[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1180 Introduced in House (IH)]
113th CONGRESS
1st Session
H. R. 1180
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 14, 2013
Mr. Crowley (for himself and Mr. Grimm) 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 2013''.
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
2015 through 2019 (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 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 3,000 in each such year.
``(iii) 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 2015 through
2019.
``(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
2019.--If the aggregate number of
positions distributed under this
paragraph during the 5-year period of
fiscal years 2015 through 2019 is less
than 15,000, the Secretary shall, in
accordance with the provisions of
clause (ii) and subparagraph (D) 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 15,000.
``(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 (G)(iii)) 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) Priority for certain hospitals.--
Subject to clause (iii), in determining for
which hospitals such an increase is provided,
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 that
emphasize training in community health
center or community-based settings or
in hospital outpatient departments.
``(III) Third, to hospitals that
are eligible for incentive payments
under section 1886(n) or 1903(t) as of
the date the hospital submits an
application for such increase under
subparagraph (A).
``(IV) Fourth, to all other
hospitals.
``(iii) Distribution to hospitals in higher
priority group prior to distribution in lower
priority groups.--The Secretary may only
distribute such an increase 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.
``(iv) Requirements for use of additional
positions.--
``(I) In general.--Subject to
subclause (II), a hospital that
receives such an increase shall ensure,
during the 5-year period beginning on
the effective date of such increase,
that--
``(aa) not less than 50
percent of the positions
attributable to such increase
that are used in a given year
during such 5-year period are
used to train full-time
equivalent residents in a
shortage specialty residency
program (as defined in
subparagraph (G)(v)), as
determined by the Secretary at
the end of such 5-year period;
``(bb) 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
``(cc) 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.--With respect to each
fiscal year described in subparagraph
(A), the Secretary shall determine
whether or not a hospital described in
subclause (I) meets the requirements of
such subclause. In the case that the
Secretary determines that such a
hospital does not meet such
requirements, the Secretary shall--
``(aa) reduce the otherwise
applicable resident limit of
the hospital by the amount by
which such limit was increased
under this paragraph; and
``(bb) provide for the
distribution of positions
attributable to such reduction
in accordance with the
requirements of this paragraph.
``(D) Limitation.--A hospital may not receive more
than 75 full-time equivalent additional residency
positions under this paragraph for any fiscal year.
``(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) 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.
``(G) 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) 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) Shortage specialty residency
program.--The term `shortage specialty
residency program' means the following:
``(I) Prior to report on shortage
specialties.--Prior to the date on
which the report of the National Health
Care Workforce Commission is submitted
under section 3 of the Resident
Physician Shortage Reduction Act of
2013, 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.
``(II) After report on shortage
specialties.--On or after the date on
which the report of the National Health
Care Workforce Commission is submitted
under such section, any approved
residency training program in a
physician specialty identified in such
report as a specialty for which there
is a shortage.''.
(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 second sentence, by striking
``subsections (h)(7) and (h)(8)'' and inserting ``subsections
(h)(7), (h)(8), and (h)(9)'';
(2) 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
(3) by adding after clause (xi), as redesignated by
subparagraph (A), the following new clause:
``(xii) For discharges occurring on or
after July 1, 2015, 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 BY NATIONAL HEALTH CARE WORKFORCE COMMISSION.
(a) Study.--The National Health Care Workforce Commission
established under section 5101 of the Patient Protection and Affordable
Care Act (Public Law 111-148) shall conduct a study of the physician
workforce. Such study shall include the identification of physician
specialties for which there is a shortage, as defined by the
Commission.
(b) Report.--Not later than January 1, 2016, the National Health
Care Workforce Commission shall submit to Congress a report on the
study conducted under subsection (a), together with recommendations for
such legislation and administrative action as the Commission determines
appropriate.
SEC. 4. 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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