Funding for EMTALA-Care of undocumented aliens
In 2005, the Centers for Medicare and Medicaid Services (CMS) announced the release of funding for physicians and other health care providers for EMTALA-mandated treatment provided to undocumented aliens. By 2008, one billion dollars will be released to states for disbursement, in addition to direct-to-provider payments.
Section 1011 of the 2003 Medicare Modernization Act required funding for emergency care of undocumented aliens and established the formula by which funds will be allocated among the states. States will, in turn, distribute funds to health care facilities and physicians who do not receive payment for services rendered from insurers or patients. Services provided between May 10, 2005 and 2008 are eligible for partial or full reimbursement, after other payment sources, such as Medicaid or private insurers, are first approached for payment.
Previously proposed measures that would have required treating physicians to inquire into a patient's citizenship status have been abandoned.
To receive reimbursement, physicians (both Medicare-participating ["PAR"] and "non-PAR") will be required to submit a Section 1011 application form. Billing will be similar to tradition Medicare billing and must be completed within 180 days of provision of services. All claims for reimbursement will be sent to TrailBlazer Health Enterprises, LLC, instead of a provider's standard Medicare carrier. The Section 1011 application can be obtained through the TrailBlazer Web site or by toll free (866) 860-1011.
Content provided by: Office of General Counsel