第八十号)に規定するこれに相当する額として政令で定める額の合計額が、著しく高額であるときは、当該要介護被保険者に対し、高額医療合算介護サービス費を支給する。

The provisions of paragraph (2) of the preceding Article apply mutatis mutandis to payment of an Allowance for High-Cost Medical and Long-Term Care Service Combined.

前条第二項の規定は、高額医療合算介護サービス費の支給について準用する。

Article 51-3Payment of an Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility

第五十一条の三(特定入所者介護サービス費の支給)

A Municipality, when a person specified by Order of the Ministry of Health, Labour and Welfare in consideration of the status of income and assets and other circumstances from among Insured Persons Requiring Long-Term Care receives any of the following Designated Facility Service, etc., Designated Community-Based Service, or Designated In-Home Service (hereinafter referred to as "Specified Long-Term Care Service" in this Article and paragraph (1) of the following Article), pays to said Insured Person Requiring Long-Term Care (hereinafter referred to as a "Specified Person Admitted to a Facility" in this Article and paragraph (1) of the following Article) an Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility for the expenses required to provide meals and the expenses required for residence or stay (hereinafter referred to as "Residence, etc.") at a Facility Covered by Long-Term Care Insurance, Designated Community-Based Service Provider, or Designated In-Home Service Provider that provides said Specified Long-Term Care Service (hereinafter referred to as "Specified Facility, etc., for Insured Long-Term Care" in this Article); provided, however, that this does not apply when said Specified Person Admitted to a Facility, in a case where he or she has been issued a designation pursuant to the provisions of Article 37, paragraph (1), receives Specified Long-Term Care Service other than the type pertaining to said designation:

市町村は、要介護被保険者のうち所得及び資産の状況その他の事情をしん酌して厚生労働省令で定めるものが、次に掲げる指定施設サービス等、指定地域密着型サービス又は指定居宅サービス(以下この条及び次条第一項において「特定介護サービス」という。)を受けたときは、当該要介護被保険者(以下この条及び次条第一項において「特定入所者」という。)に対し、当該特定介護サービスを行う介護保険施設、指定地域密着型サービス事業者又は指定居宅サービス事業者(以下この条において「特定介護保険施設等」という。)における食事の提供に要した費用及び居住又は滞在(以下「居住等」という。)に要した費用について、特定入所者介護サービス費を支給する。ただし、当該特定入所者が、第三十七条第一項の規定による指定を受けている場合において、当該指定に係る種類以外の特定介護サービスを受けたときは、この限りでない。

Admission to a Community-Based Facility for Preventive Daily Long-Term Care of the Elderly Covered by Public Aid;

The amount of the Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility is to be the total sum of the amount as prescribed in item (i) and the amount as prescribed in item (ii) below:

特定入所者介護サービス費の額は、第一号に規定する額及び第二号に規定する額の合計額とする。

the amount after the amount determined by the Minister of Health, Labour, and Welfare after considering the status of food expenses for an average household budget, the income status of the Specified Person Admitted to a Facility, and other circumstances (hereinafter referred to as "Maximum Allowance for Meal Expense" in this Article and the following Article, paragraph (2)) is deducted from the amount of expenses determined by the Minister of Health, Labour, and Welfare after considering the average expenses required to provide meals at a Specified Facility, etc., for Insured Long-Term Care (in a case when said amount exceeds the actual expenses of providing said meals, the amount is the actual expenses of providing said meals; herein referred to as "Base Cost for Meal Expenses" in this Article and in the following Article, paragraph (2));

特定介護保険施設等における食事の提供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費用の額(その額が現に当該食事の提供に要した費用の額を超えるときは、当該現に食事の提供に要した費用の額とする。以下この条及び次条第二項において「食費の基準費用額」という。)から、平均的な家計における食費の状況及び特定入所者の所得の状況その他の事情を勘案して厚生労働大臣が定める額(以下この条及び次条第二項において「食費の負担限度額」という。)を控除した額

the amount after the amount provided by the Minister of Health, Labour, and Welfare after considering the income status of the Specified Person Admitted to a Facility and other circumstances (herein referred to as "Maximum Allowance for Residence Expenses") is deducted from the amount provided by the Minister of Health, Labour, and Welfare after considering the average expenses necessary for Residence, etc., at a Specified Facility, etc., for Insured Long-Term Care, the status of such facility, and other circumstances (in a case when such amount exceeds the actual expenses for said Residence, etc., the amount is the actual expenses for said Residence, etc.; herein referred to as "Base Costs for Residence" in this Article and the following Article, paragraph (2)).

特定介護保険施設等における居住等に要する平均的な費用の額及び施設の状況その他の事情を勘案して厚生労働大臣が定める費用の額(その額が現に当該居住等に要した費用の額を超えるときは、当該現に居住等に要した費用の額とする。以下この条及び次条第二項において「居住費の基準費用額」という。)から、特定入所者の所得の状況その他の事情を勘案して厚生労働大臣が定める額(以下この条及び次条第二項において「居住費の負担限度額」という。)を控除した額

When the expenses necessary of providing meals, Residence, etc., at a Specified Facility, etc., for Insured Long-Term Care, and other circumstances have changed significantly from the Base Cost for Meal Expense or Maximum Allowance for Meal Expense, or Base Costs for Residence or Maximum Allowance for Residence Expenses after the Minister of Health, Labour, and Welfare has issued a determination of these expenses, the Minister must revise those amounts immediately.

