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(2) PAYMENT AMOUNTS.--Subject to paragraph (3), the following amounts shall be payable under this section to a children's hospital for a cost reporting period described in paragraph (1):
[Page: S1377] GPO's PDF
(A) DIRECT EXPENSES.--The amount determined under subsection (b) for direct expenses described in paragraph (1)(A).
(B) INDIRECT EXPENSES.--The amount determined under subsection (c) for indirect expenses described in paragraph (1)(B)
(3) CAPPED AMOUNT.--
(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 OF PAYMENTS FOR DIRECT EXPENSES.--If the Secretary determines that the amount of funds appropriated under subsection (e)(1) 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 pursuant to paragraph (2)(A) for such period on a pro rata basis to reflect such shortfall.
(b) AMOUNT OF PAYMENT FOR DIRECT MEDICAL EDU CATION .--
(1) IN GENERAL.--The amount determined under this subsection for payments to a children's hospital for direct expenses relating to approved medical res idency training programs for a cost reporting period beginning in or after fiscal year 2000 and before fiscal year 2004 is equal to the product of--
(A) the updated per resident amount for direct medical edu cation, as determined under paragraph (2), for the cost reporting period; and
(B) the number of full-time equivalent residents in the hospital's approved medical res idency 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) UPDATED PER RESIDENT AMOUNT FOR DIRECT MEDICAL EDU CATION .--The updated per resident amount for direct medical edu cation for a hospital for a cost reporting period ending in a fiscal year is an amount equal to the per resident amount 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))) increased by the percentage increase in the Consumer Price Index for All Urban Consumers (United States city average) from fiscal year 1999 through the fiscal year involved.
(c) AMOUNT OF PAYMENT FOR INDIRECT MEDICAL EDU CATION .--
(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 cost reporting period beginning in or after fiscal year 2000 and before fiscal year 2004 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 medical res idency training programs for the cost reporting period; 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 in such year under subsection (e)(2).
(d) MAKING OF PAYMENTS.--
(1) INTERIM PAYMENTS.--The Secretary shall estimate, before the beginning of each cost reporting period for a hospital for which the payments may be made under this section, the amounts of the payments for such period 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 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 total 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) DIRECT MEDICAL EDU CATION .--
(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 res idency training programs 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 beginning 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 beginning in the following fiscal year shall be increased by the amount of such difference.
(2) INDIRECT MEDICAL EDU CATION .--There are hereby appropriated, out of any money in the Treasury not otherwise appropriated, for payments under this section for indirect expenses associated with the treatment of more severely ill patients and the additional costs related to the teaching of residents 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 such Act (42 U.S.C. 1396 et seq.).
(g) DEFINITIONS.--In this section:
(1) APPROVED MEDICAL RES IDENCY TRAINING PROGRAM.--The term ``approved medical res idency 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 MED ICAL EDU CATION COS TS.--The term ``direct graduate med ical edu cation cos ts'' 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.
Mr. KENNEDY. Mr. President, America's children--from the smallest premature baby to the tallest teenager--deserve access to doctors trained specifically in meeting their health needs. I commend Senator KERREY's leadership in this bipartisan legislation introduced today to provide greater support to children's hospitals, so that they can continue to train the kinds of doctors that children need.
In the United States, there are 53 freestanding pediatric hospitals--less than 1% of all the hospitals in the country. Yet they train more than a quarter of all pediatricians and more than half of all pediatric specialists. These hospitals also help train other doctors who need experience in taking care of children--including family doctors, neurologists, and surgeons.
Children's hospitals typically provide care for the sickest children--those whose medical need s are not easily met in the local and community hospitals. Patients in children's hospitals include a higher percentage of our nation's uninsured children and low-income children. These hospitals are the source of many new lifesaving strategies, such as treating childhood cancer and helping premature babies to breathe.
But the ability of children's hospitals to train doctors is in increasing jeopardy. Funds for training residents are declining as changes take place in the ways we pay for our health care. For most hospitals, support for graduate medi cal educ ation is f unded through Medicare. But since freestanding children's hospitals treat almost no Medicare patients, they receive almost no federal support or other support for training their residents.
Democrats and Republicans recognize that qualified children's physicians are needed as much as other types of physicians. Under this bill, the Department of Health and Human Services is authorized to provide support to freestanding children's hospitals for such training. It means that children's hospitals will receive the same level of support that this country gives to other teaching hospitals. Under this legislation funds will be distributed fairly, by using a formula that considers variations across the country in the cost of such training. Safeguards are included to guarantee that the dollars are spent only when residents are actually trained.
