Article 43Maximum Amount of Payment Pertaining to an Allowance for In-Home Long-Term Care Service

①The 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.

②The 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.

③A 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.

④A 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.

⑥In 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.