[House Report 109-508]
[From the U.S. Government Publishing Office]
109th Congress Report
HOUSE OF REPRESENTATIVES
2d Session 109-508
======================================================================
CHILDREN'S HOSPITAL GME SUPPORT REAUTHORIZATION ACT OF 2006
_______
June 20, 2006.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Barton of Texas, from the Committee on Energy and Commerce,
submitted the following
R E P O R T
[To accompany H.R. 5574]
[Including cost estimate of the Congressional Budget Office]
The Committee on Energy and Commerce, to whom was referred
the bill (H.R. 5574) to amend the Public Health Service Act to
reauthorize support for graduate medical education programs in
children's hospitals, having considered the same, report
favorably thereon with an amendment and recommend that the bill
as amended do pass.
CONTENTS
Page
Amendment........................................................ 1
Purpose and Summary.............................................. 3
Background and Need for Legislation.............................. 3
Hearings......................................................... 4
Committee Consideration.......................................... 4
Committee Votes.................................................. 4
Committee Oversight Findings..................................... 4
Statement of General Performance Goals and Objectives............ 4
New Budget Authority, Entitlement Authority, and Tax Expenditures 4
Committee Cost Estimate.......................................... 5
Congressional Budget Office Estimate............................. 5
Federal Mandates Statement....................................... 6
Advisory Committee Statement..................................... 7
Constitutional Authority Statement............................... 7
Applicability to Legislative Branch.............................. 7
Section-by-Section Analysis of the Legislation................... 7
Changes in Existing Law Made by the Bill, as Reported............ 8
Amendment
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Children's Hospital GME Support
Reauthorization Act of 2006''.
SEC. 2. PROGRAM OF PAYMENTS TO CHILDREN'S HOSPITALS THAT OPERATE
GRADUATE MEDICAL EDUCATION PROGRAMS.
(a) In General.--Section 340E of the Public Health Service Act (42
U.S.C. 256e) is amended--
(1) in subsection (a), by inserting ``and each of fiscal
years 2007 through 2011'' after ``for each of fiscal years 2000
through 2005'';
(2) in subsection (f)(1)(A)--
(A) in clause (ii), by striking ``and'' at the end;
(B) in clause (iii), by striking the period at the
end and inserting ``; and''; and
(C) by adding at the end the following:
``(iv) for each of fiscal years 2007 through
2011, $100,000,000.''; and
(3) in subsection (f)(2)--
(A) in the matter before subparagraph (A), by
striking ``subsection (b)(1)(A)'' and inserting
``subsection (b)(1)(B)'';
(B) in subparagraph (B), by striking ``and'' at the
end;
(C) in subparagraph (C), by striking the period at
the end and inserting ``; and''; and
(D) by adding at the end the following:
``(D) for each of fiscal years 2007 through 2011,
$200,000,000.''.
(b) Reduction in Payments for Failure to File Annual Report.--
Subsection (b) of section 340E of the Public Health Service Act (42
U.S.C. 256e) is amended--
(1) in paragraph (1), in the matter before subparagraph (A),
by striking ``paragraph (2)'' and inserting ``paragraphs (2)
and (3)''; and
(2) by adding at the end the following:
``(3) Annual reporting required.--
``(A) Reduction in payment for failure to report.--
``(i) In general.--The amount payable under
this section to a children's hospital for a
fiscal year (beginning with fiscal year 2008
and after taking into account paragraph (2))
shall be reduced by 25 percent if the Secretary
determines that--
``(I) the hospital has failed to
provide the Secretary, as an addendum
to the hospital's application under
this section for such fiscal year, the
report required under subparagraph (B)
for the previous fiscal year; or
``(II) such report fails to provide
the information required under any
clause of such subparagraph.
