CMS Pub. 100-02, ch. 1, § 130.2

For an RNHCI to receive payment under the Medicare program, the beneficiary must

make a written election to receive benefits under §1821 of the Act. To elect religious

nonmedical health care services, the beneficiary or the beneficiary’s legal representative

must attest that the individual is conscientiously opposed to acceptance of nonexcepted

medical treatment, and the individual’s acceptance of such treatment would be

inconsistent with the individual’s sincere religious beliefs.

Religious non-medical care or religious method of healing means health care furnished

under established religious tenets that prohibit conventional or unconventional medical

care for the treatment of a beneficiary, and the sole reliance on these religious tenets to

fulfill a beneficiary's total health care needs.

Medical care or treatment means health care furnished by or under the direction of a

licensed physician that can involve diagnosing, treating, or preventing disease and other

damage to the mind and body. It may involve the use of pharmaceuticals, diet, exercise,

surgical intervention, and technical procedures.

The signed and notarized election must include a statement that the receipt of

nonexcepted medical services would constitute a revocation of the election and may limit

further receipt of payment of religious nonmedical health care services. The election is

effective on the date it is signed, and it remains in effect until revoked in writing or by the

receipt and filing of a claim for nonexcepted medical treatment.

The completed election form must be filed with the specialty contractor, a copy retained

by the RNHCI provider and a copy provided to the beneficiary. See Pub. 100-04,

Medicare Claims Processing Manual, Chapter 3, Section 170 for instructions on

submission of elections to the specialty contractor.

Section 1821 defines “excepted” medical treatment as medical care or treatment that is

received involuntarily or is required under Federal, State or local law. The term is

intended to identify the kinds of medical services that can be provided to a beneficiary

with an election for RNHCI services without revoking the election.

Examples of excepted medical care include, but are not limited to the following:

• A beneficiary that receives vaccinations required by a State or local jurisdiction.

This is compliant behavior to meet government requirements and not considered as

voluntarily seeking medical care or services; or

• A beneficiary who is involved in an accident and receives medical attention at the

accident scene, or in transport to the hospital, or at the hospital before being able to

make their beliefs and wishes known; or

• A beneficiary who is unconscious and receives emergency care and is hospitalized

before regaining consciousness or bei ng able to locate his or her legal

representative.

“Nonexcepted” medical treatment is defined as medical care or treatment other than

excepted medical treatment. The term is intended to define the kinds of medical services

that, if received by a beneficiary who has previously elected RNHCI services, would

revoke the individual's election of services.

Examples of nonexcepted medical care could include but are not limited to the following:

• A beneficiary receiving medical diagnosis and/or treatment for persistent headaches

and/or chest pains.

• A beneficiary in an RNHCI who is transferring to a community hospital to have

radiological studies and the reduction of a fracture.

• A beneficiary with intractable back pain receiving medical, surgical, or chiropractic

services.

• A beneficiary who has requested a physician to prescribe a wheelchair or other

durable medical equipment item.

Note that the terms ‘excepted’ and ‘nonexcepted’ care represent mutually exclusive

conditions under §1821 of the Social Security Act. Medicare contractors may use the

examples above in making determinations of excepted and nonexcepted care.