New Source of Federal Funds for Emergency Care Presents Novel Challenges to Providers

On May 9, after receiving myriad comments form the provider community, immigrant advocates, and others, the Centers for Medicare and Medicaid Services (CMS) released its long-awaited final implementation notice detailing the requirements with which providers must comply to receive funds under Section 1011 of the Medicare Prescription Drug, Improvement and Modernization Act. This section of the new Medicare drug law provides $250 million each year from fiscal year 2005 through 2008 to reimburse some of the costs to physicians, hospitals, and ambulance services of providing emergency services to undocumented and other specified immigrants. Physicians, hospitals, and ambulance services are eligible to receive Section 1011 payments. By far one of the most challenging aspects of Section 1011 for providers will be requirements that they verify patients' eligibility for the program. On Jul 8, CMS announced that TrailBlazer will act as the national contractor for all Section 1011 claims. Providers have 180 days from the close of the third federal fiscal quarter to submit claims.