I 

108TH CONGRESS 

1ST SESSION H. R. 819

To amend the Balanced Budget Act of 1997 to extend and modify the 

reimbursement of State and local funds expended for emergency health 

services furnished to undocumented aliens. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 13, 2003

Mr. KOLBE (for himself, Mr. FLAKE, Mr. SHADEGG, Mr. HAYWORTH, Mr. 

RENZI, Mr. PASTOR, Mr. GRIJALVA, and Mr. REYES) introduced the following bill; which was referred to the Committee on Appropriations, and 

in addition to the Committee on Energy and Commerce, for a period to 

be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee 

concerned 

A BILL

To amend the Balanced Budget Act of 1997 to extend and 

modify the reimbursement of State and local funds expended for 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 ‘‘Local Emergency 

5 Health Services Reimbursement Act of 2003’’. 
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1 SEC. 2. FEDERAL REIMBURSEMENT OF EMERGENCY 

2 HEALTH SERVICES FURNISHED TO UNDOCU3 MENTED ALIENS. 

4 Section 4723 of the Balanced Budget Act of 1997 

5 (8 U.S.C. 1611 note) is amended to read as follows: 

6 ‘‘SEC. 4723. FEDERAL REIMBURSEMENT OF EMERGENCY 

7 HEALTH SERVICES FURNISHED TO UNDOCU8 MENTED ALIENS. 

9 ‘‘(a) TOTAL AMOUNT AVAILABLE FOR ALLOT10 MENT.—There is appropriated, out of any funds in the 

11 Treasury not otherwise appropriated, $1,450,000,000 for 

12 each of fiscal years 2004 through 2008, for the purpose 

13 of making allotments under this section to States de14 scribed in paragraph (1) or (2) of subsection (b). Funds 

15 appropriated under the preceding sentence shall remain 

16 available until expended. 

17 ‘‘(b) STATE ALLOTMENTS.—

18 ‘‘(1) BASED ON PERCENTAGE OF UNDOCU19 MENTED ALIENS.—

20 ‘‘(A) IN GENERAL.—Out of the amount 

21 appropriated under subsection (a) for each fis22 cal year, the Secretary shall use $957,000,000 

23 of such amount to make allotments for each 

24 such fiscal year in accordance with subpara25 graph (B). 
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1 ‘‘(B) FORMULA.—The amount of the allot2 ment for each State for a fiscal year shall be 

3 equal to the product of—

4 ‘‘(i) the total amount available for al5 lotments under this paragraph for the fis6 cal year; and 

7 ‘‘(ii) the percentage of undocumented 

8 aliens residing in the State with respect to 

9 the total number of such aliens residing in 

10 all States, as determined by the Statistics 

11 Division of the Immigration and Natu12 ralization Service, as of January 2003, 

13 based on the 2000 decennial census. 

14 ‘‘(2) BASED ON NUMBER OF UNDOCUMENTED

15 ALIEN APPREHENSION STATES.—

16 ‘‘(A) IN GENERAL.—Out of the amount 

17 appropriated under subsection (a) for a fiscal 

18 year, the Secretary shall use $493,000,000 of 

19 such amount to make allotments for each such 

20 fiscal year for each of the 6 States with the 

21 highest number of undocumented alien appre22 hensions for such fiscal year. 

23 ‘‘(B) DETERMINATION OF ALLOTMENTS.—

24 The amount of the allotment for each State de25 scribed in subparagraph (A) for a fiscal year 
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1 shall bear the same ratio to the total amount 

2 available for allotments under this paragraph 

3 for the fiscal year as the ratio of the number 

4 of undocumented alien apprehensions in the 

5 State in the fiscal year bears to the total of 

6 such numbers for all such States for such fiscal 

7 year. 

8 ‘‘(C) DATA.—For purposes of this para9 graph, the highest number of undocumented 

10 alien apprehensions for a fiscal year shall be 

11 based on the 4 most recent quarterly apprehen12 sion rates for undocumented aliens in such 

13 States, as reported by the Immigration and 

14 Naturalization Service. 

15 ‘‘(3) RULE OF CONSTRUCTION.—Nothing in 

16 this section shall be construed as prohibiting a State 

17 that is described in both of paragraphs (1) and (2) 

18 from receiving an allotment under both paragraphs 

19 for a fiscal year. 

20 ‘‘(c) USE OF FUNDS.—

21 ‘‘(1) AUTHORITY TO MAKE PAYMENTS.—From 

22 the allotments made for a State under subsection (b) 

23 for a fiscal year, the Secretary shall pay directly to 

24 local governments, hospitals, or other providers lo25 cated in the State (including providers of services re-
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1 ceived through an Indian Health Service facility 

2 whether operated by the Indian Health Service or by 

3 an Indian tribe or tribal organization) that provide 

4 uncompensated emergency health services furnished 

5 to undocumented aliens during that fiscal year, and 

6 to the State, such amounts (subject to the total 

7 amount available from such allotments) as the local 

8 governments, hospitals, providers, or State dem9 onstrate were incurred for the provision of such 

10 services during that fiscal year. 

