,,ii  #aac? ,,congress  #a/ ,session    
,s4 #aeeg  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,septemb] #bg1         
#bjac,mr4 ,casey 7= himself1 ,mr4       
,isakson1 ,mr4 ,:iteh\se1 ,mr4 ,alex&]1 
,mr4 ,br[n1 ,mr4 ,kirk1 ,mr4 ,h>k91 ,mr4
 ,blunt1 ,ms4 ,w>r51 ,mr4 ,rob]ts1 ,mr4 
,blum5?al1 ,mr4 ,murphy1 & ,mr4 ,re$7   
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,heal?1 ,education1 ,labor1 & ,p5sions  
,a ,,bill  ,to am5d ! ,public ,heal?    
,s]vice ,act to reau?orize support =    
graduate m$ical education programs 9    
*ildr5's hospitals4  #a4 ,%ort title    
,?is ,act may be cit$ z ! ,*ildr5's     
,hospital ,,gme ,support ,reau?orization
 ,act ( #bjac4  #b4 ,program ( paym5ts  
to *ildr5's hospitals t op]ate graduate 
m$ical education programs  7a7 ,9 g5]al 
,section #cdj;,e ( ! ,public ,heal?     
,s]vice ,act 7#db ,u4,s4,c4 #bef;e7 is  
am5d$-- 7#a7 9 subsection 7a71 by /rik+ 
?r\gh #bjje & ea* ( fiscal ye>s #bjjg   
?r\gh #bjaa & ins]t+ ?r\gh #bjje1 ea* ( 

fiscal ye>s #bjjg ?r\gh #bjaa1 & ea* (  
fiscal ye>s #bjad ?r\gh #bjah2 &  7#b7 9
 subsection 7f7-- 7,a7 9 p>agraph       
7#a77;,a7-- 7i7 9 clause 7iii71 by /rik+
 &2  7ii7 9 clause 7iv71 by /rik+ !     
p]iod & ins]t+ 2 &2 &  7iii7 by add+ at 
! end ! foll[+3  7v7 = ea* ( fiscal ye>s
 #bjad ?r\gh #bjah1 #ajj1jjj1jjj4  2 &  
7,b7 9 p>agraph 7#b7-- 7i7 9 subp>agraph
 7,c71 by /rik+ &2  7ii7 9 subp>agraph  
7,d71 by /rik+ ! p]iod & ins]t+ 2 &2 &  
7iii7 by add+ at ! end ! foll[+3  7,e7 =
 ea* ( fiscal ye>s #bjad ?r\gh #bjah1   
#bjj1jjj1jjj4  4  7b7 ,report to        
,congress ,section #cdj;,e7b77#c77;,d7 (
 ! ,public ,heal? ,s]vice ,act 7#db     
,u4,s4,c4 #bef;e7b77#c77;,d77 is am5d$  
by /rik+ ,n lat] ?an ! end ( fiscal ye> 
#bjaa & ins]t+ ,n lat] ?an ! end (      
fiscal ye> #bjah4  #c4 ,support (       
,graduate ,m$ical ,education ,programs 9
 c]ta9 hospitals ,section #cdj;,e ( !   
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #bef;e7 is am5d$ by add+ at ! 
end ! foll[+3  7h7 ,additional          

provisions  7#a7 ,9 g5]al ,! ,secret>y  
is au?oriz$ to make available up to #be 
p]c5t ( ! total am\nts 9 excess (       
#bde1jjj1jjj appropriat$ "u p>agraphs   
7#a7 & 7#b7 ( subsection 7f71 b n to    
exce$ #g1jjj1jjj1 = paym5ts to hospitals
 qualifi$ z describ$ 9 p>agraph 7#b71 = 
! direct & indirect exp5ses associat$ ) 
op]at+ approv$ graduate m$ical resid5cy 
tra9+ programs1 z describ$ 9 subsection 
7a74  7#b7 ,qualifi$ hospitals  7,a7 ,9 
g5]al ,to qualify to receive paym5ts "u 
p>agraph 7#a71 a hospital %all be a     
free-/&+ hospital-- 7i7 ) a ,m$ic>e     
paym5t agreem5t & t is exclud$ f !      
,m$ic>e inpati5t hospital prospective   
paym5t sy/em pursuant to section        
#ahhf7;d77#a77;,b7 ( ! ,social ,security
 ,act & its accompany+ regulations2     
7ii7 ^: inpati5ts are pr$om9antly       
individuals "u #ah ye>s ( age2  7iii7 t 
has an approv$ m$ical resid5cy tra9+    
program z def9$ 9 section               
#ahhf7;h77#e77;,a7 ( ! ,social ,security
 ,act2 &  7iv7 t is n o!rwise qualifi$  

to receive paym5ts "u ?is section or    
section #ahhf7;h7 ( ! ,social ,security 
,act4  7,b7 ,e/abli%m5t ( resid5cy cap  
,9 ! case ( a free/&+ *ildr5's hospital 
t1 on ! date ( enactm5t ( ?is           
subsection1 meets ! requirem5ts (       
subp>agraph 7,a7 b = :i* ! ,secret>y has
 n det]m9$ an av]age numb] ( full-"t    
equival5t resid5ts "u section           
#ahhf7;h77#d7 ( ! ,social ,security     
,act1 ! ,secret>y may e/abli% su* numb] 
( full-"t equival5t resid5ts = !        
purposes ( calculat+ paym5ts "u ?is     
subsection4  7#c7 ,paym5ts ,paym5ts to  
hospitals made "u ?is subsection %all be
 made 9 ! same mann] z paym5ts are made 
to *ildr5's hospitals1 z describ$ 9     
subsections 7b7 ?r\gh 7e74  7#d7 ,paym5t
 am\nts ,! direct & indirect paym5t     
am\nts "u ?is subsection %all be det]m9$
 us+ p] resid5t am\nts t are no great]  
?an ! p] resid5t am\nts us$ = det]m9+   
direct & indirect paym5t am\nts "u      
subsection 7a74  7#e7 ,report+ ,a       
hospital receiv+ paym5ts "u ?is         

subsection %all be subject to ! report+ 
requirem5ts "u subsection 7b77#c74  7#f7
 ,rema9+ funds  7,a7 ,9 g5]al ,if !     
paym5ts to qualifi$ hospitals "u        
p>agraph 7#a7 = a fiscal ye> are less   
?an ! total am\nt made available "u su* 
p>agraph = t fiscal ye>1 any rema9+     
am\nts = su* fiscal ye> may be made     
available to all hospitals p>ticipat+ 9 
! program "u ?is subsection or          
subsection 7a74  7,b7 ,quality bonus    
sy/em ,= purposes ( di/ribut+ ! rema9+  
am\nts describ$ 9 subp>agraph 7,a71 !   
,secret>y may e/abli% a quality bonus   
sy/em1 :]eby ! ,secret>y di/ributes     
bonus paym5ts to hospitals p>ticipat+ 9 
! program "u ?is subsection or          
subsection 7a7 t meet /&>ds specifi$ by 
! ,secret>y1 :i* may include a focus on 
quality measurem5t & improvem5t1        
int]p]sonal & communications skills1    
deliv]+ pati5t-c5t]$ c>e1 & practic+ 9  
integrat$ heal? sy/ems1 includ+ tra9+ 9 
community-bas$ sett+s4 ,9 develop+ su*  
/&>ds1 ! ,secret>y %all collaborate )   

relevant /akehold]s1 includ+ program    
accr$it+ bodies1 c]tify+ bo>ds1 tra9+   
programs1 heal? c>e organizations1 heal?
 c>e pur*as]s1 & pati5t & consum] gr\ps4
  4