I 

111TH CONGRESS 

1ST SESSION H. R. 1386 

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. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 9, 2009 

Mr. FILNER introduced the following bill; which was referred to the 

Committee on Energy and Commerce 

A BILL 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Pay for all your Un5 documented Procedures (PAY UP!) Act of 2009’’. 


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1 SEC. 2. MAKING PERMANENT THE PROGRAM OF FEDERAL 

2 REIMBURSEMENT OF EMERGENCY HEALTH 

3 SERVICES FURNISHED TO UNDOCUMENTED 

4 ALIENS. 

5 (a) IN GENERAL.—Subsection (a)(1) of section 1011 

6 of the Medicare Prescription Drug, Improvement, and 

7 Modernization Act of 2003 (Public Law 108–173) is 

8 amended— 

9 (1) by inserting ‘‘and for each of fiscal years 

10 2010 through 2014’’ after ‘‘each of fiscal years 2005 

11 through 2008’’; and 

12 (2) by adding at the end the following: ‘‘There 

13 are authorized to be appropriated to the Secretary 

14 for fiscal year 2015 and each succeeding fiscal year 

15 such sums as may be necessary for such purpose.’’. 

16 (b) REALLOCATION OF UNSPENT FUNDS IN A FIS17 CAL YEAR.— 

18 (1) IN GENERAL.—Subsection (b) of such sec19 tion is amended— 

20 (A) in paragraph (1)— 

21 (i) in subparagraph (A), by striking 

22 ‘‘subparagraph (B)’’ and inserting ‘‘sub23 paragraphs (B) and (C)’’; and 

24 (ii) by adding at the end the following 

25 new subparagraph: 


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1 ‘‘(C) REALLOTMENT OF UNSPENT

2 FUNDS.— 

3 ‘‘(i) IN GENERAL.—If the amounts al4 lotted under this paragraph with respect to 

5 one or more States for a fiscal year are not 

6 fully expended under this section during 

7 the fiscal year and there is one or more 

8 full expenditure States for the fiscal year, 

9 the Secretary shall provide for the reallot10 ment of the aggregate unexpended portion 

11 of such amounts (for expenditure under 

12 this paragraph in the succeeding fiscal 

13 year) among eligible providers in full ex14 penditure States in the same proportion as 

15 the ratio of— 

16 ‘‘(I) the amount of each full ex17 penditure State’s allotment under this 

18 paragraph for such fiscal year (deter19 mined without regard to this subpara20 graph); to 

21 ‘‘(II) the sum of all the amounts 

22 determined for all full expenditure 

23 States under subclause (I). 

24 ‘‘(ii) IF NO FULL EXPENDITURE

25 STATE.—If the amounts allotted under this 


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1 paragraph with respect to one or more 

2 States for a fiscal year are not fully ex3 pended under this section during the fiscal 

4 year and there is no full expenditure State 

5 for the fiscal year, the aggregate unex6 pended portion shall be added to the ag7 gregate amount available for allotment 

8 available under paragraph (1) for the suc9 ceeding fiscal year. 

10 ‘‘(iii) FULL EXPENDITURE STATE DE11 FINED.—In this subparagraph, the term 

12 ‘full expenditure State’ means, with respect 

13 to a fiscal year, a State described in sub14 paragraph (A) which has received an allot15 ment under this paragraph for the fiscal 

16 year and which has fully expended such al17 lotment by the end of such fiscal year.’’; 

18 and 

19 (B) in paragraph (2)— 

20 (i) in subparagraph (B), by inserting 

21 ‘‘, subject to subparagraph (D),’’ after 

22 ‘‘shall’’; and 

23 (ii) by adding at the end the following 

24 new subparagraph: 


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1 ‘‘(D) REALLOTMENT OF UNSPENT

2 FUNDS.—The provisions of subparagraph (C) of 

3 paragraph (1) shall apply with respect to allot4 ments made under this paragraph to a State 

5 described in subparagraph (A) in the same 

6 manner as such subparagraph (C) applies with 

7 respect to allotments made to a State under 

8 paragraph (1).’’. 

9 (2) EFFECTIVE DATE.—The amendments made 

10 by paragraph (1) shall apply to allotments for fiscal 

11 years beginning before, during, or after fiscal 2010; 

12 except that, in applying such amendments for fiscal 

13 years that began before the date of the enactment 

14 of this Act— 

15 (A) the allotments to a State for such fis16 cal years under paragraph (1) or (2) of section 

17 1011(b) of the Medicare Prescription Drug, Im18 provement, and Modernization Act of 2003 

19 (Public Law 108–173) shall be treated as being 

20 a single allotment under the respective para21 graph for the fiscal year in which this Act is en22 acted; and 


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1 (B) such fiscal years shall be treated as 

2 being such the fiscal year in which this Act is 

3 enacted. 

Æ 


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