Children's Hospital GME Support Reauthorization Act of 2013

Bill: 113-s-1557
Sponsor: full_name: Sen. Casey, Robert P., Jr. [D-PA]
Introduced: 2013-09-27
Policy area: Health
Subjects: Child health

Education programs funding

Health care quality

Health facilities and institutions

Health programs administration and funding

Medical education

Medicare
Latest action: action_date: 2014-04-07
text: Became Public Law No: 113-98.

Summaries:
action_date: 2013-09-27
action_desc: Introduced in Senate
text: <p>Children's Hospital GME Support Reauthorization Act of 2013 - Amends the Public Health Service Act to extend and reauthorize appropriations through FY2018 for payments to children's hospitals associated with operating approved graduate medical residency training programs.</p> <p>Authorizes the Secretary of Health and Human Services (HHS) to: (1) make available up to 25 percent of the total amounts in excess of specified appropriations for payments to certain hospitals with a Medicare payment agreement that are excluded from the Medicare inpatient hospital prospective payment system and whose inpatients are predominantly under 18 years of age; and (2) establish a quality bonus system for distribution of excess payments to such hospitals, which may include a focus on quality measurement and improvement, interpersonal and communications skills, delivering patient-centered care, and practicing in integrated health systems.</p>

action_date: 2013-10-30
action_desc: Reported to Senate without amendment
text: <p><b>(This measure has not been amended since it was introduced. The summary of that version is repeated here.)</b></p> <p>Children's Hospital GME Support Reauthorization Act of 2013 - Amends the Public Health Service Act to extend and reauthorize appropriations through FY2018 for payments to children's hospitals associated with operating approved graduate medical residency training programs.</p> <p>Authorizes the Secretary of Health and Human Services (HHS) to: (1) make available up to 25 percent of the total amounts in excess of specified appropriations for payments to certain hospitals with a Medicare payment agreement that are excluded from the Medicare inpatient hospital prospective payment system and whose inpatients are predominantly under 18 years of age; and (2) establish a quality bonus system for distribution of excess payments to such hospitals, which may include a focus on quality measurement and improvement, interpersonal and communications skills, delivering patient-centered care, and practicing in integrated health systems.</p>

action_date: 2013-11-12
action_desc: Passed Senate without amendment
text: <p><b>(This measure has not been amended since it was introduced. The summary of that version is repeated here.)</b></p> <p>Children's Hospital GME Support Reauthorization Act of 2013 - Amends the Public Health Service Act to extend and reauthorize appropriations through FY2018 for payments to children's hospitals associated with operating approved graduate medical residency training programs.</p> <p>Authorizes the Secretary of Health and Human Services (HHS) to: (1) make available up to 25 percent of the total amounts in excess of specified appropriations for payments to certain hospitals with a Medicare payment agreement that are excluded from the Medicare inpatient hospital prospective payment system and whose inpatients are predominantly under 18 years of age; and (2) establish a quality bonus system for distribution of excess payments to such hospitals, which may include a focus on quality measurement and improvement, interpersonal and communications skills, delivering patient-centered care, and practicing in integrated health systems.</p>

action_date: 2014-04-01
action_desc: Passed House without amendment
text: <p><b>(This measure has not been amended since it was introduced. The summary of that version is repeated here.)</b></p> <p>Children's Hospital GME Support Reauthorization Act of 2013 - Amends the Public Health Service Act to extend and reauthorize appropriations through FY2018 for payments to children's hospitals associated with operating approved graduate medical residency training programs.</p> <p>Authorizes the Secretary of Health and Human Services (HHS) to: (1) make available up to 25 percent of the total amounts in excess of specified appropriations for payments to certain hospitals with a Medicare payment agreement that are excluded from the Medicare inpatient hospital prospective payment system and whose inpatients are predominantly under 18 years of age; and (2) establish a quality bonus system for distribution of excess payments to such hospitals, which may include a focus on quality measurement and improvement, interpersonal and communications skills, delivering patient-centered care, and practicing in integrated health systems.</p>

