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 60 (Renewal of Designation)

(1) The designation set forth in paragraph 2 of Article 54 shall lose their effects by elapse of the period if they are not renewed every 6 years.

(2) The provision set forth in paragraph 2 of Article 68 of Employee’s Health Insurance Act applies mutatis mutandis to renewal set forth in designation the preceding paragraph. In such case, the other necessary replacement of technical terms shall be prescribed in the Cabinet Order.

Article 61 (Responsibilities of Designated Medical Payment Institutes for Services and Supports for Persons with Disabilities)

Designated medical payment institutes for services and supports for persons with disabilities shall provide high-quality and appropriate medical care for services and supports for persons with disabilities pursuant to the provision of Ordinance of the Ministry of Health, Labour and Welfare.

Article 62 (Policy for Medical Examination)

(1) Policies for medical examination of designated medical payment institutes for services and supports for persons with disabilities shall be governed by policies for medical examination of health insurance.

(2) In the event that it is not possible to comply with the policy for medical examination provided in the preceding paragraph or it is not appropriate to comply therewith, a policy for medical examination shall be decided by Minister of Health, Labour and Welfare.

Article 63 (Guidance by Prefectural Governor)

Designated medical payment institutes for services and supports for persons with disabilities shall follow guidance specified by a prefectural governor in conducting medical care for services and supports for persons with disabilities.

Article 64 (Alternation Notification)

If a designated medical payment institute for services and supports for persons with disabilities amended its name, location of the medical institutes pertaining to such designation or the other matters prescribed in Ordinance of the Ministry of Health, Labour and Welfare, it shall notify that effect to the prefectural governor pursuant to the provision of Ordinance of the Ministry of Health, Labour and Welfare.

Article 65 (Declination of Designation)

A designated medical payment institute for services and supports for persons with disabilities may decline its designation by taking notice period of not less than 1month.

Article 66 (Report, etc.)

(1) In the event that a prefectural governor acknowledges it necessary for implementation of medical care for services and supports for persons with disabilities, he/she may order designated medical payment institutes for services and supports for persons with disabilities, ex-establishers, managers, doctors, pharmacists or other employees of designated medical payment institutes for services and supports for persons with disabilities (hereinafter referred to as "ex-establishers, etc." in this paragraph) to submit or to present reports, or medical charts, documents, books or other materials; may require establishers, managers, doctors, pharmacists and other employees (including ex-establishers, etc.) to appear; or may cause such staff persons to question those who concerned or to inspect the facilities, or medical charts, documents, books, and other materials concerning designated medical payment institutes for services and supports for persons with disabilities.

(2) The provision of paragraph 2 of Article 9 applies mutatis mutandis to the question or inspection pursuant to the provision of the preceding paragraph; the provision of paragraph 3 of the same Article applies mutatis mutandis to the authorities pursuant to the provision of the preceding paragraph.

(3) In the event that a designated medical payment institute for services and supports for persons with disabilities does not report, submit or present pursuant to the provision of paragraph 1, or they provide false report or refuse, hinder or avoid the inspection pursuant to the same paragraph, the prefectural governor may instruct to suspend or to suspend payment for medical care for services and supports for persons with disabilities from municipalities, etc. to such designated medical payment institute for services and supports for persons with disabilities.

Article 67 (Admonishment and Order, etc.)

(1) In the event that a prefectural governor acknowledges that a designated medical payment institute for services and supports for persons with disabilities does not provide high-quality and appropriate medical care for services and supports for persons with disabilities, he/she may admonish establishers of such designated medical institute for services and supports for persons with disabilities with setting a time limit to comply with the provisions of Article 61 or Article 62.

(2) In the event that the prefectural governor admonished pursuant to the provision of the preceding paragraph, if the establishers of designated medical payment institute for services and supports for persons with disabilities do not obey the admonishment within the period set forth in the preceding paragraph, such governors may make that effect public.

(3) In the event that the designated medical payment institute for services and supports for persons with disabilities which has received admonition pursuant to the provisions of paragraph 1, does not take any means pertaining to the admonishment without just causes, the prefectural governor may order such establishers of the designated medical institute for services and supports for persons with disabilities to take actions pertaining to such admonishment with setting a time limit.

