[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 5041 Introduced in Senate (IS)]
<DOC>
117th CONGRESS
2d Session
S. 5041
To amend title XVIII of the Social Security Act to provide for the
distribution of additional residency positions in psychiatry and
subspecialties.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
September 29, 2022
Ms. Stabenow (for herself, Mr. Daines, and Mr. Menendez) 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 in psychiatry and
subspecialties.
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 ``Training Psychiatrists for the
Future Act''.
SEC. 2. DISTRIBUTION OF ADDITIONAL RESIDENCY POSITIONS IN PSYCHIATRY
AND PSYCHIATRY SUBSPECIALTIES.
(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 ``and (9)'' and
inserting ``(9), and (10)'';
(2) in paragraph (4)(H)(i), by striking ``and (9)'' and
inserting ``(9), and (10)''; and
(3) by adding at the end the following new paragraph:
``(10) Distribution of additional residency positions in
psychiatry and psychiatry subspecialties.--
``(A) Additional residency positions.--
``(i) In general.--For fiscal year 2025,
and for each succeeding fiscal year until the
aggregate number of full-time equivalent
residency positions distributed under this
paragraph is equal to the aggregate number of
such positions made available (as specified in
clause (ii)(I)), the Secretary shall, subject
to the succeeding provisions of this paragraph,
increase the otherwise applicable resident
limit for each qualifying hospital (as defined
in subparagraph (F)) that submits a timely
application under this subparagraph by such
number as the Secretary may approve effective
beginning July 1 of the fiscal year of the
increase.
``(ii) Number available for distribution.--
``(I) Total number available.--The
aggregate number of such positions made
available under this paragraph shall be
equal to 400.
``(II) Annual limit.--The aggregate
number of such positions so made
available shall not exceed 200 for a
fiscal year.
``(iii) Distribution for psychiatry or
psychiatry subspecialty residencies.--Each of
the positions made available under this
paragraph shall be in a psychiatry or
psychiatry subspecialty residency (as defined
in subparagraph (F)).
``(iv) Process for distributing
positions.--
``(I) Rounds of applications.--The
Secretary shall initiate a separate
round of applications for an increase
under clause (i) for each fiscal year
for which such an increase is to be
provided.
``(II) 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 31 of the
fiscal year of the increase. Such
increase shall be effective beginning
July 1 of such fiscal year.
``(B) Distribution.--For purposes of providing an
increase in the otherwise applicable resident limit
under subparagraph (A), the following shall apply:
``(i) Considerations in distribution.--In
determining for which qualifying 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 training years
beginning after the date the increase would be
effective, as determined by the Secretary.
``(ii) 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 such aggregate
number to the following categories of
hospitals:
``(I) To hospitals that are located
in a rural area (as defined in section
1886(d)(2)(D)) or are treated as being
located in a rural area pursuant to
section 1886(d)(8)(E).
``(II) To hospitals in which the
reference resident level of the
hospital (as specified in subparagraph
(F)(iv)) is greater than the otherwise
applicable resident limit.
``(III) 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).
``(IV) To 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.
``(V) To hospitals located in
States with less than 27 residents per
100,000 people.
``(C) Requirements.--
``(i) In general.--Subject to clause (ii),
a hospital that receives an increase in the
otherwise applicable resident limit under this
paragraph shall ensure, during the 5-year
period beginning on the date of such increase,
that--
``(I) the number of full-time
equivalent residents in a psychiatry or
psychiatry subspecialty residency (as
defined in subparagraph (F)), excluding
any additional positions attributable
to an increase under this paragraph, is
not less than the average number of
full-time equivalent residents in such
a residency during the 3 most recent
cost reporting periods ending prior to
the date of enactment of this
paragraph; and
``(II) all of the positions
attributable to such increase are in a
psychiatry or psychiatry subspecialty
residency (as determined by the
Secretary).
The Secretary may determine whether a hospital
has met the requirements under this clause
during such 5-year period in such manner and at
such time as the Secretary determines
appropriate, including at the end of such 5-
year period.
``(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 either of the requirements
under subclause (I) or (II) 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.
``(iii) Limitation.--A hospital may not
receive more than 10 additional full-time
equivalent residency positions under this
paragraph.
``(iv) Prohibition on distribution to
hospitals without an increase agreement.--No
increase in the otherwise applicable resident
limit of a hospital may be made under this
paragraph 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 this
paragraph.
``(D) Application of per resident amounts for
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 nonprimary care computed under
paragraph (2)(D) for that hospital.
``(E) 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.
``(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),
(8)(B), and (9)(A).
``(ii) Psychiatry or psychiatry
subspecialty residency.--The term `psychiatry
or psychiatry subspecialty residency' means a
residency in psychiatry as accredited by the
Accreditation Council for Graduate Medical
Education for the purpose of preventing,
diagnosing, and treating mental health
disorders.
``(iii) Qualifying hospital.--The term
`qualifying hospital' means a hospital
described in any of subclauses (I) through (V)
of subparagraph (B)(ii).
``(iv) Reference resident level.--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.
``(v) Resident level.--The term `resident
level' has the meaning given such term in
paragraph (7)(C)(i).''.
(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 ``and
(h)(9)'' and inserting ``(h)(9), and (h)(10)'';
(2) by moving clause (xii) 4 ems to the left; and
(3) by adding at the end the following new clause:
``(xiii) For discharges occurring on or after July 1, 2024,
insofar as an additional payment amount under this subparagraph
is attributable to resident positions distributed to a hospital
under subsection (h)(10), the indirect teaching adjustment
factor shall be computed in the same manner as provided under
clause (ii) with respect to such resident positions.''.
(c) Prohibition on Judicial Review.--Section 1886(h)(7)(E) of the
Social Security Act (42 U.S.C. 1395ww--4(h)(7)(E)) is amended by
inserting ``paragraph (10),'' after ``paragraph (8),''.
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