*Note - A printable version of all related Questions and Answers is now available.
What is EMTALA?
EMTALA stands for the Emergency Medical Treatment and Labor Act. In general, as codified in Sections 1866(a)(1)(I), 1866(a)(1)(N) and 1867 of the Social Security Act (the Act), EMTALA requires a Medicare-participating hospital that has an emergency department to provide appropriate medical screening to individuals who request examination or treatment to determine whether or not an emergency medical condition exists and, if so, to stabilize the condition and/or provide an appropriate transfer. A participating hospital shall not delay in providing the required screening, treatment or transfer to inquire about an individual’s payment method or insurance status.
Where can the public find additional information regarding EMTALA?
CMS published a final regulation clarifying its policies related to the responsibilities of Medicare-participating hospitals in treating individuals with emergency medical conditions in the Federal Register on Sept. 9, 2003 (68 Federal Register 53222).
What is the relationship between EMTALA and MMA Section 1011?
In general, Section 1011 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) seeks to reimburse eligible providers (as defined in Section 1011(e)(1)), for a portion of their otherwise unreimbursed costs incurred for furnishing EMTALA (as discussed in Question A1 above) and other related emergency health services to undocumented and other specified aliens (as defined in Section 1011(c)(5)).
Question A4
How much money is available for reimbursement under Section 1011?
Section 1011 provides $250 million per year for fiscal years 2005-2008.
Question A5
How will the Section 1011 funds be allocated?
Section 1011 funds are allocated by state. 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 highest number of undocumented alien apprehensions.
Question A6
Who will receive payments from the respective state allotments?
Where may I find additional information regarding the Section 1011 program and how the program is being administered?
CMS has established a Section 1011 Web site, which can be found at: www.cms.hhs.gov/UndocAliens/01_overview.asp. This Web site provides a link to the Section 1011 statutory language at: www.cms.hhs.gov/UndocAliens/downloads/sec1011.pdf and an electronic copy of the Section 1011 Final Policy Notice at: www.cms.hhs.gov/UndocAliens/downloads/cms10130.pdf, which: (1) establishes the general framework and procedural rules for submitting an enrollment application and payment requests; (2) establishes general statements of policy; and (3) provides CMS' interpretation of Section 1011.
On July 7, 2005, CMS designated TrailBlazer as the national contractor for the Section 1011 program. TrailBlazer will enroll eligible providers, assist providers with enrollment and billing questions, calculate provider payment amounts and serve as the compliance contractor. Interested parties are encouraged to visit the TrailBlazer Web site at www.trailblazerhealth.com/section1011/ and sign up for the TrailBlazer Section 1011 listserv.
Would EMTALA services provided at a clinic (such as a rural health center)be eligible for payment for services furnished to eligible aliens described in (c)(5) of Section 1011?
No. The Section 1011 statutory language specifies that eligible providers include only hospitals, physicians and providers of ambulance services. Section 1011 further provides that the term “hospital” has the meaning given in Section 1861(e) of the Social Security Act (42 U.S.C. 1395x(e)) and shall include critical access hospitals as defined in Section 1861(mm)(1) of the Act. The statutory language further specifies that eligible services include only those health care services required by application of EMTALA. EMTALA relates only to hospitals that have hospital emergency departments. Therefore, services provided at entities other than hospitals with hospital emergency departments are not eligible for Section 1011 payment. If there is a question as to whether a particular institution participates in Medicare as a hospital or CAH, the Medicare regional office for the State in which the institution is located should be contacted to determine the status of the institution.
Question A9
What is the connection between the Section 1011 program and the current national immigration reform situation?
Question A10
Isn't Medicaid denying claims by deciding the claim is for non-emergency services?
Question A12
How do I change my contact information?
Question A13
If a provider does not participate in the Section 1011 program will they be considered non-compliant?
Providers are not required to participate, as participation in the Section 1011 program is optional and voluntary.
This information may be found on the Q&A page of the Section 1011 Web site under question C3.
Question A14
Prior to Section 1011 funding, Immigration Health Services (I.H.S.) paid claims for health care administered to undocumented aliens in the custody of the U.S. Border Patrol. However, the I.H.S. is now denying claims and directing providers to contact TrailBlazer to request payment from the Section 1011 program. Since Section 1011 is the payer of last resort, how are providers to submit their payment requests?
Providers should continue to submit Section 1011 payment requests according to current Section 1011 policy.
At this time, I.H.S. does not cover EMTALA or EMTALA-related services. The I.H.S. Treatment Authorization Request (TAR) refers the provider to TrailBlazer to request payment from the Section 1011 program for EMTALA services only. This is consistent with I.H.S. and Section 1011 policy. The provider may continue to submit claims to I.H.S. for services not covered under Section 1011. Providers should contact the I.H.S. for further explanation of I.H.S. coverage at (800) 479-0523.
Some hospitals are cautious about participating in the program because of privacy issues for the undocumented patients. What practices are in place to ensure that patients can access needed healthcare without any repercussions?
Trailblazer will distribute via listserv and post below the most frequent and pertinent questions and answers to Section 1011 inquiries. Providers are encouraged to direct their inquiries to the physical or email addresses or call center number below.
TrailBlazer Health Enterprises, LLC Section 1011 P.O. Box 660529 Dallas, Texas 75266-0529 Direct email inquiries to: section.1011@trailblazerhealth.com Section 1011 Customer Call Center (866) 860-1011