MMA Section-1011 Emergency Health Services Furnished to Undocumented Aliens

Justification for Other than Full and Open Competition "Source Selection Information - see FAR 2.101 and 3.104" 1. Identification of the agency and contracting activity a. Federal agency and contracting activity: Department of Health and Human Services (DHHS) Centers for Medicare & Medicaid Service (CMS) Office of Acquisition & Grants Management (OAGM) Division of Medicare Contracts (DMC) b. Sponsoring organization: Centers for Medicare & Medicaid Service (CMS) Center for Medicare (CM) Provider Billing Group (PBG) Division of Institutional Claims Processing (DICP) c. Contracting Officer Technical Representative Information: Diana Motsiopoulos Centers for Medicare & Medicaid Services 7500 Security Blvd Mail Stop C4-10-07 Woodlawn, MD 21244 diana.motsiopoulos@cms.hhs.gov 410-786-3379 2. Nature and/or description of the action being approved a. Acquisition purpose and objectives: The purpose for this Justification for Other than Full and Open Competition (JOFOC) is to obtain approval for CMS to add an option year to the current Section 1011- Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens contract (HHSM-500-2005-00015C). This option year will serve as a bridge-contract to allow for un-interrupted services provided through this contract and resolution of the protest action filed by the incumbent contractor. A new contract has been awarded, through full and open competition but protested as stated above. This bridge contract in the form of an additional option year added to the existing contract is necessary to cover the period from the expiration of the current contract (June 30, 2010) to the resolution of the protest action and award of the new contract. CMS needs to retain the existing contractor, Trailblazer Health Enterprises, LLC to complete this work under FAR 6.302-1 because they are able to continue this work without interruption during the protest and transition period. No other provider is capable of providing these specific services to CMS at this time. The requested option period will last for approximately twelve (12) months (6 months base period with an option for 6 additional months) with a period of performance running from 7/1/2010 through 6/30/2011. b. Project background: On December 8, 2003, the President signed into law the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (Pub. L. 108-173) (MMA), Section 1011, Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens. Pursuant to Section 1011 of the act, Congress has mandated that the Secretary of Health and Human Services directly pay hospitals, physicians, and ambulance providers (including Indian Health Service and Indian tribe and tribal organizations) for their otherwise un-reimbursed costs of providing services required by section 1867 of the Social Security Act (EMTALA) and related hospital inpatient, outpatient, and ambulance services furnished to undocumented aliens, aliens paroled into the United States at a United States port of entry for the purpose of receiving such services, and Mexican citizens permitted temporary entry to the United States with a laser visa. Section 1011 provided $250 million per year for fiscal years (FY) 2005-2008 for payments to eligible providers for emergency health services rendered to undocumented aliens and other specified aliens. Two-thirds of the funds were divided among all 50 states and the District of Columbia based on their relative percentages of undocumented aliens. One-third was divided among the six states with the largest number of undocumented alien apprehensions. From the respective state remaining allotments, payments will be made directly to hospitals, certain physicians, and ambulance providers for some of all of the costs of providing emergency health care required under section 1867 and related hospital inpatient, outpatient and ambulance services to eligible individuals. Eligible providers may include an Indian Health Service facility whether operated by the Indian Health Service or by an Indian tribe or tribal organization. A Medicare critical access hospital (CAH) is also a hospital under the statutory definition. Payments under section 1011 may only be made to the extent that care was not otherwise reimbursed (through insurance or otherwise) for such services during that fiscal year. Sections 1866(a) (1) (I), 1866(a) (1) (N), and 1867 of the Social Security Act impose specific obligations on Medicare participating hospitals that offer emergency services. These obligations concern individuals who come to a hospital emergency department and request examination or treatment for medical conditions, and apply to all of these individuals, regardless of whether or not they are beneficiaries of any program under the Act. Section 1867 of the Act sets forth requirements for medical screening examinations of medical conditions, as well as necessary stabilizing treatment or appropriate transfer. In addition, section 1867(h) of the Act specifically prohibits a delay in providing required screening or stabilization services in order to inquire about the individual's payment method or insurance status. Section 1867(d) of the Act provides for the imposition of civil monetary penalties on hospitals