II 

111TH CONGRESS 

1ST SESSION S. 1742 

To amend the Public Health Service Act to provide assistance for graduate 

medical education funding for women’s hospitals. 

IN THE SENATE OF THE UNITED STATES 

OCTOBER 1, 2009 

Mr. WHITEHOUSE (for himself, Mr. CASEY, and Mr. SPECTER) 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 provide assistance for graduate medical education funding for women’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 ‘‘Women’s Hospitals 

5 Education Equity Act’’. 

6 SEC. 2. SUPPORT OF GRADUATE MEDICAL EDUCATION 

7 PROGRAMS IN WOMEN’S HOSPITALS. 

8 Subpart IX of part D of title III of the Public Health 

9 Service Act (42 U.S.C. 256e et seq.) is amended— 


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1 (1) in the subpart heading, by adding ‘‘and 

2 Women’s Hospitals’’ at the end; and 

3 (2) by adding at the end the following: 

4 ‘‘SEC. 340E-1. SUPPORT OF GRADUATE MEDICAL EDU5 CATION PROGRAMS IN WOMEN’S HOSPITALS. 

6 ‘‘(a) PAYMENTS.—The Secretary shall make two pay7 ments under this section to each women’s hospital for each 

8 of fiscal years 2010 through 2014, one for the direct ex9 penses and the other for indirect expenses associated with 

10 operating approved graduate medical residency training 

11 programs. The Secretary shall promulgate regulations 

12 pursuant to the rulemaking requirements of title 5, United 

13 States Code, which shall govern payments made under this 

14 subpart. 

15 ‘‘(b) AMOUNT OF PAYMENTS.— 

16 ‘‘(1) IN GENERAL.—Subject to paragraphs (2) 

17 and (3), the amounts payable under this section to 

18 a women’s hospital for an approved graduate med19 ical residency training program for a fiscal year 

20 shall be each of the following: 

21 ‘‘(A) DIRECT EXPENSE AMOUNT.—The 

22 amount determined in accordance with sub23 section (c) for direct expenses associated with 

24 operating approved graduate medical residency 

25 training programs for a fiscal year. 


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1 ‘‘(B) INDIRECT EXPENSE AMOUNT.—The 

2 amount determined in accordance with sub3 section (c) for indirect expenses associated with 

4 the treatment of more severely ill patients and 

5 the additional costs relating to teaching resi6 dents in such programs for a fiscal year. 

7 ‘‘(2) CAPPED AMOUNT.— 

8 ‘‘(A) IN GENERAL.—The total of the pay9 ments made to women’s hospitals under para10 graph (1)(A) or paragraph (1)(B) in a fiscal 

11 year shall not exceed the funds appropriated 

12 under subsection (f) for such payments for that 

13 fiscal year. 

14 ‘‘(B) PRO RATA REDUCTIONS OF PAY15 MENTS FOR DIRECT EXPENSES.—If the Sec16 retary determines that the amount of funds ap17 propriated under subsection (e) for a fiscal year 

18 is insufficient to provide the total amount of 

19 payments otherwise due for such periods under 

20 paragraph (1)(A), the Secretary shall reduce 

21 the amounts so payable on a pro rata basis to 

22 reflect such shortfall. 

23 ‘‘(3) ANNUAL REPORTING REQUIRED.—The 

24 provisions of subsection (b)(3) of section 340E shall 

25 apply to women’s hospitals under this section in the 


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1 same manner as such provisions apply to children’s 

2 hospitals under such section 340E. In applying such 

3 provisions, the Secretary may make such modifica4 tions as may be necessary to apply such provisions 

5 to women’s hospitals. 

