1.Short
title; table of contents
(a)This Act may be cited
as the Graduate Medical Education
Reform Act of 2010
.
(b)The table of contents of this Act is as follows:
Sec. 1. Short title; table of
contents.
Sec. 2. Medicare indirect medical education performance
adjustment and primary care training bonus.
Sec. 3. Payments for graduate medical education to hospitals
not otherwise eligible for payments under the Medicare program.
Sec. 4. Increasing graduate medical education
transparency.
Sec. 5. Establishment of trust fund.
Sec. 6. Partial financing for trust fund from fees on insured
and self-insured health plans.
2.Medicare
indirect medical education performance adjustment and primary care training
bonusSection 1886(d)(5)(B) of
the Social Security Act (42 U.S.C. 1395ww(d)(1)(B)) is amended—
(1)by redesignating
the clause (x) as added by section 5505(b) of the Patient Protection and
Affordable Care Act as clause (xi); and
(2)by adding at the
end the following new clauses:
(xii)Adjustment for
performance
(I)The
Secretary shall establish and implement procedures under which the amount of
payments that a hospital would otherwise receive for indirect medical education
costs under this subparagraph for discharges occurring during an applicable
period is adjusted based on the performance of the hospital on measures of
health care work force priorities specified by the Secretary.
(II)The
measures of health care workforce priorities specified by the Secretary under
this clause shall include the extent of training provided in—
- (aa)primary care (as defined in subclause
(VII)), excluding fellowships;
- (bb)a variety of settings and
systems;
- (cc)the coordination of patient care across
settings;
- (dd)the relevant cost and value of various
diagnostic and treatment options;
- (ee)interprofessional and multidisciplinary
care teams;
- (ff)methods for identifying system errors
and implementing system solutions; and
- (gg)the use of health information
technology.
(III)Measure development
procedures
- (aa)The measures
of health care workforce priorities specified by the Secretary under this
clause shall be measures that have been adopted or endorsed by a consensus
organization (such as the Accreditation Council for Graduate Medical Education
or the Commission on Osteopathic College Accreditation), that include measures
that have been submitted by teaching hospitals and medical schools, and that
the Secretary identifies as having used a consensus-based process for
developing such measures.
- (bb)Not later than January 1, 2013, the Secretary shall
publish in the Federal Register a proposed set of measures for use under this
clause. The Secretary shall provide for a period of public comment on such
measures.
- (cc)Not later than June 30, 2013, the Secretary shall
publish in the Federal Register the set of measures to be specified by the
Secretary for use under this clause.
(IV)Subject
to subclause (V), the Secretary shall determine the amount of any adjustment
under this clause to payments to a hospital under this subparagraph in an
applicable period. Such adjustment may not exceed an amount equal to 3 percent
of the total amount that the hospital would otherwise receive under this
subparagraph in such period.
(V)In
making adjustments under this clause, the Secretary shall ensure that the total
amount of payments made to all hospitals under this subparagraph for an
applicable period is equal to the total amount of payments that would have been
made to such hospitals under this subparagraph in such period if this clause
and clause (xii)(III) had not been enacted.
(VI)In this clause, the term primary care means
family medicine, general internal medicine, general pediatrics, preventive
medicine, obstetrics and gynecology, and psychiatry.
(VII)Applicable period
definedIn this clause, the term applicable period
means the 12-month period beginning on July 1 of each year (beginning with
2013).
(xiii)Bonus payment for training in
primary care
(I)Subject
to subclause (III), in the case of discharges occurring during an applicable
period, in addition to the amount of payments that a hospital receives for
indirect medical education costs under this subparagraph for such discharges
(determined after any adjustment under clause (xii)), there shall also be paid
to the hospital an amount equal to 1 percent of such payments if, during such
applicable period, at least 33 percent of full-time equivalent residents
(excluding fellowships) enrolled in the hospital's medical residency training
programs were enrolled in medical residency training programs in primary care
(as defined in clause (xii)(VI)).
(II)Payments from Medical Education Trust
FundPayments to hospitals
under subclause (I) shall be made from the Medical Education Trust Fund under
section 9512 of the Internal Revenue Code of 1986.
(III)The
total of the payments made to eligible hospitals under subclause (I) with
respect to an applicable period shall not exceed an amount equal to the funds
appropriated to such Trust Fund under subsection (b)(1) of such section 9512
for the fiscal year ending on September 30 of such applicable
period.
.
3.Payments for
graduate medical education to hospitals not otherwise eligible for payments
under the Medicare programTitle XVIII of the Social Security Act (42
U.S.C. 1395 et seq.) is amended by adding at the end the following new
section:
1899B.Graduate medical education payments for hospitals not
otherwise eligible(a)
(1)The Secretary shall establish a program under which
payments are made to eligible hospitals for each applicable period for direct
expenses and indirect expenses associated with operating approved graduate
medical residency training programs.
(2)Under
the program under paragraph (1), the provisions of section 340E of the Public
Health Service Act shall apply to payments to eligible hospitals in a similar
manner as such provisions apply to payments to children's hospitals under such
section 340E, except that—
(A)payments to
eligible hospitals under the program shall be made from the Medical Education
Trust Fund under section 9512 of the Internal Revenue Code of 1986; and
(B)the total of the
payments made to eligible hospitals under the program in an applicable period
shall not exceed an amount equal to—
(i)the funds
appropriated to such Trust Fund under subsection (b)(1) of such section 9512
for the fiscal year ending on September 30 of such applicable period;
minus
(ii)the total amount
of payments made to hospitals under section 1886(d)(5)(B)(xiii) in applicable
period.
