,i #aacth ,,congress #ast ,session ,h4 ,r4 #aahj ,,in ,,the ,,house ,,of ,,representatives ,march #ad1 #bjac ,mr4 ,crowley 7for himself and ,mr4 ,grimm7 introduced the following bill2 which was referred to the ,committee on ,ways and ,means1 and in addition to the ,committee on ,energy and ,commerce1 for a period to be subsequently determined by the ,speaker1 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 positions1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,resident ,physician ,shortage ,reduction ,act of #bjac4 #b4 ,distribution of additional residency positions 7a7 ,in general ,section #ahhf7;h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7h77 is amended-- 7#a7 in paragraph 7#d77;,f77i71 by striking paragraphs 7#g7 and 7#h7 and inserting paragraphs 7#g71 7#h71 and 7#i72 7#b7 in paragraph 7#d77;,h77i71 by striking paragraphs 7#g7 and 7#h7 and inserting paragraphs 7#g71 7#h71 and 7#i72 7#c7 in paragraph 7#g77;,e71 by inserting paragraph 7#i71 after paragraph 7#h712 and 7#d7 by adding at the end the following new paragraph3 7#i7 ,distribution of additional residency positions 7,a7 ,additional residency positions 7i7 ,in general ,for each of fiscal years #bjae through #bjai 7and succeeding fiscal years if the ,secretary determines that there are additional residency positions available to distribute under clause 7iv77,,ii771 the ,secretary shall1 subject to clause 7ii7 and subparagraph 7,d71 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 #a of the fiscal year of the increase4 7ii7 ,number available for distribution ,for each such fiscal year1 the ,secretary shall determine the total number of additional residency positions available for distribution under clause 7i7 in accordance with the following3 7,i7 ,allocation to hospitals already operating over resident limit ,one-third of such number shall be available for distribution only to hospitals described in subparagraph 7,b74 7,,ii7 ,aggregate limitation ,except as provided in clause 7iv77,i71 the aggregate number of increases in the otherwise applicable resident limit under this subparagraph shall be equal to #c1jjj in each such year4 7iii7 ,process for distributing positions 7,i7 ,rounds of applications ,the ,secretary shall initiate #e separate rounds of applications for an increase under clause 7i71 #a round with respect to each of fiscal years #bjae through #bjai4 7,,ii7 ,number available ,in each of such rounds1 the aggregate number of positions available for distribution in the fiscal year under clause 7ii7 shall be distributed1 plus any additional positions available under clause 7iv74 7,,iii7 ,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 #a of the fiscal year of the increase4 ,such increase shall be effective for portions of cost reporting periods beginning on or after ,july #a of that fiscal year4 7iv7 ,positions not distributed during the fiscal year 7,i7 ,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 7as described in clause 7ii71 including after application of this subclause71 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 year4 7,,ii7 ,exception if positions not distributed by end of fiscal year #bjai ,if the aggregate number of positions distributed under this paragraph during the #e-year period of fiscal years #bjae through #bjai is less than #ae1jjj1 the ,secretary shall1 in accordance with the provisions of clause 7ii7 and subparagraph 7,d7 and the considerations and priority described in subparagraph 7,c71 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 #ae1jjj4 7,b7 ,allocation of distribution for positions to hospitals already operating over resident limit 7i7 ,in general ,subject to clauses 7ii7 and 7iii71 in the case of a hospital in which the reference resident level of the hospital 7as specified in subparagraph 7,g77iii77 is greater than the otherwise applicable resident limit1 the increase in the otherwise applicable resident limit under subparagraph 7,a7 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 7,a77ii77,i7 for such fiscal year and the quotient of-- 7,i7 the number of resident positions by which the reference resident level of the hospital exceeds the otherwise applicable resident limit for the hospital2 and 7,,ii7 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 hospitals4 7ii7 ,requirements ,a hospital described in clause 7i7-- 7,i7 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 #aj and the hospital trains at least #be percent of the full-time equivalent residents of the hospital in primary care and general surgery 7as of the date of enactment of this paragraph72 and 7,,ii7 shall continue to train at least #be percent of the full-time equivalent residents of the hospital in primary care and general surgery for the #e-year period beginning on such date4 ,in the case where the ,secretary determines that a hospital described in clause 7i7 no longer meets the requirement of subclause 7,,ii71 the ,secretary may reduce the otherwise applicable resident limit of the hospital by the amount by which such limit was increased under this subparagraph4 7iii7 ,clarification regarding eligibility for other additional residency positions ,nothing in this subparagraph shall be construed as preventing a hospital described in clause 7i7 from applying for and receiving additional residency positions under this paragraph that are not reserved for distribution under this subparagraph4 7,c7 ,distribution of other positions ,for purposes of determining an increase in the otherwise applicable resident limit under subparagraph 7,a7 7other than such an increase described in subparagraph 7,b771 the following shall apply3 7i7 ,considerations in distribution ,in determining for which hospitals such an increase is provided under subparagraph 7,a71 the ,secretary shall take into account the demonstrated likelihood of the hospital filling the positions made available under this paragraph within the first #e cost reporting periods beginning after the date the increase would be effective1 as determined by the ,secretary4 7ii7 ,priority for certain hospitals ,subject to clause 7iii71 in determining for which hospitals such an increase is provided1 the ,secretary shall distribute the increase in the following priority order3 7,i7 ,first1 to hospitals in ,states with 7aa7 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 #a1 #bjjj1 and that have achieved or continue to progress toward ,full ,accreditation status 7as such term is defined by the ,liaison ,committee on ,medical ,education7 or toward ,accreditation status 7as such term is defined by the ,american ,osteopathic ,association ,commission on ,osteopathic ,college ,accreditation71 or 7bb7 additional locations and branch campuses established on or after ,january #a1 #bjjj1 by medical schools with ,full ,accreditation status 7as such term is defined by the ,liaison ,committee on ,medical ,education7 or ,accreditation status 7as such term is defined by the ,american ,osteopathic ,association ,commission on ,osteopathic ,college ,accreditation74 7,,ii7 ,second1 to hospitals that emphasize training in community health center or community-based settings or in hospital outpatient departments4 7,,iii7 ,third1 to hospitals that are eligible for incentive payments under section #ahhf7n7 or #aijc7t7 as of the date the hospital submits an application for such increase under subparagraph 7,a74 7,,iv7 ,fourth1 to all other hospitals4 7iii7 ,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 7ii7 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 year4 7iv7 ,requirements for use of additional positions 7,i7 ,in general ,subject to subclause 7,,ii71 a hospital that receives such an increase shall ensure1 during the #e-year period beginning on the effective date of such increase1 that-- 7aa7 not less than #ej percent of the positions attributable to such increase that are used in a given year during such #e-year period are used to train full-time equivalent residents in a shortage specialty residency program 7as defined in subparagraph 7,g77v771 as determined by the ,secretary at the end of such #e-year period2 7bb7 the total number of full-time equivalent residents1 excluding any additional positions attributable to such increase1 is not less than the average number of full-time equivalent residents during the #c most recent cost reporting periods ending on or before the effective date of such increase2 and 7cc7 the ratio of full-time equivalent residents in a shortage specialty residency program 7as so defined7 is not less than the average ratio of full-time equivalent residents in such a program during the #c most recent cost reporting periods ending on or before the effective date of such increase4 7,,ii7 ,redistribution of positions if hospital no longer meets certain requirements ,with respect to each fiscal year described in subparagraph 7,a71 the ,secretary shall determine whether or not a hospital described in subclause 7,i7 meets the requirements of such subclause4 ,in the case that the ,secretary determines that such a hospital does not meet such requirements1 the ,secretary shall-- 7aa7 reduce the otherwise applicable resident limit of the hospital by the amount by which such limit was increased under this paragraph2 and 7bb7 provide for the distribution of positions attributable to such reduction in accordance with the requirements of this paragraph4 7,d7 ,limitation ,a hospital may not receive more than #ge full-time equivalent additional residency positions under this paragraph for any fiscal year4 7,e7 ,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 paragraph1 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 7#b77;,d7 for that hospital4 7,f7 ,permitting facilities to apply aggregation rules ,the ,secretary shall permit hospitals receiving additional residency positions attributable to the increase provided under this paragraph to1 beginning in the fifth year after the effective date of such increase1 apply such positions to the limitation amount under paragraph 7#d77;,f7 that may be aggregated pursuant to paragraph 7#d77;,h7 among members of the same affiliated group4 7,g7 ,definitions ,in this paragraph3 7i7 ,otherwise applicable resident limit ,the term otherwise applicable resident limit means1 with respect to a hospital1 the limit otherwise applicable under subparagraphs 7,f77i7 and 7,h7 of paragraph 7#d7 on the resident level for the hospital determined without regard to this paragraph but taking into account paragraphs 7#g77;,a71 7#g77;,b71 7#h77;,a71 and 7#h77;,b74 7ii7 ,reference resident level ,except as otherwise provided in subclause 7,,ii71 the term reference resident level means1 with respect to a hospital1 the resident level for the most recent cost reporting period of the hospital ending on or before the date of enactment of this paragraph1 for which a cost report has been settled 7or1 if not1 submitted 7subject to audit771 as determined by the ,secretary4 7iii7 ,resident level ,the term resident level has the meaning given such term in paragraph 7#g77;,c77i74 7iv7 ,shortage specialty residency program ,the term shortage specialty residency program means the following3 7,i7 ,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 #c of the ,resident ,physician ,shortage ,reduction ,act of #bjac1 any approved residency training program in a specialty identified in the report entitled ,the ,physician ,workforce3 ,projections and ,research into ,current ,issues ,affecting ,supply and ,demand1 issued in ,december #bjjh by the ,health ,resources and ,services ,administration1 as a specialty whose baseline physician requirements projections exceed the projected supply of total active physicians for the period of #bjje through #bjbj4 7,,ii7 ,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 section1 any approved residency training program in a physician specialty identified in such report as a specialty for which there is a shortage4 4 7b7 ,,ime ,section #ahhf7;d77#e77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,b77 is amended-- 7#a7 in clause 7v71 in the second sentence1 by striking subsections 7h77#g7 and 7h77#h7 and inserting subsections 7h77#g71 7h77#h71 and 7h77#i72 7#b7 by redesignating clause 7x71 as added by section #eeje7;b7 of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh71 as clause 7xi7 and moving such clause #d ems to the left2 and 7#c7 by adding after clause 7xi71 as redesignated by subparagraph 7,a71 the following new clause3 7xii7 ,for discharges occurring on or after ,july #a1 #bjae1 insofar as an additional payment amount under this subparagraph is attributable to resident positions distributed to a hospital under subsection 7h77#i71 the indirect teaching adjustment factor shall be computed in the same manner as provided under clause 7ii7 with respect to such resident positions4 4 #c4 ,study and report by national health care workforce commission 7a7 ,study ,the ,national ,health ,care ,workforce ,commission established under section #eaja of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh7 shall conduct a study of the physician workforce4 ,such study shall include the identification of physician specialties for which there is a shortage1 as defined by the ,commission4 7b7 ,report ,not later than ,january #a1 #bjaf1 the ,national ,health ,care ,workforce ,commission shall submit to ,congress a report on the study conducted under subsection 7a71 together with recommendations for such legislation and administrative action as the ,commission determines appropriate4 #d4 ,study and report on strategies for increasing diversity 7a7 ,study ,the ,comptroller ,general of the ,united ,states 7in this section referred to as the ,comptroller ,general7 shall conduct a study on strategies for increasing the diversity of the health professional workforce4 ,such study shall include an analysis of strategies for increasing the number of health professionals from rural1 lower income1 and underrepresented minority communities1 including which strategies are most effective for achieving such goal4 7b7 ,report ,not later than #b years after the date of enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report on the study conducted under subsection 7a71 together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate4