Article 49Designation of Medical Care Providers
第四十九条（医療機関の指定）
The Minister of Health, Labour and Welfare shall designate the providers in charge of the medical care for medical assistance under this Act with regard to hospitals or clinics, or pharmacies, established by the State, and a prefectural governor shall designate such providers with regard to any other hospitals or clinics (including institutions that are specified by a Cabinet Order as being equivalent to such hospitals or clinics), or pharmacies.
厚生労働大臣は、国の開設した病院若しくは診療所又は薬局について、都道府県知事は、その他の病院若しくは診療所（これらに準ずるものとして政令で定めるものを含む。）又は薬局について、この法律による医療扶助のための医療を担当させる機関を指定する。
Article 49-2Application for Designation and Standards
第四十九条の二（指定の申請及び基準）
The designation under the preceding Article by the Minister of Health, Labour and Welfare is to be made upon application by the establisher of a hospital or clinic, or of a pharmacy, as provided by Order of the Ministry of Health, Labour and Welfare.
厚生労働大臣による前条の指定は、厚生労働省令で定めるところにより、病院若しくは診療所又は薬局の開設者の申請により行う。
In the case where an application under the preceding paragraph has been filed, the Minister of Health, Labour and Welfare must not make the designation under the preceding Article if any of the following items applies:
the hospital or clinic, or pharmacy, pertaining to the application is not a medical institution providing services covered by health insurance or a pharmacy providing services covered by health insurance prescribed in Article 63, paragraph (3), item (i) of the Health Insurance Act (Act No. 70 of 1922);
当該申請に係る病院若しくは診療所又は薬局が、健康保険法（大正十一年法律第七十号）第六十三条第三項第一号に規定する保険医療機関又は保険薬局でないとき。
when the applicant has been sentenced to imprisonment or a severer punishment and execution of said sentence has not yet been completed or has not yet expired;
申請者が、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であるとき。
when the applicant is punished by a fine pursuant to the provisions of this Act or another Act pertaining to health and medical care or public aid for citizens as determined by a Cabinet Order and execution of said penalty has not yet been completed or has not yet expired;
申請者が、この法律その他国民の保健医療若しくは福祉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であるとき。
the applicant is a person whose designation has been rescinded pursuant to Article 51, paragraph (2) and for whom five years have not elapsed from the date of the rescission (including a person who was, within 60 days before the date on which the notice under Article 15 of the Administrative Procedure Act pertaining to the disposition of the rescission was given, the administrator of the hospital or clinic, or pharmacy, whose designation was rescinded, and for whom five years have not elapsed from the date of the rescission); except where the case falls under a case specified by Order of the Ministry of Health, Labour and Welfare as one for which it is found appropriate not to treat it as falling under the main clause of this item, in consideration of the degree of responsibility the applicant had regarding the facts that were the grounds for the disposition of rescission of the designation;
the applicant is a person who gave notice of declination of the designation pursuant to Article 51, paragraph (1) (excluding a person with reasonable grounds for the declination of the designation) during the period from the date on which the notice under Article 15 of the Administrative Procedure Act pertaining to the disposition of rescission of the designation under Article 51, paragraph (2) was given to the date of making the disposition or the date of deciding not to make the disposition, and for whom five years have not elapsed from the date of the notice of declination;
the applicant is a person who gave notice of declination of the designation pursuant to Article 51, paragraph (1) (excluding a person with reasonable grounds for the declination of the designation) during the period from the date on which the inspection under Article 54, paragraph (1) was conducted to the scheduled hearing decision date (meaning the specific date, where the Minister of Health, Labour and Welfare has notified the applicant, as provided by Order of the Ministry of Health, Labour and Welfare and within 10 days from the date on which the inspection was conducted, of a specific date as the date on which it is expected to be decided, based on the results of the inspection, whether to hold a hearing on the disposition of rescission of the designation under Article 51, paragraph (2)), and for whom five years have not elapsed from the date of the notice of declination;
in the case where notice of declination of the designation pursuant to Article 51, paragraph (1) was given within the period prescribed in item (v), the applicant (excluding a person with reasonable grounds for the declination of the designation) is a person who was, within 60 days before the date of the notice referred to in that item, the administrator of the hospital or clinic, or pharmacy, pertaining to the notice of declination, and for whom five years have not elapsed from the date of the notice of declination;
the applicant is a person who, within five years before the application for designation, committed an illegal or grossly unjust act relating to the medical care of public assistance recipients; or
申請者が、指定の申請前五年以内に被保護者の医療に関し不正又は著しく不当な行為をした者であるとき。
the administrator of the hospital or clinic, or pharmacy, pertaining to the application is a person falling under any of items (ii) through the preceding item.
