
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 23, 2000]
[Document not affected by Public Laws enacted between
  January 23, 2000 and December 4, 2001]
[CITE: 42USC1395i-5]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                       CHAPTER 7--SOCIAL SECURITY
 
        SUBCHAPTER XVIII--HEALTH INSURANCE FOR AGED AND DISABLED
 
        Part A--Hospital Insurance Benefits for Aged and Disabled
 
Sec. 1395i-5. Conditions for coverage of religious nonmedical 
        health care institutional services
        

(a) In general

    Subject to subsections (c) and (d) of this section, payment under 
this part may be made for inpatient hospital services or post-hospital 
extended care services furnished an individual in a religious nonmedical 
health care institution only if--
        (1) the individual has an election in effect for such benefits 
    under subsection (b) of this section; and
        (2) the individual has a condition such that the individual 
    would qualify for benefits under this part for inpatient hospital 
    services or extended care services, respectively, if the individual 
    were an inpatient or resident in a hospital or skilled nursing 
    facility that was not such an institution.

(b) Election

                           (1) In general

        An individual may make an election under this subsection in a 
    form and manner specified by the Secretary consistent with this 
    subsection. Unless otherwise provided, such an election shall take 
    effect immediately upon its execution. Such an election, once made, 
    shall continue in effect until revoked.

                              (2) Form

        The election form under this subsection shall include the 
    following:
            (A) A written statement, signed by the individual (or such 
        individual's legal representative), that--
                (i) the individual is conscientiously opposed to 
            acceptance of nonexcepted medical treatment; and
                (ii) the individual's acceptance of nonexcepted medical 
            treatment would be inconsistent with the individual's 
            sincere religious beliefs.

            (B) A statement that the receipt of nonexcepted medical 
        services shall constitute a revocation of the election and may 
        limit further receipt of services described in subsection (a) of 
        this section.

                           (3) Revocation

        An election under this subsection by an individual may be 
    revoked by voluntarily notifying the Secretary in writing of such 
    revocation and shall be deemed to be revoked if the individual 
    receives nonexcepted medical treatment for which reimbursement is 
    made under this subchapter.

               (4) Limitation on subsequent elections

        Once an individual's election under this subsection has been 
    made and revoked twice--
            (A) the next election may not become effective until the 
        date that is 1 year after the date of most recent previous 
        revocation, and
            (B) any succeeding election may not become effective until 
        the date that is 5 years after the date of the most recent 
        previous revocation.

                   (5) Excepted medical treatment

        For purposes of this subsection:

        (A) Excepted medical treatment

            The term ``excepted medical treatment'' means medical care 
        or treatment (including medical and other health services)--
                (i) received involuntarily, or
                (ii) required under Federal or State law or law of a 
            political subdivision of a State.

        (B) Nonexcepted medical treatment

            The term ``nonexcepted medical treatment'' means medical 
        care or treatment (including medical and other health services) 
        other than excepted medical treatment.

(c) Monitoring and safeguard against excessive expenditures

                    (1) Estimate of expenditures

        Before the beginning of each fiscal year (beginning with fiscal 
    year 2000), the Secretary shall estimate the level of expenditures 
    under this part for services described in subsection (a) of this 
    section for that fiscal year.

                     (2) Adjustment in payments

        (A) Proportional adjustment

            If the Secretary determines that the level estimated under 
        paragraph (1) for a fiscal year will exceed the trigger level 
        (as defined in subparagraph (C)) for that fiscal year, the 
        Secretary shall, subject to subparagraph (B), provide for such a 
        proportional reduction in payment amounts under this part for 
        services described in subsection (a) of this section for the 
        fiscal year involved as will assure that such level (taking into 
        account any adjustment under subparagraph (B)) does not exceed 
        the trigger level for that fiscal year.

        (B) Alternative adjustments

            The Secretary may, instead of making some or all of the 
        reduction described in subparagraph (A), impose such other 
        conditions or limitations with respect to the coverage of 
        covered services (including limitations on new elections of 
        coverage and new facilities) as may be appropriate to reduce the 
        level of expenditures described in paragraph (1) to the trigger 
        level.

