§1396l — Title 42 The Public Health and Welfare | U.S. Code

Summary

Lets a state Medicaid plan pay a hospital for nursing‑facility care the hospital gives if the hospital has an agreement under section 1395tt and meets the nursing‑facility rules in section 1396r. Payment is usually the State’s average per‑patient‑day rate for routine nursing‑facility services from the previous calendar year. Ancillary services are paid by the usual hospital reasonable‑cost rules. The hospital must subtract total routine reimbursements for all long‑term‑care patients (including those under subchapter XVIII, this subchapter, and private‑pay) from its total routine costs before figuring hospital routine reimbursement. A State may instead set a different payment rate under section 1396a(a)(13)(A).

Title 42, §1396l

The Public Health and Welfare — Source: USLM XML via OLRC

(a)Notwithstanding any other provision of this subchapter, payment may be made, in accordance with this section, under a State plan approved under this subchapter for nursing facility services furnished by a hospital which has in effect an agreement under section 1395tt of this title and which, with respect to the provision of such services, meets the requirements of subsections (b) through (d) of section 1396r of this title.

(b)(1)Except as provided in paragraph (3), payment to any such hospital, for any nursing facility services furnished pursuant to subsection (a), shall be at a rate equal to the average rate per patient-day paid for routine services during the previous calendar year under the State plan to nursing facilities, respectively,11 So in original, “, respectively,” probably should not appear. located in the State in which the hospital is located. The reasonable cost of ancillary services shall be determined in the same manner as the reasonable cost of ancillary services provided for inpatient hospital services.

(2)With respect to any period for which a hospital has an agreement under section 1395tt of this title, in order to allocate routine costs between hospital and long-term care services, the total reimbursement for routine services due from all classes of long-term care patients (including subchapter XVIII, this subchapter, and private pay patients) shall be subtracted from the hospital total routine costs before calculations are made to determine reimbursement for routine hospital services under the State plan.

(3)Payment to all such hospitals, for any nursing facility services furnished pursuant to subsection (a), may be made at a payment rate established by the State in accordance with the requirements of section 1396a(a)(13)(A) of this title.

Notes & Related Subsidiaries

Editorial Notes

Amendments

1987—Pub. L. 100–203, § 4211(h)(9)(A), substituted “nursing facility services” for “skilled nursing and intermediate care services” in section catchline. Subsec. (a). Pub. L. 100–203, § 4211(h)(9)(B), substituted “nursing facility services” for “skilled nursing facility services and intermediate care facility services” and inserted “and which, with respect to the provision of such services, meets the requirements of subsections (b) through (d) of section 1396r of this title” before period at end. Subsec. (b)(1). Pub. L. 100–203, § 4211(h)(9)(C), substituted “nursing facility services” for “skilled nursing or intermediate care facility services” and “nursing facilities” for “skilled nursing and intermediate care facilities”. Subsec. (b)(3). Pub. L. 100–203, § 4211(h)(9)(D), substituted “nursing facility services” for “skilled nursing or intermediate care facility services”. 1984—Subsec. (b)(1). Pub. L. 98–369, § 2369(a)(1), substituted “Except as provided in paragraph (3), payment” for “Payment”. Subsec. (b)(3). Pub. L. 98–369, § 2369(a)(2), added par. (3).

Statutory Notes and Related Subsidiaries

Effective Date

of 1987 AmendmentAmendment by Pub. L. 100–203 applicable to nursing facility services furnished on or after Oct. 1, 1990, without regard to whether

Regulations

implementing such amendment are promulgated by such date, except as otherwise specifically provided in section 1396r of this title, with transitional rule, see section 4214(a), (b)(2) of Pub. L. 100–203, as amended, set out as an

Effective Date

note under section 1396r of this title.

Effective Date

of 1984 Amendment Pub. L. 98–369, div. B, title III, § 2369(b), July 18, 1984, 98 Stat. 1110, provided that: “The

Amendments

made by this section [amending this section] shall apply to payments for services furnished after the date of the enactment of this Act [July 18, 1984].”

Effective Date

Section effective on date on which final

Regulations

to implement the section are first issued, see section 904(d) of Pub. L. 96–499, set out as an

Effective Date

note under section 1395tt of this title.

§1396l Hospital providers of nursing facility services

Summary

Title 42, §1396l

Notes & Related Subsidiaries

Editorial Notes

Amendments

Statutory Notes and Related Subsidiaries

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Regulations

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Amendments

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Regulations

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