§1395i–5 Conditions for Coverage of Religious Nonmedical Health Care Institutional Services

Summary

Medicare can pay for hospital-level or home health care given by a religious nonmedical health care institution only if the person has filed a written choice saying they refuse ordinary medical treatment for religious reasons and would otherwise qualify for those Medicare benefits if they were in a regular hospital, skilled nursing facility, or home health agency. The written choice must be in the form the Secretary requires, signed by the person or their legal representative, say they are conscientiously opposed to nonexcepted medical treatment, and say that getting such treatment would conflict with their sincere religious beliefs. Getting a nonexcepted medical treatment that Medicare pays for ends (revokes) the choice. A person can cancel the choice in writing. If a person makes and then cancels the choice twice, the next new choice cannot start until 1 year after the last cancellation, and any later new choice cannot start until 5 years after the last cancellation. “Excepted” medical care means care given involuntarily, care required by law, and, starting December 29, 2022, the COVID‑19 vaccine and how it is given as described in the Medicare rules; “nonexcepted” means everything else. Before each fiscal year (starting 2000) the Secretary must estimate how much will be spent on these services. If the estimate is above a set “trigger” level, the Secretary must cut payments proportionally or set other limits (like limiting new elections or facilities) so spending does not go over the trigger. The trigger began at $20,000,000 for fiscal year 1998 and rises each year by the consumer price index, with certain adjustments and a limit on some increases. The Secretary watches actual spending and adjusts the trigger if spending was higher or lower. There is no administrative or court review of these estimates or reductions. If payments are reduced, the institution may increase what it charges the person by the amount of the reduction. If spending exceeds the trigger for three straight fiscal years (starting no earlier than 2002), future payments after the next January 1 will be made only for people who already had an active election on that January 1 and only while that election stays in effect. Each year (starting 1999) the Secretary must report spending and trends to Congress.