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

DEPARTMENT OF HEALTH AND HUMAN SERVICES, CENTERS FOR MEDICARE AND MEDICAID SERVICES

 

Authorization

Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Public Law 108-73, Section 1011; also referred to as the 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 Specified Use.

 

Uses and Use Restrictions

Section 1867 of the Social Security Act dealing with the Emergency Medical Treatment and Active Labor Act (EMTALA) requires a hospital that has an emergency department to provide appropriate medical screening to individuals who request examination or treatment to determine whether or not an emergency medical condition exists. If such a condition does exist, the hospital is required to stabilize the condition and/or provide an appropriate transfer, regardless of the individual's ability to pay for treatment. Undocumented aliens are frequently unable to pay for the EMTALA-required care they receive from hospitals and other providers.

 

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

Not later than September 1, 2004, the Secretary shall establish a process under which eligible providers located in a State may request payments. This process will include guidance regarding claims submission and documentation standards.

 

Application and Award Process

Preapplication Coordination

This program is excluded from coverage under E.O. 12372.

Application Procedure

CMS expects to establish an enrollment application process via a paperwork reduction act notice prior to September 1, 2004.

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

Established when program announcements are published in the Federal Register.

 

Range of Approval/Disapproval Time

Appeals

There are no formal appeals procedures. If an application is disapproved, the reasons for disapproval will be fully stated.

Renewals

Not applicable.

 

Assistance Considerations

Formula and Matching Requirements

No State or local matching funds are required for this activity.

Length and Time Phasing of Assistance

This project is authorized for four years beginning in FY 2005.

 

Post Assistance Requirements

Reports

Periodic reports are due to CMS in accordance with the timeframes established by CMS.

Audits

All payment transactions identifiable to Federal Reimbursement for Emergency Health Services Furnished to Undocumented Aliens are subject to audit or medical review by the Secretary or his designated agent. In accordance with the provisions of OMB Circular No. A-133 (Revised, June 27, 2003), "Audits of States, Local Governments, and Nonprofit Organizations," nonfederal entities that expend financial assistance of $500,000 or more a year in Federal awards will have a single or a program-specific audit conducted for that year. Nonfederal entities that expend less than $500,000 a year in Federal awards are exempt from federal audit requirements for that year, except as noted in Circular No. A-133.

Records

Financial records, supporting documents, statistical records, and all other records pertinent to the project shall be retained for at least three years or until resolution of any audit questions.

 

Program Accomplishments

Not applicable. This is a new project under the MMA.

 

Financial Information

Account Identification

75-0516-0-1-551.

Obligations

FY 03 $0; FY 04 est $0; and FY 05 est $250,000,000.

Range and Average of Financial Assistance

Not applicable. This is a new project under the MMA.

 

Regulations, Guidelines and Literature

Since section 1011 does not amend the Social Security Act and does not include specific rulemaking authority, we do not have the authority to issue a notice of proposed rulemaking or implement regulations for this section of MMA. Thus, as an alternative to the notice-and-comment process, CMS will request public comment regarding our proposed implementation strategy via this document, and implement this section of MMA by publishing a Paperwork Reduction Act (PRA) notice in the Federal Register, an action that in any case is necessary for clearing the associated information collection instruments. In addition to finalizing the information collection instruments, the PRA package will provide substantive information regarding our implementation approach and our interpretation of section 1011. Given the statutory date for implementing this provision, we will use the emergency PRA notice and clearance process as outlined in the PRA regulations 5 CFR 1320.13. Under this process, the normal 60-day and 30-day comment periods will be abbreviated to ensure that the procedural requirements and associated policies are approved by OMB prior to the statutory implementation date.

 

Related Programs

None.

 

Information Contacts

Regional or Local Office

None.

Headquarters Office

Program Contact: James Bossenmeyer, Center for Medicare Management, Hospital and Ambulatory Group, 7500 Security Boulevard, Baltimore, MD 21244. Telephone (410) 786-9317.

Web Site Address

http://www.cms.hhs.gov/contracts

 

Examples of Funded Projects

Not applicable.

 

Criteria for Selecting Proposals

Not applicable.