[Congressional Record Volume 152, Number 81 (Wednesday, June 21, 2006)]
[House]
[Pages H4365-H4368]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
CHILDREN'S HOSPITAL GME SUPPORT REAUTHORIZATION ACT OF 2006
Mr. DEAL of Georgia. Mr. Speaker, I move to suspend the rules and
pass the bill (H.R. 5574) to amend the Public Health Service Act to
reauthorize support for graduate medical education programs in
children's hospitals, as amended.
The Clerk read as follows:
H.R. 5574
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 Hospital GME
Support Reauthorization Act of 2006''.
SEC. 2. PROGRAM OF PAYMENTS TO CHILDREN'S HOSPITALS THAT
OPERATE GRADUATE MEDICAL EDUCATION PROGRAMS.
(a) In General.--Section 340E of the Public Health Service
Act (42 U.S.C. 256e) is amended--
(1) in subsection (a), by inserting ``and each of fiscal
years 2007 through 2011'' after ``for each of fiscal years
2000 through 2005'';
(2) in subsection (f)(1)(A)--
(A) in clause (ii), by striking ``and'' at the end;
(B) in clause (iii), by striking the period at the end and
inserting ``; and''; and
(C) by adding at the end the following:
``(iv) for each of fiscal years 2007 through 2011,
$100,000,000.''; and
(3) in subsection (f)(2)--
(A) in the matter before subparagraph (A), by striking
``subsection (b)(1)(A)'' and inserting ``subsection
(b)(1)(B)'';
(B) in subparagraph (B), by striking ``and'' at the end;
(C) in subparagraph (C), by striking the period at the end
and inserting ``; and''; and
(D) by adding at the end the following:
``(D) for each of fiscal years 2007 through 2011,
$200,000,000.''.
(b) Reduction in Payments for Failure to File Annual
Report.--Subsection (b) of section 340E of the Public Health
Service Act (42 U.S.C. 256e) is amended--
(1) in paragraph (1), in the matter before subparagraph
(A), by striking ``paragraph (2)'' and inserting ``paragraphs
(2) and (3)''; and
(2) by adding at the end the following:
``(3) Annual reporting required.--
``(A) Reduction in payment for failure to report.--
``(i) In general.--The amount payable under this section to
a children's hospital for a fiscal year (beginning with
fiscal year 2008 and after taking into account paragraph (2))
shall be reduced by 25 percent if the Secretary determines
that--
``(I) the hospital has failed to provide the Secretary, as
an addendum to the hospital's application under this section
for such fiscal year, the report required under subparagraph
(B) for the previous fiscal year; or
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``(II) such report fails to provide the information
required under any clause of such subparagraph.
``(ii) Notice and opportunity to provide missing
information.--Before imposing a reduction under clause (i) on
the basis of a hospital's failure to provide information
described in clause (i)(II), the Secretary shall provide
notice to the hospital of such failure and the Secretary's
intention to impose such reduction and shall provide the
hospital with the opportunity to provide the required
information within a period of 30 days beginning on the date
of such notice. If the hospital provides such information
within such period, no reduction shall be made under clause
(i) on the basis of the previous failure to provide such
information.
``(B) Annual report.--The report required under this
subparagraph for a children's hospital for a fiscal year is a
report that includes (in a form and manner specified by the
Secretary) the following information for the residency
academic year completed immediately prior to such fiscal
year:
``(i) The types of resident training programs that the
hospital provided for residents described in subparagraph
(C), such as general pediatrics, internal medicine/
pediatrics, and pediatric subspecialties, including both
medical subspecialties certified by the American Board of
Pediatrics (such as pediatric gastroenterology) and non-
medical subspecialties approved by other medical
certification boards (such as pediatric surgery).
``(ii) The number of training positions for residents
described in subparagraph (C), the number of such positions
recruited to fill, and the number of such positions filled.
