H.R. 4578House108th Congress (2003-2005)In Committee

Children's Hospitals Education Equity and Research (CHEER) Act of 2004

Legislative Activity

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2 earlier actions

HouseCommittee Latest Action

Referred to the Subcommittee on Health.

Health Subcommittee

July 7, 2004

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HouseIntro Referral

Introduced in House

June 15, 2004

HouseIntro Referral

Referred to the House Committee on Energy and Commerce.

Energy and Commerce Committee

June 15, 2004

HouseCommittee

Referred to the Subcommittee on Health.

Health Subcommittee

July 7, 2004

Floor Debate

5 members

What members said about H.R. 4578 on the floor

1 Republican4 Democrats

Rep. Anna G. EshooD-CA-14 · Oct 6, 2004

Mr. Speaker, I want to thank my good friend, the gentleman from Ohio (Mr. Brown), for his leadership as ranking member on this Subcommittee on Health, which is so important not only here in the…

Mr. Speaker, I want to thank my good friend, the gentleman from Ohio (Mr. Brown), for his leadership as ranking member on this Subcommittee on Health, which is so important not only here in the Congress but for our entire country; and to my good friend, the gentleman from Florida (Mr. Bilirakis), our chairman. Surely we would not be here this afternoon were it not for his support and pushing to bring this to the floor so that we can consider it.

What this bill is about, Mr. Speaker, is legislation that is going to fix a flaw in the Children's Hospital Graduate Medical Education payment formula. This formula inadvertently penalizes Lucile Packard Children's Hospital, which is in my district in Palo Alto.

If I just might depart for a moment, Lucile Packard is the mother and the visionary that established this hospital in Palo Alto. There are many from across the world and from different parts of the country that come to have their children cared for there. So I think she is watching us, and she would be very proud. Were it not for Lucile Packard, as I said, this hospital would not exist today.

Mr. Speaker, a portion of the Graduate Medical Education calculation is based on the severity of case mixes. At Lucile Packard Hospital, which is only one of two hospitals in the United States that offers pregnancy and healthy newborn services, it is then penalized. Most do not take care of healthy newborn babies. When they become part of the mix with the very ill ones, the formula becomes skewed. So if the hospital did not care for the healthy newborns, we would not be here today.

The Committee on Energy and Commerce took a look at this to fix it permanently. As the gentleman stated, that will be taken care of in 2006. Today, we are fixing the small gap between now and 2006. It is going to go a long way.

I want to reassure my colleagues, there are not any costs associated with the bill. This is paid for by a reduction in the fiscal year 2005 payment to all hospitals that receive these payments under the program, and that would not have happened unless the hospitals came together. And they have endorsed this. There is endorsement from the National Association of Children's Hospitals, and I want to thank them for coming together to allow this to happen.

I also want to thank John Ford on the staff of the gentleman from Michigan (Mr. Dingell) and certainly Chuck Clapton on the staff of the gentleman from Texas (Chairman Barton), and I want to urge all my colleagues to vote in favor of H.R. 5204. It is going to help a great deal, and that help is going to be appreciated not only by the children and their families, but also the young physicians that have devoted themselves to a life in medicine; and in this graduate medical payment, it will enjoy the fullness it should and this will be repaired.

Again, I thank the gentleman from Florida (Mr. Bilirakis), most of all for his friendship that I have enjoyed and benefited from and am grateful for since first coming to the House.

Rep. Michael BilirakisR-FL-9 · Oct 6, 2004

Mr. Speaker, I move to suspend the rules and pass the bill (H.R. 5204) to amend section 340E of the Public Health Service Act (relating to children's hospitals) to modify provisions regarding the…

Mr. Speaker, I move to suspend the rules and pass the bill (H.R. 5204) to amend section 340E of the Public Health Service Act (relating to children's hospitals) to modify provisions regarding the determination of the amount of payments for indirect expenses associated with operating approved graduate medical residency training programs.

Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days within which to revise and extend their remarks and include extraneous material on the bill.

