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S.592
Healthy Kids 2000 Act (Introduced in the Senate)
TITLE II--PAYMENTS TO CHILDREN'S HOSPITALS THAT OPERATE GME
PROGRAMS
SEC. 201. SHORT TITLE.
This title may be cited as the `Pediatric Medical Education , Training, and Research Act
of 1999'.
SEC. 202. PROGRAM OF PAYMENTS TO CHILDREN'S HOSPITALS THAT OPERATE GRADUATE MEDICAL EDUCATION PROGRAMS.
(1) IN GENERAL- The Secretary shall make payment under this section to
each children's hospital for each hospital cost reporting period beginning
after fiscal year 1999 and before fiscal year 2004 for the direct and
indirect expenses associated with operating approved medical residency training
programs.
(2) PAYMENT AMOUNT- Subject to paragraph (3), the amount payable under
this section to a children's hospital for direct and indirect expenses
relating to approved medical
residency training programs for a cost reporting period ending in a fiscal
year is equal to the sum of the amount determined under subsection (b) and
the amount determined under subsection (c) for such hospital for such fiscal
year.
(A) IN GENERAL- The payments to children's hospitals established in
this subsection for cost reporting periods ending in any fiscal year shall
not exceed the funds appropriated under subsection (e) for that fiscal
year.
(B) PRO RATA REDUCTIONS- If the Secretary determines that the amount
of funds appropriated under subsection (e) for cost reporting periods
ending in any fiscal year is insufficient to provide the total amount of
payments otherwise due for such periods, the Secretary shall reduce each
of the amounts payable under this section for such period on a pro rata
basis to reflect such shortfall.
(b) AMOUNT OF PAYMENT FOR DIRECT MEDICAL EDUCATION -
(1) IN GENERAL- The amount determined under this subsection for payments
to a children's hospital for direct expenses relating to approved medical residency training programs
for a cost reporting period ending in fiscal years 2000 through 2003 is
equal to the product of--
(A) the per resident rate for direct medical education , as determined under
paragraph (2), for the cost reporting period; and
(B) the weighted average number of full-time equivalent residents in
the hospital's approved medical residency training
programs (as determined under section 1886(h)(4) of the Social Security
Act (42 U.S.C. 1395ww(h)(4))) for the cost reporting period.
(2) PER RESIDENT RATE FOR DIRECT MEDICAL EDUCATION -
(A) IN GENERAL- The per resident rate for direct medical education for a hospital for a
cost reporting period is the updated rate determined under subparagraph
(B).
(B) COMPUTATION UPDATED RATE- The updated rate determined under this
subparagraph is equal to the lesser of--
(i) a rate equal to the weighted average of the per resident rates
computed under section 1886(h)(2) of the Social Security Act (42 U.S.C.
1395ww(h)(2)) for cost reporting periods ending during fiscal year 1999
for all hospitals located in the
Metropolitan Statistical Area in which the hospital involved is located; or
(ii) the per resident rate for cost reporting periods ending during
fiscal year 1999 for the hospital involved (as determined by the
Secretary using the methodology described in section 1886(h)(2)(E)) of
such Act (42 U.S.C. 1395ww(h)(2)(E)));
each such rate updated by the hospital market basket increase
percentage from fiscal year 1999 through the fiscal year
involved.
(c) 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 relating to approved medical residency training programs
for a cost reporting period ending in fiscal years 2000 through 2003 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 weighted average number of full-time equivalent
residents in the hospitals' approved medical residency training
programs (as determined under section 1886(h)(4) of the Social Security
Act (42 U.S.C. 1395ww(h)(4))) for the cost reporting period; and
(B) assure that the aggregate of the payments for indirect expenses
relating to approved medical
residency training programs under this section in a fiscal year are equal
to the amount appropriated for such expenses in such year under subsection
(e)(2).
(1) INTERIM PAYMENTS- The Secretary shall estimate, before the beginning
of each cost reporting period for a hospital for which a payment may be made
under this section, the amount of the payment for such period and shall
(subject to paragraph (2)) make payment of such amount in 26 equal interim
installments during such period.
(2) WITHHOLDING- The Secretary shall withhold up to 25 percent from each
interim installment paid under paragraph (1).
(3) RECONCILIATION- At the end of each such period, the hospital shall
submit to the Secretary such information as the Secretary determines to be
necessary to determine the percent (if any) of the amount withheld under
paragraph (2) that is due under this section for the hospital for the
period. 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.
(e) LIMITATION ON EXPENDITURES-
(1) PAYMENT FOR DIRECT MEDICAL EDUCATION EXPENSES REPRESENTING
MEDICARE'S SHARE OF SUCH EXPENSES-
(A) IN GENERAL- Subject to subparagraph (B), there are hereby
appropriated, out of any money in the Treasury not otherwise appropriated,
for payments under this section for direct expenses relating to approved
medical residency training
programs for a cost reporting period for cost reporting periods beginning
in--
(i) fiscal year 2000, $35,000,000;
(ii) fiscal year 2001, $95,000,000;
(iii) fiscal year 2002, $95,000,000; and
(iv) fiscal year 2003, $95,000,000.
(B) CARRYOVER OF EXCESS- If the amount of payments under this section
for cost reporting periods ending in fiscal year 2000, 2001, or 2002 is
less than the amount provided under this paragraph for such payments for
such periods, then the amount available under this paragraph for cost
reporting periods ending in the following fiscal year shall be increased
by the amount of such difference.
(2) PAYMENT FOR INDIRECT MEDICAL EDUCATION EXPENSES REPRESENTING
MEDICARE'S SHARE OF SUCH EXPENSES- There are hereby appropriated, out of any
money in the Treasury not otherwise appropriated, for payments under this
section for indirect expenses relating to approved medical residency training programs
for a cost reporting period for cost reporting periods beginning in--
(A) fiscal year 2000, $65,000,000;
(B) fiscal year 2001, $190,000,000;
(C) fiscal year 2002, $190,000,000; and
(D) fiscal year 2003, $190,000,000.
(f) RELATION TO MEDICARE AND MEDICAID PAYMENTS- Notwithstanding any other
provision of law, payments under this section to a hospital for a cost
reporting period--
(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)) to the hospital for such cost reporting period,
but
(2) shall not affect the amounts otherwise payable to such hospitals
under a State Medicaid plan under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.).
(g) DEFINITIONS- In this section:
(1) APPROVED MEDICAL
RESIDENCY TRAINING PROGRAM- The term `approved medical residency training program'
has the meaning given such term 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.
TITLE III--PEDIATRIC PUBLIC HEALTH PROMOTION
Subtitle A--National Center for Birth Defects Research and
Prevention
SEC. 301. NATIONAL CENTER FOR BIRTH DEFECTS RESEARCH AND PREVENTION.
Title III of the Public Health Service Act (42 U.S.C. 241 et seq.) is
amended by adding at the end the following:
`PART Q--PEDIATRIC PUBLIC HEALTH PROMOTION
`SEC. 399L. NATIONAL CENTER FOR BIRTH DEFECTS RESEARCH AND PREVENTION.
`(a) ESTABLISHMENT- There is established within the Centers for Disease
Control and Prevention a center to be known as the National Center for Birth
Defects Research and Prevention.
`(b) PURPOSE- The general purpose of the National Center established under
subsection (a) shall be to--
`(1) collect, analyze, and make available data on birth defects,
including data on the causes of such defects and on the incidence and
prevalence of such defects;
`(2) conduct applied epidemiological research on the prevention of such
defects; and
`(3) provide information and education to the public on the
prevention of such defects.
`(c) DIRECTOR- The National Center established under subsection (a) shall
be headed by a director to be appointed by the Secretary.
`(d) TRANSFERS- There shall be transferred to the National Center
established under subsection (a) all activities, budgets and personnel of the
National Center for Environmental Health that relate to birth defects, folic
acid, cerebral palsy, mental retardation, child development, newborn
screening, autism, fragile X syndrome, fetal alcohol syndrome, pediatric
genetics, and disability prevention.
`(e) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be
appropriated such sums as may be necessary to carry out this section.'.
Subtitle B--Pregnant Mothers and Infants Health Promotion
SEC. 311. SHORT TITLE.
This subtitle may be cited as the `Pregnant Mothers and Infants Health
Protection Act'.
SEC. 312. FINDINGS.
Congress makes the following findings:
(1) Alcohol consumption by a woman during her pregnancy can cause the
woman to have a miscarriage and otherwise cause serious harm to her baby,
including low birth weight, birth defects, and behavioral problems.
(2) Illegal drug usage can cause problems such as miscarriage, early
birth, or high or low blood pressure for the mother.
(3) Exposure to illegal drugs often causes babies to die before or after
they are born. If a baby is born alive, the newborn might be addicted to
drugs and have painful withdrawal. Drug exposure may also cause severe
damage to the newborn's organs, such as the brain, eyes, ears, heart,
kidneys, or genitals.
(4) Smoking tobacco products during pregnancy significantly increases
maternal and fetal risk and accounts for 20 to 30 percent of the low birth
weight rate and 10 percent of the fetal and infant death rate in the United
States.
(5) Infants of mothers who smoke during and after pregnancy have nearly
a 3 fold increase in the risk of Sudden Infant Death Syndrome (referred to
in this section as `SIDS') as compared to infants of mothers who do not
smoke.
(6) Smoking during pregnancy has been associated with certain childhood
cancers and birth defects, and it increases the risk of spontaneous
abortion, premature rupture of membranes, and delivery of a stillborn
infant.
(7) Smoking during pregnancy may impede the growth of the fetus and
increase the likelihood of mental retardation by 50 percent.
(8) The proportion of women who quit smoking during pregnancy but
relapse within 6 months is nearly 63 percent, thereby exposing their infants
to passive smoke and increasing their risk of SIDS and other health related
problems.
