I 
112TH CONGRESS 
1ST SESSION 
H. R. 541 
To amend section 1011 of the Medicare Prescription Drug, Improvement, 
and Modernization Act of 2003 (Public Law 108–173) to make perma-
nent the program of Federal reimbursement of emergency health services 
furnished to undocumented aliens. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 8, 2011 
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 Fed-
eral reimbursement of emergency health services fur-
nished to undocumented aliens. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Pay for all your Un-
documented Procedures (PAY UP!) Act of 2011’’. 
VerDate Mar 15 2010 
00:43 Feb 10, 2011
Jkt 099200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H541.IH
H541
jbell on DSKDVH8Z91PROD with BILLS
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; 42 
U.S.C. 1395dd note) is amended— 
(1) by inserting ‘‘and for each of fiscal years 
2012 through 2016’’ 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 2017 and each succeeding fiscal year 
such sums as may be necessary for such purpose.’’. 
(b) REALLOCATION OF UNSPENT FUNDS IN A FIS-
CAL YEAR.— 
(1) IN GENERAL.—Subsection (b) of such sec-
tion is amended— 
(A) in paragraph (1)— 
(i) in subparagraph (A), by striking 
‘‘subparagraph (B)’’ and inserting ‘‘sub-
paragraphs (B) and (C)’’; and 
(ii) by adding at the end the following 
new subparagraph: 
VerDate Mar 15 2010 
00:43 Feb 10, 2011
Jkt 099200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H541.IH
H541
jbell on DSKDVH8Z91PROD with BILLS
‘‘(C) 
REALLOTMENT
OF
UNSPENT 
FUNDS.— 
‘‘(i) IN GENERAL.—If the amounts al-
lotted 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 reallot-
ment of the aggregate unexpended portion 
of such amounts (for expenditure under 
this paragraph in the succeeding fiscal 
year) among eligible providers in full ex-
penditure States in the same proportion as 
the ratio of— 
‘‘(I) the amount of each full ex-
penditure State’s allotment under this 
paragraph for such fiscal year (deter-
mined without regard to this subpara-
graph); 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 
VerDate Mar 15 2010 
00:43 Feb 10, 2011
Jkt 099200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H541.IH
H541
jbell on DSKDVH8Z91PROD with BILLS
paragraph with respect to one or more 
States for a fiscal year are not fully ex-
pended under this section during the fiscal 
year and there is no full expenditure State 
for the fiscal year, the aggregate unex-
pended portion shall be added to the ag-
gregate amount available for allotment 
available under paragraph (1) for the suc-
ceeding fiscal year. 
‘‘(iii) FULL EXPENDITURE STATE DE-
FINED.—In this subparagraph, the term 
‘full expenditure State’ means, with respect 
to a fiscal year, a State described in sub-
paragraph (A) which has received an allot-
ment under this paragraph for the fiscal 
year and which has fully expended such al-
lotment 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: 
VerDate Mar 15 2010 
00:43 Feb 10, 2011
Jkt 099200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H541.IH
H541
jbell on DSKDVH8Z91PROD with BILLS
‘‘(D) 
REALLOTMENT
OF
UNSPENT 
FUNDS.—The provisions of subparagraph (C) of 
paragraph (1) shall apply with respect to allot-
ments 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 year 
2012 except that, in applying such amendments for 
fiscal years that began before the date of the enact-
ment of this Act— 
(A) the allotments to a State for such fis-
cal years under paragraph (1) or (2) of section 
1011(b) of the Medicare Prescription Drug, Im-
provement, and Modernization Act of 2003 
(Public Law 108–173) shall be treated as being 
a single allotment under the respective para-
graph for the fiscal year in which this Act is en-
acted; and 
VerDate Mar 15 2010 
00:43 Feb 10, 2011
Jkt 099200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H541.IH
H541
jbell on DSKDVH8Z91PROD with BILLS