In the Senate of the United States,

September 26, 2006.

Resolved, That the bill from the House of Representatives (H.R. 5574) entitled ‘‘An Act to amend the Public

Health Service Act to reauthorize support for graduate medical education programs in children’s hospitals.’’, do pass

with the following

AMENDMENT:

Strike out all after the enacting clause and insert:

1 SECTION 1. SHORT TITLE.

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

3 GME Support Reauthorization Act of 2006’’.
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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 Health

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

6 (1) in subsection (a), by inserting ‘‘and each of

7 fiscal years 2007 through 2011’’ after ‘‘for each of fis8 cal years 2000 through 2005’’;

9 (2) in subsection (e)(1), by striking ‘‘26’’ and in10 serting ‘‘12’’;

11 (3) in subsection (f)(1)(A)—

12 (A) in clause (ii), by striking ‘‘and’’ at the

13 end;

14 (B) in clause (iii), by striking the period at

15 the end and inserting ‘‘; and’’; and

16 (C) by adding at the end the following:

17 ‘‘(iv) for each of fiscal years 2007

18 through 2011, $110,000,000.’’; and

19 (4) in subsection (f)(2)—

20 (A) in the matter before subparagraph (A),

21 by striking ‘‘subsection (b)(1)(A)’’ and inserting

22 ‘‘subsection (b)(1)(B)’’;

23 (B) in subparagraph (B), by striking ‘‘and’’

24 at the end;

25 (C) in subparagraph (C), by striking the

26 period at the end and inserting ‘‘; and’’; and
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1 (D) by adding at the end the following:

2 ‘‘(D) for each of fiscal years 2007 through

3 2011, $220,000,000.’’.

4 (b) REDUCTION IN PAYMENTS FOR FAILURE TO FILE

5 ANNUAL REPORT.—Subsection (b) of section 340E of the

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

7 (1) in paragraph (1), in the matter before sub8 paragraph (A), by striking ‘‘paragraph (2)’’ and in9 serting ‘‘paragraphs (2) and (3)’’; and

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

11 ‘‘(3) ANNUAL REPORTINGREQUIRED.—

12 ‘‘(A) REDUCTION IN PAYMENT FOR FAILURE

13 TO REPORT.—

14 ‘‘(i) IN GENERAL.—The amount pay15 able under this section to a children’s hos16 pital for a fiscal year (beginning with fiscal

17 year 2008 and after taking into account

18 paragraph (2)) shall be reduced by 25 per19 cent if the Secretary determines that—

20 ‘‘(I) the hospital has failed to pro21 vide the Secretary, as an addendum to

22 the hospital’s application under this

23 section for such fiscal year, the report

24 required under subparagraph (B) for

25 the previous fiscal year; or
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1 ‘‘(II) such report fails to provide

2 the information required under any

3 clause of such subparagraph.

4 ‘‘(ii) NOTICE AND OPPORTUNITY TO

5 PROVIDE MISSINGINFORMATION.—Before

6 imposing a reduction under clause (i) on

7 the basis of a hospital’s failure to provide

8 information described in clause (i)(II), the

9 Secretary shall provide notice to the hos10 pital of such failure and the Secretary’s in11 tention to impose such reduction and shall

12 provide the hospital with the opportunity to

13 provide the required information within a

14 period of 30 days beginning on the date of

15 such notice. If the hospital provides such in16 formation within such period, no reduction

17 shall be made under clause (i) on the basis

18 of the previous failure to provide such infor19 mation.

20 ‘‘(B) ANNUAL REPORT.—The report re21 quired under this subparagraph for a children’s

22 hospital for a fiscal year is a report that in23 cludes (in a form and manner specified by the

24 Secretary) the following information for the resi-
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1 dency academic year completed immediately

2 prior to such fiscal year:

3 ‘‘(i) The types of resident training pro4 grams that the hospital provided for resi5 dents described in subparagraph (C), such

6 as general pediatrics, internal medicine/pe7 diatrics, and pediatric subspecialties, in8 cluding both medical subspecialties certified

9 by the American Board of Pediatrics (such

10 as pediatric gastroenterology) and non-med11 ical subspecialties approved by other med12 ical certification boards (such as pediatric

13 surgery).

14 ‘‘(ii) The number of training positions

15 for residents described in subparagraph (C),

16 the number of such positions recruited to

17 fill, and the number of such positions filled.

18 ‘‘(iii) The types of training that the

19 hospital provided for residents described in

20 subparagraph (C) related to the health care

21 needs of different populations, such as chil22 dren who are underserved for reasons of

23 family income or geographic location, in24 cluding rural and urban areas.
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1 ‘‘(iv) The changes in residency train2 ing for residents described in subparagraph

3 (C) which the hospital has made during

4 such residency academic year (except that

5 the first report submitted by the hospital

6 under this subparagraph shall be for such

7 changes since the first year in which the

8 hospital received payment under this sec9 tion), including—

10 ‘‘(I) changes in curricula, train11 ing experiences, and types of training

12 programs, and benefits that have re13 sulted from such changes; and

14 ‘‘(II) changes for purposes of

15 training the residents in the measure16 ment and improvement of the quality

17 and safety of patient care.

18 ‘‘(v) The numbers of residents described

19 in subparagraph (C) who completed their

20 residency training at the end of such resi21 dency academic year and care for children

22 within the borders of the service area of the

23 hospital or within the borders of the State

24 in which the hospital is located. Such num25 bers shall be disaggregated with respect to
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1 residents who completed residencies in gen2 eral pediatrics or internal medicine/pediat3 rics, subspecialty residencies, and dental

4 residencies.

5 ‘‘(C) RESIDENTS.—The residents described

6 in this subparagraph are those who—

7 ‘‘(i) are in full-time equivalent resident

8 training positions in any training program

9 sponsored by the hospital; or

10 ‘‘(ii) are in a training program spon11 sored by an entity other than the hospital,

12 but who spend more than 75 percent of

13 their training time at the hospital.

14 ‘‘(D) REPORT TO CONGRESS.—Not later

15 than the end of fiscal year 2011, the Secretary,

16 acting through the Administrator of the Health

17 Resources and Services Administration, shall

18 submit a report to the Congress—

19 ‘‘(i) summarizing the information sub20 mitted in reports to the Secretary under

21 subparagraph (B);

22 ‘‘(ii) describing the results of the pro23 gram carried out under this section; and

24 ‘‘(iii) making recommendations for im25 provements to the program.’’.
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1 (c) TECHNICAL AMENDMENTS.—Section 340E of the

2 Public Health Service Act (42 U.S.C. 256e) is further

3 amended—

4 (1) in subsection (c)(2)(E)(ii), by striking ‘‘de5 scribed in subparagraph (C)(ii)’’ and inserting ‘‘ap6 plied under section 1886(d)(3)(E) of the Social Secu7 rity Act for discharges occurring during the preceding

8 fiscal year’’;

9 (2) in subsection (e)(2), by striking the first sen10 tence; and

11 (3) in subsection (e)(3), by striking ‘‘made to

12 pay’’ and inserting ‘‘made and pay’’.

Attest:

Secretary.
109TH CONGRESS

2D SESSION H. R. 5574

AMENDMENT