``(ii) Notice and opportunity to provide
missing information.--Before imposing a
reduction under clause (i) on the basis of a
hospital's failure to provide information
described in clause (i)(II), the Secretary
shall provide notice to the hospital of such
failure and the Secretary's intention to impose
such reduction and shall provide the hospital
with the opportunity to provide the required
information within a period of 30 days
beginning on the date of such notice. If the
hospital provides such information within such
period, no reduction shall be made under clause
(i) on the basis of the previous failure to
provide such information.
``(B) Annual report.--The report required under this
subparagraph for a children's hospital for a fiscal
year is a report that includes (in a form and manner
specified by the Secretary) the following information
for the residency academic year completed immediately
prior to such fiscal year:
``(i) The types of resident training programs
that the hospital provided for residents
described in subparagraph (C), such as general
pediatrics, internal medicine/pediatrics, and
pediatric subspecialties, including both
medical subspecialties certified by the
American Board of Pediatrics (such as pediatric
gastroenterology) and non-medical
subspecialties approved by other medical
certification boards (such as pediatric
surgery).
``(ii) The number of training positions for
residents described in subparagraph (C), the
number of such positions recruited to fill, and
the number of such positions filled.
``(iii) The types of training that the
hospital provided for residents described in
subparagraph (C) related to the health care
needs of different populations, such as
children who are underserved for reasons of
family income or geographic location, including
rural and urban areas.
``(iv) The changes in residency training for
residents described in subparagraph (C) which
the hospital has made during such residency
academic year (except that the first report
submitted by the hospital under this
subparagraph shall be for such changes since
the first year in which the hospital received
payment under this section), including--
``(I) changes in curricula, training
experiences, and types of training
programs, and benefits that have
resulted from such changes; and
``(II) changes for purposes of
training the residents in the
measurement and improvement of the
quality and safety of patient care.
``(v) The numbers of residents described in
subparagraph (C) who completed their residency
training at the end of such residency academic
year and care for children within the borders
of the service area of the hospital or within
the borders of the State in which the hospital
is located. Such numbers shall be disaggregated
with respect to residents who completed
residencies in general pediatrics or internal
medicine/pediatrics, subspecialty residencies,
and dental residencies.
``(C) Residents.--The residents described in this
subparagraph are those who--
``(i) are in full-time equivalent resident
training positions in any training program
sponsored by the hospital; or
``(ii) are in a training program sponsored by
an entity other than the hospital, but who
spend more than 75 percent of their training
time at the hospital.
``(D) Report to congress.--Not later than the end of
fiscal year 2011, the Secretary, acting through the
Administrator of the Health Resources and Services
Administration, shall submit a report to the Congress--
``(i) summarizing the information submitted
in reports to the Secretary under subparagraph
(B);
``(ii) describing the results of the program
carried out under this section; and
``(iii) making recommendations for
improvements to the program.''.
(c) Technical Amendments.--Section 340E of the Public Health Service
Act (42 U.S.C. 256e) is further amended--
(1) in subsection (c)(2)(E)(ii), by striking ``described in
subparagraph (C)(ii)'' and inserting ``applied under section
1886(d)(3)(E) of the Social Security Act for discharges
occurring during the preceding fiscal year'';
(2) in subsection (e)(2), by striking the first sentence; and
(3) in subsection (e)(3), by striking ``made to pay'' and
inserting ``made and pay''.
Purpose and Summary
H.R. 5574 reauthorizes the Children's Hospitals Graduate
Medical Education Program from 2007 until 2011 to fund
residency programs in children's hospitals.
Background and Need for Legislation
H.R. 5574 reauthorizes the Children's Hospital Graduate
Medical Education program from fiscal year 2007 through fiscal
year 2011.
The Children's Hospital Graduate Medical Education (CHGME)
program was established on December 16, 1999, as part of the
Public Health Services Act (P.L. 106-129), and was later
amended by the Children's Health Act of 2000 (P.L. 106-310).
The authorization expired at the end of fiscal year 2005. The
program is administered by the Health Resources and Service
Administration (HRSA).
The CHGME program is designed to help children's teaching
hospitals that do not receive significant Federal support for
their resident and intern training programs through the
Medicare program because of their low Medicare patient volume.
