CMS Implements $1 Billion Program to Help Hospital, Other Recoup Unpaid Emergency Room Costs | CMS | 7.22.03
The Centers for Medicare & Medicaid Services (CMS) today announced a new program to provide $1 billion over four years to help hospitals and other providers recoup the costs of providing needed medical care to uninsured patients who cannot pay their hospital bills regardless of their citizenship status.
“Emergency services are a critical part of public health for everyone in our communities, including undocumented immigrants,” said Mark B. McClellan, M.D., Ph.D., administrator of CMS. “Hospitals and health professionals on the front lines of providing emergency care for everyone need our support. With $250 million a year in new funding, the new Medicare law gives us a greater ability than ever to provide that support.”
The MMA set aside $250 million a year for the next four years (FY 2005 through 2008) to help hospitals and certain other emergency care providers recoup a portion of their costs associated with providing emergency services to qualified individuals who are uninsured or cannot afford emergency care. Each state will receive funding based on the formula established in the law. Payments will be made directly to hospitals, physicians, and ambulance providers, including Indian Health Service facilities and Indian tribes and tribal organizations, as long as they did not receive payment from any other source such as the person treated or an insurance company.
“We intend to use this new program to support all aspects of emergency treatment – including hospital, physician, and ambulance services – that have been strained by providing uncompensated care for undocumented immigrants,” said Dr. McClellan. “This funding will strengthen all of the components of emergency health care to help make sure that everyone in the community gets emergency help when they need it.”
In implementing the new assistance, Medicare proposes to allocate payments based on the costs incurred for the initial emergency services and associated services, including physician and ambulance services. According to the new law, two-thirds of the funds will be distributed to all states with the remaining third going to those states with the largest number of apprehensions of undocumented aliens.
Under the Emergency Medical Treatment and Labor Act (EMTALA) hospitals with emergency rooms are required to treat and stabilize patients who present with emergency medical needs regardless of their ability to pay or citizenship status. The cost of this care often strains hospital budgets and can threaten a hospital’s ability to keep its emergency room open.
“We encourage everyone involved in providing emergency care to review our proposal and help us craft the best plan to help hospitals and other providers remain vital providers of health care to their communities,” Dr. McClellan said.
CMS posted on its Web site a policy paper that outlines the proposed implementation approach. The agency is seeking public comment through August 16 and anticipates having an implementation plan in place by the September 1 deadline set in the Medicare Modernization Act (MMA). The proposed policy paper can be viewed at http://www.cms.hhs.gov/providers/mma1011.pdf.
