[House Report 112-205]
[From the U.S. Government Publishing 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.
* * * * * * *