S.Amdt. 3031

SA 3031. Mr. WHITEHOUSE (for himself and Mr. Casey) submitted an
amendment intended to be proposed to amendment SA 2786 proposed by Mr.
Reid (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill
H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the
first-time homebuyers credit in the case of members of the Armed Forces
and certain other Federal employees, and for other purposes; which was
ordered to lie on the table; as follows:

On page 1507, after line 19, insert the following:

SEC. 5510. SUPPORT OF GRADUATE MEDICAL EDUCATION PROGRAMS IN
WOMEN'S HOSPITALS.

Subpart IX of part D of title III of the Public Health
Service Act (42 U.S.C. 256e et seq.) is amended--
(1) in the subpart heading, by adding ``and Women's
Hospitals'' at the end; and
(2) by adding at the end the following:

``SEC. 340E-1. SUPPORT OF GRADUATE MEDICAL EDUCATION PROGRAMS
IN WOMEN'S HOSPITALS.

``(a) Payments.--The Secretary shall make two payments
under this section to each women's hospital for each of
fiscal years 2010 through 2014, one for the direct expenses
and the other for indirect expenses associated with operating
approved graduate medical residency training programs. The
Secretary shall promulgate regulations pursuant to the
rulemaking requirements of title 5, United States Code, which
shall govern payments made under this subpart.
``(b) Amount of Payments.--
``(1) In general.--Subject to paragraphs (2) and (3), the
amounts payable under this section to a women's hospital for
an approved graduate medical residency training program for a
fiscal year shall be each of the following:
``(A) Direct expense amount.--The amount determined in
accordance with subsection (c) for direct expenses associated
with operating approved graduate medical residency training
programs for a fiscal year.
``(B) Indirect expense amount.--The amount determined in
accordance with subsection (c) for indirect expenses
associated with the treatment of more severely ill patients
and the additional costs relating to teaching residents in
such programs for a fiscal year.
``(2) Capped amount.--
``(A) In general.--The total of the payments made to
women's hospitals under paragraph (1) in a fiscal year shall
not exceed the funds appropriated under subsection (e) for
such payments for that fiscal year.
``(B) Pro rata reductions of payments.--If the Secretary
determines that the amount of funds appropriated under
subsection (e) for a fiscal year is insufficient to provide
the total amount of payments otherwise due for such periods
under paragraph (1), the Secretary shall reduce the amounts
so payable on a pro rata basis to reflect such shortfall.

[[Page S12721]]

``(3) Annual reporting required.--The provisions of
subsection (b)(3) of section 340E shall apply to women's
hospitals under this section in the same manner as such
provisions apply to children's hospitals under such section
340E. In applying such provisions, the Secretary may make
such modifications as may be necessary to apply such
provisions to women's hospitals.
``(c) Application of Certain Provisions.--The provisions of
subsections (c) and (d) of section 340E shall apply to
women's hospitals under this section in the same manner as
such provisions apply to children's hospitals under such
section 340E. In applying such provisions, the Secretary may
make such modifications as may be necessary to apply such
provisions to women's hospitals.
``(d) Making of Payments.--
``(1) Interim payments.--The Secretary shall determine,
before the beginning of each fiscal year involved for which
payments may be made for a hospital under this section, the
amounts of the payments for direct graduate medical education
and indirect medical education for such fiscal year and shall
(subject to paragraph (2)) make the payments of such amounts
in 12 equal interim installments during such period. Such
interim payments to each individual hospital shall be based
on the number of residents reported in the hospital's most
recently filed Medicare cost report prior to the application
date for the Federal fiscal year for which the interim
payment amounts are established. In the case of a hospital
that does not report residents on a Medicare cost report,
such interim payments shall be based on the number of
residents trained during the hospital's most recently
completed Medicare cost report filing period.
``(2) Withholding.--The Secretary shall withhold up to 25
percent from each interim installment for direct and indirect
graduate medical education paid under paragraph (1) as
necessary to ensure a hospital will not be overpaid on an
interim basis.
``(3) Reconciliation.--Prior to the end of each fiscal
year, the Secretary shall determine any changes to the number
of residents reported by a hospital in the application of the
hospital for the current fiscal year to determine the final
amount payable to the hospital for the current fiscal year
for both direct expense and indirect expense amounts. Based
on such determination, the Secretary shall recoup any
overpayments made and pay any balance due to the extent
possible. The final amount so determined shall be considered
a final intermediary determination for the purposes of
section 1878 of the Social Security Act and shall be subject
to administrative and judicial review under that section in
the same manner as the amount of payment under section
1886(d) of such Act is subject to review under such section.
``(e) Authorization of Appropriations.--There are
authorized to be appropriated to carry out this section,
$12,000,000 for fiscal year 2010, and such sums as may be
necessary for each of fiscal years 2011 through 2014.
``(f) Definitions.--In this section:
``(1) Approved graduate medical residency training
program.--The term `approved graduate medical residency
training program' has the meaning given the term `approved
medical residency training program' in section 1886(h)(5)(A)
of the Social Security Act.
``(2) Direct graduate medical education costs.--The term
`direct graduate medical education costs' has the meaning
given such term in section 1886(h)(5)(C) of the Social
Security Act.
``(3) Women's hospital.--The term `women's hospital' means
a hospital--
``(A) that has a Medicare provider agreement under title
XVIII of the Social Security Act;
``(B) that has an approved graduate medical residency
training program;
``(C) that has not been excluded from the Medicare
prospective payment system;
``(D) that had at least 3,000 births during 2007, as
determined by the Centers for Medicare & Medicaid Services;
and
``(E) with respect to which and as determined by the
Centers for Medicare & Medicaid Services, less than 4 percent
of the total discharges from the hospital during 2007 were
Medicare discharges of individuals who, as of the time of the
discharge--
``(i) were enrolled in the original Medicare fee-for-
service program under part A of title XVIII of the Social
Security Act; and
``(ii) were not enrolled in--

``(I) a Medicare Advantage plan under part C of title XVIII
of that Act;
``(II) an eligible organization under section 1876 of that
Act; or
``(III) a PACE program under section 1894 of that Act.''.

______