Children's Hospitals Education Equity Act

Mr. Speaker, this week the House passed legislation to reauthorize the Children's Hospital Graduate Medical Education program. While a celebration should be in order, I am disappointed the bill was considered on suspension, preventing amendments to improve the program.

The bill passed by this Chamber fails to correct a glaring mental health parity issue, which prevents the inclusion of children's psychiatric teaching hospitals in this program. Because these hospitals are classified by Medicare as psychiatric hospitals rather than as children's hospitals, they are ineligible for entry into the program.

In order to fix this oversight and to address the acute need for additional health care providers trained in child psychiatry, I introduced legislation, H.R. 2558, the Children's Hospitals Education Equity Act, which would include certain children's psychiatric hospitals in the definition to determine eligibility.

I look forward to working with my colleagues on both sides of the aisle to correct this inequity and to advance our Nation another step closer to achieving full mental health parity.

Gregory K. Fritz: Parity for Kids' Mental Health

[From the Providence Journal, Aug. 30, 2011]

(By Gregory K. Fritz)

Despite the passage of the federal mental-health parity

bill, stigma and prejudice are still alive and well when it

comes to legislation affecting children's psychiatric

hospitals. The latest example of how our government continues

to maintain discriminatory funding policies specifically

directed against children with mental-health issues involves

federal support for graduate medical education (GME).

Although this issue is far overshadowed by the federal debt

issue, those who care about the mental health of children

need to be aware that achieving true parity still entails

overcoming significant obstacles. Getting children's

psychiatric hospitals recognized as legitimate sites of

medical education is one such obstacle on the road to real

parity that has both symbolic and pragmatic importance.

The history of federal support for training physicians

during their hospital residencies goes back to the

establishment of Medicare, in 1965. Recognizing that America

needs a steady supply of physicians in all the areas of

medicine, and that their training carries substantial

additional expense for teaching hospitals, Medicare

authorization includes a per-resident reimbursement that is

provided to hospitals through a complicated formula. One

element for determining GME payments is the percentage of a

hospital's reimbursement that comes from Medicare. That

children's hospitals would thus be excluded from the program

(because Medicare pays virtually zero for children's medical

care) was unintentional, but it took 34 years for this

oversight to be corrected.

The Children's Hospitals Graduate Medical Education Payment

Program (CHGME), in 1999, established a pool to provide

residency education support to children's hospitals in a

system modeled after the Medicare GME system. The

unintentional disincentive to train pediatric generalists and

specialists was removed and pediatric training accelerated

dramatically. This year, a total of $317.5 million offsets

the training expenses of 5,500 residents at 46 children's

hospitals, and the CHGME program is widely considered a

success.

Parallel to the initial oversight in the Medicare bill, in

the arcane definition of a children's hospital detailed in

the CHGME regulations is language making it impossible for

children's psychiatric hospitals to qualify. Only the most

cynical observer would conclude that this was a deliberate

attempt to exclude children's psychiatric hospitals and the

child psychiatric and pediatric residents they train,

especially since no medical specialty represents a greater

shortage area than child and adolescent psychiatry. Yet,

steady efforts since 2002 to correct this oversight have thus

far been unsuccessful.

The CHGME reauthorization needed for the program to

continue would seem to offer the ideal opportunity to end

this de facto discrimination against children with mental-

health problems. Sen. Sheldon Whitehouse and Representatives

David Cicilline and James Langevin, all Rhode Island

Democrats, have offered similar versions of a brief amendment

to the reauthorization that would correct the language to

reflect the original bill's intent.

If passed, it would admit four or five children's

psychiatric hospitals that meet strict criteria into the pool

of hospitals eligible for CHGME reimbursement. A larger

taxpayer outlay is not requested; rather, the existing money

would be spread slightly more thinly (an estimated 30

additional residents would be added to the current 5,500).

One would think it a small price to pay to correct an

injustice, but passage is far from guaranteed.

As a child psychiatrist working at Bradley Hospital, one of

the psychiatric hospitals that would finally be included, I'm

far from dispassionate about this issue. I see every day the

agony experienced by families with autism, childhood suicide,

adolescent substance abuse or pediatric bipolar disorder;

it's different, but no less severe, than the pain associated

with juvenile diabetes or leukemia. As are all mental-health

professionals, I'm troubled by the months-long waiting lists

that prevent children's access to child psychiatric services.

The distinction between psychological and physiological

disorders is artificial and antiquated, reflecting outdated

fears and prejudices. In short, I see no valid reason to

perpetuate the exclusion of children's psychiatric hospitals

from the mechanism designed to support physicians' training.

Neither do the thousands of members of 39 national

organizations who have signed on to a letter urging support

of the Whitehouse amendment. Mental-health parity is the law

in principle; the CHGME reauthorization should make it be the

case in practice.

Gregory K. Fritz, M.D., is academic director at Bradley

Hospital and the editor of the Brown University Child and

Adolescent Behavior Letter.