Article 43Maximum Amount of Payment Pertaining to an Allowance for In-Home Long-Term Care Service
第四十三条（居宅介護サービス費等に係る支給限度額）
The total sum of allowances that are paid monthly for In-Home Service pertaining to one classification of In-Home Service, etc., that an Insured In-Home Person Requiring Long-Term Care during the period determined by Ordinance of Ministry of Health, Labour, and Welfare for each classification of In-Home Service, etc. (which means with regard to In-Home Service (including equivalent services; hereinafter the same applies in this Article) and Community-Based Service (including equivalent services except for Admission to a Community-Based Facility for Preventive Daily Long-Term Care of the Elderly Covered by Public Aid; the same applies hereinafter in this Article) by categories of two or more types as determined by the Minister of Health, Labour, and Welfare, considering the inter-substitution by each type of category; the same applies hereinafter) may not exceed the amount equivalent to 90 percent of the amount calculated pursuant to the provisions of Order of the Ministry of Health, Labour, and Welfare based on the base amount of maximum payment for each category of Allowance for In-Home Long-Term Care Service, etc. The total sum of allowance is the total amount of Allowance for In-Home Long-Term Care Service or Exceptional Allowance for In-Home Long-Term Care Service, or the total amount of Allowance for Community-Based Long-Term Care Service to be paid for Community-Based Service or the total amount of Exceptional Allowance for Community-Based Long-Term Care Service.
居宅要介護被保険者が居宅サービス等区分（居宅サービス（これに相当するサービスを含む。以下この条において同じ。）及び地域密着型サービス（これに相当するサービスを含み、地域密着型介護老人福祉施設入所者生活介護を除く。以下この条において同じ。）について、その種類ごとの相互の代替性の有無等を勘案して厚生労働大臣が定める二以上の種類からなる区分をいう。以下同じ。）ごとに月を単位として厚生労働省令で定める期間において受けた一の居宅サービス等区分に係る居宅サービスにつき支給する居宅介護サービス費の額の総額及び特例居宅介護サービス費の額の総額並びに地域密着型サービスにつき支給する地域密着型介護サービス費の額の総額及び特例地域密着型介護サービス費の額の総額の合計額は、居宅介護サービス費等区分支給限度基準額を基礎として、厚生労働省令で定めるところにより算定した額の百分の九十に相当する額を超えることができない。
The base amount of maximum payment by classification of Allowance for In-Home Long-Term Care Service, etc., as prescribed in the preceding paragraph is to be an amount determined by the Minister of Health, Labour, and Welfare by classification of In-Home Service, etc., and by considering the standard use, according to the categories of Condition of Need for Long-Term Care, of In-Home Service pertaining to the category of said In-Home Service and Community-Based Service, etc., during the period as determined by Order of the Ministry of Health, Labour, and Welfare as prescribed in the same paragraph, and standards, etc., provided by the Minister of Health, Labour, and Welfare as set forth in each item of Article 41, paragraph (4) and each item of Article 42-2, paragraph (2) pertaining to said In-Home Service and Community-Based Service.
A Municipality, notwithstanding the provisions of the preceding paragraph and pursuant to the provisions of a municipal ordinance, in lieu of the base amount of maximum payment for the categories of allowances for In-Home Long-Term Care, etc., as prescribed in paragraph (1), may determine an amount exceeding said base amount as the base amount of maximum payment for the categories of allowances for In-Home Long-Term Care, etc., in said Municipality.
A Municipality, with regard to the total sum of the total amount of allowances for In-Home Long-Term Care and exceptional allowances for In-Home Long-Term Care that are paid by each type of In-Home Service and the total amount of allowances for Community-Based Service and exceptional allowances for Community-Based Service that are paid by each type of Community-Based Service when said allowances are paid monthly to an Insured In-Home Person Requiring Long-Term Care by the type of In-Home Service and Community-Based Service (limited to those types that are included in categories of In-Home Service, etc., and that are determined by the Minister of Health, Labour, and Welfare) during the period as determined by Order of the Ministry of Health, Labour, and Welfare, may determine that said total sum may not exceed 90 percent of the calculated standard amount pursuant to the provisions of Order of the Ministry of Health, Labour, and Welfare based on base amount of maximum payment for the categories of allowances for In-Home Long-Term Care, etc.
