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Federal reimbursement for treating the undocumented not enough, officials say

March 07, 2010|By SILVIO J. PANTA, Staff Writer
  • JOSELITO VILLERO PHOTO A sign shows the direction to the emergency room at El Centro Regional Medical Center on Wednesday.
JOSELITO VILLERO PHOTO
A sign shows the direction to the emergency room at El Centro Regional Medical Center on Wednesday.

No one gets turned away for medical treatment in the Imperial Valley, including undocumented immigrants who are injured or become ill, health care officials said.

But the amount of federal reimbursement for emergency room treatment of patients identified as undocumented, or who are brought in by a U.S. Border Patrol agent, is not enough, Tisha Benavidez, director of patient accounting and access at El Centro Regional Medical Center, said.

ECRMC is where treatment is sought for or by the undocumented, who don’t often reveal their immigration status, Benavidez said.

Nineteen percent of the medical charges for treatment of undocumented patients are covered by the U.S. Department of Homeland Security’s Bureau of Immigration and Customs Enforcement, Benavidez said. ICE paid $58,000 to ECRMC last fiscal year to cover those charges, she said.

But the claims ICE deny get referred to the Section 1011 program, which is part of the Medicare Modernization Act of 2003. It is aimed at paying back eligible health providers for emergency services given to undocumented people.

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“They deny a lot of our claims,” Benavidez said of ICE.

The amount received is not commensurate with the cost that goes into treating the undocumented for emergency room care or active labor, Benavidez said.

While the reimbursement under Section 1011 differs year to year, $150,000 was paid to ECRMC last year, Benavidez said. The sum is substantially more than what ICE pays but it does not go far enough, she said.

“The reimbursement rate is 15 percent under Section 1011,” Benavidez said.

But reimbursement is determined by statute and the federal registration system which formulated the methodology for payment, according to an official with the Centers for Medicare and Medicaid, the federal agency that oversees Section 1011.

The CMS official, who refused to be identified and to whom all questions about Section 1011 were deferred, said there are very strict rules for which patient, or what medical service, is eligible for reimbursement.

Moreover, the CMS official said payments should “be pretty consistent” with other hospitals, depending on the different services and times for stabilization.

“(Section 1011) only pays for services up to the stabilization of the patient,” the official said.

Reimbursement under Section 1011 guidelines for undocumented persons brought to the ER by a Border Patrol agent relies on whether the person is detained or in custody, Billi Jo Gervacio, community relations representative for ECRMC, said.

The difference is important since reimbursement is paid if the undocumented person is in federal custody during an ER visit, Gervacio said.

The undocumented is part of the roughly $20 million the hospital incurs annually in unpaid claims that sometimes get written off as “charity,” Benavidez said.

The actual number of ER visits by undocumented immigrants is unknown but the estimates of such patients coming in are 300 to 400 a year, Benavidez said.

The cost for caring and treating the undocumented — which can sometimes include a helicopter flight out to a San Diego-area hospital — amount to $1.6 million to $2 million, Benavidez said.

In the same way patients can’t get turned away for lack of insurance, medical service won’t be refused to them because of their immigration status, Benavidez said.

“We treat every patient the same who come through our doors,” she said.

>> Staff Writer Silvio J. Panta can be reached 760-337-3442 or at spanta@ivpressonline.com

JOSELITO VILLERO PHOTO
A sign shows the direction to the emergency room at El Centro Regional Medical Center on Wednesday.
JOSELITO VILLERO PHOTO
A sign shows the direction to the emergency room at El Centro Regional Medical Center on Wednesday.
JOSELITO VILLERO PHOTO
Tisha Benavidez, director of patient accounting and access, talks about the financial impact of treating undocumented aliens in the emergency room at El Centro Regional Medical Center in El Centro recently. At right is Billi Jo Gervacio, manager of customer service and volunteer programs.
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