LONG-TERM CARE INSURANCE ACT
Act No. 8403, Apr. 27, 2007
Amended by Act No. 9510, Mar. 18, 2009
Act No. 9693, May 21, 2009
Act No. 11141, Dec. 31, 2011
Act No. 12067, Aug. 13, 2013
Act No. 13647, Dec. 29, 2015
Act No. 14215, May 29, 2016
Act No. 14321, Dec. 2, 2016
CHAPTER I GENERAL PROVISIONS
The purpose of this Act is to pursue the improvement of health of older persons and the stabilization of their livelihood during post-retirement life, relieve family members from the burden of supporting them, and enhance the quality of life of citizens by providing for matters concerning long-term care benefits, such as aid provided for physical activities and household chores to older persons who have difficulties in carrying on with daily life on their own due to old age or senile diseases.
The terms used in this Act shall be defined as follows:
| 1. | The term "older persons" means an elderly person who is not less than 65 years of age or a person who is less than 65 years of age and suffers from a geriatric disease specified by Presidential Decree, such as Alzheimer's disease or a cerebrovascular disease; |
| 2. | The term "long-term care benefits" means services, such as aid in physical activities and household chores or nursing, or money, etc. paid instead of such services provided to a person who is determined to have difficulties in carrying on with daily life on his/her own for six months or longer, pursuant to Article 15 (2); |
| 3. | The term "long-term care program" means a program of providing long-term care benefits to older persons with financial resources, such as, long-term care insurance contribution, contributions, etc. from the State and local governments; |
| 4. | The term "long-term care institution" means an institution designated pursuant to Article 31 or a long-term care institution for home care that is entitled to deemed designated under Article 32 and that provides long-term care benefits; |
| 5. | The term "long-term care worker" means a person who works for a long-term care institution to provide aid, etc. for physical activities or household chores of older persons. |
| Article 3 (Fundamental Principles for Providing Long-Term Care Benefits) |
| (1) | Long-term care benefits shall be provided appropriately within the extent necessary for older persons, comprehensively taking into consideration mental and physical conditions, the living environment of each older person, and needs and choices of each older person and his/her family members. |
| (2) | Benefit for home care service, which are long-term care benefits provided at home while an older person continues his/her living with his/her family members, shall be provided preferentially among other long-term care benefits. |
| (3) | Long-term care benefits shall be provided along with medical service to prevent older persons' mental and physical conditions and health from deterioration. |
| Article 4 (Responsibilities, etc. of State and Local Governments) |
| (1) | The State and each local government shall provide services necessary for older persons to maintain good mental and physical conditions (hereinafter referred as "services for prevention of geriatric disease") so that they can carry on with daily life on their own. |
| (2) | The State may subsidize expenses incurred by each local government or the National Health Insurance Service under the National Health Insurance Act (hereinafter referred to as the "NHIS") in providing services for prevention of geriatric diseases. |
| (3) | The State and each local government shall increase the number of long-term care institutions and support the establishment of long-term care institutions to secure a sufficient number of long-term care institutions so as to smoothly provide long-term care benefits, taking into consideration the population of older persons, local characteristics, etc. |
| (4) | The State and each local government may provide the NHIS with assistance in administrative or financial affairs so that long-term care benefits can be smoothly provided. |
| (5) | The State and each local government shall fully endeavor to give better treatment to long-term care workers and improve their welfare and status. <Newly Inserted by Act No. 14215, May 29, 2016> |
| Article 5 (Direction of State's Policy on Long-Term Care Benefits) |
The State shall, when it establishes and implements a master plan for long-term care pursuant to Article 6, endeavor to provide not only older persons but also all citizens who suffer hardship in carrying on with daily life on their own, including the disabled, etc., with long-term care benefits and services of aiding physical activities and furthermore shall take measures to assist them in stabilizing their living and achieving self-support.
| Article 6 (Master Plan for Long-Term Care) |
| (1) | The Minister of Health and Welfare shall establish and implement a master plan for long-term care with the following matters included therein for each five-year period in order to smoothly provide older persons with long-term care benefits: <Amended by Act No. 14215, May 29, 2016> |
| 1. | The number of persons eligible for long-term care benefits each year and a plan for the procurement of financial resources; |
| 2. | A scheme for the management of long-term care institutions and professional human resources for long-term care for each year; |
| 3. | Matters concerning the treatment of long-term care workers; |
| 4. | Other matters specified by Presidential Decree concerning long-term care of older persons. |
| (2) | The head of each local government shall establish and implement a detailed implementation plan in accordance with the master plan for long-term care under paragraph (1). |
| (1) | The Minister of Health and Welfare shall survey the following matters on a regular basis at an interval of three years in order to ascertain the current situation of long-term care services and shall publish the results of the survey: |
| 1. | Mattes concerning approval of eligibility for long-term care; |
| 2. | Matters concerning the number of beneficiaries eligible for long-term care benefits (hereinafter referred to as "beneficiaries") according to the rating of the need assessment committee for long term care under Article 52 (hereinafter referred to as the "need assessment committee"), the level of the benefits, and the degree of satisfaction of the beneficiaries; |
| 3. | Matters concerning long-term care institutions; |
| 4. | Matters concerning the working conditions, treatment, and number of long-term care staff; |
| 5. | Other matters specified by Ordinance of the Ministry of Health and Welfare with regard to long-term care services. |
| (2) | Matters necessary for the methods, contents, etc. of the survey pursuant to paragraph (1) shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
[This Article Newly Inserted by Act No. 14215, May 29, 2016]
CHAPTER II LONG-TERM CARE INSURANCE
| Article 7 (Long-Term Care Insurance) |
| (1) | The Minister of Health and Welfare shall exercise overall control over the long-term care insurance program. |
| (2) | The NHIS shall be the insurer of the long-term care insurance program. |
| (4) | Where a foreigner specified by Presidential Decree including foreign workers, etc. as defined in the Act on the Employment, etc. of Foreign Workers applies for exclusion, the NHIS may exclude such foreigner from the insured of a the long-term care insurance, as prescribed by Ordinance of the Ministry of Health and Welfare, notwithstanding paragraph (3). <Newly Inserted by Act No. 9510, Mar. 18, 2009; Act No. 9932, Jan. 18, 2010> |
| Article 8 (Collection of Long-Term Care Insurance Contribution) |
| (1) | The NHIS shall collect long-term care insurance contribution to finance the expenses incurred in running long-term care programs. |
| (2) | Long-term care insurance contribution under paragraph (1) shall be collected together with the insurance contribution under Article 69 of the National Health Insurance Act (hereafter referred to as "health insurance contribution" in this Article). The NHIS shall separate long-term care insurance contribution from health insurance contribution in its notice for payment. <Amended by Act No. 11141, Dec. 31, 2011> |
| (3) | The NHIS shall manage long-term care contribution and health insurance contribution, collected together pursuant to paragraph (2), in separate accounts, respectively. |
| Article 9 (Calculation of Long-Term Care Insurance Contribution) |
| (2) | The long-term care insurance contribution rate under paragraph (1) shall be prescribed by Presidential Decree, subject to deliberation by the Long-Term Care Committee established under Article 45. |
| Article 10 (Reduction and Exemption of Long-Term Care Insurance Contribution for Persons with Disabilities, etc.) |
The NHIS may fully or partially reduce or exempt long-term care insurance contribution, as prescribed by Presidential Decree, for a person with a disability as defined in the Act on Welfare of Persons with Disabilities or a similar person specified by Presidential Decree, if the person is the insured of a long-term care insurance or a dependent to the insured of a long-term care insurance but fails to be determined as a beneficiary under Article 15 (2).
| Article 11 (Application Mutatis Mutandis to Eligibility, etc. for Long-Term Care Insurance) |
Articles 5, 6, 8 through 11, 69 (1) through (3), 76 through 86, and 110 of the National Health Insurance Act shall apply mutatis mutandis to the acquisition and forfeiture of eligibility for the insured of a long-term care insurance or a dependent to the insured of a long-term care insurance, the payment, collection, and disposition of deficits, of long-term care insurance contribution. In such cases, the term "insurance contribution" shall be construed as "long-term care insurance contribution," the term "health insurance" as "long-term care insurance," and the term "the insured" as "the insured of a long-term care insurance." <Amended by Act No. 11141, Dec. 31, 2011>
CHAPTER III APPROVAL FOR LONG-TERM CARE
| Article 12 (Eligibility for Application for Long-Term Care) |
Persons eligible for filing an application for approval for long-term care are older persons and shall meet any of the following eligibility requirements:
| 1. | The insured of a long-term care insurance or a dependent to the insured of a long-term care insurance; |
| Article 13 (Application for Approval for Long-Term Care) |
| (1) | A person who files an application (hereinafter referred to as "applicant") for approval for long-term care (hereinafter referred to as "application") with the NHIS, shall submit the application along with a referral issued by a medical doctor or an oriental medicine doctor (hereinafter referred to as "medical doctor's referral"), as prescribed by Ordinance of the Ministry of Health and Welfare: Provided, That a medical doctor's referral may be submitted up until the NHIS submits data to the need assessment committee pursuant to Article 15 (1). |
| (2) | Notwithstanding paragraph (1), persons specified by Presidential Decree, such as persons who are unable to move around freely or persons, etc. who have difficulty in getting access to a medical institution because they reside in an island or a remote area, need not submit a medical doctor's referral. |
| (3) | Fees for issuing a medical doctor's referral, the method of allocation of such fees, the scope of issuers, and other necessary matters shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
| Article 14 (Investigation of Application for Approval for Long-Term Care) |
| (1) | Upon receipt of an application pursuant to Article 13 (1), the NHIS shall instruct its employees to investigate the following matters, as prescribed by Ordinance of the Ministry of Health and Welfare: Provided, That where it is impracticable to conduct an investigation directly due to geographical circumstances, etc. or where it is deemed necessary for investigations, the NHIS may request the competent Special Self-Governing City, Special Self-Governing Province, or Si/Gun/Gu (referring to an autonomous Gu; hereinafter the same shall apply) to conduct an investigation on its behalf or conduct a joint investigation: <Amended by Act No. 12067, Aug. 13, 2013> |
| 1. | Mental and physical status of the applicant; |
| 2. | Types and details of long-term care benefits that the applicant needs; |
| 3. | Other matters specified by Ordinance of the Ministry of Health and Welfare as necessary for long-term care. |
| (2) | A person engaged in an investigation pursuant to paragraph (1) shall give prior notice of the date, time, and place of investigation, and personal information on the person in charge of such investigation to the applicant. |
| (3) | Upon completion of the investigation, the NHIS or the Special Self-Governing City, Special Self-Governing Province, or Si/Gun/Gu, which was requested to investigate pursuant to the proviso to paragraph (1), shall prepare a report on the investigation outcomes. The Special Self-Governing City, Special Self-Governing Province, or Si/Gun/Gu, which was requested to engage in the investigation, shall, without delay, send a report on the investigation outcomes to the NHIS. <Amended by Act No. 12067, Aug. 13, 2013> |
| Article 15 (Need Assessment for long Term Care, etc.) |
| (1) | Upon completion of an investigation under Article 14, the NHIS shall submit a report on results of the investigation, the relevant application, a medical doctor's referral, and other data necessary for examination to the need assessment committee. <Amended by Act No. 14215, May 29, 2016> |
| (2) | If the need assessment committee finds that an applicant meets the eligibility requirements for application under Article 12 and that the applicant has difficulties in carrying on with daily life on his/her own for six months or more, it shall confirm the applicant as a beneficiary according to the standards for need assessment prescribed by Presidential Decree concerning mental and physical conditions and the seriousness, etc. of conditions that require long-term care. <Amended by Act No. 14215, May 29, 2016> |
| (3) | Each need assessment committee may, when it examines and assesses pursuant to paragraph (2), hear opinions of the persons concerned, such as the applicant, his/her family members, and the medical doctor who issued a medical doctor's referral. |
| Article 16 (Period of Need Assessment for Long-Term Care) |
| (1) | Each need assessment committee shall complete rating for long-term care under Article 15 within 30 days from the day on which an applicant files an application: Provided, That the period may be extended within the maximum of 30 days, if a thorough investigation into an applicant is required or exceptional circumstances make it impossible to complete rating within the prescribed period. |
| (2) | The NHIS shall, if it intends to extend the period of examination and rating for approval for long-term care pursuant to the proviso to paragraph (1), notify the relevant applicant or his/her agent of details and grounds for such extension and the extended period. |
| Article 17 (Letter of Approval for Long-Term Care) |
| (1) | Upon completion of examination on approval and rating for long-term care by the need assessment committee, the NHIS shall without delay prepare a letter of approval for long-term care with the following matters described therein and dispatch it to the beneficiary: |
| 1. | Long-term care rating; |
| 2. | Types and details of long-term care benefits; |
| 3. | Matters specified by Ordinance of the Ministry of Health and Welfare concerning long-term care benefits. |
| (2) | Upon completion of examination on approval and rating for long-term care by the need assessment committee, the NHIS shall notify of details of, and grounds for, such determination to each applicant who is determined as an ineligible beneficiary. In such cases, the Special Self-Governing City Mayor or Special Self-Governing Province Governor or the head of a Si/Gun/Gu (referring to the head of an autonomous Gu; hereinafter the same shall apply) may request the NHIS to notify such details and grounds, and the NHIS so requested shall comply with the request. <Amended by Act No. 12067, Aug. 13, 2013> |
| (3) | When the NHIS sends a letter of approval for long-term care pursuant to paragraph (1), it shall prepare a standard plan for the use of long-term care within the extent of the monthly cap under Article 28 and dispatch the plan along with the letter of approval so that long-term care benefits can be used efficiently. |
| (4) | Necessary matters concerning the methods of preparation of letters of approval for long-term care and a standard plan for the use of long-term care under paragraphs (1) and (3) shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
| Article 18 (Matters to Be Considered in Preparation of Letters of Approval for Long-Term Care) |
The NHIS shall take the following matters into consideration, when it determines the type and details of long-term care benefits pursuant to Article 17 (1) 2 in preparing letters of approval for long-term care: | 1. | The beneficiary's rating of long-term care and his/her living environment; |
| 2. | Needs and choices of the beneficiary and his/her family members; |
| 3. | Current status of facilities operated by the relevant long-term care institution, if such facilities are provided as benefits. |
| Article 19 (Effective Period of Approval for Long-Term Care) |
| (1) | The effective period of the approval for long-term care under Article 15 shall be at least one year and shall be prescribed by Presidential Decree. |
| (2) | The method of calculating the effective period under paragraph (1) and other necessary matters shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
| Article 20 (Renewal of Approval for Long-Term Care) |
| (1) | A beneficiary, who intends to continue to receive long-term care benefits after the effective period of the approval for long-term care under Article 19 terminates, shall file an application for renewal of approval for long-term care. |
| (2) | An application for renewal of approval for long-term care under paragraph (1) shall be filed at least 30 days before the end of the effective period. |
| (3) | Articles 12 through 19 shall apply mutatis mutandis to the procedure for renewal of approval for long-term care. |
| Article 21 (Change of Rating, etc. for Long-Term Care) |
| (1) | A beneficiary who receives long-term care benefits shall, if he/she intends to have the rating for long-term care or the type or details of long-term care benefits changed when receiving long-term care benefits, file an application for such change with the NHIS. |
| (2) | Articles 12 through 19 shall apply mutatis mutandis to procedures for change of a rating for long-term care. |
| Article 22 (Filing of Application, etc. for Approval for Long-Term Care through Agent) |
| (1) | If a person who intends to receive long-term care benefits or a beneficiary is unable to file an application for approval for long-term care, for renewal of approval for long-term care, or for change of the rating for long-term care in accordance with this Act on his/her own due to a physical or mental condition, one of his/her family members or relatives or any other interested party may act as his/her agent in filing such an application. |
| (2) | A public official in exclusive charge of social welfare under the Social Welfare Services Act may act as an agent for a person who resides within his/her jurisdiction in filing an application for approval for long-term care or any other application under paragraph (1), subject to consent of the applicant or the applicant's family. |
| (3) | Notwithstanding paragraphs (1) and (2), where a person who intends to receive long-term care benefits or a beneficiary is unable to file an application for approval for long-term care or any other application under paragraph (1), a person designated by the competent Special Self-Governing Mayor, Special Self-Governing Province Governor, or the head of the competent Si/Gun/Gu may act as an agent for such a person or beneficiary in filing the application. <Amended by Act No. 12067, Aug. 13, 2013> |
| (4) | Matters necessary for the method of, and procedures for, etc. filing an application for approval for long-term care or any other application under paragraphs (1) through (3) shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
CHAPTER IV TYPES OF LONG-TERM CARE BENEFITS
| Article 23 (Types of Long-Term Care Benefits) |
| (1) | Types of long-term care benefits under this Act are as follows: <Amended by Act No. 10785, Jun. 7, 2011; Act No. 13647, Dec. 29, 2015> |
| 1. | Benefit for home care service: |
| (a) | Home visit care: Long-term care benefits provided in a manner that a long-term care staff visits a beneficiary's home, etc. to assist the beneficiary with physical activities, household chores, etc.; |
| (b) | Home visit bathing: Long-term care benefits provided in a manner that a long-term care worker visits a beneficiary's home, etc. to give a bath to the beneficiary using equipments for bathing; |
| (c) | Home visit nursing: Long-term care benefits provided in a manner that a nurse working as a long-term care helper visits a beneficiary's home, etc. to provide nursing service, assist in medical treatment, give counsel on care, or treat dental hygiene, etc. in accordance with a written instruction of a medical doctor, an oriental medicine doctor, or a dentist (hereinafter referred to as "written instruction for home visit nursing"); |
| (d) | Day and night care: Long-term care benefits provided in a manner that a beneficiary is admitted to a long-term care institution for care for certain hours a day to assist him/her with physical activities or to provide him/her with educational or training programs, etc. for maintaining and improving mental and physical functions; |
| (e) | Short-term respite care: Long-term care benefits provided in a manner that a beneficiary is admitted to a long-term care institution for care for a certain period within the maximum prescribed by Ordinance of the Ministry of Health and Welfare to assist him/her with physical activities or to provide educational or training programs, etc. for maintaining and improving mental and physical functions; |
| (f) | Other benefit for home care service: Long-term care benefits prescribed by Presidential Decree and provided in a manner that provides a beneficiary with assistive devices necessary to support his/her daily life and physical activities or to maintain and improve cognitive functions or with assistance for rehabilitation by home visit; |
| 2. | Institutional care benefit: Long-term care benefits provided in a manner that a beneficiary is admitted to a medical welfare facility for older persons referred to in Article 34 of the Welfare of Older Persons Act, which is operated by a long-term care institution for a long term to provide educational or training programs, etc. for assisting a beneficiary with physical activities or maintaining and improving mental functions; |
| 3. | Care allowance for special cases: |
| (a) | Family care benefit in cash: Long-term care benefits reimbursed for family pursuant to Article 24; |
| (b) | Exceptional care benefit in cash: Special long-term care benefits reimbursed pursuant to Article 25; |
| (c) | Nursing expenses of a long-term care hospital: Long-term care benefits reimbursed for admission to a long-term care hospital pursuant to Article 26. |
| (2) | Necessary matters concerning types of, and standards for, long-term care institutions eligible for providing long-term benefits pursuant to paragraph (1) 1 and 2 and the scope, duties, and continuing education of long-term care workers for each type of long-term care benefit shall be prescribed by Presidential Decree. |
| (3) | Standards and procedure for, and the method and scope of, providing long-term care benefits shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
| Article 24 (Family Care Benefit in Cash) |
| (1) | If any of the following beneficiaries has received long-term care benefits equivalent to home visit care under Article 23 (1) 1 (a) from a family member or another person, the NHIS may provide the beneficiary with family care benefit in cash in accordance with guidelines prescribed by Presidential Decree: |
| 1. | A person who resides in an area determined and publicly notified by the Minister of Health and Welfare as an area in which long-term care institutions are significantly insufficient, such as an island or a remote area; |
| 2. | A person recognized by the Minister of Health and Welfare as one who has difficulty in using long-term benefits provided by long-term care institutions due to a natural disaster or any other reason similar thereto; |
| 3. | A person who needs to receive long term care from his/her family members, etc. due to his/her physical or mental conditions, character, etc. |
| (2) | Procedures for reimbursement of family care benefit in cash under paragraph (1) and other necessary matters shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
| Article 25 (Exceptional Care Benefit in Cash) |
| (1) | If a beneficiary has received long-term care benefits equivalent to home care or institutional care benefit from a facility for geriatric care or any similar institution or facility other than long-term care institutions, the NHIS may reimburse the beneficiary for some expenses incurred in receiving the relevant long-term care benefits as exceptional care benefit in cash, in accordance with guidelines prescribed by Presidential Decree. |
