LegiStorm

Summary:

The Children’s Hospitals Graduate Medical Education (CHGME) program provides direct financial support to children’s hospitals to train medical residents and fellows. The program is administered by the Health Resources and Services Administration (HRSA) within the Department of Health and Human Services (HHS) and is authorized in Section 340E of the Public Health Service Act (PHSA). CHGME receives annual discretionary appropriations and received $299.3 million in FY2017. The program is currently funded at $135 million for FY2018 under P.L. 115-141, which provided full-year appropriations for FY2018. Hospitals typically receive support for graduate medical education (GME) through Medicare, and those payments are provided to hospitals based on their Medicare patient volume. Because the Medicare program is used primarily by people who are over the age of 65, and children’s hospitals treat primarily people below the age of 18, children’s hospitals have low Medicare patient volume and receive few Medicare GME payments. Prior to the CHGME program, advocates argued that the lack of direct federal support for GME in children’s hospitals impeded the development of the pediatric workforce. Program proponents argued that children’s hospitals, rather than general hospitals, are more likely to have the patient volume necessary to train pediatric subspecialists. Since the program was created in 1999, the size of the pediatric subspecialty workforce has increased. The CHGME program supports the training of nearly half of general pediatricians and more than half of all pediatric subspecialists. In the most recent year for which final training data are available (academic year 2016-2017), the program provided financial support to more than 7,100 medical residents and fellows. In FY2017, the program supported training at 58 free-standing children’s hospitals located in 29 states, the District of Columbia, and Puerto Rico. The program’s appropriations are authorized through FY2018. Legislation to reauthorize the CHGMEth program is under consideration in the 115 Congress. On July 23, 2018, the Dr. Benjy Frances Brooks Children’s Hospital GME Support Reauthorization Act of 2018 (H.R. 5385) passed the House. S. 2597 was introduced in the Senate and reported by the Senate Committee on Health, Education, Labor and Pensions on April 25, 2018. Both bills would reauthorize the program through FY2023 and would increase the program’s authorized appropriations. The House bill would authorize an annual appropriation of $325 million, allocating $105 million for Direct Graduate Medical Education Payments (DGME) and $220 million for Indirect Graduate Medical Education Payments (IME). Neither bill would make substantive changes to the program. The Senate-reported bill would authorize an annual appropriation of $330 million, allocating $110 million for DGME and $220 million for IME. The President’s budget for FY2019 proposed to eliminate funding for this program; instead, it proposed that CHGME funds be combined with other sources of GME support, which would require new legislation. As part of considering the consolidation proposal and the program’s potential reauthorization, Congress may evaluate a number of related policy issues. These include, but are not limited to, whether the program size is appropriate (i.e., whether the current number of residents trained is appropriate to meet the current and future workforce needs), whether the program’s level of support per resident is appropriate, and whether the volume and type of information that the CHGME program collects is appropriate and being utilized effectively.