Mid-Atlantic Health Law TOPICS

Health care providers are often called upon to treat individuals before learning much about the individual. Providers often learn, once the appropriate care has been given, that the individual has no capacity to pay for the care.
Certain federal and state programs, such as Medicaid and Medicare, can sometimes help pay for these services. However, undocumented immigrant patients are generally not eligible for these government programs, and often lack an ability to pay through other means.
Hospitals, in particular, are greatly affected by this phenomenon. The Emergency Medical Treatment and Labor Act (EMTALA) requires all hospitals to treat a patient that comes to a hospital emergency room with an emergency condition, until such time as that patient has been stabilized. The hospital may not inquire as to the patient's status or ability to pay until such time as the patient has been stabilized. This results in many hospitals being legally required to provide care to illegal immigrants, which care is often ultimately uncompensated.
To help relieve some of the burden on providers, Congress passed Section 1011 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). Section 1011 provides $250 million per year for fiscal years 2005 through 2008 for payments to eligible providers for emergency health services provided to undocumented aliens and other specified aliens. Two-thirds of this money is allocated to each state in proportion to each state's relative percentage of undocumented aliens, with the final one-third being divided among the six states with the largest number of undocumented alien apprehensions.
A. Who is covered?
Section 1011 authorizes payment to hospitals, physicians, and ambulance companies that provide uncompensated care to certain aliens. Payment is authorized for care given to undocumented aliens, aliens who have been permitted to enter the United States for the purpose of receiving eligible services, and Mexican citizens permitted to enter the United States under the authority of a biometric machine readable border crossing identification card. These latter aliens are Mexican citizens who have been allowed to enter certain border zones in California, Arizona, New Mexico and Texas for a period of up to 30 days.
Payment is not authorized, and will not be made, for care given to foreign nationals possessing a non-immigrant visa.
B. Which services?
The Centers for Medicare and Medicaid Services (CMS) is the federal agency charged with administering Section 1011. CMS has reasoned that, because EMTALA requires hospitals to give care to patients for a certain period, Section 1011 funds will be used to pay for care given during this same period.
Thus, a hospital may apply for Section 1011 payment for care given to an alien patient from the time the patient comes to the emergency room until the time the patient is stabilized. Both hospital services and physician services will be covered for this time period. However, should the hospital continue to give care after stabilization, such care will not be eligible for payment under Section 1011.
In addition, ambulance services will be covered for all medically necessary transportation of a patient to the first hospital at which the patient is seen.
C. Pre-Requisites
CMS has taken the position that a provider must seek reimbursement from all available sources prior to requesting Section 1011 payment. These sources would include federal sources, state sources, third-party payers, and direct payment by the patient himself. Once a provider has sought reimbursement from all applicable sources, if the provider remains uncompensated for the care, the provider may request payment under Section 1011.
Each provider who wishes to receive Section 1011 payments must submit an enrollment application with CMS. The application can be found at CMS' website, at http://www.cms.gov/Regulations-and-Guidance/Legislation/UndocAliens/