[Congressional Record (Bound Edition), Volume 152 (2006), Part 15]
[House]
[Pages 20448-20451]
[From the U.S. 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 
concur in the Senate amendment to the bill (H.R. 5574) to amend the 
Public Health Service Act to reauthorize support for graduate medical 
education programs in children's hospitals.
  The Clerk read as follows:

       Senate amendment:
       Strike out all after the enacting clause and insert:

     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 (e)(1), by striking ``26'' and inserting 
     ``12'';
       (3) 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, 
     $110,000,000.''; and
       (4) in subsection (f)(2)--
       (A) in the matter before subparagraph (A), by striking 
     ``subsection (b)(1)(A)'' and inserting ``subsection 
     (b)(1)(B)'';

[[Page 20449]]

       (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, 
     $220,000,000.''.
       (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
       ``(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 New Jersey (Mr. Pallone) each 
will control 20 minutes.
  The Chair recognizes the gentleman from Georgia.


                             General Leave

  Mr. DEAL of Georgia. Mr. Speaker, I ask unanimous consent that all 
Members may have 5 legislative days within which to revise and extend 
their remarks on this legislation 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.
  Today, I rise 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.

                              {time}  1415

  By reauthorizing this important but relatively young program, we are 
able to help ensure that the mission of these teaching hospitals is 
continued.
  Mr. Speaker, I am proud to say that this legislation makes 
improvements to the program by strongly encouraging the participating 
hospitals to report important new data measures to the Department of 
Health and Human Services.
  As my colleagues are aware, we originally considered this bill under 
suspension of the rules on June 21, and the legislation passed by a 
strong bipartisan vote of 421-4. We are here today to reconsider this 
legislation because the Senate passed this bill with an amendment by 
unanimous consent on Tuesday.
  This legislation will keep the important reporting requirement 
reforms embodied in the House bill. I encourage my colleagues to 
support this bill today so that we can send this important legislation 
to the President for his signature.
  I would like to thank the chairman of the Senate Health, Education, 
Labor and Pensions Committee, Senator Enzi of Wyoming, for his 
leadership and hard work in moving this bill through the Senate. I 
would like to thank the 20 members of the Energy and Commerce Committee 
who joined me as original cosponsors of the bill.
  Mr. Speaker, I would also like to specifically commend Chairman 
Deborah Pryce of Ohio and Chairman Nancy Johnson of Connecticut for 
their strong and continued leadership on this important issue.
  I encourage my colleagues to support the legislation.
  Mr. Speaker, I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  I also rise in support of H.R. 5574, the Children's Hospital GME 
Support Reauthorization Act of 2006. I do want to thank the ranking 
member of our health subcommittee, Mr. Sherrod Brown, for his support 
on our side of the aisle. He was the person who really took the lead on 
this legislation.
  The legislation, as you know, reauthorizes the Children's Hospital 
Graduate Medical Education program until 2011 to fund residency 
programs in Children's Hospitals. This program is designed to help 
Children's teaching hospitals that do not receive significant Federal 
support for their resident

[[Page 20450]]

