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Title 42, The Public Health and WelfareRelease 119-110

§1396l Hospital Providers of Nursing Facility Services

Title 42 › CHAPTER 7 — SOCIAL SECURITY › SUBCHAPTER XIX — GRANTS TO STATES FOR MEDICAL ASSISTANCE PROGRAMS › § 1396l

Last updated Sep 23, 2026|Official source

Summary

Lets Medicaid pay hospitals for nursing-home type care when the hospital has an agreement under section 1395tt and meets the rules in subsections (b)–(d) of section 1396r. Normally the hospital is paid the average per-patient-day rate that nursing homes in the State got under the State plan in the previous calendar year. Costs for extra services are figured the same way as for inpatient hospital care. To split routine costs, the total routine payments from all long-term care patients (including subchapter XVIII, this subchapter, and private-pay) must be subtracted from the hospital’s total routine costs before computing hospital routine reimbursement. A State may instead set a payment rate under section 1396a(a)(13)(A).

Full Legal Text

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, 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.

Legislative History

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.

Reference

Citations & Metadata

Citation

42 U.S.C. § 1396l

Title 42, The Public Health and Welfare

Last Updated

Sep 23, 2026

Release point: 119-110