Hospitals need help with Unfunded Mandates for Treating Illegal Immigrants in the Emergency Room; managing risks of I-9 Compliance and Preparing for E-Verify; and Recruiting Foreign Nurses to ease
Hospitals need help with Unfunded Mandates for Treating Illegal Immigrants in the Emergency Room; managing risks of I-9 Compliance and Preparing for E-Verify; and Recruiting Foreign Nurses to ease critical staff shortages.
***DIAGNOSIS CRITICAL*** How the Immigration Crisis Impacts the Financial and Operational Health of your Hospital Eliot Norman Corporate Immigration Compliance Team Williams Mullen Richmond, VA [email_address] For updates: http://tinyurl.com/immupdates - Arlene J. Diosegy, Esq. Health Care Practice Group Williams Mullen Durham, NC 27703 firstname.lastname@example.org
Any patient who comes to the emergency department requesting examination or treatment for a medical condition must be provided with an appropriate medical screening examination to determine if he is suffering from an “emergency medical condition”.
This examination must be given without regard to the individual’s ability to pay and immigration status.
If patient is suffering from “an emergency medical condition,” the hospital must either provide the patient with treatment until the patient is stable or under certain circumstances, transfer the patient to another hospital.
11.9 million+ undocumented immigrants in the United States
Undocumented immigrants make up 4% of the U.S. population
Since the mid-1990s, the most rapid growth in the number of undocumented immigrants has been in states that previously had relatively small foreign-born populations. As a result, North Carolina is now among the states with largest numbers of undocumented migrants (approximately 300,000+) and One of the Fastest Growing States in terms of the increase in “illegals” or “undocumented”
One study found that annual per capita expenses for health care were 86% lower for uninsured immigrant children than for uninsured U.S.-born children — but emergency department expenditures were more than three times as high.*
Many undocumented immigrants post-pone treatment until an emergency arises.
Immigrants are significantly more likely to be uninsured than native citizens and undocumented immigrants are usually ineligible for government healthcare services (except Emergency Medicaid—used mainly for childbirth)
*Mohanty SA, Woolhandler S, Himmelstein DU, Pati S, Carrasquillo O, Bor DH. Health care expenditures
of immigrants in the United States: a nationally representative analysis. Am J Public Health 2005;95:1431-1438
If patient presents with an emergency medical condition:
(1) there should be no prior authorization before providing patient with a medical screening or stabilization.
(2) there should be no financial responsibility or advanced beneficiary notification- Hospital should not request that a patient complete a financial responsibility form or an advanced beneficiary notification form prior to providing a screening examination.
(3) only a physician or a qualified medical personnel (as defined in hospital’s bylaws) must conduct the medical screening examination.
Or Use Traditional Green Cards from other Countries:
6 Steps including proof of PERM (electronically-filed labor certification , testing shortages in U.S. market (Sunday Newspaper Ads)
But new problems regarding Retrogression= Long Wait (3-5 years for Green Cards)
No fix in sight on Visa Quotas
Procedures for Other Essential Health Care Professionals
Limited J-1 waivers for H-1Bs for foreign M.D.s completing residencies in U.S.
30 Conrad Physician slots per state for Green Cards for Foreign Physicians
PTs: a little better - can obtain temporary H-1B visas
Best Source of Foreign Medical Specialists: Canada and Mexico: Favored Treatment under NAFTA. Bilingual skills help with Hispanic patient population: Applies: RNs, PTs, also to Allied Health Workers, including Medical Techs
“Best Practices” for Recruiting Foreign Healthcare Talent
Consider it temporary solution for “hard-to-fill” positions
Plan Ahead, will not be a “quick-fix” except for use of NAFTA Treaty for Canadian and Mexican citizens
Broaden Recruitment starting with North America: some Job Fairs in Canada are closer than those in Chicago and California
Position of AHA and NCHA in easing restrictions on foreign doctors educated at U.S. Medical Schools?
Engage an immigration advisor to monitor develop-ments, work on pro-active strategies
Part 3: Worksite Enforcement Risks to Hospitals
The problem: Government makes employers verify identity/work authorization of all hires: U.S. citizens and foreign nationals.
These I-9s =Huge “Paper Chase”. And E-Verify is coming….
Enforced by Civil Fines For First offense: $375 to $3200 for substantive violations
Even Paperwork Violations: Fines Range from $ 110 to $1100
Your Hospital is a large employer whose workforce reflects new demographics of North Carolina
Not immune from worksite enforcement by Feds.