and intern training programs through the Medicare program because of 
their low volume of Medicare patients.
  Full-service teaching hospitals receive funds for graduate medical 
education through Medicare payments, but prior to the enactment of this 
program, independent Children's teaching hospitals did not have a 
similar program to fund their resident training programs for 
physicians.
  Thankfully, Congress recognized this inequity and the financial 
disadvantage it placed on Children's Hospital. Now, Mr. Speaker, money 
from this program helps to support the broad teaching goals of 
Children's teaching hospitals, including training health care 
professionals, providing rare and specialized clinical services, and 
innovative clinical care, providing care to the poor and underserved, 
and conducting biomedical research.
  Teaching hospitals have higher costs than other hospitals because of 
the special services they provide. This legislation seeks to alleviate 
that burden. On June 21, 2005, the House overwhelmingly passed 
legislation authorizing $100 million a year for fiscal years 2007 
through 2011, to offset direct medical education costs of graduate 
medical education in Children's Hospitals.
  The Senate amended this legislation and increased that authorization 
for direct costs to $110 million a year for fiscal years 2007 through 
2011.
  The Senate also increased the funds authorized for the indirect 
medical education costs of graduate medical by $20 million, providing 
$220 million for fiscal years 2007 through 2011.
  These commendable changes will provide needed funds to the Children's 
Hospital Graduate Medical Education program. Again, I want to thank the 
chairman who is here on the floor, our Republican chairman, Mr. Deal, 
because this did end up being a bipartisan effort. I know you played a 
major role in making it a consensus bill. I urge all of my colleagues 
to support the legislation.
  Mr. Speaker, I reserve the balance of my time.
  Mr. DEAL of Georgia. Mr. Speaker, I yield 4 minutes to the 
gentlewoman from Connecticut (Mrs. Johnson), a long-time supporter of 
this program.
  Mrs. JOHNSON of Connecticut. Mr. Speaker, I thank the gentleman from 
Georgia for yielding me time.
  I rise in enthusiastic support of H.R. 5574, legislation that 
reauthorizes the Children's Hospital Graduate Medical Education 
program.
  It is a little recognized fact that we support medical education 
through Medicare payments. And since there are not a lot of Medicare 
patients in Children's Hospitals, we found that we were providing 
inadequate support for the training of pediatricians, and especially as 
pediatrics became a specialty with the same spectrum of subspecialties 
as are common in the rest of medicine.
  So in 1998 Congresswoman Pryce from Ohio and I authored this program, 
and I really appreciate the good work of Chairman Nathan Deal from 
Georgia in bringing it to the floor with bipartisan support to 
reauthorize it for another 5 years.
  When we first started this program, Federal GME support for 
Children's Hospitals was at .5 percent of what Medicare was providing 
for other teaching hospitals. Thanks to the legislation and the support 
over the years that Congress has given it, today Federal GME supports 
80 percent of the cost of residencies in Children's Hospitals.
  That is a wonderful thing, because as a result of that, 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, improve the quality of the 
training programs, and strengthen the caliber of the residents they 
train.
  The program works. It is improving the care available to our children 
across the country. The Children's GME Hospitals accounted for more 
than 80 percent of the growth in pediatric subspecialty training 
programs in the country, and more than 65 percent of the growth in the 
number of pediatric subspecialists trained. That has been critical at 
the time when many regions of the country, including major metropolitan 
areas, have experienced shortages of pediatric subspecialists: 
pediatric cardiologists, pediatric oncologists, and so it goes.
  In Connecticut, the pediatric residency program at the University of 
Connecticut School of Medicine is currently training 57 residents at 
Connecticut's Children's Medical Center. These residents provide care 
to children in all hospital settings, including primary care, emergency 
care, inpatient care, critical care and subspecialty clinics.
  Mr. Speaker, I want to thank my colleagues for authorizing this 
program for the full 5 years and recognize my colleague from Ohio, 
Congresswoman Pryce, for her leadership in this work over the last 7 
years. It has been a huge success for children across America, and we 
salute those hospitals that specialize in the complex care of children 
with very serious illnesses as we pass this legislation today.
  Mr. PALLONE. Mr. Speaker, I have no additional speakers and yield 
back the balance of my time.
  Mr. DEAL of Georgia. Mr. Speaker, I have no other requests for time.
  In closing, I would like to express my appreciation to Mr. Pallone, 
who was an original cosponsor of this legislation. And it is true that 
we have made a bipartisan effort. I think that is the way we should do 
more things around here. I appreciate the cooperative spirit with which 
this bill has now moved through both bodies.
  Ms. PRYCE of Ohio. Mr. Speaker, I rise today in support of H.R. 5574, 
legislation that will reauthorize and strengthen the children's 
hospital graduate medical education program.
  I want to thank Chairman Barton and Chairman Deal for their 
commitment to prioritizing this important measure this year--it's been 
a great team effort and I appreciate the Committee's support for 
children's health.
  I also want to extend a special thanks to Congresswoman Nancy Johnson 
of Connecticut. We've been strong partners over the years on children's 
health issues--enactment of Children's Hospital GME back in 1999 is one 
of my proudest moments working together.
  We've had great success increasing the Federal investment in this 
program ever since--from Members on both sides of the aisle.
  The Ohio delegation has helped lead the charge--in no small part 
thanks to the efforts of our esteemed Chairman of the Labor HHS 
Appropriations Subcommittee, Ralph Regula.
  I am extremely fortunate to have an extraordinary children's hospital 
in my hometown of Columbus, OH. Strong leadership, a clear vision, and 
a compassionate team of medical professionals has made Columbus 
Children's one of the best hospitals in the nation caring for sick 
children.
  The CHGME program has helped the hospital--and hospitals all across 
America--do what they do best--provide the best training to doctors to 
deliver the best patient care possible. And we can all agree that our 
children deserve nothing short of the very best.
  A vote in favor of H.R. 5574 will send it to the President's desk and 
reauthorize this important program for another 5 years. I urge my 
colleagues to support this measure.
  Mr. GENE GREEN of Texas. Mr. Speaker, I rise in support of this bill 
to reauthorize the Children's Hospital Graduate Medical Education 
Program. Seven years ago, Congress established this program to provide 
the federal support needed for training activities at our children's 
teaching hospitals. In other hospital settings, training dollars needed 
for residents are funded, in part, through Medicare's graduate medical 
education program. With relatively few Medicare patients being served 
at children's hospitals, however, children's teaching hospitals cannot 
fully benefit from Medicare's graduate medical education program. CHGME 
was established to help alleviate the inequity faced by children's 
hospitals with respect to the training of their residents.
  Since its inception in 1999, the CHGME program has achieved 
tremendous success and enabled our children's teaching hospitals to 
address reductions in the number of pediatric residents. With this 
funding, children's teaching hospitals--such as Texas Children's 
Hospital in my hometown of Houston--have been able to keep their 
residency programs ali ve and ensure that the pediatricians treating 
our children and our grandchildren are trained at the best facilities 
in the country.
  It's no surprise that the same children's teaching hospitals 
receiving CHGME funds provide the ideal training grounds for pediatric

