[House Report 112-205]
[From the U.S. Government Printing Office]


112th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 1st Session                                                    112-205

======================================================================



 
      CHILDREN'S HOSPITAL GME SUPPORT REAUTHORIZATION ACT OF 2011

                                _______
                                

 September 12, 2011.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

  Mr. Upton, from the Committee on Energy and Commerce, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 1852]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 1852) to amend the Public Health Service Act to 
reauthorize support for graduate medical education programs in 
children's hospitals, having considered the same, report 
favorably thereon without amendment and recommend that the bill 
do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     1
Background and Need for Legislation..............................     2
Hearings.........................................................     2
Committee Consideration..........................................     2
Committee Votes..................................................     3
Committee Oversight Findings.....................................     3
Statement of General Performance Goals and Objectives............     3
New Budget Authority, Entitlement Authority, and Tax Expenditures     3
Earmark..........................................................     3
Committee Cost Estimate..........................................     3
Congressional Budget Office Estimate.............................     3
Federal Mandates Statement.......................................     5
Advisory Committee Statement.....................................     5
Applicability to Legislative Branch..............................     5
Section-by-Section Analysis of the Legislation...................     5
Changes in Existing Law Made by the Bill.........................     5

                          Purpose and Summary

    H.R. 1852, ``Children's Hospital GME Support 
Reauthorization Act of 2011,'' was introduced by Representative 
Joseph Pitts (R-PA) on May 11, 2011, and subsequently referred 
to the Committee on Energy and Commerce.
    The goal of H.R. 1852 is to amend the Public Health Service 
Act to reauthorize support for graduate medical education 
programs in children's hospitals for 5 years. In addition, the 
bill moves the deadline for the report on the program ahead by 
one year.

                  Background and Need for Legislation

    The Children's Hospital Graduate Medical Education Program 
(CHGME) was enacted in 1999 as part of the Healthcare Research 
and Quality Act (P.L. 106-129) to provide freestanding 
children's hospitals with discretionary Federal support for 
direct and indirect expenses associated with operating medical 
residency training programs. Since few children's hospitals 
receive Medicare funds, the legislation was designed to correct 
the exclusion of pediatric training in the Medicare GME 
program. CHGME provides funding to 56 hospitals in 30 states to 
support pediatric residency training. Today, freestanding 
children's hospitals train over 40% of pediatricians, 43% of 
pediatric specialists, and most pediatric researchers.
    On October 6, 2006, the CHGME Support Reauthorization Act 
(P.L. 109-307) was enacted and extended the program through FY 
2011. H.R. 1852 extends the CHGME program again until 2016 at 
its current authorization level. The Report to Congress on the 
CHGME program was moved to year four, a year before the bill 
expires in 2016. The Report includes a summary of the annual 
reports prepared by the grantees as a requirement for funding. 
The Report details the types of residency programs, the number 
of training positions, types of training, any changes in 
residency training curriculum, a review of patient and safety 
care, and the number of residents who complete training. It 
also includes recommendations for how to improve the program.

                                Hearings

    The Subcommittee on Health on July 11, 2001 held a hearing 
on H.R. 1852, ``Children's Hospital GME Support Reauthorization 
Act of 2011.'' The Subcommittee received testimony from:
           Janet Heinrich, Dr.P.H., R.N., Associate 
        Administrator, Bureau of Health Professions, Health 
        Resources and Services Administration (HRSA)
           Thomas R. Insel, M.D., Director, National 
        Institute of Mental Health, National Institutes of 
        Health

                        Committee Consideration

    H.R. 1852 was introduced by Mr. Pitts on May 11, 2011, and 
was referred to the Committee on Energy and Commerce.
    On July 26, 2011, the Subcommittee on Health met in open 
markup session and approved H.R. 1852, ``Children's Hospital 
GME Support Reauthorization Act of 2011,'' by voice vote.
    On July 28, 2011, the Energy and Commerce Committee met in 
open markup session and ordered H.R. 1852 reported to the 
House, without amendment, by a voice vote.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the record votes 
on the motion to report legislation and amendments thereto. 
There were no record votes taken in connection with ordering 
H.R. 1852 reported. A motion by Mr. Upton to order H.R. 1852 
reported to the House, without amendment, was agreed to by a 
voice vote.