``(iii) The types of training that the hospital provided
for residents described in subparagraph (C) related to the
health care needs of different populations, such as children
who are underserved for reasons of family income or
geographic location, including rural and urban areas.
``(iv) The changes in residency training for residents
described in subparagraph (C) which the hospital has made
during such residency academic year (except that the first
report submitted by the hospital under this subparagraph
shall be for such changes since the first year in which the
hospital received payment under this section), including--
``(I) changes in curricula, training experiences, and types
of training programs, and benefits that have resulted from
such changes; and
``(II) changes for purposes of training the residents in
the measurement and improvement of the quality and safety of
patient care.
``(v) The numbers of residents described in subparagraph
(C) who completed their residency training at the end of such
residency academic year and care for children within the
borders of the service area of the hospital or within the
borders of the State in which the hospital is located. Such
numbers shall be disaggregated with respect to residents who
completed residencies in general pediatrics or internal
medicine/pediatrics, subspecialty residencies, and dental
residencies.
``(C) Residents.--The residents described in this
subparagraph are those who--
``(i) are in full-time equivalent resident training
positions in any training program sponsored by the hospital;
or
``(ii) are in a training program sponsored by an entity
other than the hospital, but who spend more than 75 percent
of their training time at the hospital.
``(D) Report to congress.--Not later than the end of fiscal
year 2011, the Secretary, acting through the Administrator of
the Health Resources and Services Administration, shall
submit a report to the Congress--
``(i) summarizing the information submitted in reports to
the Secretary under subparagraph (B);
``(ii) describing the results of the program carried out
under this section; and
``(iii) making recommendations for improvements to the
program.''.
(c) Technical Amendments.--Section 340E of the Public
Health Service Act (42 U.S.C. 256e) is further amended--
(1) in subsection (c)(2)(E)(ii), by striking ``described in
subparagraph (C)(ii)'' and inserting ``applied under section
1886(d)(3)(E) of the Social Security Act for discharges
occurring during the preceding fiscal year'';
(2) in subsection (e)(2), by striking the first sentence;
and
(3) in subsection (e)(3), by striking ``made to pay'' and
inserting ``made and pay''.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
Georgia (Mr. Deal) and the gentleman from Ohio (Mr. Brown) each will
control 20 minutes.
The Chair recognizes the gentleman from Georgia.
General Leave
Mr. DEAL of Georgia. Mr. Speaker, I would ask unanimous consent that
all Members may have 5 legislative days in which to revise and extend
their remarks and to insert extraneous material on the bill.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Georgia?
There was no objection.
Mr. DEAL of Georgia. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, I rise today in support of H.R. 5574, the Children's
Hospital Graduate Medical Education Support Reauthorization Act of
2006, which is legislation to reauthorize the Children's Hospital
Graduate Medical Education Payment Program for another 5 years.
Without question, Children's Hospitals are an integral part of this
country's health care delivery system. They improve health outcomes by
providing a unique set of specialized health care services and
treatment options for children.
The Children's Hospital Graduate Medical Education Payment Program is
designed to provide financial assistance to children's teaching
hospitals which do not receive significant Federal support for their
resident and intern training programs through Medicare because of their
low Medicare patient volume. By reauthorizing this important but
relatively young program, we are able to help ensure that the mission
of these teaching hospitals is continued.
I am also proud to say that this legislation makes improvement to the
program by strongly encouraging the participating hospitals to report
important new data measures to the Department of Health and Human
Services.
I am proud to sponsor this legislation with my friend from Ohio and
the ranking member of the health subcommittee, Mr. Brown. And I would
like to thank the 20 members of the Energy and Commerce Committee who
joined us as original cosponsors of this bill.
I would also like to commend Chairman Deborah Pryce of Ohio and
Chairman Nancy Johnson of Connecticut for their strong and continued
leadership on this important issue.
Again, I encourage my colleagues to support this legislation.
Mr. Speaker, I reserve the balance of my time.