| (2) | The scope of institutions or facilities eligible for recognition of long-term care benefits under paragraph (1), procedures for reimbursement of exceptional care benefit in cash, and other necessary matters shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
| Article 26 (Nursing Expenses of Long-Term Care Hospitals) |
| (1) | If a beneficiary is admitted to a long-term care hospital referred to in Article 3 (2) 3 (d) of the Medical Service Act, the NHIS may reimburse the beneficiary for some expenses incurred for long-term care as nursing expenses in the long-term care hospital, in accordance with guidelines prescribed by Presidential Decree. <Amended by Act No. 9386, Jan. 30, 2009; Act No. 10785, Jun. 7, 2011> |
| (2) | Procedures for reimbursement of nursing expenses in long-term care hospitals under paragraph (1) and other necessary matters shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
CHAPTER V PROVISION OF LONG-TERM CARE BENEFITS
| Article 27 (Date for Providing Long-Term Care Benefits) |
| (1) | Beneficiaries shall become eligible for long-term care benefits on the day on which a letter of approval for long-term care under Article 17 (1) is delivered. |
| (2) | Notwithstanding paragraph (1), if a beneficiary has no family member who can take care of him/her or if any reason specified by Presidential Decree exists, the beneficiary shall become eligible for long-term care benefits even during the period between the day on which an application is filed and the day on which a letter of approval for long-term care is delivered. |
| (3) | The scope of, and the procedure for, long-term care benefits approved pursuant to paragraph (2) and other relevant matters shall be prescribed by Presidential Decree. |
| Article 27-2 (Account for Receipt of Care Allowance for Special Cases) |
| (1) | The NHIS shall pay care allowance for special cases into a bank account opened in the name of a beneficiary (hereinafter referred to as “account for receipt of care allowance for special cases”) upon request of the beneficiary: Provided, That when it is impracticable to transfer to an account for receipt of care allowance for special cases due to communication failure or other unavoidable reason prescribed by Presidential Decree, care allowance for special cases may be paid in cash or by other means prescribed by Presidential Decree. |
| (2) | A financial institution which opens accounts for receipt of care allowance for special cases shall ensure that only care allowance for special cases are transferred to such accounts. |
| (3) | Methods of and procedures for request under paragraph (1) and matters necessary to operate accounts for receipt of care allowance for special cases shall be prescribed by Presidential Decree. |
[This Article Newly Inserted by Act No. 14321, Dec. 2, 2016]
| Article 28 (Monthly Cap of Long-Term Care Benefits) |
| (1) | Long-term care benefits shall be provided within the extent of a monthly cap. In such cases, the monthly cap shall be calculated by taking into consideration the rating for long-term care, the type of long-term care benefits, etc. |
| (2) | The guidelines for, and the method of, calculation of the monthly cap pursuant to paragraph (1) and other necessary matters shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
| Article 29 (Limitations on Long-Term Care Benefits) |
| (1) | The NHIS may, if a person who receives, or is eligible to receive, long-term care benefits falls under any of the following subparagraphs, suspend or discontinue providing long-term care benefits: |
| 1. | If the person obtained the approval for long-term care by fraud or other unjust means; |
| 2. | If the person obtained the approval for long-term care by causing an accident on purpose or by committing an unlawful act. |
| (2) | The NHIS may, if a person who receives long-term care benefits fails to comply with a demand referred to in Article 60 or 61 or refuses to give an answer without a justifiable reason, discontinue providing long-term benefits. |
| Article 30 (Application Mutatis Mutandis to Limitations, etc. on Long-Term Care Benefits) |
Article 53 (1) 4 and (2) through (6) and Article 54 of the National Health Insurance Act shall apply mutatis mutandis to limitations on, and the suspension of, long-term care benefits to persons who default payment of insurance contribution under this Act. In such cases, the term "the insured" shall be construed as "the insured of a long-term care insurance," the term "insurance benefit" as "long-term care benefit." <Amended by Act No. 11141, Dec. 31, 2011>
CHAPTER VI LONG-TERM CARE INSTITUTIONS
| Article 31 (Designation of Long-Term Care Institutions) |
| (1) | Any person who intends to establish and operate a long-term care institution shall obtain designation from a Special Self-Governing City Mayor, Special Self-Governing Province Governor, or the head of a Si/Gun/Gu who has jurisdiction over the location of the institution. <Amended by Act No. 12067, Aug. 13, 2013> |
| (2) | Any person who intends to obtain designation as a long-term care institution pursuant to paragraph (1) shall be equipped with facilities and human resources specified by Ordinance of the Ministry of Health and Welfare as necessary for long-term care. |
| (3) | When a Special Self-Governing City Mayor, Special Self-Governing Province Governor, or the head of a Si/Gun/Gu designates a long-term care institution pursuant to paragraph (1), he/she shall give immediate notice of details of designation to the NHIS. <Amended by Act No. 12067, Aug. 13, 2013> |
| (4) | The procedure for designation of long-term care institutions and other necessary matters shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
| Article 32 (Establishment of Long-Term Care Institution for Home Care) |
| (1) | Any person who intends to provide one or more of long term care benefits, from among benefit for home care service referred to in Article 23 (1) 1, shall establish a long-term care institution for home care with facilities and human resources equipped therefor and file a report thereon with the competent Special Self-Governing City Mayor, Special Self-Governing Province Governor, or the head of the competent Si/Gun/Gu. Upon receipt of such report, the competent Special Self-Governing City Mayor, Special Self-Governing Province Governor, or the head of the competent Si/Gun/Gu shall give notice of details of the report to the NHIS. <Amended by Act No. 12067, Aug. 13, 2013> |
| (2) | Each long-term care institution for home care that has filed a report on its establishment pursuant to the former part of paragraph (1) shall be construed as a long-term care institution. |
| (3) | Each long-term care institution for home care installed and operated by any person other than medical institutions shall, if it provides home visit nursing services, have a nurse as a manager in charge of home visit nursing. |
| (4) | Standards for the facilities and human resources referred to in paragraph (1) and other necessary matters shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
| Article 32-2 (Disqualifications) |
Any of the following persons shall not be qualified for the designation of a long-term care institution under Article 31 or for the reporting of establishment of a long-term care institution for home care under Article 32: | 1. | A minor, or a person under the adult guardianship or under the limited guardianship; |
| 4. | A person declared bankrupt but not yet reinstated; |
| 5. | A person in whose case five years have not passed yet since imprisonment without prison labor or any severer penalty to which he/she had been sentenced was completely executed (or is deemed to have been completely executed) or was remitted; |
| 6. | A person who was sentenced to the suspension of imprisonment without prison labor or any severer penalty and is still in the period of suspension; |
| 7. | A corporation whose representative falls under any of the subparagraphs 1 through 6. |
[This Article Newly Inserted by Act No. 13647, Dec. 29, 2015]
| Article 33 (Changes in Facilities and Human Resources of Long-Term Care Institutions) |
When a long-term care institution makes a change in any major matter specified by Ordinance of the Ministry of Health and Welfare with regard to facilities and human resources, it shall report such change to the competent Special Self-Governing City Mayor, Special Self-Governing Province Governor, or the head of the competent Si/Gun/Gu, as prescribed by Ordinance of the Ministry of Health and Welfare. Upon receipt of such report, the competent Special Self-Governing City Mayor, Special Self-Governing Province Governor, or the head of the competent Si/Gun/Gu shall give immediate notice of details of the change to the NHIS. <Amended by Act No. 12067, Aug. 13, 2013>
| Article 34 (Providing Information on Long-Term Care Institutions, etc.) |
| (1) | Each long-term care institution shall publish records of its current status, such as details of benefits provided by the long-term care institution and its facilities, human resources, etc. on the website operated by the NHIS in order to help each beneficiary easily choose long-term care benefits and assure the quality of benefits provided by the long-term care institution. |
| (2) | Details and methods, and procedures for, the publication under paragraph (1) and other necessary matters shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
| Article 35 (Obligations, etc. of Long-Term Care Institutions) |
| (1) | No long-term care institution shall, upon receiving an application for long-term care benefits from a beneficiary, refuse to provide long-term care benefits: Provided, That the foregoing shall not apply if its capacity for admission is exhausted or if it has any other justifiable ground. |
| (2) | Each long-term care institution shall provide long-term care benefits in compliance with the standards and procedure for, and the method of, providing long-term benefits prescribed in Article 23 (3). |
| (3) | The head of each long-term care institution shall issue a statement of expenses for long-term care benefits to each beneficiary to whom he/she has provided long-term care benefits. |
| (4) | The head of each long-term care institution shall keep and manage records on the provision of long-term care benefits, and neither the head nor a worker of a long-term care institution shall make any false document about the provision of a long-term care benefit. <Newly Inserted by Act No. 10127, Mar. 17, 2010; Act No. 13647, Dec. 29, 2015> |
| (5) | No long-term care institution shall exempt or reduce the expenses for home care and institutional care benefits that a beneficiary shall bear (hereinafter referred to as “co-payment”), for the purpose of pursuing profits, in addition to the amount exempted under the proviso to Article 40 (1) or abated under Article 40 (3). <Newly Inserted by Act No. 12067, Aug. 13, 2013> |
| (6) | No person shall introduce, refer, or solicit a beneficiary to a long-term care institution or instigate another person to commit such an act by offering or promising to offer money, goods, labor, entertainment, or any other benefits, for the purpose of pursuing profits. <Newly Inserted by Act No. 12067, Aug. 13, 2013> |
| (7) | The statement of expenses for long-term care benefits under paragraph (3), details of records on the provision of long-term care benefits to be recorded and managed pursuant to paragraph (4) and the period of retaining such records, and other necessary matters shall be prescribed by Ordinance of the Ministry of Health and Welfare. <Amended by Act No. 10127, Mar. 17, 2010; Act No. 12067, Aug. 13, 2013> |
| Article 35-2 (Financial Accounting Standards for Long-Term Care Institutions) |
| (1) | The head of a long-term care institutions shall operate the long-term care institution in a transparent manner in accordance with the financial and accounting standards prescribed by Ordinance of the Ministry of Health and Welfare (hereinafter referred to as the "financial accounting standards for long-term care institutions): Provided, That the financial accounting standards under Article 34 (3) of the Social Welfare Services Act shall apply to the social welfare facilities established pursuant to Article 34 of the aforesaid Act, among long-term care institutions. |
| (2) | The Minister of Health and Welfare shall consider characteristics of each long-term care institution, the timing for enforcement, etc. when he/she formulates the financial accounting standards for long-term care institutions. |
[This Article Newly Inserted by Act No. 14215, May 29, 2016]
| Article 36 (Reporting on Closure, etc. of Long-Term Care Institutions) |
| (1) | When the head of a long-term care institution intends to close or suspend its business operations, he/she shall report it to the competent Special Self-Governing City Mayor, Special Self-Governing Province Governor, or the head of the competent Si/Gun/Gu at least 30 days before the scheduled date of business closure or suspension. Upon receipt of such report, the competent Special Self-Governing City Mayor, Special Self-Governing Province Governor, or the head of the competent Si/Gun/Gu shall give immediate notice of details of the report to the NHIS. <Amended by Act No. 12067, Aug. 13, 2013> |
| (2) | When the head of a long-term care institution intends to close or suspend business operations of the long-term care institution, he/she shall formulate and implement a plan for measures to be taken to ensure that beneficiaries using the long-term care institution can use another long-term care institution and shall take other measures for protecting rights and interests of beneficiaries. <Newly Inserted by Act No. 13647, Dec. 29, 2015> |
| (3) | Upon receipt of a report on closure or suspension of business operations from a long-term care institution pursuant to paragraph (1), the competent Special Self-Governing City Mayor, Special Self-Governing Province Governor, or the head of the competent Si/Gun/Gu shall ascertain whether the head of the long-term care institution has taken measures for protecting rights and interests of beneficiaries in accordance with paragraph (2) and shall recommend the long-term care institution to withdraw the closure of business operations or shall take other measures, if it is anticipated that the closure of business operations will cause a serious problem in providing long-term care benefits due to the absence of alternative long-term care institution in the vicinity or due to other circumstances. <Amended by Act No. 13647, Dec. 29, 2015> |
| (4) | When a Special Self-Governing City Mayor, Special Self-Governing Province Governor, or the head of a Si/Gun/Gu issues an order to a medical welfare facility for older persons or any similar facility (limited to cases where the facility concerned is operated by a long-term care institution) to suspend or close business operations pursuant to Article 43 of the Welfare of Older Persons Act, he/she shall give immediate notice of details of the order to the NHIS. <Amended by Act No. 12067, Aug. 13, 2013> |
| (5) | When the head of a long-term care institution files a report on the closure or suspension of business operations pursuant to paragraph (1), he/she shall transfer records relating to the provision of long-term care benefits to the NHIS, as prescribed by Ordinance of the Ministry of Health and Welfare: Provided, That the head of a long-term care institution who files a report on suspension may retain records relating to the provision of long-term care benefits under his/her custody, if he/she obtains permission therefor from the NHIS by not later than the day before the scheduled date of suspension of business operations. <Newly Inserted by Act No. 10127, Mar. 17, 2010; Act No. 12067, Aug. 13, 2013> |
| Article 36-2 (Corrective Order) |
If a long-term care institution breaches financial accounting standards, a Special Self-Governing City Mayor, Special Self-Governing Province Governor, or the head of a Si/Gun/Gu may order the long-term care institution to rectify the relevant breaches within a given period of not more than six months.
