Certification of Religious Nonmedical Healthcare Institutions

2054.1 - Certification of Religious Nonmedical Healthcare Institutions (RNHCIs) (Rev. 1, 05-21-04) The Boston Regional Office has the primary responsibility for the approval and certification process to ensure and verify that the RNHCI conforms to specific Conditions of Coverage and all of the Conditions of Participation. An RNHCI is a provider that meets the definition as described in §1861(ss)(1) of the Act and meets the following qualifying Medicare Conditions of Coverage provisions as specified in 42 CFR 403.720. To qualify as a Medicare or Medicaid RNHCI an institution must meet all ten of the following requirements: • Is described in subsection (c)(3) of §501 of the Internal Revenue Code of 1986 and is exempt from taxes under subsection 501(a); • Is lawfully operated under all applicable Federal, State, and local laws and regulations; • 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. (NOTE: Religious components of the healing are not covered); • Furnishes nonmedical items and services exclusively through nonmedical nursing personnel who are experienced in caring for the physical needs of nonmedical patients. For example, caring for the physical needs such as assistance with activities of daily living; assistance in moving, positioning, and ambulation; nutritional needs; and comfort and support measures; • Furnishes nonmedical items and services to inpatients on a 24-hour basis; • 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; • Is not owned by, under common ownership with, or has 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 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 in §403.738(c)); • Has in effect a utilization review plan that meets the requirements of §403.720(a)(8); • Provides information CMS may require to implement §1821 of the Act, including information relating to quality of care and coverage determinations; and • Meets other requirements CMS finds necessary in the interest of the health and safety of the patients who receive services in the institution. 2054.1A - Other Medicare Conditions of Coverage (Rev. 1, 05-21-04) The remaining Conditions of Coverage are specific to Medicare; however, a State may elect to employ any or all of these requirements within their optional Medicaid State plan amendment. 2054.1B - Valid Election Requirements (Rev. 1, 05-21-04) The regulations at 42 CFR 403.724 present the elements necessary for a Medicare beneficiary to complete an election to receive care in an RNHCI. The RO determines whether or not the RNHCI has adequately ensured that the Medicare beneficiary’s valid election statement has been included with the RNHCI’s administrative records and/or patient care records. NOTE: The facility is to provide the fiscal intermediary the original of the election statement, which will be used for each Medicare beneficiary in the RNHCI and retain a copy in its files. The provisions for valid elections include the following general requirements: • The election statement must be made by the Medicare beneficiary or by his or her legal representative. It must include written statements that: o The beneficiary is conscientiously opposed to acceptance of nonexcepted medical treatment; o The beneficiary acknowledges that acceptance of nonexcepted medical treatment is inconsistent with his or her sincere religious beliefs; o The beneficiary acknowledges that receipt of nonexcepted medical care constitutes a revocation of the election and may limit further receipt of services in an RNHCI; o The beneficiary acknowledges that the election may be revoked by submitting a written statement to CMS; and o The beneficiary acknowledges that the revocation will not prevent or delay access to medical services available under Medicare Part A in other types of facilities. A valid election must also: • Be signed and dated by the beneficiary or by his or her legal representative, not prior to reaching Medicare eligibility and beneficiary status; • Be notarized; • Include an original copy submitted on file to CMS (CMS is represented for this purpose by the intermediary); and • Include any other information obtained regarding prior elections or revocations. A beneficiary’s election is revoked by one of the following: • The beneficiary receives nonexcepted medical treatment for which Medicare payment is made; or • The beneficiary voluntarily revokes the election and notifies CMS in writing. NOTE: “Excepted” and “nonexcepted” medical care are defined are defined in 42 CFR 403.702. The receipt of excepted medical care or treatment as defined in 403.702 does not revoke the election made by a beneficiary. The beneficiary’s ability to elect is limited once the election has been made and revoked twice (see §403.724(c)). Organ Transplant Programs