New Program to Pay for Uncompensated Emergency Care to Undocumented Immigrants

[CAL/AAEM News Service]

New Program to Pay for Uncompensated Emergency Care to Undocumented Immigrants

Source: CMA Alert (http://www.calphys.org/html/cc017.asp) 
Date: October 27, 2005


The Centers for Medicare & Medicaid Services (CMS) recently launched a new federal
program that will reimburse physicians and hospitals for emergency and on-call care
provided to undocumented immigrants. The program, Section 1011 of the Medicare
Modernization Act of 2003, will provide California with $288 million over four years. 

Under the Emergency Medical Treatment and Labor Act (EMTALA), hospitals that maintain an
emergency department must provide emergency medical services to anyone regardless of
ability to pay. The cost of this care often strains hospital and physician budgets and
can threaten a hospital’s ability to keep its emergency room open. This year, the cost of
those uncompensated services is expected to reach $1 billion.

Physicians can seek payment for unreimbursed care provided to undocumented patients on or
after May 10, 2005. Claims will be paid according to the Medicare fee schedule for
EMTALA-related emergency services. Payments will be made directly to physicians on a
quarterly basis. Payments may, however, be subject to a pro rata reduction if the state’s
quarterly allocation is insufficient to provide full reimbursement to all providers
submitting claims. Second-quarter claims (services provided from May 10 to June 1) are
due December 27. CMS has contracted with TrailBlazer Health Enterprises to administer
payments nationwide. TrailBlazer will begin actual claims adjudication and payment
disbursement in February 2006.

To determine a patient’s eligibility, providers are required to ask certain questions
that may indirectly reveal the patient’s citizenship or immigration status. CMA is
worried, however, that this will intimidate undocumented patients and discourage them
from seeking care. CMA continues to urge CMS to adopt a documentation process that would
not deter such patients from seeking care.

This federal program is the “payor of last resort.” That means California physicians who
provide emergency and on-call care to undocumented immigrants must first bill the Maddy
Emergency Medical Services (EMS) fund. The federal program will pay the difference
between the amount paid by the EMS fund and the Medicare rate. 

Click here for provider enrollment information.

Contact: TrailBlazer Health Services, 866/860-1011.



Cyrus Shahpar & Brian Potts 
Managing Editors, CAL/AAEM News Service
University of California, Irvine

The CAL/AAEM Archives are available at: http://maillists.uci.edu/mailman/public/calaaem/



	
		
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