[This Article Newly Inserted by Act No. 14215, May 29, 2016]
| Article 37 (Cancellation, etc. of Designation as Long-Term Care Institutions) |
| (1) | Where a long-term care institution falls under any of the following circumstances, the competent Special Self-Governing City Mayor, Special Self-Governing Province Governor, or the head of the competent Si/Gun/Gu may cancel its designation or issue an order to suspend its business operations for a period of not more than six months: Provided, That he/she shall cancel the designation, if a long-term care institution falls under subparagraph 1, 2-2, or 7: <Amended by Act No. 12067, Aug. 13, 2013; Act No. 13647, Dec. 29, 2015> |
| 1. | Where a long-term care institution obtains designation by fraud or other unjust means; |
| 2. | Where a long-term care institution does not meet the standards for the designation under Article 31 (2); |
| 2-2. | Where a long-term care institution falls under any subparagraph of Article 32-2: Provided, That the foregoing shall not apply where its representative is replaced within three months, if the institution is a corporation that falls under subparagraph 7 of Article 32-2; |
| 3. | Where a long-term care institution refuses to provide long-term care benefits, in violation of Article 35 (1); |
| 3-2. | Where a long-term care institution exempts or abates a beneficiary’s co-payment, in violation of Article 35 (5); |
| 3-3. | Where a long-term care institution is involved in the introduction, referral, or solicitation of a beneficiary, or instigates a person to commit such an act, in violation of Article 35 (6); |
| 4. | Where a long-term care institution claims expenses for domiciliary or facility benefits by fraud or other unjust means; |
| 5. | Where a long-term care institution fails to comply with an order to submit records pursuant to Article 61 (2) or submits false records, refuses, interferes with, or evades an inquiry or inspection, or falsely respond to such inquiry or inspection; |
| 6. | Where a worker, etc. of a long-term care institution commits any of the following acts: |
| (a) | Committing assault and battery upon the body of a beneficiary or inflicting any injury upon a beneficiary; |
| (b) | Committing sexual violence or sexual harrassment that leads to a sense of sexual shame upon a beneficiary; |
| (c) | Abandoning a beneficiary under his/her custody or supervision or inadvertently neglecting basic protective measures, including sheltering, food, and clothing, or medical treatment; |
| 7. | Where a long-term care institution provides long-term care benefits during a period of business suspension. |
| (2) | When a Special Self-Governing City Mayor, Special Self-Governing Province Governor, or the head of a Si/Gun/Gu cancels designation or issues an order to suspend business pursuant to paragraph (1), he/she shall give immediate notice of details thereof to the NHIS and the Minister of Health and Welfare, as prescribed by Ordinance of the Ministry of Health and Welfare. In such cases, the head of a Si/Gun/Gu shall give such notice to the Minister of Health and Welfare via the competent Special Metropolitan City Mayor, Metropolitan City Mayor, or Do Governor. <Amended by Act No. 12067, Aug. 13, 2013> |
| (3) | Where a long-term care institution for home care falls under any of the following circumstances, the competent Special Self-Governing City Mayor, Special Self-Governing Province Governor, or the head of the competent Si/Gun/Gu may issue an order to close down its facilities or suspend its business operations for a period of not more than six months: Provided, That he/she must issue an order to close down the business, if a long-term care institution for home care falls under subparagraph 1, 2-2, or 5: <Amended by Act No. 12067, Aug. 13, 2013; Act No. 13647, Dec. 29, 2015; Act No. 14215, May 29, 2016> |
| 1. | Where a long-term care institution for home care has made a report by fraud or other unjust means; |
| 2. | Where a long-term care institution for home care is not equipped with facilities or human resources required pursuant to Article 32 (1); |
| 2-2. | Where a long-term care institution for home care falls under paragraph (1) 2-2; |
| 3. | Where a long-term care institution for home care falls under paragraph (1) 3, 3-2, 3-3, 5, or 6; |
| 4. | Where a long-term care institution for home care claims expenses for benefit for home care service by fraud or other unjust means; |
| 5. | Where a long-term care institution for home care provides long-term care benefits during a period of business suspension; |
| 6. | Where a long-term care institution for home care fails to comply with an order issued under Article 36-2 to rectify breaches or commits accounting fraud. |
| (4) | When a Special Self-Governing City Mayor, Special Self-Governing Province Governor, or the head of a Si/Gun/Gu orders a long-term care institution for home care to close or suspend business pursuant to paragraph (3), he/she shall give immediate notice of details of the order to the NHIS and the Minister of Health and Welfare as prescribed by Ordinance of the Ministry of Health and Welfare, and the head of a Si/Gun/Gu in such cases shall give notice to the Minister of Health and Welfare via the competent Special Metropolitan City Mayor, Metropolitan City Mayor, or Do Governor. The designation of a long-term care institution for home care is deemed cancelled under paragraph (1), when an order to close business is issued to the long-term care institution for home care. <Amended by Act No. 12067, Aug. 13, 2013> |
| (5) | Where a long-term care institution has its designation cancelled or its business operations suspended pursuant to paragraph (1) or a long-term care institution for home care is closed or has its business operations suspended pursuant to paragraph (3), the competent Special Self-Governing City Mayor, Special Self-Governing Province Governor, or the head of the competent Si/Gun/Gu shall move the beneficiaries that have used the long-term care institution to another long-term care institution and take other necessary measures to protect rights and interests of the beneficiaries. <Newly Inserted by Act No. 13647, Dec. 29, 2015> |
| (6) | Either of the following persons shall not be qualified for the designation of a long-term care institution under Article 31 or for filing a report on the establishment of a long-term care institution for home care under Article 32: <Amended by Act No. 12067, Aug. 13, 2013; Act No. 13647, Dec. 29, 2015> |
| 1. | A person (including the representative of the corporation, if the person is a corporation) in whose case three years have not passed yet since he/she had his/her designation cancelled or was ordered to close down the business pursuant to paragraph (1) or (3); |
| 2. | A person (including the representative of a corporation, if the person is a corporation) in whose case a period of business suspension has not elapsed yet since he/she was ordered to suspend business pursuant to paragraph (1) or (3). |
| (7) | The guidelines for administrative dispositions pursuant to paragraphs (1) and (3) shall be prescribed by Ordinance of the Ministry of Health and Welfare. <Amended by Act No. 12067, Aug. 13, 2013> |
| Article 37-2 (Imposition, etc. of Penalty Surcharges) |
| (1) | If a Special Self-Governing City Mayor, Special Self-Governing Province Governor, or the head of a Si/Gun/Gu is required to issue an order to suspend business to a long-term care institution for an act specified in any subparagraph of Article 37 (1) or (3) (excluding Article 37 (1) 4 and (3) 4) but deems there is an extraordinary circumstance specified by the Minister of Health and Welfare in the case, such that business suspension is anticipated to cause severe inconvenience to beneficiaries who use the long-term care institution concerned, he/she may impose a penalty surcharge of not exceeding 50 million won on such long-term care institution in lieu of the order of business suspension: Provided, That the foregoing shall not apply to cases specified by Ordinance of the Ministry of Health and Welfare with respect to violations of Article 37 (1) 6. |
| (2) | If a Special Self-Governing City Mayor, Special Self-Governing Province Governor, or the head of a Si/Gun/Gu is required to issue an order to suspend business to a long-term care institution for an act specified in Article 37 (1) 4 or (3) 4 but deems there is an extraordinary circumstance specified by the Minister of Health and Welfare in the case, such that business suspension is anticipated to cause severe inconvenience to beneficiaries who use the long-term care institution concerned, he/she may impose an amount of not more than five times the amount claimed by fraud or other unjust means as a penalty surcharge on such long-term care institution in lieu of the order of business suspension. |
| (3) | The amount of a penalty surcharge to be imposed by type and degree of violations subject to the imposition of penalty surcharges under paragraph (1) or (2), the procedure for the imposition of penalty surcharges, and other necessary matters shall be prescribed by Presidential Decree. |
| (4) | If a person upon whom a penalty surcharge has been imposed under paragraph (1) or (2) fails to pay it by the due date for payment, the competent Special Self-Governing City Mayor, Special Self-Governing Province Governor, or the head of the competent Si/Gun/Gu shall collect it in the same manner as delinquent local taxes are collected. |
| (5) | A Special Self-Governing City Mayor, Special Self-Governing Province Governor, or the head of a Si/Gun/Gu shall keep and maintain records of the imposition and collection of penalty surcharges under paragraph (1) or (2), as prescribed by Ordinance of the Ministry of Health and Welfare. |
[This Article Newly Inserted by Act No. 12067, Aug. 13, 2013]
| Article 37-3 (Disclosure of Violations, etc.) |
| (1) | If a disposition made under Article 37 or 37-2 against a long-term care institution on the ground that it filed a false claim for expenses for home care or institutional care benefits becomes final in either of the following cases, the competent Special Self-Governing City Mayor, Special Self-Governing Province Governor, or the head of the competent Si/Gun/Gu may disclose the information specified by Presidential Decree to the public, such as the relevant violation, the details of the disposition, the name and address of the long-term care institution concerned, the name of the head of the long-term care institution concerned, and other information necessary for discerning it from other long-term care institutions: |