Mr. BROWN of Ohio. Mr. Speaker, I yield myself such time as I may
consume.
It has been a pleasure working with Chairman Deal from Georgia to
introduce and move this legislation through the House. I appreciate his
strong support and concern about funding, of creating an ongoing, more
predictable funding treatment for graduate medical education.
Children's Hospitals, as we know, care for our Nation's youngest
members, helping them grow and thrive. When a child develops a serious
illness, these hospitals fight back with every weapon at their
disposal, focused expertise, cutting-edge technology, a mission that
embraces all children regardless of their family's income, regardless
of their insurance status, regardless of their family's ability to pay.
Like other teaching hospitals, freestanding Children's Hospitals, we
have many of them in Ohio, in Akron, in Toledo, Columbus and in
Youngstown, freestanding Children's Hospitals make it a priority to
pass on their expertise. They train the next generation of children's
health care providers, ensuring a steady stream of physicians fluent
and conversant in the unique challenges of pediatric care.
Most of our Nation's teaching hospitals rely on the Medicare GME
program, Graduate Medical Education program, to help cover the costs
associated with training new physicians.
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However, Children's Hospitals, as I discovered in Akron Children's
some years ago, which obviously serve few Medicare patients, the
program for the elderly, are largely excluded from this funding. Before
the enactment of Children's Hospital GME, this anomaly forced
Children's Hospitals to divert funding from their medical mission to
their teaching mission. Two crucial missions, teaching and health care,
serving children, one source of funding with no cushion in it, and who
is caught in the middle of this funding squeeze? Sick children. It
makes no sense to finance Graduate Medical Education for professionals
who treat adults but not for professionals who treat children.
In 1999, Chairman Bilirakis and I introduced legislation to address
this investment gap. Since its enactment, the Children's Hospital GME
program has met and surpassed expectations. Our
[[Page H4367]]
Nation's investment in Children's Hospitals enables these providers to
simultaneously train tomorrow's pediatric workforce and treat today's
young patients, many of whom are battling for their lives. Serious
illness is always heartrending, but when serious illness takes a child,
it is an unfathomable loss. Children's Hospitals save young lives, and
there is no mission more important than that.
Earlier this year, the administration proposed cutting the funding
for Children's GME by 66 percent. Such a drastic cut would have
devastating effects on the Nation's 60 freestanding Children's
Hospitals, including the six that serve my home State of Ohio, and
including Ms. Pryce's Columbus Children's Hospital and have an impact
on those like Rainbow in Cleveland that are not freestanding but still
need the revenue to train their pediatric specialists. Columbus
Children's Hospital alone would have faced a 76 percent cut in GME
funding.
My child was at that hospital after an accident once. I know how
serious and important they take their work and what a terrific job they
do at that hospital in Columbus.
The Bush administration never justified the 66 percent cut. That is
not all that surprising since it simply cannot be justified. This
program works.
It is true that reckless fiscal decisions, tax cuts during wartime
comes to mind, this body and the other body have continued to cut taxes
for the wealthiest of our citizens and then logically the President
proposes a 66 percent cut in Children's Hospital funding. Those
reckless decisions by the Republican majority have plunged the Federal
budget into the red. But the President is not doing any of us favors,
and both parties recommend that, people sitting on the floor, Mr.
Murphy and Chairman Deal and Ms. Pryce. The President is not doing us
any favors when he tries to compensate for his fiscal mistakes by
making more of them. You would not take pennies from your child's piggy
bank to pay off your million dollar yacht. You should not take dollars
from our Children's Hospitals to pay off your trillion dollar tax cut.
That would be a mistake.
Republicans and Democrats alike reaffirmed our support in committee
for full GME funding when we passed this legislation out of the
Commerce Committee, which Chairman Deal and Chairman Barton led. There
is no 60 percent cut in the authorization. There should be no 66
percent cut in the appropriation.
This legislation, Mr. Speaker, helps safeguard our Nation's greatest
asset: our children. I hope all Members of this body join Chairman Deal
and me in supporting it.
