[Congressional Record Volume 144, Number 94 (Wednesday, July 15, 1998)]
[Extensions of Remarks]
[Pages E1311-E1312]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




    THE GRADUATE MEDICAL EDUCATION TECHNICAL AMENDMENTS ACT OF 1998

                                 ______
                                 

                        HON. JOHN ELIAS BALDACCI

                                of maine

                    in the house of representatives

                        Wednesday, July 15, 1998

  Mr. BALDACCI. Mr. Speaker, I rise today to introduce the Graduate 
Medical Education Technical Amendments Act of 1998. This bill addresses 
the serious, albeit unintended consequences of reimbursement changes 
for Graduate Medical Education residency programs, particularly rural 
family practice residency programs, resulting from the Balanced Budget 
Act of 1997.
  Various adjustments in the Graduate Medical Education program (GME) 
resulted from last year's Balanced Budget Act (BBA). In an attempt to 
reign in costs and address a nationwide glut of physicians, 
reimbursement levels have been capped for all hospitals, including 
those in rural and underserved areas. While there may be an 
overabundance of physicians willing to serve in cities like Boston or 
New York or Los Angeles, towns like Lewiston in my district in Maine 
lack an adequate number of physicians, especially family practice 
physicians. The bill that I am introducing with the support of 
Congressman Allen will ensure that rural areas maintain the flexibility 
needed to react to primary physician shortages. This legislation also 
clarifies the definition of rural facilities allowed ``special 
consideration'' under the GME reimbursement caps. These changes are 
essential for my state, and for many others around the country.
  The Balanced Budget Act of 1997 places a cap on the number of 
residents ``in the hospital'' as of December 31, 1996, as opposed to 
the number of residents enrolled in the GME program. Due to instances 
of residents on leave from the hospital or in training at ambulatory 
care facilities in the base cost reporting period, many hospitals are 
facing a lowered cap. This cap does not reflect the true number of 
residents enrolled in their programs. The problem is acute for family 
practice residency programs, which rely heavily on site training of 
their residents.
  Also lost in the GME reimbursement changes in the Balanced Budget Act 
of 1997 is the definition of rural programs given flexibility under the 
cap. Clarification is needed in order to recognize the innovative 
programs

[[Page E1312]]

being established in many districts in which urban institutions provide 
a ``rural track'', training residents to serve in rural communities. 
The definition of facilities allowed ``special consideration'' under 
the cap restrictions should be expanded to include programs that are 
targeting rural communities, even if the hospital itself is located in 
a non-rural area. Many small community hospitals offer only one 
residency program, and these are primarily family practice programs. 
Those hospitals with only a single residency program should be exempt 
from the cap in order to allow the facilities the flexibility to adapt 
to the needs of their community.
  Another shortfall of the GME reimbursement changes effects new 
primary care residency programs which were in the process of expanding 
their programs to meet the needs of their rural communities when the 
Balanced Budget Act became law. The published interim final rule 
arbitrarily utilizes August 5, 1997 as the date by which all new 
residency programs had to fill their allocation of residency slots. 
There are programs that were recently accredited which did not have 
time to meet their full allotment of residency slots. For this reason, 
the legislation I am introducing today would change the cut-off date to 
September 30, 1999. These developing programs should be allowed to come 
to fruition.
  Mr. Speaker, similar legislation has been introduced in the other 
body of my colleagues and friend, Senator Susan Collins. I ask that 
Members of the House examine how their rural residency programs will be 
affected by the GME changes mandated by the Balanced Budget Act, and 
that they support this legislation which seeks only to give rural 
communities an opportunity to meet the health care needs of their 
citizens.

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