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MIR-2006-6AB, June 2006
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Section 1011: Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens – An Update
Provider Types Affected
Physicians, hospitals, and ambulance services that provide emergency health services to undocumented aliens
Provider Action Needed
Impact to You
You may not be receiving funds that are available to you for services you furnish to undocumented aliens, and the Centers for Medicare & Medicaid Services (CMS) is providing this Special Edition article to inform and/or remind you about these available funds.
What You Need to Know
The Medicare Prescription Drug Improvement and Modernization Act (MMA) (Section 1011) provides $250 million each year for fiscal years (FY) 2005-2008 for payments to eligible providers for emergency health services given to undocumented and other specified aliens. You may be eligible to receive some of these funds.
What You Need to Do
See the Background and Additional Information sections of this article for further details.
Background
CMS previously issued MLN Matters Special Edition article SE0535 (MMA – CMS’s Implementation of Section 1011 of the Medicare Modernization Act – Federal Funding of Emergency Health Services Furnished to Undocumented Aliens) to inform physicians, hospitals, and ambulance services about the federal funding available to help pay for services furnished to undocumented aliens. (See SE0535 at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0535.pdf  on the CMS Web site.)
Because some providers may not be utilizing these available funds, CMS is issuing this additional Special Edition article to inform (and remind) providers about the funds that are available for emergency health services furnished to undocumented aliens.
The MMA (Section 1011: Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens) provides $250 million each year for fiscal years (FY) 2005-2008 for payments to eligible providers for emergency health services given to undocumented and other specified aliens:
- Two-thirds of the funds are divided among all 50 states and the District of Columbia, based on their relative percentages of undocumented aliens; and
- One-third of the funds are divided among the six states with the largest number of undocumented alien apprehensions.
Note: Current state allocations of these funds may be viewed at http://www.cms.hhs.gov/UndocAliens/04_state_alloc.asp#TopOfPage  on the CMS Web site.
From the respective state allotments, payments are made directly to enrolled hospitals, physicians, and ambulance providers for some or all of the costs of providing emergency health care (required under Section 1867) and related hospital inpatient services, outpatient services, and ambulance services provided to eligible individuals.
As of May 1, 2006, nationally, over 9,000 provider enrollment applications have been approved. The first Section 1011 payment to providers was issued on February 27, 2006, totaling nearly $25.5 million, and the next quarterly payment to providers will be made on May 29, 2006.
TrailBlazer Health Enterprises, LLC, is the national contractor for the Section 1011 program and is the only contractor for processing all requests for Section 1011 provider payments. So, if you want to request 1011 payments, you must do so by enrolling with TrailBlazer, and then submit your requests to TrailBlazer. Do NOT submit requests for 1011 payment to your regular fiscal intermediary or carrier. To learn more about the Section 1011 program, or to enroll as a provider, see the TrailBlazer Web site at https://www.trailblazerhealth.com/section1011/ .
TrailBlazer can also be contacted directly by telephone at (866) 860-1011.
Additional Information
Additional information regarding Section 1011 of the MMA and CMS’s policy for the implementation and administration of this program can be found at http://www.cms.hhs.gov/UndocAliens/ on the CMS Web site.
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.
MLN Matters Number: SE0633
Related Change Request (CR) #: N/A
Effective Date: N/A
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