Medical Care Act

A general incorporated association that has as its members the following persons (excluding persons engaged in a business for profit; hereinafter referred to as "participating corporations, etc." in this Chapter) and persons specified by an Order of the Ministry of Health, Labour and Welfare as persons necessary for efficiently providing high-quality and appropriate medical care in the region, and that has the purpose of establishing policies for promoting coordination of operations pertaining to a hospital, clinic, long-term care health facility, or integrated facility for medical and long-term care (hereinafter referred to as "hospital, etc." in this Chapter) (hereinafter referred to as the "medical coordination promotion policy" in this Chapter) and performing medical coordination promotion operations may obtain approval from the governor of the prefecture to which the area to promote the relevant coordination specified in the articles of incorporation (hereinafter referred to as "medical coordination promotion area") belongs (in the case where the relevant medical coordination promotion area extends over two or more prefectures, any one of these prefectures):

a corporation that establishes a hospital, etc. in the medical coordination promotion area; or

a corporation that establishes or manages in the medical coordination promotion area a facility or office related to nursing care business (meaning business that provides welfare services or health and medical services to persons with physical or mental disabilities that hinder them from performing daily activities, including care for bathing, excretion, meals, etc., functional training, nursing care and medical treatment management, and other services, to enable them to lead self-reliant daily lives according to their abilities) and other businesses that contribute to the establishment of a community-based integrated care system (hereinafter referred to as "nursing care business, etc." in this Chapter);

a person (excluding corporations) that establishes a hospital, etc. in the medical coordination promotion area; or

a person (excluding corporations) that establishes or manages a facility or office related to nursing care business, etc. in the medical coordination promotion area.

The medical coordination promotion operations set forth in the preceding paragraph means the following operations and other operations performed for the purpose of promoting coordination of operations pertaining to a hospital, etc. in accordance with the medical coordination promotion policy:

training to improve the qualities of medical care professionals;

supplying medicines, medical equipment and other supplies necessary for operations pertaining to a hospital, etc.; and

fund lending and other support specified by an Order of the Ministry of Health, Labour and Welfare as support for raising funds necessary for a participating corporation, etc. (excluding the persons listed in items (iii) and (iv) of the preceding paragraph) to perform operations pertaining to a hospital, etc.

A general incorporated association that intends to obtain the approval set forth in paragraph (1) of the preceding Article (hereinafter referred to as "approval for medical coordination promotion" in this Chapter), pursuant to the provisions of a Cabinet Order, must apply to the prefectural governor with a medical coordination promotion policy.

The medical coordination promotion policy must contain the following particulars:

the medical coordination promotion area;

particulars concerning the sharing of functions and the coordination of operations among hospitals, etc. established by participating corporations, etc. in the medical coordination promotion area (referred to as "participating hospitals, etc." in paragraph (4) and Article 70-11);

particulars concerning the targets of the particulars listed in the preceding item; and

other particulars specified by an Order of the Ministry of Health, Labour and Welfare.

Beyond the particulars listed in each item of paragraph (2), the medical coordination promotion policy may contain particulars concerning the coordination of operations among participating hospitals, etc. and participating nursing care facilities, etc. (referring to facilities or offices pertaining to nursing care business, etc. established or managed by a participating corporation, etc. in a medical coordination promotion area; the same applies in Article 70-11).

When the medical coordination promotion area pertaining to an application for approval for medical coordination promotion extends over two or more prefectures, the prefectural governor who conducts the affairs concerning the approval for medical coordination promotion must be determined through consultation among the governors of the prefectures to which the relevant medical coordination promotion area belongs. In this case, the prefectural governor who has received the application for approval for medical coordination promotion is to notify the general incorporated association that has applied for approval for medical coordination promotion of the prefectural governor who is to conduct the affairs concerning the approval for medical coordination promotion.

When the prefectural governor finds that a general incorporated association that has applied for approval for medical coordination promotion conforms to the following standards, the prefectural governor may grant approval for medical coordination promotion to the relevant general incorporated association:

the main purpose of the general incorporated association is to perform medical coordination promotion operations (which means the medical coordination promotion operations prescribed in Article 70, paragraph (2); the same applies hereinafter in this Chapter);

the general incorporated association has the financial basis and technical capability necessary to perform medical coordination promotion operations;

in the performance of medical coordination promotion operations, the general incorporated association does not provide any special benefits to its members, directors, auditors, employees or any other related parties specified by Cabinet Order;

the articles of incorporation stipulate that, where a person set forth in Article 70, paragraph (1), item (iii) or (iv) is a member, the operations and investments set forth in item (iii) of paragraph (2) of that Article are not to be carried out;

