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。
Read this with the articles around it
(Medical Expenses for Home-Nursing)
When an insured person receives, from a person designated by the Minister of Health, Labour and Welfare (hereinafter referred to as a "designated home-nursing provider")…
被保険者が、厚生労働大臣が指定する者（以下「指定訪問看護事業者」という。）から当該指定に係る訪問看護事業（疾病又は負傷により、居宅において継続して療養を受ける状態にある者（主治の医師がその治療の必要の程度につき厚生労働省令で定める基準に適合していると認めたものに限る。）に対し、その者の居宅において看護師その他厚生労働…
Open this provision(Medical Expenses for Home-Nursing)
The amount of expenses for home nursing is calculated by deducting, from the amount specified by the Minister of Health, Labour and Welfare for the home nursing taking into account the average…
訪問看護療養費の額は、当該指定訪問看護につき指定訪問看護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ところにより算定した費用の額から、その額に第七十四条第一項各号に掲げる場合の区分に応じ…
Open this provision(Standards for Operations in Designated Home-Nursing Services)
Beyond what is provided for in the preceding paragraph, standards for operations of a designated home-nursing business are provided for by the Minister of Health, Labour, and Welfare.
前項に規定するもののほか、指定訪問看護の事業の運営に関する基準は、厚生労働大臣が定める。
Open this provision(Standards for Operations in Designated Home-Nursing Services)
When specifying matters concerning the standards for operations of a designated home-nursing business prescribed in the preceding paragraph…
厚生労働大臣は、前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。）を定めようとするときは、中央社会保険医療協議会に諮問するものとする。
Open this provision(Benefits for Medical Treatment)
Municipalities and Societies shall pay benefits for the types of medical treatment listed in the following items with respect to an insured person's illness and injury; provided, however…
市町村及び組合は、被保険者の疾病及び負傷に関しては、次の各号に掲げる療養の給付を行う。ただし、当該被保険者の属する世帯の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。
Open this provisionIn cases where co-payment shall be made pursuant to the provisions of paragraph (1) of the preceding Article, any fraction of less than five yen in the amount of co-payment set forth in the same…
前条第一項の規定により一部負担金を支払う場合においては、同項の一部負担金の額に五円未満の端数があるときは、これを切り捨て、五円以上十円未満の端数があるときは、これを十円に切り上げるものとする。
Open this provision(Co-payment in Cases Where Benefits for Medical Treatment Are Received)
A person who receives benefit for medical treatment in relation to an Health Insurance-Covered Medical Institution, etc. pursuant to the provisions of Article 36, paragraph (3) shall pay…
第三十六条第三項の規定により保険医療機関等について療養の給付を受ける者は、その給付を受ける際、次の各号の区分に従い、当該給付につき第四十五条第二項又は第三項の規定により算定した額に当該各号に掲げる割合を乗じて得た額を、一部負担金として、当該保険医療機関等に支払わなければならない。
Open this provisionMunicipalities and Societies may, pursuant to Cabinet Order provisions, reduce the ratio of co-payment set forth in Article 42, paragraph (1) by Municipal Ordinance or by constitution.
市町村及び組合は、政令で定めるところにより、条例又は規約で、第四十二条第一項に規定する一部負担金の割合を減ずることができる。
Open this provisionMunicipalities and Societies may take any of the measures listed in the following items with respect to any insured person who is under special circumstances and for whom it is found difficult to…
市町村及び組合は、特別の理由がある被保険者で、保険医療機関等に第四十二条又は前条の規定による一部負担金を支払うことが困難であると認められるものに対し、次の各号の措置を採ることができる。
Open this provision(Medical Fees Payable to Health Insurance-Covered Medical Institutions, etc.)
Municipalities and Societies may entrust affairs concerning the examination and payment pursuant to the provisions of the preceding paragraph to a Federation of National Health Insurance Associations…
市町村及び組合は、前項の規定による審査及び支払に関する事務を都道府県の区域を区域とする国民健康保険団体連合会（加入している都道府県、市町村及び組合の数がその区域内の都道府県、市町村及び組合の総数の三分の二に達しないものを除く。）又は医療情報基盤・診療報酬審査支払機構法（昭和二十三年法律第百二十九号）による医療情報基盤…
Open this provision(Medical Fees Payable to Health Insurance-Covered Medical Institutions, etc.)
Of the affairs concerning the review of medical bills conducted by a Federation of National Health Insurance Associations as entrusted pursuant to the provisions of the preceding paragraph or those…
国民健康保険団体連合会は、前項の規定及び健康保険法第七十六条第五項の規定による委託を受けて行う診療報酬請求書の審査に関する事務のうち厚生労働大臣の定める診療報酬請求書の審査に係るものを、一般社団法人又は一般財団法人であつて、審査に関する組織その他の事項につき厚生労働省令で定める要件に該当し…
Open this provision(Medical Fees Payable to Health Insurance-Covered Medical Institutions, etc.)
