To amend the Balanced Budget Act of 1997 to extend and modify the reimbursement of State and local funds expended for emergency health services furnished to undocumented aliens.

February 13, 2003

Mr. KYL (for himself, Mr. MCCAIN, Mr. DOMENICI, Mrs. FEINSTEIN, Mr. CORNYN, and Mr. SCHUMER) introduced the following bill; which was read twice and referred to the Committee on Finance

To amend the Balanced Budget Act of 1997 to extend and modify the reimbursement of State and local funds expended for 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 `Local Emergency Health Services Reimbursement Act of 2003'.

SEC. 2. FEDERAL REIMBURSEMENT OF EMERGENCY HEALTH SERVICES FURNISHED TO UNDOCUMENTED ALIENS.

Section 4723 of the Balanced Budget Act of 1997 (8 U.S.C. 1611 note) is amended to read as follows:

`SEC. 4723. FEDERAL REIMBURSEMENT OF EMERGENCY HEALTH SERVICES FURNISHED TO UNDOCUMENTED ALIENS.

`(a) TOTAL AMOUNT AVAILABLE FOR ALLOTMENT- There is appropriated, out of any funds in the Treasury not otherwise appropriated, $1,450,000,000 for each of fiscal years 2004 through 2008, for the purpose of making allotments under this section to States described in paragraph (1) or (2) of subsection (b). Funds appropriated under the preceding sentence shall remain available until expended.

`(b) STATE ALLOTMENTS-

`(1) BASED ON PERCENTAGE OF UNDOCUMENTED ALIENS-

`(A) IN GENERAL- Out of the amount appropriated under subsection (a) for each fiscal year, the Secretary shall use $957,000,000 of such amount to make allotments for each such fiscal year in accordance with subparagraph (B).

`(B) FORMULA- The amount of the allotment for each State for a fiscal year shall be equal to the product of--

`(i) the total amount available for allotments under this paragraph for the fiscal year; and

`(ii) the percentage of undocumented aliens residing in the State with respect to the total number of such aliens residing in all States, as determined by the Statistics Division of the Immigration and Naturalization Service, as of January 2003, based on the 2000 decennial census.

`(2) BASED ON NUMBER OF UNDOCUMENTED ALIEN APPREHENSION STATES-

`(A) IN GENERAL- Out of the amount appropriated under subsection (a) for a fiscal year, the Secretary shall use $493,000,000 of such amount to make allotments for each such fiscal year for each of the 6 States with the highest number of undocumented alien apprehensions for such fiscal year.

`(B) DETERMINATION OF ALLOTMENTS- The amount of the allotment for each State described in subparagraph (A) for a fiscal year shall bear the same ratio to the total amount available for allotments under this paragraph for the fiscal year as the ratio of the number of undocumented alien apprehensions in the State in the fiscal year bears to the total of such numbers for all such States for such fiscal year.

`(C) DATA- For purposes of this paragraph, the highest number of undocumented alien apprehensions for a fiscal year shall be based on the 4 most recent quarterly apprehension rates for undocumented aliens in such States, as reported by the Immigration and Naturalization Service.

`(3) RULE OF CONSTRUCTION- Nothing in this section shall be construed as prohibiting a State that is described in both of paragraphs (1) and (2) from receiving an allotment under both paragraphs for a fiscal year.

`(c) USE OF FUNDS-

`(1) AUTHORITY TO MAKE PAYMENTS- From the allotments made for a State under subsection (b) for a fiscal year, the Secretary shall pay directly to local governments, hospitals, or other providers located in the State (including providers of services received through an Indian Health Service facility whether operated by the Indian Health Service or by an Indian tribe or tribal organization) that provide uncompensated emergency health services furnished to undocumented aliens during that fiscal year, and to the State, such amounts (subject to the total amount available from such allotments) as the local governments, hospitals, providers, or State demonstrate were incurred for the provision of such services during that fiscal year.

`(2) LIMITATION ON STATE USE OF FUNDS- Funds paid to a State from allotments made under subsection (b) for a fiscal year may only be used for making payments to local governments, hospitals, or other providers for costs incurred in providing emergency health services to undocumented aliens or for State costs incurred with respect to the provision of emergency health services to such aliens.

`(3) INCLUSION OF COSTS INCURRED WITH RESPECT TO CERTAIN ALIENS- Uncompensated emergency health services furnished to aliens who have been allowed to enter the United States for the sole purpose of receiving emergency health services may be included in the determination of costs incurred by

a State, local government, hospital, or other provider with respect to the provision of such services.

`(d) APPLICATIONS; ADVANCE PAYMENTS; REALLOTMENT OF UNUSED FUNDS-

`(1) DEADLINE FOR ESTABLISHMENT OF APPLICATION PROCESS-

`(A) IN GENERAL- Not later than July 31, 2003, the Secretary shall establish a process under which States, local governments, hospitals, or other providers located in the State may apply for payments from allotments made under subsection (b) for a fiscal year for uncompensated emergency health services furnished to undocumented aliens during that fiscal year.

`(B) INCLUSION OF MEASURES TO COMBAT FRAUD- The Secretary shall include in the process established under subparagraph (A) measures to ensure that fraudulent payments are not made from the allotments determined under subsection (b) or from amounts reallotted under paragraph (3).

`(2) ADVANCE PAYMENT; RETROSPECTIVE ADJUSTMENT- The process established under paragraph (1) shall allow for making payments under this section for each quarter of a fiscal year on the basis of advance estimates of expenditures submitted by applicants for such payments and such other investigation as the Secretary may find necessary, and for making reductions or increases in the payments as necessary to adjust for any overpayment or underpayment for prior quarters.

`(3) REALLOTMENT OF UNUSED FUNDS-

`(A) IN GENERAL- With respect to allotments made under subsection (b) for a fiscal year, the amount of any allotment to a State for a fiscal year that the Secretary determines will not be expended during that fiscal year or the succeeding fiscal year shall be available for reallotment during the second succeeding fiscal year, on such date as the Secretary may determine, to other States with allotments under that subsection that the Secretary determines will use such excess amounts during that second succeeding fiscal year.

`(B) DETERMINATION OF REALLOTMENTS- Reallotments under subparagraph (A) shall be made in the same manner as allotments are determined under paragraphs (1) and (2) of subsection (b) but only with respect to those States that the Secretary determines qualify for a reallotment for a fiscal year under that subparagraph.

`(C) TREATMENT- Any amount reallotted under subparagraph (A) to a State is deemed to be part of its allotment under subsection (b) for the fiscal year in which the reallotment occurs.

`(e) DEFINITIONS- In this section:

`(1) HOSPITAL- The term `hospital' has the meaning given such term in section 1861(e) of the Social Security Act (42 U.S.C. 1395x(e)).

`(2) INDIAN TRIBE; TRIBAL ORGANIZATION- The terms `Indian tribe' and `tribal organization' have the meanings given such terms in section 4 of the Indian Health Care Improvement Act.

`(3) PROVIDER- The term `provider' includes a physician, any other health care professional licensed under State law, and any other entity that furnishes emergency health services, including ambulance services.

`(4) SECRETARY- The term `Secretary' means the Secretary of Health and Human Services.

`(5) STATE- The term `State' means the 50 States and the District of Columbia.

`(f) ENTITLEMENT- This section constitutes budget authority in advance of appropriations Acts and represents the obligation of the Federal Government to provide for the payment of amounts provided under this section.'.

END