[Congressional Record Volume 145, Number 127 (Monday, September 27, 1999)]
[House]
[Pages H8873-H8874]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                               AMENDMENTS

  Under clause 8 of rule XVIII, proposed amendments were submitted as 
follows:

                               H.R. 2506

                Offered By: Mrs. Johnson of Connecticut

       Amendment No. 18: At the end of the bill, add the following 
     new section:

     SEC. 4. PROGRAM OF PAYMENTS TO CHILDREN'S HOSPITALS THAT 
                   OPERATE GRADUATE MEDICAL EDUCATION PROGRAMS.

       Part D of title III of the Public Health Service Act (42 
     U.S.C. 254b et seq.) is amended by adding at the end the 
     following subpart:

    ``Subpart IX--Support of Graduate Medical Education Programs in 
                          Children's Hospitals

     ``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 and 2001, one for the direct expenses and 
     the other for indirect expenses associated with operating 
     approved graduate medical residency training programs.
       ``(b) Amount of Payments.--
       ``(1) In general.--Subject to paragraph (2), 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) Direct expense amount.--The amount determined under 
     subsection (c) for direct expenses associated with operating 
     approved graduate medical residency training programs.
       ``(B) Indirect expense amount.--The amount determined under 
     subsection (d) for indirect expenses associated with the 
     treatment of more severely ill patients and the additional 
     costs relating to teaching residents in such programs.
       ``(2) Capped amount.--
       ``(A) In general.--The total of the payments made to 
     children's hospitals under paragraph (1)(A) or paragraph 
     (1)(B) in a fiscal year shall not exceed the funds 
     appropriated under paragraph (1) or (2), respectively, of 
     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 (f)(1) 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.
       ``(c) Amount of Payment for Direct Graduate Medical 
     Education.--
       ``(1) In general.--The amount determined under this 
     subsection for payments to a children's hospital for direct 
     graduate expenses relating to approved graduate medical 
     residency training programs for a fiscal year is equal to the 
     product of--
       ``(A) the updated per resident amount for direct graduate 
     medical education, as determined under paragraph (2)); and
       ``(B) the average number of full-time equivalent residents 
     in the hospital's graduate approved medical residency 
     training programs (as determined under section 1886(h)(4) of 
     the Social Security Act during the fiscal year.
       ``(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) Determination of hospital single per resident 
     amount.--The Secretary shall compute for each hospital 
     operating an approved graduate medical education program 
     (regardless of whether or not it is a children's hospital) a 
     single per resident amount equal to the average (weighted by 
     number of full-time equivalent residents) of the primary care 
     per resident amount and the non-primary care per resident 
     amount computed under section 1886(h)(2) of the Social 
     Security Act for cost reporting periods ending during fiscal 
     year 1997.
       ``(B) Determination of wage and non-wage-related proportion 
     of the single per resident amount.--The Secretary shall 
     estimate the average proportion of the single per resident 
     amounts computed under subparagraph (A) that is attributable 
     to wages and wage-related costs.
       ``(C) Standardizing per resident amounts.--The Secretary 
     shall establish a standardized per resident amount for each 
     such hospital--
       ``(i) by dividing the single per resident amount computed 
     under subparagraph (A) into a wage-related portion and a non-
     wage-related portion by applying the proportion determined 
     under subparagraph (B);
       ``(ii) by dividing the wage-related portion by the factor 
     applied under section 1886(d)(3)(E) of the Social Security 
     Act for discharges occurring during fiscal year 1999 for the 
     hospital's area; and
       ``(iii) by adding the non-wage-related portion to the 
     amount computed under clause (ii).
       ``(D) Determination of national average.--The Secretary 
     shall compute a national average per resident amount equal to 
     the average of the standardized per resident amounts computed 
     under subparagraph (C) for such hospitals, with the amount 
     for each hospital weighted by the average number of full-time 
     equivalent residents at such hospital.
       ``(E) Application to individual hospitals.--The Secretary 
     shall compute for each such hospital that is a children's 
     hospital a per resident amount--
       ``(i) by dividing the national average per resident amount 
     computed under subparagraph (D) into a wage-related portion 
     and a non-wage-related portion by applying the proportion 
     determined under subparagraph (B);
       ``(ii) by multiplying the wage-related portion by the 
     factor described in subparagraph (C)(ii) for the hospital's 
     area; and
       ``(iii) by adding the non-wage-related portion to the 
     amount computed under clause (ii).
       ``(F) Updating rate.--The Secretary shall update such per 
     resident amount for each such children's hospital by the 
     estimated percentage increase in the consumer price index for 
     all urban consumers during the period beginning October 1997 
     and ending with the midpoint of the hospital's cost reporting 
     period that begins during fiscal year 2000.
       ``(d) Amount of Payment for Indirect Medical Education.--
       ``(1) In general.--The amount determined under this 
     subsection for payments to a children's hospital for indirect 
     expenses associated with the treatment of more severely ill 
     patients and the additional costs related to the teaching of 
     residents for a fiscal year is equal to an amount determined 
     appropriate by the Secretary.
       ``(2) Factors.--In determining the amount under paragraph 
     (1), the Secretary shall--
       ``(A) take into account variations in case mix among 
     children's hospitals and the number of full-time equivalent 
     residents in the hospitals' approved graduate medical 
     residency training programs; and
       ``(B) assure that the aggregate of the payments for 
     indirect expenses associated with the treatment of more 
     severely ill patients and the additional costs related to the 
     teaching of residents under this section in a fiscal year are 
     equal to the amount appropriated for such expenses for the 
     fiscal year involved under subsection (f)(2).
       ``(e) 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

