Social welfare system

HIV and Social Welfare

Medical Payment Assistance Using the Physical Disability Certificate

Medical payment for services and supports for persons with disabilities (medical rehabilitation and medical aid for children with potential disabilities)
What does medical payment for services and supports for persons with disabilities mean?
Until March 31, 2006, public funding for disabilities had been covered separately under medical rehabilitation (Physically Disabled Persons Welfare Act), medical aid for children with potential disabilities (Child Welfare Act), and outpatient psychiatry (Mental Health and Welfare Law). When the Services and Supports for Persons with Disabilities Act went into effect on April 1, 2006, these separate budgets were combined and titled, "medical payment for services and supports for persons with disabilities".
How does the medical payment for services and supports for persons with disabilities cover medical rehabilitation?
Anyone over 18 years of age with a Physical Disability Certificate can apply for medical fee assistance, in accordance to family income, for treatment to ease or prevent the worsening of an impediment. This assistance is available only at designated medical facilities appointed by prefectural and major city governments. HIV infection is categorized at "immune dysfunction" and as such is eligible for medical rehabilitation, which includes antiviral treatment and the treatment of opportunistic infections. This coverage will not apply to treatment of conditions unrelated to HIV (such as tooth decay).
How does the medical payment for services and supports for persons with disabilities cover medical aid for children with potential disabilities?

Children under 18 who have a physical disability or if untreated could be left with a disability in the future are eligible for medical fee assistance, in accordance to family income, for treatment to cure or lessen the disability. It is the children's version of the medical payment for services and supports for persons with disabilities covering rehabilitation treatment, however there is no need to submit a Physical Disability Certificate. This assistance is available only at designated medical facilities appointed by prefectural and major city governments.

HIV infection falls within the boundaries of "immune dysfunction caused by human immunodeficiency virus". Other categories carried over from the Child Welfare Act are: 1) orthopedic impairment, 2) visual impairment, 3) impaired hearing and balance function, 4) vocal, speech, and mastication disorder, 5) impaired cardiac function, 6) renal impairment, 7) small intestine dysfunction, and 8) other visceral disorders.

Can the medical payment for services and supports for persons with disabilities be used anywhere?
The only places where this system can be applied are medical facilities and pharmacies designated by prefectural and major city governments, as prescribed in Article 5 of the Services and Supports for Persons with Disabilities Act. Specifically, they are the medical facilities and pharmacies listed under "designated facilities" on the claimant's certificate. This is why it is important to designate a facility that operates under medical payment for services and supports for persons with disabilities when applying for grant approval.
How has the system changed from its previous rehabilitation and child welfare counterparts?
1. Recognized number of households.
(Former) Medical rehabilitation and medical aid for children with potential disabilities
All family members residing at the address indicated on the registry are recognized as one household.
(Present) Medical payment for services and supports for persons with disabilities
Members of a family who share medical insurance are recognized as one household. In other words, family members holding separate insurance policies are considered to be separate households.
2. Calculation of medical fees.
(Former) Medical rehabilitation and medical aid for children with potential disabilities
The cost-bearing limit, based on household income of the previous year, will be determined by the local public office. Copayment will differ for outpatient and hospitalization treatment.
(Present) Medical payment for services and supports for persons with disabilities
Copayment is set at 10% of the total medical bill. This amount, to be paid by the individual, is the same for outpatients and inpatients. For low-income households however, the cost-bearing limit per month is set at 2,500 yen or 5,000 yen, depending on the household annual income. For average to high-income families, maximum copayment will fall under the high cost medical care benefit unless a severe disability requires long-term treatment ("severe yet sustainable"), in which case the limit will be alleviated in accordance to the household income.
* Persons with HIV infections will be categorized as "severe yet sustainable".
3. "Severe yet sustainable"
The category entitled "severe yet sustainable" is a new addition under medical payment for services and supports for persons with disabilities regarding copayment of medical fees. Its purpose is to alleviate the burden of payment on those with an average income or higher, when diseases and symptoms require expensive treatment for an extended period of time, by setting a maximum monthly copayment based on household income. Within the medical payment for services and supports for persons with disabilities (medical rehabilitation and medical aid for children with disabilities), disorders considered "severe yet sustainable" are renal impairment, small intestine dysfunction, and immune dysfunction. In addition, assistance will be considered for patients with the burden of continued high costs and those receiving treatment under several categories within the insurance policy, regardless of their type of disease.
4. Issuance of claimant's certificate granting medical payment for services and supports for persons with disabilities
(Former) Medical rehabilitation and medical aid for children with potential disabilities
The recovery consultation office for persons with physical disabilities reviews the application for medical rehabilitation or medical aid for children with disabilities, after which local authorities determine the cost-bearing limit. Following that, "medical rehabilitation tickets" are issued and mailed to designated medical facilities. Patients do not receive any form of claimant certification.
(Present) Medical payment for services and supports for persons with disabilities
The recovery consultation office for persons with physical disabilities reviews the application for medical payment for services and supports for persons with disabilities, after which local authorities determine the cost-bearing limit. Following that, a "claimant's certificate granting medical payment for services and supports for persons with disabilities" will be issued, along with a "maximum copayment control chart", to the individual (* see note). There is no issuance to medical facilities. Each government has its own format of documentation.
* The purpose of this control chart is to document each payment at designated medical institutions to control payments for each month so that they do not exceed the upper limit.
5. Payment of medical fees.
(Former) Medical rehabilitation and medical aid for children with potential disabilities
Designated medical facilities do not require procedures at the front desk.
(Present) Medical payment for services and supports for persons with disabilities
Submit your "claimant's certificate granting medical payment for services and supports for persons with disabilities" and "maximum copayment control chart" to the designated institution or appointed pharmacy for prescriptions. The 10% copayment will be calculated and you will be charged within the maximum limit indicated on your control chart. After payment, the clerk will enter the amount on your chart, with the date and name of institution. If there are several payments made within one month, once the maximum is indicated on your chart, there will be no further charges.
6. Payment for meals during hospitalization.
(Former) Medical rehabilitation and medical aid for children with potential disabilities
No charge for meals during hospitalization.
(Present) Medical payment for services and supports for persons with disabilities
As a general rule, all hospital meals will be charged in full.
How do I apply for medical payment for services and supports for persons with disabilities (medical rehabilitation and medical aid for children with potential disabilities)?
Prepare all documents necessary for application and submit them to the government office in your jurisdiction. Application forms and other documentation in relation to application are available at your local government office and designated medical facility. The longest term is one year, so you will need to apply for renewal each year. Family members may apply on your behalf. Medical social workers are also known to make applications by proxy.
When can I start using medical payment for services and supports for persons with disabilities (medical rehabilitation and medical aid for children with potential disabilities)?
You may start using your claimant's certificate from the date of issue. In the case of medical rehabilitation, application for medical payment for services and supports for persons with disabilities generally comes after application for the Physical Disability Certificate. If there is an emergency, it is possible to make both applications at the same time. Please ask your nearest public welfare division or medical social worker for details.
Can I use my medical payment for services and supports for persons with disabilities together with my Severe Disability Medical Expenses Assistance Program (Welfare and Medical Service)?
Each government has its own system of medical care (welfare) benefits for persons with severe disabilities. Please ask your local government office of medical social worker for details.
For Example: In the case of Hiroshima City
Holders of a claimant's certificate granting medical payment for services and supports for persons with disabilities who are also eligible for medical care (welfare) benefits for persons with severe disabilities may use both together, thus further reducing copayment expenditures.
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