Or liability for illegal labor hired by your contractors: The “Wal-Mart” Problem ( $11 million criminal forfeiture)
The New I-9 Form and List of Acceptable Documents
NEW LIST OF ACCEPTABLE DOCUMENTS EMPHASIS: “ALL DOCUMENTS MUST BE UNEXPIRED” and be more careful in accepting List A Documents that show Identity and Work Eligibility
NEW I-9 FORM Effective April 3, 2009 Section 1: Employee fills in but Employer Pays Fine if its not Correct or Complete: Data Used For E-Verify Translator/Preparer Certificate Section 2: HR: Fills in Info From Originals of List A or List B and C Documents HR Certification: “UNDER PENALTY OF PERJURY” Section 3: HR Re-Verifies Work Authorization, again under “penalty of perjury”
MINI-WEBINAR The Nuts and Bolts of Filling in the NEW I-9 Form Link to audio and slides for your HR Managers: http://www.williamsmullen.com/filling-in-the-new-i-9-03-23-2009/
Medicare Section 1011: $1 Billion for 2005-2008: complicated allocations, money may still be there;
Funding Expired September 30, 2008
Some Senators urged Congress to extend Section 1011 program
May 19, 2008 AHA NEWS: A bipartisan group of 15 senators urged congressional leaders to extend Section 1011 of the Medicare program, which helps reimburse hospitals for emergency services provided to undocumented immigrants. “Section 1011 plays a critical role in helping to stabilize our states’ health care safety net and preserve access to care,” the group said in a letter to leaders of the Senate and its Finance Committee. “We hope that you concur and include a two-year extension of Section 1011 in this year’s Medicare bill.” Authorized by the Medicare Modernization Act of 2003, the program is set to expire Sept. 30,2008, Congress authorized $250 million annually for the program in fiscal years 2005-2008. Under the Emergency Medical Treatment and Labor Act, hospitals must treat anyone who needs emergency care, regardless of their ability to pay.
Result: “De Nada” (Nothing)
Part 1: EMTALA Reimbursement for Caring for Undocumented * Immigrants
S. 3101 and S. 3118 (EMTALA Funds)
Never made it to a Senate Floor Vote in 2008
Only Partial Solution: $250 million/year is welcome but nationally still is a drop in the bucket..
Added complication: Section 111 of MMSEA: beginning January 2009 may kick working illegals with phony SSNs out of Group Health Plans, adding to the uninsured
* Most immigrants not here legally are not undocumented, they are documented, its just that their paperwork is phony, which is why SSA has identified 10 million SSNs that don’t match.
What is needed? Our view: Comprehensive Immigration Reform to:
move 12 million illegals into health care system if they are already here working and paying taxes, why cant they get health insurance or coverage under Medicare?
If nothing done, even with health care reform, 25% of uninsured will stay uninsured and continue to over-utilize your ER and other hospital services
Part 2: Staffing Shortages & Congressional Inaction
Emergency Nursing Relief Act. No Floor Vote. Would have added 20,000 Green Cards annually until 2011 for RNs and Physical Therapists
20,000= only 5% of current vacancies
Would also have paid $1500 per Green Card into Nurse Enhancement Fund to increase faculty to educate more nurses in the U.S.
No Changes in Quotas/Complex Visa Rules for Qualified Foreign M.D.s, Health Care Professionals
Position of AHA? NCHA?
Part 3: Your Governments and your I-9 /E-Verify Immigration Paperwork
Allows Crazy Patchwork Quilt of Federal and State Laws requiring hospitals to verify who can work and their identities
Moving large employers to E-Verify System (100,000 already enrolled)
Puts Burden on Hospitals to card-check employees
at risk of Fines or Worse
Until we move to National ID or E-Verify System, Hospital Management needs to adequately support HR Managers in dealing with the confusion emanating from Washington DC and get competent help
Position of AHA? HCHA?
The Future: Health Care Reform Should Be Linked to Immigration Reform
Questions or Comments? Arlene J. Diosegy, Esq. Health Care Practice Group Williams Mullen Durham, NC 919.981.4096 email@example.com Eliot Norman Corporate Immigration Compliance Team Williams Mullen Richmond, VA 804.783.6482 [email_address] For updates: http://tinyurl.com/immupdates #6295695