[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 2526 Reported in Senate (RS)]






                                                       Calendar No. 774
108th CONGRESS
  2d Session
                                S. 2526

                          [Report No. 108-388]

  To reauthorize the Children's Hospitals Graduate Medical Education 
                                Program.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 16, 2004

   Mr. Bond (for himself, Mr. Kennedy, Mr. DeWine,  Mrs. Murray, Mr. 
Talent, Mr. Biden, Mr. Kerry, Mr. Warner, Mr. Cornyn, Mr. Durbin, Mrs. 
 Clinton, Mrs. Boxer, Ms. Landrieu, Mr. Fitzgerald, Mrs. Lincoln, Mr. 
 Hatch, Mr. Schumer, Mr. Voinovich, Mr. Bennett, Mr. Dodd, Mr. Dayton, 
 Mrs. Feinstein, Mr. Allen, and Mr. Campbell) introduced the following 
  bill; which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

                            October 7, 2004

                Reported by Mr. Gregg, with an amendment
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

_______________________________________________________________________

                                 A BILL


 
  To reauthorize the Children's Hospitals Graduate Medical Education 
                                Program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

<DELETED>SECTION 1. SHORT TITLE.</DELETED>

<DELETED>    This Act may be cited as the ``Children's Hospitals 
Educational Equity and Research Act'' or the ``CHEER Act''.</DELETED>

