長期照顧特約管理辦法

The following regulations (“Regulations”) have been formulated in accordance with Article 32–1 of the Long-Term Care Services Act ( “the Act”).

1Pursuant to Article 32-1 of this Act, units providing long-term care services as defined in Articles 10 through 13 of this Act, (hereinafter referred to as 'long-term care service provider'), shall include agencies, institutions, legal persons, organizations, business entities, or social work offices established or registered in accordance with the law.

2The long-term care service providers that offer long-term care services payment items described under Article 7, Paragraph 2 of the Regulations for Long-term Care Service Application and Payment (“Payment Regulations”) must first obtain the approval of the competent authority of municipalities and counties (cities) (“local competent authority”) and sign an administrative contract to become a long-term care provider by contract.

3The types of long-term care services payment items and the qualifications required for each type of service are shown in Appendix I.

Each local competent authority shall set up and announce service regions within its jurisdiction based on local long-term care demand, service needs, geographical conditions, and population distribution.

1Legally established or registered institutions, legal persons, and associations with experience in care services, professional services or care management services may apply to establish community integrated services center with the approval of the local competent authority to provide services such as long-term care planning, service referrals, communication and coordination, and other management matters.

2Care plans formulated in accordance with the preceding paragraph shall be reported to the local competent authority for approval before implementation.

1The long-term care service providers and the institutions, legal persons, and associations described in Paragraph 1 of the preceding article (collectively, “applicants”) that wish to apply to provide the services listed in Article 2, Paragraph 2 and Article 4, Paragraph 1 shall fill out an application and submit the necessary documents (listed in Appendix II) to the local competent authority of the appropriate service region(s) established in accordance with Article 3.

2Applicants shall make up any missing documents or information and submit it by the deadline specified by the local competent authority. Failure to do so shall result in automatic rejection of the application.

1The local competent authorities shall complete the review and approval process based on the service regions and resources described in Article 3 within 30 days of receiving an application. If necessary, they may extend the review period for another 30 days after notifying the applicant in writing. Upon receiving notification of approval, applicants shall sign an administrative contract with local authorities within 30 days.

2The results of the review described in the preceding paragraph shall include the permitted service region(s) and long-term care services payment items as well as the approval validity period, as described in Article 10 herein.

3The local authorities shall record the approval results and contract terms described in Paragraph 1 herein in the information system maintained by the central competent authority. The same shall apply when contract terms are amended.

1The local competent authority may reject an application described in Paragraph 1 of the preceding article if it finds the application to be inconsistent with the needs or available resources in the service region or under any of the following circumstances:

21. Currently under business suspension.

32. The applicant has unresolved cases with the local competent authority and is refusing to cooperate.

43. The applicant has outstanding monetary obligations to the local competent authority.

54. The applicant is required by law to undergo appraisal but failed or received a ‘C’ or lower grade in the most recent appraisal.

65. The licenses or certificates of long-term care personnel hired by the applicant have expired and have yet to be renewed.

76. The applicant harbors service personnel who are ineligible for long-term care payments under Article 18; Article 19, Paragraph 2; or Article 20, Paragraph 3 of the Payment Regulations.

87. The applicant had a contract terminated under Article 32, Paragraph 1, Subparagraphs 2 through 10 in the most recent one-year period or has unpaid fines associated with violations of long-term care regulations

1The local competent authorities shall reject applications by new care providers established by the representative or responsible person of a defunct care provider whose contract was terminated under Article 32, Paragraph 1, Subparagraphs 2 through 10 at any time within the three-year period preceding the application.

2If the three-year period has expired, the application may be approved. However, if the newly established care provider is again found to be in violation of Article 32, Paragraph 1, Subparagraphs 2 through 10, any care providers established by the same representative/responsible person shall be barred from submitting another application for a period of five years.

Applicants that wish to provide two or more long-term care services payment items but that are determined by the local competent authority to be only eligible for certain specific items may be awarded a contract to provide only specified items.