Mr. Speaker, I reserve the balance of my time.
Mr. DEAL of Georgia. Mr. Speaker, I am pleased to yield 3 minutes to
the gentlewoman from Ohio (Ms. Pryce).
Ms. PRYCE of Ohio. Mr. Speaker, I thank the chairman for yielding me
this time.
I rise today in support of H.R. 5574, legislation that will
reauthorize and strengthen the Children's Hospital Graduate Medical
Education program.
Mr. Speaker, once in a great while, a program stands out among a
crowded field of programs that grabs the attention of policymakers.
Back in 1999, together with the gentlewoman from Connecticut (Mrs.
Johnson), we saw such a program and took the reins to bring it to our
colleagues' attention.
This program, known as Graduate Medical Education, was great at
providing teaching hospitals that served Medicare patients with the
tools and resources they needed to train doctors and treat patients.
But what we realized was that the program did not reach teaching
hospitals that treat children. Obviously, Children's Hospitals do not
receive much in the way of Medicare payments. In fact, at the time no
Federal program provided Children's Hospitals with the resources they
needed to train and retain doctors and treat kids.
So in response to this inequity, Congresswoman Johnson and I worked
with our colleagues to enact legislation that created a discretionary
program to pay for Graduate Medical Education at Children's Hospitals.
Under the strong leadership of Chairman Ralph Regula of the Labor,
Health and Human Services Appropriation Subcommittee, Congress has
taken the extraordinary step of providing equitable GME funding for
independent Children's Hospitals at a level of about $300 million over
the past several years. This program has strong bipartisan support and
extraordinary support in my home State of Ohio.
I feel extraordinarily fortunate to have a state-of-the-art
Children's Hospital in my hometown of Columbus, Ohio, as was mentioned
earlier. At a time when programs are, and should be, scrutinized for
their effectiveness and value, I am proud to report on what Children's
Hospital in Columbus has been able to accomplish with the funding for
the program we are seeking to reauthorize today. In the past 5 years,
Columbus Children's has increased the number of physicians trained each
year by over 100 percent. It has doubled residency fellowship programs
and has launched these programs in areas of local and national
shortage, such as pediatric surgical critical care, child neurology,
and child abuse and neglect. It has initiated programs for primary care
in underserved urban and rural areas. And because the Children's
Hospital GME program has provided for the cost of their residency
training, just as the Federal Government has always done for adult
hospitals, these improvements for education and training of physicians
for children have not come at the expense of patient care or research.
What all of this means is that the program is working. It is
contributing to an improvement in the quality of care that our children
receive at Children's Hospitals all across America. And that is exactly
what our kids deserve.
I want to thank my colleagues, Chairman Deal and Ranking Member
Brown, for prioritizing the reauthorization of this important program
and commend all of the Children's Hospitals across the country for
their extraordinary commitment to the health of our Nation's children.
As the motto of Children's Hospital in Columbus states: ``For Every
Child, For Every Reason.'' That is what Children's Hospitals are all
about and why I am so proud to support this worthy program. I urge my
colleagues to support it as well.
Mr. BROWN of Ohio. Mr. Speaker, I reserve the balance of my time.
Mr. DEAL of Georgia. Mr. Speaker, I yield 3 minutes to the gentleman
from Pennsylvania (Mr. Murphy), member of the Energy and Commerce
Committee.
Mr. MURPHY. Mr. Speaker, I thank the distinguished chairman for
yielding me this time.
Mr. Speaker, as a psychologist who spent many years working in the
Children's Hospital of Pittsburgh, I was pleased to cosponsor H.R.
5574, the Children's Hospital GME Support Reauthorization Act of 2006,
and I am pleased to speak on the bill today.
