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Children's Hospital GME Support Reauthorization

Floor Speech

Location: Washington, DC

Mr. President, I rise on behalf of my colleagues, Senators HARKIN, ALEXANDER, CASEY and ISAKSON to submit the following statement for the Record.

On October 30, 2013, the Health, Education, Labor, and Pensions Committee unanimously reported the Children's Hospital GME Support Reauthorization Act of 2013, S. 1557, out of Committee. On November 12, 2013, the Senate passed S. 1557 by unanimous consent.

This legislation is the product of years of bipartisan negotiation, a process which resulted in broad Senate support for the Act. The list of original Senate cosponsors for S. 1557 demonstrates this point. This list includes Senators CASEY, ISAKSON, HARKIN, ALEXANDER, BLUMENTHAL, BLUNT, BROWN, KIRK, MURPHY, REED, ROBERTS, WARREN, and WHITEHOUSE.

Prior to the enactment of the Children's Hospital Graduate Medical Education, CHGME, Payment Program, there was significant disparity in federal graduate medical education, GME, support between adult teaching hospitals and children's teaching hospitals. In 1998, children's hospitals received less than 0.5 percent of the level of federal GME support that adult teaching hospitals received. In the 2001 final rule for the CHGME Payment Program, the Department of Health and Human Services, HHS, wrote, ``The intent of the CHGME Act is to create parity in GME payments among all hospitals providing GME. It is clear that primarily two factors cause this disparity in children's hospitals: (1) low Medicare utilization; and (2) Prospective Payment System (PPS)-exempt status.''

The CHGME Payment Program has made considerable progress in achieving parity in GME payments, increasing the number of pediatric training positions at participating children's hospitals. However, a small number of freestanding children's teaching hospitals remain ineligible for the program. In 2003, Senate Committee on Appropriations noted the following:

It has come to the Committee's attention that a limited number of freestanding perinatal hospitals and children's psychiatric hospitals have been excluded from participation in this program despite the fact that these teaching institutions are not eligible for Graduate Medical Education funding under Medicare. The Committee expects [the Health Resources and Services Administration (HRSA)] to explore the appropriateness of including these hospitals in the Children's Hospitals Graduate Medical Education Program and to offer recommendations that might allow for their inclusion.

Senate Report 108-81.

HRSA responded in a 2004 report to Congress which concluded that addressing this eligibility issue would require Congress to amend the statue governing the CHGME Payment Program. S. 1557 addresses this long-standing issue. The reauthorization legislation authorizes the Secretary of the Department of Health and Human Services, HHS, to make available up to 25 percent of CHGME appropriations that exceed $245 million for ``qualified hospitals'' that: (1) have a Medicare payment agreement and are excluded from Medicare inpatient hospital prospective payment system; (2) have inpatients that are predominantly individuals under 18 years of age; (3) have an approved medical residency training program; and (4) are not otherwise eligible to receive payments from the CHGME Payment Program or the Medicare program. The total amount the Secretary can make available for these purposes in any fiscal year is limited to $7 million, thus ensuring that adequate resources remain available for the children's hospitals that currently participate in the program.

The Children's Hospital GME Support Reauthorization Act provides the Secretary with the necessary authority to address the disparity in GME payment facing certain children's teaching hospitals. These changes are in keeping with the intent of the CHGME Payment Program. As such, these hospitals should have the opportunity to apply for support through the CHGME Payment Program in order to sustain and build their teaching programs, and ultimately increase the supply of much-needed pediatricians and pediatric specialists. We urge the Secretary to weigh these benefits in using the new authority under S. 1557 should funding be available.

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