[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4235 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 4235

   To amend the Public Health Service Act to provide assistance for 
       graduate medical education funding for women's hospitals.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            December 8, 2009

 Mr. Kennedy introduced the following bill; which was referred to the 
                    Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
   To amend the Public Health Service Act to provide assistance for 
       graduate medical education funding for women's hospitals.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Women's Hospitals Education Equity 
Act''.

SEC. 2. SUPPORT OF GRADUATE MEDICAL EDUCATION PROGRAMS IN WOMEN'S 
              HOSPITALS.

    Subpart IX of part D of title III of the Public Health Service Act 
(42 U.S.C. 256e et seq.) is amended--
            (1) in the subpart heading, by adding ``and Women's 
        Hospitals'' at the end;
            (2) in section 340E(a), by striking ``subpart'' and 
        inserting ``section''; and
            (3) by adding at the end the following:

``SEC. 340E-1. SUPPORT OF GRADUATE MEDICAL EDUCATION PROGRAMS IN 
              WOMEN'S HOSPITALS.

    ``(a) Payments.--The Secretary shall make two payments under this 
section to each women's hospital for each of fiscal years 2010 through 
2014, 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 section.
    ``(b) Amount of Payments.--
            ``(1) In general.--Subject to paragraphs (2) and (3), the 
        amounts payable under this section to a women's hospital for an 
        approved graduate medical residency training program for a 
        fiscal year shall be each of the following:
                    ``(A) Direct expense amount.--The amount determined 
                in accordance with subsection (c) for direct expenses 
                associated with operating approved graduate medical 
                residency training programs for a fiscal year.
                    ``(B) Indirect expense amount.--The amount 
                determined in accordance with subsection (c) for 
                indirect expenses associated with the treatment of more 
                severely ill patients and the additional costs relating 
                to teaching residents in such programs for a fiscal 
                year.
            ``(2) Capped amount.--
                    ``(A) In general.--The total of the payments made 
                to women's hospitals under paragraph (1) in a fiscal 
                year shall not exceed the funds appropriated under 
                subsection (f) for such payments for that fiscal year.
                    ``(B) Pro rata reductions of payments.--If the 
                Secretary determines that the amount of funds 
                appropriated under subsection (f) for a fiscal year is 
                insufficient to provide the total amount of payments 
                otherwise due for such periods under paragraph (1), the 
                Secretary shall reduce the amounts so payable on a pro 
                rata basis to reflect such shortfall.
    ``(c) Application of Annual Reporting and Other Provisions.--The 
provisions of subsections (b)(3), (c), and (d) of section 340E shall 
apply with respect to women's hospitals funded under this section in 
the same manner as such provisions apply with respect to children's 
hospitals funded under such section 340E. In applying such provisions, 
the Secretary may make such modifications as may be necessary to apply 
such provisions with respect to women's hospitals.
    ``(d) Making of Payments.--
            ``(1) Interim payments.--The Secretary shall determine, 
        before the beginning of each fiscal year involved for which 
        payments may be made for a hospital under this section, the 
        amounts of the payments for direct graduate medical education 
        and indirect medical education for such fiscal year and shall 
        (subject to paragraph (2)) make the payments of such amounts in 
        12 equal interim installments during such period. Such interim 
        payments to each individual hospital shall be based on the 
        number of residents reported in the hospital's most recently 
        filed Medicare cost report prior to the application date for 
        the Federal fiscal year for which the interim payment amounts 
        are established. In the case of a hospital that does not report 
        residents on a Medicare cost report, such interim payments 
        shall be based on the number of residents trained during the 
        hospital's most recently completed Medicare cost report filing 
        period.
            ``(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) 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 
        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 1886(d) of such Act is subject 
        to review under such section.
    ``(e) Definitions.--In this section:
            ``(1) Approved graduate medical residency training 
        program.--The term `approved graduate medical residency 
        training program' has the meaning given the term `approved 
        medical residency training program' in section 1886(h)(5)(A) of 
        the Social Security Act.
            ``(2) Direct graduate medical education costs.--The term 
        `direct graduate medical education costs' has the meaning given 
        such term in section 1886(h)(5)(C) of the Social Security Act.
            ``(3) Women's hospital.--The term `women's hospital' means 
        a hospital--
                    ``(A) that has a Medicare provider agreement under 
                title XVIII of the Social Security Act;
                    ``(B) that has an approved graduate medical 
                residency training program;
                    ``(C) that has not been excluded from the Medicare 
                prospective payment system;
                    ``(D) that had at least 3,000 births during 2007, 
                as determined by the Centers for Medicare & Medicaid 
                Services; and
                    ``(E) with respect to which and as determined by 
                the Centers for Medicare & Medicaid Services, less than 
                4 percent of the total discharges from the hospital 
                during 2007 were Medicare discharges of individuals 
                who, as of the time of the discharge--
                            ``(i) were enrolled in the original 
                        Medicare fee-for-service program under part A 
                        of title XVIII of the Social Security Act; and
                            ``(ii) were not enrolled in--
                                    ``(I) a Medicare Advantage plan 
                                under part C of title XVIII of that 
                                Act;
                                    ``(II) an eligible organization 
                                under section 1876 of that Act; or
                                    ``(III) a PACE program under 
                                section 1894 of that Act.
    ``(f) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, $12,000,000 for fiscal year 
2010, and such sums as may be necessary for each of fiscal years 2011 
through 2014.''.
                                 <all>