II 110th CONGRESS 1st Session S. 588 IN THE SENATE OF THE UNITED STATES February 14, 2007 Mr. Nelson of Florida (for himself, Mr. Reid, and Mr. Biden) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XVIII of the Social Security Act to increase the Medicare caps on graduate medical education positions for States with a shortage of residents.

1.

Short title

This Act may be cited as the Resident Physician Shortage Reduction Act of 2007.

2.

Increasing the Medicare caps on graduate medical education positions for states with a shortage of residents

(a)

Direct Graduate Medical Education

Section 1886(h)(4)(F) of the Social Security Act (42 U.S.C. 1395ww(h)(4)(F)) is amended— (1)in clause (i), by inserting clause (iii) and after subject to; and (2)by adding at the end the following new clause: (iii)

Increase in caps on graduate medical education positions for states with a shortage of residents

(I)

In general

For cost reporting periods beginning on or after the date that is 16 months after the date of enactment of the Resident Physician Shortage Reduction Act of 2007, the Secretary shall increase the otherwise applicable limit on the total number of full-time equivalent residents in the field of allopathic or osteopathic medicine determined under clause (i) with respect to a qualifying hospital in an eligible State by an amount determined appropriate by the Secretary. Such increase shall be phased-in over a period of 5 cost reporting periods beginning with the first cost reporting period in which the increase is applied under the previous sentence to the hospital. For each eligible State the aggregate number of such increases shall be— (aa)not less than 15; and (bb)not greater than the State resident cap increase. (II)

Qualifying hospital

In this clause, the term qualifying hospital means a hospital located in an eligible State that the Secretary determines should receive an increase under this clause in the otherwise applicable limit on the total number of full-time equivalent residents in the field of allopathic or osteopathic medicine. (III)

Eligible State

In this clause, the term eligible State means a State for which the National median medical resident ratio exceeds the State medical resident ratio. (IV)

State resident cap increase

In this clause, the term State resident cap increase means, with respect to a State, 1/4 of the product of— (aa)the difference between the National median medical resident ratio and the State medical resident ratio; and (bb)the State population (as determined for purposes of subclause (VI)). (V)

National median medical resident ratio

In this clause, the term National median medical resident ratio means the median of all State medical resident ratios. (VI)

State medical resident ratio

In this clause, the term State medical resident ratio means, with respect to any State, the ratio of full-time equivalent residents in the State in approved medical residency training programs as of the date of enactment of the Resident Physician Shortage Reduction Act of 2007 to the population of the State as of such date, as determined by the Secretary. (VII)

State

In this clause, the term State means a State and the District of Columbia. (VIII)

Considerations in determining resident cap increases

In determining whether a hospital is a qualifying hospital, and how much of an increase in the resident cap a qualifying hospital shall receive under subclause (I), the Secretary shall take into consideration the demonstrated likelihood of the hospital filling resident positions that would be made available as a result of such increase within the first 3 cost reporting periods beginning on or after the date that is 16 months after the date of enactment of the Resident Physician Shortage Reduction Act of 2007. The Secretary shall also take into consideration whether the new resident positions will be in primary care, preventive medicine, or geriatrics programs. . (b)

Indirect Medical Education

Section 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) is amended by adding at the end the following new clause: (x)Clause (iii) of subsection (h)(4)(F) shall apply to clause (v) in the same manner and for the same period as such clause (iii) applies to clause (i) of such subsection. .