I 

111TH CONGRESS 

1ST SESSION H. R. 4235 

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

medical education funding for women’s hospitals. 

IN THE HOUSE OF REPRESENTATIVES 

DECEMBER 8, 2009 

Mr. KENNEDY introduced the following bill; which was referred to the 

Committee on Energy and Commerce 

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; 

3 (2) in section 340E(a), by striking ‘‘subpart’’ 

4 and inserting ‘‘section’’; and 

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

6 ‘‘SEC. 340E–1. SUPPORT OF GRADUATE MEDICAL EDU7 CATION PROGRAMS IN WOMEN’S HOSPITALS. 

8 ‘‘(a) PAYMENTS.—The Secretary shall make two pay9 ments under this section to each women’s hospital for each 

10 of fiscal years 2010 through 2014, one for the direct ex11 penses and the other for indirect expenses associated with 

12 operating approved graduate medical residency training 

13 programs. The Secretary shall promulgate regulations 

14 pursuant to the rulemaking requirements of title 5, United 

15 States Code, which shall govern payments made under this 

16 section. 

17 ‘‘(b) AMOUNT OF PAYMENTS.— 

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

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

20 a women’s hospital for an approved graduate med21 ical residency training program for a fiscal year 

22 shall be each of the following: 

23 ‘‘(A) DIRECT EXPENSE AMOUNT.—The 

24 amount determined in accordance with sub25 section (c) for direct expenses associated with 


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1 operating approved graduate medical residency 

2 training programs for a fiscal year. 

3 ‘‘(B) INDIRECT EXPENSE AMOUNT.—The 

4 amount determined in accordance with sub5 section (c) for indirect expenses associated with 

6 the treatment of more severely ill patients and 

7 the additional costs relating to teaching resi8 dents in such programs for a fiscal year. 

9 ‘‘(2) CAPPED AMOUNT.— 

10 ‘‘(A) IN GENERAL.—The total of the pay11 ments made to women’s hospitals under para12 graph (1) in a fiscal year shall not exceed the 

13 funds appropriated under subsection (f) for 

14 such payments for that fiscal year. 

15 ‘‘(B) PRO RATA REDUCTIONS OF PAY16 MENTS.—If the Secretary determines that the 

17 amount of funds appropriated under subsection 

18 (f) for a fiscal year is insufficient to provide the 

19 total amount of payments otherwise due for 

20 such periods under paragraph (1), the Sec21 retary shall reduce the amounts so payable on 

22 a pro rata basis to reflect such shortfall. 

23 ‘‘(c) APPLICATION OF ANNUAL REPORTING AND

24 OTHER PROVISIONS.—The provisions of subsections 

25 (b)(3), (c), and (d) of section 340E shall apply with reVerDate Nov 24 2008 06:11 Dec 09, 2009 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4235.IH H4235

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1 spect to women’s hospitals funded under this section in 

2 the same manner as such provisions apply with respect 

3 to children’s hospitals funded under such section 340E. 

4 In applying such provisions, the Secretary may make such 

5 modifications as may be necessary to apply such provisions 

6 with respect to women’s hospitals. 

7 ‘‘(d) MAKING OF PAYMENTS.— 

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

9 determine, before the beginning of each fiscal year 

10 involved for which payments may be made for a hos11 pital under this section, the amounts of the pay12 ments for direct graduate medical education and in13 direct medical education for such fiscal year and 

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

15 of such amounts in 12 equal interim installments 

16 during such period. Such interim payments to each 

17 individual hospital shall be based on the number of 

18 residents reported in the hospital’s most recently 

19 filed Medicare cost report prior to the application 

20 date for the Federal fiscal year for which the interim 

21 payment amounts are established. In the case of a 

22 hospital that does not report residents on a Medicare 

23 cost report, such interim payments shall be based on 

24 the number of residents trained during the hospital’s 


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1 most recently completed Medicare cost report filing 

2 period. 

3 ‘‘(2) WITHHOLDING.—The Secretary shall with4 hold up to 25 percent from each interim installment 

5 for direct and indirect graduate medical education 

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

7 hospital will not be overpaid on an interim basis. 

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

9 each fiscal year, the Secretary shall determine any 

10 changes to the number of residents reported by a 

11 hospital in the application of the hospital for the 

12 current fiscal year to determine the final amount 

13 payable to the hospital for the current fiscal year for 

14 both direct expense and indirect expense amounts. 

15 Based on such determination, the Secretary shall re16 coup any overpayments made and pay any balance 

17 due to the extent possible. The final amount so de18 termined shall be considered a final intermediary de19 termination for the purposes of section 1878 of the 

20 Social Security Act and shall be subject to adminis21 trative and judicial review under that section in the 

22 same manner as the amount of payment under sec23 tion 1886(d) of such Act is subject to review under 

24 such section. 

25 ‘‘(e) DEFINITIONS.—In this section: 


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1 ‘‘(1) APPROVED GRADUATE MEDICAL RESI2 DENCY TRAINING PROGRAM.—The term ‘approved 

3 graduate medical residency training program’ has 

4 the meaning given the term ‘approved medical resi5 dency training program’ in section 1886(h)(5)(A) of 

6 the Social Security Act. 

7 ‘‘(2) DIRECT GRADUATE MEDICAL EDUCATION

8 COSTS.—The term ‘direct graduate medical edu9 cation costs’ has the meaning given such term in 

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

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

12 hospital’ means a hospital— 

13 ‘‘(A) that has a Medicare provider agree14 ment under title XVIII of the Social Security 

15 Act; 

16 ‘‘(B) that has an approved graduate med17 ical residency training program; 

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

19 Medicare prospective payment system; 

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

21 2007, as determined by the Centers for Medi22 care & Medicaid Services; and 

23 ‘‘(E) with respect to which and as deter24 mined by the Centers for Medicare & Medicaid 

25 Services, less than 4 percent of the total disVerDate Nov 24 2008 06:11 Dec 09, 2009 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H4235.IH H4235

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1 charges from the hospital during 2007 were 

2 Medicare discharges of individuals who, as of 

3 the time of the discharge— 

4 ‘‘(i) were enrolled in the original 

5 Medicare fee-for-service program under 

6 part A of title XVIII of the Social Security 

7 Act; and 

8 ‘‘(ii) were not enrolled in— 

9 ‘‘(I) a Medicare Advantage plan 

10 under part C of title XVIII of that 

11 Act; 

12 ‘‘(II) an eligible organization 

13 under section 1876 of that Act; or 

14 ‘‘(III) a PACE program under 

15 section 1894 of that Act. 

16 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

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

18 $12,000,000 for fiscal year 2010, and such sums as may 

19 be necessary for each of fiscal years 2011 through 2014.’’. 

Æ 


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