Article 59Payment of an Exceptional Allowance for Preventive Long-Term Care Service Plan
第五十九条(特例介護予防サービス計画費の支給)
A Municipality, in the following cases, pay an Exceptional Allowance for Preventive Long-Term Care Service Plan to an Insured In-Home Person Requiring Support:
when a Municipality determines it necessary in a case when an Insured In-Home Person Requiring Support receives Preventive Long-Term Care Support other than Designated Preventive Long-Term Care Support or equivalent service (limited to services provided by a provider that performs a business that is found to satisfy those, among the standards determined by Municipal Ordinance as set forth in Article 115-24, paragraph (1) pertaining to the business of Designated Preventive Long-Term Care Support and the number of employees determined by Municipal Ordinance as set forth in the same paragraph, and the standards concerning effective support methods for Prevention of Long-Term Care pertaining to Designated Preventive Long-Term Care Support as prescribed in paragraph (2) of the same Article and the standards concerning the management of the business of Designated Preventive Long-Term Care Support, that are determined by the Municipal Ordinance of said Municipality; herein referred to as "Preventive Long-Term Care Support Applicable to Standards" in the following item and the following paragraph);
when a Municipality determines it necessary in a case when an Insured In-Home Person Requiring Support that is domiciled on an isolated island or other location where it is significantly difficult to secure Designated Support for Prevention of Long-Term Care, and Preventive Long-Term Care Support Applicable to Standards, and where it is defined by standards as determined by the Minister of Health, Labour, and Welfare, receives Preventive Long-Term Care Support or equivalent service other than Designated Support for Prevention of Long-Term Care or Preventive Long-Term Care Support Applicable to Standards;
指定介護予防支援及び基準該当介護予防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支援被保険者が、指定介護予防支援及び基準該当介護予防支援以外の介護予防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:
the standards concerning the employees that engage in Preventive Long-Term Care Support Applicable to Standards and the number of said employees;
基準該当介護予防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 management of the business of Preventive Long-Term Care Support Applicable to Standards that are determined by Order of the Ministry of Health, Labour and Welfare as being closely related to the appropriate use of services by Persons Requiring Support who use them, appropriate treatment, ensuring of safety, and maintenance of confidentiality, etc.
基準該当介護予防支援の事業の運営に関する事項であって、利用する要支援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 Exceptional Allowance for Preventive Long-Term Care Service Plan is to be specified by a 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 Preventive Long-Term Care Support or equivalent service (in a case said calculated amount exceeds the amount of actual expenses of said Preventive Long-Term Care Support or equivalent service, the base amount is to be the actual expenses required for said Preventive Long-Term Care Support or equivalent service).
The mayor of a Municipality, when he or she determines the necessity for the payment of an Exceptional Allowance for Preventive Long-Term Care Service Plan, may order a person that is or was in charge of the Preventive Long-Term Care Support pertaining to said payment or equivalent service (herein referred to as "Person, etc., in Charge of Preventive Long-Term Care Support, etc." 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 Preventive Long-Term Care Support, etc., pertaining to said payment in order to inspect said record books and documents, and other items.
市町村長は、特例介護予防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、当該支給に係る介護予防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「介護予防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、若しくは当該介護予防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.
第五十九条の二(一定以上の所得を有する居宅要支援被保険者に係る介護予防サービス費等の額)
In the case of applying the provisions determined in each of the following items to the Prevention Benefit listed in those items that is received by an Insured In-Home Person Requiring Support who is a Primary Insured Person and whose amount of income calculated as determined by Cabinet Order is equal to or more than the amount determined by Cabinet Order (excluding an Insured In-Home Person Requiring Support prescribed in the following paragraph), the phrase "90 percent" in these provisions is to be deemed to be replaced with "80 percent":
payment of an Allowance for Preventive Long-Term Care Service:Article 53, paragraph (2), item (i) and item (ii), and Article 55, paragraph (1), paragraph (4), and paragraph (6);
介護予防サービス費の支給 第五十三条第二項第一号及び第二号並びに第五十五条第一項、第四項及び第六項
payment of an Exceptional Allowance for Preventive Long-Term Care Service:Article 54, paragraph (3) and Article 55, paragraph (1), paragraph (4), and paragraph (6);
payment of an Allowance for Community-Based Preventive Long-Term Care Service:Article 54-2, paragraph (2), item (i) and item (ii), and Article 55, paragraph (1), paragraph (4), and paragraph (6);
地域密着型介護予防サービス費の支給 第五十四条の二第二項第一号及び第二号並びに第五十五条第一項、第四項及び第六項
payment of an Exceptional Allowance for Community-Based Preventive Long-Term Care Service:Article 54-3, paragraph (2) and Article 55, paragraph (1), paragraph (4), and paragraph (6);
特例地域密着型介護予防サービス費の支給 第五十四条の三第二項並びに第五十五条第一項、第四項及び第六項
payment of an Allowance for Purchasing Equipment for Preventive Long-Term Care Covered by Public Aid:Article 56, paragraph (3), paragraph (4), and paragraph (7);
payment of an Allowance for Preventive Long-Term Care Home Modification:Article 57, paragraph (3), paragraph (4) and paragraph (7).
