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Emergency Services for Undocumented or Unqualified Aliens

Emergency Services for Undocumented or Unqualified Aliens. MD AAHAM Meeting Oct. 21, 2011. The Backlog. Sh arp rise in the number of undocumented or unqualified aliens in Maryland increased the volume of X02 cases Limited Staff Resources 1 FTE; staff added; alternatives

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Emergency Services for Undocumented or Unqualified Aliens

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  1. Emergency Services for Undocumented orUnqualified Aliens MD AAHAM Meeting Oct. 21, 2011

  2. The Backlog • Sharp rise in the number of undocumented or unqualified aliens in Maryland increased the volume of X02 cases • Limited Staff Resources • 1 FTE; staff added; alternatives identified • Duplicate requests • Influx of applications that do not meet federal or state emergency criteria

  3. Federal and State Laws • 42CFR 440.255 (c) • COMAR 10.09.24.05-2 • “Emergency medical services, including labor and delivery services, are for the treatment of an emergency medical condition that, after sudden onset, manifests itself by acute symptoms of sufficient severity, including severe pain, such that the absence of immediate medical attention can reasonably be expected to result in: 1) placing the individual’s health in serious jeopardy; 2)serious impairment to bodily functions; or 3) serious dysfunction of any bodily organ or part.”

  4. Resolution Timeline • Board of Public Works approved contract with Delmarva on Sept. 7, 2011 • Utilization Control Contractor (Delmarva) currently working on the backlog of about 2000 cases • All backlog cases to be reviewed prior to Dec 31, 2011, but Delmarva hopes sooner • Please do not send duplicate cases • Please do not appeal for untimeliness

  5. Procedural Modifications

  6. Trends • Due to the large volume of cases in the backlog, you will see an increased volume in approvals and denials • Other states have had CMS audits where feds are very strict on the definition of “emergency” • Taxpayer dollars used for undocumented or unqualified alien services are increasingly controversial

  7. Q & A • How long should you wait to appeal? • Please wait to appeal for untimeliness until after Dec. 31, 2011 • Who should you contact to learn when a request was sent to SRT? • The case manager at the Local Department • After Jan. 1, 2012, who should you contact with concerns related to the backlog or the modified procedures? • Primary contact, Lisa Oelfke, Health Policy Analyst, OES loelfke@dhmh.state.md.us • Secondary contact, Debbie Ruppert, Exec. Director, OES druppert@dhmh.state.md.us

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