II 111th CONGRESS 1st Session S. 1742 IN THE SENATE OF THE UNITED STATES October 1, 2009 Mr. Whitehouse (for himself, Mr. Casey, and Mr. Specter) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To amend the Public Health Service Act to provide assistance for graduate medical education funding for women's hospitals.

1.

Short title

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

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; and (2)by adding at the end the following:

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 subpart. (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)(A) or paragraph (1)(B) 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 for direct expenses

If the Secretary determines that the amount of funds appropriated under subsection (e) for a fiscal year is insufficient to provide the total amount of payments otherwise due for such periods under paragraph (1)(A), the Secretary shall reduce the amounts so payable on a pro rata basis to reflect such shortfall. (3)

Annual reporting required

The provisions of subsection (b)(3) of section 340E shall apply to women's hospitals under this section in the same manner as such provisions apply to children's hospitals under such section 340E. In applying such provisions, the Secretary may make such modifications as may be necessary to apply such provisions to women's hospitals. (c)

Application of certain provisions

The provisions of subsections (c) and (d) of section 340E shall apply to women's hospitals under this section in the same manner as such provisions apply to children's hospitals under such section 340E. In applying such provisions, the Secretary may make such modifications as may be necessary to apply such provisions 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)

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. (f)

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.

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