and physicians responsible for negligently violating a requirement of that section, through actions such as the following: (a) Negligently failing to appropriately screen an individual seeking medical care; (b) negligently failing to provide stabilizing treatment to an individual with an emergency medical condition; or (c) negligently transferring an individual in an inappropriate manner (Section 1867(e)(4) of the Act defines "transfer" to include both transfers to other health care facilities and cases in which the individual is released from the care of the hospital without being moved to another health care facility.) These provisions, taken together, are frequently referred to as the Emergency Medical Treatment and Labor Act (EMTALA), also known as the patient antidumping statute. EMTALA was passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). Congress enacted these antidumping provisions in the Social Security Act because of its concern with an increasing number of reports that hospital emergency rooms were refusing to accept or treat individuals with emergency conditions if the individuals did not have insurance. Payments may be only for services furnished to certain individuals described in the statute as: 1) undocumented aliens; 2) aliens who have been paroled into the United States at a port of entry for the purpose of receiving eligible services; and 3) Mexican citizens permitted to enter the United States for not more than 72 hours under the authority of a biometric machine readable border crossing identification card (also referred to as a "laser visa") issued in accordance with the requirements of regulations prescribed under a specific section of the Immigration and Nationality Act. 3. Description of the supplies or services required to meet the agency's needs (including the estimated value): a. Project title: Section 1011 - Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens b. Project description: See item 2.b above. Requirement type: Emergency Health Care Services - Type of action: Contract Modification to add an Option Year to a current contract that is due to expire June 30, 2010. - Proposed contract/order type: Cost-plus-fixed fee - Acquisition identification number: Current contract- HHSM-500-2005-00015C, FMIB # 8013 , MACAPP # 100190 c. Total estimated dollar value and performance/delivery period: Contract Performance period - July 1, 2010 - June 30, 2011 Dollar Value - Approximately $6,500,000.00 4. Identification of the statutory authority permitting other than full and open competition: This acquisition is conducted under the authority of 10 United States Code (U.S.C.) 2304(c) (1) or 41 U.S.C. 253(c) (1) as set forth in Federal Acquisition Regulation (FAR) 6.302, Circumstances permitting other than full and open competition in accordance with FAR 6.302-1, only one responsible source and no other supplies or services will satisfy agency requirements. 5. Demonstration that the proposed contractor(s) unique qualifications or the nature of the acquisition requires use of the authority cited: a. Name and address of the proposed contractor(s): TrailBlazer Health Enterprises, LLC 8330 Lyndon B. Johnson Freeway Dallas, TX 75243-1137 Phone: 469-372-4902 b. Nature of the acquisition and proposed unique qualifications of the contractor: Trailblazer Health Enterprises, LLC has been performing the Section 1011- Emergency health requirements successfully for the past five (5) years, and is currently the only contractor set up with the appropriate infrastructure, operations, and experienced staff capable of performing these services on a continuous basis without any interruption of services. 6. Description of the efforts made to ensure that offers are solicited from as many potential sources as practicable. Indicate whether a Federal Business Opportunities notice was or will be publicized as required by FAR Subpart 5.2 and, if not, which exception under FAR 5.202 applies: The current contract was awarded through a full and open competition. A notice will be published in Fed Biz Ops as required by FAR subpart 5.2 for the proposed modification. 7. Determination by the Contracting Officer that the anticipated cost/price to the Government will be fair and reasonable: It is anticipated that the current contractor will maintain approximately the same cost level as was previously negotiated under the existing contract HHSM-500-2005-00015C, dated July 1, 2005. Additionally, substantial historical cost information detailing 1011 service costs have been accumulated by CMS and will be used to determine fair market value. A determination that the anticipated cost/ price(s) are fair and reasonable will be based on these sources. 8. Description of the market research conducted (see FAR Part 10) and the results, or a statement of the reasons market research was not conducted: On January 6, 2009, a Sources Sought Synopsis was posted to FBO to determine the applicability of a small business (e.g., 8(a), service-disabled veteran-owned small business, HUBZone small business, small disadvantaged business, veteran-owned small business, and women-owned small business) set-aside. The market research conducted established that the Government's requirements cannot be met by a type of service customarily available in the marketplace (non-commercial item), a small business concern set-aside was not applicable, and that a full and open competition, FAR Part 15 procurement was applicable. The current contract, RFP-CMS-2009-0022 was competed as a full and open competition in accordance with FAR Subpart 6.1 and was posted on FBO on September 9, 2009. 9. Any other facts supporting the use of other than full and open competition: As a result of the Protest action filed on April 19, 2010 by the incumbent contractor (Trailblazer Health Enterprises) requiring a stay of performance on the new contract award, and the fact that the current contract ends June 30, 2010, it is imperative that this present contract be extended so that the MMA Section -1011 Emergency Health service benefits remain un-interrupted. It would be impossible to have any other contractor create the necessary infrastructure, hire experienced staff and transition the work from the incumbent contractor to a new contractor without disrupting the MMA Section - 1011 Emergency Health services. 10. Listing of sources, if any, that expressed, in writing, an interest in the acquisition: No additional sources expressed any interest in writing other than those offerors who submitted proposals under the full and open competition that was awarded on March 31, 2010. 11. Statement of the actions, if any, the agency may take to remove or overcome any barriers to competition before any subsequent acquisition for the required supplies or services: CMS has successfully competed and awarded this contract on March 31, 2010. The JOFOC is necessary to extend the current contract during the protest action and transition and award to a new contractor. ? 12. Program office certification: For the reasons indicated above, it is therefore recommended that CMS modify the current contract to add an additional option year to continue the 1011 Emergency Health services. This is to certify that the portions of this justification that have been developed by the undersigned program office personnel, including supporting information and/or data verifying the Government's minimum needs, schedule requirements and other rationale for other than full and open competition, are accurate and complete as required by FAR, Part 6.303-1(b). ___________________________________ ___________ Diana Motsiopoulos Date Contracting Officer Technical Representative Division of Institutional Claims Processing ___________________________________ ___________ Lorraine Zicha Date Director Division of Institutional Claims Processing ___________________________________ ___________ Stewart Streimer Date Director Provider Billing Group 13. Contracting Officer Certification: This is to certify that the justification for the proposed acquisition has been reviewed and that to the best of my knowledge and belief the information and/or data provided to support the rationale and recommendation for approval is accurate and complete as required by FAR, Part 6.304. ___________________________________ ___________ M. K. Markman Date Contracting Officer Division of Medicare Contracts 14. Concurrence by OAGM: __________________________________ ___________ Linda Hook Date Director, Division of Medicare Contracts __________________________________ ___________ Pamela Collins Date Group Director, Medicare Contracts Group __________________________________ ___________ Melissa Starinsky Date Director, Acquisition Support & Policy Staff __________________________________ ___________ Rodney Benson Date Director, Office of Acquisition & Grants Management 15. Approval by Competition Advocate: __________________________________ ___________ Michelle Snyder Date Deputy Chief Operating Officer Competition Advocate Justification for Other than Full and Open Competition "Source Selection Information - see FAR 2.101 and 3.104" 1. Identification of the agency and contracting activity a. Federal agency and contracting activity: Department of Health and Human Services (DHHS) Centers for Medicare & Medicaid Service (CMS) Office of Acquisition & Grants Management (OAGM) Division of Medicare Contracts (DMC) b. Sponsoring organization: Centers for Medicare & Medicaid Service (CMS) Center for Medicare (CM) Provider Billing Group (PBG) Division of Institutional Claims Processing (DICP) c. Contracting Officer Technical Representative Information: Diana Motsiopoulos Centers for Medicare & Medicaid Services 7500 Security Blvd Mail Stop C4-10-07 Woodlawn, MD 21244 diana.motsiopoulos@cms.hhs.gov 410-786-3379 2. Nature and/or description of the action being approved a. Acquisition purpose and objectives: The purpose for this Justification for Other than Full and Open Competition (JOFOC) is to obtain approval for CMS to add an option year to the current Section 1011- Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens contract (HHSM-500-2005-00015C). This option year will serve as a bridge-contract to allow for un-interrupted services provided through this contract and resolution of the protest action filed by the incumbent contractor. A new contract has been awarded, through full and open competition but protested as stated above. This bridge contract in the form of an additional option year added to the existing contract is