A long-term care service administrative contract shall be valid for three years. The term of the contract, including the effective and expiration dates, shall be clearly indicated.

1The local competent authorities shall notify long-term care providers by contract and community integrated service centers (collectively, “contracted service providers”) to renew their contracts 90 days prior to the contract expiration date. Contracted service providers that fail to respond to the notification at least 30 days prior to the expiration date shall be deemed as having chosen to not renew their contract.

2If a long-term care provider by contract has chosen not to renew its contract, as described in the preceding paragraph, the local competent authority shall immediately begin to formulate plans for the placement of long-term care service recipient(s) and payment of service fees in accordance with Article 33.

1Contracted service providers shall hang or put up the designated long-term care service contract sign issued by the central competent authority in a clearly visible location at their place of business.

2Upon contract termination, rescission, or non-renewal, contracted service providers shall remove the sign described in the preceding paragraph and replace it with a notice of service termination. In the event of contract amendment, they shall put up a notice of the amended contract terms near where the sign is located.

3Contracted service providers with a website shall put up notices similar to those described in the preceding paragraph on their website.

The long-term care providers by contract that are assigned long-term care service recipients by a community integrated service center or the local competent authority shall provide case updates to said center or authority by the applicable deadlines stipulated in the contract. The same shall apply to community integrated service centers that are assigned cases by the local competent authority.

1The long-term care providers by contracts shall sign a written contract with the long-term care service recipient(s), family members, or fee payers.

2Contracts for care services, professional services, transportation services, and respite care service providers shall conform to the required contract format and shall include the mandatory and prohibitory provisions set forth by the central competent authority in accordance with Article 42, Paragraph 2 of the Act.

1If a long-term care provider by contract is rendered temporarily unable to provide services due to a disaster described in Article 2, Paragraph 1 of the Disaster Prevention and Protection Act, a communicable disease described in Article 3, Paragraph 1 of the Communicable Disease Control Act, or other force majeure event, the provider shall notify the community integrated service center or local competent authority within 24 hours.

2The long-term care providers by contracts shall notify the community integrated service center or local competent authority of any of the following by the following business day:

31. An event described in the preceding paragraph which does not threaten the lives and safety of long-term care service recipient(s)

42. A home care long-term care service recipient(s) who is determined to be eligible under Article 10, Paragraph 1 of the Payment Regulations

53. A long-term care personnel found to have violated Article 56 of the Act

The long-term care providers by contract shall issue receipts for services rendered in a format consistent with the Act and other applicable regulations. Such receipts shall indicate the care packages and costs of services rendered (see Appendix IV of the Payment Regulations for a list of service codes), with a table of service types, quantities, dates, unit and total costs, copayment, and other details included as an appendix.

1The personnel of contracted service providers shall prepare records and such records shall be managed by a designated person and duly retained for at least 7 years. Records about minors shall be retained until at least seven years after they reach the age of majority.

2Medical information contained in the records described in the preceding paragraph shall additionally be handled in accordance with the Medical Care Act and related laws.

3Records may be destroyed following the conclusion of the retention periods described in the preceding two paragraphs in a manner that ensures personal data safety.

4Any contracted service providers described in Paragraph 1 that is unable to continue providing service shall transfer the service records to their successor(s), who shall continue to retain the records in accordance with the preceding two paragraphs. If there are no successors, the service users or their representatives may request their service records from the long-term care provider by contract . Any remaining records shall continue to be retained for another six months before destruction.

5The contracted service providers that are unable to retain service records due to a justifiable cause may hand over such records to the local competent authority for retention.

Unless otherwise stipulated in their contract, the contracted service providers shall upload a service log by the 10th of each month for the previous month in the format specified by the central competent authority to the information system maintained by the same authority.

1In the event of a change in their registration details, contracted service providers shall present the approval documents for the change issued by the industry competent authority to the local competent authority within 10 days in order to have their contract amended.

2If a contracted service provider is contracted by two or more local competent authorities, it shall undertake the process described in the preceding paragraph with each local competent authority.

