[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3722 Introduced in House (IH)]
2d Session
H. R. 3722
To amend section 1011 of the Medicare Prescription Drug, Improvement,
and Modernization Act of 2003 to impose conditions on Federal
reimbursement of emergency health services furnished to undocumented
aliens.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
January 21, 2004
Mr. Rohrabacher introduced the following bill; which was referred to
the Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To amend section 1011 of the Medicare Prescription Drug, Improvement,
and Modernization Act of 2003 to impose conditions on Federal
reimbursement of emergency health services furnished to undocumented
aliens.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Undocumented Alien Emergency Medical
Assistance Amendments of 2004''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) The provision of medical care by public or private
health care providers to undocumented aliens is appropriate
only--
(A) to protect the health and safety of United
States citizens;
(B) to save the life of an undocumented alien in a
life-threatening medical emergency; and
(C) to stabilize an emergency medical condition so
that an undocumented alien can be repatriated for
medical treatment in the alien's own country.
(2) Federal reimbursement of emergency hospital services
furnished to undocumented aliens should be conditioned upon
obtaining sufficient information to promptly remove the aliens.
(3) Employers who employ undocumented aliens without
completing employment authorization verification procedures
should be held liable for uncompensated emergency services
furnished to such aliens.
SEC. 3. CONDITIONS FOR RECEIPT OF FEDERAL ASSISTANCE FOR EMERGENCY
SERVICES FOR UNDOCUMENTED ALIENS.
(a) In General.--Section 1011 of the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 (Public Law 108-173) is
amended--
(1) in subsection (d)(1), by adding at the end the
following new subparagraph:
``(C) Application of requirement.--Under such
process, the Secretary shall not provide payment under
subsection (c) to an eligible provider that is a
hospital for eligible services for an alien described
in subsection (c)(5)(A) unless the requirements of
subsection (f) are met by that provider with respect to
such alien.'';
(2) in subsection (e)(2), by adding at the end the
following new sentence: ``Such term also includes, with respect
to an undocumented alien described in subsection (c)(5)(A),
costs for emergency medical transportation and evacuation
incurred by a hospital in transferring and removing the alien
to a foreign country for receipt of appropriate health care
services.''; and
(3) by adding at the end the following new subsection:
``(f) Requirement for Collection of Immigration-Related Information
for Undocumented Aliens.--
``(1) In general.--No payment may be made under subsection
(c) to a hospital with respect to the provision of eligible
services to an undocumented alien described in subsection
(c)(5)(A) unless the following requirements are met:
``(A) The hospital has obtained in good faith from
the alien (or a legal guardian or other representative
on behalf of the alien) the following information in a
document that is signed by the alien (or such guardian
or representative) under oath or affirmation and that
is in a form that includes a notice that fraudulent or
false statements constitute a criminal act punishable
under Federal law:
``(i) The citizenship of the alien.
``(ii) The immigration status of the alien.
``(iii) The address of the alien in the
United States.
``(iv) Such personal or financial data
regarding the alien as the hospital routinely
requires of non-indigent patients, including
information regarding health insurance.
``(v) Information on the identity of any
current employer of the alien for whom the
alien has executed an Internal Revenue Service
Form W-4.
A hospital is not liable for the accuracy of the
information provided under this subparagraph so long as
it exercises reasonable care and good faith in
obtaining the information.
``(B) The hospital obtains one or more identifiers
for the alien and records such identifiers in a
digital, electronic format specified by the Secretary
in consultation with the Secretary of Homeland
Security. Such format shall be compatible with at least
one interoperable database maintained by the Secretary
of Homeland Security for the purpose of verifying the
identity and immigration status of aliens.
``(C) The hospital transmits to the Secretary of
Homeland Security, in a digital, electronic format and
manner specified by such Secretary, the information
provided under subparagraph (A) and the identifier (or
identifiers) obtained under subparagraph (B).
``(2) Maintenance of hospital records.--For a period of at
least 5 years, a hospital referred to in paragraph (1) shall
maintain the original documents described in paragraph (1)(A)
on file and makes such documents available for examination by
the Secretary and the Secretary of Homeland Security or their
designees.
``(3) Provision of technical support.--The Secretary of
Homeland Security shall provide hospitals under this section
with software, training, and technical support services, at no
cost to the hospital, to assist and enable hospitals to comply
with the requirements of paragraph (1).
``(4) Prompt action by dhs.--The Secretary of Homeland
Security shall take steps as may be necessary--
``(A) to obtain, process, and promptly review
information transmitted under paragraph (1)(C);
``(B) to determine whether an alien for whom such
information is transmitted is removable under any
provision of Federal immigration law; and
``(C) to initiate removal proceedings under the
relevant provisions of the Immigration and Nationality
Act in the case of any such alien who is identified as
being removable.
``(5) Removability.--An undocumented alien who obtains
eligible services through a hospital and does not provide for
payment for such services and who fails to provide accurate
information described in paragraph (1)(A) or an identifier (as
defined in paragraph (6)) shall be treated as removable on the
ground described in section 237(a)(5) of the Immigration and
Nationality Act (8 U.S.C. 1227(a)(5)).
``(6) Definition of identifier.--In this section, the term
`identifier' means a fingerprint or other biometric identifier
as the Secretary of Homeland Security may require.