action_date: 2014-04-07
action_desc: Public Law
text: <p><b>(This measure has not been amended since it was introduced. The summary of that version is repeated here.)</b></p> <p>Children's Hospital GME Support Reauthorization Act of 2013 - Amends the Public Health Service Act to extend and reauthorize appropriations through FY2018 for payments to children's hospitals associated with operating approved graduate medical residency training programs.</p> <p>Authorizes the Secretary of Health and Human Services (HHS) to: (1) make available up to 25 percent of the total amounts in excess of specified appropriations for payments to certain hospitals with a Medicare payment agreement that are excluded from the Medicare inpatient hospital prospective payment system and whose inpatients are predominantly under 18 years of age; and (2) establish a quality bonus system for distribution of excess payments to such hospitals, which may include a focus on quality measurement and improvement, interpersonal and communications skills, delivering patient-centered care, and practicing in integrated health systems.</p>

tv_txt: II 113th CONGRESS 1st Session S. 1557 IN THE SENATE OF THE UNITED STATES September 27, 2013 Mr. Casey (for himself, Mr. Isakson , Mr. Whitehouse , Mr. Alexander , Mr. Brown , Mr. Kirk , Mr. Harkin , Mr. Blunt , Ms. Warren , Mr. Roberts , Mr. Blumenthal , Mr. Murphy , and Mr. Reed ) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To amend the Public Health Service Act to reauthorize support for graduate medical education programs in children’s hospitals.

1. Short title This Act may be cited as the Children’s Hospital GME Support Reauthorization Act of 2013 . 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 striking through 2005 and each of fiscal years 2007 through 2011 and inserting through 2005, each of fiscal years 2007 through 2011, and each of fiscal years 2014 through 2018 ; and (2) in subsection (f)— (A) in paragraph (1)(A)— (i) in clause (iii), by striking and ; (ii) in clause (iv), by striking the period and inserting ; and ; and (iii) by adding at the end the following: (v) for each of fiscal years 2014 through 2018, $100,000,000. ; and (B) in paragraph (2)— (i) in subparagraph (C), by striking and ; (ii) in subparagraph (D), by striking the period and inserting ; and ; and (iii) by adding at the end the following: (E) for each of fiscal years 2014 through 2018, $200,000,000. . (b) Report to Congress Section 340E(b)(3)(D) of the Public Health Service Act (42 U.S.C. 256e(b)(3)(D)) is amended by striking Not later than the end of fiscal year 2011 and inserting Not later than the end of fiscal year 2018 . 3. Support of Graduate Medical Education Programs in certain hospitals Section 340E of the Public Health Service Act ( 42 U.S.C. 256e ) is amended by adding at the end the following: (h) Additional provisions (1) In general The Secretary is authorized to make available up to 25 percent of the total amounts in excess of $245,000,000 appropriated under paragraphs (1) and (2) of subsection (f), but not to exceed $7,000,000, for payments to hospitals qualified as described in paragraph (2), for the direct and indirect expenses associated with operating approved graduate medical residency training programs, as described in subsection (a). (2) Qualified hospitals (A) In general To qualify to receive payments under paragraph (1), a hospital shall be a free-standing hospital— (i) with a Medicare payment agreement and that is excluded from the Medicare inpatient hospital prospective payment system pursuant to section 1886(d)(1)(B) of the Social Security Act and its accompanying regulations; (ii) whose inpatients are predominantly individuals under 18 years of age; (iii) that has an approved medical residency training program as defined in section 1886(h)(5)(A) of the Social Security Act; and (iv) that is not otherwise qualified to receive payments under this section or section 1886(h) of the Social Security Act. (B) Establishment of residency cap In the case of a freestanding children’s hospital that, on the date of enactment of this subsection, meets the requirements of subparagraph (A) but for which the Secretary has not determined an average number of full-time equivalent residents under section 1886(h)(4) of the Social Security Act, the Secretary may establish such number of full-time equivalent residents for the purposes of calculating payments under this subsection. (3) Payments Payments to hospitals made under this subsection shall be made in the same manner as payments are made to children's hospitals, as described in subsections (b) through (e). (4) Payment amounts The direct and indirect payment amounts under this subsection shall be determined using per resident amounts that are no greater than the per resident amounts used for determining direct and indirect payment amounts under subsection (a). (5) Reporting A hospital receiving payments under this subsection shall be subject to the reporting requirements under subsection (b)(3). (6) Remaining funds (A) In general If the payments to qualified hospitals under paragraph (1) for a fiscal year are less than the total amount made available under such paragraph for that fiscal year, any remaining amounts for such fiscal year may be made available to all hospitals participating in the program under this subsection or subsection (a). (B) Quality bonus system For purposes of distributing the remaining amounts described in subparagraph (A), the Secretary may establish a quality bonus system, whereby the Secretary distributes bonus payments to hospitals participating in the program under this subsection or subsection (a) that meet standards specified by the Secretary, which may include a focus on quality measurement and improvement, interpersonal and communications skills, delivering patient-centered care, and practicing in integrated health systems, including training in community-based settings. In developing such standards, the Secretary shall collaborate with relevant stakeholders, including program accrediting bodies, certifying boards, training programs, health care organizations, health care purchasers, and patient and consumer groups. .