当該申請に係る病院若しくは診療所又は薬局の管理者が第二号から前号までのいずれかに該当する者であるとき。
In the case where an application under paragraph (1) has been filed, the Minister of Health, Labour and Welfare may refrain from making the designation under the preceding Article if the hospital or clinic, or pharmacy, pertaining to the application falls under any of the following items:
it has repeatedly received guidance under Article 50, paragraph (2), regarding the medical care of public assistance recipients, on the grounds that there is a risk of lacking appropriateness in its content;
beyond what is provided for in the preceding item, it is found to be extremely inappropriate as a provider to be in charge of medical care for medical assistance.
前号のほか、医療扶助のための医療を担当させる機関として著しく不適当と認められるものであるとき。
The provisions of the preceding three paragraphs apply mutatis mutandis to the designation under the preceding Article by a prefectural governor. In this case, the term "clinic" in paragraph (1) is deemed to be replaced with "clinic (including those specified by the Cabinet Order referred to in the preceding Article; the same applies in the following paragraph and paragraph (3))", and the term "or a pharmacy providing services covered by health insurance" in paragraph (2), item (i) is deemed to be replaced with "or a pharmacy providing services covered by health insurance, or an office or facility specified by Order of the Ministry of Health, Labour and Welfare".
Article 49-3Renewal of Designation
第四十九条の三（指定の更新）
The designation under Article 49 loses its effect upon the lapse of the period unless it is renewed every six years.
第四十九条の指定は、六年ごとにその更新を受けなければ、その期間の経過によつて、その効力を失う。
In the case where an application for renewal under the preceding paragraph has been filed, if the disposition on the application has not been made by the day of expiry of the period under that paragraph (hereinafter referred to in this Article as the "validity period of designation"), the previous designation remains in force even after the expiry of the validity period of designation until the disposition is made.
In a case as set forth in the preceding paragraph, when the designation is renewed, the validity period of designation is to be from the date following the date of expiry of the prior validity period of designation.
The provisions of the preceding Article and Article 68, paragraph (2) of the Health Insurance Act apply mutatis mutandis to the renewal of the designation under paragraph (1). In this case, necessary technical replacement of terms is to be specified by Cabinet Order.
前条及び健康保険法第六十八条第二項の規定は、第一項の指定の更新について準用する。この場合において、必要な技術的読替えは、政令で定める。
Article 50Obligations of Designated Medical Care Providers
第五十条（指定医療機関の義務）
A designated medical care provider shall provide medical care to public assistance recipients considerately and meticulously, in accordance with the rules provided by the Minister of Health, Labour and Welfare.
A designated medical care provider shall follow any guidance provided by the Minister of Health, Labour and Welfare or a prefectural governor with regard to medical care for public assistance recipients.
Article 50-2Notification of Change, etc.
第五十条の二（変更の届出等）
A designated medical care provider shall, when there has been a change to the name of said designated medical care provider or any other matters specified by an Ordinance of the Ministry of Health, Labour and Welfare, or when having discontinued, suspended or resumed the operations of said designated medical care provider, notify the Minister of Health, Labour and Welfare or prefectural governor who has made the designation under Article 49 to that effect within ten days, pursuant to the provisions of an Ordinance of the Ministry of Health, Labour and Welfare.
Article 51Declination and Rescission of Designation
第五十一条（指定の辞退及び取消し）
A designated medical care provider may decline the designation by giving advance notice of thirty days or more.
指定医療機関は、三十日以上の予告期間を設けて、その指定を辞退することができる。
When a designated medical care provider falls under any of the following items, the Minister of Health, Labour and Welfare, in the case of a medical care provider designated by the Minister of Health, Labour and Welfare, and a prefectural governor, in the case of a medical care provider designated by a prefectural governor, may rescind the designation or suspend the whole or part of the effect of the designation for a specified period:
指定医療機関が、次の各号のいずれかに該当するときは、厚生労働大臣の指定した医療機関については厚生労働大臣が、都道府県知事の指定した医療機関については都道府県知事が、その指定を取り消し、又は期間を定めてその指定の全部若しくは一部の効力を停止することができる。
When a designated medical care provider has come to fall under any of Article 49-2, paragraph (2), items (i) to (iii) or item (ix);
指定医療機関が、第四十九条の二第二項第一号から第三号まで又は第九号のいずれかに該当するに至つたとき。
When a designated medical care provider has come to fall under any of the items of Article 49-2, paragraph (3);
指定医療機関が、第四十九条の二第三項各号のいずれかに該当するに至つたとき。
When a designated medical care provider has violated the provisions of Article 50 or the following Article;
When there has been any impropriety in a claim for medical treatment fees by a designated medical care provider;
指定医療機関の診療報酬の請求に関し不正があつたとき。
When a designated medical care provider, having been ordered pursuant to the provisions of Article 54, paragraph (1) to make a report or to submit or present clinical records, books and documents or other articles, has failed to comply with the order, or has made a false report;
When an establisher or a worker of a designated medical care provider, having been requested to appear pursuant to the provisions of Article 54, paragraph (1), has failed to comply, has failed to answer or has given a false answer to questions under the provisions of that paragraph, or has refused, obstructed or avoided an inspection under the provisions of that paragraph; however, this excludes the case where, when a worker of the designated medical care provider has committed such an act, the establisher of the designated medical care provider has exercised due care and supervision in order to prevent the act;
When a designated medical care provider has received the designation under Article 49 by fraudulent means;
In addition to the cases listed in the preceding items, when a designated medical care provider has violated this Act, any other Act relating to the health, medical care or welfare of the people that is specified by Cabinet Order, or an order or disposition based on these Acts;
In addition to the cases listed in the preceding items, when a designated medical care provider has engaged in a fraudulent or grossly unjust act in relation to medical care for public assistance recipients;
When the administrator of a designated medical care provider is a person who engaged in a fraudulent or grossly unjust act in relation to medical care for public assistance recipients within five years before the time when the rescission of the designation or the suspension of the whole or part of the effect of the designation is about to be carried out.
