S. 1557 

One Hundred Thirteenth Congress 

of the 

United States of America 

AT THE SECOND SESSION 

Begun and held at the City of Washington on Friday, 

the third day of January, two thousand and fourteen 

An Act 

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

education programs in children’s hospitals. 

Be it enacted by the Senate and House of Representatives of 

the United States of America in Congress assembled, 

SECTION 1. SHORT TITLE. 

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

Reauthorization Act of 2013’’. 

SEC. 2. PROGRAM OF PAYMENTS TO CHILDREN’S HOSPITALS THAT 

OPERATE GRADUATE MEDICAL EDUCATION PROGRAMS. 

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

Act (42 U.S.C. 256e) is amended— 

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

of fiscal years 2007 through 2011’’ and inserting ‘‘through 2005, 

each of fiscal years 2007 through 2011, and each of fiscal 

years 2014 through 2018’’; and 

(2) in subsection (f)— 

(A) in paragraph (1)(A)— 

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

(ii) in clause (iv), by striking the period and 

inserting ‘‘; and’’; and 

(iii) by adding at the end the following: 

‘‘(v) for each of fiscal years 2014 through 2018, $100,000,000.’’; and 

(B) in paragraph (2)— 

(i) in subparagraph (C), by striking ‘‘and’’; 

(ii) in subparagraph (D), by striking the period 

and inserting ‘‘; and’’; and 

(iii) by adding at the end the following: 

‘‘(E) for each of fiscal years 2014 through 2018, $200,000,000.’’. 

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

Health Service Act (42 U.S.C. 256e(b)(3)(D)) is amended by striking 

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

later than the end of fiscal year 2018’’. 

SEC. 3. SUPPORT OF GRADUATE MEDICAL EDUCATION PROGRAMS IN 

CERTAIN HOSPITALS. 

Section 340E of the Public Health Service Act (42 U.S.C. 256e) 

is amended by adding at the end the following: 

‘‘(h) ADDITIONAL PROVISIONS.— 

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

available up to 25 percent of the total amounts in excess of 
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$245,000,000 appropriated under paragraphs (1) and (2) of 

subsection (f), but not to exceed $7,000,000, for payments to 

hospitals qualified as described in paragraph (2), for the direct 

and indirect expenses associated with operating approved graduate medical residency training programs, as described in subsection (a). 

‘‘(2) QUALIFIED HOSPITALS.— 

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

under paragraph (1), a hospital shall be a free-standing 

hospital— 

‘‘(i) with a Medicare payment agreement and that 

is excluded from the Medicare inpatient hospital 

prospective payment system pursuant to section 

1886(d)(1)(B) of the Social Security Act and its accompanying regulations; 

‘‘(ii) whose inpatients are predominantly individuals under 18 years of age; 

‘‘(iii) that has an approved medical residency 

training program as defined in section 1886(h)(5)(A) 

of the Social Security Act; and 

‘‘(iv) that is not otherwise qualified to receive payments under this section or section 1886(h) of the 

Social Security Act. 

‘‘(B) ESTABLISHMENT OF RESIDENCY CAP.—In the case 

of a freestanding children’s hospital that, on the date of 

enactment of this subsection, meets the requirements of 

subparagraph (A) but for which the Secretary has not 

determined an average number of full-time equivalent residents under section 1886(h)(4) of the Social Security Act, 

the Secretary may establish such number of full-time 

equivalent residents for the purposes of calculating payments under this subsection. 

‘‘(3) PAYMENTS.—Payments to hospitals made under this 

subsection shall be made in the same manner as payments 

are made to children’s hospitals, as described in subsections 

(b) through (e). 

‘‘(4) PAYMENT AMOUNTS.—The direct and indirect payment 

amounts under this subsection shall be determined using per 

resident amounts that are no greater than the per resident 

amounts used for determining direct and indirect payment 

amounts under subsection (a). 

‘‘(5) REPORTING.—A hospital receiving payments under this 

subsection shall be subject to the reporting requirements under 

subsection (b)(3). 

‘‘(6) REMAINING FUNDS.— 

‘‘(A) IN GENERAL.—If the payments to qualified hospitals under paragraph (1) for a fiscal year are less than 

the total amount made available under such paragraph 

for that fiscal year, any remaining amounts for such fiscal 

year may be made available to all hospitals participating 

in the program under this subsection or subsection (a). 

‘‘(B) QUALITY BONUS SYSTEM.—For purposes of distributing the remaining amounts described in subparagraph 

(A), the Secretary may establish a quality bonus system, 

whereby the Secretary distributes bonus payments to hospitals participating in the program under this subsection 
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or subsection (a) that meet standards specified by the Secretary, which may include a focus on quality measurement 

and improvement, interpersonal and communications skills, 

delivering patient-centered care, and practicing in 

integrated health systems, including training in community-based settings. In developing such standards, the Secretary shall collaborate with relevant stakeholders, 

including program accrediting bodies, certifying boards, 

training programs, health care organizations, health care 

purchasers, and patient and consumer groups.’’. 

Speaker of the House of Representatives. 

Vice President of the United States and

President of the Senate.