[Congressional Record Volume 160, Number 52 (Tuesday, April 1, 2014)]
[Senate]
[Pages S1914-S1915]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




            CHILDREN'S HOSPITAL GME SUPPORT REAUTHORIZATION

  Mr. WHITEHOUSE. Mr. President, I rise on behalf of my colleagues, 
Senators Harkin, Alexander, Casey and Isakson to submit the following 
statement for the Record.
  On October 30, 2013, the Health, Education, Labor, and Pensions 
Committee unanimously reported the Children's Hospital GME Support 
Reauthorization Act of 2013, S. 1557, out of Committee. On November 12, 
2013, the Senate passed S. 1557 by unanimous consent.
  This legislation is the product of years of bipartisan negotiation, a 
process which resulted in broad Senate support for the Act. The list of 
original Senate cosponsors for S. 1557 demonstrates this point. This 
list includes Senators Casey, Isakson, Harkin, Alexander, Blumenthal, 
Blunt, Brown, Kirk, Murphy, Reed, Roberts, Warren, and Whitehouse.
  Prior to the enactment of the Children's Hospital Graduate Medical 
Education, CHGME, Payment Program, there was significant disparity in 
federal graduate medical education, GME, support between adult teaching 
hospitals and children's teaching hospitals. In 1998, children's 
hospitals received less than 0.5 percent of the level of federal GME 
support that adult teaching hospitals received. In the 2001 final rule 
for the CHGME Payment Program, the Department of Health and Human 
Services, HHS, wrote, ``The intent of the CHGME Act is to create parity 
in GME payments among all hospitals providing GME. It is clear that 
primarily two factors cause this disparity in children's hospitals: (1) 
low Medicare utilization; and (2) Prospective Payment System (PPS)-
exempt status.''
  The CHGME Payment Program has made considerable progress in achieving 
parity in GME payments, increasing the number of pediatric training 
positions at participating children's hospitals. However, a small 
number of freestanding children's teaching hospitals remain ineligible 
for the program. In 2003, Senate Committee on Appropriations noted the 
following:

       It has come to the Committee's attention that a limited 
     number of freestanding perinatal hospitals and children's 
     psychiatric hospitals have been excluded from participation 
     in this program despite the fact that these teaching 
     institutions are not eligible for Graduate Medical Education 
     funding under Medicare. The Committee expects [the Health 
     Resources and Services Administration (HRSA)] to explore the 
     appropriateness of including these hospitals in the 
     Children's Hospitals Graduate Medical Education Program and 
     to offer recommendations that might allow for their 
     inclusion.

Senate Report 108-81.
  HRSA responded in a 2004 report to Congress which concluded that 
addressing this eligibility issue would require Congress to amend the 
statue governing the CHGME Payment Program. S. 1557 addresses this 
long-standing issue. The reauthorization legislation authorizes the 
Secretary of the Department of Health and Human Services, HHS, to make 
available up to 25 percent of CHGME appropriations that exceed $245 
million for ``qualified hospitals'' that: (1) have a Medicare payment 
agreement and are excluded from Medicare inpatient hospital prospective 
payment system; (2) have inpatients that are predominantly individuals 
under 18 years of age; (3) have an approved medical residency training 
program; and (4) are not otherwise eligible to receive payments from 
the CHGME Payment Program or the Medicare program. The total amount the 
Secretary can make available for these purposes in any fiscal year is 
limited to $7 million, thus ensuring that adequate resources remain 
available for the children's hospitals that currently participate in 
the program.
  The Children's Hospital GME Support Reauthorization Act provides the 
Secretary with the necessary authority to address the disparity in GME 
payment facing certain children's teaching hospitals. These changes are 
in keeping with the intent of the CHGME Payment Program. As such, these 
hospitals should have the opportunity to apply for support through the 
CHGME Payment Program in order to sustain and build their teaching 
programs, and ultimately increase the supply of much-needed 
pediatricians and pediatric specialists. We urge the Secretary

[[Page S1915]]

to weigh these benefits in using the new authority under S. 1557 should 
funding be available.

                          ____________________