[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 348 Introduced in Senate (IS)]
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116th CONGRESS
1st Session
S. 348
To amend title XVIII of the Social Security Act to provide for the
distribution of additional residency positions, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
February 6, 2019
Mr. Menendez (for himself, Mr. Boozman, and Mr. Schumer) 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 provide for the
distribution of additional residency positions, and for other purposes.
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 ``Resident Physician Shortage
Reduction Act of 2019''.
SEC. 2. DISTRIBUTION OF ADDITIONAL RESIDENCY POSITIONS.
(a) In General.--Section 1886(h) of the Social Security Act (42
U.S.C. 1395ww(h)) is amended--
(1) in paragraph (4)(F)(i), by striking ``paragraphs (7)
and (8)'' and inserting ``paragraphs (7), (8), and (9)'';
(2) in paragraph (4)(H)(i), by striking ``paragraphs (7)
and (8)'' and inserting ``paragraphs (7), (8), and (9)'';
(3) in paragraph (7)(E), by inserting ``paragraph (9),''
after ``paragraph (8),''; and
(4) by adding at the end the following new paragraph:
``(9) Distribution of additional residency positions.--
``(A) Additional residency positions.--
``(i) In general.--For each of fiscal years
2021 through 2025 (and succeeding fiscal years
if the Secretary determines that there are
additional residency positions available to
distribute under clause (iii)(II)), the
Secretary shall increase the otherwise
applicable resident limit for each qualifying
hospital that submits a timely application
under this subparagraph by such number as the
Secretary may approve for portions of cost
reporting periods occurring on or after July 1
of the fiscal year of the increase. Except as
provided in clause (iii), the aggregate number
of increases in the otherwise applicable
resident limit under this subparagraph shall be
equal to 3,000 in each of fiscal years 2021
through 2025, of which at least 1,500 in each
such fiscal year shall be used for full-time
equivalent residents training in a shortage
specialty residency program (as defined in
subparagraph (F)(iii)).
``(ii) Process for distributing
positions.--
``(I) Rounds of applications.--The
Secretary shall initiate 5 separate
rounds of applications for an increase
under clause (i), 1 round with respect
to each of fiscal years 2021 through
2025.
``(II) Number available.--In each
of such rounds, the aggregate number of
positions available for distribution in
the fiscal year as a result of an
increase in the otherwise applicable
resident limit (as described in clause
(i)) shall be distributed, plus any
additional positions available under
clause (iii).
``(III) Timing.--The Secretary
shall notify hospitals of the number of
positions distributed to the hospital
under this paragraph as result of an
increase in the otherwise applicable
resident limit by January 1 of the
fiscal year of the increase. Such
increase shall be effective for
portions of cost reporting periods
beginning on or after July 1 of that
fiscal year.
``(iii) Positions not distributed during
the fiscal year.--
``(I) In general.--If the number of
resident full-time equivalent positions
distributed under this paragraph in a
fiscal year is less than the aggregate
number of positions available for
distribution in the fiscal year (as
described in clause (i), including
after application of this subclause),
the difference between such number
distributed and such number available
for distribution shall be added to the
aggregate number of positions available
for distribution in the following
fiscal year.
``(II) Exception if positions not
distributed by end of fiscal year
2025.--If the aggregate number of
positions distributed under this
paragraph during the 5-year period of
fiscal years 2021 through 2025 is less
than 15,000, the Secretary shall, in
accordance with the considerations
described in subparagraph (B)(i) and
the priority described in subparagraph
(B)(ii), conduct an application and
distribution process in each subsequent
fiscal year until such time as the
aggregate amount of positions
distributed under this paragraph is
equal to 15,000.
``(B) Distribution to certain hospitals.--
``(i) Consideration in distribution.--In
determining for which hospitals the increase in
the otherwise applicable resident limit is
provided under subparagraph (A), the Secretary
shall take into account the demonstrated
likelihood of the hospital filling the
positions made available under this paragraph
within the first 5 cost reporting periods
beginning after the date the increase would be
effective, as determined by the Secretary.
``(ii) Priority for certain hospitals.--
Subject to clause (iii), in determining for
which hospitals the increase in the otherwise
applicable resident limit is provided under
subparagraph (A), the Secretary shall
distribute the increase in the following
priority order:
``(I) First, to hospitals in States
with (aa) new medical schools that
received `Candidate School' status from
the Liaison Committee on Medical
Education or that received `Pre-
Accreditation' status from the American
Osteopathic Association Commission on
Osteopathic College Accreditation on or
after January 1, 2000, and that have
achieved or continue to progress toward
`Full Accreditation' status (as such
term is defined by the Liaison
Committee on Medical Education) or
toward `Accreditation' status (as such
term is defined by the American
Osteopathic Association Commission on
Osteopathic College Accreditation), or
(bb) additional locations and branch
campuses established on or after
January 1, 2000, by medical schools
with `Full Accreditation' status (as
such term is defined by the Liaison
Committee on Medical Education) or
`Accreditation' status (as such term is
defined by the American Osteopathic
Association Commission on Osteopathic
College Accreditation).
``(II) Second, to hospitals in
which the resident level of the
hospital is greater than the otherwise
applicable resident limit during the
most recent cost reporting period
ending on or before the date of
enactment of this paragraph.
``(III) Third, to hospitals with
which the Secretary cooperates under
section 7302(d) of title 38, United
States Code.
``(IV) Fourth, to hospitals that
emphasize training in community-based
settings or in hospital outpatient
departments.