The Children's Hospital Graduate Medical Education program has been
of significant help to Children's Hospitals across the country, like
Children's Hospital of Pittsburgh, whose pediatrics department is also
headed by Dr. David Perlmutter. For several years I served on the staff
of Children's Hospital in Pittsburgh and remain on the faculty of the
School of Medicine at the University of Pittsburgh as an associate
professor of pediatrics; so I have seen firsthand through many years
the ongoing value of pediatric education for young physicians where
they have so much of their learning that comes not from books but at
the bedside. Children's Hospitals provide the world class expertise
needed to teach the next generation of medical professionals.
Recently, I received a letter from Mr. Roger Oxendale, the president
of the Children's Hospital of Pittsburgh, who summarized the importance
of the bill by saying, ``The Children's Hospital Graduate Medical
Education program provides the ability to serve all children through
clinical care, research, and public health advocacy, as well as its
primary purpose of the training of future pediatricians, pediatric
specialists, and pediatric research scientists.'' And this bill, he
said, ``means a great deal to our hospital and the future of pediatric
medicine.'' That support has really echoed throughout our Nation's
Children's Hospitals in terms of the service they provide but also what
is needed to keep that ongoing medical education going.
This payment program provides Federal funds to freestanding
Children's
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Hospitals to support the training of pediatric and other residents in
Graduate Medical Education programs. This program compensates for the
disparity in the level of Federal funding for teaching hospitals for
pediatrics versus other hospitals.
So I would urge all of my colleagues to support this vital and
necessary legislation to reauthorize the training for pediatric
programs for another 5 years and to ensure that America can continue to
meet the health care needs of our Nation's children with high quality.
Mr. BROWN of Ohio. Mr. Speaker, I ask my colleagues to join Ms. Pryce
and Mr. Murphy and Chairman Deal in passing this legislation
unanimously.
Mr. Speaker, I yield back the balance of my time.
Mr. DEAL of Georgia. Mr. Speaker, I am pleased to yield 3 minutes to
one of the real leaders in this area, the gentlewoman from Connecticut
(Mrs. Johnson).
Mrs. JOHNSON of Connecticut. I thank the gentleman for yielding.
I rise in strong support of H.R. 5574, legislation to reauthorize the
Children's Hospital Graduate Medical Education program. Back in 1998,
before my colleague from Ohio, Congresswoman Pryce, and I authored this
legislation, Children's Hospitals' residencies were getting .5 percent
of what Medicare provided for other teaching hospitals. Thanks to that
legislation that we authored and put in place a number of years ago,
Federal GME support for Children's Hospitals approaches 80 percent of
what Medicare provides to other teaching hospitals. Yes, only 80
percent.
Nonetheless, as a result, Children's Hospitals have been able to
increase the number of residents they train, including both general
pediatricians and pediatric specialists, increase the number of
training programs they provide, and improve the quality of the training
they provide and strengthen the programs they provide not only to
residents but to the communities.
Between 2000 and 2005 in my own State of Connecticut, the Connecticut
Children's Medical Center increased the total number of full-time
equivalent residents by 31 percent. About 50 percent of their graduates
pursue careers in primary care and 50 percent go on to subspecialty
fellowship programs. In addition to so significantly strengthening our
capacity to care for children with serious medical problems, they also
have introduced new curricula to provide training in community
pediatrics and professional development and, indeed, have had a
systemic impact on the practice of pediatrics in many settings
throughout the State.
I am proud of what they have accomplished. I am proud of what we have
done here on this floor and in preceding Congresses to strengthen the
training of pediatricians and pediatric specialists, and I urge support
of this legislation.
And I thank my colleague, Mr. Deal, for the work of him and his
subcommittee and the full committee in bringing this forward this week.
Mr. DAVIS of Illinois. Mr. Speaker, I rise in support of H.R. 5574,
the Children's Hospital GME Support Reauthorization Act of 2006. In
FY2002, 59 children's hospitals received payments totaling $276
million. These hospitals provide specialized health care for infants,
children and adolescents. Most have a wide variety of pediatric
specialists to care for all types of medical problems.