In the case of applying the provisions determined in each of the items of the preceding paragraph to the Prevention Benefit listed in those items that is received by an Insured In-Home Person Requiring Support who is a Primary Insured Person and whose amount of income calculated as determined by Cabinet Order is equal to or more than the amount determined by Cabinet Order that exceeds the amount determined by Cabinet Order in that paragraph, the phrase "90 percent" in these provisions is to be deemed to be replaced with "70 percent".
In a case when a Municipality applies the provisions determined in each item of paragraph (1) of the preceding Article to a Prevention Benefit listed in those items that an Insured In-Home Person Requiring Support receives, for whom it is deemed to be difficult to pay necessary expenses for Preventive Long-Term Care Service (including equivalent services; the same applies hereinafter in this Article), Community-Based Service for Preventive Long-Term Care (including equivalent services; the same applies hereinafter in this Article), or Home Modification due to a disaster or other special reasons as determined by Order of the Ministry of Health, Labour and Welfare (excluding a case when they are applied with the terms replaced pursuant to the provisions of that Article), the term "90 percent" in these provisions is to be deemed to be replaced with "the percentage provided by a Municipality within the range exceeding 90 percent and 100 percent or less".
In a case when a Municipality applies the provisions determined in each item of paragraph (1) of the preceding Article to a Prevention Benefit listed in those items that an Insured In-Home Person Requiring Support receives, for whom it is deemed to be difficult to pay necessary expenses for Preventive Long-Term Care Service, Community-Based Service for Preventive Long-Term Care, or Home Modification due to a disaster or other special circumstance as determined by Order of the Ministry of Health, Labour and Welfare (limited to a case when they are applied with the terms replaced pursuant to the provisions of that paragraph), the phrase "80 percent" in these provisions applied with the terms replaced pursuant to the provisions of that paragraph is to be deemed to be replaced with "the percentage provided by a Municipality within the range exceeding 80 percent and 100 percent or less".
In a case when a Municipality applies the provisions determined in each item of paragraph (1) of the preceding Article to a Prevention Benefit listed in those items that an Insured In-Home Person Requiring Support receives, for whom it is deemed to be difficult to pay necessary expenses for Preventive Long-Term Care Service, Community-Based Service for Preventive Long-Term Care, or Home Modification due to a disaster or other special circumstance as determined by Order of the Ministry of Health, Labour and Welfare (limited to a case when they are applied with the terms replaced pursuant to the provisions of paragraph (2) of that Article), the phrase "70 percent" in these provisions applied with the terms replaced pursuant to the provisions of paragraph (2) of that Article is to be deemed to be replaced with "the percentage provided by a Municipality within the range exceeding 70 percent and 100 percent or less".
Article 61Payment of an Allowance for High-Cost Preventive Long-Term Care Service
第六十一条(高額介護予防サービス費の支給)
When the amount that is obtained by deducting from the amount calculated pursuant to the provisions of a Cabinet Order as the total amount of each expense required for Preventive Long-Term Care Service (including equivalent service) or Community-Based Service for Preventive Long-Term Care (including equivalent service) that an Insured In-Home Person Requiring Support receives, the total amount of Allowance for Preventive Long-Term Care Service, Exceptional Allowance for Preventive Long-Term Care Service, Allowance for Community-Based Preventive Long-Term Care Service, and Exceptional Allowance for Community-Based Preventive Long-Term Care Service that are actually paid for said expenses (herein referred to as "User Charge for Preventive Long-Term Care Service" in paragraph (1) of the following Article) is significantly large, a Municipality pays an Allowance for High-Cost Preventive Long-Term Care Service to said Insured In-Home Person Requiring Support.
市町村は、居宅要支援被保険者が受けた介護予防サービス(これに相当するサービスを含む。)又は地域密着型介護予防サービス(これに相当するサービスを含む。)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介護予防サービス費、特例介護予防サービス費、地域密着型介護予防サービス費及び特例地域密着型介護予防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「介護予防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、当該居宅要支援被保険者に対し、高額介護予防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 Preventive Long-Term Care Service, the amount of said allowance, and other matters necessary for payment of an Allowance for High-Cost Preventive Long-Term Care Service are prescribed by a Cabinet Order after considering the impact on the household budget from the burden of the expenses necessary for Preventive Long-Term Care Service or Community-Based Service for Preventive Long-Term Care.
前項に規定するもののほか、高額介護予防サービス費の支給要件、支給額その他高額介護予防サービス費の支給に関して必要な事項は、介護予防サービス又は地域密着型介護予防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。
第六十一条の二(高額医療合算介護予防サービス費の支給)
A Municipality, when the total of the User Charge for Preventive Long-Term Care Service of an Insured In-Home Person Requiring Support (in a case when an Allowance for High-Cost Preventive 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 In-Home Person Requiring Support (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, is significantly large, pays an Allowance for High-Cost Medical and Preventive Long-Term Care Service Combined to said Insured In-Home Person Requiring Support.
市町村は、居宅要支援被保険者の介護予防サービス利用者負担額(前条第一項の高額介護予防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)及び当該居宅要支援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、当該居宅要支援被保険者に対し、高額医療合算介護予防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 Preventive Long-Term Care Service Combined.
前条第二項の規定は、高額医療合算介護予防サービス費の支給について準用する。