| 1. | Where the amount of the false claim is at least ten million won; |
| 2. | Where the amount of the false claim is at least 10/100 of the total expenses for long-term care benefits. |
| (2) | In order to deliberate on whether to disclose information under paragraph (1), a Special Self-Governing City Mayor, Special Self-Governing Province Governor, or the head of a Si/Gun/Gu may establish and operate a committee for deliberation on disclosure. |
| (3) | The method of determining whether to disclose information under paragraph (1), the method and procedure for disclosure, and matters necessary for the establishment and operation of the committee for deliberation on disclosure under paragraph (2) shall be prescribed by Presidential Decree. |
[This Article Newly Inserted by Act No. 12067, Aug. 13, 2013]
| Article 37-4 (Succession to Effects of Administrative Dispositions) |
| (1) | The effects of an administrative disposition imposed for an act specified in any subparagraph of Article 37 (1) or (3) (hereinafter referred to as “administrative disposition”) are transferred to any of the following persons for three years from the date of imposing such disposition: <Amended by Act No. 13647, Dec. 29, 2015> |
| 1. | The transferee, where the long-term care institution concerned is transferred; |
| 2. | The corporation newly incorporated as a consequence of a merger of corporations or surviving the merger, where corporations are merged; |
| 3. | The person (including the representative of a corporation, if the person is a corporation) who operates another long-term care institution at the same place after the former long-term care institution was closed and who has been punished by an administrative disposition or his/her spouse or lineal relatives by blood. |
| (2) | If proceedings for an administrative disposition are pending, such proceedings may continue against any of the following persons: <Amended by Act No. 13647, Dec. 29, 2015> |
| 1. | The transferee, where the long-term care institution concerned is transferred; |
| 2. | The corporation newly incorporated as a consequence of a merger of corporations or surviving the merger, where corporations are merged; |
| 3. | The person (including the representative of a corporation, if the person is a corporation) who operates another long-term care institution at the same place within one year after the former long-term care institution was closed and who has committed the relevant violation or his/her spouse or lineal relatives by blood. |
| (3) | Notwithstanding paragraphs (1) and (2), the foregoing paragraphs shall not apply to a person specified in any subparagraph of paragraph (1) or (2) (hereinafter referred to as “transferee or such”), if the person proves that he/she was ignorant of the administrative disposition or violation at the time of acquisition by transfer, merger, or operation. |
| (4) | A person, who was punished by an administrative disposition or against whom proceedings for such disposition are pending, shall give immediate notice of the fact to the transferee or such, as prescribed by Ordinance of the Ministry of Health and Welfare. |
[This Article Newly Inserted by Act No. 12067, Aug. 13, 2013]
| Article 37-5 (Restriction on Provision of Long-Term Care Benefits) |
| (1) | If a worker of a long-term care institution takes part in filing a claim for reimbursement of expenses for home care or institutional care benefits by fraud or other unjust means, the competent Special Self-Governing City Mayor, Special Self-Governing Province Governor, or the head of the competent Si/Gun/Gu may take measures to place restrictions on the worker's provision of long-term care benefits for a period of not more than one year. |
| (2) | When a Special Self-Governing City Mayor, Special Self-Governing Province Governor, or the head of a Si/Gun/Gu take measures under paragraph (1), he/she shall notify the NHIS of details thereof, without delay. |
| (3) | The criteria and methods for measures to be taken to restrict the provision of long-term care benefits, the methods and procedure for the notification of such measures, and other necessary matters shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
[This Article Newly Inserted by Act No. 13647, Dec. 29, 2015]
CHAPTER VII EXPENSES, ETC. FOR HOME CARE OR INSTITUTIONAL CARE BENEFIT
| Article 38 (Claim, Reimbursement, etc. for Expenses for Home care or Institutional Care Benefits) |
| (1) | Each long-term care institution shall, when it has provided home care or institutional care benefits pursuant to Article 23 to a beneficiary, file a claim for reimbursement of expenses for the long-term care benefits with the NHIS. |
| (2) | The NHIS shall, upon receiving a claim for reimbursement of expenses for home care or institutional care benefits from a long-term care institution pursuant to paragraph (1), review the claim and pay the NHIS' share of expenses incurred in providing long-term care (referring to an amount calculated by deducting the beneficiary's co-payment from expenses for home care or institutional care benefits) to the long-term care institution. |
| (3) | The NHIS may adjust expenses for long-term care benefits by adding or subtracting an amount according to results of the evaluation under Article 54 (2) of long-term care benefits provided by a long-term care institution. |
| (4) | A long-term care institution shall spend part of the reimbursement paid for expenses for long-term care benefits for personnel expenses for long-term care workers at the rate determined and publicly notified by the Minister of Health and Welfare. <Newly Inserted by Act No. 14215, May 29, 2016> |
| (5) | Matters concerning guidelines for the examination on the review of expenses for home care or institutional care benefits, guidelines for the addition to or subtraction from expenses for long-term care benefits, the procedure for filing claims, the method of payment, and other relevant matters under paragraphs (1) through (3) shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
| Article 39 (Calculation of Expenses for Home Care or Institutional Care Benefit) |
| (1) | Expenses for home care or institutional care benefits shall be determined and publicly notified by the Minister of Health and Welfare according to each type of benefits, each rating of long-term care, etc. subject to deliberation by the Long-Term Care Committee referred to in Article 45. |
| (2) | The Minister of Health and Welfare may, when he/she determines expenses for home care or institutional care benefits pursuant to paragraph (1), consider whether expenses for the establishment of a long-term care institution were subsidized by the State or a local government as prescribed by Presidential Decree. |
| (3) | Necessary matters concerning detailed methods of the calculation of expenses for home care or institutional care benefits under paragraph (1), items of such expenses, etc. shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
| Article 40 (Beneficiary's Co-Payment of Expenses) |
| (1) | Each beneficiary shall bear expenses for domiciliary or facility benefits at either of the following rates: Provided, That the foregoing shall not apply to the beneficiaries under Article 3 (1) 1 of the Medical Care Assistance Act: <Amended by Act No. 13647, Dec. 29, 2015> |
| 1. | Benefit for home care service: 15/100 of expenses for relevant long-term care benefits; |
| 2. | Institutional care benefits: 20/100 of expenses for relevant long-term care benefits. |
| (2) | Expenses for the following long-term care benefits shall be fully borne by a beneficiary: |
| 1. | Long-term care benefits that shall be excluded from the scope and coverage of the benefits under the provisions of this Act; |
| 2. | A difference in cases where a beneficiary decided to take long-term care benefits different from the type and details of long-term care benefits described in the relevant letter of approval for long-term care under Article 17 (1) 2; |
| 3. | Long-term care benefits exceeding the monthly cap of long-term care benefits under Article 28. |
| (3) | Any of the following persons shall be eligible for reduction of his/her co-payment of expenses by 50/100: <Amended by Act No. 9693, May 21, 2009; Act No. 10127, Mar. 17, 2010> |
| 2. | A person whose income, property, etc. is not more than a specific amount prescribed and publicly notified by the Minister of Health and Welfare: Provided, That such amount applicable to persons who reside in an island, a remote area, a rural community, etc. may be prescribed separately; |
| 3. | A person who suffers hardships in making a living due to a natural disaster or any cause or event specified by Ordinance of the Ministry of Health and Welfare. |
| (4) | Matters necessary for the method of calculating beneficiary's co-payment of expenses and procedures for, and the method of, abatement thereof under paragraphs (1) through (3) shall be prescribed by Ordinance of the Ministry of Health and Welfare. <Amended by Act No. 9693, May 21, 2009> |
| Article 41 (Compensation Payable to Family Members, etc. for Long-Term Care) |
| (1) | If a beneficiary has been provided with long-term care equivalent to home visit care referred to in Article 23 (1) 1 (a) by a family member or another person and if the total amount of long-term care benefits so provided does not exceed an amount determined and publicly notified by the Minister of Health and Welfare, the NHIS may reduce or exempt part of the beneficiary's co-payment or may take any other measure as a substitute for such reduction or exemption, as prescribed by Ordinance of the Ministry of Health and Welfare. |
| (2) | Necessary matters, such as the method, etc. of reduction and exemption of a beneficiary's co-payment pursuant to paragraph (1), shall be prescribed by Ordinance of the Ministry of Health and Welfare. |
| Article 42 (Calculation, etc. of Expenses for Issuance of Written Instruction for Home Visit Nursing) |
Necessary matters concerning expenses for the issuance of written instructions for home visit nursing under Article 23 (1) 1 (c), the method of allocation of such expenses, and the procedures for filing claims for reimbursement of such expenses and paying such expenses shall be prescribed by Ordinance of the Ministry of Health and Welfare.
