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Services and Supports for Persons with Disabilities Act (Act No. 123 of 2005)

Chapter II Payment for Services and Supports for Persons with Disabilities

Section 3 Grant of Medical Expenses for Services and Supports for Personswith Disabilities; Medical Care Treatment Expenses; and Appropriate Medical Care Treatment Expenses

 

Article 52 (Grant Approval of Medical Expenses for Services and Supports for Persons with Disabilities)

(1) A persons with disabilities or a guardian of children with disabilities who intends to receive medical expenses for services and supports for persons with disabilities shall be certified by a municipality etc. to grant medical expenses for services and supports for persons with disabilities (hereinafter referred to as "grant approval").

(2) The provision set forth in paragraph 2 of Article 19 applies mutatis mutandis to grant approval conducted by municipalities, etc.; the provisions of paragraph 3 and paragraph 4 of the same Article apply to grant approval conducted by municipalities. In such case, the other necessary replacement of technical terms shall be prescribed in the Cabinet Order.

Article 53 (Application)

(1) A person with disabilities or a guardian of children with disabilities who intends to receive grant approval shall apply to a municipality etc. pursuant to the provision of Ordinance of the Ministry of Health, Labour and Welfare.

(2) The application set forth in the preceding paragraph may be filed by way of the municipalities where such person with disabilities or such guardian of children with disabilities has the person's domicile (if such person with disabilities or such guardian of children with disabilities does not has domicile or domicile is not clear, the municipality where the person with disabilities or the guardian has the person's current residence) pursuant to the provision of the Cabinet Order.

Article 54 (Grant Approval, etc.)

(1) In the event that the person with disabilities, etc. pertaining to the application set forth in the preceding paragraph needs to receive medical expenses for services and supports for persons with disabilities in the light of the person's conditions of physical disabilities or mental disorders, if the person is appropriate to the standard prescribed in the Cabinet Order as considering income status of such persons with disabilities or other family members of households to which the person with disabilities belongs or the conditions of the medical treatment, a municipality etc. shall conduct grant approval per kind of medical care for services and supports for persons with disabilities prescribed in Ordinance of the Ministry of Health, Labour and Welfare; unless such person with disabilities, etc. can receive medical care of the kind prescribed in Ordinance of the Ministry of Health, Labour and Welfare among medical care for services and supports for persons with disabilities pursuant to the provisions of Act on Relief to Wounded and Sick Retired Soldiers (Act No. 168 of 1963) or Act on Medical Care and Treatment for Persons Who Have Caused Serious Cases Under the Condition of Insanity (Act No. 110 of 2003).

(2) In the event a municipality conducted grant approval, it shall decide medical payment institutes where the person with disabilities, etc. pertaining to such grant approval receives medical care for services and supports for persons with disabilities among the medical institutes designated by the prefectural governor (hereinafter referred to as "designated medical payment institutes for services and supports for persons with disabilities") pursuant to the provision of the provisions of Ordinance of the Ministry of Health, Labour and Welfare.

(3) In the event that a municipality conducted grant approval, it shall deliver a claimant certification pursuant to the provision of Ordinance of the Ministry of Health, Labour and Welfare for medical care for services and supports for persons with disabilities which describe valid periods for grant approval provided in the succeeding Article, names of designated medical payment institutes for services and supports for persons with disabilities, and the other matters prescribed in Ordinance of the Ministry of Health, Labour and Welfare (hereinafter referred to as "claimant certifications for medical care") to the person with disabilities or the guardian of children with disabilities (hereinafter referred to as "persons with disabilities, or others given grant approval").

Article 55 (Valid Period for Grant Approval)

Grant approval shall maintain their validity only for the period prescribed in Ordinance of the Ministry of Health, Labour and Welfare (hereinafter referred to as "valid period for grant approval").

Article 56 (Alternation of Grant Approval)

(1) In the event a person with disabilities given grant approval has necessity to alternate the designated medical payment institutes for services and supports for persons with disabilities pursuant to the provision of paragraph 2 of Article 54 or the other matters prescribed in Ordinance of the Ministry of Health, Labour and Welfare pertaining to grant approval which the person is presently provided, the person may apply for alternation such grant approval to the municipality pursuant to the provisions of Ordinance of the Ministry of Health, Labour and Welfare.

