§1395i–5 Conditions for coverage of religious nonmedical health care institutional services

Summary

Payments for hospital, extended care, or home health services given by a religious nonmedical health care institution will only be made if the person has signed a written choice saying they refuse regular medical care for religious reasons and if the person would otherwise qualify for the same services in a hospital, skilled nursing facility, or from a home health agency. The written choice must be made on a form the Secretary sets, takes effect right away unless the form says otherwise, and stays in effect until the person revokes it. The form must say the person objects to nonexcepted medical treatment for sincere religious reasons and must warn that getting nonexcepted medical care will cancel the choice and may limit future services. A choice is revoked either by sending a written notice to the Secretary or by getting nonexcepted medical treatment that is paid for under the program. After two revocations, the next new choice cannot take effect until 1 year after the most recent revocation, and later choices cannot take effect until 5 years after the most recent revocation. “Excepted medical treatment” means care received involuntarily, care required by law, and, effective December 29, 2022, COVID-19 vaccines; “nonexcepted” means other medical care. Each year the Secretary must estimate spending for these services (starting with fiscal year 2000). If estimated spending would exceed a trigger level, the Secretary must lower payments proportionally or set other limits (like limiting new elections or facilities) so spending does not go over the trigger. The unadjusted trigger level was $20,000,000 for fiscal year 1998 and rises each year by the percentage increase in the CPI‑U for the 12 months ending the July before the fiscal year. The Secretary will monitor actual spending (starting fiscal year 1999) and may raise or lower the next year’s trigger by the amount spending was over or under the trigger, but any increase in a year cannot exceed $50,000,000. If spending exceeds the trigger for three straight fiscal years (the first of those being no earlier than fiscal year 2002), then benefits given on or after the first January 1 after those three years will be paid only for people who had an election in effect on that January 1 and only while that election lasts. At the start of each fiscal year (starting fiscal year 1999), the Secretary must send Congress a report showing spending, estimates, trends, and reasons for any major changes.