                      Committee Oversight Findings

    Pursuant to clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the oversight findings and 
recommendations of the Committee are reflected in the 
descriptive portions of this report.

         Statement of General Performance Goals and Objectives

    In accordance with clause 3(c)(4) of rule XIII of the Rules 
of the House of Representatives, the performance goals and 
objectives of the Committee are reflected in the descriptive 
portions of this report.

           New Budget Authority, Entitlement Authority, and 
                            Tax Expenditures

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee finds that H.R. 
1852, the ``Children's Hospital GME Support Reauthorization Act 
of 2011,'' would result in no new or increased budget 
authority, entitlement authority, or tax expenditures or 
revenues.

                                Earmark

    In compliance with clause 9(e), 9(f), and 9(g) of rule XXI, 
the Committee finds that H.R. 1852, ``Children's Hospital GME 
Support Reauthorization Act of 2011,'' contains no earmarks.

                        Committee Cost Estimate

    The Committee adopts as its own the cost estimate prepared 
by the Director of the Congressional Budget Office pursuant to 
section 402 of the Congressional Budget Act of 1974.

                  Congressional Budget Office Estimate

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
provided by the Congressional Budget Office pursuant to section 
402 of the Congressional Budget Act of 1974:

H.R. 1852--Children's Hospital GME Support Reauthorization Act of 2011

    Summary: H.R. 1852 would amend the Public Health Service 
Act to reauthorize payments to children's hospitals operating 
training programs that provide graduate medical education. 
Payments would be made to such hospitals for both direct and 
indirect costs related to graduate medical education. Direct 
costs are those related to operating a medical education 
program, such as the salaries of medical students, while 
indirect costs are those intended to compensate hospitals for 
patient care costs that are expected to be higher in teaching 
hospitals than in non-teaching hospitals.
    H.R. 1852 would reauthorize the appropriation of $330 
million a year over the 2012-2016 period for payments to 
children's hospitals. CBO estimates that implementing the bill 
would cost $248 million in 2012 and $1,568 million over the 
2012-2016 period, assuming the appropriation of the authorized 
amounts. Pay-as-you-go procedures do not apply to this 
legislation because it would not affect direct spending or 
revenues.
    The bill contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA).
    Estimated cost to the Federal Government: The estimated 
budgetary impact of H.R. 1852 is shown in the following table. 
The costs of this legislation fall within budget function 550 
(health).

----------------------------------------------------------------------------------------------------------------
                                                                    By fiscal year, in millions of dollars--
                                                              --------------------------------------------------
                                                                2012    2013    2014    2015    2016   2012-2016
----------------------------------------------------------------------------------------------------------------
                                  CHANGES IN SPENDING SUBJECT TO APPROPRIATION

Authorization Level..........................................     330     330     330     330     330     1,650
Estimated Outlays............................................     248     330     330     330     330     1,568
----------------------------------------------------------------------------------------------------------------