[[Page 20451]]

residents. These hospitals house the Nation's leading pediatric 
research institutions and provide residents with experience in treating 
the whole range of childhood health care problems, from routine 
immunizations to pediatric trauma care and pediatric oncology.
  Continued CHGME funding is critical if our children's hospitals can 
continue providing quality care to low-income children, as well as 
children whose families have private health insurance. Nearly 50 
percent of care delivered at our children's hospitals nationwide is 
provided to Medicaid beneficiaries, and CHGME payments help cover the 
gap created by a Medicaid reimbursement policy that covers only 80 
percent of care delivered to Medicaid patients.
  The CHGME program provides children's teaching hospitals with real 
funding, without which their residency programs would face severe 
financial strain. Texas Children's Hospital in Houston is one of the 
top children's hospitals in the country and received nearly $11 million 
last year in CHGME payments. Even with this funding, Texas Children's 
absorbed an additional $11.5 million in unreimbursed costs associated 
with their training of pediatric residents.
  We want our pediatricians trained at quality hospitals like Texas 
Children's, where they can put their skills to use on a diverse set of 
patients. Through this type of education and training, pediatric 
residents can leave children's teaching hospitals and travel to all 
corners of the country armed with the experience to effectively treat 
the young patients in their community. CHGME makes this possible, and I 
encourage my colleagues to support the reauthorization of this 
important program.
  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 
concur in the Senate amendment to the bill, H.R. 5574.
  The question was taken; and (two-thirds having voted in favor 
thereof) the rules were suspended and the Senate amendment was 
concurred in.
  A motion to reconsider was laid on the table.

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