This Act comes into effect as of the day specified by Cabinet Order within a period not exceeding one year and six months from the date of promulgation; provided, however, that the provisions of Chapter V, Article 84, Article 87, paragraph (2), Article 31, and Article 32 of the Supplementary Provisions (excluding the provisions to amend Article 13, paragraph (2) of the Health Insurance Claims Review & Reimbursement Services Act pursuant to the provisions of Article 31 of the Supplementary Provisions) come into effect as of the day specified by Cabinet Order within a period not exceeding one year and three months from the date of promulgation, and the provisions of Chapter II, Article 30 (limited to the part concerning the Central Social Insurance Medical Council), and Article 38 through Article 40 of the Supplementary Provisions come into effect as of the day specified by Cabinet Order within a period not exceeding three months from the date of promulgation.

Until the date specified by Cabinet Order, a prefecture is to carry out a project (hereinafter referred to as "sickbed conversion promotion services") to subsidize the expenses required for a conversion of beds (meaning reducing the number of beds of the type specified by Order of the Ministry of Health, Labour and Welfare among the types of beds listed in the items of Article 7, paragraph (2) of the Medical Care Act, while increasing the maximum number of persons who may be admitted, by new establishment or expansion, to a long-term care medical institution prescribed in Article 8, paragraph (29) of the Long-Term Care Insurance Act or another facility specified by Order of the Ministry of Health, Labour and Welfare, within a number equivalent to the number of reduced beds; the same applies hereinafter) carried out by the establisher of the hospital or clinic that is a medical institution providing services covered by health insurance, with regard to a medical institution providing services covered by health insurance in the area of the prefecture (limited to one established by a medical corporation or another person specified by Order of the Ministry of Health, Labour and Welfare), in order to promote the optimization of medical expenses in the prefecture.

①When the prefectural governor intends to determine the amount of expenses required for a sickbed conversion promotion services, the governor must consult with and obtain the consent of the Minister of Health, Labour and Welfare in advance.

②In holding the consultation under the preceding paragraph, the Minister of Health, Labour and Welfare is to make adjustments so that the total of the amounts of expenses required for sickbed conversion promotion services in each prefecture does not exceed the amount obtained by multiplying the total of the estimated amounts of expenses incurred in providing benefits for medical treatment, etc. of all Associations of Medical Care Systems for the Elderly Aged 75 and older in the relevant fiscal year by the rate specified by Cabinet Order, taking into consideration the prospects for bed conversion in all prefectures, the estimated amount of expenses required for it, and other factors.

③When a prefecture has determined the amount of expenses required for sickbed conversion promotion services, the Minister of Health, Labour and Welfare must notify the Organization of that amount.

A prefecture is to pay the expenses required for a sickbed conversion promotion services and the expenses required for the execution of affairs concerning the services.

The national government, pursuant to the provisions of a Cabinet Order, grants an amount equivalent to 10 / 27 of the amount of expenses required for a sickbed conversion promotion services to a prefecture.

①The amount equivalent to 12/27 of the expenses borne by a prefecture pursuant to the provisions of Article 4 of the Supplementary Provisions is to be covered, pursuant to the provisions of Cabinet Order, by the bed conversion subsidies granted by the Organization to that prefecture.

②The bed conversion subsidies referred to in the preceding paragraph are to be covered by the bed conversion support payments collected by the Organization pursuant to the provisions of paragraph (1) of the following Article.

①The Organization collects bed conversion support payments and contributions for administrative expenses related to bed conversion subsidies (hereinafter referred to as "bed conversion support payment, etc.") from Insurers (in the case of National Health Insurance, the prefecture; the same applies hereinafter, except in Article 9-2, paragraph (4) of the Supplementary Provisions) each fiscal year in order to cover the expenses required for the services prescribed in Article 11, paragraph (1) of the Supplementary Provisions and for the handling of affairs relating to the services.

②An insurer has the obligation to pay a ward transfer support grant, etc.

