[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1645 Introduced in House (IH)]







106th CONGRESS
  1st Session
                                H. R. 1645

  To amend title XVIII of the Social Security Act to provide for full 
payment rates under Medicare to hospitals for costs of direct graduate 
   medical education of residents for residency training programs in 
 specialties or subspecialties which the Secretary of Health and Human 
Services designates as critical need specialty or subspecialty training 
                               programs.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 29, 1999

   Mr. Stark (for himself, Mr. McDermott, Mr. Lewis of Georgia, Mrs. 
    Thurman, Ms. Kaptur, Ms. Jackson-Lee of Texas, Mr. Filner, Mr. 
Cummings, Ms. Brown of Florida, Mr. Frost, and Mr. Hilliard) introduced 
  the following bill; which was referred to the Committee on Ways and 
Means, and in addition to the Committee on Commerce, for a period to be 
subsequently determined by the Speaker, in each case for consideration 
  of such provisions as fall within the jurisdiction of the committee 
                               concerned

_______________________________________________________________________

                                 A BILL


 
  To amend title XVIII of the Social Security Act to provide for full 
payment rates under Medicare to hospitals for costs of direct graduate 
   medical education of residents for residency training programs in 
 specialties or subspecialties which the Secretary of Health and Human 
Services designates as critical need specialty or subspecialty training 
                               programs.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Critical Need GME 
Protection Act of 1999''.

SEC. 2. FULL FTE PAYMENT FOR RESIDENTS IN CRITICAL NEED SPECIALTY OR 
              SUBSPECIALTY TRAINING PROGRAMS.

    (a) Treatment as Initial Residency Period.--
            (1) In general.--Section 1886(h)(5)(F) of the Social 
        Security Act (42 U.S.C. 1395ww(h)(5)(F)) is amended--
                    (A) in clause (i)--
                            (i) by striking ``clause (ii)'' and 
                        inserting ``clause (ii) or (iii)''; and
                            (ii) by striking ``and'' at the end;
                    (B) in clause (ii), by striking the period at the 
                end and inserting ``, and''; and
                    (C) by inserting after clause (ii), the following 
                new clause:
                            ``(iii) subject to the requirement for 
                        budget neutrality under paragraph (7), a period 
                        of years, determined by the Secretary under 
                        subparagraph (K)(iv), during which an 
                        individual is in a residency training program 
                        designated by the Secretary as a critical need 
                        specialty or subspecialty, as defined in 
                        subparagraph (K), shall be treated as part of 
                        the initial residency period, but shall not be 
                        counted against any limitation on the initial 
                        residency period.''.
            (2) Determination of critical need specialty or 
        subspecialty.--Section 1886(h)(5) of such Act (42 U.S.C. 
        1395ww(h)(5)) is amended by adding at the end the following new 
        subparagraph:
                    ``(K) Critical need speciality.--
                            ``(i) Definition.--The term `critical need 
                        specialty or subspecialty' means a specialty or 
                        subspecialty designated by the Secretary under 
                        this subparagraph with a current or imminent 
                        critical shortage of physicians.
                            ``(ii) Criteria.--For purposes of 
                        designating a critical need specialty or 
                        subspecialty under this subparagraph, the 
                        Secretary shall prescribe criteria for 
                        determining critical shortages of physicians or 
                        residents in approved medical residency 
                        training programs. The Secretary shall publish 
                        in the Federal Register the criteria 
                        established under this clause and the form and 
                        manner by which data is submitted for the 
                        Secretary's review under this subparagraph.
                            ``(iii) Period of designation.--
                                    ``(I) In general.--A designation of 
                                a critical need specialty or 
                                subspecialty under this subparagraph 
                                shall apply until the Secretary 
                                determines the specialty or 
                                subspecialty does not meet the criteria 
                                for designation as a critical need 
                                specialty or subspecialty.
                                    ``(II) Report.--In the event the 
                                Secretary determines that a specialty 
                                or subspecialty no longer meets the 
                                criteria for being a critical need 
                                specialty or subspecialty, the 
                                Secretary shall submit a report to 
                                Congress describing the reasons for 
                                discontinuing the designation.''.
    (b) Maintaining Budget Neutrality.--Section 1886(h) of such Act (42 
U.S.C. 1395ww(h)) is amended by adding at the end the following new 
paragraph:
    ``(7) Budget Neutrality Adjustment for Critical Need Specialty or 
Subspecialty Designation.--If the Secretary designates a critical need 
specialty or subspecialty for a fiscal year, the Secretary shall make a 
proportional adjustment to payment amounts under this subsection for 
such fiscal year so that the aggregate of the payments under this 
subsection for such fiscal year shall equal the aggregate payments that 
would have been made under this subsection for such fiscal year if the 
Secretary had not designated a critical need specialty or 
subspecialty.''.
    (c) Effective Date.--The amendments made by this Act shall apply 
with respect to payments under section 1886(h) of the Social Security 
Act (42 U.S.C. 1395ww(h)) made for residents in, or beginning training 
in, a critical need specialty or subspecialty on or after July 1, 2000.
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