Article 95Recession of Designation of Designated Home-Nursing Provider
第九十五条(指定訪問看護事業者の指定の取消し)
The Minister of Health, Labour and Welfare may rescind the designation referred to in Article 88, paragraph (1) pertaining to a designated home-nursing provider that falls under any of the following items:
the designated home-nursing provider has become unable to meet the standards and number of employees specified by Order of the Ministry of Health, Labour, and Welfare referred to in Article 92, paragraph (1) with regard to nurses and other employees at a home-nursing provider office to which the designation pertains;
the designated home-nursing provider is no longer able to appropriately operate designated home-nursing services in accordance with standards for operations of designated home-nursing services prescribed in Article 92, paragraph (2) (including when applied mutatis mutandis to Article 111, paragraph (3) and Article 149);
there was a wrongful claim for payment pursuant to the provisions of Article 88, paragraph (6) (including when applied mutatis mutandis to Article 111, paragraph (3) and Article 149);
the designated home-nursing provider has been ordered to make a report, or submit or present record books or documents pursuant to the provisions of paragraph (1) of the preceding Article (including when applied mutatis mutandis to Article 111, paragraph (3) and Article 149; the same applies hereinafter in this Article), but fails to comply with the order or submits a false report;
the designated home-nursing provider, or a nurse or employee at the home-nursing service office to which the designation pertains has been requested to appear pursuant to the provisions of paragraph (1) of the preceding Article but failed to respond or reply to questions pursuant to the provisions of the same paragraph, answered untruthfully, or refused, obstructed, or evaded an inspection pursuant to the provisions of the same paragraph (except when a nurse or employee at the home-nursing service office to which the designation pertains performed that conduct but the designated home-nursing provider had made efforts to provide reasonable care and supervision so as to prevent the conduct);
there are grounds that correspond to any of item (ii) through the preceding item with respect to designated home-nursing for insured persons and their dependents pursuant to medical insurance laws other than this act or for insured persons pursuant to the Act on Assurance of Medical Care for Elderly People;
この法律以外の医療保険各法による被保険者若しくは被扶養者の指定訪問看護又は高齢者の医療の確保に関する法律による被保険者の指定訪問看護に関し、第二号から前号までのいずれかに相当する事由があったとき。
the designated home-nursing provider received its designation by wrongful means;
指定訪問看護事業者が、不正の手段により指定訪問看護事業者の指定を受けたとき。
the designated home-nursing provider has been sentenced to a fine pursuant to the provisions of this Act or other medical insurance laws which are specified by Cabinet Order and the payment of the fine has not yet been completed or the fine still applies;
指定訪問看護事業者が、この法律その他国民の保健医療に関する法律で政令で定めるものの規定により罰金の刑に処せられ、その執行を終わり、又は執行を受けることがなくなるまでの者に該当するに至ったとき。
the designated home-nursing provider has come to fall under the category of a person who has been sentenced to imprisonment or a severer punishment, and the execution of the sentence has not been completed or the execution of the sentence still applies; or
指定訪問看護事業者が、拘禁刑以上の刑に処せられ、その執行を終わり、又は執行を受けることがなくなるまでの者に該当するに至ったとき。
beyond what is provided for in the preceding items, the designated home nursing service provider violates this Act, other medical insurance laws which are specified by Cabinet Order, or an order or disposition based thereon.
第九十六条(公示)
The Minister of Health, Labour and Welfare must make public notice of the cases listed below in those cases:
厚生労働大臣は、次に掲げる場合には、その旨を公示しなければならない。
a home-nursing provider is designated;
指定訪問看護事業者の指定をしたとき。
there is a notification pursuant to the provisions of Article 93 (except for a change of matters specified by Order of the Ministry of Health, Labour, and Welfare referred to in the same Article and matters pertaining to suspension or recommencement of business provided by the same Article); or
the designation of a designated home-nursing provider is rescinded pursuant to the provisions of the preceding Article.
