#aacth ,,congress  #ast ,session  ,s4   
#aeeg  ,,an ,,act  ,to amend the ,public
 ,health ,service ,act to reauthorize   
support for graduate medical education  
programs in children's hospitals4  #a4  
,short title ,this ,act may be cited as 
the ,children's ,hospital ,,gme ,support
 ,reauthorization ,act of #bjac4  #b4   
,program of payments to children's      
hospitals that operate graduate medical 
education programs  7a7 ,in general     
,section #cdj;,e of the ,public ,health 
,service ,act 7#db ,u4,s4,c4 #bef;e7 is 
amended-- 7#a7 in subsection 7a71 by    
striking through #bjje and each of      
fiscal years #bjjg through #bjaa and    
inserting through #bjje1 each of fiscal 
years #bjjg through #bjaa1 and each of  
fiscal years #bjad through #bjah2 and   
7#b7 in subsection 7f7-- 7,a7 in        
paragraph 7#a77;,a7-- 7i7 in clause     
7iii71 by striking and2  7ii7 in clause 
7iv71 by striking the period and        
inserting 2 and2 and  7iii7 by adding at
 the end the following3  7v7 for each of

 fiscal years #bjad through #bjah1      
#ajj1jjj1jjj4  2 and  7,b7 in paragraph 
7#b7-- 7i7 in subparagraph 7,c71 by     
striking and2  7ii7 in subparagraph     
7,d71 by striking the period and        
inserting 2 and2 and  7iii7 by adding at
 the end the following3  7,e7 for each  
of fiscal years #bjad through #bjah1    
#bjj1jjj1jjj4  4  7b7 ,report to        
,congress ,section #cdj;,e7b77#c77;,d7  
of the ,public ,health ,service ,act    
7#db ,u4,s4,c4 #bef;e7b77#c77;,d77 is   
amended by striking ,not later than the 
end of fiscal year #bjaa and inserting  
,not later than the end of fiscal year  
#bjah4  #c4 ,support of ,graduate       
,medical ,education ,programs in certain
 hospitals ,section #cdj;,e of the      
,public ,health ,service ,act 7#db      
,u4,s4,c4 #bef;e7 is amended by adding  
at the end the following3  7h7          
,additional provisions  7#a7 ,in general
 ,the ,secretary is authorized to make  
available up to #be percent of the total
 amounts in excess of #bde1jjj1jjj      

appropriated under paragraphs 7#a7 and  
7#b7 of subsection 7f71 but not to      
exceed #g1jjj1jjj1 for payments to      
hospitals qualified as described in     
paragraph 7#b71 for the direct and      
indirect expenses associated with       
operating approved graduate medical     
residency training programs1 as         
described in subsection 7a74  7#b7      
,qualified hospitals  7,a7 ,in general  
,to qualify to receive payments under   
paragraph 7#a71 a hospital shall be a   
free-standing hospital-- 7i7 with a     
,medicare payment agreement and that is 
excluded from the ,medicare inpatient   
hospital prospective payment system     
pursuant to section #ahhf7;d77#a77;,b7  
of the ,social ,security ,act and its   
accompanying regulations2  7ii7 whose   
inpatients are predominantly individuals
 under #ah years of age2  7iii7 that has
 an approved medical residency training 
program as defined in section           
#ahhf7;h77#e77;,a7 of the ,social       
,security ,act2 and  7iv7 that is not   

otherwise qualified to receive payments 
under this section or section #ahhf7;h7 
of the ,social ,security ,act4  7,b7    
,establishment of residency cap ,in the 
case of a freestanding children's       
hospital that1 on the date of enactment 
of this subsection1 meets the           
requirements of subparagraph 7,a7 but   
for which the ,secretary has not        
determined an average number of         
full-time equivalent residents under    
section #ahhf7;h77#d7 of the ,social    
,security ,act1 the ,secretary may      
establish such number of full-time      
equivalent residents for the purposes of
 calculating payments under this        
subsection4  7#c7 ,payments ,payments to
 hospitals made under this subsection   
shall be made in the same manner as     
payments are made to children's         
hospitals1 as described in subsections  
7b7 through 7e74  7#d7 ,payment amounts 
,the direct and indirect payment amounts
 under this subsection shall be         
determined using per resident amounts   

that are no greater than the per        
resident amounts used for determining   
direct and indirect payment amounts     
under subsection 7a74  7#e7 ,reporting  
,a hospital receiving payments under    
this subsection shall be subject to the 
reporting requirements under subsection 
7b77#c74  7#f7 ,remaining funds  7,a7   
,in general ,if the payments to         
qualified hospitals under paragraph 7#a7
 for a fiscal year are less than the    
total amount made available under such  
paragraph for that fiscal year1 any     
remaining amounts for such fiscal year  
may be made available to all hospitals  
participating in the program under this 
subsection or subsection 7a74  7,b7     
,quality bonus system ,for purposes of  
distributing the remaining amounts      
described in subparagraph 7,a71 the     
,secretary may establish a quality bonus
 system1 whereby the ,secretary         
distributes bonus payments to hospitals 
participating in the program under this 
subsection or subsection 7a7 that meet  

standards specified by the ,secretary1  
which may include a focus on quality    
measurement and improvement1            
interpersonal and communications skills1
 delivering patient-centered care1 and  
practicing in integrated health systems1
 including training in community-based  
settings4 ,in developing such standards1
 the ,secretary shall collaborate with  
relevant stakeholders1 including program
 accrediting bodies1 certifying boards1 
training programs1 health care          
organizations1 health care purchasers1  
and patient and consumer groups4  4     
,passed the ,senate ,november #ab1      
#bjac4,secretary