Medicare Program Integrity Manual (Pub. 100-08), Ch. 10 § 10.2.1.12

Religious Non-Medical Health Care Institutions (RNHCIs)

Last amended: 2021Year: 2021Length: 451 wordsOfficial source
10.2.1.12 - Religious Non-Medical Health Care Institutions (RNHCIs) (Rev. 10868; Issued: 07-14-21; Effective: 08-13-21; Implementation: 08-13-21) A. General Background Information RNHCIs furnish only nonmedical nursing services and items to people who choose to rely solely on obtaining a religious method of healing and for whom the acceptance of medical services would be inconsistent with their religious views. Such nonmedical services are performed exclusively through nonmedical nursing personnel who are experienced in caring for the physical needs of nonmedical patients (e.g., 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). RNHCIs do not perform any medical screenings, examinations, diagnoses, or treatments, including the administration of drugs. Each beneficiary who wishes to receive services in an RNHCI must make a valid and formal written statement (or “election”) to do so. (The specific election requirements are discussed in 42 CFR § 403.724 and Pub. 100-07, chapter 2, section 2054.1B.) CMS’s Boston Northeast SOG Location (in coordination with the CMS Central Office) has primary responsibility over the approval and certification of RNHCIs. RNHCIs are not certified by the state but must meet all of the conditions of coverage outlined in 42 CFR §403.720 as well as all conditions of participation. (See 42 CFR §§ 403.730 through 403.746 regarding RNCHI conditions of participation.) For purposes of provider enrollment, the three most important conditions are that the provider: a. Must not be owned by, under common ownership with, or have an ownership interest of 5 percent or more in a provider of medical treatment or services. b. Must not be 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 42 CFR § 403.738(c)). c. Must be a non-profit organization per subsection (c)(3) of § 501 of the Internal Revenue Code of 1986, and exempt from taxes under subsection 501(a). (See Pub. 100-07, chapter 2, section 2054.1 for additional conditions.) To this end, the contractor shall (1) examine Sections 5 and 6 of the Form CMS-855A and (2) verify the provider’s non-profit status to ensure that the aforementioned conditions are met. B. Additional Information For more information on RNCHIs, refer to: • Section 1861(ss)(1) of the Social Security Act • 42 CFR Part 403, subpart G • Pub. 100-07, chapter 2, sections 2054, 2054.1, 2054.1A and 2054.1B • Pub. 100-04, chapter 3, sections 170 - 180 • Pub. 100-02, chapter 1, sections 130 – 130.4.2 For guidance on the appropriate contractor jurisdiction for incoming RNCHI applications, please see Pub. 100-04, chapter 1, section 20.
Medicare Program Integrity Manual (Pub. 100-08), Ch. 10 § 10.2.1.12: Religious Non-Medical Health Care Institutions (RNHCIs) | Justis AI