CMS Still Has Not Finalized Process For Health Care Provider Reimbursement Under “Section 1011”

IMMIGRANTS & PUBLIC BENEFITS

Health Care

CMS still has not finalized process for health care provider reimbursement under “Section 1011”
Immigrants' Rights Update, Vol. 18, No. 6, September 21, 2004

Questions remain about the implementation of section 1011 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. Section 1011 appropriates $1 billion over four years to reimburse hospitals, physicians, and emergency transportation providers for uncompensated emergency health services to immigrants who are undocumented or paroled into the United States to receive services, or to Mexican citizens with “border crossing” cards. The statute provides that payments will be made directly to providers but does not specify a method for allocating the payments.

On July 21, 2004, the federal Centers for Medicare and Medicaid Services (CMS) issued a policy paper on its proposed implementation of section 1011. The paper proposes an individual claims–based payment methodology. The process laid out in the CMS paper would require providers to question patients about their immigration status and retain records of patients’ status and individual identifying information. Health care providers and advocates objected to the CMS’s proposed approach, citing concerns about deterring immigrant families from seeking needed health services and placing burdens on health care providers. These concerns received substantial media coverage and attention from members of Congress. (For more on this, see “Centers for Medicare and Medicaid Services Details Proposed Process for Distributing Emergency Services Reimbursement Funds,” Immigrants’ Rights Update, Aug. 9, 2004, p. 13.)

On Sept. 1, the statutory deadline for the CMS to establish a process for eligible providers to claim section 1011 reimbursement, the CMS released provider enrollment forms through a Paperwork Reduction Act filing with the Office of Management and Budget. The CMS did not release any details about the process for providers to claim reimbursement, but simply stated in its filing that it would issue its payment methodology “shortly.” Advocates, health care providers, and some members of Congress continue to encourage CMS to abandon the individual claims–based payment method for reimbursing providers and to adopt in its place a statistical methodology that does not require providers to question patients about their status.