Federal Reimbursement of Emergency Health Services furnished to Undocumented Aliens

Published on AidPage by IDILOGIC on Jun 24, 2005

Administered by:

Purpose of this program:

To reimburse eligible providers for their otherwise un-reimbursed costs associated with furnishing emergency health services to undocumented and certain other aliens.

Possible uses and use restrictions...

Section 1867 of the Social Security Act dealing with the Emergency Medical Treatment and Active Labor Act (EMTALA) requires a hospital that has an emergency department to provide appropriate medical screening to individuals who request examination or treatment to determine whether or not an emergency medical condition exists. If such a condition does exist, the hospital is required to stabilize the condition and/or provide an appropriate transfer, regardless of the individual's ability to pay for treatment. Undocumented aliens are frequently unable to pay for the EMTALA-required care they receive from hospitals and other providers.

Who is eligible to apply...

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).

Eligible Applicant Categories:
Eligible Functional Categories:
Credentials/Documentation

Not later than September 1, 2004, the Secretary shall establish a process under which eligible providers located in a State may request payments. This process will include guidance regarding claims submission and documentation standards.

Note:This is a brief description of the credentials or documentation required prior to, or along with, an application for assistance.

About this section:

This section indicates who can apply to the Federal government for assistance and the criteria the potential applicant must satisfy. For example, individuals may be eligible for research grants, and the criteria to be satisfied may be that they have a professional or scientific degree, 3 years of research experience, and be a citizen of the United States. Universities, medical schools, hospitals, or State and local governments may also be eligible. Where State governments are eligible, the type of State agency will be indicated (State welfare agency or State agency on aging) and the criteria that they must satisfy.

Certain federal programs (e.g., the Pell Grant program which provides grants to students) involve intermediate levels of application processing, i.e., applications are transmitted through colleges or universities that are neither the direct applicant nor the ultimate beneficiary. For these programs, the criteria that the intermediaries must satisfy are also indicated, along with intermediaries who are not eligible.

How to apply...

Application Procedure:

CMS expects to establish an enrollment application process via a paperwork reduction act notice prior to September 1, 2004.

Note: Each program will indicate whether applications are to be submitted to the Federal headquarters, regional or local office, or to a State or local government office.

Award Procedure:

Official notice of approved claims for emergency health care services will be transmitted to eligible providers pursuant to procedures established prior to September 1, 2004 and published in the Federal Register.

Note: Grant payments may be made by a letter of credit, advance by Treasury check, or reimbursement by Treasury check. Awards may be made by the headquarters office directly to the applicant, an agency field office, a regional office, or by an authorized county office. The assistance may pass through the initial applicant for further distribution by intermediate level applicants to groups or individuals in the private sector.

Deadlines and process...

Deadlines

Established when program announcements are published in the Federal Register.

Note: When available, this section indicates the deadlines for applications to the funding agency which will be stated in terms of the date(s) or between what dates the application should be received. When not available, applicants should contact the funding agency for deadline information.

Range of Approval/Disapproval Time

Not applicable.

Preapplication Coordination

This program is excluded from coverage under E.O. 12372.

Note: This section indicates whether any prior coordination or approval is required with governmental or nongovernmental units prior to the submission of a formal application to the federal funding agency.

Appeals

There are no formal appeals procedures. If an application is disapproved, the reasons for disapproval will be fully stated.

Note: In some cases, there are no provisions for appeal. Where applicable, this section discusses appeal procedures or allowable rework time for resubmission of applications to be processed by the funding agency. Appeal procedures vary with individual programs and are either listed in this section or applicants are referred to appeal procedures documented in the relevant Code of Federal Regulations (CFR).

Renewals

Not applicable.

Note: In some instances, renewal procedures may be the same as for the application procedure, e.g., for projects of a non-continuing nature renewals will be treated as new, competing applications; for projects of an ongoing nature, renewals may be given annually.

Who can benefit...

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

Beneficiaries
About this section:

This section lists the ultimate beneficiaries of a program, the criteria they must satisfy and who specifically is not eligible. The applicant and beneficiary will generally be the same for programs that provide assistance directly from a Federal agency. However, financial assistance that passes through State or local governments will have different applicants and beneficiaries since the assistance is transmitted to private sector beneficiaries who are not obligated to request or apply for the assistance.

What types of assistance...

How much financial aid...

Range and Average of Financial Assistance

Not applicable. This is a new project under the MMA.

Note: This section lists the representative range (smallest to largest) of the amount of financial assistance available. These figures are based upon funds awarded in the past fiscal year and the current fiscal year to date. Also indicated is an approximate average amount of awards which were made in the past and current fiscal years.

Obligations

FY 03 $0; FY 04 est $0; and FY 05 est $250,000,000.

Note: The dollar amounts listed in this section represent obligations for the past fiscal year (PY), estimates for the current fiscal year (CY), and estimates for the budget fiscal year (BY) as reported by the Federal agencies. Obligations for non-financial assistance programs indicate the administrative expenses involved in the operation of a program.

Account Identification

75-0516-0-1-551.

Note: Note: This 11-digit budget account identification code represents the account which funds a particular program. This code should be consistent with the code given for the program area as specified in Appendix III of the Budget of the United States Government.

Examples of funded projects...

Not applicable.

About this section

This section indicates the different types of projects which have been funded in the past. Only projects funded under Project Grants or Direct Payments for Specified Use should be listed here. The examples give potential applicants an idea of the types of projects that may be accepted for funding. The agency should list at least five examples of the most recently funded projects.

Program accomplishments...

Not applicable. This is a new project under the MMA.

Criteria for selecting proposals...

Not applicable.

Assistance considerations...

Length and Time Phasing of Assistance

This project is authorized for four years beginning in FY 2005.

