View all text of Part A [§ 1395c - § 1395i-6]
§ 1395i–5. Conditions for coverage of religious nonmedical health care institutional services
(a) In generalSubject to subsections (c) and (d), payment under this part may be made for inpatient hospital services or post-hospital extended care services furnished an individual in a religious nonmedical health care institution and for home health services furnished an individual by a religious nonmedical health care institution only if—
(1) the individual has an election in effect for such benefits under subsection (b); and
(2) the individual has a condition such that the individual would qualify for benefits under this part for inpatient hospital services, extended care services, or home health services, respectively, if the individual were an inpatient or resident in a hospital or skilled nursing facility, or receiving services from a home health agency, that was not such an institution.
(b) Election
(1) In general
(2) FormThe election form under this subsection shall include the following:
(A) A written statement, signed by the individual (or such individual’s legal representative), that—
(i) the individual is conscientiously opposed to acceptance of nonexcepted medical treatment; and
(ii) the individual’s acceptance of nonexcepted medical treatment would be inconsistent with the individual’s sincere religious beliefs.
(B) A statement that the receipt of nonexcepted medical services shall constitute a revocation of the election and may limit further receipt of services described in subsection (a).
(3) Revocation
(4) Limitation on subsequent electionsOnce an individual’s election under this subsection has been made and revoked twice—
(A) the next election may not become effective until the date that is 1 year after the date of most recent previous revocation, and
(B) any succeeding election may not become effective until the date that is 5 years after the date of the most recent previous revocation.
(5) Excepted medical treatmentFor purposes of this subsection:
(A) Excepted medical treatmentThe term “excepted medical treatment” means medical care or treatment (including medical and other health services)—
(i) received involuntarily,
(ii) required under Federal or State law or law of a political subdivision of a State, or
(iii) effective beginning on December 29, 2022, that is a COVID–19 vaccine and its administration described in section 1395x(s)(10)(A) of this title.
(B) Nonexcepted medical treatment
(c) Monitoring and safeguard against excessive expenditures
(1) Estimate of expenditures
(2) Adjustment in payments
(A) Proportional adjustment
(B) Alternative adjustments
(C) Trigger levelFor purposes of this subsection—
(i) In general
(ii) Unadjusted trigger levelThe “unadjusted trigger level” for—(I) fiscal year 1998, is $20,000,000, or(II) a succeeding fiscal year is the amount specified under this clause for the previous fiscal year increased by the percentage increase in the consumer price index for all urban consumers (all items; United States city average) for the 12-month period ending with July preceding the beginning of the fiscal year.
(D) Prohibition of administrative and judicial review
(E) Effect on billing
(3) Monitoring expenditure level
(A) In general
(B) Adjustment in trigger level
(i) In general
(ii) Limitation on carryforward
(d) Sunset
(e) Annual reportAt the beginning of each fiscal year (beginning with fiscal year 1999), the Secretary shall submit to the Committee on Ways and Means of the House of Representatives and the Committee on Finance of the Senate an annual report on coverage and expenditures for services described in subsection (a) under this part and under State plans under subchapter XIX. Such report shall include—
(1) level of expenditures described in subsection (c)(1) for the previous fiscal year and estimated for the fiscal year involved;
(2) trends in such level; and
(3) facts and circumstances of any significant change in such level from the level in previous fiscal years.
(Aug. 14, 1935, ch. 531, title XVIII, § 1821, as added Pub. L. 105–33, title IV, § 4454(a)(2), Aug. 5, 1997, 111 Stat. 428; amended Pub. L. 108–173, title VII, § 706(a), Dec. 8, 2003, 117 Stat. 2339; Pub. L. 117–328, div. FF, title IV, § 4138(a), Dec. 29, 2022, 136 Stat. 5925.)