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.



Agency - Department of Health and Human Services

The Department of Health and Human Services is the Federal government's principal agency for protecting the health of all Americans and providing essential human services, especially to those who are least able to help themselves.




Program Accomplishments

Not Applicable.

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 2 CFR 200, Subpart E - Cost Principles.

Aplication 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 Procedures

This program is excluded from coverage under 2 CFR 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards. Not applicable

Award Procedures

Not applicable.

Deadlines

Not Applicable.

Authorization

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

Range of Approval/Disapproval Time

None.

Appeals

None.

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 beginning in FY 2005 until all appropriated funds have been exhausted. Method of awarding/releasing assistance: lump sum.

Post Assistance Requirements

Reports

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.

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.

Financial Information

Account Identification

75-0516-0-1-551.

Obigations

(Formula Grants (Apportionments)) FY 16 $0; FY 17 est $0; and FY 18 est $0

Range and Average of Financial Assistance

None.

Regulations, Guidelines, and Literature

This information can be found in the Final Policy Notice at the following link: www.cms.gov/UndocAliens.02 policy.asp

Information Contacts

Regional or Local Office

None.

Headquarters Office

Lorraine Zicha, 7500 Security Boulevard, Baltimore, Maryland 21244 Email: Lorraine.Zicha@cms.hhs.gov Phone: (410) 786-0048

Criteria for Selecting Proposals

Not Applicable.




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Edited by: Michael Saunders

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