,i  #aac? ,,congress  #a/ ,session  ,h4 
,r4 #aahj  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,m>* #ad1 #bjac ,mr4  
,cr[ley 7= himself & ,mr4 ,grimm7       
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,ways & ,means1 & 9    
addition to ! ,committee on ,en]gy &    
,comm]ce1 = a p]iod to be subsequ5tly   
det]m9$ by ! ,speak]1 9 ea* case =      
consid]ation ( su* provisions z fall )9 
! jurisdiction ( ! committee conc]n$  ,a
 ,,bill  ,to am5d title ,,xviii ( !     
,social ,security ,act to provide = !   
di/ribution ( additional resid5cy       
positions1 & = o!r purposes4  #a4 ,%ort 
title ,?is ,act may be cit$ z ! ,resid5t
 ,physician ,%ortage ,r$uction ,act (   
#bjac4  #b4 ,di/ribution ( additional   
resid5cy positions  7a7 ,9 g5]al        
,section #ahhf7;h7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acieww7h77 is     
am5d$--  7#a7 9 p>agraph 7#d77;,f77i71  
by /rik+ p>agraphs 7#g7 & 7#h7 & ins]t+ 
p>agraphs 7#g71 7#h71 & 7#i72  7#b7 9   
p>agraph 7#d77;,h77i71 by /rik+         

p>agraphs 7#g7 & 7#h7 & ins]t+ p>agraphs
 7#g71 7#h71 & 7#i72  7#c7 9 p>agraph   
7#g77;,e71 by ins]t+ p>agraph 7#i71 aft]
 p>agraph 7#h712 &  7#d7 by add+ at !   
end ! foll[+ new p>agraph3  7#i7        
,di/ribution ( additional resid5cy      
positions  7,a7 ,additional resid5cy    
positions  7i7 ,9 g5]al ,= ea* ( fiscal 
ye>s #bjae ?r\gh #bjai 7& succe$+ fiscal
 ye>s if ! ,secret>y det]m9es t !re are 
additional resid5cy positions available 
to di/ribute "u clause 7iv77,,ii771 !   
,secret>y %all1 subject to clause 7ii7 &
 subp>agraph 7,d71 increase ! o!rwise   
applicable resid5t limit = ea* qualify+ 
hospital t submits a timely application 
"u ?is subp>agraph by su* numb] z !     
,secret>y may approve = portions ( co/  
report+ p]iods occurr+ on or aft] ,july 
#a ( ! fiscal ye> ( ! increase4  7ii7   
,numb] available = di/ribution ,= ea*   
su* fiscal ye>1 ! ,secret>y %all det]m9e
 ! total numb] ( additional resid5cy    
positions available = di/ribution "u    
clause 7i7 9 accordance ) ! foll[+3     

7,i7 ,allocation to hospitals already   
op]at+ ov] resid5t limit ,"o-?ird ( su* 
numb] %all be available = di/ribution   
only to hospitals describ$ 9 subp>agraph
 7,b74  7,,ii7 ,aggregate limitation    
,except z provid$ 9 clause 7iv77,i71 !  
aggregate numb] ( increases 9 ! o!rwise 
applicable resid5t limit "u ?is         
subp>agraph %all be equal to #c1jjj 9   
ea* su* ye>4  7iii7 ,process = di/ribut+
 positions  7,i7 ,r\nds ( applications  
,! ,secret>y %all initiate #e sep>ate   
r\nds ( applications = an increase "u   
clause 7i71 #a r\nd ) respect to ea* (  
fiscal ye>s #bjae ?r\gh #bjai4  7,,ii7  
,numb] available ,9 ea* ( su* r\nds1 !  
aggregate numb] ( positions available = 
di/ribution 9 ! fiscal ye> "u clause    
7ii7 %all be di/ribut$1 plus any        
additional positions available "u clause
 7iv74  7,,iii7 ,tim+ ,! ,secret>y %all 
notify hospitals ( ! numb] ( positions  
di/ribut$ to ! hospital "u ?is p>agraph 
z a result ( an increase 9 ! o!rwise    
applicable resid5t limit by ,janu>y #a (

 ! fiscal ye> ( ! increase4 ,su*        
increase %all be effective = portions ( 
co/ report+ p]iods beg9n+ on or aft]    
,july #a ( t fiscal ye>4  7iv7          
,positions n di/ribut$ dur+ ! fiscal ye>
  7,i7 ,9 g5]al ,if ! numb] ( resid5t   
full-"t equival5t positions di/ribut$ "u
 ?is p>agraph 9 a fiscal ye> is less ?an
 ! aggregate numb] ( positions available
 = di/ribution 9 ! fiscal ye> 7z        
describ$ 9 clause 7ii71 includ+ aft]    
application ( ?is subclause71 ! diff]5ce
 betwe5 su* numb] di/ribut$ & su* numb] 
available = di/ribution %all be add$ to 
! aggregate numb] ( positions available 
= di/ribution 9 ! foll[+ fiscal ye>4    
7,,ii7 ,exception if positions n        
di/ribut$ by end ( fiscal ye> #bjai ,if 
! aggregate numb] ( positions di/ribut$ 
"u ?is p>agraph dur+ ! #e-ye> p]iod (   
fiscal ye>s #bjae ?r\gh #bjai is less   
?an #ae1jjj1 ! ,secret>y %all1 9        
accordance ) ! provisions ( clause 7ii7 
& subp>agraph 7,d7 & ! consid]ations &  
priority describ$ 9 subp>agraph 7,c71   

