---
kind: "section"
citation: "42 U.S.C. § 1396l"
title: "42"
title_heading: "The Public Health and Welfare"
number: "1396l"
heading: "Hospital providers of nursing facility services"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/1396l"
units:
  - "Chapter 7 — Social Security"
  - "Subchapter XIX — Grants to States for Medical Assistance Programs"
---

# §1396l. Hospital providers of nursing facility services

- (a) Notwithstanding any other provision of this subchapter, payment may be made, in accordance with this section, under a [State](/usc/42/619.md?p=5) plan approved under this subchapter for [nursing facility services](/usc/42/1396d.md?p=f) furnished by a [hospital](/usc/42/300s–3.md?p=1) which has in effect an agreement under [section 1395tt of this title](/usc/42/1395tt.md) and which, with respect to the provision of such services, meets the requirements of subsections (b) through (d) of [section 1396r of this title](/usc/42/1396r.md).
- (b)
  - (1) Except as provided in [paragraph (3)](#b-3), payment to any such [hospital](/usc/42/300s–3.md?p=1), for any [nursing facility services](/usc/42/1396d.md?p=f) furnished pursuant to [subsection (a)](#a), shall be at a rate equal to the average rate per patient-day paid for routine services during the previous calendar year under the [State](/usc/42/619.md?p=5) plan to [nursing facilities](/usc/42/1396d.md?p=c), respectively,[^1] located in the [State](/usc/42/619.md?p=5) in which the [hospital](/usc/42/300s–3.md?p=1) is located. The reasonable cost of ancillary services shall be determined in the same manner as the reasonable cost of ancillary services provided for inpatient [hospital](/usc/42/300s–3.md?p=1) services.
  - (2) With respect to any period for which a [hospital](/usc/42/300s–3.md?p=1) has an agreement under [section 1395tt of this title](/usc/42/1395tt.md), in order to allocate routine costs between [hospital](/usc/42/300s–3.md?p=1) and [long-term care](/usc/42/1397j.md?p=14-A) services, the total reimbursement for routine services due from all classes of [long-term care](/usc/42/1397j.md?p=14-A) patients ([including](/usc/42/1301.md?p=b) subchapter XVIII, this subchapter, and private pay patients) shall be subtracted from the [hospital](/usc/42/300s–3.md?p=1) total routine costs before calculations are made to determine reimbursement for routine [hospital](/usc/42/300s–3.md?p=1) services under the [State](/usc/42/619.md?p=5) plan.
  - (3) Payment to all such [hospitals](/usc/42/300s–3.md?p=1), for any [nursing facility services](/usc/42/1396d.md?p=f) furnished pursuant to [subsection (a)](#a), may be made at a payment rate established by the [State](/usc/42/619.md?p=5) in accordance with the requirements of [section 1396a(a)(13)(A) of this title](/usc/42/1396a.md?p=a-13-A).

## Footnotes

[^1]: So in original, “, respectively,” probably should not appear.

## Source credit

(Aug. 14, 1935, ch. 531, title XIX, § 1913, as added Pub. L. 96–499, title IX, § 904(b), Dec. 5, 1980, 94 Stat. 2617; amended Pub. L. 98–369, div. B, title III, § 2369(a), July 18, 1984, 98 Stat. 1110; Pub. L. 100–203, title IV, § 4211(h)(9), Dec. 22, 1987, 101 Stat. 1330–206.)

## Notes

### Editorial Notes

### Amendments

1987—Pub. L. 100–203, § 4211(h)(9)(A), substituted “nursing facility services” for “skilled nursing and intermediate care services” in section catchline.

Subsec. (a). Pub. L. 100–203, § 4211(h)(9)(B), substituted “nursing facility services” for “skilled nursing facility services and intermediate care facility services” and inserted “and which, with respect to the provision of such services, meets the requirements of subsections (b) through (d) of section 1396r of this title” before period at end.

Subsec. (b)(1). Pub. L. 100–203, § 4211(h)(9)(C), substituted “nursing facility services” for “skilled nursing or intermediate care facility services” and “nursing facilities” for “skilled nursing and intermediate care facilities”.

Subsec. (b)(3). Pub. L. 100–203, § 4211(h)(9)(D), substituted “nursing facility services” for “skilled nursing or intermediate care facility services”.

1984—Subsec. (b)(1). Pub. L. 98–369, § 2369(a)(1), substituted “Except as provided in paragraph (3), payment” for “Payment”.

Subsec. (b)(3). Pub. L. 98–369, § 2369(a)(2), added par. (3).

### Statutory Notes and Related Subsidiaries

### Effective Date of 1987 Amendment

Amendment by Pub. L. 100–203 applicable to nursing facility services furnished on or after Oct. 1, 1990, without regard to whether regulations implementing such amendment are promulgated by such date, except as otherwise specifically provided in section 1396r of this title, with transitional rule, see section 4214(a), (b)(2) of Pub. L. 100–203, as amended, set out as an Effective Date note under section 1396r of this title.

### Effective Date of 1984 Amendment

Pub. L. 98–369, div. B, title III, § 2369(b), July 18, 1984, 98 Stat. 1110, provided that: “The amendments made by this section [amending this section] shall apply to payments for services furnished after the date of the enactment of this Act [July 18, 1984].”

### Effective Date

Section effective on date on which final regulations to implement the section are first issued, see section 904(d) of Pub. L. 96–499, set out as an Effective Date note under section 1395tt of this title.