Centers For Medicare And Medicaid Services Details Proposed Process For Distributing Emergency Services Reimbursement Funds

IMMIGRANTS & PUBLIC BENEFITS

Health Care

Centers for Medicare and Medicaid Services details proposed process for distributing emergency services reimbursement funds
Immigrants' Rights Update, Vol. 18, No. 5, August 9, 2004

The Centers for Medicare and Medicaid Services (CMS) has released a “policy paper” that details its proposed process for distributing funds allocated under section 1011 of the Medicare Prescription Drug, Modernization and Improvement Act (“section 1011”). Section 1011 appropriates a billion dollars over a four-year period to reimburse hospitals, physicians, and emergency transportation–providers for unreimbursed emergency services to non–U.S. citizens who are undocumented, have temporary permission to enter into the United States on “border crossing cards,” or are paroled into the U.S. to receive emergency health care.

The Medicare law provides that the reimbursement funds be distributed directly to the healthcare providers but does not set forth a process for determining the amounts providers will receive. NILC, healthcare providers, and other advocates urged the CMS to adopt a “proxy”-based reimbursement methodology to avoid deterring undocumented persons and their families from seeking needed health care. A proxy method would use a formula to determine the proportion of a provider’s total uncompensated care costs attributable to persons within the reimburseable categories. The CMS’s policy paper rejects the “proxy” proposal and relies on an individual claims–based method to allocate section 1011 funds among providers. The CMS’s proposed process requires providers to query individual patients about their immigration status and encourages providers to obtain documents, such as foreign driver’s licenses, that the CMS perceives to identify persons as undocumented.

The CMS has provided a form for providers to use in making the immigration status determination. The proposed policy paper states that providers may make the immigration status determination through their state’s Medicaid application but asks providers to supplement the application with the level of information provided on the form. The form contains individual identifying information, including the patient’s name, address and telephone number; asks questions about the patient’s immigration status; and collects information about documentation in the patient’s possession, including falsified driver’s licenses and Social Security numbers.

The policy paper contemplates that providers will submit aggregated claims for reimbursement to the CMS on a quarterly basis. The policy paper requires hospitals and other providers to maintain the records of patients’ status for auditing purposes and does not include any provisions for protecting the confidentiality of these records.

The CMS did not publish the policy paper in the Federal Register and has declined requests that it engage in a formal notice-and-comment rulemaking process. The CMS is accepting comments until Aug. 16, 2004. The policy paper is posted on NILC’s website at www.nilc.org/immspbs/health/Issue_Briefs/Sec1011Reimbrsmnt.pdf.