        (C) Trigger level

            For purposes of this subsection--
            (i) In general

                Subject to adjustment under paragraph (3)(B), the 
            ``trigger level'' for a year is the unadjusted trigger level 
            described in clause (ii).
            (ii) Unadjusted trigger level

                The ``unadjusted trigger level'' for--
                    (I) fiscal year 1998, is $20,000,000, or
                    (II) a succeeding fiscal year is the amount 
                specified under this clause for the previous fiscal year 
                increased by the percentage increase in the consumer 
                price index for all urban consumers (all items; United 
                States city average) for the 12-month period ending with 
                July preceding the beginning of the fiscal year.

        (D) Prohibition of administrative and judicial review

            There shall be no administrative or judicial review under 
        section 1395ff of this title, 1395oo of this title, or otherwise 
        of the estimation of expenditures under subparagraph (A) or the 
        application of reduction amounts under subparagraph (B).

        (E) Effect on billing

            Notwithstanding any other provision of this subchapter, in 
        the case of a reduction in payment provided under this 
        subsection for services of a religious nonmedical health care 
        institution provided to an individual, the amount that the 
        institution is otherwise permitted to charge the individual for 
        such services is increased by the amount of such reduction.

                  (3) Monitoring expenditure level

        (A) In general

            The Secretary shall monitor the expenditure level described 
        in paragraph (2)(A) for each fiscal year (beginning with fiscal 
        year 1999).

        (B) Adjustment in trigger level

            (i) In general

                If the Secretary determines that such level for a fiscal 
            year exceeded, or was less than, the trigger level for that 
            fiscal year, then, subject to clause (ii), the trigger level 
            for the succeeding fiscal year shall be reduced, or 
            increased, respectively, by the amount of such excess or 
            deficit.
            (ii) Limitation on carryforward

                In no case may the increase effected under clause (i) 
            for a fiscal year exceed $50,000,000.

(d) Sunset

    If the Secretary determines that the level of expenditures described 
in subsection (c)(1) of this section for 3 consecutive fiscal years 
(with the first such year being not earlier than fiscal year 2002) 
exceeds the trigger level for such expenditures for such years (as 
determined under subsection (c)(2) of this section), benefits shall be 
paid under this part for services described in subsection (a) of this 
section and furnished on or after the first January 1 that occurs after 
such 3 consecutive years only with respect to an individual who has an 
election in effect under subsection (b) of this section as of such 
January 1 and only during the duration of such election.

(e) Annual report

    At the beginning of each fiscal year (beginning with fiscal year 
1999), the Secretary shall submit to the Committee on Ways and Means of 
the House of Representatives and the Committee on Finance of the Senate 
an annual report on coverage and expenditures for services described in 
subsection (a) of this section under this part and under State plans 
under subchapter XIX of this chapter. Such report shall include--
        (1) level of expenditures described in subsection (c)(1) of this 
    section for the previous fiscal year and estimated for the fiscal 
    year involved;
        (2) trends in such level; and
        (3) facts and circumstances of any significant change in such 
    level from the level in previous fiscal years.

(Aug. 14, 1935, ch. 531, title XVIII, Sec. 1821, as added Pub. L. 105-
33, title IV, Sec. 4454(a)(2), Aug. 5, 1997, 111 Stat. 428.)


                             Effective Date

    Section 4454(d) of Pub. L. 105-33 provided that: ``The amendments 
made by this section [enacting this section and amending sections 1320a-
1, 1320c-11, 1395x, 1396a, and 1396g of this title] shall take effect on 
the date of the enactment of this Act [Aug. 5, 1997] and shall apply to 
items and services furnished on or after such date. By not later than 
July 1, 1998, the Secretary of Health and Human Services shall first 
issue regulations to carry out such amendments. Such regulations may be 
issued so they are effective on an interim basis pending notice and 
opportunity for public comment. For periods before the effective date of 
such regulations, such regulations shall recognize elections entered 
into in good faith in order to comply with the requirements of section 
1821(b) of the Social Security Act [subsec. (b) of this section].''

                  Section Referred to in Other Sections

    This section is referred to in section 1395x of this title.
