
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 23, 2000]
[Document affected by Public Law 106-310 Section 2001]
[CITE: 42USC256e]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                    CHAPTER 6A--PUBLIC HEALTH SERVICE
 
                SUBCHAPTER II--GENERAL POWERS AND DUTIES
 
                       Part D--Primary Health Care
 
subpart ix--support of graduate medical education programs in children's 
                                hospitals
 
Sec. 256e. 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 and 2001, one for the 
direct expenses and the other for indirect expenses associated with 
operating approved graduate medical residency training programs.

(b) Amount of payments

                           (1) In general

        Subject to paragraph (2), the amounts payable under this section 
    to a children's hospital for an approved graduate medical residency 
    training program for a fiscal year are each of the following 
    amounts:

        (A) Direct expense amount

            The amount determined under subsection (c) of this section 
        for direct expenses associated with operating approved graduate 
        medical residency training programs.

        (B) Indirect expense amount

            The amount determined under subsection (d) of this section 
        for indirect expenses associated with the treatment of more 
        severely ill patients and the additional costs relating to 
        teaching residents in such programs.

                          (2) Capped amount

        (A) In general

            The total of the payments made to children's hospitals under 
        paragraph (1)(A) or paragraph (1)(B) in a fiscal year shall not 
        exceed the funds appropriated under paragraph (1) or (2), 
        respectively, of subsection (f) of this section for such 
        payments for that fiscal year.

        (B) Pro rata reductions of payments for direct expenses

            If the Secretary determines that the amount of funds 
        appropriated under subsection (f)(1) of this section for a 
        fiscal year is insufficient to provide the total amount of 
        payments otherwise due for such periods under paragraph (1)(A), 
        the Secretary shall reduce the amounts so payable on a pro rata 
        basis to reflect such shortfall.

(c) Amount of payment for direct graduate medical education

                           (1) In general

        The amount determined under this subsection for payments to a 
    children's hospital for direct graduate expenses relating to 
    approved graduate medical residency training programs for a fiscal 
    year is equal to the product of--
            (A) the updated per resident amount for direct graduate 
        medical education, as determined under paragraph (2); and
            (B) the average number of full-time equivalent residents in 
        the hospital's graduate approved medical residency training 
        programs (as determined under section 1395ww(h)(4) of this title 
        during the fiscal year.

    (2) Updated per resident amount for direct graduate medical 
                                  education

        The updated per resident amount for direct graduate medical 
    education for a hospital for a fiscal year is an amount determined 
    as follows:

        (A) Determination of hospital single per resident amount

            The Secretary shall compute for each hospital operating an 
        approved graduate medical education program (regardless of 
        whether or not it is a children's hospital) a single per 
        resident amount equal to the average (weighted by number of 
        full-time equivalent residents) of the primary care per resident 
        amount and the non-primary care per resident amount computed 
        under section 1395ww(h)(2) of this title for cost reporting 
        periods ending during fiscal year 1997.

        (B) Determination of wage and non-wage-related proportion of the 
                single per resident amount

            The Secretary shall estimate the average proportion of the 
        single per resident amounts computed under subparagraph (A) that 
        is attributable to wages and wage-related costs.

        (C) Standardizing per resident amounts

            The Secretary shall establish a standardized per resident 
        amount for each such hospital--
                (i) by dividing the single per resident amount computed 
            under subparagraph (A) into a wage-related portion and a 
            non-wage-related portion by applying the proportion 
            determined under subparagraph (B);
                (ii) by dividing the wage-related portion by the factor 
            applied under section 1395ww(d)(3)(E) of this title for 
            discharges occurring during fiscal year 1999 for the 
            hospital's area; and
                (iii) by adding the non-wage-related portion to the 
            amount computed under clause (ii).

        (D) Determination of national average

            The Secretary shall compute a national average per resident 
        amount equal to the average of the standardized per resident 
        amounts computed under subparagraph (C) for such hospitals, with 
        the amount for each hospital weighted by the average number of 
        full-time equivalent residents at such hospital.

        (E) Application to individual hospitals

            The Secretary shall compute for each such hospital that is a 
        children's hospital a per resident amount--
                (i) by dividing the national average per resident amount 
            computed under subparagraph (D) into a wage-related portion 
            and a non-wage-related portion by applying the proportion 
            determined under subparagraph (B);
                (ii) by multiplying the wage-related portion by the 
            factor described in subparagraph (C)(ii) for the hospital's 
            area; and
                (iii) by adding the non-wage-related portion to the 
            amount computed under clause (ii).

        (F) Updating rate

            The Secretary shall update such per resident amount for each 
        such children's hospital by the estimated percentage increase in 
        the consumer price index for all urban consumers during the 
        period beginning October 1997 and ending with the midpoint of 
        the hospital's cost reporting period that begins during fiscal 
        year 2000.

(d) Amount of payment for indirect medical education

                           (1) In general

        The amount determined under this subsection for payments to a 
    children's hospital for indirect expenses associated with the 
    treatment of more severely ill patients and the additional costs 
    related to the teaching of residents for a fiscal year is equal to 
    an amount determined appropriate by the Secretary.

                             (2) Factors

        In determining the amount under paragraph (1), the Secretary 
    shall--
            (A) take into account variations in case mix among 
        children's hospitals and the number of full-time equivalent 
        residents in the hospitals' approved graduate medical residency 
        training programs; and
            (B) assure that the aggregate of the payments for indirect 
        expenses associated with the treatment of more severely ill 
        patients and the additional costs related to the teaching of 
        residents under this section in a fiscal year are equal to the 
        amount appropriated for such expenses for the fiscal year 
        involved under subsection (f)(2) of this section.

(e) 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 26 equal interim installments during such period.

                           (2) Withholding

        The Secretary shall withhold up to 25 percent from each interim 
    installment for direct graduate medical education paid under 
    paragraph (1).

                         (3) Reconciliation

        At the end of each fiscal year for which payments may be made 
    under this section, the hospital shall submit to the Secretary such 
    information as the Secretary determines to be necessary to determine 
    the percent (if any) of the total amount withheld under paragraph 
    (2) that is due under this section for the hospital for the fiscal 
    year. Based on such determination, the Secretary shall recoup any 
    overpayments made, or pay any balance due. The amount so determined 
    shall be considered a final intermediary determination for purposes 
    of applying section 1395oo of this title and shall be subject to 
    review under that section in the same manner as the amount of 
    payment under section 1395ww(d) of this title is subject to review 
    under such section.

(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) of this section--
                (i) for fiscal year 2000, $90,000,000; and
                (ii) for fiscal year 2001, $95,000,000.

        (B) Carryover of excess

            The amounts appropriated under subparagraph (A) for fiscal 
        year 2000 shall remain available for obligation through the end 
        of fiscal year 2001.

                   (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)(A) of this section--
            (A) for fiscal year 2000, $190,000,000; and
            (B) for fiscal year 2001, $190,000,000.

(g) 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 1395ww(h)(5)(A) of this 
    title.

                       (2) Children's hospital

        The term ``children's hospital'' means a hospital described in 
    section 1395ww(d)(1)(B)(iii) of this title.

             (3) Direct graduate medical education costs

        The term ``direct graduate medical education costs'' has the 
    meaning given such term in section 1395ww(h)(5)(C) of this title.

(July 1, 1944, ch. 373, title III, Sec. 340E, as added Pub. L. 106-129, 
Sec. 4, Dec. 6, 1999, 113 Stat. 1671.)