(4) In the event that the prefectural governor placed an order pursuant to the provision set forth in the preceding paragraph, he/she shall make that effect public.

(5) In the event that a municipality acknowledges that an establisher of the designated medical payment institute for services and supports for persons with disabilities does not provide high-quality and appropriate medical care for services and supports for persons with disabilities pursuant to the provision of Article 61 or Article 62, it shall notify that effect to the prefectural governor of the location of the medical institute pertaining to such designation.

Article 68 (Rescission of Designation, etc.)

(1) A prefectural governor may rescind the designation of paragraph 2 of Article 54 pertaining to such designated medical payment institute for services and supports for persons with disabilities, or may suspend all or a part of validity of the designation with setting a period of time in the event it falls under any of the following items.

(i) In the event that a designated medical payment institute for services and supports for persons with disabilities has fallen into categories of each item set forth in paragraph 2 of Article 59.

(ii) In the event that a designated medical payment institute for services and supports for persons with disabilities has fallen into categories of item 4, item 5, item 10 or item 11 set forth in paragraph 3 of Article 36 which are applied mutatis mutandis pursuant to paragraph 3 of Article 59.

(iii) In the event that a designated medical payment institutes for services and supports for persons with disabilities violated the provision of Article 61 or Article 62.

(iv) In the event that there was a deceit concerning demand for medical expense for services and supports for persons with disabilities.

(v) In the event that a designated medical payment institute for services and supports for persons with disabilities was ordered to submit or to present reports, or medical charts, documents books or other materials pursuant to the provisions of the paragraph 1 of Article 66 but does not comply with the orders,or they provide false reports.

(vi) In the event that a designated medical payment institute for services and supports for persons with disabilities was ordered to appear pursuant to the provision of paragraph 1 of Article 66 but does not comply with the order, does not answer to the questions pursuant to the provision of the same paragraph or provide false reports, or he/she refuse, hinder, or avoid the inspection pursuant to the same paragraph Provided, however, the case shall be excepted in the event that such designated medical payment institute for services and supports for persons with disabilities endeavor to conduct appropriate admonishment and supervision so as to prevent the actions in the event that employees of the institute conducted the above actions.

(2) The provisions of item 8 through item 12 of paragraph 1 and paragraph 2 of Article 50 apply mutatis mutandis to the rescission or validity suspension of designate medical payment institutes for services and supports for persons with disabilities of the preceding paragraph. In such case, the other necessary replacement of technical terms shall be prescribed in the Cabinet Order.

Article 69 (Public Notice)

A prefectural governor shall make a public notice in the following cases: In the event that designation

(i) was conducted for a designated medical payment institute for services and supports for persons with disabilities set forth in paragraph 2 of Article 54.

(ii) In the event that application pursuant to the provision of Article 64 (except the application pertaining to alternation of the matters prescribed in Ordinance of the Ministry of Health, Labour) was filed.

(iii) In the event that designation for a designated medical payment institute for services and supports for persons with disabilities pursuant to the provision of Article 65 was declined.

(iv) In the event that designation for a designated medical payment institute for services and supports for persons with disabilities was rescinded pursuant to the provision of the preceding Article.

Article 70 (Grant of Medical Care Treatment Expenses)

(1) In the event that a person with disabilities given grant approval pursuant to nursing care payment (limited to payment pertaining to medical care treatment expenses) has received medical care treatment expenses from designated welfare service business operators for persons with disabilities, etc. during valid period for grant approval, a municipality shall grant medical care treatment expenses pursuant to the provision of Ordinance of the Ministry of Health, Labour and Welfare to such persons with disabilities pertaining to such grant approval for the expenses which were required for such medical care treatment expenses.

(2) The provisions of paragraph 3 through paragraph 6 of Article 58 apply mutatis mutandis to medical care treatment expenses. In such case, the other necessary replacement of technical terms shall be prescribed in the Cabinet Order.

