[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2389 Introduced in House (IH)]
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118th CONGRESS
1st Session
H. R. 2389
To amend title XVIII of the Social Security Act to provide for the
distribution of additional residency positions, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 29, 2023
Ms. Sewell (for herself and Mr. Fitzpatrick) 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 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 2023''.
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),
(8), (9), and (10)'' and inserting ``paragraphs (7), (8), (9),
(10), and (11)'';
(2) in paragraph (4)(H)(i), by striking ``paragraphs (7),
(8), (9), and (10)'' and inserting ``paragraphs (7), (8), (9),
(10), and (11)'';
(3) in paragraph (7)(E), by inserting ``paragraph (10),''
after ``paragraph (8),''; and
(4) by adding at the end the following new paragraph:
``(11) Distribution of additional residency positions.--
``(A) Additional residency positions.--
``(i) In general.--For each of fiscal years
2025 through 2031 (and succeeding fiscal years
if the Secretary determines that there are
additional residency positions available to
distribute under clause (iv)(II)), the
Secretary shall, subject to clause (ii) and
subparagraph (D), increase the otherwise
applicable resident limit for each qualifying
hospital (as defined in subparagraph (H)) 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.
``(ii) Number available for distribution.--
For each such fiscal year, the Secretary shall
determine the total number of additional
residency positions available for distribution
under clause (i) in accordance with the
following:
``(I) Allocation to hospitals
already operating over resident
limit.--One-third of such number shall
be available for distribution only to
hospitals described in subparagraph
(B).
``(II) Aggregate limitation.--
Except as provided in clause (iv)(I),
the aggregate number of increases in
the otherwise applicable resident limit
under this subparagraph shall be equal
to 2,000 in each such year.
``(iii) Process for distributing
positions.--
``(I) Rounds of applications.--The
Secretary shall initiate 7 separate
rounds of applications for an increase
under clause (i), 1 round with respect
to each of fiscal years 2025 through
2031.
``(II) Number available.--In each
of such rounds, the aggregate number of
positions available for distribution in
the fiscal year under clause (ii) shall
be distributed, plus any additional
positions available under clause (iv).
``(III) Timing.--The Secretary
shall notify hospitals of the number of
positions distributed to the hospital
under this paragraph as a 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.
``(iv) 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 (ii), 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
2031.--If the aggregate number of
positions distributed under this
paragraph during the 7-year period of
fiscal years 2025 through 2031 is less
than 14,000, the Secretary shall, in
accordance with the provisions of
clause (ii) and subparagraph (E) and
the considerations and priority
described in subparagraph (C), 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 14,000.
``(B) Allocation of distribution for positions to
hospitals already operating over resident limit.--
``(i) In general.--Subject to clauses (ii)
and (iii), in the case of a hospital in which
the reference resident level of the hospital
(as specified in subparagraph (H)(ii)) is
greater than the otherwise applicable resident
limit, the increase in the otherwise applicable
resident limit under subparagraph (A) for a
fiscal year described in such subparagraph
shall be an amount equal to the product of the
total number of additional residency positions
available for distribution under subparagraph
(A)(ii)(I) for such fiscal year and the
quotient of--
``(I) the number of resident
positions by which the reference
resident level of the hospital exceeds
the otherwise applicable resident limit
for the hospital; and
``(II) the number of resident
positions by which the reference
resident level of all such hospitals
with respect to which an application is
approved under this paragraph exceeds
the otherwise applicable resident limit
for such hospitals.
``(ii) Requirements.--A hospital described
in clause (i)--
``(I) is not eligible for an
increase in the otherwise applicable
resident limit under this subparagraph
unless the amount by which the
reference resident level of the
hospital exceeds the otherwise
applicable resident limit is not less
than 10 and the hospital trains at
least 25 percent of the full-time
equivalent residents of the hospital in
primary care and general surgery (as of
the date of enactment of this
paragraph); and
``(II) shall continue to train at
least 25 percent of the full-time
equivalent residents of the hospital in
primary care and general surgery for
the 5-year period beginning on such
date.
In the case where the Secretary determines that
a hospital described in clause (i) no longer
meets the requirement of subclause (II), the
Secretary may reduce the otherwise applicable
resident limit of the hospital by the amount by
which such limit was increased under this
subparagraph.