(9) Effective prenatal smoking, alcohol, and illegal drug cessation
methods increase the rate of cessation during pregnancy.
SEC. 313. ESTABLISHMENT.
Part Q of title III of the Public Health Service Act (as added by section
301) is amended by adding at the end the following:
`SEC. 399M. PROGRAMS REGARDING PRENATAL AND POSTNATAL HEALTH.
`(a) IN GENERAL- The Secretary, acting through the Director of the Centers
for Disease Control and Prevention, shall carry out programs--
`(1) to collect, analyze, and make available data on prenatal smoking,
alcohol and illegal drug usage, including data on the implications of such
activities and on the incidence and prevalence of such activities and their
implications;
`(2) to conduct applied epidemiological research on the prevention of
prenatal and postnatal smoking, alcohol and illegal drug usage;
`(3) to support, conduct, and evaluate the effectiveness of educational
and cessation programs; and
`(4) to provide information and education to the public on the
prevention and implications of prenatal and postnatal smoking, alcohol and
illegal drug usage.
`(b) GRANTS- In carrying out subsection (a), the Secretary may award
grants to and enter into contracts
with States, local governments, scientific and academic institutions,
Federally qualified health centers, and other public and nonprofit entities, and
may provide technical and consultative assistance to such entities.
`(c) AUTHORIZATION OF APPROPRIATIONS- There is authorized to be
appropriated to carry out this section, $15,000,000 for each of the fiscal
years 2000 and 2001, and such sums as may be necessary for each of the fiscal
years 2002 and 2003.'.
Subtitle C--Safe Motherhood Monitoring and Prevention
Research
SEC. 321. SHORT TITLE.
This Act may be cited as the `Safe Motherhood Monitoring and Prevention
Research Act'.
SEC. 322. AMENDMENT TO PUBLIC HEALTH SERVICE ACT.
Part Q of title III of the Public Health Service Act (as added by section
301 and amended by section 311) is further amended by adding at the end the
following:
`SEC. 399N. SAFE MOTHERHOOD MONITORING.
`(a) PURPOSE- It is the purpose of this section to develop monitoring
systems at the local, State, and national level to better understand the
burden of maternal complications and mortality and to decrease the disparities
among population at risk of death and complications from pregnancy.
`(b) ACTIVITIES- For the purpose described in subsection (a), the
Secretary may carry out the following activities:
`(1) The Secretary, acting through the Centers for Disease Control and
Prevention, may establish and implement a national monitoring and
surveillance program to identify and promote the investigation of deaths and
severe complications that occur during pregnancy.
`(2) The Secretary, acting through the Centers for Disease Control and
Prevention, may expand the Pregnancy Risk Assessment Monitoring System to
provide surveillance and collect data in each of the 50 States.
`(3) The Secretary, acting through the Centers for Disease Control and
Prevention, may expand the Maternal and Child Health Epidemiology Program to
provide technical support, financial assistance, or the time-limited
assignment of senior epidemiologists to maternal and child health programs
in each of the 50 States.
`(c) AUTHORIZATION OF APPROPRIATIONS- There is authorized to be
appropriated to carry out this section, $25,000,000 for each fiscal year.'.
`SEC. 399O. PREVENTION RESEARCH TO ENSURE SAFE MOTHERHOOD.
`(a) PURPOSE- It is the purpose of this section to provide the Centers for
Disease Control and Prevention with the authority to further expand research
concerning risk factors, prevention strategies, and the roles of the family,
health care providers and the community in safe motherhood.
`(b) RESEARCH- The Secretary, acting through the Centers for Disease
Control and Prevention, may carry out activities to expand research relating
to--
`(1) encouraging preconception counseling, especially for at risk
populations such as diabetics;
`(2) the identification of critical components of prenatal delivery and
postpartum care;
`(3) the identification of outreach and support services, such as folic
acid education , that are
available for pregnant women;
`(4) the identification of women who are at high risk for
complications;
`(5) preventing preterm delivery;
`(6) preventing urinary tract infections;
`(7) preventing unnecessary caesarean sections;
`(8) an examination of the higher rates of maternal mortality among
African American women;
`(9) an examination of the relationship between domestic violence and
maternal complications and mortality;
`(10) preventing smoking, alcohol and illegal drug usage before, during
and after pregnancy;
`(11) preventing infections that cause maternal and infant
complications; and
`(12) other areas determined appropriate by the Secretary.
`(c) AUTHORIZATION OF APPROPRIATIONS- There is authorized to be
appropriated to carry out this section, $20,000,000 for each fiscal year.
`SEC. 399P. PREVENTION PROGRAMS TO ENSURE SAFE MOTHERHOOD.
`(a) IN GENERAL- The Secretary, acting through the Centers for Disease
Control and Prevention may carry out activities to promote safe motherhood,
including--
`(1) public education
campaigns on healthy pregnancies and the building of partnerships with
outside organizations concerned about safe motherhood;
`(2) education programs
for physicians, nurses and other health care providers; and
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