| Article 43 (Recovery of Unjust Enrichment or Unjust Profit) |
| (1) | In any of the following cases, the NHIS shall recover the amount equivalent to long-term care benefits or the expenses for the long-term care benefits from the person to whom the long-term care benefits have been provided: <Amended by Act No. 13647, Dec. 29, 2015> |
| 1. | If a person has received long-term care benefits in excess of the monthly cap referred to in Article 28; |
| 2. | If a person whose long-term care benefits shall be subject to limitations pursuant to Article 29 or 30 has received long-term care benefits; |
| 3. | If a person has filed claims for reimbursement of expenses for home care or institutional care benefits by fraud or other unjust means under Article 37 (1) 4 or (3) 4 and received the reimbursement; |
| 4. | If a person has received long-term care benefits or the payment of expenses for long-term care benefits from the NHIS without any cause under this Act. |
| (2) | If long-term care benefits were provided based on a false report, certificate, or diagnosis in the case of paragraph (1), the NHIS may demand a person who was involved in the fraudulent act to pay the money recoverable pursuant to paragraph (1) jointly with the person who has received long-term care benefits. |
| (3) | In the case of paragraph (1), the NHIS may demand a person who belongs to the same household as the person who has received long-term care benefits by fraud or other unjust means (referring to a person who supports a recipient of long-term care benefits or a person who owes a duty to support a person who received long-term care benefits pursuant to any other statutes) to pay the money recoverable pursuant to paragraph (1) jointly with the recipient of long-term care benefits by fraud or other unjust means. |
| (4) | In the case of paragraph (1), if a long-term care institution has received the payment of expenses for long-term care benefits from a beneficiary by fraud or other unjust means, the NHIS shall recover the payment from the long-term care institution and return it to the beneficiary. |
| Article 44 (Right to Demand Reimbursement) |
| (1) | The NHIS shall, when it provides long-term care benefits to a beneficiary because a third party's act gives rise to a cause of providing long-term care benefits, acquire a right to demand the third party to reimburse it from damages within the maximum expenses incurred in such benefits. |
| (2) | In the case of paragraph (1), if the person who received long-term care benefits already collected damages from the third party, the NHIS shall not provide long-term care benefits within the maximum of damages collected. |
CHAPTER VIII LONG-TERM CARE COMMITTEE
| Article 45 (Establishment and Functions of Long-Term Care Committee) |
The Minister of Health and Welfare shall have the Long-Term Care Committee under his/her control in order to have the Committee deliberate on the following matters:
| 1. | Long-term care insurance contribution rates under Article 9 (2); |
| 2. | Standards for paying family care benefit in cash, exceptional care benefit in cash, and nursing expenses of long-term care hospitals pursuant to Articles 24 through 26; |
| 3. | Expenses for home care and institutional care benefits referred to in Article 39; |
| 4. | Other essential matters specified by Presidential Decree. |
| Article 46 (Composition of Long-Term Care Committee) |
| (1) | The Long-Term Care Committee shall be comprised of not less than 16, but not more than 22 members, including one Chairperson and one Vice Chairperson. |
| (2) | Committee members except the Chairperson shall be appointed or commissioned by the Minister of Health and Welfare, and the number of persons in a group under each of the following subparagraphs shall be equal: |
| 1. | Persons, each of whom represents an employees' organization, an employers' organization, a non-governmental organization (referring to a non-profit, non-governmental organization under Article 2 of the Assistance for Non-Profit, Non-Governmental Organizations Act), an older persons' organization, an organization of farmers or fishers, or an organization of self-employed entrepreneurs; |
| 2. | Persons, each of whom represents a long-term care institution or medical community; |
| 3. | Public officials, each of whom belongs to an appropriate central administrative agency specified by Presidential Decree and is a member of the Senior Civil Service Corps; persons, each of whom represents an academia or a research community related to long-term care; or persons recommended by the President of the NHIS. |
| (3) | The Vice Minister of Health and Welfare shall take the chair of the Committee, and the Vice Chairperson shall be appointed by the Chairperson from among the committee members. |
| (4) | The term of office for each member of the Long-Term Care Committee shall be three years: Provided, That the term of office for each public official serving as a committee member shall be the term of his/her service as a public official. |
| Article 47 (Operation of Long-Term Care Committee) |
| (1) | Meetings of the Long-Term Care Committee shall be duly formed with a majority of members present and shall adopt a resolution by an affirmative vote of a majority of members present at each meeting. |
| (2) | The Long-term Care Committee may have working committees for each area for efficient operation. |
| (3) | Except as otherwise prescribed by this Act, the composition and operation of the Long-Term Care Committee and other necessary matters shall be prescribed by Presidential Decree. |
CHAPTER VIII-II SUPPORT CENTERS FOR LONG-TERM CARE WORKERS
| Article 47-2 (Establishment, etc. of Support Centers for Long-Term Care Workers) |
| (1) | A local government may establish and operate a support center for long-term care workers in order to protect rights of long-term care workers. |
| (2) | A support center for long-term care workers shall provide the following services: |
| 1. | Counseling service and assistance as countermeasures against violations of rights of long-term care workers; |
| 2. | Assistance in training programs for empowering long-term care workers; |
| 3. | Programs for health management, including medical examination of long-term care workers; |
| 4. | Other matters specified by Presidential Decree as necessary for services, etc. of long-term care workers. |
| (3) | Other matters necessary for the establishment, operation, etc. of support centers for long-term care workers shall be prescribed by Municipal Ordinance of each local government in accordance with provisions of the relevant Ordinance of the Ministry of Health and Welfare. |
[This Article Newly Inserted by Act No. 14215, May 29, 2016]
CHAPTER IX INSTITUTION RESPONSIBLE FOR ADMINISTRATION AND OPERATION
| Article 48 (Institution, etc. Responsible for Administration and Operation) |
| (1) | The institution responsible for the administration and operation of the long-term care program shall be the NHIS. |
| (2) | The NHIS shall undertake the following service: <Amended by Act No. 10127, Mar. 17, 2010> |
| 1. | Management of eligibility for long-term care insurance of the insured and their dependents and recipients of medical benefits; |
| 2. | Imposition and collection of long-term care insurance contribution; |
| 3. | Investigation of applicants; |
| 4. | Operation of need assessment committees and confirmation of ratings for long-term care; |
| 5. | Preparation of letters of approval for long-term care and delivery of standard plans for the use of long-term care; |
| 6. | Control and evaluation of long-term care benefits; |
| 7. | Matters concerning assistance in use of long-term care benefits, such as providing beneficiaries with information, guidance, and counselling service; |
| 8. | Review on expenses for home care or institutional care benefits and payment of care allowance for special cases; |
| 9. | Verification of details of long-term care benefits provided; |
| 10. | Surveys, research, and public relations activities on the long-term care program; |
| 11. | Projects for preventing geriatric diseases; |
| 12. | Imposition and collection of unjust enrichment or unjust profit under this Act; |
| 13. | Establishment and operation of long-term care institutions to develop criteria for the provision of long-term care benefits and deliberate on the appropriateness of long-term care benefit expenses; |
| 14. | Other services entrusted by the Minister of Health and Welfare in conjunction with the long-term care program. |
| (3) | The NHIS shall consider the alleviation of the imbalance between regions in view of the population of older persons and local characteristics when it intends to establish a long-term care institution pursuant to paragraph (2) 13 and shall establish and operate the long-term care institution within the minimum extend for objectives of the establishment thereof. <Newly Inserted by Act No. 10127, Mar. 17, 2010; Act No. 13647, Dec. 29, 2015> |
| (4) | Articles of the NHIS under Article 17 of the National Health Insurance Act shall include and describe the following matters with regard to the long-term care program: <Amended by Act No. 10127, Mar. 17, 2010; Act No. 11141, Dec. 31, 2011> |
| 1. | Long-term care insurance contribution; |
| 2. | Long-term care benefits; |
| 3. | Budgeting and settlement of accounts for the long-term care program; |
| 4. | Other matters specified by Presidential Decree. |
| Article 49 (NHIS' Organization, etc. for Long-Term Care Program of NHIS) |
When the NHIS establishes regulations on the organization of the NHIS pursuant to Article 29 of the National Health Insurance Act, it shall separate organizations that shall undertake the long-term care program, independent of organizations that shall undertake health insurance: Provided, That the foregoing shall not apply to business affairs related to the management of eligibility and the imposition and collection of insurance contribution referred to in Article 48 (2) 1 and 2. <Amended by Act No. 11141, Dec. 31, 2011>
| Article 50 (Accounting of Long-Term Care Program) |
| (1) | The NHIS shall install and operate separate accounts for the long-term care program. |
| (2) | The NHIS shall manage the funds for services of long-term care programs provided with financial resources of long-term care insurance contribution separately from the funds for the services of long-term care programs provided with financial resources of contributions from the State and local governments: Provided, That it does not need to separately manage the funds for the administration and operation. |
| Article 51 (Application Mutatis Mutandis to Delegation, etc. of Authority) |
Articles 32 and 38 of the National Health Insurance Act shall apply mutatis mutandis to the delegation of President's authority under this Act and reserves. In such cases, the term "insurance benefits" shall be construed as "long-term care benefits." <Amended by Act No. 11141, Dec. 31, 2011>
| Article 52 (Establishment of Need Assessment Committee) |
| (1) | The NHIS shall have need assessment committees to deliberate on approval for long-term care and confirmation of rating for long-term care. |
| (2) | A need assessment committee shall be established in each Special Self-Governing City, Special Self-Governing Province, or Si/Gun/Gu: Provided, That two or more need assessment committees may be established in one Special Self-Governing City, Special Self-Governing Province, or Si/Gun/Gu or one need assessment committee may be established by two or more integrated local governments, such as Special Self-Governing Cities, Special Self-Governing Provinces, and Sis/Guns/Gus, taking into consideration the size of population and other relevant facts. <Amended by Act No. 12067, Aug. 13, 2013> |
| (3) | Each need assessment committee shall be comprised of 15 members, including one Chairperson. |
| (4) | Members of each need assessment committee shall be commissioned by the President of the NHIS, from among the persons described in the following paragraphs. In such cases, at least seven members shall be recommended by the competent Special Self-Governing City Mayor, Special Self-Governing Province Governor, or the head of the competent Si/Gun/Gu, and at least one medical doctor or oriental medicine doctor shall be included in each committee: <Amended by Act No. 12067, Aug. 13, 2013> |
| 3. | Public officials who belong to a Special Self-Governing City, Special Self-Governing Province, or Si/Gun/Gu; |
| 4. | Other persons who have abundant knowledge and experience in law or long-term care. |
| (5) | The term of office for each member of each need assessment committee shall be three years: Provided, That the term of office of a public official serving as a member shall be the term of his/her service as public official. |
| Article 53 (Operation of Need Assessment Committees) |
| (1) | The chairperson of each need assessment committee shall be commissioned by the competent Special Self-Governing City Mayor, Special Self-Governing Province Governor, or the head of the competent Si/Gun/Gu, from among committee members. In such cases, where one need assessment committee is established by two or more integrated Special Self-Governing Cities, Special Self-Governing Provinces, or Sis/Guns/Gus under the proviso to Article 52 (2), the chairperson of such need assessment committee shall be commissioned jointly by the competent Special Self-Governing City Mayors, Special Self-Governing Province Governors, and the heads of the competent Sis/Guns/Gus. <Amended by Act No. 12067, Aug. 13, 2013> |
| (2) | Meetings of each need assessment committee shall be duly formed with a majority of members present and shall adopt a resolution by an affirmative vote of a majority of members present at the meeting. |
| (3) | Except as otherwise expressly provided for in this Act, the composition and operation of need assessment committees and other necessary matters shall be prescribed by Presidential Decree. |
| Article 54 (Control and Evaluation of Long-Term Care Benefits) |
| (1) | The NHIS shall continuously control and evaluate details of long-term care benefits provided by each long-term care institution and endeavor to improve the quality of long-term care benefits. |
| (2) | The NHIS shall evaluate whether a long-term care institution has provided long-term care benefits appropriately in accordance with the standards, procedure, method, etc. of long-term care benefits prescribed in Article 23 (3) and may publish the results of the evaluation on its website and take other measures as may be necessary. <Amended by Act No. 13647, Dec. 29, 2015> |
| (3) | The methods of the evaluation of details of provided long-term care benefits and the publication of results of the evaluation pursuant to paragraph (2) and other necessary matters shall be prescribed by Ordinance of the Ministry of Health and Welfare. <Amended by Act No. 13647, Dec. 29, 2015> |
CHAPTER X FILING OBJECTION OR APPLICATION FOR EXAMINATION
| Article 55 (Raising of Objection) |
| (1) | Any person not satisfied with a disposition made by the NHIS with regard to approval or rating for long-term care, long-term care benefits, unjust enrichment or unjust profit, expenses for long-term care benefits, or long-term care insurance contribution may raise an objection with the NHIS. |
| (2) | An objection under paragraph (1) shall be raised in writing within 90 days from the date on which the relevant disposition is made: Provided, That the foregoing shall not apply to cases where a person successfully vindicates him/herself that he/she was unable to raise an objection due to a justifiable reason within the period prescribed in the main sentence. |
| (3) | The NHIS shall organize a long-term care review committee to have the committee to deliberate on the cases of objections under paragraph (1). |
| (4) | The composition and operation of the committee for the examination on long-term care, the term of office for members of the committee, and other necessary matters shall be prescribed by Presidential Decree. |
| Article 56 (Application for Examination) |
| (1) | Any person who is dissatisfied with a decision on an objection under Article 55 may file an application for examination with the committee for the adjudication on long-term care (hereinafter referred to as the "adjudication committee") within 90 days from the date on which the relevant decision is made. |
| (2) | The adjudication committee shall be under the control of the Minister of Health and Welfare and shall be comprised of not more than 20 members, including one Chairperson. |
| (3) | Members of the adjudication committee shall be appointed or commissioned by the Minister of Health and Welfare, from among appropriate public officials and persons who have abundant knowledge and experience in law or long-term care services. |
| (4) | The composition and operation of the adjudication committee and other necessary matters shall be prescribed by Presidential Decree. |
| Article 57 (Administrative Litigation) |
Any person who has an objection to a disposition made by the NHIS or who is dissatisfied with a decision on an objection under Article 55 or a decision on an application for examination under Article 56 may file an administrative litigation, as prescribed by the Administrative Litigation Act.
CHAPTER XI SUPPLEMENTARY PROVISIONS
| Article 58 (State's Subsidization) |
| (1) | The State shall grant the NHIS an amount equivalent to 20/100 of the estimated revenue of long-term care insurance contribution each year as subsidies within budgetary limits of the pertinent year. |
| (2) | The State and each local government shall fully bear expenses that the NHIS shall otherwise bear for long-term care benefits to recipient of medical benefits, for the issuance of medical doctor's referral, and for the issuance of written instructions for home visit nursing (including the expenses that the NHIS shall otherwise bear as a consequence of exemption or reduction granted pursuant to the proviso to Article 40 (1) or Article 40 (3) 1) and expenses for administration and operation, as prescribed by Presidential Decree. |
| (3) | The amount that each local government is required to bear pursuant to paragraph (2) shall be borne by the competent Special Metropolitan City, Metropolitan City, Special Self-Governing City, Do, Special Self-Governing Province, and Si/Gun/Gu, as prescribed by Ordinance of the Ministry of Health and Welfare. <Amended by Act No. 12067, Aug. 13, 2013> |
| (4) | The imposition and collection of the share of expenses borne by local governments pursuant to paragraphs (2) and (3), the management of the financial resources, and other necessary matters shall be prescribed by Presidential Decree. |
| Article 59 (Use of Electronic Documents) |
| (1) | All documents related to long-term care programs shall be recorded, managed, and preserved in electronic format, as prescribed by Ordinance of the Ministry of Health and Welfare. <Amended by Act No. 12067, Aug. 13, 2013> |
| (2) | The NHIS and each long-term care institution shall use electronic media or a method of exchanging electronic documents for filing an application for designation of a long-term care institution, filing claims for expenses for home care or institutional care benefits, and the payment for such claims. |
| (3) | Notwithstanding paragraphs (1) and (2), it does not need to use electronic documents, electronic media, or a method of exchanging electronic documents in an area specified by the Minister of Health and Welfare as an area in which conditions of an information and communications network or facilities for information and communications service are bad. |
| Article 60 (Submission, etc. of Data) |
| (1) | The NHIS may, if deemed necessary for carrying out the long-term care program, such as the verification of details of long-term care benefits provided, the management and evaluation of long-term care benefits, and the calculation of long-term care insurance contribution, demand any of the following persons to submit data: |
| 1. | The insured of a long-term care insurance, a dependent of the insured, or a recipient of medical benefits; |
| 2. | A beneficiary or a long-term care institution. |
| (2) | Any person who is requested to submit data pursuant to paragraph (1) shall comply with such request in good faith. |
| Article 61 (Reporting and Inspection) |
| (1) | The Minister of Health and Welfare or a Special Self-Governing City Mayor, Special Self-Governing Province Governor, or the head of a Si/Gun/Gu may order any of the following persons to submit a report or data on remuneration, income, or any other matters specified by Ordinance of the Ministry of Health and Welfare or instruct subordinate public officials to inquire of the interested parties or inspect the relevant documents: <Amended by Act No. 12067, Aug. 13, 2013> |
| 1. | The insured of a long-term care insurance; |
| 3. | Recipient of medical benefits. |
| (2) | The Minister of Health and Welfare or a Special Self-Governing City Mayor, Special Self-Governing Province Governor, or the head of a Si/Gun/Gu may order either of the following persons to submit data relevant to long-term care benefits, such as details of long-term care benefits provided or instruct subordinate public officials to inquire of the interested parties or inspect the relevant documents: <Amended by Act No. 12067, Aug. 13, 2013> |
| 1. | Long-term care institution; |
| 2. | Recipient of long-term care benefits. |
| (3) | In cases of paragraph (1) or (2), public officials shall carry an identification certifying their authority and a document that states the matters specified by Ordinance of the Ministry of Health and Welfare, including the period and scope of inspection, the persons in charge of the inspection, and the relevant statutes, and present the document to interested parties. <Amended by Act No. 13647, Dec. 29, 2015> |
| (4) | Except as otherwise expressly provided for in this Act, provisions of the Framework Act on Administrative Investigations shall apply to the procedure for, methods, etc. of the inquiry or inspection under paragraphs (1) and (2). <Newly Inserted by Act No. 13647, Dec. 29, 2015> |
| Article 62 (Prohibition of Divulgence of Confidential Information) |
None of the following persons shall divulge confidential information known to him/her in the course of performing his/her duties: <Amended by Act No. 12067, Aug. 13, 2013>
| 1. | A person who is working or has worked for a Special Self-Governing City, Special Self-Governing Province, or Si/Gun/Gu, the NHIS, a need assessment committee, or a long-term care institution; |
| 2. | A person who has provided benefits related to family care benefit in cash, exceptional care benefit in cash, or nursing expenses of long-term care hospitals pursuant to any provision of Articles 24 through 26. |
When a Special Self-Governing City Mayor, Special Self-Governing Province Governor, or the head of a Si/Gun/Gu intends to make any of the following dispositions or public disclosure, he/she shall hold hearings thereon: <Amended by Act No. 13647, Dec. 29, 2015>
| 1. | The cancellation of the designation of a long-term care institution or the issuance of an order to suspend business pursuant to Article 37 (1); |
| 2. | The issuance of an order to close down a long-term care institution for home care or to suspend business of such an institution pursuant to Article 37 (3); |
| 3. | The disclosure of violations or such to the public pursuant to Article 37-3; |
| 4. | Restriction on the provision of long-term care benefits pursuant to Article 37-5 (1). |
[This Article Wholly Amended by Act No. 12067, Aug. 13, 2013]
| Article 64 (Application Mutatis Mutandis to Prescription, etc.) |
Articles 91, 92, 96, 103, 104, 107, 111 and 112 of the National Health Insurance Act shall apply mutatis mutandis to the prescription, the calculation of a period, the supply of data, the supervision over the NHIS and others, the delegation or entrustment of authority, the entrustment of business affairs, the disposal of a fractional number, and other matters. In such cases, the term "insurance contribution" shall be construed as "long-term care insurance contribution," the term "insurance benefits" as "long-term care benefits," the term "care institution" as "long-term care institution," and the term "health insurance program" as "long-term care program." <Amended by Act No. 11141, Dec. 31, 2011>
| Article 65 (Prohibition of Legal Fiction as Income or Similar under other Acts) |
| Article 66 (Protection of Beneficiary Rights) |
| (1) | A right to receive long-term care benefits shall not be transferred, seized, or offered as security to or by someone else. <Amended by Act No. 14321, Dec. 2, 2016> |
| (2) | Claim on deposit of an account for receipt of care allowance for special cases under Article 27-2 (1) shall not be seized. <Newly Inserted by Act No. 14321, Dec. 2, 2016> |
CHAPTER XII PENALTY PROVISIONS
| Article 67 (Penalty Provisions) |
| (1) | Any of the following persons shall be punished by imprisonment with labor for not more than two years or by a fine not exceeding 20 million won: |
| 1. | A person who establishes and operates a long-term care institution without being designated, in violation of Article 31, or obtains designation of a long-term care institution by fraud or other unjust means; |
| 2. | A person who establishes and operates a long-term care institution for home care without filing a report thereon, in violation of Article 32, or files such report by fraud or other unjust menas; |
| 3. | A person who exempts or abates a beneficiary’s co-payment, in violation of Article 35 (5); |
| 4. | A person who is involved in the introduction, referral, or solicitation of a beneficiary or instigates another person to commit such an act, in violation of Article 35 (6); |
| 5. | A person who divulges confidential information known to him/her in the course of performing his/her duties, in violation of Article 62. |
| (2) | Either of the following persons shall be punished by imprisonment with labor for not more than one year or by a fine not exceeding ten million won: <Amended by Act No. 13647, Dec. 29, 2015> |
| 1. | A person who refuses to provide a long-term care benefit without a justifiable ground, in violation of Article 35 (1); |
| 2. | A person who receives, or aids and abets another person to receive, a long-term care benefit by fraud or other unjust means; |
| 3. | A person who does not take measures for protecting rights and interests under Article 36 (2), without good cause. |
[This Article Wholly Amended by Act No. 12067, Aug. 13, 2013]
| Article 68 (Joint Penalty Provisions) |
If the representative of a corporation or an agent or employee of or other persons employed by the corporation, or an individual commits an offence referred to in Article 67 in connection with the business of the corporation or the individual, not only shall such offender be punished, but also the corporation or the individual shall be punished by a fine under the same Articles: Provided, That the same shall not apply where such corporation or individual has not been negligent in paying due attention and supervision in connection with the relevant duties to prevent such offence. <Amended by Act No. 10127, Mar. 17, 2010>
| Article 69 (Administrative Fines) |
| (1) | Any of the following persons who do not have justifiable grounds shall be subject to an administrative fine of not more than five million won: <Amended by Act No. 10127, Mar. 17, 2010; Act No. 12067, Aug. 13, 2013; Act No. 13647, Dec. 29, 2015> |
| 1. | Deleted; <by Act No. 12067, Aug. 13, 2013> |
| 2. | A person who fails to file a report, or files such report by fraud or other unjust means, in violation of Article 33; |