``(iii) Clarification regarding eligibility
for other additional residency positions.--
Nothing in this subparagraph shall be construed
as preventing a hospital described in clause
(i) from applying for and receiving additional
residency positions under this paragraph that
are not reserved for distribution under this
subparagraph.
``(C) Distribution of other positions.--For
purposes of determining an increase in the otherwise
applicable resident limit under subparagraph (A) (other
than such an increase described in subparagraph (B)),
the following shall apply:
``(i) Considerations in distribution.--In
determining for which hospitals such an
increase 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) Minimum distribution for certain
categories of hospitals.--With respect to the
aggregate number of such positions available
for distribution under this paragraph, the
Secretary shall distribute not less than 10
percent of such aggregate number to each of the
following categories of hospitals:
``(I) Hospitals that are located in
a rural area (as defined in subsection
(d)(2)(D)) or are treated as being
located in a rural area pursuant to
subsection (d)(8)(E) or are located in
Alaska, Hawaii, or a territory of the
United States.
``(II) Hospitals in which the
reference resident level of the
hospital (as specified in subparagraph
(H)(ii)) is greater than the otherwise
applicable resident limit.
``(III) 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).
``(IV) Hospitals that serve areas
designated as health professional
shortage areas under section
332(a)(1)(A) of the Public Health
Service Act, as determined by the
Secretary.
``(iii) Prioritization in distribution to
hpsa hospitals.--In distributing positions to a
hospital described in clause (ii)(IV), the
Secretary shall give priority to hospitals that
are affiliated with--
``(I) a historically Black medical
school (as defined in subparagraph
(H)); or
``(II) any other school listed in
section 326(e)(1) of the Higher
Education Act of 1965 that establishes
a medical college.
``(D) Prohibition on distribution to hospitals
without an increase agreement.--No increase in the
otherwise applicable resident limit of a hospital may
be made under subparagraph (C) unless such hospital
agrees to increase the total number of full-time
equivalent residency positions under the approved
medical residency training program of such hospital by
the number of such positions made available by such
increase under the subparagraph.
``(E) 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, paragraph (9), and paragraph (10)
over the period of fiscal years 2025 through
2031.
``(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.
``(F) 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.
``(G) Permitting facilities to apply aggregation
rules.--The Secretary shall permit hospitals receiving
additional residency positions attributable to the
increase provided under this paragraph to, beginning in
the fifth year after the effective date of such
increase, apply such positions to the limitation amount
under paragraph (4)(F) that may be aggregated pursuant
to paragraph (4)(H) among members of the same
affiliated group.
``(H) 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),
(8)(B), (9), (10)(A). and (10)(B).
``(ii) Reference resident level.--Except as
otherwise provided in subclause (II), the term
`reference resident level' means, with respect
to a hospital, the resident level for the most
recent cost reporting period of the hospital
ending on or before the date of enactment of
this paragraph, for which a cost report has
been settled (or, if not, submitted (subject to
audit)), as determined by the Secretary.
``(iii) Resident level.--The term `resident
level' has the meaning given such term in
paragraph (7)(C)(i).
``(iv) Qualifying hospital.--The term
`qualifying hospital' means a hospital
described in subparagraph (B)(i) or any of
subclauses (I) through (IV) of subparagraph
(C)(ii).
``(v) Historically black medical school.--
The term `historically Black medical school'
means Howard University College of Medicine,
Charles R. Drew University of Medicine and
Science, Meharry Medical College, Morehouse
School of Medicine, Xavier University Graduate
School of Health Sciences and Medical School,
and Maryland College of Osteopathic Medicine at
Morgan State University.''.
(b) IME.--Section 1886(d)(5)(B) of the Social Security Act (42
U.S.C. 1395ww(d)(5)(B)) is amended--
(1) in clause (v), in the third sentence, by striking
``subsections (h)(7), (h)(8), (h)(9), and (h)(10)'' and
inserting ``subsections (h)(7), (h)(8), (h)(9), (h)(10), and
(h)(11)''; and
(2) by adding after clause (xiii) the following new clause:
``(xiv) For discharges occurring on or
after July 1, 2026, insofar as an additional
payment amount under this subparagraph is
attributable to resident positions distributed
to a hospital under subsection (h)(11), 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 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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