Graduate medical education is funded through Medicare payments
to full service teaching hospitals. Prior to the enactment of
this program, independent children's teaching hospitals did not
have a similar program to fund resident training programs for
physicians. Congress recognized this inequity and the financial
disadvantage it placed on children's hospitals.
Hearings
On May 9, 2006, the Subcommittee on Health held a hearing
entitled ``Examining the Children's Hospital Graduate Medical
Education Program.'' The Subcommittee received testimony from:
Kerry Nesseler, Associate Administrator, Bureau of Health
Professions, Health Resources and Services Administration, U.S.
Department of Health and Human Services; Patrick Magoon,
President and CEO, Children's Memorial Hospital, Chicago,
Illinois; and Bill Considine, President and CEO, Akron
Children's Hospital, Akron, Ohio.
Committee Consideration
On Thursday, June 8, 2006, the Subcommittee on Health met
in open markup session and approved H.R. 5573 for Full
Committee consideration, without amendment, by a voice vote, a
quorum being present. On Thursday, June 15, 2006, the Committee
on Energy and Commerce met in open markup session and ordered
H.R. 5573 reported to the House, amended, by a voice vote, a
quorum being present.
Committee Votes
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list the record votes
on the motion to report legislation and amendments thereto.
There were no record votes taken in connection with ordering
H.R. 5574 reported. A motion by Mr. Deal to order H.R. 5574
reported to the House, amended, was agreed to by a voice vote.
Committee Oversight Findings
Pursuant to clause 3(c)(1) of rule XIII of the Rules of the
House of Representatives, the Committee held an oversight
hearing and made findings that are reflected in this report.
Statement of General Performance Goals and Objectives
The goal of H.R. 5574 is to reauthorize the Children's
Hospital Graduate Medical Education Program to provide
independent children's hospitals with Federal assistance for
their pediatric residency training programs.
New Budget Authority, Entitlement Authority, and Tax Expenditures
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee finds that H.R.
5574, the Children's Hospital GME Support Reauthorization Act
of 2006, would result in no new or increased budget authority,
entitlement authority, or tax expenditures or revenues.
Committee Cost Estimate
The Committee adopts as its own the cost estimate prepared
by the Director of the Congressional Budget Office pursuant to
section 402 of the Congressional Budget Act of 1974.
Congressional Budget Office Estimate
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives, the following is the cost estimate
provided by the Congressional Budget Office pursuant to section
402 of the Congressional Budget Act of 1974:
U.S. Congress,
Congressional Budget Office,
Washington, DC, June 19, 2006.
Hon. Joe Barton,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 5574, the
Children's Hospital GME Support Reauthorization Act of 2006.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Camile
Williams.
Sincerely,
Donald B. Marron,
Acting Director.
Enclosure.
H.R. 5574--Children's Hospital GME Support Reauthorization Act of 2006
Summary: H.R. 5574 would amend the Public Health Service
Act to authorize payments to children's hospitals that operate
graduate medical education programs. Payments would be made to
such hospitals for both ``direct'' and ``indirect'' costs
related to graduate medical education. Direct costs are related
to the cost of operating a medical education program, such as
the salaries of medical residents, while indirect costs are
intended to compensate hospitals for patient care costs that
are expected to be higher in teaching hospitals than in non-
teaching hospitals.
H.R. 5574 would authorize the appropriation of $300 million
a year over the 2007-2011 period for payments to children's
hospitals. CBO estimates that implementing the bill would cost
$225 million in 2007 and $1.4 billion over the 2007-2011
period, assuming the appropriation of the authorized amounts.
H.R. 5574 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA).
Children's hospitals that are operated by government entities
could benefit from grants authorized by the bill for graduate
medical training.
Estimated cost to the Federal Government: The estimated
budgetary impact of H.R. 5574 is shown in the following table.
The costs of this legislation fall within budget function 550
(health).