厚生労働大臣は、食費の基準費用額若しくは食費の負担限度額又は居住費の基準費用額若しくは居住費の負担限度額を定めた後に、特定介護保険施設等における食事の提供に要する費用又は居住等に要する費用の状況その他の事情が著しく変動したときは、速やかにそれらの額を改定しなければならない。

When a Specified Person Admitted to a Facility receives Specified Long-Term Care Service from a Specified Facility, etc., for Insured Long-Term Care, a Municipality may pay the expenses required for providing meals and Residence, etc., that said Specified Person Admitted to a Facility should pay to said Specified Facility, etc., for Insured Long-Term Care, within the limit of the amount to be paid to said Specified Person Admitted to a Facility as an Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility on behalf of said Specified Person Admitted to a Facility to said Specified Facility, etc., for Insured Long-Term Care

特定入所者が、特定介護保険施設等から特定介護サービスを受けたときは、市町村は、当該特定入所者が当該特定介護保険施設等に支払うべき食事の提供に要した費用及び居住等に要した費用について、特定入所者介護サービス費として当該特定入所者に対し支給すべき額の限度において、当該特定入所者に代わり、当該特定介護保険施設等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 Long-Term Care Service to a Person Admitted to a Specified Facility is paid to the Specified Person Admitted to a Facility.

前項の規定による支払があったときは、特定入所者に対し特定入所者介護サービス費の支給があったものとみなす。

A Municipality, notwithstanding the provisions of paragraph (1) in a case when a Specified Person Admitted to a Facility paid to a Specified Facility, etc., for Insured Long-Term Care, an amount exceeding the Base Cost for Meal Expense or the Base Costs for Residence (with regard to a Specified Person Admitted to a Facility, one who is deemed to be paid an Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility pursuant to the provisions of the preceding paragraph, Maximum Allowance for Meal Expense, or Maximum Allowance for Residence Expenses) as the expenses necessary for providing meals or for Residence, etc., does not pay an Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility.

市町村は、第一項の規定にかかわらず、特定入所者が特定介護保険施設等に対し、食事の提供に要する費用又は居住等に要する費用として、食費の基準費用額又は居住費の基準費用額(前項の規定により特定入所者介護サービス費の支給があったものとみなされた特定入所者にあっては、食費の負担限度額又は居住費の負担限度額)を超える金額を支払った場合には、特定入所者介護サービス費を支給しない。

A Municipality, when a Specified Facility, etc., for Insured Long-Term Care, requests an Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility, pays said allowance after conducting an examination according to the provisions of paragraph (1), paragraph (2) and the preceding paragraph.

市町村は、特定介護保険施設等から特定入所者介護サービス費の請求があったときは、第一項、第二項及び前項の定めに照らして審査の上、支払うものとする。

The provisions of Article 41, paragraph (3), paragraph (10), and paragraph (11) apply mutatis mutandis to the payment of an Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility and the provisions of paragraph (8) of the same Article apply mutatis mutandis to a Specified Facility, etc., for Insured Long-Term Care in this case, the necessary technical replacement of terms in these provisions is provided by a Cabinet Order.

第四十一条第三項、第十項及び第十一項の規定は特定入所者介護サービス費の支給について、同条第八項の規定は特定介護保険施設等について準用する。この場合において、これらの規定に関し必要な技術的読替えは、政令で定める。

In addition to the provisions as prescribed in the preceding paragraphs, the other necessary matters the payment of an Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility and a request for an Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility by a Specified Facility, etc., for Insured Long-Term Care, 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、特定入所者介護サービス費の支給及び特定介護保険施設等の特定入所者介護サービス費の請求に関して必要な事項は、厚生労働省令で定める。

A Municipality, in the following cases, pay an Exceptional Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility to a Specified Person Admitted to a Facility:

市町村は、次に掲げる場合には、特定入所者に対し、特例特定入所者介護サービス費を支給する。

when the Municipality determines it necessary in a case when a Specified Person Admitted to a Facility receives Specified Long-Term Care Service prior to the date said Certification of Needed Long-Term Care becomes effective due to an emergency or other compelling reason;

特定入所者が、当該要介護認定の効力が生じた日前に、緊急その他やむを得ない理由により特定介護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 otherwise specified by Cabinet Order.

その他政令で定めるとき。

The amount of an Exceptional Allowance for Long-Term Care Service to a Person Admitted to a Specified Facility is established by a Municipality based on the total sum of the amounts remaining after the amount of Base Cost for Meal Expense is deducted from the Maximum Allowance for Meal Expense with regard to the expense required to provide said meal and the amount of Base Costs for Residence is deducted from the amount of Maximum Allowance for Residence Expenses with regard to the expense required for said Residence, etc..

特例特定入所者介護サービス費の額は、当該食事の提供に要した費用について食費の基準費用額から食費の負担限度額を控除した額及び当該居住等に要した費用について居住費の基準費用額から居住費の負担限度額を控除した額の合計額を基準として、市町村が定める。

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