(2) In the event that a municipality acknowledges it necessary to alternate the matters prescribed in Ordinance of the Ministry of Health, Labour and Welfare set forth the preceding paragraph, it may make decision on alternation of grant approval in response to the application set forth in the same paragraph or by its authorities for persons with disabilities given grant approval, pursuant to the provision of Ordinance of the Ministry of Health, Labour and Welfare. In such case, a municipality shall require such person with disabilities given grant approval, etc. to submit the person's claimant certification for medical care.

(3) The provision of paragraph 2 of Article 19 applies mutatis mutandis to the approval of alternation of grant approval conducted by municipalities, etc. set forth the preceding paragraph; the provisions of paragraph 3 and 4 of the same Article apply mutatis mutandis to alternation of grant approval conducted by municipalities set forth in the preceding paragraph. In such case, the other necessary replacement of technical terms shall be prescribed in the Cabinet Order.

(4) In the event that a municipality made decision on alternation of grant approval set forth in paragraph 2, it shall state the matters pertaining to such approval on a claimant certification for medical care and return it.

Article 57 (Rescission of Grant Approval)

(1) The municipality which made grant approval may rescind such grant approval in the following cases:

(i) In the event that the municipality acknowledges that the person with disabilities, etc. pertaining to grant approval no longer needs to receive medical care for services and supports for persons with disabilities in the light of the person's status of physical disabilities or mental disorders.

(ii) In the event that the municipality acknowledges that the person with disabilities given grant approval has come to possess domiciles within the area of other than such municipality (except in the event that the municipality acknowledges that person with disabilities pertaining to grant approval has come to possess domiciles within the area of other than such municipality due to placement in a specified facility).

(iii) In the event that the person with disabilities pertaining to grant approval does not respond to inspection pursuant to the provision of paragraph 1 of Article 9 without just cause.

(iv) In other cases of being prescribed in the Cabinet Order.

(2) The municipalities rescinded grant approval pursuant to the provision of the preceding paragraph shall require the persons with disabilities given grant approval pertaining to such rescission to return the person's claimant certification for medical care pursuant to the provision of Ordinance of the Ministry of Health, Labour and Welfare.

Article 58 (Grant of Medical Expenses for Services and Supports for Persons with Disabilities)

(1) In the event that a person with disabilities given grant approval has received medical care for services and supports for persons with disabilities pertaining to such designation (hereafter "designated medical care for services and supports for persons with disabilities") from designated medical payment institutes for services and supports for persons with disabilities prescribed in paragraph 2 of Article 54 during valid period for grant approval, a municipality etc. shall grant medical expenses for services and supports for persons with disabilities to such person with disabilities pertaining to such grant approval for the expenses which were required for such designated medical care for services and supports for persons with disabilities pursuant to the provision of Ordinance of Ministry of Health, Labour and Welfare.

(2) A person with disabilities given grant approval who intends to receive designated medical payment for services and supports for persons with disabilities shall receive such designated medical care for services and supports for persons with disabilities by presenting the person's claimant certification for medical care to designated medical institutes for services and supports for persons with disabilities pursuant to the provision of Ordinaries of Ministry of Health, Labour and Welfare ;provided, however, that this is not applied in the case of an emergency or unavoidable circumstances.

(3) The amount of medical expenses for services and supports for persons with disabilities shall be the total amount given in item 1 (If dietary therapy (prescribed in item 1 of paragraph 2 of Article 63 of the Employee’s Health Insurance Act) is included in designated medical care for services and supports for persons with disabilities, the amount is the amount added the amount given in item 1 and item 2, and if life therapy (prescribed in item 2 of paragraph 2 of same Article of the Act) is included in designated medical care for services and supports for persons with disabilities, the amount is the amount added the amount given in item 1 and item 3 ).