tv_txt: II Calendar No. 227 113th CONGRESS 1st Session S. 1557 IN THE SENATE OF THE UNITED STATES September 27, 2013 Mr. Casey (for himself, Mr. Isakson , Mr. Whitehouse , Mr. Alexander , Mr. Brown , Mr. Kirk , Mr. Harkin , Mr. Blunt , Ms. Warren , Mr. Roberts , Mr. Blumenthal , Mr. Murphy , Mr. Reed , Mr. Franken , Mr. Moran , and Ms. Stabenow ) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions October 30, 2013 Reported by Mr. Harkin , without amendment A BILL To amend the Public Health Service Act to reauthorize support for graduate medical education programs in children’s hospitals.

1. Short title This Act may be cited as the Children’s Hospital GME Support Reauthorization Act of 2013 . 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 striking through 2005 and each of fiscal years 2007 through 2011 and inserting through 2005, each of fiscal years 2007 through 2011, and each of fiscal years 2014 through 2018 ; and (2) in subsection (f)— (A) in paragraph (1)(A)— (i) in clause (iii), by striking and ; (ii) in clause (iv), by striking the period and inserting ; and ; and (iii) by adding at the end the following: (v) for each of fiscal years 2014 through 2018, $100,000,000. ; and (B) in paragraph (2)— (i) in subparagraph (C), by striking and ; (ii) in subparagraph (D), by striking the period and inserting ; and ; and (iii) by adding at the end the following: (E) for each of fiscal years 2014 through 2018, $200,000,000. . (b) Report to Congress Section 340E(b)(3)(D) of the Public Health Service Act (42 U.S.C. 256e(b)(3)(D)) is amended by striking Not later than the end of fiscal year 2011 and inserting Not later than the end of fiscal year 2018 . 3. Support of Graduate Medical Education Programs in certain hospitals Section 340E of the Public Health Service Act ( 42 U.S.C. 256e ) is amended by adding at the end the following: (h) Additional provisions (1) In general The Secretary is authorized to make available up to 25 percent of the total amounts in excess of $245,000,000 appropriated under paragraphs (1) and (2) of subsection (f), but not to exceed $7,000,000, for payments to hospitals qualified as described in paragraph (2), for the direct and indirect expenses associated with operating approved graduate medical residency training programs, as described in subsection (a). (2) Qualified hospitals (A) In general To qualify to receive payments under paragraph (1), a hospital shall be a free-standing hospital— (i) with a Medicare payment agreement and that is excluded from the Medicare inpatient hospital prospective payment system pursuant to section 1886(d)(1)(B) of the Social Security Act and its accompanying regulations; (ii) whose inpatients are predominantly individuals under 18 years of age; (iii) that has an approved medical residency training program as defined in section 1886(h)(5)(A) of the Social Security Act; and (iv) that is not otherwise qualified to receive payments under this section or section 1886(h) of the Social Security Act. (B) Establishment of residency cap In the case of a freestanding children’s hospital that, on the date of enactment of this subsection, meets the requirements of subparagraph (A) but for which the Secretary has not determined an average number of full-time equivalent residents under section 1886(h)(4) of the Social Security Act, the Secretary may establish such number of full-time equivalent residents for the purposes of calculating payments under this subsection. (3) Payments Payments to hospitals made under this subsection shall be made in the same manner as payments are made to children's hospitals, as described in subsections (b) through (e). (4) Payment amounts The direct and indirect payment amounts under this subsection shall be determined using per resident amounts that are no greater than the per resident amounts used for determining direct and indirect payment amounts under subsection (a). (5) Reporting A hospital receiving payments under this subsection shall be subject to the reporting requirements under subsection (b)(3). (6) Remaining funds (A) In general If the payments to qualified hospitals under paragraph (1) for a fiscal year are less than the total amount made available under such paragraph for that fiscal year, any remaining amounts for such fiscal year may be made available to all hospitals participating in the program under this subsection or subsection (a). (B) Quality bonus system For purposes of distributing the remaining amounts described in subparagraph (A), the Secretary may establish a quality bonus system, whereby the Secretary distributes bonus payments to hospitals participating in the program under this subsection or subsection (a) that meet standards specified by the Secretary, which may include a focus on quality measurement and improvement, interpersonal and communications skills, delivering patient-centered care, and practicing in integrated health systems, including training in community-based settings. In developing such standards, the Secretary shall collaborate with relevant stakeholders, including program accrediting bodies, certifying boards, training programs, health care organizations, health care purchasers, and patient and consumer groups. .

