Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens
To reimburse eligible providers for their otherwise un-reimbursed costs associated with furnishing emergency health services to undocumented and certain other aliens.
General information about this opportunity
Last Known Status
Agency: Department of Health and Human Services
Office: Centers for Medicare and Medicaid Services
Type(s) of Assistance Offered
DIRECT PAYMENTS FOR A SPECIFIED USE
Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Public Law 108-73, Section 1011; Medicare Modernization Act (MMA).
Who is eligible to apply/benefit from this assistance?
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).
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.
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 2 CFR 200, Subpart E - Cost Principles.
What is the process for applying and being award this assistance?
Preapplication coordination is not applicable. Environmental impact information is not required for this program. This program is excluded from coverage under E.O. 12372.
This program is excluded from coverage under 2 CFR 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards. Not applicable
Approval/Disapproval Decision Time
How are proposals selected?
How may assistance be used?
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.
What are the requirements after being awarded this opportunity?
No program reports are required. No cash reports are required. The Centers for Medicare & Medicaid Services (CMS) has designated Novitas Solutions (formerly Highmark Medicare Services) as the national contractor for Section 1011 and Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens.
Novitas Medicare Services will enroll eligible providers, assist providers with enrollment and billing questions, calculate provider payment amounts, and serve as the compliance contractor.
Novitas Medicare Services will send CMS periodic reports on the payments and they can also found be on their website at www.novitas-solutions.com/section1011/index.html. Periodic reports are due to CMS in accordance with the timeframes established by CMS. No performance monitoring is required.
No audits are required for this program.
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.
Other 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 beginning in FY 2005 until all appropriated funds have been exhausted. Method of awarding/releasing assistance: lump sum.
Who do I contact about this opportunity?
Regional or Local Office
Lorraine Zicha, 7500 Security Boulevard, Baltimore, Maryland 21244 Email: Lorraine.Zicha@cms.hhs.gov
Phone: (410) 786-0048
(Formula Grants (Apportionments)) FY 14 $5,649,016; FY 15 est $2,251,560; and FY 16 est $2,000,000
Range and Average of Financial Assistance
Regulations, Guidelines and Literature
This information can be found in the Final Policy Notice at the following link:
Examples of Funded Projects