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113th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 1st Session                                                      113-3

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



 
      CHILDREN'S HOSPITAL GME SUPPORT REAUTHORIZATION ACT OF 2013

                                _______
                                

February 4, 2013.--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. 297]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 297) 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..............................................     2
Background and Need for the Legislation..........................     2
Hearings.........................................................     2
Committee Consideration..........................................     3
Committee Votes..................................................     3
Committee Oversight Findings.....................................     3
Statement of General Performance Goals and Objectives............     3
New Budget Authority, Entitlement Authority, and Tax Expenditures     3
Earmarks, Limited Tax Benefits, and Limited Tariff Benefits......     3
Committee Cost Estimate..........................................     3
Congressional Budget Office Estimate.............................     3
Federal Mandates Statement.......................................     5
Duplication of Federal Programs..................................     5
Disclosure of Directed Rule Makings..............................     5
Advisory Committee Statement.....................................     6
Applicability to Legislative Branch..............................     6
Section-by-Section Analysis of the Legislation...................     6
Changes in Existing Law Made by the Bill, as Reported............     6

                          Purpose and Summary

    H.R. 297, the ``Children's Hospital GME Support 
Reauthorization Act of 2013,'' was introduced on January 15, 
2013, by Rep. Joseph R. Pitts (R-PA) and subsequently referred 
to the Committee on Energy and Commerce.
    The legislation would amend the Public Health Service Act 
(PHSA) to reauthorize support for graduate medical education in 
children's hospitals for five years. In addition, the bill 
would move the deadline for the report on the program ahead by 
one year to FY 2016.

                Background and Need for the Legislation

    The Children's Hospital Graduate Medical Education (CHGME) 
program was first 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 graduate medical education program.
    Today, the CHGME program provides funding to 56 hospitals 
in 30 States to support pediatric residency training. Together, 
freestanding children's hospitals train over 40% of 
pediatricians, 43% of pediatric specialists, and most pediatric 
researchers.
    Congress reauthorized CHGME twice, each time with broad 
bipartisan support. In 2000, the CHGME program was reauthorized 
through FY 2005 as part of the ``Children's Health Act of 
2000'' (P.L. 106-310). In 2006, the ``CHGME Support 
Reauthorization Act'' (P.L. 109-307) reauthorized the program 
for an additional five years through FY 2011.
    In 2011, H.R. 1852, the Children's Hospital Graduate 
Medical Education Reauthorization Act of 2011, was introduced 
to reauthorize the program through FY 2016. The text of H.R. 
1852 was updated for time-frames and incorporated into S. 1440 
prior to its consideration by the House of Representatives on 
December 19, 2012. No further action was taken during the 112th 
Congress.
    H.R. 297 would extend the CHGME program until FY 2017 at 
the statutory authorization level of $330 million. Any cost 
associated with enacting the provisions of this Act should be 
paid for out of existing funds.
    The report to Congress on the CHGME program required by the 
bill would be moved to FY 2016, a year before the authority for 
the program would expire. The report includes a summary of the 
annual reports prepared by the grantees as a requirement for 
funding that describes the types of residency programs, the 
types and number of training positions, any changes in 
residency training curriculum, a review of patient and safety 
care, and the number of residents who complete training.

                                Hearings

    The Committee on Energy and Commerce has not held hearings 
on the legislation. However, the Subcommittee on Health held a 
hearing on H.R. 1852 during the 112th Congress.

                        Committee Consideration

    On January 22, 2013, the Energy and Commerce Committee met 
in open markup session and approved H.R. 297, the ``Children's 
Hospital GME Support Reauthorization Act of 2013,'' by 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. 297 reported. A motion by Mr. Upton to order H.R. 297 
reported to the House, without amendment, was agreed to by 
unanimous consent.

                      Committee Oversight Findings

    Pursuant to clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee has not held an 
oversight or legislative hearing on this legislation.

         Statement of General Performance Goals and Objectives

    The goal of the legislation is to train pediatric residents 
in order to maintain an adequate supply of pediatricians and 
pediatric specialists in the health care workforce.

   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. 
297, the ``Children's Hospital GME Support Reauthorization Act 
of 2013,'' would result in no new or increased budget 
authority, entitlement authority, or tax expenditures or 
revenues.