necessary to cover the period from the expiration of the current contract (June 30, 2010) to the resolution of the protest action and award of the new contract. CMS needs to retain the existing contractor, Trailblazer Health Enterprises, LLC to complete this work under FAR 6.302-1 because they are able to continue this work without interruption during the protest and transition period. No other provider is capable of providing these specific services to CMS at this time. The requested option period will last for approximately twelve (12) months (6 months base period with an option for 6 additional months) with a period of performance running from 7/1/2010 through 6/30/2011. b. Project background: On December 8, 2003, the President signed into law the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (Pub. L. 108-173) (MMA), Section 1011, Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens. Pursuant to Section 1011 of the act, Congress has mandated that the Secretary of Health and Human Services directly pay hospitals, physicians, and ambulance providers (including Indian Health Service and Indian tribe and tribal organizations) for their otherwise un-reimbursed costs of providing services required by section 1867 of the Social Security Act (EMTALA) and related hospital inpatient, outpatient, and ambulance services furnished to undocumented aliens, aliens paroled into the United States at a United States port of entry for the purpose of receiving such services, and Mexican citizens permitted temporary entry to the United States with a laser visa. Section 1011 provided $250 million per year for fiscal years (FY) 2005-2008 for payments to eligible providers for emergency health services rendered to undocumented aliens and other specified aliens. Two-thirds of the funds were divided among all 50 states and the District of Columbia based on their relative percentages of undocumented aliens. One-third was divided among the six states with the largest number of undocumented alien apprehensions. From the respective state remaining allotments, payments will be made directly to hospitals, certain physicians, and ambulance providers for some of all of the costs of providing emergency health care required under section 1867 and related hospital inpatient, outpatient and ambulance services to eligible individuals. Eligible providers may include an Indian Health Service facility whether operated by the Indian Health Service or by an Indian tribe or tribal organization. A Medicare critical access hospital (CAH) is also a hospital under the statutory definition. Payments under section 1011 may only be made to the extent that care was not otherwise reimbursed (through insurance or otherwise) for such services during that fiscal year. Sections 1866(a) (1) (I), 1866(a) (1) (N), and 1867 of the Social Security Act impose specific obligations on Medicare participating hospitals that offer emergency services. These obligations concern individuals who come to a hospital emergency department and request examination or treatment for medical conditions, and apply to all of these individuals, regardless of whether or not they are beneficiaries of any program under the Act. Section 1867 of the Act sets forth requirements for medical screening examinations of medical conditions, as well as necessary stabilizing treatment or appropriate transfer. In addition, section 1867(h) of the Act specifically prohibits a delay in providing required screening or stabilization services in order to inquire about the individual's payment method or insurance status. Section 1867(d) of the Act provides for the imposition of civil monetary penalties on hospitals and physicians responsible for negligently violating a requirement of that section, through actions such as the following: (a) Negligently failing to appropriately screen an individual seeking medical care; (b) negligently failing to provide stabilizing treatment to an individual with an emergency medical condition; or (c) negligently transferring an individual in an inappropriate manner (Section 1867(e)(4) of the Act defines "transfer" to include both transfers to other health care facilities and cases in which the individual is released from the care of the hospital without being moved to another health care facility.) These provisions, taken together, are frequently referred to as the Emergency Medical Treatment and Labor Act (EMTALA), also known as the patient antidumping statute. EMTALA was passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). Congress enacted these antidumping provisions in the Social Security Act because of its concern with an increasing number of reports that hospital emergency rooms were refusing to accept or treat individuals with emergency conditions if the individuals did not have insurance. Payments may be only for services furnished to certain individuals described in the statute as: 1) undocumented aliens; 2) aliens who have been paroled into the United States at a port of entry for the purpose of receiving eligible services; and 3) Mexican citizens permitted to enter the United States for not more than 72 hours under the authority of a biometric machine readable border crossing identification card (also referred to as a "laser