Article 52Medical Treatment Policy and Medical Treatment Fees
第五十二条（診療方針及び診療報酬）
The medical treatment policy and the medical treatment fees of a designated medical care provider shall be in accordance with the medical treatment policy and the medical treatment fees of the National Health Insurance.
指定医療機関の診療方針及び診療報酬は、国民健康保険の診療方針及び診療報酬の例による。
In the case where the medical treatment policy and the medical treatment fees prescribed in the preceding paragraph cannot be adopted or are considered inappropriate, the medical treatment policy and the medical treatment fees shall be in accordance with the rules provided by the Minister of Health, Labour and Welfare.
前項に規定する診療方針及び診療報酬によることのできないとき、及びこれによることを適当としないときの診療方針及び診療報酬は、厚生労働大臣の定めるところによる。
Article 53Examination and Payment of Medical Expenses
第五十三条（医療費の審査及び支払）
A prefectural governor may examine the contents of medical treatment provided by and the claims for medical treatment fees made by a designated medical care provider as needed and decide the amount of the medical treatment fees that the designated medical care provider may claim pursuant to the provisions of the preceding Article.
A designated medical care provider shall follow the decision under the preceding paragraph made by a prefectural governor.
When a prefectural governor decides on the amount of medical treatment fees that a designated medical care provider may claim pursuant to the provisions of paragraph (1), he/she shall hear the opinion of an examination committee prescribed in the Act on the Medical Information Infrastructure and Medical Fee Examination and Payment Organization (Act No. 129 of 1948) or an examination organ related to medical care that has been specified by Cabinet Order.
A prefecture, city, or a town or village with a welfare office may entrust affairs concerning the payment of medical treatment fees to designated medical care providers to the Medical Information Infrastructure and Medical Fee Examination and Payment Organization or a person specified by an Order of the Ministry of Health, Labour and Welfare.
No request for review may be made with regard to a decision on the amount of the medical treatment fees under the provisions of paragraph (1).
第一項の規定による診療報酬の額の決定については、審査請求をすることができない。
第五十四条（報告等）
A prefectural governor (the Minister of Health, Labour and Welfare or a prefectural governor, in the case of a designated medical care provider designated by the Minister of Health, Labour and Welfare) may, when finding it necessary with regard to medical assistance, order a designated medical care provider, or a person who was the establisher, administrator, doctor, pharmacist or other worker of a designated medical care provider (hereinafter in this paragraph referred to as a "former establisher, etc."), to report on matters found necessary or to submit or present clinical records, books and documents or other articles, request the establisher, administrator, doctor, pharmacist or other worker of a designated medical care provider (including a former establisher, etc.) to appear, or have a relevant official question persons concerned, or inspect on-site at the designated medical care provider its equipment or clinical records, books and documents or other articles.
都道府県知事（厚生労働大臣の指定に係る指定医療機関については、厚生労働大臣又は都道府県知事）は、医療扶助に関して必要があると認めるときは、指定医療機関若しくは指定医療機関の開設者若しくは管理者、医師、薬剤師その他の従業者であつた者（以下この項において「開設者であつた者等」という。）に対して、必要と認める事項の報告若しくは診療録、帳簿書類その他の物件の提出若しくは提示を命じ、指定医療機関の開設者若しくは管理者、医師、薬剤師その他の従業者（開設者であつた者等を含む。）に対し出頭を求め、又は当該職員に、関係者に対して質問させ、若しくは当該指定医療機関について実地に、その設備若しくは診療録、帳簿書類その他の物件を検査させることができる。
The provisions of Article 28, paragraphs (3) and (4) shall apply mutatis mutandis to an inspection under the provisions of the preceding paragraph.