[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 1302 Introduced in Senate (IS)]
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118th CONGRESS
1st Session
S. 1302
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
April 26, 2023
Mr. Menendez (for himself, Mr. Boozman, Mr. Schumer, and Ms. Collins)
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 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 ``and (10)'' and
inserting ``(10), and (11)'';
(2) in paragraph (4)(H)(i), by striking ``and (10)'' and
inserting ``(10), and (11)'';
(3) in paragraph (7)(E), by inserting ``paragraph (11),''
after ``paragraph (10),''; 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 (iii)(II)), the
Secretary shall increase the otherwise
applicable resident limit for each qualifying
hospital (as defined in subparagraph (G)) 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
2,000 in each of fiscal years 2025 through
2031.
``(ii) 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 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 31 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
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 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 14,000.
``(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) 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).
``(II) Hospitals in which the
reference resident level of the
hospital (as specified in subparagraph
(G)(iii)) 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) Special rule.--In distributing
positions under clause (ii), the Secretary
shall not prioritize hospitals in multiple
categories over hospitals in an individual
category or based on section 332 of the Public
Health Service Act.
``(C) 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) 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 and paragraphs (9) and (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.
``(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),
(8)(B), (9)(A), (9)(B), (10)(A), and (10)(B).
``(ii) Qualifying hospital.--The term
`qualifying hospital' means a hospital
described in any of subclauses (I) through (IV)
of subparagraph (B)(ii).
``(iii) 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.
``(iv) Resident level.--The term `resident
level' has the meaning given such term in
paragraph (7)(C)(i).''.
(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)(10)'' and inserting
``(h)(10), and (h)(11)''.
(2) Conforming provision.--Section 1886(d)(5)(B) of the
Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) is amended by
adding after clause (xiii) the following new clause:
``(ix) For discharges occurring on or after July 1, 2025,
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.''.
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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