[Congressional Record Volume 150, Number 131 (Tuesday, November 16, 2004)]
[Senate]
[Pages S11385-S11386]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




        CHILDREN'S HOSPITALS EDUCATIONAL EQUITY AND RESEARCH ACT

  Mr. FRIST. Mr. President, I ask unanimous consent that the Senate 
proceed to the immediate consideration of Calendar No. 774, S. 2526.
  The PRESIDING OFFICER. The clerk will report the bill by title.
  The legislative clerk read as follows:

       A bill (S. 2526) to reauthorize the Children's Hospitals 
     Graduate Medical Education Program.

  There being no objection, the Senate proceeded to consider the bill 
which was reported from the Committee on Health, Education, Labor, and 
Pensions, with an amendment.
  (Strike the part printed in black brackets and insert the part 
printed in italic.)

                                S. 2526

       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 ``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) Description of Amount of Payments.--Section 340E(b) of 
     the Public Health Service Act (42 U.S.C. 256e(b)) is 
     amended--
       [(1) in paragraph (1)(B), by striking ``relating to 
     teaching residents in such'' and inserting ``associated with 
     graduate medical residency training''; and
       [(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)''.
       [(c) Direct Graduate Medical Education.--Section 340E(c) of 
     the Public Health Service Act (42 U.S.C. 245e(c)) is 
     amended--
       [(1) in paragraph (1)--
       [(A) in the matter preceding subparagraph (A), by striking 
     ``product'' and inserting ``sum'';
       [(B) in subparagraph (A), by striking ``(A) the updated per 
     resident'' and inserting the following:
       [``(A) the product of--
       [``(i) the updated per resident''.
       [(C) by redesignating subparagraph (B) as clause (ii) and 
     indenting appropriately;
       [(D) in subparagraph (A)(ii) (as so redesignated)--
       [(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
       [(ii) by striking the period and inserting ``; and''; and
       [(E) by inserting after subparagraph (A) the following:
       [``(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
       [(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''.
       [(d) Indirect Graduate Medical Education.--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)''.
       [(e) Nature of Payments.--Section 340E(e) of the Public 
     Health Service Act (42 U.S.C. 256e(e)) is amended--
       [(1) in paragraph (2), by striking the first sentence;
       [(2) in paragraph (3)--
       [(A) by striking ``made to pay'' and inserting ``made and 
     pay''; and
       [(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
       [(3) by adding at the end the following:
       [``(4) Appeals.--
       [``(A) In general.--A decision affecting the amount payable 
     to a hospital pursuant to this section shall--
       [``(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
       [``(ii) be handled expeditiously so that the review 
     decision is reflected in the final reconciliation for the 
     year in which the appeal is made.
       [``(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.
       [``(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.''.
       [(f) 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) in subparagraph (A)--
       [(i) in clause (ii), by striking ``and'';
       [(ii) in clause (iii), by striking the period at the end 
     and inserting a semicolon; and
       [(iii) 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, including an annual adjustment to 
     reflect increases in the Consumer Price Index.''; and
       [(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
       [(2) in paragraph (2)--
       [(A) by redesignating subparagraphs (A), (B), and (C) as 
     clauses (i), (ii), and (iii), respectively, and indenting 
     appropriately;
       [(B) by striking ``There are hereby authorized'' and 
     inserting the following:
       [``(A) In general.--There are authorized'';
       [(C) in clause (ii) (as redesignated by this paragraph), by 
     striking ``and'';
       [(D) in clause (iii) (as redesignated by this paragraph), 
     by striking the period at the end and inserting a semicolon;
       [(E) by adding at the end of subparagraph (A) (as 
     designated by this paragraph), the following:
       [``(iv) for fiscal year 2006, $220,000,000; and
       [``(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
       [(F) at the end of paragraph (2), by adding the following:
       [``(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.''.
       [(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--
       [``(A) the meaning given such term in section 1886(h)(5)(C) 
     of the Social Security Act; and
       [``(B) costs of approved educational activities, as such 
     term is used in section 1886(a)(4) of the Social Security 
     Act.''.]

     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

[[Page S11386]]

     ``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.

  Mr. FRIST. Mr. President, I ask unanimous consent that the committee-
reported amendment be agreed, the bill, as amended, be read a third 
time and passed, and the motion to reconsider be laid upon the table, 
and any statements relating thereto be printed in the Record without 
intervening action or debate.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The committee amendment in the nature of a substitute was agreed to.
  The bill (S. 2526), as amended, was passed.

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