<DELETED>SEC. 2. REAUTHORIZATION OF CHILDREN'S HOSPITALS GRADUATE 
              MEDICAL EDUCATION PROGRAM.</DELETED>

<DELETED>    (a) Extension of Program.--Section 340E(a) of the Public 
Health Service Act (42 U.S.C. 256e(a)) is amended by striking ``2005'' 
and inserting ``2010''.</DELETED>
<DELETED>    (b) Description of Amount of Payments.--Section 340E(b) of 
the Public Health Service Act (42 U.S.C. 256e(b)) is amended--
</DELETED>
        <DELETED>    (1) in paragraph (1)(B), by striking ``relating to 
        teaching residents in such'' and inserting ``associated with 
        graduate medical residency training''; and</DELETED>
        <DELETED>    (2) in paragraph (2)(A), by inserting before the 
        period at the end ``, except as provided under paragraphs 
        (1)(A) and (2)(B) of subsection (f)''.</DELETED>
<DELETED>    (c) Direct Graduate Medical Education.--Section 340E(c) of 
the Public Health Service Act (42 U.S.C. 245e(c)) is amended--
</DELETED>
        <DELETED>    (1) in paragraph (1)--</DELETED>
                <DELETED>    (A) in the matter preceding subparagraph 
                (A), by striking ``product'' and inserting 
                ``sum'';</DELETED>
                <DELETED>    (B) in subparagraph (A), by striking ``(A) 
                the updated per resident'' and inserting the 
                following:</DELETED>
                <DELETED>    ``(A) the product of--</DELETED>
                        <DELETED>    ``(i) the updated per 
                        resident''.</DELETED>
                <DELETED>    (C) by redesignating subparagraph (B) as 
                clause (ii) and indenting appropriately;</DELETED>
                <DELETED>    (D) in subparagraph (A)(ii) (as so 
                redesignated)--</DELETED>
                        <DELETED>    (i) by inserting ``but without 
                        giving effect to section 1886(h)(7) of such 
                        Act'' after ``section 1886(h)(4) of the Social 
                        Security Act''; and</DELETED>
                        <DELETED>    (ii) by striking the period and 
                        inserting ``; and''; and</DELETED>
                <DELETED>    (E) by inserting after subparagraph (A) 
                the following:</DELETED>
                <DELETED>    ``(B) amounts for other approved education 
                programs that are provider-operated, as defined for 
                purposes of Medicare payment, limited to not more than 
                30 percent of costs that would be allowed for such 
                programs under Medicare rules for hospitals reimbursed 
                under section 1886(d) of the Social Security Act.''; 
                and</DELETED>
        <DELETED>    (2) in paragraph (2)(B), by inserting before the 
        period at the end ``, without giving effect to section 
        1886(d)(3)(E)(ii) of the Social Security Act''.</DELETED>
<DELETED>    (d) Indirect Graduate Medical Education.--Section 340E(d) 
of the Public Health Service Act (42 U.S.C. 256e(d)) is amended--
</DELETED>
        <DELETED>    (1) in paragraph (1), by striking ``related to'' 
        and inserting ``associated with''; and</DELETED>
        <DELETED>    (2) in paragraph (2)(A)--</DELETED>
                <DELETED>    (A) by inserting ``ratio of the'' after 
                ``hospitals and the''; and</DELETED>
                <DELETED>    (B) by inserting at the end before the 
                semicolon ``to beds (but excluding beds or bassinets 
                assigned to healthy newborn infants)''.</DELETED>
<DELETED>    (e) Nature of Payments.--Section 340E(e) of the Public 
Health Service Act (42 U.S.C. 256e(e)) is amended--</DELETED>
        <DELETED>    (1) in paragraph (2), by striking the first 
        sentence;</DELETED>
        <DELETED>    (2) in paragraph (3)--</DELETED>
                <DELETED>    (A) by striking ``made to pay'' and 
                inserting ``made and pay''; and</DELETED>
                <DELETED>    (B) by striking ``to the extent possible'' 
                and all that follows through the end of the paragraph 
                and inserting the following: ``. To the greatest extent 
                possible, amounts recouped from a hospital are to be 
                distributed to other hospitals in the same fiscal year. 
                Amounts recouped from a hospital and not disbursed to 
                other hospitals in the same fiscal year shall remain 
                available for distribution during the subsequent fiscal 
                year. Unless there is fraud, amounts paid to a hospital 
                without a demand for recoupment by the end of the 
                fiscal year shall be final and not subject to 
                recoupment.''; and</DELETED>
        <DELETED>    (3) by adding at the end the following:</DELETED>
        <DELETED>    ``(4) Appeals.--</DELETED>
                <DELETED>    ``(A) In general.--A decision affecting 
                the amount payable to a hospital pursuant to this 
                section shall--</DELETED>
                        <DELETED>    ``(i) be subject to review under 
                        section 1878 of the Social Security Act in the 
                        same manner as a final determination of a 
                        fiscal intermediary of the amount of payment 
                        under 1886(d) of such Act is subject to review; 
                        and</DELETED>
                        <DELETED>    ``(ii) be handled expeditiously so 
                        that the review decision is reflected in the 
                        final reconciliation for the year in which the 
                        appeal is made.</DELETED>
                <DELETED>    ``(B) Limitation.--A review decision 
                pursuant to this section shall not affect payments for 
a fiscal year prior to the fiscal year in which the review decision is 
rendered.</DELETED>
                <DELETED>    ``(C) Application to subsequent fiscal 
                years.--The Secretary shall apply a review decision in 
                determining the amount of payment for the appealing 
                hospital in the fiscal year in which the decision is 
                rendered and in subsequent years, unless the law at 
                issue in the review decision is amended or there are 
                material differences between the facts for the fiscal 
                year for which the review decision is rendered and the 
                year for which payment is made. Nothing in this section 
                shall be construed to prohibit a hospital from 
                appealing similar determinations in subsequent 
                periods.''.</DELETED>
<DELETED>    (f) Authorization of Appropriations.--Section 340E(f) of 
the Public Health Service Act (42 U.S.C. 256e(f)) is amended--
</DELETED>
        <DELETED>    (1) in paragraph (1)--</DELETED>
                <DELETED>    (A) in subparagraph (A)--</DELETED>
                        <DELETED>    (i) in clause (ii), by striking 
                        ``and'';</DELETED>
                        <DELETED>    (ii) in clause (iii), by striking 
                        the period at the end and inserting a 
                        semicolon; and</DELETED>
                        <DELETED>    (iii) by adding at the end the 
                        following:</DELETED>
                        <DELETED>    ``(iv) for fiscal year 2006, 
                        $110,000,000; and</DELETED>
                        <DELETED>    ``(v) for each of fiscal years 
                        2007 through 2010, such sums as may be 
                        necessary, including an annual adjustment to 
                        reflect increases in the Consumer Price 
                        Index.''; and</DELETED>
                <DELETED>    (B) in subparagraph (B), by striking ``for 
                fiscal year 2000'' and all that follows and inserting 
                ``for fiscal year 2006 and each subsequent fiscal year 
                shall remain available for obligation for the year 
                appropriated and the subsequent fiscal year.''; 
                and</DELETED>
        <DELETED>    (2) in paragraph (2)--</DELETED>
                <DELETED>    (A) by redesignating subparagraphs (A), 
                (B), and (C) as clauses (i), (ii), and (iii), 
                respectively, and indenting appropriately;</DELETED>
                <DELETED>    (B) by striking ``There are hereby 
                authorized'' and inserting the following:</DELETED>
                <DELETED>    ``(A) In general.--There are 
                authorized'';</DELETED>
                <DELETED>    (C) in clause (ii) (as redesignated by 
                this paragraph), by striking ``and'';</DELETED>
                <DELETED>    (D) in clause (iii) (as redesignated by 
                this paragraph), by striking the period at the end and 
                inserting a semicolon;</DELETED>
                <DELETED>    (E) by adding at the end of subparagraph 
                (A) (as designated by this paragraph), the 
                following:</DELETED>
                        <DELETED>    ``(iv) for fiscal year 2006, 
                        $220,000,000; and</DELETED>
                        <DELETED>    ``(v) for each of fiscal years 
                        2007 through 2010, such sums as may be 
                        necessary, including an annual adjustment to 
                        reflect increases in the Consumer Price 
                        Index.''; and</DELETED>
                <DELETED>    (F) at the end of paragraph (2), by adding 
                the following:</DELETED>
                <DELETED>    ``(B) Carryover of excess.--To the extent 
                that amounts are not expended in the year for which 
                they are appropriated, the amounts appropriated under 
                subparagraph (A) for fiscal year 2006 and each 
                subsequent fiscal year shall remain available for 
obligation through the end of the following fiscal year.''.</DELETED>
<DELETED>    (g) Definitions.--Section 340E(g)(3) of the Public Health 
Service Act (42 U.S.C. 256e(g)(3)) is amended by striking ``has'' and 
all that follows through the end of the sentence and inserting the 
following: ``includes--</DELETED>
                <DELETED>    ``(A) the meaning given such term in 
                section 1886(h)(5)(C) of the Social Security Act; 
                and</DELETED>
                <DELETED>    ``(B) costs of approved educational 
                activities, as such term is used in section 1886(a)(4) 
                of the Social Security Act.''.</DELETED>