visa") issued in accordance with the requirements of regulations prescribed under a specific section of the Immigration and Nationality Act. 3. Description of the supplies or services required to meet the agency's needs (including the estimated value): a. Project title: Section 1011 - Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens b. Project description: See item 2.b above. Requirement type: Emergency Health Care Services - Type of action: Contract Modification to add an Option Year to a current contract that is due to expire June 30, 2010. - Proposed contract/order type: Cost-plus-fixed fee - Acquisition identification number: Current contract- HHSM-500-2005-00015C, FMIB # 8013 , MACAPP # 100190 c. Total estimated dollar value and performance/delivery period: Contract Performance period - July 1, 2010 - June 30, 2011 Dollar Value - Approximately $6,500,000.00 4. Identification of the statutory authority permitting other than full and open competition: This acquisition is conducted under the authority of 10 United States Code (U.S.C.) 2304(c) (1) or 41 U.S.C. 253(c) (1) as set forth in Federal Acquisition Regulation (FAR) 6.302, Circumstances permitting other than full and open competition in accordance with FAR 6.302-1, only one responsible source and no other supplies or services will satisfy agency requirements. 5. Demonstration that the proposed contractor(s) unique qualifications or the nature of the acquisition requires use of the authority cited: a. Name and address of the proposed contractor(s): TrailBlazer Health Enterprises, LLC 8330 Lyndon B. Johnson Freeway Dallas, TX 75243-1137 Phone: 469-372-4902 b. Nature of the acquisition and proposed unique qualifications of the contractor: Trailblazer Health Enterprises, LLC has been performing the Section 1011- Emergency health requirements successfully for the past five (5) years, and is currently the only contractor set up with the appropriate infrastructure, operations, and experienced staff capable of performing these services on a continuous basis without any interruption of services. 6. Description of the efforts made to ensure that offers are solicited from as many potential sources as practicable. Indicate whether a Federal Business Opportunities notice was or will be publicized as required by FAR Subpart 5.2 and, if not, which exception under FAR 5.202 applies: The current contract was awarded through a full and open competition. A notice will be published in Fed Biz Ops as required by FAR subpart 5.2 for the proposed modification. 7. Determination by the Contracting Officer that the anticipated cost/price to the Government will be fair and reasonable: It is anticipated that the current contractor will maintain approximately the same cost level as was previously negotiated under the existing contract HHSM-500-2005-00015C, dated July 1, 2005. Additionally, substantial historical cost information detailing 1011 service costs have been accumulated by CMS and will be used to determine fair market value. A determination that the anticipated cost/ price(s) are fair and reasonable will be based on these sources. 8. Description of the market research conducted (see FAR Part 10) and the results, or a statement of the reasons market research was not conducted: On January 6, 2009, a Sources Sought Synopsis was posted to FBO to determine the applicability of a small business (e.g., 8(a), service-disabled veteran-owned small business, HUBZone small business, small disadvantaged business, veteran-owned small business, and women-owned small business) set-aside. The market research conducted established that the Government's requirements cannot be met by a type of service customarily available in the marketplace (non-commercial item), a small business concern set-aside was not applicable, and that a full and open competition, FAR Part 15 procurement was applicable. The current contract, RFP-CMS-2009-0022 was competed as a full and open competition in accordance with FAR Subpart 6.1 and was posted on FBO on September 9, 2009. 9. Any other facts supporting the use of other than full and open competition: As a result of the Protest action filed on April 19, 2010 by the incumbent contractor (Trailblazer Health Enterprises) requiring a stay of performance on the new contract award, and the fact that the current contract ends June 30, 2010, it is imperative that this present contract be extended so that the MMA Section -1011 Emergency Health service benefits remain un-interrupted. It would be impossible to have any other contractor create the necessary infrastructure, hire experienced staff and transition the work from the incumbent contractor to a new contractor without disrupting the MMA Section - 1011 Emergency Health services. 10. Listing of sources, if any, that expressed, in writing, an interest in the acquisition: No additional sources expressed any interest in writing other than those offerors who submitted proposals under the full and open competition that was awarded on March 31, 2010. 11. Statement of the actions, if any, the agency may take to remove or overcome any barriers to competition before any subsequent acquisition for the required supplies or services: CMS has successfully competed and awarded this contract on March 31, 2010. The JOFOC is necessary to extend the current contract during the protest action and transition and award to a new contractor. ? 