Subsection 3 Payment of Transport Expenses
第三款 移送費の支給
第九十七条
When an insured person has been transported to a hospital or clinic in order to receive medical treatment (including medical treatment covered by medical expenses combined with treatment outside insurance coverage), the insurer pays, as transport expenses, an amount calculated pursuant to Order of the Ministry of Health, Labour and Welfare to the insured person.
被保険者が療養の給付(保険外併用療養費に係る療養を含む。)を受けるため、病院又は診療所に移送されたときは、移送費として、厚生労働省令で定めるところにより算定した金額を支給する。
The transport expenses referred to in the preceding paragraph are to be paid only if the insurer finds it necessary pursuant to Order of Ministry of Health, Labour and Welfare.
前項の移送費は、厚生労働省令で定めるところにより、保険者が必要であると認める場合に限り、支給するものとする。
Subsection 4 Auxiliary Provisions
第四款 補則
Article 98Insured Persons Who Have Become a Day Worker and Their Dependents
第九十八条(被保険者が日雇労働者又はその被扶養者となった場合)
If an insured person has lost eligibility and become a specially-insured day laborer or a dependent thereof, and, at the time of loss of the eligibility, the person receives a benefit for medical treatment, medical treatment covered by expenses for dietary treatment for inpatients, medical treatment covered by expenses for living support for inpatients, medical treatment covered by expenses for medical treatment combined with treatment outside insurance coverage, medical treatment covered by medical expenses, or medical treatment covered by medical expenses for home-nursing, or a designated in-home service covered by expenses for in-home long-term care service pursuant to the provisions of the Long-Term Care Insurance Act (meaning designated in-home service prescribed in Article 41, paragraph (1) of the same Act; the same applies in Article 129, paragraph (2), item (ii)),or an in-home service covered by an exceptional allowance for in-home long-term care service (meaning in-home service prescribed in Article 8, paragraph (1) of the same Act; the same applies in Article 129, paragraph (2), item (ii) and Article 135, paragraph (1)), a service equivalent thereto, a designated community-based service covered by expenses for community-based long-term care service (meaning designated community-based service prescribed in Article 42-2, paragraph (1) of the same Act; the same applies in Article 129, paragraph (2), item (ii)), a community-based service covered by an exceptional allowance for community-based long-term care service (meaning community-based service prescribed in Article 8, paragraph (14) of the same Act; the same applies in Article 129, paragraph (2), item (ii) and Article 135, paragraph (1)), a service equivalent thereto, a designated facility service, etc. covered by expenses for long-term care facility service (meaning designated facility service, etc. prescribed in Article 48, paragraph (1) of the same Act; the same applies in Article 129, paragraph (2), item (ii)), a facility service covered by an exceptional allowance for long-term care facility service (meaning facility service prescribed in Article 8, paragraph (26) of the same Act; the same applies in Article 129, paragraph (2), item (ii) and Article 135, paragraph (1)), a designated service to prevent long-term care covered by expenses for service to prevent long-term care (meaning designated service to prevent long-term care prescribed in Article 53, paragraph (1) of the same Act; the same applies in Article 129, paragraph (2), item (ii)), a service to prevent long-term care covered by exceptional allowance for service to prevent long-term care (meaning service to prevent long-term care prescribed in Article 8-2, paragraph (1) of the same Act; the same applies in Article 129, paragraph (2), item (ii) and Article 135, paragraph (1)), or a service equivalent thereto, pursuant to the provisions of the same Act, that is equivalent to medical treatment, then the person may receive from the relevant insurer benefits for medical treatment, expenses for dietary treatment for inpatients, expenses for living support for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, or transport expenses with respect to the relevant illness or injury, and any illness arising therefrom.
