"What changed in the comprehensive community care addition in the FY2026 revision?" "I heard the dementia comprehensive care addition is gone—what happens to our billing?" These questions come up often at clinics that follow patients with hypertension, diabetes, or dyslipidemia over the long term. Based on materials published by the Ministry of Health, Labour and Welfare (MHLW), this article organizes the points effective June 1, 2026, eligible patients, clinic facility standards, whether notification is needed, and the newly created outpatient data submission addition.
Disclaimer: This article provides general information based on publicly available information as of October 13, 2026. The MHLW's public notices and circulars, and the guidance of your regional bureau of health and welfare, are authoritative for points, facility standards, and notification handling. Always confirm the latest original text and your regional bureau before making a final decision on notification or billing.
For the overall picture of the FY2026 revision, see Medical Fee Revision 2026: Changes Clinics Should Know, and for internal medicine highlights, see Fee Revision: Internal Medicine. The after-hours response system addition, one of the facility standards, is covered in After-Hours Response System Addition: FY2026 Points, Requirements for Types 1–4, and Notification.
Conclusion: key points of the FY2026 revision
| Item | Content (from June 1, 2026) |
|---|---|
| Structure | The dementia comprehensive community care addition/fee was merged into the comprehensive community care addition/fee |
| Points (clinic addition) | Type 1: 38 points for patients with dementia etc. / 28 points for other chronic conditions. Type 2: 31 / 21 points |
| Eligible patients | Patients with any of dyslipidemia, hypertension, diabetes, chronic heart failure, or chronic kidney disease who also receive long-term care or preventive care benefits were added |
| Physician staffing | Clinics in areas with limited medical resources need 1.4 full-time-equivalent physicians instead of 2 |
| Partner pharmacy | If the clinic can dispense antipyretic analgesics etc. in-house for emergencies, the partner pharmacy need not be available 24 hours |
| New | Outpatient data submission addition (10 points, once per month) |
- The points carry over the previous values: 38/31 from the dementia addition and 28/21 from the comprehensive community care addition. The patient category now determines the points.
- Clinics already notified are listed in the circular as "not requiring notification" (see below).
Points (clinics)
| Type | Patients with dementia etc. | Patients with other chronic conditions |
|---|---|---|
| Comprehensive community care addition 1 | 38 points | 28 points |
| Comprehensive community care addition 2 | 31 points | 21 points |
Hospitals notify the "comprehensive community care fee" (types 1 and 2), which was merged in the same way. This article focuses on the addition that clinics bill.
Eligible patients: two categories
The MHLW overview material organizes them as follows.
Patients with dementia etc. (38 / 31 points)
Patients who meet all of the following:
- They have dementia, or are insured persons requiring long-term care or support who receive long-term care or preventive care benefits
- They have at least one other disease besides dementia (suspected diagnoses excluded)
- In the same month they receive neither of the following at that medical institution:
- A prescription of more than 5 oral drugs per prescription
- A prescription containing more than 3 antidepressants, antipsychotics, anxiolytics, and hypnotics combined
Patients with other chronic conditions (28 / 21 points)
Either of the following (suspected diagnoses are not counted for any disease):
- Patients with two or more of the six diseases: dyslipidemia, hypertension, diabetes, chronic heart failure, chronic kidney disease (excluding those on chronic maintenance dialysis), and dementia
- Patients with any one of dyslipidemia, hypertension, diabetes, chronic heart failure, or chronic kidney disease who also receive long-term care or preventive care benefits (newly added)
In practice, you need a routine to confirm care-need certification through patient interviews and the long-term care insurance card. How that information is held in your billing system depends on the system you use.
