When an insured person has received, at or from a designated home-nursing provider (meaning the designated home-nursing provider as set forth in Article 88, paragraph (1) of the Health Insurance Act; hereinafter the same shall apply), designated home nursing (meaning the designated home nursing as set forth in that paragraph; hereinafter the same shall apply), Municipalities and Societies shall pay medical expenses for home-nursing to the Householder or Society member of the household to which said insured person belongs with respect to expenses incurred in such designated home nursing; provided, however, that this shall not apply during any period in which said Householder or Society member is subject to the application of Article 54-3, paragraph (1) or the main clause of paragraph (2) with respect to said insured person.
市町村及び組合は、被保険者が指定訪問看護事業者（健康保険法第八十八条第一項に規定する指定訪問看護事業者をいう。以下同じ。）について指定訪問看護（同項に規定する指定訪問看護をいう。以下同じ。）を受けたときは、当該被保険者の属する世帯の世帯主又は組合員に対し、その指定訪問看護に要した費用について、訪問看護療養費を支給する。ただし、当該世帯主又は組合員が当該被保険者について第五十四条の三第一項又は第二項本文の規定の適用を受けている間は、この限りでない。
The medical expenses for home-nursing set forth in the preceding paragraph shall be paid only if a Municipality or Society finds it necessary, as provided by Order of the Ministry of Health, Labour and Welfare.
When an insured person seeks to receive designated home nursing, the insured person is to, as provided by Order of the Ministry of Health, Labour and Welfare, receive confirmation of being an insured person from the designated home-nursing provider of the insured person's choice by electronic eligibility confirmation, etc., and receive that designated home nursing.
The amount of medical expenses for home-nursing shall be calculated by deducting, from the amount calculated for such designated home-nursing in accordance with the rules prescribed by the Minister of Health, Labour and Welfare pursuant to the provisions of Article 88, paragraph (4) of the Health Insurance Act, the amount calculated by multiplying such amount by the applicable ratio listed in the items of paragraph (1) of Article 42, in accordance with the categories listed in the items of the same paragraph (or, when the ratio for co-payment has been reduced pursuant to the provisions of Article 43, paragraph (1), the ratio after such reduction) (or, when any of the measures listed in the items of paragraph (1) of Article 44 needs be taken with respect to the co-payment set forth in Article 42, paragraph (1) for benefits for the medical treatment, the amount calculated as if the relevant measures were taken).
When an insured person has received designated home nursing at or from a designated home-nursing provider, Municipalities and Societies may, on behalf of the Householder or Society member of the household to which said insured person belongs, pay to said designated home-nursing provider expenses incurred in said designated home nursing that are payable by that Householder or Society member to said designated home-nursing provider, within the limit of the amount payable to that Householder or Society member as medical expenses for home-nursing.
When a payment is made pursuant to the provisions of the preceding paragraph, the Householder or Society member shall be deemed to have received medical expenses for home-nursing.
前項の規定による支払があつたときは、世帯主又は組合員に対し訪問看護療養費の支給があつたものとみなす。
The provisions of Article 42-2 shall apply mutatis mutandis to the payment of the amount calculated by deducting, from the amount of expenses calculated pursuant to the provisions of paragraph (4) in the case set forth in paragraph (5), the amount payable as medical expenses for home-nursing with respect to expenses incurred in the relevant designated home-nursing.
Upon acceptance of the payment of expenses incurred in designated home-nursing, the designated home-nursing provider must, pursuant to the provisions of Ordinance of the Ministry of Health, Labour and Welfare, issue a receipt therefor to the Householder or Society member who makes such payment.
Upon receipt of a claim by a designated home-nursing provider for medical expenses for home-nursing, Municipalities and Societies shall make payment after conducting an examination according to the method for calculating the amount set forth in paragraph (4) and the rules set forth in the following paragraph.
The rules for cases where a designated home-nursing provider provides designated home-nursing under a national health insurance program shall be governed by the standards for the operation of a designated home-nursing provider prescribed in Article 92, paragraph (2) of the Health Insurance Act (limited to the provisions concerning the handling of designated home-nursing) and, when it is difficult or is not found appropriate for said standards to govern such rules, said rules shall be prescribed by Ordinance of the Ministry of Health, Labour and Welfare.
指定訪問看護事業者が、国民健康保険の指定訪問看護を提供する場合の準則については、健康保険法第九十二条第二項に規定する指定訪問看護の事業の運営に関する基準（指定訪問看護の取扱いに関する部分に限る。）の例によるものとし、これにより難いとき又はよることが適当と認められないときの準則については、厚生労働省令で定める。
No designated home-nursing shall be included in any of the types of medical treatment listed in the items of paragraph (1) of Article 36.
The provisions of paragraph (3) of Article 92 of the Health Insurance Act and paragraphs (5) through (8) of Article 45 of this Act shall apply mutatis mutandis to designated home-nursing received at or from a designated home-nursing provider and the payment of medical expenses for home-nursing associated with such service. In this case, any technical replacement of terms necessary for these provisions shall be specified by Cabinet Order.
健康保険法第九十二条第三項及び本法第四十五条第五項から第八項までの規定は、指定訪問看護事業者について受けた指定訪問看護及びこれに伴う訪問看護療養費の支給について準用する。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。
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