      Earmarks, Limited Tax Benefits, and Limited Tariff Benefits

    In compliance with clause 9(e), 9(f), and 9(g) of rule XXI 
of the House of Representatives, the Committee finds that H.R. 
297, the ``Children's Hospital GME Support Reauthorization Act 
of 2013,'' contains no earmarks, limited tax benefits, or 
limited tariff benefits.

                        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:

                                                  February 1, 2013.
Hon. Fred Upton,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 297, the 
Children's Hospital GME Support Reauthorization Act of 2013.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Lisa Ramirez-
Branum.
            Sincerely,
                                              Douglas W. Elmendorf.
    Enclosure.

H.R. 297--Children's Hospital GME Support Reauthorization Act of 2013

    Summary: H.R. 297 would amend the Public Health Service Act 
to authorize payments to children's hospitals for 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. 297 would authorize the appropriation of $300 million 
a year for each of fiscal years 2013 through 2017 for payments 
to children's hospitals. CBO estimates that implementing the 
bill would cost $23 million in 2013 and $1.2 billion over the 
2013-2018 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. 297 is shown in the following table. 
The costs of this legislation fall within budget function 550 
(health).

----------------------------------------------------------------------------------------------------------------
                                                             By fiscal year, in millions of dollars--
                                                ----------------------------------------------------------------
                                                   2013     2014     2015     2016     2017     2018   2013-2018
----------------------------------------------------------------------------------------------------------------
                                  CHANGES IN SPENDING SUBJECT TO APPROPRIATION

Estimated Authorization Level..................       30      300      300      300      300        0     1,230
Estimated Outlays..............................       23      233      300      300      300       75     1,230
----------------------------------------------------------------------------------------------------------------

    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 expired in 2011. 
However, the program has continued to receive funding through 
appropriations. For example, in the Continuing Appropriations 
Resolution, 2013, the Congress appropriated $270 million (on an 
annualized basis) through March 27, 2013.
    H.R. 297 would authorize annual appropriations of $300 
million for the program for the 2013 through 2017 period. 
Because the Congress has already appropriated $270 million for 
fiscal year 2013, CBO estimates that implementing H.R. 297 
would increase the funding for fiscal year 2013 by $30 million 
to a total of $300 million. For this estimate, CBO assumes that 
H.R. 297 will be enacted in fiscal year 2013 and that the 
authorized amount will be appropriated for each year.
    H.R. 297 would authorize the appropriation of $110 million 
a year for 2013 through 2017 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 $190 
million a year for 2013 through 2017 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 discharges, 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 $23 million in 2013 and $1.2 billion over the 
2013-2018 period, assuming appropriation of the specified 
amounts. The low estimated cost for 2013 reflects the fact that 
the agency already has a current-year funding level of $270 
million (on an annualized basis, through March 27, 2013).
    Intergovernmental and private-sector impact: H.R. 297 
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: Alexia Diorio.
    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.

                    Duplication of Federal Programs

    No provision of H.R. 297, the ``Children's Hospital GME 
Support Reauthorization Act of 2013,'' establishes or 
reauthorizes a program of the Federal Government known to be 
duplicative of another Federal program, a program that was 
included in any report from the Government Accountability 
Office to Congress pursuant to section 21 of Public Law 111-
139, or a program related to a program identified in the most 
recent Catalog of Federal Domestic Assistance.

                  Disclosure of Directed Rule Makings

    The Committee estimates that enacting H.R. 297, the 
``Children's Hospital GME Support Reauthorization Act of 
2013,'' specifically directs to be completed no specific rule 
makings within the meaning of 5 U.S.C. 551.

                      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

    Section 1 states that the legislation may be cited as the 
``Children's Hospitals GME Support Reauthorization of 2013.''

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

    Section 2 (a) amends Section 340E of the PHSA to extend the 
authorization of the CHGME program through FY 2017.
    Section 2 (b) also amends Section 340E of the PHSA to move 
the deadline for the Report to Congress ahead by one year to FY 
2016, one year prior to the expiration of the authorization.

         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 2005, each of fiscal years 2007 through 2011, and 
each of fiscal years 2013 through 2017, 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 2016, 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 and each of fiscal years 
                        2013 through 2017, $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 and each of fiscal years 2013 through 
                2017, $220,000,000.

           *       *       *       *       *       *       *