Religious Nonmedical Health Care Institutions—90%

Benefits are provided for religious nonmedical health care institutions if a patient is admitted for the process of healing (not rest or study) and is under the care of a provider qualifying as a religious nonmedical health care institution. To qualify, an institution must meet all of the following requirements:

• It must be a tax-exempt organization under Section 501(c)(3) of the Internal Revenue Code.
• It must be lawfully operated under all applicable federal, state, and local laws and regulations.
• It must provide only nonmedical nursing items and services exclusively to patients who choose to rely solely upon a religious method of healing, through experienced nonmedical personnel, and on a 24-hour basis.
• It cannot provide medical items or services (including screening, examination, diagnosis, or administration of drugs) to its patients, or be affiliated by common ownership or otherwise with an institution that provides such services.
• It must have in effect a specialized utilization review plan and must provide this plan with information required to monitor quality of care and to provide for coverage determinations.

Patients being treated in a religious nonmedical health care institution must make an election to receive such benefits. Additionally, reimbursement in these institutions is available only to patients having a condition such that they would be inpatients in a hospital or skilled nursing facility were it not for their religious beliefs. Reimbursement is on a reasonable cost basis and may be made only for items and services normally furnished in such institutions (i.e., nonmedical nursing services and related items).