3Local competent authorities shall complete the contract amendment review process within 30 days of receiving an application from a contracted service provider.

Community integrated service centers, including their personnel, are prohibited from requesting any charges from long-term care providers by contract.

1The long-term care providers by contract shall clearly stipulate the rights and obligations of care workers in their service agreement.

2The term “caregiving service personnel” in the preceding paragraph shall mean long-term care personnel described in Article 2, Paragraph 1, Subparagraph 1 of the Regulations for the Training, Certification, Continuous Education and Registration for Long-Term Care Personnel.

Any contracted service provider established by a labor cooperative shall ensure that the working conditions of members providing long-term care services satisfy the related labor laws and regulations in accordance with Article 32–2, Paragraph 2 of the Act, and shall ensure that labor conditions are consistent with the applicable labor regulations, , and shall specify this in the administrative contract.

In principle, the long-term care providers by contract that offer home care services, adult foster care, professional services, transportation services, or respite care service at home shall arrange for someone other than the long-term care service recipient(s)’ spouse or a lineal relative within the second degree of kinship (by blood or by marriage) to serve as the caregiver.

The long-term care providers by contract are prohibited from poaching long-term care service recipients from other care providers by offering referral bonuses, service fee discounts, or other incentives.

1The administrative contract shall expressly stipulate that a long-term care provider by contract that commits any of the following violations during the contract period, shall be imposed one demerit point on the contractual long-term care services payment items:

21. Receiving a fine under Article 49, Paragraph 1 of the Act for offering discounts on fees payable by long-term care service recipient(s), thus violating Article 8-1, Paragraph 3 of the same Act

32. Receiving a fine under the applicable regulations for violating Article 32–2 of the Act

43. Violation of the provisions in Article 19–1, Paragraph 1 of the Regulations for the Training, Certification, Continuous Education and Registration for Long-Term Care Personnel includes refusing requests for support from caregiving service personnel.

54. Failure to make the necessary improvements by the stipulated deadline after violating care plan and payment guidelines set forth under Article 4, Paragraph 2 herein

65. Failure to respond to the community integrated services center or local competent authority without just cause by the stipulated deadline after accepting a case assignment in accordance with Article 13 herein

76. Failure to sign a written contract with long-term care service recipient(s) or their family members or fee payers in accordance with Article 14, Paragraph 1 herein, or having signed a contract that is inconsistent with the mandatory/prohibitory stipulations provided in Article 42, Paragraph 2 of the Act

The administrative contract shall expressly stipulate that a long-term care provider by contract shall be deemed in breach of the administrative contract and be imposed one demerit point if it has committed any of the offenses described in Subparagraphs 4, 8, 9, 10, 16, and 18 of the preceding article a second time after avoiding a demerit point due to improvements made following the first offense. Upon issuance of the demerit point, the violation record shall be reset to zero.

1The administrative contract shall expressly stipulate that a long-term care provider by contract that commits any of the following violations during the contract period, shall be imposed two demerit points on the contractual long-term care services payment items：

21. Repeating an offense described in Article 25

32. Repeating an offense described in the preceding article

4A long-term care provider by contract that commits the same offense three times or more during the contract period may be subject to progressively greater demerit points by the local competent authority.

1The administrative contract shall expressly stipulate that a community integrated service center that commits any of the following violations during the contract period, shall be imposed one demerit point on the contractual long-term care services payment items:

21. Being fined in accordance with the applicable regulations for violating Article 32–2, Paragraph 2 of the Act

32. Failure to respond to the community integrated service centers or local competent authority without just cause after accepting a case assignment in accordance with Article 13 herein

43. Failure to prepare, retain, or hand over records in accordance with Article 17 herein, or forging or falsifying such records, and failing to make the necessary improvements by the stipulated deadline

54. Failing to make the necessary corrections following a failure to provide service information in a timely manner in accordance with Article 18 herein; providing false information; or providing care services through a personnel who is not named in the information system maintained by the central competent authority

65. Failure to amend a contract in accordance with Article 19, Paragraph 1 or 2 by the stipulated deadline

76. Requesting benefits from long-term care providers by contract, thus violating Article 20 herein

The administrative contract shall expressly stipulate that a community integrated service center shall be deemed in breach of the administrative contract and be imposed one demerit point if it commits an offense described in Subparagraphs 3, 4, 9, 10, and 12 of the preceding article a second time after avoiding a demerit point due to improvements made following the first offense. Upon issuance of the demerit point, the violation record shall be reset to zero.

