[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3425 Introduced in House (IH)]

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116th CONGRESS
  1st Session
                                H. R. 3425

To amend title XVIII of the Social Security Act to establish rules for 
 payment for graduate medical education (GME) costs for hospitals that 
   establish a new medical residency training program after hosting 
                 resident rotators for short durations.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 21, 2019

 Mr. Kind (for himself and Mr. Holding) introduced the following bill; 
which was referred to the Committee on Ways and Means, and in addition 
      to the Committee on Energy and 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 establish rules for 
 payment for graduate medical education (GME) costs for hospitals that 
   establish a new medical residency training program after hosting 
                 resident rotators for short durations.

    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 ``Advancing Medical Resident Training 
in Community Hospitals Act of 2019''.

SEC. 2. MEDICARE GME TREATMENT OF HOSPITALS ESTABLISHING NEW MEDICAL 
              RESIDENCY TRAINING PROGRAMS AFTER HOSTING MEDICAL 
              RESIDENT ROTATORS FOR SHORT DURATIONS.

    (a) Redetermination of Approved FTE Resident Amount.--Section 
1886(h)(2)(F) of the Social Security Act (42 U.S.C. 1395ww(h)(2)(F)) is 
amended--
            (1) by inserting ``(i)'' before ``In the case of''; and
            (2) by adding at the end the following:
                    ``(ii) In applying this subparagraph in the case of 
                a hospital that, on or after the date of the enactment 
                of this clause, begins to train residents and has not 
                entered into a GME affiliation agreement (as defined by 
                the Secretary for purposes of paragraph (4)(H)(ii)), 
                the Secretary shall not establish an FTE resident 
                amount until such time as the Secretary determines that 
                the hospital has trained at least 1.0 full-time-
                equivalent resident in an approved medical residency 
                training program in a cost reporting period.
                    ``(iii) In applying this subparagraph for cost 
                reporting periods beginning on or after the date of 
                enactment of this clause, in the case of a hospital 
                that, as of such date of enactment, has an approved FTE 
                resident amount based on the training in an approved 
                medical residency program of--
                            ``(I) less than 1.0 full-time-equivalent 
                        resident in any cost reporting period beginning 
                        before October 1, 1997, as determined by the 
                        Secretary; or
                            ``(II) no more than 3.0 full-time-
                        equivalent residents in any cost reporting 
                        period beginning on or after October 1, 1997, 
                        and before the date of the enactment of this 
                        clause, as determined by the Secretary,
                in lieu of such FTE resident amount the Secretary 
                shall, in accordance with the methodology described in 
                section 413.77(e) of title 42 of the Code of Federal 
                Regulations (or any successor regulation), establish a 
                new FTE resident amount if the hospital trains at least 
                1.0 full-time-equivalent resident (in the case of a 
                hospital described in subclause (I)) or more than 3.0 
                full-time-equivalent residents (in the case of a 
                hospital described in subclause (II)) in a cost 
                reporting period beginning on or after such date of 
                enactment and before the date that is 5 years after 
                such date of enactment.
                    ``(iv) For purposes of carrying out this 
                subparagraph for cost reporting periods beginning on or 
                after the date of the enactment of this clause, a 
                hospital shall report full-time-equivalent residents on 
                its cost report for a cost reporting period if the 
                hospital trains at least 1.0 full-time-equivalent 
                residents in an approved medical residency training 
                program in such period.
                    ``(v) As appropriate, the Secretary may consider 
                information from any cost reporting period necessary to 
                establish a new FTE resident amount as described in 
                clause (iii).''.
    (b) Redetermination of FTE Resident Limitation.--Section 
1886(h)(4)(H)(i) of the Social Security Act (42 U.S.C. 
1395ww(h)(4)(H)(i)) is amended--
            (1) by inserting ``(I)'' before ``The Secretary''; and
            (2) by adding at the end the following:
                            ``(II) In applying this clause in the case 
                        of a hospital that, on or after the date of the 
                        enactment of this subclause, begins to train 
                        residents in a new approved medical residency 
                        training program (as defined by the Secretary), 
                        the Secretary shall not determine a limitation 
                        applicable to the hospital under subparagraph 
                        (F) until such time as the Secretary determines 
                        that the hospital has trained at least 1.0 
                        full-time-equivalent resident in such new 
                        approved medical residency training program in 
                        a cost reporting period.
                            ``(III) In applying this clause in the case 
                        of a hospital that, as of the date of the 
                        enactment of this subclause, has a limitation 
                        under subparagraph (F), based on a cost 
                        reporting period beginning before October 1, 
                        1997, of less than 1.0 full-time-equivalent 
                        resident, the Secretary shall adjust the 
                        limitation in the manner applicable to a new 
                        approved medical residency training program if 
                        the Secretary determines the hospital trains at 
                        least 1.0 full-time-equivalent residents in a 
                        program year beginning on or after such date of 
                        enactment and before the date that is 5 years 
                        after such date of enactment.
                            ``(IV) In applying this clause in the case 
                        of a hospital that, as of the date of the 
                        enactment of this subclause, has a limitation 
                        under subparagraph (F), based on a cost 
                        reporting period beginning on or after October 
                        1, 1997, and before such date of enactment, of 
                        no more than 3.0 full-time-equivalent 
                        residents, the Secretary shall adjust the 
                        limitation in the manner applicable to a new 
                        approved medical residency training program if 
                        the Secretary determines the hospital begins 
                        training more than 3.0 full-time-equivalent 
                        residents in a program year beginning on or 
                        after such date of enactment and before the 
                        date that is 5 years after such date of 
                        enactment.
                            ``(V) An adjustment to the limitation 
                        applicable to a hospital made pursuant to 
                        subclause (III) or (IV) shall be made in a 
                        manner consistent with the methodology, as 
                        appropriate, in section 413.79(e) of title 42, 
                        Code of Federal Regulations (or any successor 
                        regulation). As appropriate, the Secretary may 
                        consider information from any cost reporting 
                        periods necessary to make such an adjustment to 
                        the limitation.''.
    (c) Technical and Conforming Amendments.--Section 1886 of the 
Social Security Act (42 U.S.C. 1395ww) is amended--
            (1) in subsection (d)(5)(B)(viii), by striking ``subsection 
        (h)(4)(H)'' and inserting ``paragraphs (2)(F)(iv) and (4)(H) of 
        subsection (h)''; and
            (2) in subsection (h)--
                    (A) in paragraph (4)(H)(iv), by striking ``an rural 
                area'' and inserting ``a rural area''; and
                    (B) in paragraph (7)(E), by striking ``under this'' 
                and all that follows through the period at the end and 
                inserting the following: ``under this paragraph, 
                paragraph (8), clause (i), (ii), (iii), or (v) of 
                paragraph (2)(F), or clause (i) or (vi) of paragraph 
                (4)(H).''.
    (d) Effective Date.--The amendments made by this section shall 
apply to payment under section 1886 of the Social Security Act (42 
U.S.C. 1395ww) for cost reporting periods beginning on or after the 
date of the enactment of this Act.
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