[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR403.720]



[Page 53-54]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 403_SPECIAL PROGRAMS AND PROJECTS--Table of Contents

 

   Subpart G_Religious Nonmedical Health Care Institutions_Benefits, 

                Conditions of Participation, and Payment

 

Sec. 403.720  Conditions for coverage.



    Medicare covers services furnished in an RNHCI if the following 

conditions are met:

    (a) The provider meets the definition of an RNHCI as defined in 

section 1861(ss)(1) of the Act. That is, it is an institution that:

    (1) Is described in section 501(c)(3) of the Internal Revenue Code 

of 1986 and is exempt from taxes under section 501(a).

    (2) Is lawfully operated under all applicable Federal, State, and 

local laws and regulations.

    (3) Furnishes only nonmedical nursing items and services to 

beneficiaries who choose to rely solely upon a religious method of 

healing and for whom the acceptance of medical services would be 

inconsistent with their religious beliefs.

    (4) Furnishes nonmedical items and services exclusively through 

nonmedical nursing personnel who are experienced in caring for the 

physical needs of nonmedical patients.

    (5) Furnishes nonmedical items and services to inpatients on a 24-

hour basis.

    (6) Does not furnish, on the basis of religious beliefs, through its 

personnel or otherwise medical items and services (including any medical 

screening, examination, diagnosis, prognosis, treatment, or the 

administration of drugs) for its patients.

    (7) Is not owned by, is not under common ownership with, or does not 

have an ownership interest of 5 percent or more in, a provider of 

medical treatment or services and is not affiliated with a provider of 

medical treatment



[[Page 54]]



or services or with an individual who has an ownership interest of 5 

percent or more in, a provider of medical treatment or services. 

(Permissible affiliations are described at Sec. 403.738(c).)

    (8) Has in effect a utilization review plan that sets forth the 

following:

    (i) Provides for review of the admissions to the institution, the 

duration of stays, and the need for continuous extended duration of 

stays in the institution, and the items and services furnished by the 

institution.

    (ii) Requires that reviews be made by an appropriate committee of 

the institution that included the individuals responsible for overall 

administration and for supervision of nursing personnel at the 

institution.

    (iii) Provides that records be maintained of the meetings, 

decisions, and actions of the review committee.

    (iv) Meets other requirements as the Secretary finds necessary to 

establish an effective utilization review plan.

    (9) Provides information CMS may require to implement section 1821 

of the Act, including information relating to quality of care and 

coverage decisions.

    (10) Meets other requirements CMS finds necessary in the interest of 

the health and safety of the patients who receive services in the 

institution. These requirements are the conditions of participation in 

this subpart.

    (b) The provider meets the conditions of participation cited in 

Sec. Sec. 403.730 through 403.746. (A provider may be deemed to meet 

conditions of participation in accordance with part 488 of this 

chapter.)

    (c) The provider has a valid provider agreement as a hospital with 

CMS in accordance with part 489 of this chapter and for payment purposes 

is classified as an extended care hospital.

    (d) The beneficiary has a condition that would make him or her 

eligible to receive services covered under Medicare Part A as an 

inpatient in a hospital or SNF.

    (e) The beneficiary has a valid election as described in Sec. 

403.724 in effect for Medicare covered services furnished in an RNHCI.