99–006 

112TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 1st Session 112–205 

CHILDREN’S HOSPITAL GME SUPPORT REAUTHORIZATION 

ACT OF 2011 

SEPTEMBER 12, 2011.—Committed to the Committee of the Whole House on the 

State of the Union and ordered to be printed 

Mr. UPTON, from the Committee on Energy and Commerce, 

submitted the following 

R E P O R T 

[To accompany H.R. 1852] 

[Including cost estimate of the Congressional Budget Office] 

The Committee on Energy and Commerce, to whom was referred 

the bill (H.R. 1852) to amend the Public Health Service Act to 

reauthorize support for graduate medical education programs in 

children’s hospitals, having considered the same, report favorably 

thereon without amendment and recommend that the bill do pass. 

CONTENTS 

Page 

Purpose and Summary ............................................................................................ 1 

Background and Need for Legislation .................................................................... 2 

Hearings ................................................................................................................... 2 

Committee Consideration ........................................................................................ 2 

Committee Votes ...................................................................................................... 3 

Committee Oversight Findings ............................................................................... 3 

Statement of General Performance Goals and Objectives .................................... 3 

New Budget Authority, Entitlement Authority, and Tax Expenditures ............. 3 

Earmark ................................................................................................................... 3 

Committee Cost Estimate ....................................................................................... 3 

Congressional Budget Office Estimate ................................................................... 3 

Federal Mandates Statement ................................................................................. 5 

Advisory Committee Statement .............................................................................. 5 

Applicability to Legislative Branch ........................................................................ 5 

Section-by-Section Analysis of the Legislation ...................................................... 5 

Changes in Existing Law Made by the Bill ........................................................... 5 

PURPOSE AND SUMMARY

H.R. 1852, ‘‘Children’s Hospital GME Support Reauthorization 

Act of 2011,’’ was introduced by Representative Joseph Pitts (R– 


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PA) on May 11, 2011, and subsequently referred to the Committee 

on Energy and Commerce. 

The goal of H.R. 1852 is to amend the Public Health Service Act 

to reauthorize support for graduate medical education programs in 

children’s hospitals for 5 years. In addition, the bill moves the 

deadline for the report on the program ahead by one year. 

BACKGROUND AND NEED FOR LEGISLATION

The Children’s Hospital Graduate Medical Education Program 

(CHGME) was enacted in 1999 as part of the Healthcare Research 

and Quality Act (P.L. 106–129) to provide freestanding children’s 

hospitals with discretionary Federal support for direct and indirect 

expenses associated with operating medical residency training programs. Since few children’s hospitals receive Medicare funds, the 

legislation was designed to correct the exclusion of pediatric training in the Medicare GME program. CHGME provides funding to 56 

hospitals in 30 states to support pediatric residency training. 

Today, freestanding children’s hospitals train over 40% of pediatricians, 43% of pediatric specialists, and most pediatric researchers. 

On October 6, 2006, the CHGME Support Reauthorization Act 

(P.L. 109–307) was enacted and extended the program through FY 

2011. H.R. 1852 extends the CHGME program again until 2016 at 

its current authorization level. The Report to Congress on the 

CHGME program was moved to year four, a year before the bill 

expires in 2016. The Report includes a summary of the annual 

reports prepared by the grantees as a requirement for funding. The 

Report details the types of residency programs, the number of 

training positions, types of training, any changes in residency 

training curriculum, a review of patient and safety care, and the 

number of residents who complete training. It also includes recommendations for how to improve the program. 

HEARINGS

The Subcommittee on Health on July 11, 2001 held a hearing on 

H.R. 1852, ‘‘Children’s Hospital GME Support Reauthorization Act 

of 2011.’’ The Subcommittee received testimony from: 

• Janet Heinrich, Dr.P.H., R.N., Associate Administrator, 

Bureau of Health Professions, Health Resources and Services 

Administration (HRSA) 

• Thomas R. Insel, M.D., Director, National Institute of 

Mental Health, National Institutes of Health 

COMMITTEE CONSIDERATION

H.R. 1852 was introduced by Mr. Pitts on May 11, 2011, and was 

referred to the Committee on Energy and Commerce. 

On July 26, 2011, the Subcommittee on Health met in open 

markup session and approved H.R. 1852, ‘‘Children’s Hospital GME 

Support Reauthorization Act of 2011,’’ by voice vote. 

On July 28, 2011, the Energy and Commerce Committee met in 

open markup session and ordered H.R. 1852 reported to the House, 

without amendment, by a voice vote. 


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COMMITTEE VOTES

Clause 3(b) of rule XIII of the Rules of the House of Representatives requires the Committee to list the record votes on the motion 

to report legislation and amendments thereto. There were no 

record votes taken in connection with ordering H.R. 1852 reported. 

A motion by Mr. Upton to order H.R. 1852 reported to the House, 

without amendment, was agreed to by a voice vote. 

COMMITTEE OVERSIGHT FINDINGS

Pursuant to clause 3(c)(1) of rule XIII of the Rules of the House 

of Representatives, the oversight findings and recommendations of 

the Committee are reflected in the descriptive portions of this 

report. 

STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

In accordance with clause 3(c)(4) of rule XIII of the Rules of the 

House of Representatives, the performance goals and objectives of 

the Committee are reflected in the descriptive portions of this 

report. 

NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND

TAX EXPENDITURES

In compliance with clause 3(c)(2) of rule XIII of the Rules of the 

House of Representatives, the Committee finds that H.R. 1852, the 

‘‘Children’s Hospital GME Support Reauthorization Act of 2011,’’ 

would result in no new or increased budget authority, entitlement 

authority, or tax expenditures or revenues. 

EARMARK

In compliance with clause 9(e), 9(f), and 9(g) of rule XXI, the 

Committee finds that H.R. 1852, ‘‘Children’s Hospital GME Support Reauthorization Act of 2011,’’ contains no earmarks. 

COMMITTEE COST ESTIMATE

The Committee adopts as its own the cost estimate prepared by 

the Director of the Congressional Budget Office pursuant to section 

402 of the Congressional Budget Act of 1974. 

CONGRESSIONAL BUDGET OFFICE ESTIMATE

Pursuant to clause 3(c)(3) of rule XIII of the Rules of the House 

of Representatives, the following is the cost estimate provided by 

the Congressional Budget Office pursuant to section 402 of the 

Congressional Budget Act of 1974: 

H.R. 1852—Children’s Hospital GME Support Reauthorization Act 

of 2011 

Summary: H.R. 1852 would amend the Public Health Service Act 

to reauthorize payments to children’s hospitals operating training 

programs that provide graduate medical education. Payments 

would be made to such hospitals for both direct and indirect costs 

related to graduate medical education. Direct costs are those related to operating a medical education program, such as the salaVerDate Mar 15 2010 05:29 Sep 13, 2011 Jkt 099006 PO 00000 Frm 00003 Fmt 6659 Sfmt 6602 E:\HR\OC\HR205.XXX HR205

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ries of medical students, while indirect costs are those intended to 

compensate hospitals for patient care costs that are expected to be 

higher in teaching hospitals than in non-teaching hospitals. 

H.R. 1852 would reauthorize the appropriation of $330 million a 

year over the 2012–2016 period for payments to children’s hospitals. CBO estimates that implementing the bill would cost $248 

million in 2012 and $1,568 million over the 2012–2016 period, assuming the appropriation of the authorized amounts. Pay-as-you-go 

procedures do not apply to this legislation because it would not affect direct spending or revenues. 

The bill contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act (UMRA). 

Estimated cost to the Federal Government: The estimated budgetary impact of H.R. 1852 is shown in the following table. The costs 

of this legislation fall within budget function 550 (health). 

By fiscal year, in millions of dollars— 

2012 2013 2014 2015 2016 2012– 

2016 

CHANGES IN SPENDING SUBJECT TO APPROPRIATION 

Authorization Level ................................................................................... 330 330 330 330 330 1,650

Estimated Outlays .................................................................................... 248 330 330 330 330 1,568 

Basis of estimate: The Health Resources and Services Administration administers a program that provides payments to children’s 

hospitals that operate graduate medical education programs. Authorization for that program expires in 2011. H.R. 1852 would reauthorize funding for the program through 2016 at a level that is 

similar to recent years. For this estimate, CBO assumes that H.R. 

1852 will be enacted before the end of fiscal year 2011 and that the 

authorized amounts will be appropriated for each year. 

