HR 1579 IH
106th CONGRESS
1st Session
H. R. 1579
To provide for payments to children's hospitals that operate graduate
medical education programs.
IN THE HOUSE OF REPRESENTATIVES
April 27, 1999
Mrs. JOHNSON of Connecticut (for herself, Mr. BROWN of Ohio, Mr. THOMAS, Mr.
GREENWOOD, Mr. BILIRAKIS, Mr. DINGELL, Mr. PORTER, Mr. YOUNG of Florida, Mr.
STARK, Mr. CAMP, Mr. RAMSTAD, Ms. DUNN, Mr. NEAL of Massachusetts, Mr. PORTMAN,
Mr. KLECZKA, Mr. ENGLISH, Mr. LEWIS of Georgia, Mr. WELLER, Mr. MCINNIS, Mr.
BILBRAY, Mr. WAXMAN, Mr. HALL of Texas, Mr. CALLAHAN, Mr. GREEN of Texas, Mr.
DIXON, Mr. OLVER, Ms. KILPATRICK, Mr. BACHUS, Mr. BAIRD, Mr. BALADACCI, Mr.
BENTSEN, Mr. BLAGOJEVICH, Mr. CAPUANO, Mr. COOK, Mr. DAVIS of Illinois, Mr.
DELAHUNT, Mr. FRANK of Massachusetts, Mr. GEJDENSON, Mr. HILLIARD, Mr. INSLEE,
Ms. EDDIE BERNICE JOHNSON of Texas, Mrs. JONES of Ohio, Mr. KUCINICH, Mr.
LAFALCE, Mr. LATOURETTE, Mr. LARSON, Mrs. MALONEY of New York, Mr. MALONEY of
Connecticut, Mr. MCGOVERN, Mr. MOAKLEY, Mr. NEY, Mr. OBERSTAR, Ms. PRYCE of
Ohio, Mr. RILEY, Mr. RODRIGUEZ, Mr. RUSH, Mr. SESSIONS, Ms. SCHAKOWSKY, Mr.
TANCREDO, Mr. TRAFICANT, Mr. SANDLIN, Mr. SHOWS, Mr. VENTO, Mr. WEYGAND, and Mr.
BECERRA) introduced the following bill; which was referred to the Committee on
Commerce, and in addition to the Committee on Ways and Means, for a period to be
subsequently determined by the Speaker, in each case for consideration of such
provisions as fall within the jurisdiction of the committee concerned
A BILL
To provide for payments to children's hospitals that operate graduate
medical education programs.
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 Hospitals Education and Research
Act of 1999'.
SEC. 2. PROGRAM OF PAYMENTS TO CHILDREN'S HOSPITALS THAT OPERATE GRADUATE
MEDICAL EDUCATION PROGRAMS.
(a) PAYMENTS- The Secretary shall make two payments under this section to
each children's hospital for each of fiscal years 2000 and 2001, one for the
direct expenses and the other for indirect expenses associated with operating
approved graduate medical residency training programs.
(1) IN GENERAL- Subject to paragraph (2), the amounts payable under this
section to a children's hospital for an approved graduate medical residency
training program for a fiscal year are each of the following amounts:
(A) DIRECT EXPENSE AMOUNT- The amount determined under subsection (c)
for direct expenses associated with operating approved graduate medical
residency training programs.
(B) INDIRECT EXPENSE AMOUNT- The amount determined under subsection
(d) for indirect expenses associated with the treatment of more severely
ill patients and the additional costs relating to teaching residents in
such programs.
(A) IN GENERAL- The total of the payments made to children's hospitals
under paragraph (1)(A) or paragraph (1)(B) in a fiscal year shall not
exceed the funds appropriated under paragraph (1) or (2), respectively, of
subsection (f) for such payments for that fiscal year.
(B) PRO RATA REDUCTIONS OF PAYMENTS FOR DIRECT EXPENSES- If the
Secretary determines that the amount of funds appropriated under
subsection (f)(1) for a fiscal year is insufficient to provide the total
amount of payments otherwise due for such periods under paragraph (1)(A),
the Secretary shall reduce the amounts so payable on a pro rata basis to
reflect such shortfall.
(c) AMOUNT OF PAYMENT FOR DIRECT GRADUATE MEDICAL EDUCATION-
(1) IN GENERAL- The amount determined under this subsection for payments
to a children's hospital for direct graduate expenses relating to approved
graduate medical residency training programs for a fiscal year is equal to
the product of--
(A) the updated per resident amount for direct graduate medical
education, as determined under paragraph (2)); and
(B) the average number of full-time equivalent residents in the
hospital's graduate approved medical residency training programs (as
determined under section 1886(h)(4) of the Social Security Act (42 U.S.C.
1395ww(h)(4))) during the fiscal year.
(2) UPDATED PER RESIDENT AMOUNT FOR DIRECT GRADUATE MEDICAL EDUCATION-
The updated per resident amount for direct graduate medical education for a
hospital for a fiscal year is an amount determined as follows:
(A) DETERMINATION OF HOSPITAL SINGLE PER RESIDENT AMOUNT- The
Secretary shall compute for each hospital operating an approved graduate
medical education program (regardless of whether or not it is a children's
hospital) a single per resident amount equal to the average (weighted by
number of full-time equivalent residents) of the primary care per resident
amount and the non-primary care per resident amount computed under section
1886(h)(2) of the Social Security Act for cost reporting periods ending
during fiscal year 1997.
(B) DETERMINATION OF WAGE AND NON-WAGE-RELATED PROPORTION OF THE
SINGLE PER RESIDENT AMOUNT- The Secretary shall estimate the average
proportion of the single per resident amounts computed under subparagraph
(A) that is attributable to wages and wage-related costs.
(C) STANDARDIZING PER RESIDENT AMOUNTS- The Secretary shall establish
a standardized per resident amount for each such hospital--
(i) by dividing the single per resident amount computed under
subparagraph (A) into a wage-related portion and a non-wage-related
portion by applying the proportion determined under subparagraph
(B);
(ii) by dividing the wage-related portion by the factor applied
under section 1886(d)(3)(E) of the Social Security Act (42 U.S.C.
1395ww(d)(3)(E)) for discharges occurring during fiscal year 1999 for
the hospital's area; and
(iii) by adding the non-wage-related portion to the amount computed
under clause (ii).
(D) DETERMINATION OF NATIONAL AVERAGE- The Secretary shall compute a
national average per resident amount equal to the average of the
standardized per resident amounts computed under subparagraph (C) for such
hospitals, with the amount for each hospital weighted by the average
number of full-time equivalent residents at such hospital.
(E) APPLICATION TO INDIVIDUAL HOSPITALS- The Secretary shall compute
for each such hospital that is a children's hospital a per resident
amount--
(i) by dividing the national average per resident amount computed
under subparagraph (D) into a wage-related portion and a
non-wage-related portion by applying the proportion determined under
subparagraph (B);
(ii) by multiplying the wage-related portion by the factor described
in subparagraph (C)(ii) for the hospital's area; and
(iii) by adding the non-wage-related portion to the amount computed
under clause (ii).
(F) UPDATING RATE- The Secretary shall update such per resident amount
for each such children's hospital by the estimated percentage increase in
the consumer price index for all urban consumers during the period
beginning October 1997 and ending with the midpoint of the hospital's cost
reporting period that begins during fiscal year 2000.
(d) AMOUNT OF PAYMENT FOR INDIRECT MEDICAL EDUCATION-
(1) IN GENERAL- The amount determined under this subsection for payments
to a children's hospital for indirect expenses associated with the treatment
of more severely ill patients and the additional costs related to the
teaching of residents for a fiscal year is equal to an amount determined
appropriate by the Secretary.
(2) FACTORS- In determining the amount under paragraph (1), the
Secretary shall--
(A) take into account variations in case mix among children's
hospitals and the number of full-time equivalent residents in the
hospitals' approved graduate medical residency training programs;
and
(B) assure that the aggregate of the payments for indirect expenses
associated with the treatment of more severely ill patients and the
additional costs related to the teaching of residents under this section
in a fiscal year are equal to the amount appropriated for such expenses
for the fiscal year involved under subsection (f)(2).
(1) INTERIM PAYMENTS- The Secretary shall determine, before the
beginning of each fiscal year involved for which payments may be made for a
hospital under this section, the amounts of the payments for direct graduate
medical education and indirect medical education for such fiscal year and
shall (subject to paragraph (2)) make the payments of such amounts in 26
equal interim installments during such period.
(2) WITHHOLDING- The Secretary shall withhold up to 25 percent from each
interim installment for direct graduate medical education paid under
paragraph (1).
(3) RECONCILIATION- At the end of each fiscal year for which payments
may be made under this section, the hospital shall submit to the Secretary
such information as the Secretary determines to be necessary to determine
the percent (if any) of the total amount withheld under paragraph (2) that
is due under this section for the hospital for the fiscal year. Based on
such determination, the Secretary shall recoup any overpayments made, or pay
any balance due. The amount so determined shall be considered a final
intermediary determination for purposes of applying section 1878 of the
Social Security Act (42 U.S.C. 1395oo) and shall be subject to review under
that section in the same manner as the amount of payment under section
1886(d) of such Act (42 U.S.C. 1395ww(d)) is subject to review under such
section.
(f) AUTHORIZATION OF APPROPRIATIONS-
(1) DIRECT GRADUATE MEDICAL EDUCATION-
(A) IN GENERAL- There are hereby authorized to be appropriated, out of
any money in the Treasury not otherwise appropriated, for payments under
subsection (b)(1)(A) --
(i) for fiscal year 2000, $90,000,000; and
(ii) for fiscal year 2001, $95,000,000.
(B) CARRYOVER OF EXCESS- The amounts appropriated under subparagraph
(A) for fiscal year 2000 shall remain available for obligation through the
end of fiscal year 2001.
(2) INDIRECT MEDICAL EDUCATION- There are hereby authorized to be
appropriated, out of any money in the Treasury not otherwise appropriated,
for payments under subsection (b)(1)(A) --
(A) for fiscal year 2000, $190,000,000; and
(B) for fiscal year 2001, $190,000,000.
(f) RELATION TO MEDICARE AND MEDICAID PAYMENTS- Notwithstanding any other
provision of law, payments under this section to a hospital for fiscal years
2000 and 2001--
(1) are in lieu of any amounts otherwise payable to the hospital under
section 1886(h) or 1886(d)(5)(B) of the Social Security Act (42 U.S.C.
1395ww(h); 1395ww(d)(5)B)) for portions of cost reporting periods occurring
during such fiscal years; but
(2) shall not affect the amounts otherwise payable to such hospitals
under a State medicaid plan under title XIX of such Act (42 U.S.C. 1396 et
seq.).
(g) DEFINITIONS- In this section:
(1) APPROVED GRADUATE MEDICAL RESIDENCY TRAINING PROGRAM- The term
`approved graduate medical residency training program' has the meaning given
the term `approved medical residency training program' in section
1886(h)(5)(A) of the Social Security Act (42 U.S.C. 1395ww(h)(5)(A)).
(2) CHILDREN'S HOSPITAL- The term `children's hospital' means a hospital
described in section 1886(d)(1)(B)(iii) of the Social Security Act (42
U.S.C. 1395ww(d)(1)(B)(iii)).
(3) DIRECT GRADUATE MEDICAL EDUCATION COSTS- The term `direct graduate
medical education costs' has the meaning given such term in section
1886(h)(5)(C) of the Social Security Act (42 U.S.C. 1395ww(h)(5)(C)).
(4) SECRETARY- The term `Secretary' means the Secretary of Health and
Human Services.
END