| Program name | care setting | Year*1 | Points*2 | Facility conditions for receiving reimbursement*3 | General conditions for receiving reimbursement |
|---|---|---|---|---|---|
| Hospitalization and discharge support fee (nyuutaiin-shien-kasan) | Inpatient | 2008 (2022) | 700 (general)/1300 (recovery-phase) | At least 25 collaborating institutions. Face-to-face meetings (video calls allowed) between staff of collaborative institutions at least three times a year. Collaboration record with care managers. Staff will be deployed to support each ward’s admission and discharge and regional cooperation activities. |
Identify patients with factors that make discharge difficult within three days of admission and conduct early interviews. Hold a multi-professional conference within seven days of admission and create a discharge support plan. |
| Comprehensive function evaluation fee (sougou-teki-kinou-hyouka-kasan) | Inpatient | 2008 (2020) | 50 | Have at least one full-time physician or dentist who has completed appropriate training*4 related to comprehensive functional evaluation or has more than one year of experience in comprehensive functional evaluation. | Target: Patients aged between 40 and 65 with a disease defined in the Long-Term Care Insurance Act or those aged 65 years and over. Comprehensive evaluation*5 is carried out as soon as possible after the condition of the patients has stabilized. Assessment is carried out by a doctor or dentist who has completed training*4. |
| Pre-discharge visit guidance fee (taiin-mae-houmon-sidouryou) | Inpatient | 1990 (2018) | 580 | None | Target: Patients scheduled to be discharged home. Visits are made to the patient’s home during hospitalization or at the time of discharge for patients who will be hospitalized for more than one month. Post-discharge care guidance is provided, taking into account the patient’s medical condition, the structure of the patient’s home, and the patient’s ability to care for himself/herself. The content of the guidance is recorded in the medical record. Public health nurses, nurses, physiotherapists, etc., under the direction of a doctor, can also provide guidance. |
| Joint guidance fee at discharge 1 and 2 (taiin-ji-kyoudou-sidouryou) | Inpatient/Home care | 2006 (2018) | 400 | None | Target: Patients scheduled to be discharged home. The staff*6 of the medical institution where the patient is hospitalized and the staff*6 of the medical institution where the patient will be treated at home after discharge jointly provide the guidance necessary for home treatment and provide written information. |
| Post-discharge visit guidance fee (taiin-go-houmon-sidouryou) | Inpatient | 2018 | 580 | None | Target: Patients with a high level of care*7 The doctor, public health nurse, midwife, or nurse provides the guidance necessary for home treatment at the patient’s home or facility. If a home care nurse accompanies the patient, 20 points will be added. |
| Guidance in cooperation with nursing care support fee (kaigo-sien-nado-renkei-sidou-ryou) | Inpatient | 2010 | 400 | None | For hospitalized patients, the doctor, or relevant medical staff, in collaboration with the care support specialist who had been in charge of the patient before hospitalization, etc., provide information on care services required after discharge from the hospital, etc. The guidance is documented in the medical record, and the prepared care plan is attached to the medical record. |
| Specified disease medical care management fee (tokutei-sikkan-ryouyou-kanri-ryou) | Outpatient | 1958 (1992) | 225(clinic)/147(100 beds>)/87(100 beds<) | It is not available for hospitals with more than 200 beds. The points are different for clinics, hospitals with less than 100 beds, and hospitals with less than 200 beds, and the smaller the size of the medical institution, the higher the points set. |
Based on the treatment plan, medical management, such as medication, exercise, and nutrition, is provided for chronic diseases specified by the Minister of Health, Labor, and Welfare, such as lifestyle-related diseases. |
| Guidance in cooperation with mental health care fee 1 (kokoro-no-rennkei-sidou-ryou) | Outpatient | 2022 | 350 | Medical institutions have established a cooperation system with psychiatry or psychosomatic medicine. The doctor providing this guidance must have received appropriate training*8 in suicide prevention, etc. |
Patients who are not hospitalized and are judged to be at risk of exacerbation of their mental illness or in need of referral to psychiatry or psychosomatic medicine due to isolation from the community. Screening is done using the SADPersons scale, EPDS, PHQ-9, or K-6. Patients are interviewed about their life problems, which are recorded in the medical record. Provide written information to the psychiatry or psychosomatic medicine department with which the patient is collaborating. |
| Program name | Result of review*1 | 1) SDH elements included in the conditions*2 (SDH elements) | 2) Assessment*3/Care setting | 3) Multidisciplinary cooperation*4 |
|---|---|---|---|---|
| Hospitalization and discharge support fee | A | Economic deprivation (socio-economic status), Abuse and young carer (family) | a/Inpatient | Yes (Including cooperation with the nursing and welfare sectors) |
| Comprehensive function evaluation fee | B | “Comprehensive evaluation of the patient’s basic ADL, cognitive function, motivation, etc.” | b/Inpatient | No |
| Pre-discharge visit guidance fee | B | “the patient’s medical condition, the household structure, caregiving capacity” | b/Inpatient | Yes |
| Joint guidance fee at discharge 1 and 2 | B | N/A | N/A /Inpatient & home care | Yes |
| Post-discharge visit guidance fee | B | N/A | N/A /Inpatient | Yes |
| Guidance in cooperation with nursing care support fee | B | “based on the patient’s physical and mental condition, etc.” | b/Inpatient | Yes |
| Specified disease medical care management fee | C | N/A | N/A /outpatient | No |
| Guidance in cooperation with mental health care fee | A | Isolation (social capital), “the patient’s challenges in life” | a/outpatient | No |
