介護事業者の実地指導、全国初の受託－東京都福祉保健財団

東京都の管理団体「東京都福祉保健財団」は、介護保険事業者への実地指導を区市町村から受託する「事業者指導・支援センター」を設置し、7月15日から事業をスタートさせた。保険者から実地指導を受託した全国初のケースとなった。
2006年の介護保険法改正において「指定市町村事務受託法人」制度が設けられ、保険者は、都道府県が指定した法人に「事業者に対する実地指導」と「要介護認定調査事務(新規調査含む)」を委託できるようになった。要介護認定調査の事務は委託が広まっているが、実地指導については前例がなかった。
　介護サービスの質の確保と保険給付適正化を目的とした実地指導は、区市町村の職員が事業者を訪問して、人員やケアプラン、報酬の請求などが基準に沿ったものかを確認し、指導を行うというもの。問題点が見つかった場合、区市町村は文書で指摘し、事業者は原則として1か月以内に改善報告書を提出することになる。
　「事業者指導・支援センター」の職員は保険者の職員に同行し、事業者への指導や結果報告などを行う。文書による問題点の指摘や改善報告書の受理、行政指導や処分が伴う監査(実地検査)については業務の対象外だ。

　今回、保険者が実地指導を委託した理由について都福祉保健局の村田由佳指導調整課長は、それぞれの保険者で理由は異なるとした上で、06年の法改正で保険者に地域密着サービスにおける指導や監査の権限が付与されたことで、「実地指導が必要だという意識が都内の全保険者に根付いてきたのではないか」と話す。また、「23区の保険者の中には、監査でも権限を行使した方がいいのではないかという声もある」とし、実地指導と両立するためにも「指定市町村事務受託法人」を活用したいという話もあったという。

　東京都福祉保健財団の「事業者指導・支援センター」は、今年5月に都から「指定市町村事務受託法人」の指定を受けた。併せて、ケアマネジャーの資格を持つ3人の職員を採用し、都の福祉保健局が実地指導についての研修などを約3か月間行った。村田課長は「人によって指導する内容や指摘事項が異なってはいけない。標準化を徹底しながら、都のノウハウを伝えた」という。
　「事業者指導・支援センター」では、江東や目黒など8区、立川や府中など10市の計18市区から業務を受託しており、15日から実地指導に同行している。年度内に204件の実地指導を行う予定だ

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