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.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Local Emergency Health Services 
Reimbursement Act of 2003''.

SEC. 2. FEDERAL REIMBURSEMENT OF EMERGENCY HEALTH SERVICES FURNISHED TO 
              UNDOCUMENTED ALIENS.

    Section 4723 of the Balanced Budget Act of 1997 (8 U.S.C. 1611 
note) is amended to read as follows:

``SEC. 4723. FEDERAL REIMBURSEMENT OF EMERGENCY HEALTH SERVICES 
              FURNISHED TO UNDOCUMENTED ALIENS.

    ``(a) Total Amount Available for Allotment.--There is appropriated, 
out of any funds in the Treasury not otherwise appropriated, 
$1,450,000,000 for each of fiscal years 2004 through 2008, for the 
purpose of making allotments under this section to States described in 
paragraph (1) or (2) of subsection (b). Funds appropriated under the 
preceding sentence shall remain available until expended.
    ``(b) State Allotments.--
            ``(1) Based on percentage of undocumented aliens.--
                    ``(A) In general.--Out of the amount appropriated 
                under subsection (a) for each fiscal year, the 
                Secretary shall use $957,000,000 of such amount to make 
                allotments for each such fiscal year in accordance with 
                subparagraph (B).
                    ``(B) Formula.--The amount of the allotment for 
                each State for a fiscal year shall be equal to the 
                product of--
                            ``(i) the total amount available for 
                        allotments under this paragraph for the fiscal 
                        year; and
                            ``(ii) the percentage of undocumented 
                        aliens residing in the State with respect to 
                        the total number of such aliens residing in all 
                        States, as determined by the Statistics 
                        Division of the Immigration and Naturalization 
                        Service, as of January 2003, based on the 2000 
                        decennial census.
            ``(2) Based on number of undocumented alien apprehension 
        states.--
                    ``(A) In general.--Out of the amount appropriated 
                under subsection (a) for a fiscal year, the Secretary 
                shall use $493,000,000 of such amount to make 
                allotments for each such fiscal year for each of the 6 
                States with the highest number of undocumented alien 
                apprehensions for such fiscal year.
                    ``(B) Determination of allotments.--The amount of 
                the allotment for each State described in subparagraph 
                (A) for a fiscal year shall bear the same ratio to the 
                total amount available for allotments under this 
                paragraph for the fiscal year as the ratio of the 
                number of undocumented alien apprehensions in the State 
                in the fiscal year bears to the total of such numbers 
                for all such States for such fiscal year.
                    ``(C) Data.--For purposes of this paragraph, the 
                highest number of undocumented alien apprehensions for 
                a fiscal year shall be based on the 4 most recent 
                quarterly apprehension rates for undocumented aliens in 
                such States, as reported by the Immigration and 
                Naturalization Service.
            ``(3) Rule of construction.--Nothing in this section shall 
        be construed as prohibiting a State that is described in both 
        of paragraphs (1) and (2) from receiving an allotment under 
        both paragraphs for a fiscal year.
    ``(c) Use of Funds.--
            ``(1) Authority to make payments.--From the allotments made 
        for a State under subsection (b) for a fiscal year, the 
        Secretary shall pay directly to local governments, hospitals, 
        or other providers located in the State (including providers of 
        services received through an Indian Health Service facility 
        whether operated by the Indian Health Service or by an Indian 
        tribe or tribal organization) that provide uncompensated 
        emergency health services furnished to undocumented aliens 
        during that fiscal year, and to the State, such amounts 
        (subject to the total amount available from such allotments) as 
        the local governments, hospitals, providers, or State 
        demonstrate were incurred for the provision of such services 
        during that fiscal year.
            ``(2) Limitation on state use of funds.--Funds paid to a 
        State from allotments made under subsection (b) for a fiscal 
        year may only be used for making payments to local governments, 
        hospitals, or other providers for costs incurred in providing 
        emergency health services to undocumented aliens or for State 
        costs incurred with respect to the provision of emergency 
        health services to such aliens.
            ``(3) Inclusion of costs incurred with respect to certain 
        aliens.--Uncompensated emergency health services furnished to 
        aliens who have been allowed to enter the United States for the 
        sole purpose of receiving emergency health services may be 
        included in the determination of costs incurred by a State, 
local government, hospital, or other provider with respect to the 
