[Congressional Record (Bound Edition), Volume 154 (2008), Part 9]
[Senate]
[Pages 12488-12489]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           TEXT OF AMENDMENTS

  SA 4980. Mr. NELSON of Florida (for himself, Mr. Reid, Mr. Johnson, 
and Mr. Pryor) submitted an amendment intended to be proposed by him to 
the bill S. 3101, to amend titles XVIII and XIX of the Social Security 
Act to extend expiring provisions under the Medicare program, to 
improve beneficiary access to preventive and mental health services, to 
enhance low-income benefit programs, and to maintain access to care in 
rural areas, including pharmacy access, and for other purposes; which 
was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. INCREASING THE MEDICARE CAPS ON GRADUATE MEDICAL 
                   EDUCATION POSITIONS FOR STATES WITH A SHORTAGE 
                   OF RESIDENTS.

       (a) Direct Graduate Medical Education.--Section 
     1886(h)(4)(F) of the Social Security Act (42 U.S.C. 
     1395ww(h)(4)(F)) is amended--
       (1) in clause (i), by inserting ``clause (iii) and'' after 
     ``subject to''; and
       (2) by adding at the end the following new clause:
       ``(iii) Increase in caps on graduate medical education 
     positions for states with a shortage of residents.--

       ``(I) In general.--For cost reporting periods beginning on 
     or after the date that is 16 months after the date of the 
     enactment of this clause, the Secretary shall increase the 
     otherwise applicable limit on the total number of full-time 
     equivalent residents in the field of allopathic or 
     osteopathic medicine determined under clause (i) with respect 
     to a qualifying hospital in an eligible State by an amount 
     determined appropriate by the Secretary. Such increase shall 
     be phased-in over a period of 5 cost reporting periods 
     beginning with the first cost reporting period in which the 
     increase is applied under the previous sentence to the 
     hospital. For each eligible State the aggregate number of 
     such increases shall be--

       ``(aa) not less than 15; and
       ``(bb) not greater than the State resident cap increase.

       ``(II) Qualifying hospital.--In this clause, the term 
     `qualifying hospital' means a hospital located in an eligible 
     State that the Secretary determines should receive an 
     increase under this clause in the otherwise applicable limit 
     on the total number of full-time equivalent residents in the 
     field of allopathic or osteopathic medicine.
       ``(III) Eligible state.--In this clause, the term `eligible 
     State' means a State for which the National median medical 
     resident ratio exceeds the State medical resident ratio.
       ``(IV) State resident cap increase.--In this clause, the 
     term `State resident cap increase' means, with respect to a 
     State, \1/4\ of the product of--

       ``(aa) the difference between the National median medical 
     resident ratio and the State medical resident ratio; and
       ``(bb) the State population (as determined for purposes of 
     subclause (VI)).

       ``(V) National median medical resident ratio.--In this 
     clause, the term `National median medical resident ratio' 
     means the median of all State medical resident ratios.
       ``(VI) State medical resident ratio.--In this clause, the 
     term `State medical resident ratio' means, with respect to 
     any State, the ratio of full-time equivalent residents in the 
     State in approved medical residency training programs as of 
     the date of the enactment of this clause to the population of 
     the State as of such date, as determined by the Secretary.
       ``(VII) State.--In this clause, the term `State' means a 
     State and the District of Columbia.
       ``(VIII) Considerations in determining resident cap 
     increases.--In determining whether a hospital is a qualifying 
     hospital, and how much of an increase in the resident cap a 
     qualifying hospital shall receive under subclause (I), the 
     Secretary shall take into consideration the demonstrated 
     likelihood of the hospital filling resident positions that 
     would be made available as a result of such increase within 
     the first 3 cost reporting periods beginning on or after the 
     date that is 16 months after the date of the enactment of 
     this clause. The Secretary shall also take into consideration 
     whether the new resident positions will be in primary care, 
     preventive medicine, or geriatrics programs.''.

       (b) Indirect Medical Education.--Section 1886(d)(5)(B) of 
     the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) is 
     amended by adding at the end the following new clause:
       ``(x) Clause (iii) of subsection (h)(4)(F) shall apply to 
     clause (v) in the same manner and for the same period as such 
     clause (iii) applies to clause (i) of such subsection.''.
                                 ______
                                 
  SA 4981. Mr. REID (for himself, Mr. Levin, Mr. Brown, Ms. Stabenow, 
Mr. Lautenberg, and Mr. Menendez) submitted an amendment intended to be 
proposed by him to the bill S. 3101, to amend titles XVIII and XIX of 
the Social Security Act to extend expiring provisions under the 
Medicare program, to improve beneficiary access to

[[Page 12489]]

preventive and mental health services, to enhance low-income benefit 
programs, and to maintain access to care in rural areas, including 
pharmacy access, and for other purposes; which was ordered to lie on 
the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. TREATMENT OF CERTAIN CANCER HOSPITALS.