Article 71 (Grant of Appropriate Medical Care Treatment Expenses)

(1) In the event that a person with disabilities given grant approval pertaining to nursing care payment (limited to payment pertaining to care treatment expenses) has received medical care treatment expenses (hereinafter referred to as "appropriate medical care treatment expenses") from appropriate places of business or appropriate facilities, municipalities shall grant appropriate medical care treatment expenses to such persons with disabilities pertaining to such grant approval for the expenses which were required for such appropriate medical care treatment expenses pursuant to the provision of Ordinance of the Ministry of Health, Labour and Welfare.

(2) The provisions of paragraphs 3 and 4 of Article 58 apply mutatis mutandis to appropriate medical care treatment expenses. In such case, the other necessary replacement of technical terms shall be prescribed in the Cabinet Order.

Article 72 (Application, mutatis mutandis)

The provisions of Article 61 and Article 62 apply mutatis mutandis to designated welfare service business operators for persons with disabilities conducting medical care treatment expenses, or appropriate places of business or appropriate facilities conducting appropriate medical treatment.

Article 73 (Examination and Payment of Medical Expenses for Services and Supports for Persons with Disabilities)

(1) A prefectural governor may occasionally examine contents of medical examination of designated medical payment institutes for services and supports for persons with disabilities, designated welfare service business operators for persons with disabilities conducting medical treatment, or appropriate places of business or appropriate facilities conducting appropriate medical treatment (hereinafter referred to as "institutes bearing public expenses") or Grant of Medical Expenses for services and supports for persons with disabilities; Medical Care Treatment Expenses; and Appropriate Medical Care Treatment Expenses (referred to as “Grant of Medical Expenses for Services and Supports for Persons with Disabilities, etc” below in this Article and in Article 75); and may decide the amount of medical care for services and supports for persons with disabilities, etc. which medical institutes bearing public expenses can demand pursuant to the provision of paragraph 5 of Article 58 (including the case where it is applied mutatis mutandis pursuant to paragraph 2 of Article 70).

(2) Medical institutes bearing public expenses shall obey decisions made by prefectural governors set forth in the preceding paragraph.

(3) In the event a prefectural governor decides amounts of medical expenses for services and supports for persons with disabilities, etc. which medical institutes bearing public expenses, he/she shall hear the opinions of the Examination Board provided in Social Insurance Medical Fee Payment Fund Act (Act No. 129 of 1948), Examination Board of National Health Insurance Medical Fee provided in NationalHealth Insurance Act or other examining institutes prescribed in the Cabinet Order.

(4) A municipality etc. may entrust its administrative affairs concerning the payments or medical expenses for services and supports for persons with disabilities, etc. to medical institutes bearing public expenses to Social Insurance Medical Fee Payment Fund, associations or other persons prescribed in Ordinance of the Ministry of Health, Labour and Welfare.

(5) In addition to the provisions of each of the preceding paragraphs, necessary matters for demand for medical expenses for services and supports for persons with disabilities, etc. shall be prescribed in Ordinance of the Ministry of Health, Labour and Welfare.

(6) Concerning the decision on amounts of medical expenses for services and supports for persons with disabilities pursuant to the provision of paragraph 1, it is not possible to file an appeal pursuant to Administrative Appeals Act (Act No. 160 of 1962).

Article 74 (Assistance etc. by Prefectures)

(1) In the event that a municipality acknowledges that it is necessary when it approve to or not to grant medical expenses for services and supports for personswith disabilities, it may hear the opinions of recovery consultation office for persons with physical disabilities or other institutes pursuant to the provision ofOrdinance of the Ministry of Health, Labour and Welfare.

(2) Concerning the service conducted by municipalities pursuant to provisions of this section, prefectures shall provide cooperation on technical matters by recovery consultation offices for persons with physical disabilities and other institutes established thereby prescribed in Ordinance of the Ministry of Health, Labour and Welfare and other necessary assistance for municipalities in response to requests from municipalities.

Article 75 (Entrustment to the Cabinet Order)

In addition to the provisions of this section, necessary matters for grant approval, claimant certification for medical care, approval or alternations of grant approval, rescission of grant approval and other medical expenses for services and supports for persons with disabilities, etc. shall be provided in the Cabinet Order.