October 30, 2013 Reported without amendment

tv_txt: 113th CONGRESS 1st Session S. 1557 IN THE SENATE OF THE UNITED STATES AN ACT To amend the Public Health Service Act to reauthorize support for graduate medical education programs in children’s hospitals.

1. Short title This Act may be cited as the Children’s Hospital GME Support Reauthorization Act of 2013 . 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 striking through 2005 and each of fiscal years 2007 through 2011 and inserting through 2005, each of fiscal years 2007 through 2011, and each of fiscal years 2014 through 2018 ; and (2) in subsection (f)— (A) in paragraph (1)(A)— (i) in clause (iii), by striking and ; (ii) in clause (iv), by striking the period and inserting ; and ; and (iii) by adding at the end the following: (v) for each of fiscal years 2014 through 2018, $100,000,000. ; and (B) in paragraph (2)— (i) in subparagraph (C), by striking and ; (ii) in subparagraph (D), by striking the period and inserting ; and ; and (iii) by adding at the end the following: (E) for each of fiscal years 2014 through 2018, $200,000,000. . (b) Report to Congress Section 340E(b)(3)(D) of the Public Health Service Act (42 U.S.C. 256e(b)(3)(D)) is amended by striking Not later than the end of fiscal year 2011 and inserting Not later than the end of fiscal year 2018 . 3. Support of Graduate Medical Education Programs in certain hospitals Section 340E of the Public Health Service Act ( 42 U.S.C. 256e ) is amended by adding at the end the following: (h) Additional provisions (1) In general The Secretary is authorized to make available up to 25 percent of the total amounts in excess of $245,000,000 appropriated under paragraphs (1) and (2) of subsection (f), but not to exceed $7,000,000, for payments to hospitals qualified as described in paragraph (2), for the direct and indirect expenses associated with operating approved graduate medical residency training programs, as described in subsection (a). (2) Qualified hospitals (A) In general To qualify to receive payments under paragraph (1), a hospital shall be a free-standing hospital— (i) with a Medicare payment agreement and that is excluded from the Medicare inpatient hospital prospective payment system pursuant to section 1886(d)(1)(B) of the Social Security Act and its accompanying regulations; (ii) whose inpatients are predominantly individuals under 18 years of age; (iii) that has an approved medical residency training program as defined in section 1886(h)(5)(A) of the Social Security Act; and (iv) that is not otherwise qualified to receive payments under this section or section 1886(h) of the Social Security Act. (B) Establishment of residency cap In the case of a freestanding children’s hospital that, on the date of enactment of this subsection, meets the requirements of subparagraph (A) but for which the Secretary has not determined an average number of full-time equivalent residents under section 1886(h)(4) of the Social Security Act, the Secretary may establish such number of full-time equivalent residents for the purposes of calculating payments under this subsection. (3) Payments Payments to hospitals made under this subsection shall be made in the same manner as payments are made to children's hospitals, as described in subsections (b) through (e). (4) Payment amounts The direct and indirect payment amounts under this subsection shall be determined using per resident amounts that are no greater than the per resident amounts used for determining direct and indirect payment amounts under subsection (a). (5) Reporting A hospital receiving payments under this subsection shall be subject to the reporting requirements under subsection (b)(3). (6) Remaining funds (A) In general If the payments to qualified hospitals under paragraph (1) for a fiscal year are less than the total amount made available under such paragraph for that fiscal year, any remaining amounts for such fiscal year may be made available to all hospitals participating in the program under this subsection or subsection (a). (B) Quality bonus system For purposes of distributing the remaining amounts described in subparagraph (A), the Secretary may establish a quality bonus system, whereby the Secretary distributes bonus payments to hospitals participating in the program under this subsection or subsection (a) that meet standards specified by the Secretary, which may include a focus on quality measurement and improvement, interpersonal and communications skills, delivering patient-centered care, and practicing in integrated health systems, including training in community-based settings. In developing such standards, the Secretary shall collaborate with relevant stakeholders, including program accrediting bodies, certifying boards, training programs, health care organizations, health care purchasers, and patient and consumer groups. .

