[Congressional Record Volume 150, Number 125 (Wednesday, October 6, 2004)]
[House]
[Pages H8253-H8255]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




    AMENDING SECTION 340E OF PUBLIC HEALTH SERVICE ACT RELATING TO 
                          CHILDREN'S HOSPITALS

  Mr. BILIRAKIS. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 5204) to amend section 340E of the Public Health Service Act 
(relating to children's hospitals) to modify provisions regarding the 
determination of the amount of payments for indirect expenses 
associated with operating approved graduate medical residency training 
programs.
  The Clerk read as follows:

                               H.R. 5204

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

     SECTION 1. DISREGARD OF NEWBORN BASSINETS IN CALCULATING CASE 
                   MIX FOR RECEIPT BY CHILDREN'S HOSPITALS OF 
                   FUNDING FOR GRADUATE MEDICAL EDUCATION 
                   PROGRAMS.

       (a) In General.--Section 340E(d) of the Public Health 
     Service Act (42 U.S.C. 256e(d)) is amended--
       (1) in paragraph (1), by striking ``related to'' and 
     inserting ``associated with''; and
       (2) in paragraph (2)(A)--
       (A) by inserting ``ratio of the'' after ``hospitals and 
     the''; and
       (B) by inserting at the end before the semicolon ``to beds 
     (but excluding beds or bassinets assigned to healthy newborn 
     infants)''.
       (b) Effective Date.--The amendments made by subsection (a) 
     shall apply to payments for periods beginning with fiscal 
     year 2005.
  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Florida (Mr. Bilirakis) and the gentleman from Ohio (Mr. Brown) each 
will control 20 minutes.
  The Chair recognizes the gentleman from Florida (Mr. Bilirakis).


                             General Leave

  Mr. BILIRAKIS. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days within which to revise and extend their 
remarks and include extraneous material on the bill.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Florida?
  There was no objection.

[[Page H8254]]

  Mr. BILIRAKIS. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I rise today in support of H.R. 5204, which would amend 
section 340(e) of the Public Health Service Act to modify provisions 
regarding the determination of the amount of payments for indirect 
expenses associated with operating approved graduate medical residency 
training programs. This legislation was introduced by the gentlewoman 
from California (Ms. Eshoo), a lady who does so many great things in 
the Congress, particularly for her district.
  Children's hospitals receive important funding through the Federal 
Children's Hospitals Graduate Medical Education, which we call GME, 
Payment Program. This funding helps train residents and better enables 
children's hospitals to serve all children, regardless their ability to 
pay.
  Next year, the Committee on Energy and Commerce plans to work to 
reauthorize the Children's Graduate Medical Education Program. As 
chairman of the Health Subcommittee and a proponent of the children's 
hospitals throughout my entire time in Congress, I plan to vigorously 
support this reauthorization.
  However, while we will be working to reauthorize the program next 
year, H.R. 5204 provides a necessary, immediate fix for a small number 
of hospitals that treat a disproportionately high number of healthy 
infants. Healthy infants. This legislation would allow these hospitals 
to receive fair CHGME payments by excluding the number of healthy beds 
and bassinets in children's hospitals from the case mix adjustment. By 
excluding these healthy beds and bassinets, these hospitals will no 
longer be penalized for treating healthy babies.
  I urge all my colleagues to support H.R. 5204 today.
  Mr. Speaker, I reserve the balance of my time.