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Children's Hospitals Educational 
Equity and Research Act'' or the ``CHEER Act''.

SEC. 2. REAUTHORIZATION OF CHILDREN'S HOSPITALS GRADUATE MEDICAL 
              EDUCATION PROGRAM.

    (a) Extension of Program.--Section 340E(a) of the Public Health 
Service Act (42 U.S.C. 256e(a)) is amended by striking ``2005'' and 
inserting ``2010''.
    (b) Direct Graduate Medical Education.--Section 340E(c) of the 
Public Health Service Act (42 U.S.C. 256e(c)) is amended--
            (1) in paragraph (1)(B), by inserting ``but without giving 
        effect to section 1886(h)(7) of such Act)'' after ``section 
        1886(h)(4) of the Social Security Act''; and
            (2) in paragraph (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''.
    (c) Indirect Graduate Medical Education.--Section 340E(d)(2)(A) of 
the Public Health Service Act (42 U.S.C. 256e(d)(2)(A)) is amended--
            (1) by inserting ``ratio of the'' after ``hospitals and 
        the''; and
            (2) by inserting before the semicolon the following: ``to 
        beds (excluding beds or bassinets assigned to healthy newborn 
        infants)''.
    (d) Nature of Payments.--Section 340E(e)(3) of the Public Health 
Service Act (42 U.S.C. 256e(e)(3)) is amended by striking ``made to 
pay'' and inserting ``made and pay''.
    (e) Authorization of Appropriations.--Section 340E(f) of the Public 
Health Service Act (42 U.S.C. 256e(f)) is amended--
            (1) in paragraph (1)(A)--
                    (A) in clause (ii), by striking ``and'';
                    (B) in clause (iii), by striking the period and 
                inserting a semicolon; and
                    (C) by adding at the end the following:
                            ``(iv) for fiscal year 2006, $110,000,000; 
                        and
                            ``(v) for each of fiscal years 2007 through 
                        2010, such sums as may be necessary.''; and
            (2) in paragraph (2)--
                    (A) in the matter preceding subparagraph (A)--
                            (i) by striking ``There are hereby 
                        authorized'' and inserting ``There are 
                        authorized''; and
                            (ii) by striking ``(b)(1)(A)'' and 
                        inserting ``(b)(1)(B)'';
                    (B) in subparagraph (B), by striking ``and'';
                    (C) in subparagraph (C), by striking the period and 
                inserting a semicolon; and
                    (D) by adding at the end the following:
                    ``(D) for fiscal year 2006, $220,000,000; and
                    ``(E) for each of fiscal years 2007 through 2010, 
                such sums as may be necessary.''.
    (f) Technical Amendment.--Section 340E(e)(2) of the Public Health 
Service Act (42 U.S.C. 256e(e)(2)) is amended by striking the first 
sentence.

SEC. 3. SENSE OF THE SENATE.

    It is the sense of the Senate that perinatal hospitals play an 
important role in providing quality care and ensuring the best possible 
outcomes for thousands of seriously ill newborns each year, and that 
medical training programs at perinatal hospitals give providers 
essential training in treating healthy mothers and babies as well as 
patients in neonatal intensive care units.




                                                       Calendar No. 774

108th CONGRESS

  2d Session

                                S. 2526

                          [Report No. 108-388]

_______________________________________________________________________

                                 A BILL

  To reauthorize the Children's Hospitals Graduate Medical Education 
                                Program.

_______________________________________________________________________

                            October 7, 2004

                       Reported with an amendment