Facility standards for clinics (type 1)
These are the main contents of Section 2-3 of the circular 保医発0305第7号 (handling of facility standards and notification for basic medical fees). Type 1 must meet all items; type 2 meets a subset.
| Item | Key points |
|---|---|
| Clinic | Hospitals are covered by the "fee," not the addition |
| Attending physician | A physician who completed appropriate training on chronic disease guidance; training on dementia is desirable |
| On-site notices | Health consultation and vaccination consultation; ability to respond to care managers and consultation support specialists; ability to prescribe for 28 days or more or issue refillable prescriptions |
| Website | In principle, post the same notices on the website (unless the clinic has no website it manages) |
| Partner pharmacy | For outpatient prescriptions, partner with a 24-hour pharmacy. Exempt if the clinic can dispense drugs needed in emergencies, such as antipyretic analgesics, antihypertensives, and bronchodilators, in-house |
| Smoking | Smoke-free premises (for leased portions of a building, the portion owned or leased) |
| Long-term care insurance | Notice that consultations on long-term care insurance are offered, issuance of physician opinion statements, plus any one of the items listed in the circular (e.g., designated home-care support provider, attending a community care conference at least once a year) |
| Home care | Provision of home medical care and a 24-hour house-call system (clinics other than home care support clinics may rely on partner institutions) |
| After-hours etc. | Any one of: notification of after-hours response system addition 1–4; 2 or more FTE physicians (at least 1 full-time); being a home care support clinic |
| Care coordination | Any one of: attending a service provider meeting, attending a community care conference, or providing consultation opportunities with care managers (in person or via ICT) |
| Track record of shifting to home visits | In the past year, patients billed for house calls or home visits after continuous outpatient care: 10 or more for home care support clinics, 3 or more for other clinics. In the past month, house calls/home visits are under 70% of patients seen |
| Decision-making support | A policy based on MHLW's guideline on decision-making for end-of-life care |
| Other | Not a clinic with a designation limited to 3 years or less under Article 68-2(1) of the Health Insurance Act |
How type 2 differs
Type 2 does not require the "home care and 24-hour house-call system" or the "track record of shifting to home visits"; it requires home care and a 24-hour contact system instead (the circular requires items (1)–(7), (9), (10), (12), and (13) of type 1 plus a 24-hour contact system). Its points are lower accordingly.
Special rule for areas with limited medical resources
For clinics located in the areas listed in Appended Table 6-2 of the "Facility Standards for Basic Medical Fees" notice, the staffing requirement is relaxed to 1.4 or more FTE physicians (at least one full-time). Check the table to see whether your location qualifies.
Notification: is it needed, and where to submit
- Medical institutions already billing as of May 31, 2026 do not need a new notification if they continue billing, under the transitional measures in the circular. The comprehensive community care addition is listed in Table 3 of the circular (facility standards revised but notification not required).
- However, if actual results after June 2026 differ from the notified standards, a change notification is required.
- New notifications use Form 2-3. A copy of the training completion certificate (a list is acceptable) must be attached, and a note on the form states that the notification must be renewed within 2 years.
- Submit to your regional bureau of health and welfare (or its branch). Check each bureau's guidance for reception methods and timing.
Pre-notification checklist
- The attending physician's training completion certificate is on hand
- Notices on health/vaccination consultation, care manager response, and long-term prescriptions/refills are posted
- The same contents are posted on the clinic website
- The partner pharmacy's 24-hour support is confirmed (or in-house dispensing for emergencies is arranged)
- The premises are smoke-free
- Physician opinion statements are issued; long-term care insurance items met and supporting documents checked
- Home care and 24-hour house-call system (type 2: 24-hour contact system) are in place
- One of: after-hours response system addition notification, physician staffing, or home care support clinic status
- A decision-making support policy is written
Changes to the medication optimization collaboration addition
For patients who also attend other medical institutions, the medication optimization collaboration addition can now be billed when advice and proposals based on prescription details and medication history sent to the other institution reduce the number of drugs. The MHLW overview organizes the eligible patients and requirements as follows.
| Before | After | |
|---|---|---|
| Eligible patients | Patients admitted to another medical institution or entering a health facility for the elderly | The same, plus patients continuously treated in the outpatient department of another medical institution |
| Information | Share medication status and history in cooperation | Provide the institution with medication status and history and ensure appropriate cooperation |
| Receiving prescription details | Within 1 month after discharge | Within 1 month after discharge, or within 3 months of providing the information |
| Drug count | The number of drugs prescribed by the other institution decreased | Same |
In addition, checking leftover medication at the patient's home and managing medication appropriately became a requirement, and it was clarified that using the electronic prescription system is one way of grasping and managing prescriptions for billed patients.
