II 

108TH CONGRESS 

2D SESSION S. 2526 

To reauthorize the Children’s Hospitals Graduate Medical Education 

Program. 

IN THE SENATE OF THE UNITED STATES 

JUNE 16, 2004 

Mr. BOND (for himself, Mr. KENNEDY, Mr. DEWINE, and Mrs. MURRAY) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To reauthorize the Children’s Hospitals Graduate Medical 

Education Program. 

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 Hospitals 

5 Educational Equity and Research Act’’ or the ‘‘CHEER 

6 Act’’. 
2 

•S 2526 IS 

1 SEC. 2. REAUTHORIZATION OF CHILDREN’S HOSPITALS 

2 GRADUATE MEDICAL EDUCATION PROGRAM. 

3 (a) EXTENSION OF PROGRAM.—Section 340E(a) of 

4 the Public Health Service Act (42 U.S.C. 256e(a)) is 

5 amended by striking ‘‘2005’’ and inserting ‘‘2010’’. 

6 (b) DESCRIPTION OF AMOUNT OF PAYMENTS.—Sec7 tion 340E(b) of the Public Health Service Act (42 U.S.C. 

8 256e(b)) is amended— 

9 (1) in paragraph (1)(B), by striking ‘‘relating 

10 to teaching residents in such’’ and inserting ‘‘associ11 ated with graduate medical residency training’’; and 

12 (2) in paragraph (2)(A), by inserting before the 

13 period at the end ‘‘, except as provided under para14 graphs (1)(A) and (2)(B) of subsection (f)’’. 

15 (c) DIRECT GRADUATE MEDICAL EDUCATION.—Sec16 tion 340E(c) of the Public Health Service Act (42 U.S.C. 

17 245e(c)) is amended— 

18 (1) in paragraph (1)— 

19 (A) in the matter preceding subparagraph 

20 (A), by striking ‘‘product’’ and inserting 

21 ‘‘sum’’; 

22 (B) in subparagraph (A), by striking ‘‘(A) 

23 the updated per resident’’ and inserting the fol24 lowing: 

25 ‘‘(A) the product of— 

26 ‘‘(i) the updated per resident’’. 
3 

•S 2526 IS 

1 (C) by redesignating subparagraph (B) as 

2 clause (ii) and indenting appropriately; 

3 (D) in subparagraph (A)(ii) (as so redesig4 nated)— 

5 (i) by inserting ‘‘but without giving 

6 effect to section 1886(h)(7) of such Act’’ 

7 after ‘‘section 1886(h)(4) of the Social Se8 curity Act’’; and 

9 (ii) by striking the period and insert10 ing ‘‘; and’’; and 

11 (E) by inserting after subparagraph (A) 

12 the following: 

13 ‘‘(B) amounts for other approved edu14 cation programs that are provider-operated, as 

15 defined for purposes of Medicare payment, lim16 ited to not more than 30 percent of costs that 

17 would be allowed for such programs under 

18 Medicare rules for hospitals reimbursed under 

19 section 1886(d) of the Social Security Act.’’; 

20 and 

21 (2) in paragraph (2)(B), by inserting before the 

22 period at the end ‘‘, without giving effect to section 

23 1886(d)(3)(E)(ii) of the Social Security Act’’. 
4 

•S 2526 IS 

1 (d) INDIRECT GRADUATE MEDICAL EDUCATION.— 

2 Section 340E(d) of the Public Health Service Act (42 

3 U.S.C. 256e(d)) is amended— 

4 (1) in paragraph (1), by striking ‘‘related to’’ 

5 and inserting ‘‘associated with’’; and 

6 (2) in paragraph (2)(A)— 

7 (A) by inserting ‘‘ratio of the’’ after ‘‘hos8 pitals and the’’; and 

9 (B) by inserting at the end before the 

10 semicolon ‘‘to beds (but excluding beds or bassi11 nets assigned to healthy newborn infants)’’. 

12 (e) NATURE OF PAYMENTS.—Section 340E(e) of the 

13 Public Health Service Act (42 U.S.C. 256e(e)) is amend14 ed— 

15 (1) in paragraph (2), by striking the first sen16 tence; 

17 (2) in paragraph (3)— 

18 (A) by striking ‘‘made to pay’’ and insert19 ing ‘‘made and pay’’; and 

20 (B) by striking ‘‘to the extent possible’’ 

21 and all that follows through the end of the 

22 paragraph and inserting the following: ‘‘. To 

23 the greatest extent possible, amounts recouped 

24 from a hospital are to be distributed to other 

25 hospitals in the same fiscal year. Amounts re-
5 

•S 2526 IS 

1 couped from a hospital and not disbursed to 

2 other hospitals in the same fiscal year shall re3 main available for distribution during the sub4 sequent fiscal year. Unless there is fraud, 