Formula and Matching Requirements

No State or local matching funds are required for this activity.

Note:
A formula may be based on population, per capita income, and other statistical factors. Applicants are informed whether there are any matching requirements to be met when participating in the cost of a project. In general, the matching share represents that portion of the project costs not borne by the Federal government. Attachment F of OMB Circular No. A-102 (Office of Management and Budget) sets forth the criteria and procedures for the evaluation of matching share requirements which may be cash or in-kind contributions made by State and local governments or other agencies, institutions, private organizations, or individuals to satisfy matching requirements of Federal grants or loans.

Cash contributions represent the grantees' cash outlay, including the outlay of money contributed to the grantee by other public agencies, institutions, private organizations, or individuals. When authorized by Federal regulation, Federal funds received from other grants may be considered as the grantees' cash contribution.

In-kind contributions represent the value of noncash contributions provided by the grantee, other public agencies and institutions, private organizations or individuals. In-kind contributions may consist of charges for real property and equipment, and value of goods and services directly benefiting and specifically identifiable to the grant program. When authorized by Federal legislation, property purchased with Federal funds may be considered as grantees' in-kind contribution.

Maintenance of effort (MOE) is a requirement contained in certain legislation, regulations, or administrative policies stating that a grantee must maintain a specified level of financial effort in a specific area in order to receive Federal grant funds, and that the Federal grant funds may be used only to supplement, not supplant, the level of grantee funds.

Post assistance requirements...

Reports

Periodic reports are due to CMS in accordance with the timeframes established by CMS.

Note: This section indicates whether program reports, expenditure reports, cash reports or performance monitoring are required by the Federal funding agency, and specifies at what time intervals (monthly, annually, etc.) this must be accomplished.

Audits

All payment transactions identifiable to Federal Reimbursement for Emergency Health Services Furnished to Undocumented Aliens are subject to audit or medical review by the Secretary or his designated agent. In accordance with the provisions of OMB Circular No. A-133 (Revised, June 27, 2003), "Audits of States, Local Governments, and Nonprofit Organizations," nonfederal entities that expend financial assistance of $500,000 or more a year in Federal awards will have a single or a program-specific audit conducted for that year. Nonfederal entities that expend less than $500,000 a year in Federal awards are exempt from federal audit requirements for that year, except as noted in Circular No. A-133.

Note: This section discusses audits required by the Federal agency. The procedures and requirements for State and local governments and nonprofit entities are set forth in OMB Circular No. A-133. These requirements pertain to awards made within the respective State's fiscal year - not the Federal fiscal year, as some State and local governments may use the calendar year or other variation of time span designated as the fiscal year period, rather than that commonly known as the Federal fiscal year (from October 1st through September 30th).

Records

Financial records, supporting documents, statistical records, and all other records pertinent to the project shall be retained for at least three years or until resolution of any audit questions.

Note: This section indicates the record retention requirements and the type of records the Federal agency may require. Not included are the normally imposed requirements of the General Accounting Office. For programs falling under the purview of OMB Circular No. A-102, record retention is set forth in Attachment C. For other programs, record retention is governed by the funding agency's requirements.

Regulations...

Authorization

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

Note: This section lists the legal authority upon which a program is based (acts, amendments to acts, Public Law numbers, titles, sections, Statute Codes, citations to the U.S. Code, Executive Orders, Presidential Reorganization Plans, and Memoranda from an agency head).

Regulations, Guidelines, And Literature

Since section 1011 does not amend the Social Security Act and does not include specific rulemaking authority, we do not have the authority to issue a notice of proposed rulemaking or implement regulations for this section of MMA. Thus, as an alternative to the notice-and-comment process, CMS will request public comment regarding our proposed implementation strategy via this document, and implement this section of MMA by publishing a Paperwork Reduction Act (PRA) notice in the Federal Register, an action that in any case is necessary for clearing the associated information collection instruments. In addition to finalizing the information collection instruments, the PRA package will provide substantive information regarding our implementation approach and our interpretation of section 1011. Given the statutory date for implementing this provision, we will use the emergency PRA notice and clearance process as outlined in the PRA regulations 5 CFR 1320.13. Under this process, the normal 60-day and 30-day comment periods will be abbreviated to ensure that the procedural requirements and associated policies are approved by OMB prior to the statutory implementation date.

Contact information...

Web Sites
Regional Or Local Office

None.

Note: This section lists the agency contact person, address and telephone number of the Federal Regional or Local Office(s) to be contacted for detailed information regarding a program such as: (1) current availability of funds and the likelihood of receiving assistance within a given period; (2) pre-application and application forms required; (3) whether a pre-application conference is recommended; (4) assistance available in preparation of applications; (5) whether funding decisions are made at the headquarters, regional or local level; (6) application renewal procedures (including continuations and supplementals) or appeal procedures for rejected applications; and (7) recently published program guidelines and material. However, for most federal programs, this section will instruct the reader to consult the so-called Appendix IV of the Catalog due to the large volume of Regional and Local Office Contacts for most agencies. This information is provided in Additional Contact Information (see below).

Headquarters Office

Program Contact: James Bossenmeyer, Center for Medicare Management, Hospital and Ambulatory Group, 7500 Security Boulevard, Baltimore, MD 21244. Telephone (410) 786-9317.

Note: This section lists names and addresses of the office at the headquarters level with direct operational responsibility for managing a program. A telephone number is provided in cases where a Regional or Local Office is not normally able to answer detailed inquiries concerning a program. Also listed are the name(s) and telephone number(s) of the information contact person(s) who can provide additional program information to applicants.

Additional Contact Information (Appendix IV)

Due to the large volume of regional and local office contacts for most agencies, full contact information is also provided separately here in a PDF format: