---
kind: "section"
citation: "42 U.S.C. § 1395i–5"
title: "42"
title_heading: "The Public Health and Welfare"
number: "1395i–5"
heading: "Conditions for coverage of religious nonmedical health care institutional services"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/1395i-5"
units:
  - "Chapter 7 — Social Security"
  - "Subchapter XVIII — Health Insurance for Aged and Disabled"
  - "Part A — Hospital Insurance Benefits for Aged and Disabled"
---

# §1395i–5. Conditions for coverage of religious nonmedical health care institutional services

- (a) **In general—** Subject to subsections [(c)](#c) and [(d)](#d), payment under this part may be made for inpatient [hospital](/usc/42/300s–3.md?p=1) services or post-[hospital](/usc/42/300s–3.md?p=1) extended care services furnished an individual in a religious nonmedical health care institution and for home health services furnished an individual by a religious nonmedical health care institution only if—
  - (1) the individual has an election in effect for such benefits under [subsection (b)](#b); and
  - (2) the individual has a condition such that the individual would qualify for benefits under this part for inpatient [hospital](/usc/42/300s–3.md?p=1) services, extended care services, or home health services, respectively, if the individual were an inpatient or resident in a [hospital](/usc/42/300s–3.md?p=1) or skilled [nursing facility](/usc/42/1397j.md?p=17-A), or receiving services from a home health [agency](/usc/42/1397n–12.md?p=1), 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](/usc/42/1301.md?p=a-6) 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](/usc/42/11851.md?p=11); and
      - (ii) the individual’s acceptance of nonexcepted medical [treatment](/usc/42/11851.md?p=11) 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)](#a).
  - (3) **Revocation—** An election under this subsection by an individual may be revoked by voluntarily notifying the [Secretary](/usc/42/1301.md?p=a-6) in writing of such revocation and shall be deemed to be revoked if the individual receives nonexcepted medical [treatment](/usc/42/11851.md?p=11) 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](/usc/42/11851.md?p=11)” means [medical care](/usc/42/1301.md?p=a-7) or [treatment](/usc/42/11851.md?p=11) ([including](/usc/42/1301.md?p=b) medical and other health services)—
      - (i) received involuntarily,
      - (ii) required under Federal or [State](/usc/42/619.md?p=5) law or law of a political subdivision of a [State](/usc/42/619.md?p=5), or
      - (iii) effective beginning on December 29, 2022, that is a COVID–19 vaccine and its [administration](/usc/42/1301.md?p=a-10) described in [section 1395x(s)(10)(A) of this title](/usc/42/1395x.md?p=s-10-A).
    - (B) **Nonexcepted medical treatment—** The term “nonexcepted medical [treatment](/usc/42/11851.md?p=11)” means [medical care](/usc/42/1301.md?p=a-7) or [treatment](/usc/42/11851.md?p=11) ([including](/usc/42/1301.md?p=b) medical and other health services) other than excepted medical [treatment](/usc/42/11851.md?p=11).
- (c) **Monitoring and safeguard against excessive expenditures—**
  - (1) **Estimate of expenditures—** Before the beginning of each [fiscal year](/usc/42/619.md?p=3) (beginning with [fiscal year](/usc/42/619.md?p=3) 2000), the [Secretary](/usc/42/1301.md?p=a-6) shall estimate the level of expenditures under this part for services described in [subsection (a)](#a) for that [fiscal year](/usc/42/619.md?p=3).
  - (2) **Adjustment in payments—**
    - (A) **Proportional adjustment—** If the [Secretary](/usc/42/1301.md?p=a-6) determines that the level estimated under [paragraph (1)](#c-1) for a [fiscal year](/usc/42/619.md?p=3) will exceed the trigger level (as defined in [subparagraph (C)](#c-2-C)) for that [fiscal year](/usc/42/619.md?p=3), the [Secretary](/usc/42/1301.md?p=a-6) shall, subject to [subparagraph (B)](#c-2-B), provide for such a proportional reduction in payment amounts under this part for services described in [subsection (a)](#a) for the [fiscal year](/usc/42/619.md?p=3) involved as will assure that such level (taking into account any adjustment under [subparagraph (B)](#c-2-B)) does not exceed the trigger level for that [fiscal year](/usc/42/619.md?p=3).
    - (B) **Alternative adjustments—** The [Secretary](/usc/42/1301.md?p=a-6) may, instead of making some or all of the reduction described in [subparagraph (A)](#c-2-A), impose such other conditions or limitations with respect to the coverage of covered services ([including](/usc/42/1301.md?p=b) limitations on new elections of coverage and new [facilities](/usc/42/1320a–3.md?p=c-5-B)) as may be appropriate to reduce the level of expenditures described in [paragraph (1)](#c-1) to the trigger level.
    - (C) **Trigger level—** For purposes of this subsection—
      - (i) **In general—** Subject to adjustment under [paragraph (3)(B)](#c-3-B), the “trigger level” for a year is the unadjusted trigger level described in [clause (ii)](#c-2-C-ii).
      - (ii) **Unadjusted trigger level—** The “unadjusted trigger level” for—
        - (I) [fiscal year](/usc/42/619.md?p=3) 1998, is $20,000,000, or
        - (II) a succeeding [fiscal year](/usc/42/619.md?p=3) is the amount specified under this clause for the previous [fiscal year](/usc/42/619.md?p=3) increased by the percentage increase in the consumer price index for all urban consumers (all items; [United States](/usc/42/1301.md?p=a-2) city average) for the 12-month period ending with July preceding the beginning of the [fiscal year](/usc/42/619.md?p=3).
    - (D) **Prohibition of administrative and judicial review—** There shall be no administrative or judicial review under [section 1395ff of this title](/usc/42/1395ff.md), [1395oo](/usc/42/1395oo.md) of this title, or otherwise of the estimation of expenditures under [subparagraph (A)](#c-2-A) or the application of reduction amounts under [subparagraph (B)](#c-2-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](/usc/42/1301.md?p=a-6) shall monitor the expenditure level described in [paragraph (2)(A)](#c-2-A) for each [fiscal year](/usc/42/619.md?p=3) (beginning with [fiscal year](/usc/42/619.md?p=3) 1999).
    - (B) **Adjustment in trigger level—**
      - (i) **In general—** If the [Secretary](/usc/42/1301.md?p=a-6) determines that such level for a [fiscal year](/usc/42/619.md?p=3) exceeded, or was less than, the trigger level for that [fiscal year](/usc/42/619.md?p=3), then, subject to [clause (ii)](#c-3-B-ii), the trigger level for the succeeding [fiscal year](/usc/42/619.md?p=3) 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)](#c-3-B-i) for a [fiscal year](/usc/42/619.md?p=3) exceed $50,000,000.
- (d) **Sunset—** If the [Secretary](/usc/42/1301.md?p=a-6) determines that the level of expenditures described in [subsection (c)(1)](#c-1) for 3 consecutive [fiscal years](/usc/42/619.md?p=3) (with the first such year being not earlier than [fiscal year](/usc/42/619.md?p=3) 2002) exceeds the trigger level for such expenditures for such years (as determined under [subsection (c)(2)](#c-2)), benefits shall be paid under this part for services described in [subsection (a)](#a) 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)](#b) as of such January 1 and only during the duration of such election.
- (e) **Annual report—** At the beginning of each [fiscal year](/usc/42/619.md?p=3) (beginning with [fiscal year](/usc/42/619.md?p=3) 1999), the [Secretary](/usc/42/1301.md?p=a-6) 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)](#a) under this part and under [State](/usc/42/619.md?p=5) plans under subchapter XIX. Such report shall include—
  - (1) level of expenditures described in [subsection (c)(1)](#c-1) for the previous [fiscal year](/usc/42/619.md?p=3) and estimated for the [fiscal year](/usc/42/619.md?p=3) 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](/usc/42/619.md?p=3).