1The administrative contract shall expressly stipulate that a community integrated service center that commits any of the following violations during the contract period, shall be imposed two demerit points on the contractual long-term care services payment items：

21. Repeating any of the offenses described in Article 28

32. Repeating any of the offenses described in the preceding article

4A community integrated service center that commits the same offense three times or more during the contract period may be subject to progressively greater violation points by the local competent authority.

1A contracted service provider that is issued demerit points in accordance with Articles 25 through 30 shall be ineligible for case assignments for a period of 30 to 180 days and, depending on the severity of the offense, may be permanently barred from accepting case assignments for certain or all types of payable long-term care services. If the suspension period is longer than the remaining term of the contract, the final day of the contract shall also be the final day of the suspension period.

2Contracted service providers that are legally required to undergo appraisal and which failed or received a grade of ‘C’ or lower in the most recent appraisal, and have been granted a remediation period by the competent authority, or who fall under any of the circumstances listed in Article 42, Items 1 through 4 or Items 7 through 9, may have their case assignments suspended for a specified period by the local competent authority. The same shall apply to long-term care providers by contract facing suspension under Article 48–1 of the Act.

3Contracted service providers found to be in violation of Article 42, Paragraph 5, 6, or 10 may be assigned fewer cases over a period specified by the local competent authority.

4The start date of case assignment suspension or reduction, as described in the preceding three paragraphs, shall be specified by the local competent authority.

1A contracted service provider that commits any of the following offenses shall be subject to contract termination by the local competent authority:

21. Business closure or relocation (at-home care service providers that relocating within the same administrative jurisdiction zone without making any change registration are exempt from this subparagraph)

32. Being ordered to suspend operations

43. The company registration being subject to the rescission or revocation by the competent authority

54. Significant falsification or inflation of submitting claim for services fees

65. Failing the most recent appraisal or receiving a grade of ‘C’ or lower and failing to make the necessary improvements by the specified deadline

76. Failure to comply with the stipulated service schedule or unilateral termination of services as per the special agreement and failing to make the necessary improvements

87. Serious violations of Article 48–1 of the Act

1The local competent authorities shall require contracted service providers facing contract termination or non-renewal to refer cases under their charge to another care provider or a suitable arrangement.

2Prior to the long-term care recipient’s appropriate placement, the contracted service provider may submit a final claim for service fees. The local competent authority may review and approve such claim, notwithstanding the time limit prescribed in Article 39, Paragraph 2.

1To better understand service conditions, the local competent authorities may require contracted care providers to submit relevant documentation or appoint inspectors to conduct on-site visits.

2When performing an on-site visit, inspectors shall present a badge or other form of identification to the contracted service provider, who shall cooperate with the inspectors and may not evade, avoid, or obstruct such visits in any way.

1The local competent authorities must conduct at least one review of services completed and service fees claim submitted by each contracted service provider during its contract period.

2The review may be based on a sample of all long-term care service recipients served. The sampling rate shall not be less than 10% of the total number of the long-term care service recipients claim submitted in the current year.

1If a contracted service provider is found to be in violation of any subparagraph of Article 42 during the review process described in the preceding article, thus rendering the it ineligible for payment, the local competent authority shall attempt to recover the associated service fees or shall deduct the equivalent amount from future payments. For serious or extended violations, punitive damages of 5–10 times the amount may be assessed, which may be increased to 10–20 times for repeat offenses.

2The local authorities shall handle the recovery/deduction process described in the preceding paragraph in accordance with the Administrative Procedure Act. In principle, the owed amount shall be collected in a lump-sum payment. However, a contracted service provider that does not have the financial resources to settle the punitive damages may apply to the local competent authority to have the equivalent amount deducted from future monthly payments over a specified period of time.