An entity to which affairs concerning the review of medical bills as specified by the Minster of Health, Labour and Welfare pursuant to the provisions of the preceding paragraph have been entrusted…
前項の規定により厚生労働大臣の定める診療報酬請求書の審査に係る事務の委託を受けた者は、当該診療報酬請求書の審査を厚生労働省令で定める要件に該当する者に行わせなければならない。
Open this provision(Medical Fees Payable to Health Insurance-Covered Medical Institutions, etc.)
In addition to what is provided for in each of the preceding paragraphs, necessary particulars concerning claims for expenses incurred in providing benefits for medical treatment by Health…
前各項に規定するもののほか、保険医療機関等の療養の給付に関する費用の請求に関して必要な事項は、厚生労働省令で定める。
Open this provision(Medical Expenses for Home-Nursing)
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…
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。
Open this provision(Medical Expenses for Home-Nursing)
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…
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。
Open this provision(Medical Expenses for 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…
訪問看護療養費の額は、当該指定訪問看護につき健康保険法第八十八条第四項の規定による厚生労働大臣の定めの例により算定した費用の額から、その額に第四十二条第一項各号の区分に応じ、同項各号に掲げる割合（第四十三条第一項の規定により一部負担金の割合が減ぜられたときは、当該減ぜられた割合とする。）を乗じて得た額（療養の給付につ…
Open this provision(Medical Expenses for Home-Nursing)
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…
被保険者が指定訪問看護事業者について指定訪問看護を受けたときは、市町村及び組合は、当該被保険者の属する世帯の世帯主又は組合員が当該指定訪問看護事業者に支払うべき当該指定訪問看護に要した費用について、訪問看護療養費として当該世帯主又は組合員に対し支給すべき額の限度において、当該世帯主又は組合員に代わり…
Open this provision(Special Medical Expenses)
In the case where a Householder who is in arrears with insurance premiums (limited to a Householder who has a domicile within the area of the Municipality) or a Society member who is in arrears with…
市町村及び組合は、保険料を滞納している世帯主（当該市町村の区域内に住所を有する世帯主に限る。）又は組合員（その世帯に属する全ての被保険者が原子爆弾被爆者に対する援護に関する法律（平成六年法律第百十七号）による一般疾病医療費の支給その他厚生労働省令で定める医療に関する給付（以下この項及び第四項において「原爆一般疾病医療…
Open this provision(Special Medical Expenses)
Even before the period specified by Order of the Ministry of Health, Labour and Welfare prescribed in the preceding paragraph has elapsed, in the case where a householder…
市町村及び組合は、前項に規定する厚生労働省令で定める期間が経過する前においても、当該市町村又は組合が保険料納付の勧奨等を行つてもなお保険料滞納世帯主等が当該保険料を納付しない場合においては、その世帯に属する被保険者が保険医療機関等から療養を受けたとき、又は指定訪問看護事業者から指定訪問看護を受けたときは…
Open this provisionSociety
「組合」
A National Health Insurance Society (国民健康保険組合): a body made up, as its members (組合員), of people engaged in the same kind of business or occupation who live in its district, which may provide national health insurance to its members and the people in their households (Articles 3, 13 and 19).
Short name set inArticle 13, paragraph (1)
electronic eligibility confirmation, etc.machine translation
「電子資格確認等」
Electronic eligibility confirmation (電子資格確認) or another method a Ministry of Health, Labour and Welfare Order (厚生労働省令) sets, by which an insured person seeking the medical treatment benefits (療養の給付) of Article 36, paragraph (1) is confirmed as insured by the medical institution or pharmacy covered by health insurance (保険医療機関等) of their choice.
Short name set inArticle 36, paragraph (3)
designated home nursingmachine translation
「指定訪問看護」
Home-visit nursing (訪問看護) given by a designated home-nursing provider (指定訪問看護事業者) at its place of business covered by the designation, for which insured persons receive medical expenses for home-nursing (訪問看護療養費).
Defined inArticle 54-2, paragraph (1)
designated home-nursing providermachine translation
「指定訪問看護事業者」
A provider the Minister of Health, Labour and Welfare has designated to run a home-visit nursing business: nursing care or help with medical treatment given at home by nurses and others a Ministry of Health, Labour and Welfare Order (厚生労働省令) names to people under continuing treatment at home for an illness or injury whom their doctor finds meet the Order's standard.
Defined inArticle 54-2, paragraph (1)