12. Program office certification: For the reasons indicated above, it is therefore recommended that CMS modify the current contract to add an additional option year to continue the 1011 Emergency Health services. This is to certify that the portions of this justification that have been developed by the undersigned program office personnel, including supporting information and/or data verifying the Government's minimum needs, schedule requirements and other rationale for other than full and open competition, are accurate and complete as required by FAR, Part 6.303-1(b). ___________________________________ ___________ Diana Motsiopoulos Date Contracting Officer Technical Representative Division of Institutional Claims Processing ___________________________________ ___________ Lorraine Zicha Date Director Division of Institutional Claims Processing ___________________________________ ___________ Stewart Streimer Date Director Provider Billing Group 13. Contracting Officer Certification: This is to certify that the justification for the proposed acquisition has been reviewed and that to the best of my knowledge and belief the information and/or data provided to support the rationale and recommendation for approval is accurate and complete as required by FAR, Part 6.304. ___________________________________ ___________ M. K. Markman Date Contracting Officer Division of Medicare Contracts 14. Concurrence by OAGM: __________________________________ ___________ Linda Hook Date Director, Division of Medicare Contracts __________________________________ ___________ Pamela Collins Date Group Director, Medicare Contracts Group __________________________________ ___________ Melissa Starinsky Date Director, Acquisition Support & Policy Staff __________________________________ ___________ Rodney Benson Date Director, Office of Acquisition & Grants Management 15. Approval by Competition Advocate: __________________________________ ___________ Michelle Snyder Date Deputy Chief Operating Officer Competition Advocate Justification for Other than Full and Open Competition "Source Selection Information - see FAR 2.101 and 3.104" 1. Identification of the agency and contracting activity a. Federal agency and contracting activity: Department of Health and Human Services (DHHS) Centers for Medicare & Medicaid Service (CMS) Office of Acquisition & Grants Management (OAGM) Division of Medicare Contracts (DMC) b. Sponsoring organization: Centers for Medicare & Medicaid Service (CMS) Center for Medicare (CM) Provider Billing Group (PBG) Division of Institutional Claims Processing (DICP) c. Contracting Officer Technical Representative Information: Diana Motsiopoulos Centers for Medicare & Medicaid Services 7500 Security Blvd Mail Stop C4-10-07 Woodlawn, MD 21244 diana.motsiopoulos@cms.hhs.gov 410-786-3379 2. Nature and/or description of the action being approved a. Acquisition purpose and objectives: The purpose for this Justification for Other than Full and Open Competition (JOFOC) is to obtain approval for CMS to add an option year to the current Section 1011- Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens contract (HHSM-500-2005-00015C). This option year will serve as a bridge-contract to allow for un-interrupted services provided through this contract and resolution of the protest action filed by the incumbent contractor. A new contract has been awarded, through full and open competition but protested as stated above. This bridge contract in the form of an additional option year added to the existing contract is necessary to cover the period from the expiration of the current contract (June 30, 2010) to the resolution of the protest action and award of the new contract. CMS needs to retain the existing contractor, Trailblazer Health Enterprises, LLC to complete this work under FAR 6.302-1 because they are able to continue this work without interruption during the protest and transition period. No other provider is capable of providing these specific services to CMS at this time. The requested option period will last for approximately twelve (12) months (6 months base period with an option for 6 additional months) with a period of performance running from 7/1/2010 through 6/30/2011. b. Project background: On December 8, 2003, the President signed into law the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (Pub. L. 108-173) (MMA), Section 1011, Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens. Pursuant to Section 1011 of the act, Congress has mandated that the Secretary of Health and Human Services directly pay hospitals, physicians, and ambulance providers (including Indian Health Service and Indian tribe and tribal organizations) for their otherwise un-reimbursed costs of providing services required by section 1867 of the Social Security Act (EMTALA) and related hospital inpatient, outpatient, and ambulance services furnished to undocumented aliens, aliens paroled into the United States at a United States port of entry for the purpose of receiving such services, and Mexican citizens permitted temporary entry to the United States with a laser visa. Section 1011 provided...