To amend section 1011 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173) to make permanent the program of Federal reimbursement of emergency health services furnished to undocumented aliens.

Summary: Pay for all your Undocumented Procedures (PAY UP!) Act of 2009 - Amends the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to make permanent the program of federal reimbursement of emergency health services furnished to undocumented aliens.

Requires a reallotment of unspent program funds in a fiscal year among eligible providers in full expenditure states according to a specified ratio. Requires addition of such funds to the aggregate amount available for allotment for the succeeding fiscal year in the event there is no full expenditure state.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Pay for all your Undocumented 
Procedures (PAY UP!) Act of 2009''.

SEC. 2. MAKING PERMANENT THE PROGRAM OF FEDERAL REIMBURSEMENT OF 
              EMERGENCY HEALTH SERVICES FURNISHED TO UNDOCUMENTED 
              ALIENS.

    (a) In General.--Subsection (a)(1) of section 1011 of the Medicare 
Prescription Drug, Improvement, and Modernization Act of 2003 (Public 
Law 108-173) is amended--
            (1) by inserting ``and for each of fiscal years 2010 
        through 2014'' after ``each of fiscal years 2005 through 
        2008''; and
            (2) by adding at the end the following: ``There are 
        authorized to be appropriated to the Secretary for fiscal year 
        2015 and each succeeding fiscal year such sums as may be 
        necessary for such purpose.''.
    (b) Reallocation of Unspent Funds in a Fiscal Year.--
            (1) In general.--Subsection (b) of such section is 
        amended--
                    (A) in paragraph (1)--
                            (i) in subparagraph (A), by striking 
                        ``subparagraph (B)'' and inserting 
                        ``subparagraphs (B) and (C)''; and
                            (ii) by adding at the end the following new 
                        subparagraph:
                    ``(C) Reallotment of unspent funds.--
                            ``(i) In general.--If the amounts allotted 
                        under this paragraph with respect to one or 
                        more States for a fiscal year are not fully 
                        expended under this section during the fiscal 
                        year and there is one or more full expenditure 
                        States for the fiscal year, the Secretary shall 
                        provide for the reallotment of the aggregate 
                        unexpended portion of such amounts (for 
                        expenditure under this paragraph in the 
                        succeeding fiscal year) among eligible 
                        providers in full expenditure States in the 
                        same proportion as the ratio of--
                                    ``(I) the amount of each full 
                                expenditure State's allotment under 
                                this paragraph for such fiscal year 
                                (determined without regard to this 
                                subparagraph); to
                                    ``(II) the sum of all the amounts 
                                determined for all full expenditure 
                                States under subclause (I).
                            ``(ii) If no full expenditure state.--If 
                        the amounts allotted under this paragraph with 
                        respect to one or more States for a fiscal year 
                        are not fully expended under this section 
                        during the fiscal year and there is no full 
                        expenditure State for the fiscal year, the 
                        aggregate unexpended portion shall be added to 
                        the aggregate amount available for allotment 
                        available under paragraph (1) for the 
                        succeeding fiscal year.
                            ``(iii) Full expenditure state defined.--In 
                        this subparagraph, the term `full expenditure 
                        State' means, with respect to a fiscal year, a 
                        State described in subparagraph (A) which has 
                        received an allotment under this paragraph for 
                        the fiscal year and which has fully expended 
                        such allotment by the end of such fiscal 
                        year.''; and
                    (B) in paragraph (2)--
                            (i) in subparagraph (B), by inserting ``, 
                        subject to subparagraph (D),'' after ``shall''; 
                        and
                            (ii) by adding at the end the following new 
                        subparagraph:
                    ``(D) Reallotment of unspent funds.--The provisions 
                of subparagraph (C) of paragraph (1) shall apply with 
                respect to allotments made under this paragraph to a 
                State described in subparagraph (A) in the same manner 
                as such subparagraph (C) applies with respect to 
                allotments made to a State under paragraph (1).''.
            (2) Effective date.--The amendments made by paragraph (1) 
        shall apply to allotments for fiscal years beginning before, 
        during, or after fiscal 2010; except that, in applying such 
        amendments for fiscal years that began before the date of the 
        enactment of this Act--
                    (A) the allotments to a State for such fiscal years 
                under paragraph (1) or (2) of section 1011(b) of the 
                Medicare Prescription Drug, Improvement, and 
                Modernization Act of 2003 (Public Law 108-173) shall be 
                treated as being a single allotment under the 
                respective paragraph for the fiscal year in which this 
                Act is enacted; and
                    (B) such fiscal years shall be treated as being 
                such the fiscal year in which this Act is enacted.