When an insured has received home-nursing (meaning care for medical treatment or necessary assistance with medical examination and treatment provided at the residence of an insured who is in a condition of continuously receiving medical treatment at home due to illness or injury (limited to an insured whom the attending physician has found to conform, as to the degree of necessity of the treatment, to the standards specified by Order of the Ministry of Health, Labour and Welfare) by a nurse or other person specified by Order of the Ministry of Health, Labour and Welfare; hereinafter referred to as "designated home-nursing") provided, by an office conducting the home-nursing business pertaining to the designation (meaning the home-nursing business prescribed in Article 88, paragraph (1) of the Health Insurance Act), from a designated home-nursing provider, the Association of Medical Care Systems for the Elderly Aged 75 and older pays the insured medical expenses for home-nursing for the expenses required for the designated home-nursing. However, this does not apply while the insured is subject to the application of Article 82, paragraph (1) or the main clause of paragraph (2).
後期高齢者医療広域連合は、被保険者が指定訪問看護事業者から当該指定に係る訪問看護事業（健康保険法第八十八条第一項に規定する訪問看護事業をいう。）を行う事業所により行われる訪問看護（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被保険者（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をいう。以下「指定訪問看護」という。）を受けたときは、当該被保険者に対し、当該指定訪問看護に要した費用について、訪問看護療養費を支給する。ただし、当該被保険者が第八十二条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 referred to in the preceding paragraph are to be paid only if the Association of Medical Care Systems for the Elderly Aged 75 and older finds it necessary pursuant to the provisions of 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、後期高齢者医療広域連合が必要と認める場合に限り、支給するものとする。
When an insured intends to receive designated home-nursing, the insured is to, as provided by Order of the Ministry of Health, Labour and Welfare, receive confirmation of being an insured from the designated home-nursing provider of the insured's choice by electronic eligibility confirmation, etc., and receive that designated home-nursing.
The amount of medical expenses for home-nursing is the amount calculated by deducting, from the amount calculated in accordance with the standards specified by the Minister of Health, Labour and Welfare in consideration of the average home-nursing expenses (meaning the average expenses required for designated home-nursing) for the relevant designated home-nursing, the amount obtained by multiplying the relevant amount by the applicable ratio specified in the items of Article 67, paragraph (1) in accordance with the categories of the cases listed in the items of the same paragraph (or, if any of the measures listed in the items of Article 69, paragraph (1) should be taken with respect to benefits for medical treatment, the amount calculated as if the relevant measures were taken).
When the Minister of Health, Labour and Welfare intends to specify the standards set forth in the preceding paragraph, the Minister must hear the opinions of the Central Social Insurance Medical Council in advance.
厚生労働大臣は、前項の基準を定めようとするときは、あらかじめ中央社会保険医療協議会の意見を聴かなければならない。
The provisions of Article 71, paragraph (2) apply mutatis mutandis to the authority of the Central Social Insurance Medical Council concerning the particulars prescribed in the preceding paragraph.
If a designated home-nursing provider requests payment of medical expenses for home-nursing, the Association of Medical Care Systems for the Elderly Aged 75 and older is to pay the expenses after conducting an examination in light of the standards specified by the Minister of Health, Labour and Welfare as set forth in paragraph (4) and the standards for business management of designated home-nursing as prescribed in paragraph (1) of the following Article (limited to the part regarding the treatment of designated home-nursing).
後期高齢者医療広域連合は、指定訪問看護事業者から訪問看護療養費の請求があつたときは、第四項の厚生労働大臣が定める基準及び次条第一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。）に照らして審査した上、支払うものとする。
The provisions of Article 70, paragraphs (4) through (7) and Article 74, paragraphs (5) through (7) apply mutatis mutandis to designated home-nursing received at or from a designated home-nursing provider and to the payment of medical expenses for home-nursing associated with the relevant service. In such a case, Cabinet Order provides for the necessary technical replacement of terms in connection with these provisions.
第七十条第四項から第七項まで及び第七十四条第五項から第七項までの規定は、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。
The provisions of Article 68 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 Article 74, paragraph (5) as applied mutatis mutandis pursuant to the preceding paragraph, the amount payable as medical expenses for home-nursing with respect to expenses incurred in the relevant designated home-nursing.
Designated home-nursing is not to be included in any of the types of medical treatment listed in the items of Article 64, paragraph (1).
Beyond what is provided for in the preceding paragraphs, necessary matters concerning the application of the calculation method specified by the Minister of Health, Labour and Welfare as set forth in paragraph (4) and a claim for medical expenses for home-nursing by a designated home-nursing provider are specified by Cabinet Order.
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