Outpatient data submission addition (new)
This rewards medical institutions that bill the comprehensive community care addition and continuously submit billing and clinical data to the MHLW.
| Item | Content |
|---|---|
| Points | 10 points, once per month |
| Main facility standards | Ability to participate properly in the outpatient survey; one designated contact; storage of records (5 years of medical records etc.); written storage rules; disease classification at ICD major-category level or finer; searchable by disease |
| Process | Notify with Form 7-10 → create and submit trial data for the 2 months after the deadline month → MHLW confirmation → notify with Form 7-11 → start billing |
| First deadline | November 20, 2026 (then February 22, May 20, August 20, November 22, 2027, and February 21, 2028) |
| Delays | If delays occur 3 times cumulatively in a survey year, a change notification is required and billing is not allowed from the following month |
The trial data covers the 2 months following the deadline month (the circular's example: a July 2027 notification means an August 20 deadline and trial data for September and October). The overview material also shows the sequence of notification, trial data creation, trial data submission, Form 7-11 notification, and start of billing; check the originals for exact timing. It is realistic to check in advance whether your EMR/billing system can export the data and whether your record-keeping rules are written down.
FAQ
Q. Do we need any procedure if we billed the dementia comprehensive community care addition? A. The merged structure carries over 38 and 31 points as the "patients with dementia etc." category. Institutions billing as of May 31, 2026 do not need a new notification. Please re-check that your actual results still match the standards.
Q. Is a care-need patient with only hypertension eligible? A. The overview states that patients with any of dyslipidemia, hypertension, diabetes, chronic heart failure, or chronic kidney disease who receive long-term care or preventive care benefits were added (suspected diagnoses excluded). For individual cases, check the circular text and your regional bureau.
Q. Can we bill without an after-hours response system addition notification? A. Meeting any one of the following is enough: notification of after-hours response system addition 1–4, 2 or more FTE physicians, or being a home care support clinic.
Summary
- From June 2026, the dementia addition was merged, and the clinic addition is 38/31 points for "patients with dementia etc." and 28/21 points for "other chronic conditions."
- Care-need patients with any of five conditions were added to the eligible patients.
- Clinics already notified need no new notification, but a change notification is required if results stop matching the standards.
- The first notification deadline for the outpatient data submission addition is November 20, 2026, and preparation takes time.
Talk to Pottech
Managing care-need information, automatic addition checks in the billing system, and exporting clinical data all depend on how your EMR and billing system are designed. Pottech supports clinics with system design that fits their billing and operations. Please feel free to contact us.
Related articles: Home-Visit Comprehensive Management Fee: How to Bill, From the Specific Disease Management Fee to the Lifestyle-Related Disease Management Fee
References
- MHLW, "FY2026 Medical Fee Revision II-3: Evaluation of family doctor, family dentist, and family pharmacist functions" (revision of the comprehensive community care addition; outpatient data submission addition) https://www.mhlw.go.jp/content/12400000/001681336.pdf
- MHLW Health Insurance Bureau, Medical Care Division, "Handling of facility standards for basic medical fees and notification procedures" (Mar 5, 2026, 保医発0305第7号) (Section 2-3, Section 2-3-2, Section 4 transitional measures, Form 2-3), posted by Kyushu Bureau https://kouseikyoku.mhlw.go.jp/kyushu/000476302.pdf
- MHLW, "Partial revision of the Facility Standards for Basic Medical Fees" (MHLW Notice No. 70 of 2026), posted by Kyushu Bureau https://kouseikyoku.mhlw.go.jp/kyushu/000476301.pdf