市町村は、居宅要介護被保険者が居宅サービス及び地域密着型サービスの種類（居宅サービス等区分に含まれるものであって厚生労働大臣が定めるものに限る。次項において同じ。）ごとに月を単位として厚生労働省令で定める期間において受けた一の種類の居宅サービスにつき支給する居宅介護サービス費の額の総額及び特例居宅介護サービス費の額の総額の合計額並びに一の種類の地域密着型サービスにつき支給する地域密着型介護サービス費の額の総額及び特例地域密着型介護サービス費の額の総額の合計額について、居宅介護サービス費等種類支給限度基準額を基礎として、厚生労働省令で定めるところにより算定した額の百分の九十に相当する額を超えることができないこととすることができる。
The base amount of maximum payment for the categories of allowances for In-Home Long-Term Care, etc., as set forth in the preceding paragraph is to be the amount specified by a municipal ordinance within the limit of the base amount of maximum payment for the categories of allowances for In-Home Long-Term Care, etc., prescribed in paragraph (1) pertaining to the categories of In-Home Service, etc., including said In-Home Service and Community-Based Service (with regard to the Municipality that provides a municipal ordinance pursuant to the provisions of paragraph (3), the base amount is to be the amount for which measures pursuant to the provisions of said municipal ordinance are undertaken) by considering each type of In-Home Service and Community-Based Service for its standard use according to the categories of Condition of Need for Long-Term Care of said In-Home Service and Community-Based Service during the period as determined by Order of the Ministry of Health, Labour, and Welfare as prescribed in the preceding paragraph and of standards, etc., provided by the Minister of Health, Labour, and Welfare as set forth in each item of Article 41, paragraph (4) and each item of Article 42-2, paragraph (2) pertaining to said In-Home Service and Community-Based Service.
前項の居宅介護サービス費等種類支給限度基準額は、居宅サービス及び地域密着型サービスの種類ごとに、同項に規定する厚生労働省令で定める期間における当該居宅サービス及び地域密着型サービスの要介護状態区分に応じた標準的な利用の態様、当該居宅サービス及び地域密着型サービスに係る第四十一条第四項各号及び第四十二条の二第二項各号の厚生労働大臣が定める基準等を勘案し、当該居宅サービス及び地域密着型サービスを含む居宅サービス等区分に係る第一項の居宅介護サービス費等区分支給限度基準額（第三項の規定に基づき条例を定めている市町村にあっては、当該条例による措置が講じられた額とする。）の範囲内において、市町村が条例で定める額とする。
In the case where, by payment of an Allowance for In-Home Long-Term Care Service, an Exceptional Allowance for In-Home Long-Term Care Service, an Allowance for Community-Based Long-Term Care Service or an Exceptional Allowance for Community-Based Long-Term Care Service, the total amount prescribed in paragraph (1) exceeds the amount equivalent to 90 percent prescribed in the same paragraph, or the total amount prescribed in paragraph (4) exceeds the amount equivalent to 90 percent prescribed in the same paragraph, the amount of said Allowance for In-Home Long-Term Care Service, Exceptional Allowance for In-Home Long-Term Care Service, Allowance for Community-Based Long-Term Care Service or Exceptional Allowance for Community-Based Long-Term Care Service is to be the amount calculated pursuant to the provisions of a Cabinet Order, notwithstanding the provisions of each item of Article 41, paragraph (4), Article 42, paragraph (3), each item of Article 42-2, paragraph (2), Article 42-2, paragraph (4), or paragraph (2) of the preceding Article.
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