A coalition of state hospital associations is lobbying the CMS to implement a fair process for its member hospitals that want to claim funds for providing emergency care to illegal immigrants under the new Medicare-reform legislation.
Approximately 400 healthcare providers participated in a conference call last month with the CMS to learn about the provisions of the new Medicare law that earmark $1 billion over four years for hospitals and physicians who have been providing uncompensated care for illegal immigrants.
Hospital executives want to see direct payments to hospitals and a process that is not tied to arbitrary cost thresholds or the volume of treatments for illegal immigrants. The group, which calls itself the Coalition for Fair Payments to Health Care Providers, also wants hospitals to receive the funding without having to tap resources and staff to determine whether patients are actually illegal immigrants.
During the conference call, providers also asked for an easy claim process and a payment formula that is similar to Medicaid's. The CMS is taking comments from the industry before establishing a process for eligible providers to request payments, which will become available beginning in October.
A CMS official said the agency would take the conference-call comments into consideration when looking at options for implementing the new policy. The CMS expects to have a formal process approved by Sept. 1 for hospitals to request payments, he said.
The process of determining whether a patient is an illegal immigrant is a tough job already for hospitals, said Lowell Brown, a healthcare lawyer with the firm Foley & Lardner in Los Angeles.
"It would be very counterproductive to place unreasonable bureaucratic obstacles to hospitals getting that assistance," Brown said. "It is a headache for every hospital on when to have a discussion with a patient on payment status. That is a delicate conversation."
Members of the coalition, which includes 12 state hospital associations and the American Hospital Association, said they are pleased that the CMS is listening to their concerns.
"The spotlight on the situation is very important to us," said Maureen Boshier, president and chief executive officer of the New Mexico Hospitals and Health Systems Association. "When you run that money against the expenditures, it doesn't go far. We have a big problem here."
New Mexico hospitals provided $200 million in uncompensated care in 2003, representing about 10% of net revenue, Boshier said. The association did not have a breakdown on how much uncompensated care went toward the treatment of illegal immigrants, she said.
The coalition sent a letter last month to the CMS making several recommendations on how to divide the payments, which will average $250 million annually for four years. The CMS has created a formula to divvy the funding. The six states that have the highest number of apprehensions of illegal immigrants will divide $83 million annually. The remaining $167 million will be divided by all 50 states based on the number of illegal immigrants counted in the 2000 census.
Boshier said an absence of cost thresholds and volume requirements would help smaller hospitals that might not treat as many illegal immigrants as hospitals in large cities. The payment should be based on the treatment of illegal immigrants, she said. "We don't feel volume thresholds are proper triggers for payment."
The coalition is also lobbying for the law to require hospitals to submit charges if they want to receive the funding in the same way they do for Medicaid, with the CMS paying a designated percentage of the amount for service. Under the Medicaid formula, hospitals would receive 81% of funding, physicians 17% and ambulance service providers 2%.
The coalition also wants hospitals not to be required to request documentation from illegal immigrants in order to have their claims qualify for the funding. Hospitals should not have to prove that patients are in the country illegally, the hospital associations wrote. In cases where patients lack a Social Security number, an address or a Medicaid card, the CMS should still accept the criteria and provide funding to the provider, they wrote.
Ernie Schmid, a senior healthcare policy analyst with the Texas Hospital Association who participated in the conference call, said hospitals should not be required to take on the duties of immigration officials while providing care. "You want to encourage people to get the services they need," he said. "There are some concerns the rules would act as immigrant control."