6 ‘‘(c) APPLICATION OF CERTAIN PROVISIONS.—The 

7 provisions of subsections (c) and (d) of section 340E shall 

8 apply to women’s hospitals under this section in the same 

9 manner as such provisions apply to children’s hospitals 

10 under such section 340E. In applying such provisions, the 

11 Secretary may make such modifications as may be nec12 essary to apply such provisions to women’s hospitals. 

13 ‘‘(d) MAKING OF PAYMENTS.— 

14 ‘‘(1) INTERIM PAYMENTS.—The Secretary shall 

15 determine, before the beginning of each fiscal year 

16 involved for which payments may be made for a hos17 pital under this section, the amounts of the pay18 ments for direct graduate medical education and in19 direct medical education for such fiscal year and 

20 shall (subject to paragraph (2)) make the payments 

21 of such amounts in 12 equal interim installments 

22 during such period. Such interim payments to each 

23 individual hospital shall be based on the number of 

24 residents reported in the hospital’s most recently 

25 filed Medicare cost report prior to the application 


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1 date for the Federal fiscal year for which the interim 

2 payment amounts are established. In the case of a 

3 hospital that does not report residents on a Medicare 

4 cost report, such interim payments shall be based on 

5 the number of residents trained during the hospital’s 

6 most recently completed Medicare cost report filing 

7 period. 

8 ‘‘(2) WITHHOLDING.—The Secretary shall with9 hold up to 25 percent from each interim installment 

10 for direct and indirect graduate medical education 

11 paid under paragraph (1) as necessary to ensure a 

12 hospital will not be overpaid on an interim basis. 

13 ‘‘(3) RECONCILIATION.—Prior to the end of 

14 each fiscal year, the Secretary shall determine any 

15 changes to the number of residents reported by a 

16 hospital in the application of the hospital for the 

17 current fiscal year to determine the final amount 

18 payable to the hospital for the current fiscal year for 

19 both direct expense and indirect expense amounts. 

20 Based on such determination, the Secretary shall re21 coup any overpayments made and pay any balance 

22 due to the extent possible. The final amount so de23 termined shall be considered a final intermediary de24 termination for the purposes of section 1878 of the 

25 Social Security Act and shall be subject to adminisVerDate Nov 24 2008 04:12 Oct 02, 2009 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1742.IS S1742

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1 trative and judicial review under that section in the 

2 same manner as the amount of payment under sec3 tion 1886(d) of such Act is subject to review under 

4 such section. 

5 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 

6 are authorized to be appropriated to carry out this section, 

7 $12,000,000 for fiscal year 2010, and such sums as may 

8 be necessary for each of fiscal years 2011 through 2014. 

9 ‘‘(f) DEFINITIONS.—In this section: 

10 ‘‘(1) APPROVED GRADUATE MEDICAL RESI11 DENCY TRAINING PROGRAM.—The term ‘approved 

12 graduate medical residency training program’ has 

13 the meaning given the term ‘approved medical resi14 dency training program’ in section 1886(h)(5)(A) of 

15 the Social Security Act. 

16 ‘‘(2) DIRECT GRADUATE MEDICAL EDUCATION

17 COSTS.—The term ‘direct graduate medical edu18 cation costs’ has the meaning given such term in 

19 section 1886(h)(5)(C) of the Social Security Act. 

20 ‘‘(3) WOMEN’S HOSPITAL.—The term ‘women’s 

21 hospital’ means a hospital— 

22 ‘‘(A) that has a Medicare provider agree23 ment under title XVIII of the Social Security 

24 Act; 


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1 ‘‘(B) that has an approved graduate med2 ical residency training program; 

3 ‘‘(C) that has not been excluded from the 

4 Medicare prospective payment system; 

5 ‘‘(D) that had at least 3,000 births during 

6 2007, as determined by the Centers for Medi7 care & Medicaid Services; and 

8 ‘‘(E) with respect to which and as deter9 mined by the Centers for Medicare & Medicaid 

10 Services, less than 4 percent of the total dis11 charges from the hospital during 2007 were 

12 Medicare discharges of individuals who, as of 

13 the time of the discharge— 

14 ‘‘(i) were enrolled in the original 

15 Medicare fee-for-service program under 

16 part A of title XVIII of the Social Security 

17 Act; and 

18 ‘‘(ii) were not enrolled in— 

19 ‘‘(I) a Medicare Advantage plan 

20 under part C of title XVIII of that 

21 Act; 

22 ‘‘(II) an eligible organization 

23 under section 1876 of that Act; or 


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1 ‘‘(III) a PACE program under 

2 section 1894 of that Act.’’. 

Æ 


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