[Congressional Record (Bound Edition), Volume 157 (2011), Part 10]
[House]
[Page 14226]
[From the U.S. Government Publishing Office, www.gpo.gov]




     CHILDREN'S HOSPITAL GRADUATE MEDICAL EDUCATION REAUTHORIZATION

  (Mr. CICILLINE asked and was given permission to address the House 
for 1 minute.)
  Mr. CICILLINE. Mr. Speaker, this week the House passed legislation to 
reauthorize the Children's Hospital Graduate Medical Education program. 
While a celebration should be in order, I am disappointed the bill was 
considered on suspension, preventing amendments to improve the program.
  The bill passed by this Chamber fails to correct a glaring mental 
health parity issue, which prevents the inclusion of children's 
psychiatric teaching hospitals in this program. Because these hospitals 
are classified by Medicare as psychiatric hospitals rather than as 
children's hospitals, they are ineligible for entry into the program.
  In order to fix this oversight and to address the acute need for 
additional health care providers trained in child psychiatry, I 
introduced legislation, H.R. 2558, the Children's Hospitals Education 
Equity Act, which would include certain children's psychiatric 
hospitals in the definition to determine eligibility.
  I look forward to working with my colleagues on both sides of the 
aisle to correct this inequity and to advance our Nation another step 
closer to achieving full mental health parity.

            Gregory K. Fritz: Parity for Kids' Mental Health

              [From the Providence Journal, Aug. 30, 2011]

                         (By Gregory K. Fritz)

       Despite the passage of the federal mental-health parity 
     bill, stigma and prejudice are still alive and well when it 
     comes to legislation affecting children's psychiatric 
     hospitals. The latest example of how our government continues 
     to maintain discriminatory funding policies specifically 
     directed against children with mental-health issues involves 
     federal support for graduate medical education (GME).
       Although this issue is far overshadowed by the federal debt 
     issue, those who care about the mental health of children 
     need to be aware that achieving true parity still entails 
     overcoming significant obstacles. Getting children's 
     psychiatric hospitals recognized as legitimate sites of 
     medical education is one such obstacle on the road to real 
     parity that has both symbolic and pragmatic importance.
       The history of federal support for training physicians 
     during their hospital residencies goes back to the 
     establishment of Medicare, in 1965. Recognizing that America 
     needs a steady supply of physicians in all the areas of 
     medicine, and that their training carries substantial 
     additional expense for teaching hospitals, Medicare 
     authorization includes a per-resident reimbursement that is 
     provided to hospitals through a complicated formula. One 
     element for determining GME payments is the percentage of a 
     hospital's reimbursement that comes from Medicare. That 
     children's hospitals would thus be excluded from the program 
     (because Medicare pays virtually zero for children's medical 
     care) was unintentional, but it took 34 years for this 
     oversight to be corrected.
       The Children's Hospitals Graduate Medical Education Payment 
     Program (CHGME), in 1999, established a pool to provide 
     residency education support to children's hospitals in a 
     system modeled after the Medicare GME system. The 
     unintentional disincentive to train pediatric generalists and 
     specialists was removed and pediatric training accelerated 
     dramatically. This year, a total of $317.5 million offsets 
     the training expenses of 5,500 residents at 46 children's 
     hospitals, and the CHGME program is widely considered a 
     success.
       Parallel to the initial oversight in the Medicare bill, in 
     the arcane definition of a children's hospital detailed in 
     the CHGME regulations is language making it impossible for 
     children's psychiatric hospitals to qualify. Only the most 
     cynical observer would conclude that this was a deliberate 
     attempt to exclude children's psychiatric hospitals and the 
     child psychiatric and pediatric residents they train, 
     especially since no medical specialty represents a greater 
     shortage area than child and adolescent psychiatry. Yet, 
     steady efforts since 2002 to correct this oversight have thus 
     far been unsuccessful.
       The CHGME reauthorization needed for the program to 
     continue would seem to offer the ideal opportunity to end 
     this de facto discrimination against children with mental-
     health problems. Sen. Sheldon Whitehouse and Representatives 
     David Cicilline and James Langevin, all Rhode Island 
     Democrats, have offered similar versions of a brief amendment 
     to the reauthorization that would correct the language to 
     reflect the original bill's intent.
       If passed, it would admit four or five children's 
     psychiatric hospitals that meet strict criteria into the pool 
     of hospitals eligible for CHGME reimbursement. A larger 
     taxpayer outlay is not requested; rather, the existing money 
     would be spread slightly more thinly (an estimated 30 
     additional residents would be added to the current 5,500). 
     One would think it a small price to pay to correct an 
     injustice, but passage is far from guaranteed.
       As a child psychiatrist working at Bradley Hospital, one of 
     the psychiatric hospitals that would finally be included, I'm 
     far from dispassionate about this issue. I see every day the 
     agony experienced by families with autism, childhood suicide, 
     adolescent substance abuse or pediatric bipolar disorder; 
     it's different, but no less severe, than the pain associated 
     with juvenile diabetes or leukemia. As are all mental-health 
     professionals, I'm troubled by the months-long waiting lists 
     that prevent children's access to child psychiatric services.
       The distinction between psychological and physiological 
     disorders is artificial and antiquated, reflecting outdated 
     fears and prejudices. In short, I see no valid reason to 
     perpetuate the exclusion of children's psychiatric hospitals 
     from the mechanism designed to support physicians' training. 
     Neither do the thousands of members of 39 national 
     organizations who have signed on to a letter urging support 
     of the Whitehouse amendment. Mental-health parity is the law 
     in principle; the CHGME reauthorization should make it be the 
     case in practice.
       Gregory K. Fritz, M.D., is academic director at Bradley 
     Hospital and the editor of the Brown University Child and 
     Adolescent Behavior Letter.

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