[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

[[Page H4366]]

       ``(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.

                              {time}  1300

  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

[[Page H4368]]

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.

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