conduct an application & di/ribution    
process 9 ea* subsequ5t fiscal ye> until
 su* "t z ! aggregate am\nt ( positions 
di/ribut$ "u ?is p>agraph is equal to   
#ae1jjj4  7,b7 ,allocation ( di/ribution
 = positions to hospitals already op]at+
 ov] resid5t limit  7i7 ,9 g5]al        
,subject to clauses 7ii7 & 7iii71 9 !   
case ( a hospital 9 :i* ! ref]5ce       
resid5t level ( ! hospital 7z specifi$ 9
 subp>agraph 7,g77iii77 is great] ?an ! 
o!rwise applicable resid5t limit1 !     
increase 9 ! o!rwise applicable resid5t 
limit "u subp>agraph 7,a7 = a fiscal ye>
 describ$ 9 su* subp>agraph %all be an  
am\nt equal to ! product ( ! total numb]
 ( additional resid5cy positions        
available = di/ribution "u subp>agraph  
7,a77ii77,i7 = su* fiscal ye> & !       
quoti5t (--  7,i7 ! numb] ( resid5t     
positions by :i* ! ref]5ce resid5t level
 ( ! hospital exce$s ! o!rwise          
applicable resid5t limit = ! hospital2 &
  7,,ii7 ! numb] ( resid5t positions by 
:i* ! ref]5ce resid5t level ( all su*   

hospitals ) respect to :i* an           
application is approv$ "u ?is p>agraph  
exce$s ! o!rwise applicable resid5t     
limit = su* hospitals4  7ii7            
,requirem5ts ,a hospital describ$ 9     
clause 7i7--  7,i7 is n eligible = an   
increase 9 ! o!rwise applicable resid5t 
limit "u ?is subp>agraph unless ! am\nt 
by :i* ! ref]5ce resid5t level ( !      
hospital exce$s ! o!rwise applicable    
resid5t limit is n less ?an #aj & !     
hospital tra9s at lea/ #be p]c5t ( !    
full-"t equival5t resid5ts ( ! hospital 
9 prim>y c>e & g5]al surg]y 7z ( ! date 
( enactm5t ( ?is p>agraph72 &  7,,ii7   
%all cont9ue to tra9 at lea/ #be p]c5t (
 ! full-"t equival5t resid5ts ( !       
hospital 9 prim>y c>e & g5]al surg]y = !
 #e-ye> p]iod beg9n+ on su* date4  ,9 ! 
case :]e ! ,secret>y det]m9es t a       
hospital describ$ 9 clause 7i7 no long] 
meets ! requirem5t ( subclause 7,,ii71 !
 ,secret>y may r$uce ! o!rwise          
applicable resid5t limit ( ! hospital by
 ! am\nt by :i* su* limit 0 increas$ "u 

?is subp>agraph4  7iii7 ,cl>ification   
reg>d+ eligibility = o!r additional     
resid5cy positions ,no?+ 9 ?is          
subp>agraph %all be con/ru$ z prev5t+ a 
hospital describ$ 9 clause 7i7 f apply+ 
= & receiv+ additional resid5cy         
positions "u ?is p>agraph t are n res]v$
 = di/ribution "u ?is subp>agraph4  7,c7
 ,di/ribution ( o!r positions ,=        
purposes ( det]m9+ an increase 9 !      
o!rwise applicable resid5t limit "u     
subp>agraph 7,a7 7o!r ?an su* an        
increase describ$ 9 subp>agraph 7,b771 !
 foll[+ %all apply3  7i7 ,consid]ations 
9 di/ribution ,9 det]m9+ = :i* hospitals
 su* an increase is provid$ "u          
subp>agraph 7,a71 ! ,secret>y %all take 
into acc\nt ! demon/rat$ likelihood ( ! 
hospital fill+ ! positions made         
available "u ?is p>agraph )9 ! fir/ #e  
co/ report+ p]iods beg9n+ aft] ! date ! 
increase w\ld be effective1 z det]m9$ by
 ! ,secret>y4  7ii7 ,priority = c]ta9   
hospitals ,subject to clause 7iii71 9   
det]m9+ = :i* hospitals su* an increase 