                              {time}  1615

  Mr. BROWN of Ohio. Mr. Speaker, I yield myself 2 minutes.
  Mr. Speaker, I am pleased to support this legislation and I want to 
commend its author the gentlewoman from California (Ms. Eshoo). She has 
played a leading role in establishing the successful graduate medical 
education program that is the focus of today's bill and a whole host of 
other issues.
  The Children's Hospital Graduate Medical Education program, known as 
Children's GME program, corrected an anomaly in medical education 
funding that prevented children's hospitals from establishing medical 
training programs for pediatricians and other children's health 
specialists, in large part because of the peculiarity of the way we 
fund graduate medical education through Medicare.
  The legislation of the gentlewoman from California (Ms. Eshoo) 
improves that program by ensuring that hospitals with special programs 
for certain newborns are not discriminated against in the calculation 
of medical education funding. This correction is included in both the 
House and Senate versions of GME reauthorization legislation.
  I am proud to be the lead Democratic sponsor of this legislation, 
along with my colleague, the gentlewoman from Connecticut (Mrs. 
Johnson), through H.R. 4578. This legislation before us today provides 
an interim solution until the reauthorization bill is written into the 
law, and I urge my colleagues to support the bill offered by the 
gentlewoman from California (Ms. Eshoo).
  Mr. BILIRAKIS. Mr. Speaker, I reserve the balance of my time.
  Mr. BROWN of Ohio. Mr. Speaker, I yield 5 minutes to the gentlewoman 
from California (Ms. Eshoo), the sponsor of the bill.
  Ms. ESHOO. Mr. Speaker, I want to thank my good friend, the gentleman 
from Ohio (Mr. Brown), for his leadership as ranking member on this 
Subcommittee on Health, which is so important not only here in the 
Congress but for our entire country; and to my good friend, the 
gentleman from Florida (Mr. Bilirakis), our chairman. Surely we would 
not be here this afternoon were it not for his support and pushing to 
bring this to the floor so that we can consider it.
  What this bill is about, Mr. Speaker, is legislation that is going to 
fix a flaw in the Children's Hospital Graduate Medical Education 
payment formula. This formula inadvertently penalizes Lucile Packard 
Children's Hospital, which is in my district in Palo Alto.
  If I just might depart for a moment, Lucile Packard is the mother and 
the visionary that established this hospital in Palo Alto. There are 
many from across the world and from different parts of the country that 
come to have their children cared for there. So I think she is watching 
us, and she would be very proud. Were it not for Lucile Packard, as I 
said, this hospital would not exist today.
  Mr. Speaker, a portion of the Graduate Medical Education calculation 
is based on the severity of case mixes. At Lucile Packard Hospital, 
which is only one of two hospitals in the United States that offers 
pregnancy and healthy newborn services, it is then penalized. Most do 
not take care of healthy newborn babies. When they become part of the 
mix with the very ill ones, the formula becomes skewed. So if the 
hospital did not care for the healthy newborns, we would not be here 
today.
  The Committee on Energy and Commerce took a look at this to fix it 
permanently. As the gentleman stated, that will be taken care of in 
2006. Today, we are fixing the small gap between now and 2006. It is 
going to go a long way.
  I want to reassure my colleagues, there are not any costs associated 
with the bill. This is paid for by a reduction in the fiscal year 2005 
payment to all hospitals that receive these payments under the program, 
and that would not have happened unless the hospitals came together. 
And they have endorsed this. There is endorsement from the National 
Association of Children's Hospitals, and I want to thank them for 
coming together to allow this to happen.
  I also want to thank John Ford on the staff of the gentleman from 
Michigan (Mr. Dingell) and certainly Chuck Clapton on the staff of the 
gentleman from Texas (Chairman Barton), and I want to urge all my 
colleagues to vote in favor of H.R. 5204. It is going to help a great 
deal, and that help is going to be appreciated not only by the children 
and their families, but also the young physicians that have devoted 
themselves to a life in medicine; and in this graduate medical payment, 
it will enjoy the fullness it should and this will be repaired.
  Again, I thank the gentleman from Florida (Mr. Bilirakis), most of 
all for his friendship that I have enjoyed and benefited from and am 
grateful for since first coming to the House.
  Mr. BROWN of Ohio. Mr. Speaker, I yield 2 minutes to the gentleman 
from Illinois (Mr. Davis).
  Mr. DAVIS of Illinois. Mr. Speaker, I rise in strong support of H.R. 
5204 and commend the gentlewoman from California (Ms. Eshoo) for her 
sponsorship of this legislation.
  I represent a congressional district that has five medical schools 
and 28 hospitals, including Children's Memorial in Chicago, which is 
one of the best in the Nation. This legislation is going to be very 
helpful to several of these institutions.
  I simply rise in strong support of this legislation, urge passage, 
and commend again the leadership of this subcommittee for its 
tremendous activity related to health care and the health care needs of 
people in these United States of America.
  Ms. JACKSON-LEE of Texas. As one of the co-chairs of the 
Congressional Children's Caucus, I urge my colleagues today to support 
H.R. 5204, amending section 304e of the Public Health Service Act as it 
relates to payments to children's hospitals under the Graduate Medical 
Education program.
  The existing provisions of the Public Service Health Act unfairly 
penalize the two hospitals in the U.S. that offer both pregnancy and 
healthy newborn services. This penalty is related to calculation of the 
reimbursements that hospitals receive under the Children's Hospital 
Graduate Medical Education program (CHGME).
  As it is currently configured, the CHGME program calculates payments 
to hospitals based on severity of the ``case mix index.'' Healthy 
newborns, like those treated in these two hospitals, reduce the 
severity of the case mix index and thus the payments to the hospitals. 
I believe the current method of calculating these payments is 
unreasonable.

[[Page H8255]]

  For example, one of the only two hospitals offering healthy newborn 
services in the U.S. is the Lucile Packard Children's Hospital. When 
healthy newborns are excluded from the calculation, the Packard 
hospital has the highest ``case mix index'' of all children's hospitals 
in California. With the healthy newborns included, it has the lowest. 
In other words, Packard is unfairly denied resources to treat seriously 
ill newborns because it also provides services to healthy newborns. 
Until the problem is corrected, the Packard hospital will continue to 
be shortchanged more than $300,000 each year.
  This bill corrects the reimbursement problem faced by these two 
hospitals only for fiscal year 2005. Another bill to reauthorize the 
Children's Hospital Graduate Medical Education Act, currently on 
referral to the Subcommittee on Health, will correct this problem in 
fiscal year 2006 and future years. This legislation is needed to 
provide relief to the two affected hospitals in fiscal year 2005. This 
legislation does not change the eligibility for hospitals to qualify 
under the CHGME program.
  I believe that it is unreasonable to penalize hospitals offering 
services to healthy newborns and urge my colleagues to support this 
legislation.
  Mr. BROWN of Ohio. Mr. Speaker, I yield back the balance of my time.
  Mr. BILIRAKIS. Mr. Speaker, I have no further speakers, and I yield 
back the balance of my time.
  The SPEAKER pro tempore (Mr. Culberson). The question is on the 
motion offered by the gentleman from Florida (Mr. Bilirakis) that the 
House suspend the rules and pass the bill, H.R. 5204.
  The question was taken; and (two-thirds having voted in favor 
thereof) the rules were suspended and the bill was passed.
  A motion to reconsider was laid on the table.

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