II 

113TH CONGRESS 

1ST SESSION S. 1557 

To amend the Public Health Service Act to reauthorize support for graduate 

medical education programs in children’s hospitals. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 27, 2013 

Mr. CASEY (for himself, Mr. ISAKSON, Mr. WHITEHOUSE, Mr. ALEXANDER, 

Mr. BROWN, Mr. KIRK, Mr. HARKIN, Mr. BLUNT, Ms. WARREN, Mr. 

ROBERTS, Mr. BLUMENTHAL, Mr. MURPHY, and Mr. REED) introduced 

the following bill; which was read twice and referred to the Committee 

on Health, Education, Labor, and Pensions 

A BILL 

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, 

3 SECTION 1. SHORT TITLE. 

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

5 GME Support Reauthorization Act of 2013’’. 

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1 SEC. 2. PROGRAM OF PAYMENTS TO CHILDREN’S HOS2 PITALS THAT OPERATE GRADUATE MEDICAL 

3 EDUCATION PROGRAMS. 

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

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

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

7 and each of fiscal years 2007 through 2011’’ and in8 serting ‘‘through 2005, each of fiscal years 2007 

9 through 2011, and each of fiscal years 2014 through 

10 2018’’; and 

11 (2) in subsection (f)— 

12 (A) in paragraph (1)(A)— 

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

14 (ii) in clause (iv), by striking the pe15 riod and inserting ‘‘; and’’; and 

16 (iii) by adding at the end the fol17 lowing: 

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

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

20 (B) in paragraph (2)— 

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

22 ‘‘and’’; 

23 (ii) in subparagraph (D), by striking 

24 the period and inserting ‘‘; and’’; and 

25 (iii) by adding at the end the fol26 lowing: 

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

2 2018, $200,000,000.’’. 

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

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

5 256e(b)(3)(D)) is amended by striking ‘‘Not later than the 

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

7 the end of fiscal year 2018’’. 

8 SEC. 3. SUPPORT OF GRADUATE MEDICAL EDUCATION 

9 PROGRAMS IN CERTAIN HOSPITALS. 

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

11 U.S.C. 256e) is amended by adding at the end the fol12 lowing: 

13 ‘‘(h) ADDITIONAL PROVISIONS.— 

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

15 to make available up to 25 percent of the total 

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

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

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

19 qualified as described in paragraph (2), for the di20 rect and indirect expenses associated with operating 

21 approved graduate medical residency training pro22 grams, as described in subsection (a). 

23 ‘‘(2) QUALIFIED HOSPITALS.— 

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

2 payments under paragraph (1), a hospital shall 

3 be a free-standing hospital— 

4 ‘‘(i) with a Medicare payment agree5 ment and that is excluded from the Medi6 care inpatient hospital prospective payment 

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

8 of the Social Security Act and its accom9 panying regulations; 

10 ‘‘(ii) whose inpatients are predomi11 nantly individuals under 18 years of age; 

12 ‘‘(iii) that has an approved medical 

13 residency training program as defined in 

14 section 1886(h)(5)(A) of the Social Secu15 rity Act; and 

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

17 receive payments under this section or sec18 tion 1886(h) of the Social Security Act. 

19 ‘‘(B) ESTABLISHMENT OF RESIDENCY

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

21 hospital that, on the date of enactment of this 

22 subsection, meets the requirements of subpara23 graph (A) but for which the Secretary has not 

24 determined an average number of full-time 

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

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1 the Social Security Act, the Secretary may es2 tablish such number of full-time equivalent resi3 dents for the purposes of calculating payments 

4 under this subsection. 

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

6 under this subsection shall be made in the same 

7 manner as payments are made to children’s hos8 pitals, as described in subsections (b) through (e). 

9 ‘‘(4) PAYMENT AMOUNTS.—The direct and indi10 rect payment amounts under this subsection shall be 

11 determined using per resident amounts that are no 

12 greater than the per resident amounts used for de13 termining direct and indirect payment amounts 

14 under subsection (a). 

15 ‘‘(5) REPORTING.—A hospital receiving pay16 ments under this subsection shall be subject to the 

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

18 ‘‘(6) REMAINING FUNDS.— 

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

20 qualified hospitals under paragraph (1) for a 

21 fiscal year are less than the total amount made 

22 available under such paragraph for that fiscal 

23 year, any remaining amounts for such fiscal 

24 year may be made available to all hospitals parmstockstill on DSK4VPTVN1PROD with BILLS

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1 ticipating in the program under this subsection 

2 or subsection (a). 

3 ‘‘(B) QUALITY BONUS SYSTEM.—For pur4 poses of distributing the remaining amounts de5 scribed in subparagraph (A), the Secretary may 

6 establish a quality bonus system, whereby the 

7 Secretary distributes bonus payments to hos8 pitals participating in the program under this 

9 subsection or subsection (a) that meet stand10 ards specified by the Secretary, which may in11 clude a focus on quality measurement and im12 provement, interpersonal and communications 

13 skills, delivering patient-centered care, and 

14 practicing in integrated health systems, includ15 ing training in community-based settings. In 

16 developing such standards, the Secretary shall 

17 collaborate with relevant stakeholders, including 

18 program accrediting bodies, certifying boards, 

19 training programs, health care organizations, 

20 health care purchasers, and patient and con21 sumer groups.’’. 

Æ 

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