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SECTION 1. SHORT TITLE.

This Act may be cited as the ''Children's Hospitals Education
Equity and Research (CHEER) Act of 2004''.

SEC. 2. REAUTHORIZATION OF CHILDREN'S HOSPITALS GRADUATE MEDICAL
EDUCATION PROGRAM.

(a) Extension of Program.--Section 340E(a) of the Public Health
Service Act (42 U.S.C. 256e(a)) is amended by striking ''2005'' and
inserting ''2010''.
(b) Description of Amount of Payments.--Section 340E(b) of the
Public Health Service Act (42 U.S.C. 256e(b)) is amended--
(1) in paragraph (1)(B), by striking ''relating to teaching
residents in such'' and inserting ''associated with graduate
medical residency training''; and
(2) in paragraph (2)(A), by inserting before the period at
the end '', except that for purposes of this paragraph such
total excludes amounts that remain available from a previous
fiscal year under paragraph (1)(B) or (2)(B) of subsection
(f)''.
(c) Direct Graduate Medical Education.--Section 340E(c) of the
Public Health Service Act (42 U.S.C. 256e(c)) is amended--
(1) in paragraph (1)--
(A) in the matter preceding subparagraph (A), by
striking ''product'' and inserting ''sum'';
(B) in subparagraph (A), by striking ''(A) the
updated per resident'' and inserting the following:
''(A) the product of--
''(i) the updated per resident'';
(C) by redesignating subparagraph (B) as clause
(ii) and indenting appropriately;
(D) in subparagraph (A)(ii) (as so redesignated)--
(i) by inserting '', but without giving
effect to section 1886(h)(7) of such Act)''
after ''section 1886(h)(4) of the Social
Security Act''; and
(ii) by striking the period and inserting
''; and''; and
(E) by inserting after subparagraph (A) the
following:
''(B) amounts for other approved education programs
that are provider-operated, as defined for purposes of
Medicare payment, limited to not more than 30 percent
of costs that would be allowed for such programs under
Medicare rules for hospitals reimbursed under section
1886(d) of the Social Security Act.''; and
(2) in paragraph (2)(B), by inserting before the period at
the end '', without giving effect to section 1886(d)(3)(E)(ii)
of the Social Security Act''.
(d) Indirect Graduate Medical Education.--Section 340E(d) of the
Public Health Service Act (42 U.S.C. 256e(d)) is amended--
(1) in paragraph (1), by striking ''related to'' and
inserting ''associated with''; and
(2) in paragraph (2)(A)--
(A) by inserting ''ratio of the'' after ''hospitals
and the''; and
(B) by inserting at the end before the semicolon
''to beds (but excluding beds or bassinets assigned to
healthy newborn infants)''.
(e) Nature of Payments.--Section 340E(e) of the Public Health
Service Act (42 U.S.C. 256e(e)) is amended--
(1) in paragraph (2), by striking the first sentence;
(2) in paragraph (3), by striking ''recoup any overpayments
made to pay any balance due to the extent possible'' and all
that follows through the end of the paragraph and inserting the
following: ''recoup any overpayments made and pay any balance
due. To the greatest extent possible, amounts recouped from a
hospital are to be distributed to other hospitals in the same
fiscal year. Amounts recouped from a hospital and not disbursed
to other hospitals in the same fiscal year shall remain
available for distribution during the subsequent fiscal year.
Unless there is fraud, amounts paid to a hospital without a
demand for recoupment by the end of the fiscal year shall be
final and not subject to recoupment.''; and
(3) by adding at the end the following:
''(4) Appeals.--
''(A) In general.--A decision affecting the amount
payable to a hospital pursuant to this section shall--
''(i) be subject to review under section
1878 of the Social Security Act in the same
manner as final determinations of a fiscal
intermediary of the amount of payment under
section 1886(d) of such Act are subject to
review; and
''(ii) be handled expeditiously so that the
review decision is reflected in the final
reconciliation for the year in which the appeal
is made.
''(B) Limitation.--A review decision pursuant to
this section shall not affect payments for a fiscal
year prior to the fiscal year in which the review
decision is rendered.
''(C) Application to subsequent fiscal years.--The
Secretary shall apply a review decision in determining
the amount of payment for the appealing hospital in the
fiscal year in which the decision is rendered and in
subsequent years, unless the law at issue in the review
decision is amended or there are material differences
between the facts for the fiscal year for which the
review decision is rendered and the year for which
payment is made. Nothing in this section shall be
construed to prohibit a hospital from appealing similar
determinations in subsequent periods.''.
(f) Authorization of Appropriations.--Section 340E(f) of the Public
Health Service Act (42 U.S.C. 256e(f)) is amended--
(1) in paragraph (1)--
(A) in subparagraph (A)--
(i) in clause (ii), by striking ''and'';
(ii) in clause (iii), by striking the
period at the end and inserting a semicolon;
and
(iii) by adding at the end the following:
''(iv) for fiscal year 2006, $110,000,000;
and
''(v) for each of fiscal years 2007 through
2010, such sums as may be necessary, including
an annual adjustment to reflect increases in
the Consumer Price Index.''; and
(B) in subparagraph (B), by striking ''for fiscal
year 2000'' and all that follows and inserting ''for
fiscal year 2006 and each subsequent fiscal year shall
remain available for obligation for the year
appropriated and the subsequent fiscal year.''; and
(2) in paragraph (2)--
(A) by redesignating subparagraphs (A), (B), and
(C) as clauses (i), (ii), and (iii), respectively, and
indenting appropriately;
(B) by striking ''There are hereby authorized'' and
inserting the following:
''(A) In general.--There are authorized'';
(C) in clause (ii) (as redesignated by this
paragraph), by striking ''and'';
(D) in clause (iii) (as redesignated by this
paragraph), by striking the period at the end and
inserting a semicolon;
(E) by adding at the end of subparagraph (A) (as
designated by this paragraph), the following:
''(iv) for fiscal year 2006, $220,000,000;
and
''(v) for each of fiscal years 2007 through
2010, such sums as may be necessary, including
an annual adjustment to reflect increases in
the Consumer Price Index.''; and
(F) at the end of paragraph (2), by adding the
following:
''(B) Carryover of excess.--To the extent that
amounts are not expended in the year for which they are
appropriated, the amounts appropriated under
subparagraph (A) for fiscal year 2006 and each
subsequent fiscal year shall remain available for
obligation through the end of the following fiscal
year.''.
(g) Definitions.--Paragraph (3) of section 340E(g) of the Public
Health Service Act (42 U.S.C. 256e(g)) is amended by striking ''has''
and all that follows through the end of the sentence and inserting ''--
''(A) has the meaning given such term in section
1886(h)(5)(C) of the Social Security Act; and
''(B) includes costs of approved educational
activities, as such term is used in section 1886(a)(4)
of the Social Security Act.''.
Children's Hospitals Education Equity and Research (CHEER) Act of 2004 - Amends the Public Health Service Act to require the Secretary of Health and Human Services to make payments through FY 2010 (currently, through FY 2005) to children's hospitals for costs associated with operating approved graduate medical resident training programs.