    Basis of estimate: The Health Resources and Services 
Administration administers a program that provides payments to 
children's hospitals that operate graduate medical education 
programs. Authorization for that program expires in 2011. H.R. 
1852 would reauthorize funding for the program through 2016 at 
a level that is similar to recent years. For this estimate, CBO 
assumes that H.R. 1852 will be enacted before the end of fiscal 
year 2011 and that the authorized amounts will be appropriated 
for each year.
    H.R. 1852 would authorize the appropriation of $110 million 
a year for 2012 through 2016 for payment toward the direct 
costs of graduate medical education in children's hospitals. 
Those funds would be awarded to eligible hospitals according to 
a formula that takes into account the number of residents each 
hospital employs and its cost per resident.
    The bill also would authorize the appropriation of $220 
million a year for 2012 through 2016 for payment toward the 
indirect costs of graduate medical education programs. Those 
payments would be made to hospitals on the basis of a formula 
that takes into account the hospital's number of discharges, 
the relative costliness of those cases as measured by a case-
mix index, the number of residents at the hospital, and the 
number of inpatient beds in the hospital complex.
    Based on historical patterns of spending for the graduate 
medical education program, CBO estimates that implementing the 
bill would cost $248 million in 2012 and $1,568 million over 
the 2012-2016 period, assuming appropriation of the specified 
amounts.
    Intergovernmental and private-sector impact: H.R. 1852 
contains no intergovernmental or private-sector mandates as 
defined in UMRA. Children's hospitals that are operated by 
governmental entities could benefit from grant funds authorized 
by the bill for graduate medical training.
    Estimate prepared by: Federal Costs: Lisa Ramirez-Branum; 
Impact on State, Local, and Tribal Governments: Lisa Ramirez-
Branum; Impact on the Private Sector: Jimmy Jin.
    Estimate approved by: Holly Harvey, Deputy Assistant 
Director for Budget Analysis.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act were created by this 
legislation.

                  Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

             Section-by-Section Analysis of the Legislation


Section 1. Short title

    The title of this Act is ``Children's Hospital GME Support 
Reauthorization Act of 2011''.

Section 2. Program of payments to children's hospitals that operate 
        graduate medical education programs

    Section 2(a) amends Section 340E of the Public Health 
Service Act to extend the authorization of the program through 
2016.
    Section 2(b) also amends Section 340E of the Public Health 
Service Act to move the deadline for Report to Congress ahead 
by one year to 2015.

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, existing law in which no change is 
proposed is shown in roman):

PUBLIC HEALTH SERVICE ACT

           *       *       *       *       *       *       *


TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE

           *       *       *       *       *       *       *


Part D--Primary Health Care

           *       *       *       *       *       *       *


     Subpart IX--Support of Graduate Medical Education Programs in 
                          Children's Hospitals

SEC. 340E. PROGRAM OF PAYMENTS TO CHILDREN'S HOSPITALS THAT OPERATE 
                    GRADUATE MEDICAL EDUCATION PROGRAMS.

  (a) Payments.--The Secretary shall make two payments under 
this section to each children's hospital for each of fiscal 
years 2000 [through 2005 and each of fiscal years 2007 through 
2011] through 2016, 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) * * *

           *       *       *       *       *       *       *

          (3) Annual reporting required.--
                  (A) * * *

           *       *       *       *       *       *       *

                  (D) Report to congress.--[Not later than the 
                end of fiscal year 2011] Not later than the end 
                of fiscal year 2015, the Secretary, acting 
                through the Administrator of the Health 
                Resources and Services Administration, shall 
                submit a report to the Congress--
                          (i) * * *

           *       *       *       *       *       *       *

  (f) Authorization of Appropriations.--
          (1) Direct graduate medical education.--
                  (A) In general.--There are hereby authorized 
                to be appropriated, out of any money in the 
                Treasury not otherwise appropriated, for 
                payments under subsection (b)(1)(A)--
                          (i) * * *

           *       *       *       *       *       *       *

                          (iv) for each of fiscal years 2007 
                        through [2011] 2016, $110,000,000.

           *       *       *       *       *       *       *

          (2) Indirect medical education.--There are hereby 
        authorized to be appropriated, out of any money in the 
        Treasury not otherwise appropriated, for payments under 
        subsection (b)(1)(B)--
                  (A) * * *

           *       *       *       *       *       *       *

                  (D) for each of fiscal years 2007 through 
                [2011] 2016, $220,000,000.

           *       *       *       *       *       *       *