H. R. 5574
One Hundred Ninth Congress
of the
United States of America 
AT THE SECOND SESSION 
Begun and held at the City of Washington on Tuesday, 
the third day of January, two thousand and six 
An Act 
To amend the Public Health Service Act to reauthorize support for graduate medical 
education programs in children’s hospitals.
Be it enacted by the Senate and House of Representatives of 
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Children’s Hospital GME Support 
Reauthorization Act of 2006’’. 
SEC. 2. PROGRAM OF PAYMENTS TO CHILDREN’S HOSPITALS THAT 
OPERATE GRADUATE MEDICAL EDUCATION PROGRAMS. 
(a) IN GENERAL.—Section 340E of the Public Health Service 
Act (42 U.S.C. 256e) is amended— 
(1) in subsection (a), by inserting ‘‘and each of fiscal years 
2007 through 2011’’ after ‘‘for each of fiscal years 2000 through 
2005’’; 
(2) in subsection (e)(1), by striking ‘‘26’’ and inserting ‘‘12’’; 
(3) in subsection (f)(1)(A)— 
(A) in clause (ii), by striking ‘‘and’’ at the end; 
(B) in clause (iii), by striking the period at the end 
and inserting ‘‘; and’’; and 
(C) by adding at the end the following: 
‘‘(iv) for each of fiscal years 2007 through 2011, 
$110,000,000.’’; and 
(4) in subsection (f)(2)— 
(A) in the matter before subparagraph (A), by striking 
‘‘subsection (b)(1)(A)’’ and inserting ‘‘subsection (b)(1)(B)’’; 
(B) in subparagraph (B), by striking ‘‘and’’ at the end; 
(C) in subparagraph (C), by striking the period at 
the end and inserting ‘‘; and’’; and 
(D) by adding at the end the following: 
‘‘(D) for each of fiscal years 2007 through 2011, 
$220,000,000.’’. 
(b) REDUCTION IN PAYMENTS FOR FAILURE TO FILE ANNUAL 
REPORT.—Subsection (b) of section 340E of the Public Health 
Service Act (42 U.S.C. 256e) is amended— 
(1) in paragraph (1), in the matter before subparagraph 
(A), by striking ‘‘paragraph (2)’’ and inserting ‘‘paragraphs (2) 
and (3)’’; and 
(2) by adding at the end the following: 
‘‘(3) ANNUAL REPORTING REQUIRED.— 
‘‘(A) REDUCTION IN PAYMENT FOR FAILURE TO REPORT.—
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‘‘(i) IN GENERAL.—The amount payable under this 
section to a children’s hospital for a fiscal year (begin-
ning with fiscal year 2008 and after taking into account 
paragraph (2)) shall be reduced by 25 percent if the 
Secretary determines that— 
‘‘(I) the hospital has failed to provide the Sec-
retary, as an addendum to the hospital’s applica-
tion under this section for such fiscal year, the 
report required under subparagraph (B) for the 
previous fiscal year; or 
‘‘(II) such report fails to provide the informa-
tion required under any clause of such subpara-
graph. 
‘‘(ii) NOTICE AND OPPORTUNITY TO PROVIDE MISSING 
INFORMATION.—Before imposing a reduction under 
clause (i) on the basis of a hospital’s failure to provide 
information described in clause (i)(II), the Secretary 
shall provide notice to the hospital of such failure 
and the Secretary’s intention to impose such reduction 
and shall provide the hospital with the opportunity 
to provide the required information within a period 
of 30 days beginning on the date of such notice. If 
the hospital provides such information within such 
period, no reduction shall be made under clause (i) 
on the basis of the previous failure to provide such 
information. 
‘‘(B) ANNUAL REPORT.—The report required under this 
subparagraph for a children’s hospital for a fiscal year 
is a report that includes (in a form and manner specified 
by the Secretary) the following information for the resi-
dency academic year completed immediately prior to such 
fiscal year: 
‘‘(i) The types of resident training programs that 
the hospital provided for residents described in 
subparagraph (C), such as general pediatrics, internal 
medicine/pediatrics, 
and 
pediatric 
subspecialties, 
including both medical subspecialties certified by the 
American Board of Pediatrics (such as pediatric gastro-
enterology) and non-medical subspecialties approved 
by other medical certification boards (such as pediatric 
surgery). 
‘‘(ii) The number of training positions for residents 
described in subparagraph (C), the number of such 
positions recruited to fill, and the number of such 
positions filled. 
‘‘(iii) The types of training that the hospital pro-
vided for residents described in subparagraph (C) 
related to the health care needs of different popu-
lations, such as children who are underserved for rea-
sons of family income or geographic location, including 
rural and urban areas. 
‘‘(iv) The changes in residency training for resi-
dents described in subparagraph (C) which the hospital 
has made during such residency academic year (except 
that the first report submitted by the hospital under 
this subparagraph shall be for such changes since the
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first year in which the hospital received payment under 
this section), including— 
‘‘(I) changes in curricula, training experiences, 
and types of training programs, and benefits that 
have resulted from such changes; and 
‘‘(II) changes for purposes of training the resi-
dents in the measurement and improvement of 
the quality and safety of patient care. 
‘‘(v) The numbers of residents described in 
subparagraph (C) who completed their residency 
training at the end of such residency academic year 
and care for children within the borders of the service 
area of the hospital or within the borders of the State 
in which the hospital is located. Such numbers shall 
be disaggregated with respect to residents who com-
pleted residencies in general pediatrics or internal 
medicine/pediatrics, 
subspecialty 
residencies, 
and 
dental residencies. 
‘‘(C) RESIDENTS.—The residents described in this 
subparagraph are those who— 
‘‘(i) are in full-time equivalent resident training 
positions in any training program sponsored by the 
hospital; or 
‘‘(ii) are in a training program sponsored by an 
entity other than the hospital, but who spend more 
than 75 percent of their training time at the hospital. 
‘‘(D) REPORT TO CONGRESS.—Not later than the end 
of fiscal year 2011, the Secretary, acting through the 
Administrator of the Health Resources and Services 
Administration, shall submit a report to the Congress— 
‘‘(i) summarizing the information submitted in 
reports to the Secretary under subparagraph (B); 
‘‘(ii) describing the results of the program carried 
out under this section; and 
‘‘(iii) making recommendations for improvements 
to the program.’’. 
(c) TECHNICAL
AMENDMENTS.—Section 340E of the Public 
Health Service Act (42 U.S.C. 256e) is further amended— 
(1) in subsection (c)(2)(E)(ii), by striking ‘‘described in 
subparagraph (C)(ii)’’ and inserting ‘‘applied under section 
1886(d)(3)(E) of the Social Security Act for discharges occurring 
during the preceding fiscal year’’; 
(2) in subsection (e)(2), by striking the first sentence; and
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(3) in subsection (e)(3), by striking ‘‘made to pay’’ and 
inserting ‘‘made and pay’’.
Speaker of the House of Representatives.
Vice President of the United States and
President of the Senate.