[Congressional Record (Bound Edition), Volume 160 (2014), Part 4]
[House]
[Pages 5331-5333]
[From the U.S. Government Publishing Office, www.gpo.gov]




      CHILDREN'S HOSPITAL GME SUPPORT REAUTHORIZATION ACT OF 2013

  Mr. PITTS. Mr. Speaker, I move to suspend the rules and pass the bill 
(S. 1557) to amend the Public Health Service Act to reauthorize support 
for graduate medical education programs in children's hospitals.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                                S. 1557

       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 2013''.

     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 striking ``through 2005 and each 
     of fiscal years 2007 through 2011'' and inserting ``through 
     2005, each of fiscal years 2007 through 2011, and each of 
     fiscal years 2014 through 2018''; and
       (2) in subsection (f)--
       (A) in paragraph (1)(A)--
       (i) in clause (iii), by striking ``and'';
       (ii) in clause (iv), by striking the period and inserting 
     ``; and''; and
       (iii) by adding at the end the following:
       ``(v) for each of fiscal years 2014 through 2018, 
     $100,000,000.''; and
       (B) in paragraph (2)--
       (i) in subparagraph (C), by striking ``and'';
       (ii) in subparagraph (D), by striking the period and 
     inserting ``; and''; and
       (iii) by adding at the end the following:
       ``(E) for each of fiscal years 2014 through 2018, 
     $200,000,000.''.
       (b) Report to Congress.--Section 340E(b)(3)(D) of the 
     Public Health Service Act (42 U.S.C. 256e(b)(3)(D)) is 
     amended by striking ``Not later than the end of fiscal year 
     2011'' and inserting ``Not later than the end of fiscal year 
     2018''.

     SEC. 3. SUPPORT OF GRADUATE MEDICAL EDUCATION PROGRAMS IN 
                   CERTAIN HOSPITALS.

       Section 340E of the Public Health Service Act (42 U.S.C. 
     256e) is amended by adding at the end the following:
       ``(h) Additional Provisions.--
       ``(1) In general.--The Secretary is authorized to make 
     available up to 25 percent of the total amounts in excess of 
     $245,000,000 appropriated under paragraphs (1) and (2) of 
     subsection (f), but not to exceed $7,000,000, for payments to 
     hospitals qualified as described in paragraph (2), for the 
     direct and indirect expenses associated with operating 
     approved graduate medical residency training programs, as 
     described in subsection (a).
       ``(2) Qualified hospitals.--
       ``(A) In general.--To qualify to receive payments under 
     paragraph (1), a hospital shall be a free-standing hospital--
       ``(i) with a Medicare payment agreement and that is 
     excluded from the Medicare inpatient hospital prospective 
     payment system pursuant to section 1886(d)(1)(B) of the 
     Social Security Act and its accompanying regulations;
       ``(ii) whose inpatients are predominantly individuals under 
     18 years of age;
       ``(iii) that has an approved medical residency training 
     program as defined in section 1886(h)(5)(A) of the Social 
     Security Act; and
       ``(iv) that is not otherwise qualified to receive payments 
     under this section or section 1886(h) of the Social Security 
     Act.
       ``(B) Establishment of residency cap.--In the case of a 
     freestanding children's hospital that, on the date of 
     enactment of this subsection, meets the requirements of 
     subparagraph (A) but for which the Secretary has not 
     determined an average number of full-time equivalent 
     residents under section

[[Page 5332]]

     1886(h)(4) of the Social Security Act, the Secretary may 
     establish such number of full-time equivalent residents for 
     the purposes of calculating payments under this subsection.
       ``(3) Payments.--Payments to hospitals made under this 
     subsection shall be made in the same manner as payments are 
     made to children's hospitals, as described in subsections (b) 
     through (e).
       ``(4) Payment amounts.--The direct and indirect payment 
     amounts under this subsection shall be determined using per 
     resident amounts that are no greater than the per resident 
     amounts used for determining direct and indirect payment 
     amounts under subsection (a).
       ``(5) Reporting.--A hospital receiving payments under this 
     subsection shall be subject to the reporting requirements 
     under subsection (b)(3).
       ``(6) Remaining funds.--
       ``(A) In general.--If the payments to qualified hospitals 
     under paragraph (1) for a fiscal year are less than the total 
     amount made available under such paragraph for that fiscal 
     year, any remaining amounts for such fiscal year may be made 
     available to all hospitals participating in the program under 
     this subsection or subsection (a).
       ``(B) Quality bonus system.--For purposes of distributing 
     the remaining amounts described in subparagraph (A), the 
     Secretary may establish a quality bonus system, whereby the 
     Secretary distributes bonus payments to hospitals 
     participating in the program under this subsection or 
     subsection (a) that meet standards specified by the 
     Secretary, which may include a focus on quality measurement 
     and improvement, interpersonal and communications skills, 
     delivering patient-centered care, and practicing in 
     integrated health systems, including training in community-
     based settings. In developing such standards, the Secretary 
     shall collaborate with relevant stakeholders, including 
     program accrediting bodies, certifying boards, training 
     programs, health care organizations, health care purchasers, 
     and patient and consumer groups.''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Pennsylvania (Mr. Pitts) and the gentleman from Texas (Mr. Gene Green) 
each will control 20 minutes.
  The Chair recognizes the gentleman from Pennsylvania.


                             General Leave

  Mr. PITTS. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days in which to revise and extend their remarks and 
insert extraneous materials in the Record on the bill.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Pennsylvania?
  There was no objection.
  Mr. PITTS. Mr. Speaker, I yield myself such time as I may consume.
  I am glad that, today, we will pass a bill that will help keep 
American children healthy. Today, the House considers S. 1557, the 
Children's Hospital GME Support Reauthorization Act of 2013. This is 
companion legislation to my own bill, H.R. 297, which passed the House 
at the beginning of this Congress. I am pleased that we have worked out 
the slight differences between the bills and that we can now 
reauthorize an important program that makes sure our Nation has enough 
doctors trained to treat children.
  The Children's Hospital Graduate Medical Education Program helps 
encourage more young doctors to pursue this important specialty. 
Without it, we would certainly see fewer medical professionals enter 
pediatrics and pediatric subspecialties.

                              {time}  1800

  Children need doctors trained just to treat them. Nationwide, this 
program supports the training of more than 5,000 doctors. Locally, in 
my area of Pennsylvania, the Children's Hospital of Philadelphia 
participates in the program.
  I have had the privilege of visiting the hospital a number of times 
and meeting with the young patients and the doctors learning how to 
treat them.
  I am proud to have worked on this legislation with Energy and 
Commerce Health Subcommittee Ranking Member Frank Pallone. We 
originally introduced this bill in the 112th Congress. It has been a 
long road. I am glad we can finally send this bill to the President for 
his signature.
  This is yet another bipartisan bill that we have successfully moved 
through the Health Subcommittee. It is proof that, despite our 
differences, we can find common ground and work together on legislation 
in a bipartisan way to help Americans stay healthy.
  I would like to especially thank Monica Volante on my staff, as well 
as the staff of the Health Subcommittee, especially Brenda Destro and 
Katie Novaria, who worked tirelessly on this legislation.
  I urge all of my colleagues to support this bill, and I reserve the 
balance of my time.
  Mr. GENE GREEN of Texas. Mr. Speaker, I yield myself such time as I 
may consume.
  I rise today in support of the Children's Hospitals GME Support 
Reauthorization Act, which reauthorizes the Children's Hospital 
Graduate Medical Education Program through 2018.
  The Children's Hospital Graduate Medical Education Program provides 
vital funding to support the training of pediatricians and pediatric 
specialists in our children's hospitals.
  Continued strong support for CHGME is essential to maintain this 
investment in our children's health care. Reauthorizing the Children's 
Hospital Graduate Medical Education Program represents a commitment to 
ensuring that children throughout the country have access to the 
quality care they need.
  Since its creation in 1999, this program has increased the number of 
pediatric health care providers, addressed critical shortages in 
pediatric specialty care, and improved access to necessary care.
  The CHGME recipient hospitals represent less than 1 percent of all 
hospitals, yet train half of all the Nation's pediatricians and 
pediatric specialists.
  As a cosponsor of the House bill that passed in 2013 and a long 
advocate for the Children's Hospital Graduate Medical Education 
Program, I applaud this bipartisan, bicameral effort to preserve and 
strengthen this important program.
  I want to recognize and applaud the leadership of Ranking Member 
Frank Pallone and Chairman Pitts on this legislation in the House.
  I also want to acknowledge the sponsors of the measure we are 
considering today, Senators Casey and Isakson. I also commend Chairman 
Upton, Chairman Harkin, and Ranking Member Alexander for making it 
possible for the House to consider this bipartisan legislation today.
  I urge my colleagues to join me in supporting S. 1557 and sending 
this legislation to the President for his signature.
  I yield back the balance of my time.
  Mr. Speaker, I rise today in support of the Children's Hospitals GME 
Support Reauthorization Act, which reauthorizes the Children's 
Hospitals Graduate Medical Education (CHGME) program through 2018.
  The CHGME program provides vital funding to support the training of 
pediatricians and pediatric specialists in children's hospitals.
  Continued strong support for CHGME is essential to maintain this 
investment in children's health care. Reauthorizing CHGME represents a 
commitment to ensuring that children throughout the country have access 
to the quality care they need.
  Since its creation in 1999, CHGME has increased the number of 
pediatric health care providers, addressed critical shortages in 
pediatric specialty care and improved access to necessary care.
  The CHGME recipient hospitals represent less than one percent of all 
hospitals, yet train half of all the nation's pediatricians and 
pediatric specialists.
  As a co-sponsor of the House bill that passed in February 2013 and a 
longtime advocate for the CHGME program, I applaud this bipartisan, 
bicameral effort to preserve and strengthen this important program.
  Mr. PITTS. Mr. Speaker, I am very pleased to ask all Members to 
support S. 1557, very important legislation with bipartisan support, 
and I yield back the balance of my time.
  Mr. WAXMAN. Mr. Speaker, I rise to support S. 1557, the Children's 
Hospital GME Support Reauthorization Act of 2013.
  S. 1557 reauthorizes the children's hospital graduate medical 
education--or CHGME--program through fiscal year 2018 at an 
authorization level of $300 million per year. The legislation also 
makes two important changes to the program. It provides for a limited 
expansion of the CHGME program to include children's psychiatric 
hospitals and other children's hospitals that have been unable--to 
date--to participate in the program for technical reasons. It also 
would allow the Secretary of Health and Human Services to redistribute 
any remaining funding set aside for the

[[Page 5333]]

newly-eligible hospitals that goes unused based upon quality measures.
  This program provides ongoing and consistent financial support to 
hospitals such as Children's Hospital of Los Angeles for the training 
of doctors who want to specialize in pediatrics. Over the years, the 
CHGME program has been enormously successful in reversing the 
significant decline in the number of pediatrician trainees across the 
country. Indeed, today, children's hospitals nationwide that are 
supported by the program train 49% of all pediatricians and 51% of all 
pediatric specialists.
  Not surprisingly, the CHGME program has a decade-long history of 
bipartisan support. The program was first established in 1999 and has 
subsequently been reauthorized on two occasions. During the 112th 
Congress and earlier this Congress, the House passed stand alone 
legislation that would have reauthorized the CHGME program for another 
five years.
  I am sure that Members on both sides of the aisle agree we want to 
make certain this important program remains in place, and we want to 
send a strong message about the importance of fully funding it.
  I want to recognize and applaud the leadership of Ranking Member 
Pallone and Chairman Pitts on CHGME legislation in the House. I also 
want to acknowledge the sponsors of the measure we are considering 
today--Senators Casey and Isakson. And, of course, I commend Chairman 
Upton, Chairman Harkin, and Ranking Member Alexander for making it 
possible for the House to consider this bipartisan legislation today.
  I urge my colleagues to join me in supporting S. 1557 and sending 
this legislation to the President for his signature.
  Mr. GINGREY of Georgia. Mr. Speaker, I rise in support of S. 1557, 
the Children's Hospital GME Support Reauthorization Act of 2013. This 
bill extends and reauthorizes funding for those children's hospitals 
with approved graduate medical residency training program. We must act 
now to promote and strengthen our country's pediatric workforce.
  It is no secret that our country faces a growing shortage of 
physicians. It is important for Congress to recognize that investments 
in our future doctors will be essential to ensuring patient access and 
quality health outcomes. If we do not have the physicians to care for 
our sick and needy, no amount of technological advancement will be 
enough to provide health care services for everyone. The vote today 
recognizes this fact, and will confirm our desire to provide adequate 
future access to pediatric care.
  As a physician of over 30 years, and one who has delivered over 5,200 
babies, I understand the tremendous impact that pediatricians have on 
the health of our children. The bipartisan support and engagement of 
this legislation points to its truly important need and I urge my 
colleagues today to vote to ensure that an adequate funding stream is 
available to train tomorrow's pediatricians.
  For these important reasons, I support S. 1557.
  Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, I rise in support of 
S. 1557, the Children's Hospital Graduate Medical Education Support 
Reauthorization Act. Passed in the Senate in November, this legislation 
is vital to our children's health care system because it provides 
freestanding children's hospitals with federal funding for graduate 
medical education.
  In my district, Children's Medical Center of Dallas trains 230 
medical residents each year and is integral in addressing the current 
physician shortage in Texas. CHGME is vital to the continuation of the 
training program at Children's and at pediatric hospitals nationwide. 
CHGME recipient hospitals make up only one percent of all hospitals and 
train nearly half of all pediatricians.
  Hospitals like Children's provide coordinated care for our nation's 
sickest kids regardless of their family's ability to pay. The CHGME 
program ensures that pediatricians and pediatric specialists are 
properly trained to care for these children, covering basic physician 
visits to complex, life-threatening cancers.
  Since 1999, CHGME has helped to address the gap in federal support 
for pediatric training and specialty pediatric care. The CHGME program 
is a critical investment in strengthening our healthcare workforce and 
is essential to maintaining the gains in pediatric care. I urge my 
colleagues to support the CHGME program and vote in favor of S. 1557, 
the Children's Hospital Graduate Medical Education Support 
Reauthorization Act.

  Mr. PALLONE. Mr. Speaker, I am pleased to rise in support of S. 1557, 
the Children's Hospital GME Support Reauthorization Act of 2013.
  As every parent knows, it's very important to have a trusted doctor 
to turn to when their child gets sick. Since its inception in 1999, the 
Children's Hospital Graduate Medical Education Program--known as 
CHGME--has helped to make sure that a doctor is there and prepared to 
diagnose any symptoms our children face.
  In fact, the program has been a true success. In the 1990s declines 
in pediatric training programs threatened the stability of the 
pediatric workforce. CHGME helped to reverse these dangerous declines. 
Even then, Congress, on a bipartisan manner recognized that if we 
didn't create and fund programs that would train doctors to treat these 
children, there won't be anyone left to take care of them.
  That is why, the House overwhelmingly supported reauthorization of 
the program in the 112th and 113th Congresses, passing standalone 
legislation in September 2011, including the reauthorization in broader 
legislation in December 2012, and approving standalone legislation one 
year ago.
  The legislation before us today--which has already cleared the Senate 
by unanimous consent--reauthorizes the program through fiscal year 2018 
and makes two important changes to the program.
  First, S. 1557 allows the Secretary of Health and Human Services to 
undertake a limited program expansion to include children's psychiatric 
hospitals and other freestanding children's hospitals that have been 
ineligible to participate in the program for technical reasons.
  Second, it gives the Secretary the authority to redistribute funding 
set-aside for the newly-eligible hospitals that is unused, based upon 
quality measures that are consistent with residency program 
accreditation criteria and that are developed in consultation with 
stakeholders.
  With this federal CHGME support, children's hospitals can play a key 
role in ensuring the continued growth of our nation's pediatric 
workforce. In 2012, the program supported the training of 6,015 
resident physicians nationally. The program will also help to enhance 
hospitals' research capabilities and improve hospitals' ability to 
provide care to vulnerable and underserved children.
  I want to thank Congressman Joe Pitts, the Chairman of our Health 
Subcommittee, for working with me on the House bill. Together with his 
help and leadership, we advanced House CHGME legislation upon convening 
the 113th Congress. A special thanks to Chairman Upton and Ranking 
Member Waxman for their support in addressing this critical program.
  I also want to commend Senators Casey and Isakson for their 
leadership on this legislation in the Senate and hard work to address 
concerns raised about children's psychiatric hospitals and other 
children's hospitals being excluded from the program in a fair and 
balanced way.
  Mr. Speaker, this program has proven results and it is past time that 
we finally reauthorize CHGME so that we can provide certainty to 
hospitals, doctors and their patients.
  Children in our communities are counting on this program to train a 
future generation of pediatricians. I urge my colleagues to vote 
``yes'' on S. 1557 and to send this measure to the President.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Pennsylvania (Mr. Pitts) that the House suspend the 
rules and pass the bill, S. 1557.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill was passed.
  A motion to reconsider was laid on the table.

                          ____________________