H.R. 1852 would authorize the appropriation of $110 million a 

year for 2012 through 2016 for payment toward the direct costs of 

graduate medical education in children’s hospitals. Those funds 

would be awarded to eligible hospitals according to a formula that 

takes into account the number of residents each hospital employs 

and its cost per resident. 

The bill also would authorize the appropriation of $220 million 

a year for 2012 through 2016 for payment toward the indirect costs 

of graduate medical education programs. Those payments would be 

made to hospitals on the basis of a formula that takes into account 

the hospital’s number of discharges, the relative costliness of those 

cases as measured by a case-mix index, the number of residents at 

the hospital, and the number of inpatient beds in the hospital complex. 

Based on historical patterns of spending for the graduate medical 

education program, CBO estimates that implementing the bill 

would cost $248 million in 2012 and $1,568 million over the 2012– 

2016 period, assuming appropriation of the specified amounts. 

Intergovernmental and private-sector impact: H.R. 1852 contains 

no intergovernmental or private-sector mandates as defined in 

UMRA. Children’s hospitals that are operated by governmental entities could benefit from grant funds authorized by the bill for graduate medical training. 


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Estimate prepared by: Federal Costs: Lisa Ramirez-Branum; Impact on State, Local, and Tribal Governments: Lisa RamirezBranum; Impact on the Private Sector: Jimmy Jin. 

Estimate approved by: Holly Harvey, Deputy Assistant Director 

for Budget Analysis. 

FEDERAL MANDATES STATEMENT

The Committee adopts as its own the estimate of Federal mandates prepared by the Director of the Congressional Budget Office 

pursuant to section 423 of the Unfunded Mandates Reform Act. 

ADVISORY COMMITTEE STATEMENT

No advisory committees within the meaning of section 5(b) of the 

Federal Advisory Committee Act were created by this legislation. 

APPLICABILITY TO LEGISLATIVE BRANCH

The Committee finds that the legislation does not relate to the 

terms and conditions of employment or access to public services or 

accommodations within the meaning of section 102(b)(3) of the Congressional Accountability Act. 

SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title 

The title of this Act is ‘‘Children’s Hospital GME Support Reauthorization Act of 2011’’. 

Section 2. Program of payments to children’s hospitals that operate 

graduate medical education programs 

Section 2(a) amends Section 340E of the Public Health Service 

Act to extend the authorization of the program through 2016. 

Section 2(b) also amends Section 340E of the Public Health Service Act to move the deadline for Report to Congress ahead by one 

year to 2015. 

CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

In compliance with clause 3(e) of rule XIII of the Rules of the 

House of Representatives, changes in existing law made by the bill, 

as reported, are shown as follows (existing law proposed to be omitted is enclosed in black brackets, new matter is printed in italic, 

existing law in which no change is proposed is shown in roman): 

PUBLIC HEALTH SERVICE ACT 

* * * * * * * 

TITLE III—GENERAL POWERS AND DUTIES OF PUBLIC 

HEALTH SERVICE 

* * * * * * * 

PART D—PRIMARY HEALTH CARE

* * * * * * * 


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Subpart IX—Support of Graduate Medical Education Programs in 

Children’s Hospitals 

SEC. 340E. 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 

øthrough 2005 and each of fiscal years 2007 through 2011¿ through 

2016, one for the direct expenses and the other for indirect expenses associated with operating approved graduate medical residency training programs. The Secretary shall promulgate regulations pursuant to the rulemaking requirements of title 5, United 

States Code, which shall govern payments made under this subpart. 

(b) AMOUNT OF PAYMENTS.— (1) * * * 

* * * * * * * 

(3) ANNUAL REPORTING REQUIRED.— 

(A) * * * 

* * * * * * * 

(D) REPORT TO CONGRESS.—øNot later than the end of 

fiscal year 2011¿ Not later than the end of fiscal year 2015, 

the Secretary, acting through the Administrator of the 

Health Resources and Services Administration, shall submit a report to the Congress— 

(i) * * * 

* * * * * * * 

(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) * * * 

* * * * * * * 

(iv) for each of fiscal years 2007 through ø2011¿ 

2016, $110,000,000. 

* * * * * * * 

(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)(B)— 

(A) * * * 

* * * * * * * 

(D) for each of fiscal years 2007 through ø2011¿ 2016, 

$220,000,000. 

* * * * * * * 

Æ 


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