(i) The expense of designated medical care for services and supports for persons with disabilities (excluding dietary therapy and life therapy; the same shall apply in this item) is the amount equivalent to 90/100 of the amount calculated according to the method used in health insurance for calculating the amount of expenses required for medical treatment; provided, however, that shall be an amount calculated pursuant to the provision in the Cabinet Order within the range of the amount calculated pursuant to the method used in health insurance for calculating the amount of expenses required for medical treatment for such medical care if an amount equivalent to 10/100 of the total expenses amount which persons with disabilities, or others awarded support grants required for designated medical care for services and supports for persons with disabilities in the same month surpasses the amount prescribed in the Cabinet Order as considering influences of such amount on domestic accounts of persons with disabilities, or others awarded grants, their conditions of disabilities, and other circumstances.

(ii)An amount obtained by deducting the dietary therapy standard cost-sharing prescribed in paragraph 2 of Article 85 of the Employee’s Health Insurance Act and the amount specified by the Minister of Health, Labour and Welfare in consideration of income status or other circumstances of such persons with disabilities, or others given grant approval from the amount calculated according to the method used in health insurance for calculating the amount of expenses required for medical treatment in such medical care for services and supports for persons with disabilities (only dietary treatment)

(iii) An amount obtained by deducting the standard liability amount prescribed in paragraph 2 of Article 85-2 of the Employee’s Health Insurance Act and the amount specified by the Minister of Health, Labour and Welfare in consideration of income status or other circumstances of such persons with disabilities, or others given grant approval from the amount calculated according to the method used in health insurance for calculating the amount of expenses required for medical treatment in such medical care for services and supports for persons with disabilities (only life therapy)

(4) In the event that it is not possible to pursuant to the method for calculating the amount required for the medical treatment prescribed in the preceding paragraph or it is not appropriate to comply therewith, a calculation method of expenses amount required for medical care for services and supports for persons with disabilities shall be pursuant to the specification by Minister of Health, Labour and Welfare.

(5) In the event that a person with disabilities, etc. pertaining to grant approval received designated medical payment for services and supports for persons with disabilities from designated medical payment institutes for services and supports for persons with disabilities, a municipality etc. may pay the expenses needed for such designated medical payment for services and supports for persons with disabilities which such persons with disabilities given grant approval should pay to such designated medical payment institutes on behalf of such person with disabilities given grant approval within the limit of the amount to be granted as medical expenses for services and supports for persons with disabilities.

(6) In the event that the payment pursuant to the provision set forth in the preceding paragraph has been made, such payment shall be deemed to be grant of medical expenses for services and supports for persons with disabilities to persons with disability given grant approval, etc.

Article 59 (Designation of Designated Medical Payment Institutes for Services and Supports for Persons with Disabilities)

(1) Designation set forth in paragraph 2 of Article 54 shall be conducted pursuant to the provision of Ordinance of the Ministry of Health, Labour and Welfare by applications from hospitals or clinics (including what are prescribed in the Cabinet Order as corresponding thereto; the same shall apply hereinafter) or establishers of pharmacies per kind of medical care for services and supports for persons with disabilities prescribed in Ordinance of the Ministry of Health, Labour and Welfare of paragraph 1 set forth in the same Article.

(2) In the event that the application set forth in the preceding paragraph is filed, a prefectural governor may refrain from designation of designated medical payment institutes for services and supports for persons with disabilities if such application falls under any of each of the following items.

Hospitals, clinics,

(i) or pharmacies pertaining to such application are not the insurance medical care institution or the health insurance pharmacies prescribed in item 1 of paragraph 3 of Article 63 of Employee’s Health Insurance Care Act, or the places of business or facilities prescribed in Ordinance of the Ministry of Health, Labour and Welfare.

(ii) Hospitals, clinics, or pharmacies pertaining to such application are what have been repeatedly directed pursuant to Article 63 or admonished pursuant to paragraph 1 of Article 67 in fear of being inappropriate in contents of their medical examination or prescription.

(iii) An applicant does not comply with orders pursuant to the provision of paragraph 3 of Article 67.

(iv) In addition to the preceding three paragraphs, hospitals, clinics, or pharmacies pertaining to such application are acknowledged to be extremely inappropriate as designated medical payment institutes for services and supports for persons with disabilities.

(3) The provision of paragraph 3 of Article 36 (except item 1 through item 3) applies mutatis mutandis to designation of designated medical payment institutes for services and supports for persons with disabilities. In such case, the other necessary replacement of technical terms shall be prescribed in the Cabinet Order.