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
-----------------------------------------------
2006 2007 2008 2009 2010 2011
----------------------------------------------------------------------------------------------------------------
SPENDING SUBJECT TO APPROPRIATION
Spending Under Current Law:
Budget Authoritya........................................... 301 0 0 0 0 0
Estimated Outlays........................................... 302 75 0 0 0 0
Proposed Changes:
Authorization Level......................................... 0 300 300 300 300 300
Estimated Outlays........................................... 0 225 300 300 300 300
Spending Under H.R. 5574:
Authorization Levela........................................ 301 300 300 300 300 300
Estimated Outlays........................................... 302 300 300 300 300 300
----------------------------------------------------------------------------------------------------------------
aThe 2006 level is the amount appropriated for that year for payments to children's hospitals that operate
graduate medical education programs.
Basis of estimate: The Health Resources and Services
Administration administers a program that provides payments to
children's hospitals that operate graduate medical education
programs. Authorization for that program expired in 2005. H.R.
5574 would authorize funding for the program through 2011. For
this estimate, CBO assumes that H.R. 5574 will be enacted
before the end of this fiscal year and that the authorized
amounts will be appropriated for each year.
H.R. 5574 would authorize the appropriation of $100 million
a year for 2007 through 2011 for payment towards the direct
costs of graduate medical education in children's hospitals.
Those funds would be allocated across eligible hospitals
according to a formula that takes into account the number of
residents each hospital employs and its cost per resident as
reported in 1997.
The bill also would authorize the appropriation of $200
million a year for 2007 through 2011 for payment towards the
indirect costs of graduate medical education programs. Those
payments would be made to hospitals on the basis of a formula
that takes into account the hospital's number of discharges,
the relative costliness of those cases are measured by a case-
mix index, and the number of residents at the hospital.
Based on historical patterns of spending for the graduate
medical education program, CBO estimates that implementing the
bill would cost $225 million in 2007 and $1.4 billion over the
2007-2011 period, assuming appropriation of the specified
amounts.
Intergovernmental and private-sector impact: H.R. 5574
contains no intergovernmental or private-sector mandates as
defined in UMRA. Children's hospitals that are operated by
governmental entities could benefit from grants authorized by
the bill for graduate medical training.
Estimate prepared by: Federal Costs: Camile Williams.
Impact on State, Local, and Tribal Governments: Leo Lex. Impact
on the Private Sector: Paige Shevlin.
Estimate approved by: Peter H. Fontaine, Deputy Assistant
Director for Budget Analysis.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates prepared by the Director of the Congressional Budget
Office pursuant to section 423 of the Unfunded Mandates Reform
Act.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act were created by this
legislation.
Constitutional Authority Statement
Pursuant to clause 3(d)(1) of rule XIII of the Rules of the
House of Representatives, the Committee finds that the
Constitutional authority for this legislation is provided in
Article I, section 8, clause 3, which grants Congress the power
to regulate commerce with foreign nations, among the several
States, and with the Indian tribes.
Applicability to Legislative Branch
The Committee finds that the legislation does not relate to
the terms and conditions of employment or access to public
services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
Section-by-Section Analysis of the Legislation
Section 1. Short title
Section 1 establishes the short title of the Act as the
``Children's Hospital GME Support Reauthorization Act of
2006.''
Section 2. Program of payments to children's hospitals that operate
graduate medical education programs
Section 2 amends Section 340E of the Public Health Service
Act to extend the authorization of the CHGME program from
fiscal year 2007 through fiscal year 2011. It also provides
authorization of appropriations for direct medical education
(DME) payments and indirect medical education (IME) payments
under CHGME through fiscal year 2011, providing $100,000,000
for DME and $200,000,000 for IME for each of fiscal years 2007
through 2011.
Section 2 also creates a mechanism by which hospitals may
voluntarily provide the Secretary of Health and Human Services
additional reporting information. In order to receive full
funding, hospitals will be required to submit an annual report.