5 amounts paid to a hospital without a demand 

6 for recoupment by the end of the fiscal year 

7 shall be final and not subject to recoupment.’’; 

8 and 

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

10 ‘‘(4) APPEALS.— 

11 ‘‘(A) IN GENERAL.—A decision affecting 

12 the amount payable to a hospital pursuant to 

13 this section shall— 

14 ‘‘(i) be subject to review under section 

15 1878 of the Social Security Act in the 

16 same manner as a final determination of a 

17 fiscal intermediary of the amount of pay18 ment under 1886(d) of such Act is subject 

19 to review; and 

20 ‘‘(ii) be handled expeditiously so that 

21 the review decision is reflected in the final 

22 reconciliation for the year in which the ap23 peal is made. 

24 ‘‘(B) LIMITATION.—A review decision pur25 suant to this section shall not affect payments 
6 

•S 2526 IS 

1 for a fiscal year prior to the fiscal year in which 

2 the review decision is rendered. 

3 ‘‘(C) APPLICATION TO SUBSEQUENT FIS4 CAL YEARS.—The Secretary shall apply a re5 view decision in determining the amount of pay6 ment for the appealing hospital in the fiscal 

7 year in which the decision is rendered and in 

8 subsequent years, unless the law at issue in the 

9 review decision is amended or there are mate10 rial differences between the facts for the fiscal 

11 year for which the review decision is rendered 

12 and the year for which payment is made. Noth13 ing in this section shall be construed to prohibit 

14 a hospital from appealing similar determina15 tions in subsequent periods.’’. 

16 (f) AUTHORIZATION OF APPROPRIATIONS.—Section 

17 340E(f) of the Public Health Service Act (42 U.S.C. 

18 256e(f)) is amended— 

19 (1) in paragraph (1)— 

20 (A) in subparagraph (A)— 

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

22 (ii) in clause (iii), by striking the pe23 riod at the end and inserting a semicolon; 

24 and 
7 

•S 2526 IS 

1 (iii) by adding at the end the fol2 lowing: 

3 ‘‘(iv) for fiscal year 2006, 

4 $110,000,000; and 

5 ‘‘(v) for each of fiscal years 2007 

6 through 2010, such sums as may be nec7 essary, including an annual adjustment to 

8 reflect increases in the Consumer Price 

9 Index.’’; and 

10 (B) in subparagraph (B), by striking ‘‘for 

11 fiscal year 2000’’ and all that follows and in12 serting ‘‘for fiscal year 2006 and each subse13 quent fiscal year shall remain available for obli14 gation for the year appropriated and the subse15 quent fiscal year.’’; and 

16 (2) in paragraph (2)— 

17 (A) by redesignating subparagraphs (A), 

18 (B), and (C) as clauses (i), (ii), and (iii), re19 spectively, and indenting appropriately; 

20 (B) by striking ‘‘There are hereby author21 ized’’ and inserting the following: 

22 ‘‘(A) IN GENERAL.—There are author23 ized’’; 

24 (C) in clause (ii) (as redesignated by this 

25 paragraph), by striking ‘‘and’’; 
8 

•S 2526 IS 

1 (D) in clause (iii) (as redesignated by this 

2 paragraph), by striking the period at the end 

3 and inserting a semicolon; 

4 (E) by adding at the end of subparagraph 

5 (A) (as designated by this paragraph), the fol6 lowing: 

7 ‘‘(iv) for fiscal year 2006, 

8 $220,000,000; and 

9 ‘‘(v) for each of fiscal years 2007 

10 through 2010, such sums as may be nec11 essary, including an annual adjustment to 

12 reflect increases in the Consumer Price 

13 Index.’’; and 

14 (F) at the end of paragraph (2), by adding 

15 the following: 

16 ‘‘(B) CARRYOVER OF EXCESS.—To the ex17 tent that amounts are not expended in the year 

18 for which they are appropriated, the amounts 

19 appropriated under subparagraph (A) for fiscal 

20 year 2006 and each subsequent fiscal year shall 

21 remain available for obligation through the end 

22 of the following fiscal year.’’. 

23 (g) DEFINITIONS.—Section 340E(g)(3) of the Public 

24 Health Service Act (42 U.S.C. 256e(g)(3)) is amended by 
9 

•S 2526 IS 

1 striking ‘‘has’’ and all that follows through the end of the 

2 sentence and inserting the following: ‘‘includes— 

3 ‘‘(A) the meaning given such term in sec4 tion 1886(h)(5)(C) of the Social Security Act; 

5 and 

6 ‘‘(B) costs of approved educational activi7 ties, as such term is used in section 1886(a)(4) 

8 of the Social Security Act.’’. 

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