①Municipalities and Societies, when they find it difficult to pay benefits for medical treatment or expenses for Dietary Treatment for inpatients, Living Support expenses for inpatients or medical expenses combined with treatment outside insurance coverage (hereinafter referred to as "Benefits for Medical Treatment, etc." in this paragraph and the following paragraph), or when, in cases where an insured person has received any medical care, medication or treatment at or from a hospital, clinic, pharmacy or any other person other than a health insurance-covered medical institution, etc., a Municipality or Society finds it unavoidable, may pay medical expenses in lieu of Benefits for Medical Treatment, etc.; provided, however, that this shall not apply during any period in which the Householder or Society member of the household to which said insured person belongs is subject to the application of Article 54-3, paragraph (1) or the main clause of paragraph (2) with respect to said insured person.

②Where an insured person has received any medical care or medication at or from a health insurance-covered medical institution, etc. without receiving confirmation of being an insured person by electronic eligibility confirmation, etc., and when Municipalities and Societies find that the failure to receive such confirmation was due to an emergency or any other unavoidable reason, they shall pay medical expenses in lieu of Benefits for Medical Treatment, etc.; provided, however, that this shall not apply during any period in which the Householder or Society member of the household to which said insured person belongs is subject to the application of Article 54-3, paragraph (1) or the main clause of paragraph (2) with respect to said insured person.

③The amount of medical expenses shall be determined by the Municipality or Society based on the amount calculated by deducting, from the amount calculated for such medical treatment (excluding Dietary Treatment and Living Support), 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, and the amount calculated by deducting, from the amount of expenses calculated for such Dietary Treatment or Living Support, the amount of Standard Co-payment for Dietary Treatment or Standard Living Expense Co-payment, respectively.

④In calculating the amount of expenses set forth in the preceding paragraph, the provisions of Article 45, paragraph (2) shall apply mutatis mutandis to cases where benefit for medical treatment shall be received, those of Article 52, paragraph (2) shall apply mutatis mutandis to cases where expenses for Dietary Treatment for inpatients shall be received, those of Article 52-2, paragraph (2) shall apply mutatis mutandis to cases where expenses for Living Support for inpatients shall be received, and those of paragraph (2) of the preceding Article shall apply mutatis mutandis to cases where medical expenses combined with treatment outside insurance coverage shall be received; provided, however, that such amount shall not exceed the amount of expenses actually incurred in the relevant medical treatment.

①When 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.

②The 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.

③When 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.

④The 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).

⑤When 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.

⑥When 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.

⑦The 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.

⑧Upon 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.

⑨Upon 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.

⑩The 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.

⑪No designated home-nursing shall be included in any of the types of medical treatment listed in the items of paragraph (1) of Article 36.

⑫The 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.

Guidance by the Minister of Health, Labour and Welfare or prefectural governors must be received by each designated home-nursing provider and nurses and other employees at the office relevant to its designation with respect to designated home-nursing.

①When the Minister of Health, Labour and Welfare or a prefectural governor finds it necessary in relation to the payment of medical expenses for home-nursing, said minister or governor may order a designated home-nursing provider or an entity which was a designated home-nursing provider or any of the persons who were nurses or other employees at the office relevant to such designation (hereinafter referred to as a "Former Designated Home-nursing Business, etc." in this paragraph) to make a report or submit or present the books and other documents, may request a designated home-nursing provider or nurses or other employees at the office relevant to its designation (including Former Designated Home-nursing Businesses, etc.) to appear, or may have personnel question persons involved or inspect the books and other documents or other articles of such designated home-nursing provider at the office relevant to its designation.

②The provisions of Article 45-2, paragraph (2) shall apply mutatis mutandis to questions asked or inspections conducted pursuant to the provisions of the preceding paragraph, and the provisions of paragraph (3) of the same Article shall apply mutatis mutandis to the authority under the provisions of the preceding paragraph.

③When a prefectural governor finds it necessary that a disposition be made pursuant to the provisions of Article 95 of the Health Insurance Act with respect to a designated home-nursing provider in relation to designated home-nursing provided under this Act, said governor must notify the Minister of Health, Labour and Welfare thereof, together with the reason therefor.