If a hospital opts not to report this data, it will be able to
access only 75% of what would have been its total amount
awarded.
The new information will include the (1) types of resident
training programs that the hospital provided for residents; (2)
number of training positions for residents; (3) types of
training that the hospital provided for residents related to
the health care needs of different populations; (4) changes in
residency training for residents which the hospital has made
during such residency academic year; and (4) number of
residents who completed their residency training at the end of
such residency academic year and care for children within the
borders of the service area of the hospital or within the
borders of the State in which the hospital is located.
Finally, section 2 corrects a technical error in the
underlying statute.
Section 3. Sense of the Senate
Section 3 recognizes the importance of perinatal hospitals
in both treating seriously ill newborns and training the
providers who are essential to their care, as well as to the
care of healthy mothers and babies.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, existing law in which no change is
proposed is shown in roman):
SECTION 340E OF THE PUBLIC HEALTH SERVICE ACT
SEC. 340E. PROGRAM OF PAYMENTS TO CHILDREN'S HOSPITALS THAT OPERATE
GRADUATE MEDICAL EDUCATION PROGRAMS.
(a) Payments.--The Secretary shall make two payments under
this section to each children's hospital for each of fiscal
years 2000 through 2005 and each of fiscal years 2007 through
2011, one for the direct expenses and the other for indirect
expenses associated with operating approved graduate medical
residency training programs. The Secretary shall promulgate
regulations pursuant to the rulemaking requirements of title 5,
United States Code, which shall govern payments made under this
subpart.
(b) Amount of Payments.--
(1) In general.--Subject to [paragraph (2)]
paragraphs (2) and (3), the amounts payable under this
section to a children's hospital for an approved
graduate medical residency training program for a
fiscal year are each of the following amounts:
(A) * * *
* * * * * * *
(3) Annual reporting required.--
(A) Reduction in payment for failure to
report.--
(i) In general.--The amount payable
under this section to a children's
hospital for a fiscal year (beginning
with fiscal year 2008 and after taking
into account paragraph (2)) shall be
reduced by 25 percent if the Secretary
determines that--
(I) the hospital has failed
to provide the Secretary, as an
addendum to the hospital's
application under this section
for such fiscal year, the
report required under
subparagraph (B) for the
previous fiscal year; or
(II) such report fails to
provide the information
required under any clause of
such subparagraph.
(ii) Notice and opportunity to
provide missing information.--Before
imposing a reduction under clause (i)
on the basis of a hospital's failure to
provide information described in clause
(i)(II), the Secretary shall provide
notice to the hospital of such failure
and the Secretary's intention to impose
such reduction and shall provide the
hospital with the opportunity to
provide the required information within
a period of 30 days beginning on the
date of such notice. If the hospital
provides such information within such
period, no reduction shall be made
under clause (i) on the basis of the
previous failure to provide such
information.
(B) Annual report.--The report required under
this subparagraph for a children's hospital for
a fiscal year is a report that includes (in a
form and manner specified by the Secretary) the
following information for the residency
academic year completed immediately prior to
such fiscal year:
(i) The types of resident training
programs that the hospital provided for
residents described in subparagraph
(C), such as general pediatrics,
internal medicine/pediatrics, and
pediatric subspecialties, including
both medical subspecialties certified
by the American Board of Pediatrics
(such as pediatric gastroenterology)
and non-medical subspecialties approved
by other medical certification boards
(such as pediatric surgery).
(ii) The number of training positions
for residents described in subparagraph
(C), the number of such positions
recruited to fill, and the number of
such positions filled.
(iii) The types of training that the
hospital provided for residents
described in subparagraph (C) related
to the health care needs of different
populations, such as children who are
underserved for reasons of family
income or geographic location,
including rural and urban areas.
(iv) The changes in residency
training for residents described in
subparagraph (C) which the hospital has
made during such residency academic
year (except that the first report
submitted by the hospital under this
subparagraph shall be for such changes
since the first year in which the
hospital received payment under this
section), including--
(I) changes in curricula,
training experiences, and types
of training programs, and
benefits that have resulted
from such changes; and
(II) changes for purposes of
training the residents in the
measurement and improvement of
the quality and safety of
patient care.