(b)Eligible
hospital definedIn this section, the term eligible
hospital means the following hospitals:
(1)A children's
hospital (as defined in section 340E(g)(2) of the Public Health Service
Act).
(2)A freestanding
psychiatric hospital that has—
(A)90 percent or
more inpatients under the age of 18;
(B)its own Medicare
provider number as of December 6, 1999; and
(C)an accredited
residency program.
(3)A
hospital—
(A)that annually has
at least 3,000 births;
(B)for which less
than 4 percent of the total annual discharges from the hospital are Medicare
discharges of individuals who, as of the time of the discharge—
(i)were entitled to,
or enrolled for, benefits under part A; and
(ii)were not
enrolled in—
(I)a Medicare
Advantage plan under part C;
(II)an eligible
organization under section 1876; or
(III)a PACE program
under section 1894;
(C)that has its own
Medicare provider number; and
(D)that has an
accredited residency program.
(c)Applicable
period definedIn this section, the term applicable
period has the meaning given that term in section
1886(d)(5)(B)(xii)(VII).
(d)The
Secretary shall promulgate regulations to carry out this
section.
.
4.Increasing
graduate medical education transparency
(a)Not later than 2 years after the date of the enactment of
this Act, and annually thereafter, the Secretary of Health and Human Services
shall submit to Congress and the National Health Care Workforce Commission
under section 5101 of the Patient Protection and Affordable Care Act a report
on the graduate medical education payments that hospitals receive under the
Medicare program. The report shall include the following information with
respect to each hospital that receives such payments:
(1)The direct
graduate medical education payments made to the hospital under section 1886(h)
of the Social Security Act (42 U.S.C. 1395ww(h)).
(2)The indirect
medical education payments made to the hospital under section 1886(d)(5)(B) of
such Act (42 U.S.C. 1395ww(d)(1)(B)).
(3)The number of
residents counted for purposes of making the payments described in paragraph
(1).
(4)The number of
residents counted for purposes of making the payments described in paragraph
(2).
(5)The number of
residents, if any, that are not counted for purposes of making payments
described in paragraph (1).
(6)The number of
residents, if any, that are not counted for purposes of making payments
described in paragraph (2).
(7)The percent that
the payments described in paragraphs (1) and (2) that are made to the hospital
make up of the total costs that the hospital incurs in providing graduate
medical education, including salaries, benefits, operational expenses, and all
other patient care costs.
5.Establishment of
trust fund
(a)Subchapter A of chapter 98 of the Internal Revenue Code
of 1986 (relating to establishment of trust funds) is amended by adding at the
end the following new section:
9512.Medical
education trust fund
(a)There is established in the Treasury of the United
States a trust fund to be known as the Medical Education Trust
Fund (hereafter in this section referred to as the Trust
Fund), consisting of such amounts as may be appropriated or credited to
such Trust Fund as provided in this section and section 9602(b).
(b)
(1)There
are hereby appropriated to the Trust Fund in each fiscal year (beginning with
fiscal year 2013) the sum of an amount equivalent to one-half (or, in the case
of fiscal year 2013, two-thirds) of the net revenues received in the Treasury
from the fees imposed under subchapter B of chapter 34 (relating to fees on
health insurance and self-insured plans).
(2)No amount may be appropriated or transferred to the
Trust Fund on and after the date of any expenditure from the Trust Fund which
is not an expenditure permitted under this section. The determination of
whether an expenditure is so permitted shall be made without regard to—
(A)any provision of
law which is not contained or referenced in this chapter or in a revenue Act;
and
(B)whether such
provision of law is a subsequently enacted provision or directly or indirectly
seeks to waive the application of this paragraph.
(c)The
Secretary of Health and Human Services shall be a trustee of the Trust
Fund.
(d)Expenditures
from trust fundAmounts in the Trust Fund are available, without
further appropriation, to the Secretary of Health and Human Services for making
payments under sections 1886(d)(5)(B)(xiii) and 1899B of the Social Security
Act.
(e)For purposes of this section, the term net
revenues means the amount estimated by the Secretary of the Treasury
based on the excess of—
(1)the fees received
in the Treasury under subchapter B of chapter 34, over
(2)the decrease in
the tax imposed by chapter 1 resulting from the fees imposed by such
subchapter.
.
(b)The table of sections for subchapter A of chapter 98 of
the Internal Revenue Code of 1986 is amended by adding at the end the following
new item:
Sec. 9512. Medical Education
Trust
Fund.
.
6.Partial
financing for trust fund from fees on insured and self-insured health
plans
(a)Section 4375(a) of the Internal Revenue Code of 1986 is
amended—
(1)by striking
$2
and inserting $4
; and
(2)by striking
$1
and inserting $3
.
(b)Conforming
amendment to the Patient-Centered Outcomes Research Trust
FundSection 9511(b)(1)(E) of the Internal Revenue Code of 1986
is amended by inserting one-half (or, in the case of fiscal year 2013,
one-third) of
after equivalent to
.