Women's Hospitals Education Equity Act - Amends the Public Health Service Act to direct the Secretary of Health and Human Services (HHS) to make two payments to each eligible women's hospital for each of FY2010-FY2014: (1) one payment for direct expenses associated with operating approved graduate medical residency training programs; and (2) one for indirect expenses associated with the treatment of more severely ill patients and the additional costs relating to teaching residents in such programs.
Requires the Secretary to: (1) make the payments in 12 equal interim installments based on the number of residents reported in the hospital's most recently filed Medicare cost report; (2) withhold up to 25% from each installment to ensure a hospital will not be overpaid on an interim basis; (3) determine, prior to the end of each fiscal year, any changes to the number of residents reported to determine the final amount; and (4) recoup any overpayments based on such determination. Considers the final amount so determined to be a final intermediary determination, subject to administrative and judicial review, under the Social Security Act.
Applies to women's hospitals funded under this Act annual reporting requirements and provisions regarding direct graduate medical education payments and indirect medical education payments applicable to children's hospitals that operate graduate medical education programs.
[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4235 Introduced in House (IH)]
111th CONGRESS
1st Session
H. R. 4235
To amend the Public Health Service Act to provide assistance for
graduate medical education funding for women's hospitals.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
December 8, 2009
Mr. Kennedy introduced the following bill; which was referred to the
Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To amend the Public Health Service Act to provide assistance for
graduate medical education funding for women's hospitals.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Women's Hospitals Education Equity
Act''.
SEC. 2. 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;
(2) in section 340E(a), by striking ``subpart'' and
inserting ``section''; and
(3) 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 section.
``(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 (f) 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 (f) 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.
``(c) Application of Annual Reporting and Other Provisions.--The
provisions of subsections (b)(3), (c), and (d) of section 340E shall
apply with respect to women's hospitals funded under this section in
the same manner as such provisions apply with respect to children's
hospitals funded under such section 340E. In applying such provisions,
the Secretary may make such modifications as may be necessary to apply
such provisions with respect 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) 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.
``(f) 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.''.
<all>
Introduced in House
Introduced in House
Referred to the House Committee on Energy and Commerce.
Referred to the Subcommittee on Health.
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