The Centers for Medicare & Medicaid Services (CMS) last week published proposed regulations that would provide $1 billion over four years to reimburse physicians and hospitals for emergency and on-call care provided to undocumented immigrants. Under the proposal, which is part of last year’s Medicare Modernization Act, California would receive $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 open its emergency room.

A single CMS-contracted intermediary will administer payments nationwide. Physicians may elect to receive payments directly or through their hospitals. CMA is working to strengthen the direct payment provisions for physicians.

CMS proposes to pay at the Medicare fee schedule on a quarterly basis. If provider payments during any quarter exceed the state’s allotment for that period, providers would be paid on a pro rata basis.

“This program will provide an infusion of new funding sorely needed for California’s emergency and on-call physicians,” said CMA CEO Jack Lewin, M.D. Although CMA leaders endorse the proposed regulation, CMA will be asking for some amendments.

CMS is requiring that providers request information about a patient’s citizenship status using the existing Medicaid enrollment application or the new one developed by CMS for this program. CMA is worried, however, that this will intimidate undocumented patients. CMA will urge CMS to adopt a documentation process that would not deter such patients from seeking care.

The deadline for public comment is August 16. CMS expects to have a final regulation in place by the September 1 deadline established by the Medicare Modernization Act of 2003.

Contact: Elizabeth McNeil, 916/444-5532 or emcneil@cmanet.org.