Passed the Senate November 12, 2013. Secretary

tv_txt: IC 113th CONGRESS 1st Session S. 1557 IN THE HOUSE OF REPRESENTATIVES November 13, 2013 Referred to the Committee on Energy and Commerce AN ACT To amend the Public Health Service Act to reauthorize support for graduate medical education programs in children’s hospitals.

1. Short title This Act may be cited as the Children’s Hospital GME Support Reauthorization Act of 2013 . 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 striking through 2005 and each of fiscal years 2007 through 2011 and inserting through 2005, each of fiscal years 2007 through 2011, and each of fiscal years 2014 through 2018 ; and (2) in subsection (f)— (A) in paragraph (1)(A)— (i) in clause (iii), by striking and ; (ii) in clause (iv), by striking the period and inserting ; and ; and (iii) by adding at the end the following: (v) for each of fiscal years 2014 through 2018, $100,000,000. ; and (B) in paragraph (2)— (i) in subparagraph (C), by striking and ; (ii) in subparagraph (D), by striking the period and inserting ; and ; and (iii) by adding at the end the following: (E) for each of fiscal years 2014 through 2018, $200,000,000. . (b) Report to Congress Section 340E(b)(3)(D) of the Public Health Service Act ( 42 U.S.C. 256e(b)(3)(D) ) is amended by striking Not later than the end of fiscal year 2011 and inserting Not later than the end of fiscal year 2018 . 3. Support of Graduate Medical Education Programs in certain hospitals Section 340E of the Public Health Service Act ( 42 U.S.C. 256e ) is amended by adding at the end the following: (h) Additional provisions (1) In general The Secretary is authorized to make available up to 25 percent of the total amounts in excess of $245,000,000 appropriated under paragraphs (1) and (2) of subsection (f), but not to exceed $7,000,000, for payments to hospitals qualified as described in paragraph (2), for the direct and indirect expenses associated with operating approved graduate medical residency training programs, as described in subsection (a). (2) Qualified hospitals (A) In general To qualify to receive payments under paragraph (1), a hospital shall be a free-standing hospital— (i) with a Medicare payment agreement and that is excluded from the Medicare inpatient hospital prospective payment system pursuant to section 1886(d)(1)(B) of the Social Security Act and its accompanying regulations; (ii) whose inpatients are predominantly individuals under 18 years of age; (iii) that has an approved medical residency training program as defined in section 1886(h)(5)(A) of the Social Security Act; and (iv) that is not otherwise qualified to receive payments under this section or section 1886(h) of the Social Security Act. (B) Establishment of residency cap In the case of a freestanding children’s hospital that, on the date of enactment of this subsection, meets the requirements of subparagraph (A) but for which the Secretary has not determined an average number of full-time equivalent residents under section 1886(h)(4) of the Social Security Act, the Secretary may establish such number of full-time equivalent residents for the purposes of calculating payments under this subsection. (3) Payments Payments to hospitals made under this subsection shall be made in the same manner as payments are made to children's hospitals, as described in subsections (b) through (e). (4) Payment amounts The direct and indirect payment amounts under this subsection shall be determined using per resident amounts that are no greater than the per resident amounts used for determining direct and indirect payment amounts under subsection (a). (5) Reporting A hospital receiving payments under this subsection shall be subject to the reporting requirements under subsection (b)(3). (6) Remaining funds (A) In general If the payments to qualified hospitals under paragraph (1) for a fiscal year are less than the total amount made available under such paragraph for that fiscal year, any remaining amounts for such fiscal year may be made available to all hospitals participating in the program under this subsection or subsection (a). (B) Quality bonus system For purposes of distributing the remaining amounts described in subparagraph (A), the Secretary may establish a quality bonus system, whereby the Secretary distributes bonus payments to hospitals participating in the program under this subsection or subsection (a) that meet standards specified by the Secretary, which may include a focus on quality measurement and improvement, interpersonal and communications skills, delivering patient-centered care, and practicing in integrated health systems, including training in community-based settings. In developing such standards, the Secretary shall collaborate with relevant stakeholders, including program accrediting bodies, certifying boards, training programs, health care organizations, health care purchasers, and patient and consumer groups. .

