‘‘(f) REQUIREMENT FOR COLLECTION OF IMMIGRA-
TION-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 fol-
lowing 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 rep-
resentative) under oath or affirmation and that 
is in a form that includes a notice that fraudu-
lent 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 rou-
tinely requires of non-indigent patients, in-
cluding information regarding health insur-
ance. 
‘‘(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 identi-
fiers 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 data-
base maintained by the Secretary of Homeland 
Security for the purpose of verifying the iden-
tity and immigration status of aliens. 
‘‘(C) The hospital transmits to the Sec-
retary of Homeland Security, in a digital, elec-
tronic format and manner specified by such 
Secretary, the information provided under sub-
paragraph (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 docu-
ments described in paragraph (1)(A) on file and 
makes such documents available for examination by 
the Secretary and the Secretary of Homeland Secu-
rity or their designees. 
‘‘(3) PROVISION OF TECHNICAL SUPPORT.—The 
Secretary of Homeland Security shall provide hos-
pitals 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 re-
quirements 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 re-
view information transmitted under paragraph 
(1)(C); 
‘‘(B) to determine whether an alien for 
whom such information is transmitted is remov-
able under any provision of Federal immigra-
tion 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 Immi-
gration and Nationality Act (8 U.S.C. 1227(a)(5)). 
‘‘(6) DEFINITION OF IDENTIFIER.—In this sec-
tion, the term ‘identifier’ means a fingerprint or 
other biometric identifier as the Secretary of Home-
land Security may require. 
‘‘(g) RESPONSIBILITY OF CERTAIN EMPLOYERS.—
‘‘(1) IN GENERAL.—In the case of an employer 
of an undocumented alien worker described in para-
graph (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
DE-
FINED.—
‘‘(A) IN GENERAL.—For purposes of this 
subsection, the term ‘undocumented alien work-
er’ means, with respect to an employer, an un-
documented 
alien 
described 
in 
subsection 
(c)(5)(A)—
‘‘(i) who is an unauthorized alien (as 
defined in section 274A(h)(3) of the Immi-
gration 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 sub-
paragraph (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 com-
pensation plan. 
‘‘(III) The alien is enrolled under 
a health benefits plan or health insur-
ance coverage that provides such level 
of coverage with respect to emergency 
medical and hospitalization benefits as 
the Secretary shall specify, in con-
sultation with the Secretary of Home-
land Security. 
‘‘(IV) The employer has assumed 
responsibility for any cost-sharing (in-
cluding applicable deductibles and co-
insurance) 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.—Notwith-
standing 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 undocu-
mented 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) with-
out 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 reason-
able 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 imme-
diate 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 enact-
ment 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 reg-
ulations 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 pe-
riod of public notice and comment of at least 90 
days. 
(2) FINAL
REGULATIONS.—The Secretary of 
Homeland Security, in consultation with the Sec-
retary 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 Judi-
ciary and Appropriations Committees of the House 
of Representatives and the Senate, the Select Com-
mittee on Homeland Security of the House of Rep-
resentatives, and the Senate Committee on Govern-
mental Affairs an annual report on the implementa-
tion 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 re-
port under paragraph (1) shall include—
(A) a cost analysis of Federal expenditures 
under such section 1011; 
(B) a description of the assistance pro-
vided to hospitals under subsection (f)(2) of 
such section;
(C) the number of undocumented aliens re-
moved 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 con-
duct an analysis of the feasibility and appropriate-
ness 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 other-
wise 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 Prescrip-
tion Drug, Improvement, and Modernization 
Act of 2003 and for which state a treaty de-
scribed in subparagraph (A) is not in effect, im-
posing a visa, port of entry, or similar sur-
charge the proceeds of which may be used to-
wards such costs and towards the cost of inter-
national medical evacuation described in such 
clause. 
(2) REPORT.—The Secretary of State shall sub-
mit to the committees described in subsection (d)(1) 
a report on the analysis under paragraph (1).
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