``(V) Fifth, to hospitals that are
not located in a rural area and operate
an approved medical residency training
program (or rural track) in a rural
area or an approved medical residency
training program with an integrated
rural track.
``(VI) Sixth, to all other
hospitals.
``(iii) Distribution to hospitals in higher
priority group prior to distribution in lower
priority groups.--The Secretary may only
distribute an increase under subparagraph (A)
to a lower priority group under clause (ii) if
all qualifying hospitals in the higher priority
group or groups have received the maximum
number of increases under such subparagraph
that the hospital is eligible for under this
paragraph for the fiscal year.
``(C) Requirements for use of additional
positions.--
``(i) In general.--Subject to clause (ii),
a hospital that receives an increase in the
otherwise applicable resident limit under
subparagraph (A) shall ensure, during the 5-
year period beginning on the effective date of
such increase, that--
``(I) not less than 50 percent of
the positions attributable to such
increase are used to train full-time
equivalent residents in a shortage
specialty residency program (as defined
in subclause (F)(iii)), as determined
by the Secretary at the end of such 5-
year period;
``(II) the total number of full-
time equivalent residents, excluding
any additional positions attributable
to such increase, is not less than the
average number of full-time equivalent
residents during the 3 most recent cost
reporting periods ending on or before
the effective date of such increase;
and
``(III) the ratio of full-time
equivalent residents in a shortage
specialty residency program (as so
defined) is not less than the average
ratio of full-time equivalent residents
in such a program during the 3 most
recent cost reporting periods ending on
or before the effective date of such
increase.
``(ii) Redistribution of positions if
hospital no longer meets certain
requirements.--In the case where the Secretary
determines that a hospital described in clause
(i) does not meet the requirements of such
clause, the Secretary shall--
``(I) reduce the otherwise
applicable resident limit of the
hospital by the amount by which such
limit was increased under this
paragraph; and
``(II) provide for the distribution
of positions attributable to such
reduction in accordance with the
requirements of this paragraph.
``(D) Limitation.--
``(i) In general.--Except as provided in
clause (ii), a hospital may not receive more
than 75 full-time equivalent additional
residency positions in the aggregate under this
paragraph over the period of fiscal years 2021
through 2025.
``(ii) Increase in number of additional
positions a hospital may receive.--The
Secretary shall increase the aggregate number
of full-time equivalent additional residency
positions a hospital may receive under this
paragraph over such period if the Secretary
estimates that the number of positions
available for distribution under subparagraph
(A) exceeds the number of applications approved
under such subparagraph over such period.
``(E) Application of per resident amounts for
primary care and nonprimary care.--With respect to
additional residency positions in a hospital
attributable to the increase provided under this
paragraph, the approved FTE per resident amounts are
deemed to be equal to the hospital per resident amounts
for primary care and nonprimary care computed under
paragraph (2)(D) for that hospital.
``(F) Definitions.--In this paragraph:
``(i) Otherwise applicable resident
limit.--The term `otherwise applicable resident
limit' means, with respect to a hospital, the
limit otherwise applicable under subparagraphs
(F)(i) and (H) of paragraph (4) on the resident
level for the hospital determined without
regard to this paragraph but taking into
account paragraphs (7)(A), (7)(B), (8)(A), and
(8)(B).
``(ii) Resident level.--The term `resident
level' has the meaning given such term in
paragraph (7)(C)(i).
``(iii) Shortage specialty residency
program.--The term `shortage specialty
residency program' means any approved residency
training program in a specialty identified in
the report entitled `The Physician Workforce:
Projections and Research into Current Issues
Affecting Supply and Demand', issued in
December 2008 by the Health Resources and
Services Administration, as a specialty whose
baseline physician requirements projections
exceed the projected supply of total active
physicians for the period of 2005 through
2020.''.
(b) IME.--
(1) In general.--Section 1886(d)(5)(B)(v) of the Social
Security Act (42 U.S.C. 1395ww(d)(5)(B)(v)), in the third
sentence, is amended by striking ``and (h)(8)'' and inserting
``(h)(8), and (h)(9)''.
(2) Conforming provision.--Section 1886(d)(5)(B) of the
Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) is amended--
(A) by redesignating clause (x), as added by
section 5505(b) of the Patient Protection and
Affordable Care Act (Public Law 111-148), as clause
(xi) and moving such clause 4 ems to the left; and
(B) by adding after clause (xi), as redesignated by
subparagraph (A), the following new clause:
``(xii) For discharges occurring on or after July 1, 2021,
insofar as an additional payment amount under this subparagraph
is attributable to resident positions distributed to a hospital
under subsection (h)(9), the indirect teaching adjustment
factor shall be computed in the same manner as provided under
clause (ii) with respect to such resident positions.''.
SEC. 3. STUDY AND REPORT ON STRATEGIES FOR INCREASING DIVERSITY.
(a) Study.--The Comptroller General of the United States (in this
section referred to as the ``Comptroller General'') shall conduct a
study on strategies for increasing the diversity of the health
professional workforce. Such study shall include an analysis of
strategies for increasing the number of health professionals from
rural, lower income, and underrepresented minority communities,
including which strategies are most effective for achieving such goal.
(b) Report.--Not later than 2 years after the date of the enactment
of this Act, the Comptroller General shall submit to Congress a report
on the study conducted under subsection (a), together with
recommendations for such legislation and administrative action as the
Comptroller General determines appropriate.
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