11 ‘‘(2) LIMITATION ON STATE USE OF FUNDS.—

12 Funds paid to a State from allotments made under 

13 subsection (b) for a fiscal year may only be used for 

14 making payments to local governments, hospitals, or 

15 other providers for costs incurred in providing emer16 gency health services to undocumented aliens or for 

17 State costs incurred with respect to the provision of 

18 emergency health services to such aliens. 

19 ‘‘(3) INCLUSION OF COSTS INCURRED WITH RE20 SPECT TO CERTAIN ALIENS.—Uncompensated emer21 gency health services furnished to aliens who have 

22 been allowed to enter the United States for the sole 

23 purpose of receiving emergency health services may 

24 be included in the determination of costs incurred by
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1 a State, local government, hospital, or other provider 

2 with respect to the provision of such services. 

3 ‘‘(d) APPLICATIONS; ADVANCE PAYMENTS; REAL4 LOTMENT OF UNUSED FUNDS.—

5 ‘‘(1) DEADLINE FOR ESTABLISHMENT OF AP6 PLICATION PROCESS.—

7 ‘‘(A) IN GENERAL.—Not later than July 

8 31, 2003, the Secretary shall establish a proc9 ess under which States, local governments, hos10 pitals, or other providers located in the State 

11 may apply for payments from allotments made 

12 under subsection (b) for a fiscal year for un13 compensated emergency health services fur14 nished to undocumented aliens during that fis15 cal year. 

16 ‘‘(B) INCLUSION OF MEASURES TO COM17 BAT FRAUD.—The Secretary shall include in 

18 the process established under subparagraph (A) 

19 measures to ensure that fraudulent payments 

20 are not made from the allotments determined 

21 under subsection (b) or from amounts reallotted 

22 under paragraph (3). 

23 ‘‘(2) ADVANCE PAYMENT; RETROSPECTIVE AD24 JUSTMENT.—The process established under para25 graph (1) shall allow for making payments under 
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1 this section for each quarter of a fiscal year on the 

2 basis of advance estimates of expenditures submitted 

3 by applicants for such payments and such other in4 vestigation as the Secretary may find necessary, and 

5 for making reductions or increases in the payments 

6 as necessary to adjust for any overpayment or un7 derpayment for prior quarters. 

8 ‘‘(3) REALLOTMENT OF UNUSED FUNDS.—

9 ‘‘(A) IN GENERAL.—With respect to allot10 ments made under subsection (b) for a fiscal 

11 year, the amount of any allotment to a State 

12 for a fiscal year that the Secretary determines 

13 will not be expended during that fiscal year or 

14 the succeeding fiscal year shall be available for 

15 reallotment during the second succeeding fiscal 

16 year, on such date as the Secretary may deter17 mine, to other States with allotments under 

18 that subsection that the Secretary determines 

19 will use such excess amounts during that sec20 ond succeeding fiscal year. 

21 ‘‘(B) DETERMINATION OF REALLOT22 MENTS.—Reallotments under subparagraph (A) 

23 shall be made in the same manner as allotments 

24 are determined under paragraphs (1) and (2) of 

25 subsection (b) but only with respect to those 
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1 States that the Secretary determines qualify for 

2 a reallotment for a fiscal year under that sub3 paragraph. 

4 ‘‘(C) TREATMENT.—Any amount reallotted 

5 under subparagraph (A) to a State is deemed 

6 to be part of its allotment under subsection (b) 

7 for the fiscal year in which the reallotment oc8 curs. 

9 ‘‘(e) DEFINITIONS.—In this section: 

10 ‘‘(1) HOSPITAL.—The term ‘hospital’ has the 

11 meaning given such term in section 1861(e) of the 

12 Social Security Act (42 U.S.C. 1395x(e)). 

13 ‘‘(2) INDIAN TRIBE; TRIBAL ORGANIZATION.—

14 The terms ‘Indian tribe’ and ‘tribal organization’ 

15 have the meanings given such terms in section 4 of 

16 the Indian Health Care Improvement Act. 

17 ‘‘(3) PROVIDER.—The term ‘provider’ includes 

18 a physician, any other health care professional li19 censed under State law, and any other entity that 

20 furnishes emergency health services, including ambu21 lance services. 

22 ‘‘(4) SECRETARY.—The term ‘Secretary’ means 

23 the Secretary of Health and Human Services. 

24 ‘‘(5) STATE.—The term ‘State’ means the 50 

25 States and the District of Columbia. 
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1 ‘‘(f) ENTITLEMENT.—This section constitutes budget 

2 authority in advance of appropriations Acts and rep3 resents the obligation of the Federal Government to pro4 vide for the payment of amounts provided under this sec5 tion.’’.

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