when the general incorporated association conducts any operations other than medical coordination promotion operations, there is no risk that the implementation of medical coordination promotion operations will be hindered by conducting any operations other than medical coordination promotion operations;

the medical coordination promotion policy does not violate the provisions of paragraphs (2) and (3) of the preceding Article;

the medical coordination promotion area is specified in the articles of incorporation;

the articles of incorporation stipulate that the members should be limited to participating corporations, etc. and persons specified by an Order of the Ministry of Health, Labour and Welfare as necessary for efficiently providing high-quality and appropriate medical care in the medical coordination promotion area;

the number of participating corporations, etc. establishing a hospital, etc. is two or more and other requirements for the composition of the participating corporations, etc. specified by an Order of the Ministry of Health, Labour and Welfare as appropriate in light of the purpose prescribed in Article 70, paragraph (1) (referred to as the "purpose of medical coordination promotion" in the following item and item (xi), (a)) are met;

no unfairly discriminatory conditions or other unreasonable conditions are attached to the member's acquisition or loss of qualification in light of the purpose of medical coordination promotion;

each member has one voting right. However, this does not apply if provisions of the articles of incorporation concerning voting rights of members, such as the number of voting rights that may be exercised at a general meeting of members, particulars on which voting rights may be exercised, conditions for exercising voting rights, fall under all of the following:

the voting rights of members are not treated in an unfairly discriminatory manner in light of the purpose of medical coordination promotion;

the voting rights of members are not treated differently according to the value of money or other property that the members have provided to the general incorporated association;

the total number of voting rights held by the participating corporations, etc. accounts for a majority of the voting rights of all members;

the articles of incorporation stipulate that persons specified by an Order of the Ministry of Health, Labour and Welfare as those who are likely to have an undue influence on the resolution of a general meeting of members due to their interest in a profit-oriented organization or its officers or other circumstances should not be designated as members, directors or auditors (referred to as "officers" in the following item);

the general incorporated association falls under all of the following with regard to its officers:

the general incorporated association has three or more directors and one or more auditors as its officers;

no more than one-third of the total number of officers consist of an officer, their spouse, their relatives within the third degree of kinship, or other persons who have a special relationship with the officer as specified by an Order of the Ministry of Health, Labour and Welfare;

at least one of the directors is a representative of an organization of academic experts on medical treatment or other persons specified by an Order of the Ministry of Health, Labour and Welfare as necessary for the effective implementation of medical coordination promotion operations;

the general incorporated association has one representative director;

the general incorporated association has a board of directors;

the articles of incorporation stipulate that the general incorporated association should have a council that meets the following requirements (referred to as the "council for regional medical coordination promotion" in Article 70-13, paragraph (2)):

the council consists of recipients of medical care or nursing care, organizations of academic experts on medical treatment and other related organizations, persons with academic background, and other related persons;

the council is able to provide necessary opinions to the general incorporated association when the relevant general incorporated association expresses the opinions prescribed in the following item;

the council is able to evaluate the status of the implementation of the operations of the general incorporated association in light of the targets set forth in paragraph (2), item (iii) of the preceding Article, and to state its opinions at a general meeting of members and board of directors meeting when it finds it necessary;

the articles of incorporation stipulate that the participating corporations, etc. should, prior to making decisions on the following particulars (excluding the particulars set forth in (a), (b) and (e) in the case of a general incorporated association whose articles of incorporation stipulate that it does not carry out the operations and investments set forth in Article 70, paragraph (2), item (iii)) and other important particulars, seek the opinions of the general incorporated association:

decision or change of the budget;

borrowings (excluding temporary borrowings to be redeemed with income within the fiscal year);

disposal of important assets pertaining to the business;

decision or change of the business plan;

change of the articles of incorporation or act of endowment;

merger or split of the corporation;

dissolution or discontinuation of business due to inability to succeed in the intended business or other reasons specified by an Order of the Ministry of Health, Labour and Welfare;

the articles of incorporation stipulate that in the event that a disposition of rescission of the approval for medical coordination promotion is made pursuant to the provisions of Article 70-21, paragraph (1) or (2), when there is a remaining balance of property acquired for medical coordination promotion purposes prescribed in Article 70-22, paragraph (2), the equivalent amount of property should be donated to the national government, local governments, medical corporations or other medical care providers specified by an Order of the Ministry of Health, Labour and Welfare (referred to as "the State, etc." in the following item) within one month from the day of the relevant disposition of rescission of the approval for medical coordination promotion;

the articles of incorporation stipulate that in the case of liquidation, the residual property is to be attributed to the state, etc.; and

beyond what is listed in each of the preceding items, the general incorporated association meets the requirements specified by an Order of the Ministry of Health, Labour and Welfare as necessary for the appropriate performance of medical coordination promotion operations.