``(g) Responsibility of Certain Employers.--
``(1) In general.--In the case of an employer of an
undocumented alien worker described in paragraph (2) for whom
payments are made to a hospital for eligible services under
this section, subject to paragraph (3), the employer shall be
liable to the Secretary for the amount of the payments so made.
``(2) Undocumented alien worker defined.--
``(A) In general.--For purposes of this subsection,
the term `undocumented alien worker' means, with
respect to an employer, an undocumented alien described
in subsection (c)(5)(A)--
``(i) who is an unauthorized alien (as
defined in section 274A(h)(3) of the
Immigration and Nationality Act (8 U.S.C.
1324a(h)(3));
``(ii) who has provided the employer with
an Internal Revenue Service Form W-4; and
``(iii) with respect to whom neither the
conditions described in subparagraph (B)(i) or
the condition described in subparagraph (B)(ii)
have been met.
``(B) Conditions for exemption.--For purposes of
subparagraph (A)(iii)--
``(i) First set of conditions.--The
conditions described in this clause for an
employer and alien are the following:
``(I) The employer and alien have
fully complied with all requirements of
the employment verification system
prescribed in section 274A(b) of the
Immigration and Nationality Act (8
U.S.C. 1324a(b)).
``(II) The employer has enrolled
the alien in a State workmen's
compensation plan.
``(III) The alien is enrolled under
a health benefits plan or health
insurance coverage that provides such
level of coverage with respect to
emergency medical and hospitalization
benefits as the Secretary shall
specify, in consultation with the
Secretary of Homeland Security.
``(IV) The employer has assumed
responsibility for any cost-sharing
(including applicable deductibles and
coinsurance) that applies to the alien.
``(ii) Alternative condition.--The
condition described in this clause for an
employer and alien are that the employer has
verified the employment authorization of the
alien through the voluntary basic employment
verification pilot program under section 403(a)
of the Immigration Reform and Immigrant
Responsibility Act of 1996 (division C of
Public Law 104-208), where available, or by any
other means made available for such
verification purposes by the Secretary of
Homeland Security.
``(3) Limitation on liability.--The liability of an
employer under this subsection shall be limited to an employer
that employs an undocumented alien worker at the time (as
specified under rules of the Secretary of Homeland Security)
the eligible services are provided for which payment may be
made by the Secretary under this section.
``(h) Limitation on Care Required.--Notwithstanding any other
provision of law (including section 1867 of the Social Security Act, 42
U.S.C. 1395dd), a hospital is not required to make available to an
undocumented alien described in subsection (c)(5)(A) care or services
if--
``(1) the alien may be transported to the alien's country
of origin (as determined in accordance with rules of the
Secretary of Homeland Security) without a significant
likelihood of material deterioration of medical condition of
the alien (or, in the case of an alien in active labor, of the
child), within reasonable medical probability, resulting from
the transfer of the alien from the hospital; or
``(2) the care--
``(A) involves organ transplantation or other
extraordinary medical treatment (or other treatment the
estimated cost of which exceeds $50,000); and
``(B) is for treatment of a condition that existed
before the alien entered the United States or is not
required as a direct and immediate result of an
accident in the United States.''.
(b) Effective Date.--The amendments made by subsection (a) shall be
effective as if included in the enactment of the Medicare Prescription
Drug, Improvement, and Modernization Act of 2003.
(c) Regulations.--
(1) In general.--The Secretary of Homeland Security, in
consultation with the Secretary of Health and Human Services,
shall issue interim regulations implementing the amendments
made by subsection (a) no later than 60 days after the date of
the enactment of this Act and shall permit a period of public
notice and comment of at least 90 days.
(2) Final regulations.--The Secretary of Homeland Security,
in consultation with the Secretary of Health and Human
Services, shall issue final regulations implementing such
amendments not later than one year after the date of
publication of such interim regulations.
(d) Annual Report on Implementation.--
(1) In general.--The Secretary of Homeland Security, in
consultation with the Secretary of Health and Human Services,
shall submit to the chairman and ranking minority member of the
Judiciary and Appropriations Committees of the House of
Representatives and the Senate, the Select Committee on
Homeland Security of the House of Representatives, and the
Senate Committee on Governmental Affairs an annual report on
the implementation of section 1011 of the Medicare Prescription
Drug, Improvement, and Modernization Act of 2003, as amended by
this section.
(2) Items to be included.--Each annual report under
paragraph (1) shall include--
(A) a cost analysis of Federal expenditures under
such section 1011;
(B) a description of the assistance provided to
hospitals under subsection (f)(2) of such section;
(C) the number of undocumented aliens removed under
subsection (f)(3) of such section; and
(D) amounts recovered from employers under
subsection (g) of such section.
(e) Feasibility of Effecting Treaties for International Medical
Evacuation.--
(1) Study.--The Secretary of State shall conduct an
analysis of the feasibility and appropriateness of the
following:
(A) Negotiating with foreign states treaties under
which such states provide payment for the cost of
international medical evacuation for their nationals
who require emergency health care in the United States
and who do not otherwise have insurance or other
coverage for the costs of such care.
(B) In the case of nationals of a foreign state for
whom significant costs are incurred under section 1011
of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 and for which state a treaty
described in subparagraph (A) is not in effect,
imposing a visa, port of entry, or similar surcharge
the proceeds of which may be used towards such costs
and towards the cost of international medical
evacuation described in such clause.
(2) Report.--The Secretary of State shall submit to the
committees described in subsection (d)(1) a report on the
analysis under paragraph (1).
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