## Source credit

(Aug. 14, 1935, ch. 531, title XVIII, § 1821, as added Pub. L. 105–33, title IV, § 4454(a)(2), Aug. 5, 1997, 111 Stat. 428; amended Pub. L. 108–173, title VII, § 706(a), Dec. 8, 2003, 117 Stat. 2339; Pub. L. 117–328, div. FF, title IV, § 4138(a), Dec. 29, 2022, 136 Stat. 5925.)

## Notes

### Editorial Notes

### Amendments

2022—Subsec. (b)(5)(A)(iii). Pub. L. 117–328 added cl. (iii).

2003—Subsec. (a). Pub. L. 108–173, § 706(a)(1), inserted “and for home health services furnished an individual by a religious nonmedical health care institution” after “religious nonmedical health care institution” in introductory provisions.

Subsec. (a)(2). Pub. L. 108–173, § 706(a)(2), substituted “, extended care services, or home health services” for “or extended care services” and inserted “, or receiving services from a home health agency,” after “skilled nursing facility”.

### Statutory Notes and Related Subsidiaries

### Effective Date

Pub. L. 105–33, title IV, § 4454(d), Aug. 5, 1997, 111 Stat. 431, 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 [42 U.S.C. 1395i–5(b)].”

### Special Rules for COVID–19 Vaccines Relating to Revocation of Election

Pub. L. 117–328, div. FF, title IV, § 4138(b), Dec. 29, 2022, 136 Stat. 5925, provided that: “Notwithstanding paragraphs (3) and (4) of section 1821(b) of the Social Security Act (42 U.S.C. 1395i–5(b)), in the case of an individual with a revocation of an election under such section prior to the date of enactment of this Act [Dec. 29, 2022] by reason of receiving a COVID–19 vaccine and its administration described in section 1861(s)(10)(A) of such Act (42 U.S.C. 1395x(s)(10)(A)), the following rules shall apply: Beginning on such date of enactment, such individual may make an election under such section, which shall take effect immediately upon its execution, if such individual would be eligible to make such an election if they had not received such COVID–19 vaccine and its administration. Such revoked election shall not be taken into account for purposes of determining the effective date for an election described in subparagraph (A) or (B) of such paragraph (4).”