被保険者が資格を喪失し、かつ、日雇特例被保険者又はその被扶養者となった場合において、その資格を喪失した際に療養の給付、入院時食事療養費に係る療養、入院時生活療養費に係る療養、保険外併用療養費に係る療養、療養費に係る療養若しくは訪問看護療養費に係る療養又は介護保険法の規定による居宅介護サービス費に係る指定居宅サービス(同法第四十一条第一項に規定する指定居宅サービスをいう。第百二十九条第二項第二号において同じ。)、特例居宅介護サービス費に係る居宅サービス(同法第八条第一項に規定する居宅サービスをいう。同号及び第百三十五条第一項において同じ。)若しくはこれに相当するサービス、地域密着型介護サービス費に係る指定地域密着型サービス(同法第四十二条の二第一項に規定する指定地域密着型サービスをいう。同号において同じ。)、特例地域密着型介護サービス費に係る地域密着型サービス(同法第八条第十四項に規定する地域密着型サービスをいう。同号及び第百三十五条第一項において同じ。)若しくはこれに相当するサービス、施設介護サービス費に係る指定施設サービス等(同法第四十八条第一項に規定する指定施設サービス等をいう。同号において同じ。)、特例施設介護サービス費に係る施設サービス(同法第八条第二十六項に規定する施設サービスをいう。同号及び第百三十五条第一項において同じ。)、介護予防サービス費に係る指定介護予防サービス(同法第五十三条第一項に規定する指定介護予防サービスをいう。同号において同じ。)若しくは特例介護予防サービス費に係る介護予防サービス(同法第八条の二第一項に規定する介護予防サービスをいう。同号及び第百三十五条第一項において同じ。)若しくはこれに相当するサービスのうち、療養に相当するものを受けているときは、当該疾病又は負傷及びこれにより発した疾病につき、当該保険者から療養の給付又は入院時食事療養費、入院時生活療養費、保険外併用療養費、療養費、訪問看護療養費若しくは移送費の支給を受けることができる。
Benefits for medical treatment, or expenses for dietary treatment for inpatients, expenses for living support for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, or transportation expenses pursuant to the provisions of the preceding paragraph are not paid when any of the events listed in the following items has occurred:
前項の規定による療養の給付又は入院時食事療養費、入院時生活療養費、保険外併用療養費、療養費、訪問看護療養費若しくは移送費の支給は、次の各号のいずれかに該当するに至ったときは、行わない。
the relevant person has become eligible for payment of benefits for medical treatment, expenses for dietary treatment for inpatients, expenses for living support for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, transport expenses, dependent's medical expenses, dependent's medical expenses for home-nursing, or dependent's transport expenses pursuant to the provisions of the next chapter with respect to the relevant illness or injury;
当該疾病又は負傷について、次章の規定により療養の給付又は入院時食事療養費、入院時生活療養費、保険外併用療養費、療養費、訪問看護療養費、移送費、家族療養費、家族訪問看護療養費若しくは家族移送費の支給を受けることができるに至ったとき。
the person has become an insured person, insured person covered by Seamen's Insurance, a dependent thereof, an insured person covered by National Health Insurance, or a person with late-stage elderly medical care insurance; or
その者が、被保険者若しくは船員保険の被保険者若しくはこれらの者の被扶養者、国民健康保険の被保険者又は後期高齢者医療の被保険者等となったとき。
six months have elapsed since the day on which the relevant person lost eligibility as an insured person.
被保険者の資格を喪失した日から起算して六月を経過したとき。
Benefits for medical treatment, or expenses for dietary treatment for inpatients, expenses for living support for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, medical expenses for home-nursing, or transport expenses pursuant to the provisions of paragraph (1) are not paid during the period in which the relevant person is eligible for payment of special medical expenses (including medical expenses paid pursuant to the provisions of Article 132 as applied mutatis mutandis to Article 145, paragraph (6)), transport expenses, or dependent's transport expenses pursuant to the provisions of the next chapter with respect to the relevant illness or injury.
Benefits for medical treatment, or expenses for dietary treatment for inpatients, expenses for living support for inpatients, medical expenses combined with treatment outside insurance coverage, medical expenses, or medical expenses for home-nursing pursuant to the provisions of paragraph (1) are not paid if the relevant person is eligible for any benefit corresponding to one of the above benefits pursuant to the provisions of the Long-Term Care Insurance Act with respect to the relevant illness or injury.