provision of such services.
    ``(d) Applications; Advance Payments; Reallotment of Unused 
Funds.--
            ``(1) Deadline for establishment of application process.--
                    ``(A) In general.--Not later than July 31, 2003, 
                the Secretary shall establish a process under which 
                States, local governments, hospitals, or other 
                providers located in the State may apply for payments 
                from allotments made under subsection (b) for a fiscal 
                year for uncompensated emergency health services 
                furnished to undocumented aliens during that fiscal 
                year.
                    ``(B) Inclusion of measures to combat fraud.--The 
                Secretary shall include in the process established 
                under subparagraph (A) measures to ensure that 
                fraudulent payments are not made from the allotments 
                determined under subsection (b) or from amounts 
                reallotted under paragraph (3).
            ``(2) Advance payment; retrospective adjustment.--The 
        process established under paragraph (1) shall allow for making 
        payments under this section for each quarter of a fiscal year 
        on the basis of advance estimates of expenditures submitted by 
        applicants for such payments and such other investigation as 
        the Secretary may find necessary, and for making reductions or 
        increases in the payments as necessary to adjust for any 
        overpayment or underpayment for prior quarters.
            ``(3) Reallotment of unused funds.--
                    ``(A) In general.--With respect to allotments made 
                under subsection (b) for a fiscal year, the amount of 
                any allotment to a State for a fiscal year that the 
                Secretary determines will not be expended during that 
                fiscal year or the succeeding fiscal year shall be 
                available for reallotment during the second succeeding 
                fiscal year, on such date as the Secretary may 
                determine, to other States with allotments under that 
                subsection that the Secretary determines will use such 
                excess amounts during that second succeeding fiscal 
                year.
                    ``(B) Determination of reallotments.--Reallotments 
                under subparagraph (A) shall be made in the same manner 
                as allotments are determined under paragraphs (1) and 
                (2) of subsection (b) but only with respect to those 
                States that the Secretary determines qualify for a 
                reallotment for a fiscal year under that subparagraph.
                    ``(C) Treatment.--Any amount reallotted under 
                subparagraph (A) to a State is deemed to be part of its 
                allotment under subsection (b) for the fiscal year in 
                which the reallotment occurs.
    ``(e) Definitions.--In this section:
            ``(1) Hospital.--The term `hospital' has the meaning given 
        such term in section 1861(e) of the Social Security Act (42 
        U.S.C. 1395x(e)).
            ``(2) Indian tribe; tribal organization.--The terms `Indian 
        tribe' and `tribal organization' have the meanings given such 
        terms in section 4 of the Indian Health Care Improvement Act.
            ``(3) Provider.--The term `provider' includes a physician, 
        any other health care professional licensed under State law, 
        and any other entity that furnishes emergency health services, 
        including ambulance services.
            ``(4) Secretary.--The term `Secretary' means the Secretary 
        of Health and Human Services.
            ``(5) State.--The term `State' means the 50 States and the 
        District of Columbia.
    ``(f) Entitlement.--This section constitutes budget authority in 
advance of appropriations Acts and represents the obligation of the 
Federal Government to provide for the payment of amounts provided under 
this section.''.

Summary: Local Emergency Health Services Reimbursement Act of 2003 - Amends the Balanced Budget Act of 1997 to appropriate $1,450,000,000 for each of FY's 2004 through 2008 for allotments to States for reimbursement of emergency health services furnished to undocumented aliens (presently such appropriations end after FY 2001). Sets forth formulas for the disbursement of funds by the Secretary of Health and Human Services. Declares that $957,000,000 shall be allotted based on a percentage of undocumented aliens and $493,000,000 shall be allotted based on numbers of undocumented alien apprehensions (in the six States with the highest number of such apprehensions).Permits a State to receive funds on both accounts. Allows funds to go to States, local governments, hospitals, or other providers in a State, including providers of services received through an Indian Health Service facility (presently funds go only to States). Permits reimbursement to providers for the uncompensated provision of emergency health services to aliens who have been allowed to enter the United States for the sole purpose of receiving such services.Directs the Secretary to ensure that fraudulent payments are not made from allotments under this Act. Allows for the reallotment of unused funds.Declares that this Act constitutes budget authority in advance of appropriations Acts.