Passed the Senate November 12, 2013. Nancy Erickson, Secretary

tv_txt: One Hundred Thirteenth Congress of the United States of America 2d Session Begun and held at the City of Washington on Friday, the third day of January, two thousand and fourteen S. 1557 IN THE SENATE OF THE UNITED STATES AN ACT To amend the Public Health Service Act to reauthorize support for graduate medical education programs in children’s hospitals.

1. Short title This Act may be cited as the Children’s Hospital GME Support Reauthorization Act of 2013 . 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 striking through 2005 and each of fiscal years 2007 through 2011 and inserting through 2005, each of fiscal years 2007 through 2011, and each of fiscal years 2014 through 2018 ; and (2) in subsection (f)— (A) in paragraph (1)(A)— (i) in clause (iii), by striking and ; (ii) in clause (iv), by striking the period and inserting ; and ; and (iii) by adding at the end the following: (v) for each of fiscal years 2014 through 2018, $100,000,000. ; and (B) in paragraph (2)— (i) in subparagraph (C), by striking and ; (ii) in subparagraph (D), by striking the period and inserting ; and ; and (iii) by adding at the end the following: (E) for each of fiscal years 2014 through 2018, $200,000,000. . (b) Report to Congress Section 340E(b)(3)(D) of the Public Health Service Act (42 U.S.C. 256e(b)(3)(D)) is amended by striking Not later than the end of fiscal year 2011 and inserting Not later than the end of fiscal year 2018 . 3. Support of Graduate Medical Education Programs in certain hospitals Section 340E of the Public Health Service Act ( 42 U.S.C. 256e ) is amended by adding at the end the following: (h) Additional provisions (1) In general The Secretary is authorized to make available up to 25 percent of the total amounts in excess of $245,000,000 appropriated under paragraphs (1) and (2) of subsection (f), but not to exceed $7,000,000, for payments to hospitals qualified as described in paragraph (2), for the direct and indirect expenses associated with operating approved graduate medical residency training programs, as described in subsection (a). (2) Qualified hospitals (A) In general To qualify to receive payments under paragraph (1), a hospital shall be a free-standing hospital— (i) with a Medicare payment agreement and that is excluded from the Medicare inpatient hospital prospective payment system pursuant to section 1886(d)(1)(B) of the Social Security Act and its accompanying regulations; (ii) whose inpatients are predominantly individuals under 18 years of age; (iii) that has an approved medical residency training program as defined in section 1886(h)(5)(A) of the Social Security Act; and (iv) that is not otherwise qualified to receive payments under this section or section 1886(h) of the Social Security Act. (B) Establishment of residency cap In the case of a freestanding children’s hospital that, on the date of enactment of this subsection, meets the requirements of subparagraph (A) but for which the Secretary has not determined an average number of full-time equivalent residents under section 1886(h)(4) of the Social Security Act, the Secretary may establish such number of full-time equivalent residents for the purposes of calculating payments under this subsection. (3) Payments Payments to hospitals made under this subsection shall be made in the same manner as payments are made to children's hospitals, as described in subsections (b) through (e). (4) Payment amounts The direct and indirect payment amounts under this subsection shall be determined using per resident amounts that are no greater than the per resident amounts used for determining direct and indirect payment amounts under subsection (a). (5) Reporting A hospital receiving payments under this subsection shall be subject to the reporting requirements under subsection (b)(3). (6) Remaining funds (A) In general If the payments to qualified hospitals under paragraph (1) for a fiscal year are less than the total amount made available under such paragraph for that fiscal year, any remaining amounts for such fiscal year may be made available to all hospitals participating in the program under this subsection or subsection (a). (B) Quality bonus system For purposes of distributing the remaining amounts described in subparagraph (A), the Secretary may establish a quality bonus system, whereby the Secretary distributes bonus payments to hospitals participating in the program under this subsection or subsection (a) that meet standards specified by the Secretary, which may include a focus on quality measurement and improvement, interpersonal and communications skills, delivering patient-centered care, and practicing in integrated health systems, including training in community-based settings. In developing such standards, the Secretary shall collaborate with relevant stakeholders, including program accrediting bodies, certifying boards, training programs, health care organizations, health care purchasers, and patient and consumer groups. .

Speaker of the House of Representatives Vice President of the United States and President of the Senate