[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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