[[Page H8874]]

     to paragraph (2)) make the payments of such amounts in 26 
     equal interim installments during such period.
       ``(2) Withholding.--The Secretary shall withhold up to 25 
     percent from each interim installment for direct graduate 
     medical education paid under paragraph (1).
       ``(3) Reconciliation.--At the end of each fiscal year for 
     which payments may be made under this section, the hospital 
     shall submit to the Secretary such information as the 
     Secretary determines to be necessary to determine the percent 
     (if any) of the total amount withheld under paragraph (2) 
     that is due under this section for the hospital for the 
     fiscal year. Based on such determination, the Secretary shall 
     recoup any overpayments made, or pay any balance due. The 
     amount so determined shall be considered a final intermediary 
     determination for purposes of applying section 1878 of the 
     Social Security Act and shall be subject to 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.
       ``(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; and
       ``(ii) for fiscal year 2001, $95,000,000.
       ``(B) Carryover of excess.--The amounts appropriated under 
     subparagraph (A) for fiscal year 2000 shall remain available 
     for obligation through the end of fiscal year 2001.
       ``(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) --
       ``(A) for fiscal year 2000, $190,000,000; and
       ``(B) for fiscal year 2001, $190,000,000.
       ``(g) 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) Children's hospital.--The term `children's hospital' 
     means a hospital described in section 1886(d)(1)(B)(iii) of 
     the Social Security Act.
       ``(3) 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.''.

                               H.R. 2506

                        Offered By: Mr. McGovern

       Amendment No. 19: Page 46, after line 2, insert the 
     following section:

     SEC. 4. STUDY REGARDING SHORTAGES OF LICENSED PHARMACISTS.

       (a) In General.--The Secretary of Health and Human Services 
     (in this section referred to as the ``Secretary''), acting 
     through the appropriate agencies of the Public Health 
     Services, shall conduct a study to determine whether and to 
     what extent there is a shortage of licensed pharmacists. In 
     carrying out the study, the Secretary shall seek the comments 
     of appropriate public and private entities regarding any such 
     shortage.
       (b) Report to Congress.--Not later than one year after the 
     date of the enactment of this Act, the Secretary shall 
     complete the study under subsection (a) and submit to the 
     Congress a report that describes the findings made through 
     the study and that contains a summary of the comments 
     received by the Secretary pursuant to such subsection.