| 2-2. | A person who fails to publish information about a long-term care institution, or falsely publishes information, in violation of Article 34; |
| 2-3. | A person who fails to issue a statement of expenses for long-term care benefits to a beneficiary, or falsely issues a statement, in violation of Article 35 (3); |
| 3. | A person who fails to keep and manage records of the provision of long-term care benefits or falsely makes records thereof, in violation of Article 35 (4); |
| 4. | A person who fails to report closure or suspension of business or fails to transfer data, or files such report by fraud or other unjust means, in violation of Article 36 (1) or (5); |
| 4-2. | A person who fails to inform a transferee, etc. without delay that an administrative disposition was imposed upon him/her or proceedings for an administrative disposition are pending, in violation of Article 37-4 (4); |
| 5. | Deleted; <by Act No. 12067, Aug. 13, 2013> |
| 6. | A person who makes a beneficiary bear expenses for long-term care benefits by fraud or other unjust means; |
| 7. | A person who fails to comply with a demand or order to submit a report or data under Article 60 or 61 or falsely submitted such report or data, or a person who refuses, interferes with, or evades an inquiry or inspection or falsely respond to an inquiry or inspection; |
| 8. | A person who takes part in filing a claim for expenses for long-term care benefits by fraud or other unjust means. |
| (2) | Administrative fines under paragraph (1) shall be imposed and collected by the competent Special Self-Governing City Mayor, Special Self-Governing Province Governor, or the head of the competent Si/Gun/Gu, as prescribed by Presidential Decree. <Newly Inserted by Act No. 12067, Aug. 13, 2013> |
| Article 70 Deleted. <by Act No. 12067, Aug. 13, 2013> |
ADDENDA
Article 1 (Enforcement Date)
This Act shall enter into force on July 1, 2008: Provided, That Chapter I (Articles 1 through 6), Chapter III (Articles 12 through 22), provisions governing long-term care workers of Article 23 (2), Chapter VI (Articles 31 through 37), Chapter VIII (Articles 45 through 47), Chapter IX (excluding Article 54), Chapter X (Articles 55 through 57), Chapter XI (excluding Article 58), and Chapter XII (Articles 67 through 70) shall enter into force on October 1, 2007. Article 2 (Preparatory Actions for Enforcement of this Act)
| (1) | The Minister for Health, Welfare and Family Affairs and the NHIS may take preparatory action as necessary for the enforcement of this Act from the date of its promulgation onwards. |
| (2) | The Minister for Health, Welfare and Family Affairs or the NHIS may request the State, local governments, a legal entity that provides social security services pursuant to any other statutes, or an organization that provides long-term care services to submit data necessary for the preparation for the enforcement of this Act. |
| (3) | Any person in receipt of a request to submit data pursuant to paragraph (2) shall comply with such request in good faith. |
Article 3 (Special Cases concerning Model Program)
| (1) | The Minister for Health, Welfare and Family Affairs may implement a model program before this Act enters into force to smoothly promote the long-term care program. |
| (2) | The Minister for Health, Welfare and Family Affairs may impose and collect long-term care insurance contribution when he/she implements the model program under paragraph (1). |
| (3) | The Minister for Health, Welfare and Family Affairs, each local government, and the NHIS may provide administrative and financial support to the model program under paragraphs (1) and (2). |
| (4) | The selection of an area for the model program under paragraph (1), procedures for, and method of, the imposition and collection of long-term care insurance contribution under paragraph (2), and other necessary matters concerning the implementation of the model program shall be prescribed by the Minister for Health, Welfare and Family Affairs. |
ADDENDA <Act No. 9386, Jan. 30, 2009>
Article 1 (Enforcement Date)
This Act shall enter into force one year after the date of its promulgation. (Proviso Omitted.)
Articles 2 through 7 Omitted.
ADDENDUM <Act No. 9510, Mar. 18, 2009>
This Act shall enter into force six months after the date of its promulgation.
ADDENDUM <Act No. 9693, May 21, 2009>
This Act shall enter into force on the date of its promulgation.
ADDENDA <Act No. 9932, Jan. 18, 2010>
Article 1 (Enforcement Date)
This Act shall enter into force two months after the date of its promulgation. (Proviso Omitted.)
Articles 2 through 5 Omitted.
ADDENDA <Act No. 10127, Mar. 17, 2010>
| (1) | (Enforcement Date) This Act shall enter into force on the date of its promulgation: Provided, That the parts that cite the provisions of Articles 35 (4) and 36 (5) in the amended provisions of Articles 35, 36 and 69 shall enter into force six months after the date of its promulgation. |
| (2) | (Transitional Measures concerning Administrative Fines) |
Former provisions shall apply to the application of administrative fines to acts conducted before this Act enters into force.
ADDENDA <Act No. 10785, Jun. 7, 2011>
Article 1 (Enforcement Date)
This Act shall enter into force six months after the date of its promulgation.
Articles 2 through 4 Omitted.
ADDENDA <Act No. 11141, Dec. 31, 2011>
Article 1 (Enforcement Date)
This Act shall enter into force on Sep. 1, 2012. (Proviso Omitted.)
Articles 2 through 22 Omitted.
ADDENDA <Act No. 12067, Aug. 13, 2013>
Article 1 (Enforcement Date)
This Act shall enter into force six months after the date of its promulgation.
Article 2 (Applicability to Penalty Surcharges)
The amended provisions of Article 37-2 shall apply to a violation committed on or after the day this Act enters into force. Article 3 (Applicability to Disclosure of Violations, etc.)
The amended provisions of Article 37-3 shall apply to a violation committed on or after the day this Act enters into force. Article 4 (Applicability to Succession to Effects of Administrative Dispositions)
The amended provisions of Article 37-4 shall apply to a disposition imposed for a violation committed on or after the day this Act enters into force. Article 5 (Transitional Measures concerning Administrative Dispositions, etc.)
Notwithstanding the amended provisions of Article 37, the imposition of administrative dispositions for a violation committed before this Act enters into force and the restriction on designation or reporting on the ground of such violation shall be governed by former provisions. Article 6 (Transitional Measures concerning Penalty Provisions and Administrative Fines)
Violations committed before this Act enters into force shall be governed by former penalty provisions and former provisions regarding administrative fines.
ADDENDA <Act No. 13647, Dec. 29, 2015>
Article 1 (Enforcement Date)
This Act shall enter into force one year after the date of its promulgation: Provided, That the amended provisions of Articles 36, 37 (5), 61, and 67 (2) 3 shall enter into force six months after the date of the promulgation of this Act, and the amended provisions of Articles 40 (1) and 43 (1) 3 shall enter into force on January 1, 2016. Article 2 (Applicability to Disqualifications and Transitional Measures concerning Incompetent Persons, etc.)
| (1) | The amended provisions of Article 32-2 shall begin to apply to the first persons who apply for the designation of a long-term care institution or reports the establishment of a long-term care institution after this Act enters into force. |
| (2) | The person under adult guardianship or under the limited guardianship pursuant to the amended provisions of subparagraph 1 of Article 32-2 are deemed to include the persons as to whom the declaration of incompetence or quasi-incompetence remains valid pursuant to Article 2 of the Addenda to the partial amendment (Act No. 10429) to the Civil Act. |
Article 3 (Applicability to Measures for Protecting Rights and Interests of Beneficiaries)
The amended provisions of Articles 36 (2) and (3) and 37 (5) shall begin to apply to the cases where business operations of an institution are closed or suspended, the designation of an institution is canceled, an institution is closed down, or its business operations are suspended after this Act enters into force. Article 4 (Applicability to Restriction on Provision of Long-Term Care Benefits and Administrative Fines)
The amended provisions of Articles 37-5 (1) and 69 (1) 8 shall begin to apply to the cases where a person takes part in a fraudulent act after this Act enters into force. Article 5 (Transitional Measures concerning Administrative Disposition for Disqualifications)
Notwithstanding the amended provisions of Article 37 (1) 2-2 and (3) 2-2, former provisions shall apply where a person who establishes and operates a long-term care institution at the time this Act enters into force become subject to the amended provisions of Article 37 (1) 2-2 or (3) 2-2 due to an event that took place before this Act enters into force as long as the person operates the long-term care institution. Article 6 (Transitional Measures concerning Restriction on Designation or Reporting)
Notwithstanding the amended provisions of Articles 37 (6) and 37-4, former provisions shall apply to the restriction on the designation or reporting of a long-term care institution on the ground of a violation committed before this Act enters into force and the transfer of the effects of administrative dispositions.
ADDENDA <Act No. 14215, May 29, 2016>
Article 1 (Enforcement Date)
This Act shall enter into force one year after the date of its promulgation: Provided, That the amended provisions of Articles 4 (5), 6 (1), and 54 (2) shall enter into force on the date of its promulgation, and the amended provisions of Article 47-2 shall enter into force six months after the date of its promulgation. Article 2 (Transitional Measures concerning Master Plan for Long-Term Care)
The master plan for long-term care formulated and implemented at the time this Act enters into force shall be deemed to have been formulated in accordance with the amended provisions of Article 6 (1). Article 3 (Transitional Measures concerning Administrative Dispositions)
Former provisions shall apply where an administrative disposition is made as to an act committed before this Act enters into force.
ADDENDUM <Act No. 14321, Dec. 2, 2016>
This Act shall enter into force six months after the date of its promulgation.