The amount of a ward transfer support grant to be collected from each of the insurers pursuant to the provisions of paragraph (1) of the preceding Article is to be the amount obtained by multiplying the amount obtained by dividing the amount equivalent to 12 / 27 of the expenses required for a ward transfer promotion services in the relevant fiscal year by the prospective total number of subscribers pertaining to all of the insurers in the relevant fiscal year calculated as specified by the Order of the Ministry of Health, Labour and Welfare, by the prospective number of subscribers pertaining to the relevant insurers in the relevant fiscal year calculated as specified by the Order of the Ministry of Health, Labour and Welfare.

The amount of contributions for administrative expenses related to bed conversion subsidies to be collected from each Insurer pursuant to the provisions of Article 7, paragraph (1) of the Supplementary Provisions is, pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, the amount calculated pursuant to the provisions of Order of the Ministry of Health, Labour and Welfare, based on the estimated amount of expenses required for the handling of affairs concerning the services of the Organization prescribed in Article 11, paragraph (1) of the Supplementary Provisions in the relevant fiscal year, in accordance with the estimated number of participants pertaining to each Insurer.

①When, by the last day of the fiscal year following the fiscal year specified by Cabinet Order (hereinafter referred to as the "covered fiscal year" in this Article), the Minister of Health, Labour and Welfare has determined the amount that the Organization is to pay to the national treasury, within the limit of the amount obtained by deducting the amount of expenses required for the services prescribed in Article 11, paragraph (1) of the Supplementary Provisions during the applicable period from the amount of bed conversion support payment, etc. collected by the Organization from Insurers pursuant to the provisions of Article 7, paragraph (1) of the Supplementary Provisions during the period from fiscal year 2008 to the covered fiscal year (hereinafter referred to as "the applicable period" in this Article) (hereinafter referred to as the "amount of bed conversion support payments, etc. collected" in this Article) (referred to as the "amount subject to calculation of payment to the national treasury, etc." in paragraph (3)), taking into consideration the ratio to the amount of bed conversion support payments, etc. collected of the amount of subsidies for the expenses required for payment of bed conversion support payments under the provisions of the Health Insurance Act and of the amounts of the treasury share, adjustment grants and subsidies for the expenses required for payment of bed conversion support payments under the provisions of the National Health Insurance Act during the applicable period, and the interest on the amount of bed conversion support payments, etc. collected, the Organization must pay that amount to the national treasury, pursuant to the provisions of Cabinet Order.

②When the Minister of Health, Labour and Welfare intends to determine the amount that the Organization is to pay to the national treasury pursuant to the provisions of the preceding paragraph, the Minister must consult with the Minister of Finance in advance.

③When, by the last day of the fiscal year following the covered fiscal year, the Minister of Health, Labour and Welfare has determined the amount that the Organization is to grant to prefectures, within the limit of the amount subject to calculation of payment to the national treasury, etc., taking into consideration the ratio of the amount of the prefectural adjustment grants for the expenses required for payment of bed conversion support payments under the provisions of the National Health Insurance Act during the applicable period to the amount of bed conversion support payments, etc. collected, and the interest on the amount of bed conversion support payments, etc. collected, the Organization must grant that amount to the prefectures, pursuant to the provisions of Cabinet Order.

④When, by the last day of the fiscal year following the covered fiscal year, the Minister of Health, Labour and Welfare has determined the amount that the Organization is to grant to each Insurer (in the case of National Health Insurance, the municipality; the same applies hereinafter in this paragraph), within the limit of the amount obtained by deducting from the amount of bed conversion support payments, etc. collected the amount of expenses required during the applicable period for the services prescribed in Article 11, paragraph (1) of the Supplementary Provisions and for the handling of affairs relating to those services, the amount paid to the national treasury by the Organization pursuant to the provisions of paragraph (1), and the amount granted to prefectures by the Organization pursuant to the provisions of the preceding paragraph, taking into consideration the ratio, calculated as specified by Order of the Ministry of Health, Labour and Welfare, of the amount of the burden of each Insurer during the applicable period to the amount of bed conversion support payments, etc. collected, and the interest on the amount of bed conversion support payments, etc. collected, the Organization must grant that amount to each Insurer, pursuant to the provisions of Cabinet Order.