Federal Reimbursement Of Emergency Health Services Furnished To Undocumented Aliens (93.784)

Program

93.784 Federal Reimbursement Of Emergency Health Services Furnished To Undocumented Aliens

Federal Agency

Agency: Department of Health and Human Services
Office: Centers For Medicare And Medicaid Services

Authorization

Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Public Law 108-73, Section 1011; Medicare Modernization Act (MMA).

Program Number

93.784

Last Known Status

Active

Objectives

To reimburse eligible providers for their otherwise un-reimbursed costs associated with furnishing emergency health services to undocumented and certain other aliens.

Types of Assistance

DIRECT PAYMENTS FOR A SPECIFIED USE

Uses and Use Restrictions

Sections 1866(a)(1)(I), 1866 (a)(1)(N), and 1867 of the Social Security Act (the Act)impose specific obligations on Medicare-participating hospitals that offer emergency services. These obligations concern individuals who come to a hospital emergency department and request examination or treatment for medical conditions, and apply to all of these individuals, regardless of whether or not they are beneficiaries of any program under the Act. Section 1867 of the Act sets forth requirements for medical screening examinations of medical conditions, as well as necessary stabilizing treatment or appropriate transfer. In addition, section 1867(h) of the Act specifically prohibits a delay in providing required screening or stabilization services in order to inquire about the individual's payment method or insurance status.

Eligibility Requirements

Applicant Eligibility

From the allotments made for a State, the Secretary of Health and Human Services shall pay an amount (subject to the total amount available from such allotments) directly to eligible providers located in the State where emergency services were incurred to the extent that the eligible provider was not otherwise reimbursed. An eligible provider defined under the statute is a hospital, physician, or provider of ambulance services(including an Indian Health Service (IHS) facility whether operated by the IHS or by an Indian tribal or tribal organization).

Beneficiary Eligibility

The amounts of money set aside for each State will be paid directly to hospitals, certain physicians, and ambulance providers for the costs of providing emergency health care required under EMTALA and related hospital inpatient, outpatient, and ambulance services (including those operated by the Indian Health Service and Indian tribes and Tribal organizations) furnished to undocumented aliens, aliens paroled into the United States at a United States port of entry for the purposes of receiving such services, and Mexican citizens permitted temporary entry to the United States with a laser visa.

Credentials/Documentation

Final policy guidance was released on May 9, 2005 regarding the implementation of section 1011 of the MMA. This notice establishes the general framework and procedural rules for submitting an enrollment application and payment requests, establishes general statements of policy, and provides CMS' interpretation of section 1011. It is posted in the "downloads" section of the following web address: http://www.cms.hhs.gov/UndocAliens/02_policy.asp#TopOfPage. This program is excluded from coverage under OMB Circular No. A-87.

Application and Award Process

Preapplication Coordination

Preapplication coordination is not applicable. Environmental impact information is not required for this program. This program is excluded from coverage under E.O. 12372.

Application Procedure

This program is excluded from coverage under OMB Circular No. A-102. This program is excluded from coverage under OMB Circular No. A-110. On September 1, 2004, the Secretary established a provider enrollment application.

Award Procedure

Official notice of approved claims for emergency health care services will be transmitted to eligible providers pursuant to procedures established prior to September 1, 2004 and published in the Federal Register.

Deadlines

Contact the headquarters or regional office, as appropriate, for application deadlines.

Range of Approval/Disapproval Time

None.

Appeals

The final payment methodology will describe the appeals process.

Renewals

None.

Assistance Considerations

Formula and Matching Requirements

Statutory formulas are not applicable to this program.

This program has no matching requirements.

This program does not have MOE requirements.

Length and Time Phasing of Assistance

This project is authorized for four years beginning in FY 2005. Method of awarding/releasing assistance: lump sum.

Post Assistance Requirements

Reports

No program reports are required. No cash reports are required. Periodic reports are due to CMS in accordance with the timeframes established by CMS. Periodic reports are due to CMS in accordance with the timeframes established by CMS. No performance monitoring is required.

Audits

No audits are required for this program.

Records

Financial records, supporting documents, statistical records, and all other records pertinent to the project shall be retained for a period consistent with the information contained in the final payment methodology.

Program Accomplishments

Fiscal Year 2008: As of March 2009, Section 1011 provides funding to 2,165 hospitals, 50,116 physicians, and 504 ambulance providers across the nation. Section 1011 has disbursed $596,200,567 in provider payments in response to 860,000 claims as of March 2009. Fiscal Year 2009: No Current Data Available Fiscal Year 2010: No Current Data Available

Financial Information

Account Identification

75-0516-0-1-551.

Obligations

(Formula Grants (Apportionments)) FY 08 $206,000,000; FY 09 est $150,000,000; FY 10 est $70,000,000

Range and Average of Financial Assistance

None.

Regulations, Guidelines and Literature

CMS intends to provide guidance through a Paperwork Reduction Act (PRA) notice. The PRA package will provide substantive information regarding CMS' final implementation approach.

Related Programs

Not Applicable.

Information Contacts

Regional or Local Office

None.

Headquarters Office

James Bossenmeyer 7500 Security Boulevard, Baltimore, Maryland 21244 Email: James.Bossenmeyer@cms.hhs.gov Phone: 4107869317

Web Site Address

None.

Examples of Funded Projects

Not Applicable.

Criteria for Selecting Proposals

Not Applicable.