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"), care for medical treatment or necessary assistance with medical treatment provided at the home of a person who is in a condition of continuing to receive medical treatment at home due to sickness or injury (limited to a person whom the attending physician finds to conform to the standards specified by Order of the Ministry of Health, Labour and Welfare as to the degree of necessity for treatment) by a nurse or other person specified by Order of the Ministry of Health, Labour and Welfare (excluding that provided by a medical institution providing services covered by health insurance, etc., or a long-term care health facility prescribed in Article 8, paragraph (28) of the Long-Term Care Insurance Act or a long-term care medical institution prescribed in paragraph (29) of that Article; hereinafter referred to as "home-nursing") that is provided by an office operating the home-nursing business pertaining to that designation (meaning the business of providing home-nursing) (hereinafter referred to as "designated home nursing"), medical expenses for home-nursing are paid to the insured person for the expenses required for that designated home nursing.
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省令で定める者が行う療養上の世話又は必要な診療の補助(保険医療機関等又は介護保険法第八条第二十八項に規定する介護老人保健施設若しくは同条第二十九項に規定する介護医療院によるものを除く。以下「訪問看護」という。)を行う事業をいう。)を行う事業所により行われる訪問看護(以下「指定訪問看護」という。)を受けたときは、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。
The medical expenses for home-nursing referred to in the preceding paragraph are paid only if the insurer finds it necessary pursuant to Order of the Ministry of Health, Labour and Welfare.
前項の訪問看護療養費は、厚生労働省令で定めるところにより、保険者が必要と認める場合に限り、支給するものとする。
A person who intends to receive designated home nursing is to, as specified by Order of the Ministry of Health, Labour and Welfare, receive confirmation of being an insured person by electronic eligibility confirmation, etc. from the designated home-nursing provider that the person selects, and receive that designated 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 expenses required for home-nursing, the amount obtained by multiplying the specified amount by the applicable ratio specified in an item of Article 74, paragraph (1) (if any of the measures listed in the items of Article 75-2, paragraph (1) need to be taken with respect to the co-payment referred to in the same paragraph for benefits for medical treatment, the amount calculated as if the relevant measures were taken), in accordance with the classifications listed in the items of the same paragraph.
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、同項各号に定める割合を乗じて得た額(療養の給付に係る同項の一部負担金について第七十五条の二第一項各号の措置が採られるべきときは、当該措置が採られたものとした場合の額)を控除した額とする。
When intending to specify the matters referred to in the preceding paragraph, the Minister of Health, Labour, and Welfare is to consult with the Central Social Insurance Medical Council.
厚生労働大臣は、前項の定めをしようとするときは、中央社会保険医療協議会に諮問するものとする。
When an insured person has received designated home-nursing from a designated home-nursing provider, the insurer may, on behalf of the relevant insured person, pay to the designated home-nursing provider expenses incurred in the designated home-nursing payable by the insured person to the designated home-nursing provider, within the limit of the amount payable to the insured person as medical expenses for home-nursing.
When a payment pursuant to the provisions of the preceding paragraph is made, it is deemed that medical expenses for home-nursing are paid to the insured person.
The provisions of Article 75 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 referred to in paragraph (6), 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 issue a receipt therefor to the insured person who made the payment, pursuant to Order of the Ministry of Health, Labour and Welfare.
When requested to pay medical expenses for home-nursing expenses by a designated home-nursing provider, an insurer is to conduct an examination in light of the matters prescribed in paragraph (4) and standards for operations in home-nursing prescribed in Article 92, paragraph (2) (limited to the part regarding the handling of designated home-nursing).
An insurer may delegate affairs concerning the examination and payment pursuant to the provisions of the preceding paragraph to the Infrastructure Organization or an NHI federation.
No designated home-nursing is to be included in any of the types of medical treatment listed in the items of Article 63, paragraph (1).
Beyond what is provided for in the provisions of the preceding paragraphs, necessary matters concerning requests for medical expenses for home-nursing by a designated home-nursing provider are specified by Order of the Ministry of Health, Labour and Welfare.