(v) The numbers of residents
described in subparagraph (C) who
completed their residency training at
the end of such residency academic year
and care for children within the
borders of the service area of the
hospital or within the borders of the
State in which the hospital is located.
Such numbers shall be disaggregated
with respect to residents who completed
residencies in general pediatrics or
internal medicine/pediatrics,
subspecialty residencies, and dental
residencies.
(C) Residents.--The residents described in
this subparagraph are those who--
(i) are in full-time equivalent
resident training positions in any
training program sponsored by the
hospital; or
(ii) are in a training program
sponsored by an entity other than the
hospital, but who spend more than 75
percent of their training time at the
hospital.
(D) Report to congress.--Not later than the
end of fiscal year 2011, the Secretary, acting
through the Administrator of the Health
Resources and Services Administration, shall
submit a report to the Congress--
(i) summarizing the information
submitted in reports to the Secretary
under subparagraph (B);
(ii) describing the results of the
program carried out under this section;
and
(iii) making recommendations for
improvements to the program.
(c) Amount of Payment for Direct Graduate Medical
Education.--
(1) * * *
(2) Updated per resident amount for direct graduate
medical education.--The updated per resident amount for
direct graduate medical education for a hospital for a
fiscal year is an amount determined as follows:
(A) * * *
* * * * * * *
(E) Application to individual hospitals.--The
Secretary shall compute for each such hospital
that is a children's hospital a per resident
amount--
(i) * * *
(ii) by multiplying the wage-related
portion by the factor [described in
subparagraph (C)(ii)] applied under
section 1886(d)(3)(E) of the Social
Security Act for discharges occurring
during the preceding fiscal year for
the hospital's area; and
* * * * * * *
(e) Making of Payments.--
(1) * * *
(2) Withholding.--[The Secretary shall withhold up to
25 percent from each interim installment for direct and
indirect graduate medical education paid under
paragraph (1).] The Secretary shall withhold up to 25
percent from each interim installment for direct and
indirect graduate medical education paid under
paragraph (1) as necessary to ensure a hospital will
not be overpaid on an interim basis.
(3) Reconciliation.--Prior to the end of each fiscal
year, the Secretary shall determine any changes to the
number of residents reported by a hospital in the
application of the hospital for the current fiscal year
to determine the final amount payable to the hospital
for the current fiscal year for both direct expense and
indirect expense amounts. Based on such determination,
the Secretary shall recoup any overpayments [made to
pay] made and pay any balance due to the extent
possible. The final amount so determined shall be
considered a final intermediary determination for the
purposes of section 1878 of the Social Security Act and
shall be subject to administrative and judicial review
under that section in the same manner as the amount of
payment under section 1186(d) of such Act is subject to
review under such section.
(f) Authorization of Appropriations.--
(1) Direct graduate medical education.--
(A) In general.--There are hereby authorized
to be appropriated, out of any money in the
Treasury not otherwise appropriated, for
payments under subsection (b)(1)(A)--
(i) for fiscal year 2000,
$90,000,000;
(ii) for fiscal year 2001,
$95,000,000; [and]
(iii) for each of the fiscal years
2002 through 2005, such sums as may be
necessary[.]; and
(iv) for each of fiscal years 2007
through 2011, $100,000,000.
* * * * * * *
(2) Indirect medical education.--There are hereby
authorized to be appropriated, out of any money in the
Treasury not otherwise appropriated, for payments under
subsection [(b)(1)(A)] (b)(1)(B)--
(A) * * *
(B) for fiscal year 2001, $190,000,000; [and]
(C) for each of the fiscal years 2002 through
2005, such sums as may be necessary[.]; and
(D) for each of fiscal years 2007 through
2011, $200,000,000.
* * * * * * *