       (a) In General.--Section 1886(d)(1) of the Social Security 
     Act (42 U.S.C. 1395ww(d)(1)) is amended--
       (1) in subparagraph (B)(v)--
       (A) by striking ``or'' at the end of subclause (II); and
       (B) by adding at the end the following:
       ``(IV) a hospital that is a nonprofit corporation, the sole 
     member of which is affiliated with a university that has been 
     the recipient of a cancer center support grant from the 
     National Cancer Institute of the National Institutes of 
     Health, and which sole member (or its predecessors or such 
     university) was recognized as a comprehensive cancer center 
     by the National Cancer Institute of the National Institutes 
     of Health as of April 20, 1983, if the hospital's articles of 
     incorporation specify that at least 50 percent of its total 
     discharges have a principal finding of neoplastic disease (as 
     defined in subparagraph (E)) and if, of December 31, 2005, 
     the hospital was licensed for less than 150 acute care beds, 
     or
       ``(V) a hospital (aa) that the Secretary has determined to 
     be, at any time on or before December 31, 2011, a hospital 
     involved extensively in treatment for, or research on, 
     cancer, (bb) that is (as of the date of such determination) a 
     free-standing facility, (cc)(aaa) for which the hospital's 
     predecessor provider entity was University Hospitals of 
     Cleveland with medicare provider number 36-0137, or (bbb) 
     received the designation on June 10, 2003, as the official 
     cancer institute of its State;'';
       (2) in subparagraph (B), by inserting after clause (v) the 
     following new clause:
       ``(vi) a hospital that--
       ``(I) is located in a State that as of December 31, 2006, 
     had only one center under section 414 of the Public Health 
     Service Act that has been designated by the National Cancer 
     Institute as a comprehensive center currently serving all 21 
     counties in the most densely populated State in the nation 
     (U.S. Census estimate for 2005: 8,717,925 persons; 1,134.5 
     persons per square mile), serving more than 70,000 patient 
     visits annually;
       ``(II) as of December 31, 2006, served as the teaching and 
     clinical care, research and training hospital for the Center 
     described in subclause (II), providing significant financial 
     and operational support to such Center;
       ``(III) as of December 31, 2006, served as a core and 
     essential element in such Center which conducts more than 130 
     clinical trial activities, national cooperative group 
     studies, investigator-initiated and peer review studies and 
     has received as of 2005 at least $93,000,000 in research 
     grant awards;
       ``(IV) as of December 31, 2006, includes dedicated patient 
     care units organized primarily for the treatment of and 
     research on cancer with approximately 125 beds, 75 percent of 
     which are dedicated to cancer patients, and contains a 
     radiation oncology department as well as specialized 
     emergency services for oncology patients; and
       ``(V) as of December 31, 2004, is identified as the focus 
     of the Center's inpatient activities in the Center's 
     application as a NCI-designated comprehensive cancer center 
     and shares the NCI comprehensive cancer designation with the 
     Center;''; and
       (3) in subparagraph (E)--
       (A) by striking ``subclauses (II) and (III)'' and inserting 
     ``subclauses (II), (III), and (IV)''; and
       (B) by inserting ``and subparagraph (B)(vi)'' after 
     ``subparagraph (B)(v)''.
       (b) Effective Dates; Payments.--
       (1) Application to cost reporting periods.--
       (A) Any classification by reason of section 
     1886(d)(1)(B)(vi) of the Social Security Act (42 U.S.C. 
     1395ww(d)(1)(B)(vi)), as inserted by subsection (a), shall 
     apply to cost reporting periods beginning on or after January 
     1, 2006.
       (B) The provisions of section 1886(d)(1)(B)(v)(IV) of the 
     Social Security Act, as added by subsection (a), shall take 
     effect on January 1, 2008.
       (2) Base target amount.--Notwithstanding subsection 
     (b)(3)(E) of section 1886 of the Social Security Act (42 
     U.S.C. 1395ww), in the case of a hospital described in 
     subsection (d)(1)(B)(vi) of such section, as inserted by 
     subsection (a)--
       (A) the hospital shall be permitted to resubmit the 2006 
     Medicare 2552 cost report incorporating a cancer hospital 
     sub-provider number and to apply the Medicare ratio-of-cost-
     to-charge settlement methodology for outpatient cancer 
     services; and
       (B) the hospital's target amount under subsection 
     (b)(3)(E)(i) of such section for the first cost reporting 
     period beginning on or after January 1, 2006, shall be the 
     allowable operating costs of inpatient hospital services 
     (referred to in subclause (I) of such subsection) for such 
     first cost reporting period.
       (3) Deadline for payments.--Any payments owed to a hospital 
     as a result of this subsection for periods occurring before 
     the date of the enactment of this Act shall be made 
     expeditiously, but in no event later than 1 year after such 
     date of enactment.
       (c) Application to Certain Hospitals.--
       (1) Inapplicability of certain requirements.--The 
     provisions of section 412.22(e) of title 42, Code of Federal 
     Regulations, shall not apply to a hospital described in 
     section 1886(d)(1)(B)(v)(V) of the Social Security Act, as 
     added by subsection (a).
       (2) Application to cost reporting periods.--If the 
     Secretary makes a determination that a hospital is described 
     in section 1886(d)(1)(B)(v)(V) of the Social Security Act, as 
     added by subsection (a), such determination shall apply as of 
     the first cost reporting period beginning on or after the 
     date of such determination.
       (3) Base period.--Notwithstanding the provisions of section 
     1886(b)(3)(E) of the Social Security Act (42 U.S.C. 
     1395ww(b)(3)(E)) or any other provision of law, the base cost 
     reporting period for purposes of determining the target 
     amount for any hospital for which a determination described 
     in paragraph (2) has been made shall be the first full 12-
     month cost reporting period beginning on or after the date of 
     such determination.
       (4) Rule.--A hospital described in subclause (V) of section 
     1886(b)(1)(B)(v) of the Social Security Act, as added by 
     subsection (a), shall not qualify as a hospital described in 
     such subclause for any cost reporting period in which less 
     than 50 percent of its total discharges have a principal 
     finding of neoplastic disease. With respect to the first cost 
     reporting period for which a determination described in 
     paragraph (2) has been made, the Secretary shall accept a 
     self-certification by the hospital, which shall be applicable 
     to such first cost reporting period, that the hospital 
     intends to have total discharges during such first cost 
     reporting period of which 50 percent or more have a principal 
     finding of neoplastic disease.

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