Section 3 Payment of Injury and Sickness Allowance, Burial Charges, Lump-Sum Allowance for Childbirth and Childcare Benefits, and Childbirth Allowance
第三節 傷病手当金、埋葬料、出産育児一時金及び出産手当金の支給
Article 99Injury and Sickness Allowance
第九十九条(傷病手当金)
When an insured person (excluding an insured person with optional and continued coverage; the same applies in Article 102, paragraph (1)) is unable to engage in labor due to medical treatment, the injury and sickness allowance is paid for the period during which the person is unable to engage in work, starting from the day on which three days elapsed after the day on which the person becomes unable to engage in work.
The amount of injury and sickness allowance per day is an amount equivalent to two-thirds of the amount equivalent to 1/30th of the average standard monthly remuneration (limited to the amount specified by the relevant insured person's insurer; the same applies hereinafter in this paragraph) of each month in the most recent 12 consecutive months before the month in which the payment of injury and sickness allowance starts (if the 1/30 amount is a figure with less than five yen in the ones place, it is to be rounded down, and if it is a figure with at least five yen but less than ten yen in the ones place, it is to be rounded up to the nearest ten yen; if the two-thirds amount is a figure with less than 0.5 yen in the ones place, it is rounded down, and if it is a figure with at least 0.5 yen but less than one yen in the ones place, it is to be rounded up to the nearest one yen); provided, however, that if the number of consecutive months for which the average standard monthly remuneration is determined is less than 12, an amount equivalent to two-thirds of an amount equivalent to smaller of the amounts listed in the following items (if the amount is a figure with less than 0.5 yen in the one place, it is to be rounded down, and if it is a figure with at least 0.5 yen but less than one yen in the ones place, it is to be rounded up to the nearest one yen).
傷病手当金の額は、一日につき、傷病手当金の支給を始める日の属する月以前の直近の継続した十二月間の各月の標準報酬月額(被保険者が現に属する保険者等により定められたものに限る。以下この項において同じ。)を平均した額の三十分の一に相当する額(その額に、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。)の三分の二に相当する金額(その金額に、五十銭未満の端数があるときは、これを切り捨て、五十銭以上一円未満の端数があるときは、これを一円に切り上げるものとする。)とする。ただし、同日の属する月以前の直近の継続した期間において標準報酬月額が定められている月が十二月に満たない場合にあっては、次の各号に掲げる額のうちいずれか少ない額の三分の二に相当する金額(その金額に、五十銭未満の端数があるときは、これを切り捨て、五十銭以上一円未満の端数があるときは、これを一円に切り上げるものとする。)とする。
an amount equivalent to 1/30th of the average standard monthly remuneration for each consecutive month before the month which includes the day on which the payment of injury and sickness allowance starts (if the amount is a figure with less than five, it is to be rounded down, and if it is a figure with at least five yen but less than ten yen, it is to be rounded up to the nearest ten yen); or
傷病手当金の支給を始める日の属する月以前の直近の継続した各月の標準報酬月額を平均した額の三十分の一に相当する額(その額に、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。)
an amount equivalent to 1/30th of the standard monthly remuneration calculated when the average standard monthly remuneration of all insured persons on September 30 in the year preceding the fiscal year which includes the day on which payment of injury and sickness allowance starts is deemed as the monthly remuneration amount which is the basis of the standard monthly amount remuneration (if the amount is a figure with less than five yen, it is to be rounded down, and if it is a figure with at least five yen but less than ten yen, it is to be rounded up to the nearest 10 yen).
傷病手当金の支給を始める日の属する年度の前年度の九月三十日における全被保険者の同月の標準報酬月額を平均した額を標準報酬月額の基礎となる報酬月額とみなしたときの標準報酬月額の三十分の一に相当する額(その額に、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。)
Beyond what is provided for in the preceding paragraph, necessary matters concerning calculation of the amount of injury and sickness allowance are specified by Order of the Ministry of Health, Labour, and Welfare.
前項に規定するもののほか、傷病手当金の額の算定に関して必要な事項は、厚生労働省令で定める。
The payment period for injury and sickness allowance is, with regard to the same sickness or injury as well as any sickness or injury caused thereby, one year and six months in total, counted from the day on which the payment starts.
傷病手当金の支給期間は、同一の疾病又は負傷及びこれにより発した疾病に関しては、その支給を始めた日から通算して一年六月間とする。