                               H.R. 2506

                        Offered By: Mr. Pascrell

       Amendment No. 20: Page 13, after line 5, insert the 
     following subsection:
       ``(d) Cancer and Cardiovascular Diseases in Women.--The 
     Director shall conduct and support research and build 
     private-public partnerships to enhance the quality, 
     appropriateness, and effectiveness of and access to health 
     services regarding cancer and cardiovascular diseases in 
     women, including with respect to the comparative 
     effectiveness, cost-effectiveness, and safety of such 
     services.

                               H.R. 2506

                        Offered By: Mr. Stearns

       Amendment No. 21: Page 21, after line 8, insert the 
     following subsection:
       ``(d) Certain Technologies and Practices Regarding Survival 
     Rates for Cardiac Arrest.--In carrying out subsection (a) 
     with respect to innovations in health care technologies and 
     clinical practice, the Director shall, in consultation with 
     appropriate public and private entities, develop 
     recommendations regarding the placement of automatic external 
     defibrillators in Federal buildings as a means of improving 
     the survival rates of individuals who experience cardiac 
     arrest in such buildings, including recommendations on 
     training, maintenance, and medical oversight, and on 
     coordinating with the system for emergency medical services.

                               H.R. 2506

                 Offered By: Mr. Thompson of California

       Amendment No. 22: Page 46, after line 2, add the following 
     section:

     SEC. 4. REPORT ON TELEMEDICINE.

       Not later than January 10, 2001, the Director of the Agency 
     for Health Research and Quality shall submit to the Congress 
     a report that--
       (1) identifies any factors that inhibit the expansion and 
     accessibility of telemedicine services, including factors 
     relating to telemedicine networks;
       (2) identifies any factors that, in addition to 
     geographical isolation, should be used to determine which 
     patients need or require access to telemedicine care;
       (3) determines the extent to which--
       (A) patients receiving telemedicine service have benefited 
     from the services, and are satisfied with the treatment 
     received pursuant to the services; and
       (B) the medical outcomes for such patients would have 
     differed if telemedicine services had not been available to 
     the patients;
       (4) determines the extent to which physicians involved with 
     telemedicine services have been satisfied with the medical 
     aspects of the services;
       (5) determines the extent to which primary care physicians 
     are enhancing their medical knowledge and experience through 
     the interaction with specialists provided by telemedicine 
     consultations; and
       (6) identifies legal and medical issues relating to State 
     licensing of health professionals that are presented by 
     telemedicine services, and provides any recommendations of 
     the Director for responding to such issues.

                               H.R. 2506

                       Offered By: Mr. Traficant

       Amendment No. 23: Page 46, after line 2, insert the 
     following section:

     SEC. 4. BUY AMERICAN PROVISIONS.

       (a) Compliance With Buy American Act.--No funds authorized 
     pursuant to this Act may be expended by an entity unless the 
     entity agrees that in expending the assistance the entity 
     will comply with sections 2 through 4 of the Act of March 3, 
     1933 (41 U.S.C. 10a-10c, popularly known as the ``Buy 
     American Act'').
       (b) Sense of Congress; Requirement Regarding Notice.--
       (1) Purchase of american-made equipment and products.--In 
     the case of any equipment or products that may be authorized 
     to be purchased with financial assistance provided under this 
     Act, it is the sense of the Congress that entities receiving 
     such assistance should, in expending the assistance, purchase 
     only American-made equipment and products.
       (2) Notice to recipients of assistance.--In providing 
     financial assistance under this Act, the Secretary of Health 
     and Human Services shall provide to each recipient of the 
     assistance a notice describing the statement made in 
     paragraph (1) by the Congress.