The administrative contract shall expressly stipulate that if contracted service providers wish to dispute a measure implemented by the local competent authority, they may file an appeal by providing specific reasons in writing within 30 days of the implementation of the measure. Each measure may only be appealed once.

1Unless otherwise stipulated in their administration contract, contracted care providers shall submit claim for service fees with the local competent authority by submitting the necessary documentation for services rendered by the 10th of each month.

2The local competent authorities may delay the review process for service fees claims submitted after the deadline stipulated in the preceding paragraph until the next monthly submitting cycle. The foregoing notwithstanding, contracted service providers must submit claims within three months of the original deadline.

1Local competent authorities shall notify contracted service providers to make the necessary corrections to missing or erroneous submitting forms/documents by a stipulated deadline.

2Local competent authorities shall complete the review process within 10 days after contracted service providers has prepared all relevant documents and data, and shall make any necessary payments within 30 days of review completion.

3Local competent authorities may delay the review process for corrections of missing or erroneous forms/documents (as described in Paragraph 1) submitted after the deadline until the next monthly review cycle. Payments for claims that are not corrected within three months of the original deadline may be exempt from the limitation set forth in the preceding paragraph.

The local competent authorities and contracted service providers may stipulate in the administrative contract that advances payment be issued to cover certain service expenses.

1Unless otherwise stipulated in the administrative contract, the local competent authorities shall consider the following items when reviewing service fees claims submitted by contracted service providers:

21. Eligibility of long-term care service recipients and qualifications of personnel

32. The limit of long-term care service benefits

43. A comparison of the care plan service items with the care service combinations and payment prices set forth in Appendix IV (Care Services Combined Table) of the Payment Regulations

54. Completeness and accuracy of the data on file in the information system maintained by the central competent authority

65. Other matters of attention specified by the local competent authority

1Local competent authorities shall refuse to pay for this portion of service fees claims submited if the contracted service provider is found to be in violation of any of the following:

21. The provision of the services listed in Appendix I to ineligible users due to negligence attributable to the contracted care provider

32. Submitting claim for services fees for care services not administered in accordance with the care plan(s) approved under Article 4, Paragraph 2 herein

43. Provision of services not stipulated in the contract, outside the contract period, or beyond the specified service region

54. Entering false or erroneous data into the information system maintained by the central competent authority

65. Failure to appoint someone other than the service long-term care service recipient’s spouse or a lineal relative within the second degree of kinship (by blood or by marriage) to serve as the personnel in accordance with Article 23 herein

76. Provision of services inconsistent with the stipulations and descriptions in Appendix IV of the Payment Regulations

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1Depending on the seriousness of the offense, the local competent authorities may report contracted service providers who are in violation of any of the following subparagraphs to the industry competent authority:

21. Violations of Article 32–2 of the Act

32. Failure to issue receipts in accordance with Article 16 herein, the Act, and other applicable regulations

43. Failure to prepare, retain, or hand over service records in accordance with Article 17 herein, or forging or falsifying such records

54. Falsification or inflation of submitting claim for services fees

65. Being convicted or sentenced to probation in a final and binding ruling for, abandoning, physically and mentally abusing, discriminating, hurting or illegally confining their service recipient(s)’ personal freedom, or infringing upon the recipient(s)’ interest and right

The target of rejecting administrative contract signing, imposing demerit points, case assignments suspension and reduction, recovery or deduction of service fees, and collection for administrative measures pertaining to a community integrated service center shall be the institution, legal person, or association that established the center.

The provisions governing care services and payments set forth in contracts between local competent authorities and organizations, institutions, legal persons, associations, businesses, and social work offices that were ratified prior to the implementation of these Regulations shall remain in effect until their respective expiry dates. However, if the provisions herein are more favorable to the contracted service provider, such provisions shall take precedence.

These Regulations shall be implemented on the date of promulgation.