The Children's Hospital GME Support Reauthorization Act is of
importance to me as it affects many citizens of my congressional
district. My district contains 26 hospitals and many are children's
hospitals. In Chicago, Advocate Lutheran General Children's Hospital
recently opened the world's first Ambient Experience pediatric
radiology suite. The project seeks to make children more comfortable
potentially reducing the need for sedation and repeat examinations.
Federal funding has helped hospitals such as Advocate Lutheran General
Children's Hospital the ability to take care of the sick children of
Chicago.
Our society must continue to recognize the needs of children. Urie
Bronfenbrenner, the co-founder of the national Head Start program, once
said, ``no society can long sustain itself unless its members have
learned the sensitivities, motivations and skills involved in assisting
and caring for other human beings.'' I am pleased that we are
continuing to understand the needs of children in our society and that
we are continuing to make progress with this issue.
Mr. CLEAVER. Mr. Speaker, I rise today to express gratitude for the
passage of H.R. 5574, the Children's Hospitals GME Support
Reauthorization Act of 2006. This bill will extend funding through
fiscal year 2011 for children's hospitals that provide approved
graduate medical residency programs. Hippocrates once said, ``Healing
is a matter of time, but is sometimes a matter of opportunity.'' Kansas
City's Children's Mercy Hospitals and Clinics continue to provide
numerous opportunities for the children of Missouri and Kansas to
receive the best pediatric healthcare available. The services
Children's Hospital Graduate Medical Education (CHGME) provides are
invaluable. The $7 million received by Children's Mercy Hospitals and
Clinics in the Greater Kansas City Metropolitan Area trains 125 interns
and residents from the University of Missouri-Kansas City Medical
School each year. The CHGME program ensures that children will continue
to receive excellent healthcare and our Nation's pediatric health
workforce will remain strong and competitive for years to come.
Since Children's Mercy Hospital in Kansas City is the only children's
hospital between St. Louis, Missouri and Denver, Colorado, I know it is
essential to continue to provide this vital funding. These valuable
funds will keep the hospitals running efficiently while training our
future pediatric care providers. I will support the restoration of
CHGME's full funding for $300 million when the House considers the
Labor, Health and Human Services, Education Appropriations Bill for
Fiscal Year 2007.
Children's Mercy Hospitals and Clinics provide services spanning from
Wichita, Kansas to Springfield, Missouri, and the passage of H.R. 5574
will ensure on-going financial support for over 60 children's
hospitals, including Children's Mercy Hospital in Kansas City where the
program started. From heart surgery to brain tumors to burn treatment,
patients at Children's Mercy Hospitals and Clinics know they are
receiving the best medical care possible and parents will never forget
the ``angels'' who saved their children's lives. I am proud to support
a program that has improved the lives of countless children nationwide,
especially in my district, Missouri's Fifth Congressional District,
while also expressing gratitude to the Missouri and Kansas delegation
for their unending support.
Mr. Speaker, please join me in expressing our pleasure at the passage
of this bill, and also to Children's Mercy Hospital in Kansas City for
providing such a valuable service to so many families. The residents of
Missouri's Fifth Congressional District take comfort in knowing the
medical experts up at Children's Mercy Hospital are constantly on call
ensure our children's well being. The health and safety of our children
should remain a national priority, and today, I am proud to be a Member
of Congress as we pass H.R. 5574.
Mr. DEAL of Georgia. Mr. Speaker, I yield back the balance of my
time.
The SPEAKER pro tempore. The question is on the motion offered by the
gentleman from Georgia (Mr. Deal) that the House suspend the rules and
pass the bill, H.R. 5574, as amended.
The question was taken.
The SPEAKER pro tempore. In the opinion of the Chair, two-thirds of
those present have voted in the affirmative.
Mr. DEAL of Georgia. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 8 of rule XX and the
Chair's prior announcement, further proceedings on this question will
be postponed.
____________________