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.

Summary: Undocumented Alien Emergency Medical Assistance Amendments of 2004 - Amends the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to: (1) prohibit Federal reimbursement of hospital-provided emergency and certain transportation services to undocumented aliens unless the hospital provides the Secretary of Homeland Security with information regarding an alien's citizenship, immigration status, financial data, and employer; (2) make the employer of certain undocumented aliens responsible for such costs; and (3) direct the Secretary to initiate removal procedures against an alien determined to be removable under Federal immigration law.

Directs the Secretary of State to analyze the feasibility of effecting treaties for international medical evacuations.

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).