Thread: On Health/Emergency care for illegals; SECTION 1011!

Has anyone looked into Section 1011? Pay attention to the Q&A section as well. Here's a summary of what it's about:

Section 1011, Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens, which is part of the Medicare Modernization Act of 2003 (MMA)

On December 8, 2003, the President signed into law the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (Pub. L. 108-173) (MMA), Section 1011, Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens.

Pursuant to Section 1011 of the act, Congress has mandated that the Secretary of Health and Human Services directly pay hospitals, physicians, and ambulance providers (including Indian Health Service and Indian tribe and tribal organizations) for their otherwise un-reimbursed costs of providing services required by section 1867 of the Social Security Act (EMTALA) and related hospital inpatient, outpatient, and ambulance services furnished to undocumented aliens, aliens paroled into the United States at a United States port of entry for the purpose of receiving such services, and Mexican citizens permitted temporary entry to the United States with a laser visa.

Enrollment InformationSection 1011 provides $250 million per year for Fiscal Years (FY) 2005-2008 for payments to eligible providers for emergency health services provided to undocumented aliens and other specified aliens. Two-thirds of the funds will be divided among all 50 states and the District of Columbia, based on their relative percentages of undocumented aliens.

One-third will be divided among the six states with the largest number of undocumented alien apprehensions. From the respective state allotments, payments will be made directly to hospitals, certain physicians and ambulance providers for some or all of the costs of providing emergency health care required under Section 1867 and related hospital inpatient, outpatient and ambulance services to eligible individuals. Eligible providers may include an Indian Health Service (IHS) facility, whether operated by the Indian Health Service or by an Indian tribe or tribal organization. A Medicare Critical Access Hospital (CAH) is also a hospital under the statutory definition.

http://www.trailblazerhealth.com/Sectio ... fault.aspx

And some examples of the Q&A section:

Question E7

If a patient provides a Social Security Number (SSN) that the provider believes to be invalid, what information should the provider maintain for patient eligibility purposes?

Only services rendered to eligible aliens, as described in (c)(5) of Section 1011, are eligible for 1011 payments. The provider should document the basis for which they believe, and the steps they have taken to verify, that the SSN is invalid. The documentation substantiating a provider's belief, including efforts at verification that the patient falls within the Section 1011 definition of eligible aliens, should be maintained. This documentation should be submitted to TrailBlazer when requested for provider Compliance Review.


Date Released:4/12/2006
Last Update:1/18/2007

Question E13

What constitutes a voluntary statement (self-attestation) by a patient that (s)he is an undocumented alien?

For purposes of Section 1011, providers should NOT directly ask a patient if (s)he is an undocumented alien. However, if a patient voluntarily declares that (s)he is an undocumented alien, the provider is potentially eligible to claim emergency services provided to the patient for Section 1011 payment purposes. A patient’s self-declaration that (s)he is an undocumented alien may include either a direct statement or an indirect statement. We would not attempt to put words in the mouths of patients in either case. However, we want to reiterate that it is the provider’s responsibility to ensure that the context of the patient’s voluntary declaration reasonably indicates that the patient is an undocumented alien.


Date Released:4/12/2006
Last Update:10/3/2006

http://www.trailblazerhealth.com/Sectio ... swers.aspx

Question B1

Section 1011 provides reimbursement for eligible services administered to particular individuals. Who are these individuals?

As defined in Section 1011(c)(5), eligible aliens include the following individuals:

* Undocumented aliens.
* Aliens who have been paroled into the United States at a United States port of entry for the purpose of receiving eligible services.
* Mexican citizens permitted to enter the United States for not more than 30 days* under the authority of a biometric machine-readable border crossing identification card (also referred to as a “laser visaâ€

Here is the whole section..........very enlightening,,,,,,,,

http://www.cms.hhs.gov/UndocAliens/down ... ec1011.pdf

The MMA was signed by President George W. Bush on December 8, 2003, after passing in Congress by a close margin.

One month later, the ten-year cost estimate was boosted to $534 billion, up more than $100 billion over the figure presented by the Bush administration during Congressional debate.

The inaccurate figure helped secure support from fiscally conservative Republicans who had promised to vote against the bill if it cost more than $400 billion.

It was reported that administration officials had concealed the higher estimate and threatened to fire government analyst Richard Foster if he revealed it.

One of the little known features of the 2003 legislation is that means testing for Medicare B (medical insurance) begins in 2007.