[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1153 Introduced in House (IH)]
<DOC>
119th CONGRESS
1st Session
H. R. 1153
To amend title XVIII of the Social Security Act to support rural
residency training funding that is equitable for all States, and for
other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 10, 2025
Mrs. Harshbarger (for herself, Ms. Schrier, and Mr. Bacon) 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 support rural
residency training funding that is equitable for all States, 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 ``Rural Physician Workforce Production
Act of 2025''.
SEC. 2. ELECTIVE RURAL SUSTAINABILITY PER RESIDENT PAYMENT FOR
RESIDENTS TRAINING IN RURAL TRAINING LOCATIONS.
(a) In General.--Section 1886 of the Social Security Act (42 U.S.C.
1395ww) is amended by adding at the end the following new subsection:
``(u) Elective Rural Sustainability Per Resident Payment Amount for
Residents Training in Rural Training Locations.--
``(1) Determination of elective rural sustainability per
resident payment amount.--
``(A) In general.--The elective rural
sustainability per resident payment amount determined
under this subsection for an applicable hospital (as
defined in paragraph (7)(A)) that makes an election
under paragraph (2), with respect to each full-time-
equivalent resident in an approved medical residency
training program that receives training in a rural
training location (as defined in paragraph (7)(C)), is
an amount equal to the difference between--
``(i) the total elective rural
sustainability amount determined under
subparagraph (B) (or, in the case of an
applicable hospital not located in a rural
area, the total elective rural sustainability
amount or urban total elective rural
sustainability amount, as applicable,
determined under such subparagraph); and
``(ii) the amount (if any) the applicable
hospital otherwise receives for direct graduate
medical education costs under subsection (h) or
section 1814(l), as applicable, with respect to
each such resident.
``(B) Total elective rural sustainability amount.--
``(i) Establishment for initial cost
reporting periods.--
``(I) In general.--Subject to
subclause (II), for cost reporting
periods beginning during the first year
beginning on or after the date of the
enactment of this subsection, the
Secretary shall establish a total
elective rural sustainability amount
for time spent by each full-time-
equivalent resident in an approved
medical residency training program that
receives training in a rural training
location. Such amount shall be the
amount that the Secretary determines is
equal to the median national direct GME
training costs per full-time-equivalent
resident for 2015 described in table 9
on page 33 of the March 2018 GAO report
on Physician Workforce (GAO-18-240),
updated for each subsequent year
through the first year beginning on or
after the date of the enactment of this
subsection, by the annual percentage
increase in the consumer price index
for all urban consumers (all items;
United States city average).
``(II) Application to urban
hospitals.--For cost reporting periods
beginning during the first year
beginning on or after the date of the
enactment of this subsection, in the
case of an applicable hospital that is
not located in a rural area--
``(aa) with respect to such
residents that receive training
in a rural track or an
integrated rural track, the
total elective rural
sustainability amount per
resident shall be equal to the
amount established under
subclause (I); and
``(bb) with respect to such
residents that receive training
in a rural training location
and who are not participating
in a rural track or an
integrated rural track, the
total elective rural
sustainability amount per
resident shall be equal to 50
percent of the amount
established under subclause (I)
(referred to in this subsection
as the `urban total elective
rural sustainability amount').
``(ii) Updating for subsequent cost
reporting periods.--For each subsequent cost
reporting period, the total elective rural
sustainability amount under clause (i)(I) and
clause (i)(II)(aa) and the urban total elective
rural sustainability amount under clause
(i)(II)(bb), respectively, are equal to such
amounts determined under such clause for the
previous cost reporting period updated, through
the midpoint of the period, by projecting the
estimated percentage change in the consumer
price index for all urban consumers (all items;
United States city average) during the 12-month
period ending at that midpoint, with
appropriate adjustments to reflect previous
under- or over-estimations under this clause in
the projected percentage change in the consumer
price index for medical care services.
``(C) Clarification.--The total elective rural
sustainability amount, the urban total elective rural
sustainability amount, and the elective rural
sustainability per resident payment amount determined
under this paragraph shall not be discounted or
otherwise adjusted based on the Medicare patient load
(as defined in subsection (h)(3)(C)) of an applicable
hospital or discharges in a diagnosis-related group.
``(2) Election.--For cost reporting periods beginning on or
after the date that is 1 year after the date of the enactment
of this subsection, an applicable hospital may elect to receive
the elective rural sustainability per resident payment amount
for each full-time-equivalent resident in an approved medical
residency training program that receives training in a rural
training location in accordance with this subsection. An
applicable hospital may make an election under the preceding
sentence regardless of whether the applicable hospital is
otherwise eligible for a payment or adjustment for indirect and
direct graduate medical education costs under subsections
(d)(5)(B) and (h) or section 1814(l), as applicable, with
respect to such residents.
``(3) Application.--The provisions of this subsection, or
the application of such provisions to an applicable hospital--
``(A) shall not result in--
``(i) the establishment of a limitation on
the number of residents in allopathic or
osteopathic medicine for purposes of
subsections (d)(5)(B) and (h) with respect to
an approved medical residency training program
of an applicable hospital (or be taken into
account in determining such a limitation during
the cap building period of an applicable
hospital); or
``(ii) the counting of any resident with
respect to which the applicable hospital
receives an elective rural sustainability per
resident payment amount under this subsection
towards the application of the limitation
described in clause (i) for purposes of
subsections (d)(5)(B) and (h); and
``(B) shall not have any effect on the
determination of--
``(i) the additional payment amount under
subsection (d)(5)(B); or
``(ii) hospital-specific approved FTE
resident amounts under subsection (h).
``(4) Allocation of payments.--In providing for payments
under this subsection, the Secretary shall provide for an
allocation of such payments between parts A and part B (and the
trust funds established under the respective parts) as
reasonably reflects the proportion of such costs associated
with the provision of services under each respective part.
``(5) Eligibility for payment.--
``(A) In general.--An applicable hospital shall be
eligible for payment of the elective rural
sustainability per resident payment amount under this
subsection for time spent by a resident training in a
rural training location if the following requirements
are met:
``(i) The resident spends the equivalent of
at least 8 weeks over the course of their
training in a rural training location.
``(ii) The hospital pays the salary and
benefits of the resident for the time spent
training in a rural training location.
``(B) Treatment of time spent in rural tracks or
integrated rural tracks.--An applicable hospital shall
be eligible for payment of the elective rural
sustainability per resident payment amount under this
subsection for all time spent by residents in an
approved medical residency program (or separately
defined track within a program) that provides more than
50 percent of the total residency training time in
rural training locations, regardless of where the
training occurs and regardless of specialty.
``(6) Determination of full-time-equivalent residents.--The
determination of full-time-equivalent residents for purposes of
this subsection shall be made in the same manner as the
determination of full-time-equivalent residents under
subsection (h)(4), but not taking into account the limitation
under subparagraph (F) of such subsection.
``(7) Definitions.--In this subsection:
``(A) Applicable hospital.--The term `applicable
hospital' means a hospital, critical access hospital,
sole community hospital (as defined in subsection
(d)(5)(D)(iii)), or rural emergency hospital (as
defined in section 1861(kkk)(2)).
``(B) Approved medical residency training program;
direct graduate medical education costs; resident.--The
terms `approved medical residency training program',
`direct graduate medical education costs', and
`resident' have the meanings given those terms in
subsection (h)(5).
``(C) Rural training location.--The term `rural
training location' means a location in which training
occurs that, based on the 2010 census or any subsequent
census adjustment, meets one or more of the following
criteria:
``(i) The training occurs in a location
that is a rural area (as defined in section
1886(d)(2)(D)), not including any hospital
treated as being located in a rural area
pursuant to section 1886(d)(8)(E).
``(ii) The training occurs in a location
that has a rural-urban commuting area code
equal to or greater than 4.0.
``(iii) The training occurs in a sole
community hospital (as defined in subsection
(d)(5)(D)(iii)) or in a location that is within
10 miles of a sole community hospital.
``(8) Budget neutrality requirement.--The Secretary shall
ensure that aggregate payments for direct medical education
costs and indirect medical education costs under this title,
including any payments under this subsection, for each year
(effective beginning on or after the date that is 1 year after
the date of enactment of this subsection) are not greater than
the aggregate payments for such costs that would have been made
under this title for the year without the application of this
subsection. For purposes of carrying out the budget neutrality
requirement under the preceding sentence, the Secretary may
make appropriate adjustments to the amount of such payments for
direct graduate medical education costs and indirect medical
education costs under subsections (h) and (d)(5)(B),
respectively.''.
(b) Treatment of Critical Access Hospitals and Sole Community
Hospitals.--
(1) Critical access hospitals.--Section 1814(l) of the
Social Security Act (42 U.S.C. 1395f(l)) is amended by adding
at the end the following new paragraph:
``(6) For cost reporting periods beginning on or after the date
that is 1 year after the date of enactment of this paragraph, the
following shall apply:
``(A) A critical access hospital may elect to be treated as
a hospital or as a non-provider setting for purposes of
counting resident time for indirect medical education costs and
direct graduate medical education costs for the time spent by
the resident in that setting under subsections (d)(5)(B) and
(h), respectively, of section 1886.
``(B) Direct medical education costs shall not be
considered reasonable costs of a critical access hospital for
purposes of payment under paragraph (1), to the extent that the
critical access hospital is treated as a non-provider setting
of another hospital or another hospital receives payment for
such costs for the time spent by the resident in that setting
pursuant to subsection (d)(5)(B), subsection (h), or subsection
(u) of section 1886.''.
(2) Sole community hospitals.--Section 1886(d)(5)(D) of the
Social Security Act (42 U.S.C. 1395ww(d)(5)(D)) is amended by
adding at the end the following new clause:
``(vi) For cost reporting periods beginning on or after the date
that is 1 year after the date of enactment of this paragraph, the
hospital-specific payment amount determined under clause (i)(I) with
respect to a sole community hospital shall not include direct medical
education costs, to the extent that the sole community hospital
receives payment for such costs for the time spent by the resident in
that setting pursuant to subsection (u).''.
(c) Conforming Amendments.--
(1) Section 1886 of the Social Security Act (42 U.S.C.
1395ww) is amended--
(A) in subsection (d)(5)(B), in the matter
preceding clause (i), by striking ``The Secretary'' and
inserting ``Subject to subsection (u), the Secretary'';
and
(B) in subsection (h)--
(i) in paragraph (1), by inserting
``subject to subsection (u)'' after
``1861(v),''; and
(ii) in paragraph (3), in the flush matter
following subparagraph (B), by striking
``subsection (k)'' and inserting ``subsection
(k) or subsection (u)''.
SEC. 3. SUPPORTING NEW, EXPANDING, AND EXISTING RURAL TRAINING TRACKS.
(a) Direct Graduate Medical Education.--Section 1886(h) of the
Social Security Act (42 U.S.C. 1395ww(h)) is amended--
(1) in paragraph (4)--
(A) in subparagraph (F)(i)--
(i) by striking ``130 percent'' and
inserting ``for cost reporting periods
beginning on or after October 1, 1997, and
before the date that is 1 year after the date
of enactment of the Rural Physician Workforce
Production Act of 2025, 130 percent''; and
(ii) by adding at the end the following:
``For cost reporting periods beginning on or
after the date that is 1 year after the date of
enactment of the Rural Physician Workforce
Production Act of 2025, such rules shall
provide that any full-time-equivalent resident
in an approved medical residency program (or
separately defined track within a program) that
provides more than 50 percent of the total
residency training time in rural training
locations (as defined in subsection (u)(6)(C)),
regardless of where the training occurs and
regardless of specialty, shall not be taken
into account for purposes of applying the
limitation under this subparagraph.''; and
(B) in subparagraph (H)--
(i) in clause (i), in the second sentence,
by inserting the following before the period:
``, in accordance with the second sentence of
clause (i) of such subparagraph''; and
(ii) in clause (iv), by inserting the
following before the period: ``, in accordance
with the second sentence of clause (i) of such
subparagraph''; and
(2) in paragraph (5), by adding at the end the following
new subparagraph:
``(L) Special rules regarding application of
elective rural sustainability per resident payment
amount.--For special rules regarding application of the
elective rural sustainability per resident payment
amount under subsection (u), see paragraph (3) of such
subsection.''.
(b) Indirect Medical Education.--Section 1886(d)(5)(B)(v) is
amended--
(1) by striking ``130 percent'' and inserting ``for cost
reporting periods beginning on or after October 1, 1997, and
before the date that is 1 year after the date of enactment of
the Rural Physician Workforce Production Act of 2025, 130
percent''; and
(2) by adding at the end the following: ``For cost
reporting periods beginning on or after the date that is 1 year
after the date of enactment of the Rural Physician Workforce
Production Act of 2025, such rules shall provide that any full-
time-equivalent resident in an approved medical residency
program (or separately defined track within a program) that
provides more than 50 percent of the total residency training
time in rural training locations (as defined in subsection
(u)(6)(C)), regardless of where the training occurs and
regardless of specialty, shall not be taken into account for
purposes of applying the limitation under this subparagraph.
For special rules regarding application of the elective rural
sustainability per resident payment amount under subsection
(u), see paragraph (3) of such subsection.''.
<all>