President Clinton's budget recognizes this high priority. It includes a $40 million downpayment until this legislation is enacted.
I look forward to working with my colleagues and the administration to assure early passage of this needed legislation. I commend both the President
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By Mrs. MURRAY (for herself and Mr. GORTON):
S. 392. A bill to designate the Federal building and United States courthouse located at West 920 Riverside Avenue in Spokane, Washington, as the ``Thomas S. Foley Federal Building and United States Courthouse,'' and the plaza at the south entrance of that building and courthouse as the ``Walter F. Horan Plaza''; to the Committee on Environment and Public Works.
THOMAS S. FOLEY FEDERAL BUILDING AND UNITED STATES COURTHOUSE
Mrs. MURRAY. Mr. President, today I have introduced legislation designating the federal building located at West 920 Riverside Avenue, Spokane, Washington, as the ``Thomas S. Foley Federal Building and United States Courthouse.'' The bill also designates the plaza located immediately in front of the building as the ``Walter F. Horan Plaza.''
Speaker Tom Foley had a long and distinguished career in the United States House of Representatives. He served for 30 years, concluding his service as Speaker of the House in the 103rd Congress. He was also Speaker in the 102nd Congress, and held positions as Majority Leader, Majority Whip, and Chairman of the House Agriculture Committee. Speaker Foley now serves as our nation's Ambassador to Japan.
Tom Foley is a native of Spokane, Washington, and earned his undergraduate and law degree from the University of Washington. His parents were highly respected citizens of Spokane.
Mr. Foley personified the high ideal to which all of us aspire as public servants and Members of Congress. First and foremost he was a gentleman who sought consensus, recognizing the value of maintaining a good working relationship among colleagues. He loved Congress, and believed it to be the best forum for democracy in the world.
Speaker Foley worked tirelessly to promote and strengthen the Northwest's economy. During my first two years as a Senator, I enjoyed working with him and I am proud of our joint efforts to help our constituents, especially in the successful promotion of Washington wheat and apples on both domestic and international markets. Without Mr. Foley, we would likely not be exporting our agricultural products to as many destinations across the globe as we do. Today, he continues to see that our goods are sold in places, such as Japan, that historically have had tightly controlled markets.
Today I also honor another Washington native, Walter F. Horan. He served 22 years, from 1943 to 1965, as the Congressman from eastern Washington. Representative Horan was raised in Wenatchee, served in the Navy during the First World War, graduated from Washington State University in Pullman, and raised apples on his family farm.
As a member of the Appropriations Committee, Representative Horan was an excellent advocate for western interests, especially those of his constituents in eastern Washington. As a farmer himself, he knew the needs of the people he served and urged the Congress to pass laws to ensure their economic prosperity. He died in 1966 and is buried in his beloved hometown of Wenatchee.
It is my honor to sponsor legislation that permanently recognizes the contributions these two Washingtonians have made to my state and our nation.
Mr. President, I ask unanimous consent that the text of the bill be printed in the RECORD.
There being no objection, the bill was ordered to be printed in the RECORD, as follows:
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
SECTION 1. DESIGNATION OF THOMAS S. FOLEY FEDERAL BUILDING AND UNITED STATES COURTHOUSE.
(a) IN GENERAL.--The Federal building and United States courthouse located at West 920 Riverside Avenue in Spokane, Washington, shall be known and designated as the ``Thomas S. Foley Federal Building and United States Courthouse''.
(b) REFERENCES.--Any reference in a law, map, regulation, document, paper, or other record of the United States to the Federal building and United States courthouse referred to in subsection (a) shall be deemed to be a reference to the ``Thomas S. Foley Federal Building and United States Courthouse''.
SEC. 2. DESIGNATION OF WALTER F. HORAN PLAZA.
(a) IN GENERAL.--The plaza located at the south entrance of the Federal building and United States courthouse referred to in section 1(a) shall be known and designated as the ``Walter F. Horan Plaza''.
(b) REFERENCES.--Any reference in a law, map, regulation, document, paper, or other record of the United States to the plaza referred to in subsection (a) shall be deemed to be a reference to the ``Walter F. Horan Plaza''.
SEC. 3. EFFECTIVE DATE.
This Act takes effect on March 6, 1999.
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