113TH CONGRESS 

1ST SESSION S. 1557 

AN ACT 

To amend the Public Health Service Act to reauthorize support for graduate medical education programs in children’s hospitals. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 
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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Children’s Hospital 

3 GME Support Reauthorization Act of 2013’’. 

4 SEC. 2. PROGRAM OF PAYMENTS TO CHILDREN’S HOS5 PITALS THAT OPERATE GRADUATE MEDICAL 

6 EDUCATION PROGRAMS. 

7 (a) IN GENERAL.—Section 340E of the Public 

8 Health Service Act (42 U.S.C. 256e) is amended— 

9 (1) in subsection (a), by striking ‘‘through 2005 

10 and each of fiscal years 2007 through 2011’’ and in11 serting ‘‘through 2005, each of fiscal years 2007 

12 through 2011, and each of fiscal years 2014 through 

13 2018’’; and 

14 (2) in subsection (f)— 

15 (A) in paragraph (1)(A)— 

16 (i) in clause (iii), by striking ‘‘and’’; 

17 (ii) in clause (iv), by striking the pe18 riod and inserting ‘‘; and’’; and 

19 (iii) by adding at the end the fol20 lowing: 

21 ‘‘(v) for each of fiscal years 2014 

22 through 2018, $100,000,000.’’; and 

23 (B) in paragraph (2)— 

24 (i) in subparagraph (C), by striking 

25 ‘‘and’’; 
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1 (ii) in subparagraph (D), by striking 

2 the period and inserting ‘‘; and’’; and 

3 (iii) by adding at the end the fol4 lowing: 

5 ‘‘(E) for each of fiscal years 2014 through 

6 2018, $200,000,000.’’. 

7 (b) REPORT TO CONGRESS.—Section 340E(b)(3)(D) 

8 of the Public Health Service Act (42 U.S.C. 

9 256e(b)(3)(D)) is amended by striking ‘‘Not later than the 

10 end of fiscal year 2011’’ and inserting ‘‘Not later than 

11 the end of fiscal year 2018’’. 

12 SEC. 3. SUPPORT OF GRADUATE MEDICAL EDUCATION 

13 PROGRAMS IN CERTAIN HOSPITALS. 

14 Section 340E of the Public Health Service Act (42 

15 U.S.C. 256e) is amended by adding at the end the fol16 lowing: 

17 ‘‘(h) ADDITIONAL PROVISIONS.— 

18 ‘‘(1) IN GENERAL.—The Secretary is authorized 

19 to make available up to 25 percent of the total 

20 amounts in excess of $245,000,000 appropriated 

21 under paragraphs (1) and (2) of subsection (f), but 

22 not to exceed $7,000,000, for payments to hospitals 

23 qualified as described in paragraph (2), for the di24 rect and indirect expenses associated with operating 
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1 approved graduate medical residency training pro2 grams, as described in subsection (a). 

3 ‘‘(2) QUALIFIED HOSPITALS.— 

4 ‘‘(A) IN GENERAL.—To qualify to receive 

5 payments under paragraph (1), a hospital shall 

6 be a free-standing hospital— 

7 ‘‘(i) with a Medicare payment agree8 ment and that is excluded from the Medi9 care inpatient hospital prospective payment 

10 system pursuant to section 1886(d)(1)(B) 

11 of the Social Security Act and its accom12 panying regulations; 

13 ‘‘(ii) whose inpatients are predomi14 nantly individuals under 18 years of age; 

15 ‘‘(iii) that has an approved medical 

16 residency training program as defined in 

17 section 1886(h)(5)(A) of the Social Secu18 rity Act; and 

19 ‘‘(iv) that is not otherwise qualified to 

20 receive payments under this section or sec21 tion 1886(h) of the Social Security Act. 

22 ‘‘(B) ESTABLISHMENT OF RESIDENCY

23 CAP.—In the case of a freestanding children’s 

24 hospital that, on the date of enactment of this 

25 subsection, meets the requirements of subpara-
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1 graph (A) but for which the Secretary has not 

2 determined an average number of full-time 

3 equivalent residents under section 1886(h)(4) of 

4 the Social Security Act, the Secretary may es5 tablish such number of full-time equivalent resi6 dents for the purposes of calculating payments 

7 under this subsection. 

8 ‘‘(3) PAYMENTS.—Payments to hospitals made 

9 under this subsection shall be made in the same 

10 manner as payments are made to children’s hos11 pitals, as described in subsections (b) through (e). 

12 ‘‘(4) PAYMENT AMOUNTS.—The direct and indi13 rect payment amounts under this subsection shall be 

14 determined using per resident amounts that are no 

15 greater than the per resident amounts used for de16 termining direct and indirect payment amounts 

17 under subsection (a). 

18 ‘‘(5) REPORTING.—A hospital receiving pay19 ments under this subsection shall be subject to the 

20 reporting requirements under subsection (b)(3). 

21 ‘‘(6) REMAINING FUNDS.— 

22 ‘‘(A) IN GENERAL.—If the payments to 

23 qualified hospitals under paragraph (1) for a 

24 fiscal year are less than the total amount made 

25 available under such paragraph for that fiscal 
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1 year, any remaining amounts for such fiscal 

2 year may be made available to all hospitals par3 ticipating in the program under this subsection 

4 or subsection (a). 

5 ‘‘(B) QUALITY BONUS SYSTEM.—For pur6 poses of distributing the remaining amounts de7 scribed in subparagraph (A), the Secretary may 

8 establish a quality bonus system, whereby the 

9 Secretary distributes bonus payments to hos10 pitals participating in the program under this 

11 subsection or subsection (a) that meet stand12 ards specified by the Secretary, which may in13 clude a focus on quality measurement and im14 provement, interpersonal and communications 

15 skills, delivering patient-centered care, and 

16 practicing in integrated health systems, includ17 ing training in community-based settings. In 

18 developing such standards, the Secretary shall 

19 collaborate with relevant stakeholders, including 

20 program accrediting bodies, certifying boards, 

21 training programs, health care organizations, 
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1 health care purchasers, and patient and con2 sumer groups.’’. 

Passed the Senate November 12, 2013. 

Attest: 

Secretary. 
113TH CONGRESS 

1ST SESSION S. 1557 

AN ACT 

To amend the Public Health Service Act to reauprograms in children’s hospitals. thorize support for graduate medical education