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, I rise today in support of H.R. 5204, which would amend section 340(e) of the Public Health Service Act to modify provisions regarding the determination of the amount of payments for indirect expenses associated with operating approved graduate medical residency training programs. This legislation was introduced by the gentlewoman from California (Ms. Eshoo), a lady who does so many great things in the Congress, particularly for her district.

Children's hospitals receive important funding through the Federal Children's Hospitals Graduate Medical Education, which we call GME, Payment Program. This funding helps train residents and better enables children's hospitals to serve all children, regardless their ability to pay.

Next year, the Committee on Energy and Commerce plans to work to reauthorize the Children's Graduate Medical Education Program. As chairman of the Health Subcommittee and a proponent of the children's hospitals throughout my entire time in Congress, I plan to vigorously support this reauthorization.

However, while we will be working to reauthorize the program next year, H.R. 5204 provides a necessary, immediate fix for a small number of hospitals that treat a disproportionately high number of healthy infants. Healthy infants. This legislation would allow these hospitals to receive fair CHGME payments by excluding the number of healthy beds and bassinets in children's hospitals from the case mix adjustment. By excluding these healthy beds and bassinets, these hospitals will no longer be penalized for treating healthy babies.

I urge all my colleagues to support H.R. 5204 today.

Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, I have no further speakers, and I yield back the balance of my time.

Rep. Sheila Jackson LeeD-TX-18 · Oct 6, 2004

As one of the co-chairs of the Congressional Children's Caucus, I urge my colleagues today to support H.R. 5204, amending section 304e of the Public Health Service Act as it relates to payments to…

As one of the co-chairs of the Congressional Children's Caucus, I urge my colleagues today to support H.R. 5204, amending section 304e of the Public Health Service Act as it relates to payments to children's hospitals under the Graduate Medical Education program.

The existing provisions of the Public Service Health Act unfairly penalize the two hospitals in the U.S. that offer both pregnancy and healthy newborn services. This penalty is related to calculation of the reimbursements that hospitals receive under the Children's Hospital Graduate Medical Education program (CHGME).

As it is currently configured, the CHGME program calculates payments to hospitals based on severity of the ``case mix index.'' Healthy newborns, like those treated in these two hospitals, reduce the severity of the case mix index and thus the payments to the hospitals. I believe the current method of calculating these payments is unreasonable.

For example, one of the only two hospitals offering healthy newborn services in the U.S. is the Lucile Packard Children's Hospital. When healthy newborns are excluded from the calculation, the Packard hospital has the highest ``case mix index'' of all children's hospitals in California. With the healthy newborns included, it has the lowest. In other words, Packard is unfairly denied resources to treat seriously ill newborns because it also provides services to healthy newborns. Until the problem is corrected, the Packard hospital will continue to be shortchanged more than $300,000 each year.

This bill corrects the reimbursement problem faced by these two hospitals only for fiscal year 2005. Another bill to reauthorize the Children's Hospital Graduate Medical Education Act, currently on referral to the Subcommittee on Health, will correct this problem in fiscal year 2006 and future years. This legislation is needed to provide relief to the two affected hospitals in fiscal year 2005. This legislation does not change the eligibility for hospitals to qualify under the CHGME program.

I believe that it is unreasonable to penalize hospitals offering services to healthy newborns and urge my colleagues to support this legislation.

Rep. Sherrod BrownD-OH-13 · Oct 6, 2004

Mr. Speaker, I yield myself 2 minutes. Mr. Speaker, I am pleased to support this legislation and I want to commend its author the gentlewoman from California (Ms. Eshoo). She has played a leading…

Rep. Danny K. DavisD-IL-7 · Oct 6, 2004

Mr. Speaker, I rise in strong support of H.R. 5204 and commend the gentlewoman from California (Ms. Eshoo) for her sponsorship of this legislation. I represent a congressional district that has five…

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Introduced in HouseIssued June 15, 2004

108th CONGRESS

2d Session

H. R. 4578

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.

Short title

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

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.