I 

108TH CONGRESS 

2D SESSION H. R. 4578

To reauthorize the Children’s Hospitals Graduate Medical Education 

Program. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 15, 2004

Mrs. JOHNSON of Connecticut (for herself, Ms. PRYCE of Ohio, Mr. BROWN

of Ohio, Mr. GREENWOOD, Mr. RAMSTAD, Mr. BURR, Ms. ESHOO, Mrs. 

BONO, Mr. MCINNIS, Mr. SHAYS, Mr. NORWOOD, Mr. CAMP, Ms. DUNN, 

and Mr. WAXMAN) introduced the following bill; which was referred to 

the Committee on Energy and Commerce 

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 Education Equity and Research (CHEER) Act of 2004’’. 
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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 that for purposes of this 

14 paragraph such total excludes amounts that remain 

15 available from a previous fiscal year under para16 graph (1)(B) or (2)(B) of subsection (f)’’. 

17 (c) DIRECT GRADUATE MEDICAL EDUCATION.—Sec18 tion 340E(c) of the Public Health Service Act (42 U.S.C. 

19 256e(c)) is amended—

20 (1) in paragraph (1)—

21 (A) in the matter preceding subparagraph 

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

23 ‘‘sum’’; 

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

25 the updated per resident’’ and inserting the fol26 lowing: 
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1 ‘‘(A) the product of—

2 ‘‘(i) the updated per resident’’; 

3 (C) by redesignating subparagraph (B) as 

4 clause (ii) and indenting appropriately; 

5 (D) in subparagraph (A)(ii) (as so redesig6 nated)—

7 (i) by inserting ‘‘, but without giving 

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

9 after ‘‘section 1886(h)(4) of the Social Se10 curity Act’’; and 

11 (ii) by striking the period and insert12 ing ‘‘; and’’; and 

13 (E) by inserting after subparagraph (A) 

14 the following: 

15 ‘‘(B) amounts for other approved edu16 cation programs that are provider-operated, as 

17 defined for purposes of Medicare payment, lim18 ited to not more than 30 percent of costs that 

19 would be allowed for such programs under 

20 Medicare rules for hospitals reimbursed under 

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

22 and 

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

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

25 1886(d)(3)(E)(ii) of the Social Security Act’’. 
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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), by striking ‘‘recoup any 

18 overpayments made to pay any balance due to the 

19 extent possible’’ and all that follows through the end 

20 of the paragraph and inserting the following: ‘‘re21 coup any overpayments made and pay any balance 

22 due. To the greatest extent possible, amounts re23 couped from a hospital are to be distributed to other 

24 hospitals in the same fiscal year. Amounts recouped 

25 from a hospital and not disbursed to other hospitals 
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1 in the same fiscal year shall remain available for dis2 tribution during the subsequent fiscal year. Unless 

3 there is fraud, amounts paid to a hospital without 

4 a demand for recoupment by the end of the fiscal 

5 year shall be final and not subject to recoupment.’’; 

6 and 

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

8 ‘‘(4) APPEALS.—

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

10 the amount payable to a hospital pursuant to 

11 this section shall—

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

13 1878 of the Social Security Act in the 

14 same manner as final determinations of a 

15 fiscal intermediary of the amount of pay16 ment under section 1886(d) of such Act 

17 are subject to review; and 

18 ‘‘(ii) be handled expeditiously so that 

19 the review decision is reflected in the final 

20 reconciliation for the year in which the ap21 peal is made. 

22 ‘‘(B) LIMITATION.—A review decision pur23 suant to this section shall not affect payments 

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

25 the review decision is rendered. 
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1 ‘‘(C) APPLICATION TO SUBSEQUENT FIS2 CAL YEARS.—The Secretary shall apply a re3 view decision in determining the amount of pay4 ment for the appealing hospital in the fiscal 

5 year in which the decision is rendered and in 

6 subsequent years, unless the law at issue in the 

7 review decision is amended or there are mate8 rial differences between the facts for the fiscal 

9 year for which the review decision is rendered 

10 and the year for which payment is made. Noth11 ing in this section shall be construed to prohibit 

12 a hospital from appealing similar determina13 tions in subsequent periods.’’. 

14 (f) AUTHORIZATION OF APPROPRIATIONS.—Section 

15 340E(f) of the Public Health Service Act (42 U.S.C. 

16 256e(f)) is amended—

17 (1) in paragraph (1)—

18 (A) in subparagraph (A)—

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

20 (ii) in clause (iii), by striking the pe21 riod at the end and inserting a semicolon; 

22 and 

23 (iii) by adding at the end the fol24 lowing: 
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1 ‘‘(iv) for fiscal year 2006, 

2 $110,000,000; and 

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

4 through 2010, such sums as may be nec5 essary, including an annual adjustment to 

6 reflect increases in the Consumer Price 

7 Index.’’; and 

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

9 fiscal year 2000’’ and all that follows and in10 serting ‘‘for fiscal year 2006 and each subse11 quent fiscal year shall remain available for obli12 gation for the year appropriated and the subse13 quent fiscal year.’’; and 

14 (2) in paragraph (2)—

15 (A) by redesignating subparagraphs (A), 

16 (B), and (C) as clauses (i), (ii), and (iii), re17 spectively, and indenting appropriately; 

18 (B) by striking ‘‘There are hereby author19 ized’’ and inserting the following: 

20 ‘‘(A) IN GENERAL.—There are author21 ized’’; 

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

23 paragraph), by striking ‘‘and’’; 
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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.—Paragraph (3) of section 

24 340E(g) of the Public Health Service Act (42 U.S.C. 
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1 256e(g)) is amended by striking ‘‘has’’ and all that follows 

2 through the end of the sentence and inserting ‘‘—

3 ‘‘(A) has the meaning given such term in 

4 section 1886(h)(5)(C) of the Social Security 

5 Act; and 

6 ‘‘(B) includes costs of approved edu7 cational activities, as such term is used in sec8 tion 1886(a)(4) of the Social Security Act.’’.

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