CMS Pub. 100-01, ch. 5, § 40

In order for a Medicare or Medicaid provider to meet the definition of an RNHCI, it must

satisfy the ten qualifying provisions as contained in Section 1861(ss)(1) of the Act.

Section 1861(ss)(1) of the Act states that an RNHCI means an institution that:

1. Is described in Subsection (c)(3) of Section 501 of the Internal Revenue Code

of 1986 and is exempt from taxes under Subsection (a) of that section. The

inability to either gain or retain this status will disqualify an institution from

participation as an RNHCI.

2. Is lawfully operated under all applicable Federal, State, and local laws and

regulations. Federal law supersedes State and local laws unless the State and

local requirements are more stringent than the Federal requirements.

3. Furnishes only nonmedical nursing items and services to patients who choose

to rely solely upon a religious method of healing and for whom the acceptance of

medical services would be inconsistent with their religious beliefs. Medicare

does not cover the religious component of the healing.

4. Furnishes nonmedical items and services exclusively through nonmedical

nursing personnel who are experienced in caring for the physical needs of these

patients. This care frequently involves: assistance in moving, turning,

positioning, and ambulation; meeting nutritional needs; and comfort and support

measures.

5. Furnishes nonmedical items and services to inpatients on a 24-hour basis.

6. Does not furnish, on the basis of its religious beliefs, through its personnel or

otherwise, medical items and services (including any medical screening,

examination, diagnosis, prognosis, treatment, or the administration of drugs) for

its patients.

7. Is not owned by, under common ownership with, or has an ownership interest

of 5 percent or more in, a provider of medical treatment or services, and is not

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. For purposes of this requirement, an affiliation does not

exist in the circumstances described in Section 1861(ss)(4) of the Act or 42 CFR

403.738(c).

8. Has in effect a utilization review plan that:

• Provides for review of admissions to the institution, of the duration of

stays, of cases of continuous extended duration, and of the items and

services furnished by the institution;

• Requires that the reviews be made by an appropriate committee of the

institution that includes the individuals responsible for overall

administration and for supervision of nursing personnel at the institution;

• Provides that records be maintained of the meetings, decisions, and

actions of the committee; and

• Meets other requirements as the Secretary finds necessary to establish

an effective utilization review plan.

9. Provides information the Secretary may require to implement Section 1821 of

the Act, including information relating to quality of care and coverage

determinations.

10. Meets other requirements the Secretary finds necessary in the interest of the

health and safety of individuals who are furnished services in the institution.

These requirements include the conditions of participation in 42 CFR 403,

Subpart G. An RNHCI must meet or exceed the conditions of participation in

order to qualify as a Medicare provider. The RNHCI must also have a valid

provider agreement with CMS.