is provid$1 ! ,secret>y %all di/ribute !
 increase 9 ! foll[+ priority ord]3     
7,i7 ,fir/1 to hospitals 9 ,/ates ) 7aa7
 new m$ical s*ools t receiv$ ,c&idate   
,s*ool /atus f ! ,liaison ,committee on 
,m$ical ,education or t receiv$         
,pre-,accr$itation /atus f ! ,am]ican   
,o/eopa?ic ,association ,commission on  
,o/eopa?ic ,college ,accr$itation on or 
aft] ,janu>y #a1 #bjjj1 & t h a*iev$ or 
cont9ue to progress t[>d ,full          
,accr$itation /atus 7z su* t]m is def9$ 
by ! ,liaison ,committee on ,m$ical     
,education7 or t[>d ,accr$itation /atus 
7z su* t]m is def9$ by ! ,am]ican       
,o/eopa?ic ,association ,commission on  
,o/eopa?ic ,college ,accr$itation71 or  
7bb7 additional locations & bran*       
campuses e/abli%$ on or aft] ,janu>y #a1
 #bjjj1 by m$ical s*ools ) ,full        
,accr$itation /atus 7z su* t]m is def9$ 
by ! ,liaison ,committee on ,m$ical     
,education7 or ,accr$itation /atus 7z   
su* t]m is def9$ by ! ,am]ican          
,o/eopa?ic ,association ,commission on  

,o/eopa?ic ,college ,accr$itation74     
7,,ii7 ,second1 to hospitals t emphasize
 tra9+ 9 community heal? c5t] or        
community-bas$ sett+s or 9 hospital     
outpati5t dep>tm5ts4  7,,iii7 ,?ird1 to 
hospitals t are eligible = inc5tive     
paym5ts "u section #ahhf7n7 or #aijc7t7 
z ( ! date ! hospital submits an        
application = su* increase "u           
subp>agraph 7,a74  7,,iv7 ,f\r?1 to all 
o!r hospitals4  7iii7 ,di/ribution to   
hospitals 9 high] priority gr\p prior to
 di/ribution 9 l[] priority gr\ps ,!    
,secret>y may only di/ribute su* an     
increase to a l[] priority gr\p "u      
clause 7ii7 if all qualify+ hospitals 9 
! high] priority gr\p or gr\ps h receiv$
 ! maximum numb] ( increases "u su*     
subp>agraph t ! hospital is eligible =  
"u ?is p>agraph = ! fiscal ye>4  7iv7   
,requirem5ts = use ( additional         
positions  7,i7 ,9 g5]al ,subject to    
subclause 7,,ii71 a hospital t receives 
su* an increase %all ensure1 dur+ !     
#e-ye> p]iod beg9n+ on ! effective date 

( su* increase1 t--  7aa7 n less ?an #ej
 p]c5t ( ! positions attributable to su*
 increase t are us$ 9 a giv5 ye> dur+   
su* #e-ye> p]iod are us$ to tra9 full-"t
 equival5t resid5ts 9 a %ortage         
specialty resid5cy program 7z def9$ 9   
subp>agraph 7,g77v771 z det]m9$ by !    
,secret>y at ! end ( su* #e-ye> p]iod2  
7bb7 ! total numb] ( full-"t equival5t  
resid5ts1 exclud+ any additional        
positions attributable to su* increase1 
is n less ?an ! av]age numb] ( full-"t  
equival5t resid5ts dur+ ! #c mo/ rec5t  
co/ report+ p]iods end+ on or be=e !    
effective date ( su* increase2 &  7cc7 !
 ratio ( full-"t equival5t resid5ts 9 a 
%ortage specialty resid5cy program 7z s 
def9$7 is n less ?an ! av]age ratio (   
full-"t equival5t resid5ts 9 su* a      
program dur+ ! #c mo/ rec5t co/ report+ 
p]iods end+ on or be=e ! effective date 
( su* increase4  7,,ii7 ,r$i/ribution ( 
positions if hospital no long] meets    
c]ta9 requirem5ts ,) respect to ea*     
fiscal ye> describ$ 9 subp>agraph 7,a71 

! ,secret>y %all det]m9e :e!r or n a    
hospital describ$ 9 subclause 7,i7 meets
 ! requirem5ts ( su* subclause4 ,9 !    
case t ! ,secret>y det]m9es t su* a     
hospital does n meet su* requirem5ts1 ! 
,secret>y %all--  7aa7 r$uce ! o!rwise  
applicable resid5t limit ( ! hospital by
 ! am\nt by :i* su* limit 0 increas$ "u 
?is p>agraph2 &  7bb7 provide = !       
di/ribution ( positions attributable to 
su* r$uction 9 accordance ) !           
requirem5ts ( ?is p>agraph4  7,d7       
,limitation ,a hospital may n receive m 
?an #ge full-"t equival5t additional    
resid5cy positions "u ?is p>agraph = any
 fiscal ye>4  7,e7 ,application ( p]    
resid5t am\nts = prim>y c>e & nonprim>y 
c>e ,) respect to additional resid5cy   
positions 9 a hospital attributable to !
 increase provid$ "u ?is p>agraph1 !    
approv$ ,,fte p] resid5t am\nts are     
deem$ to be equal to ! hospital p]      
resid5t am\nts = prim>y c>e & nonprim>y 
c>e comput$ "u p>agraph 7#b77;,d7 = t   
hospital4  7,f7 ,p]mitt+ facilities to  

apply aggregation rules ,! ,secret>y    
%all p]mit hospitals receiv+ additional 
resid5cy positions attributable to !    
increase provid$ "u ?is p>agraph to1    
beg9n+ 9 ! fif? ye> aft] ! effective    
date ( su* increase1 apply su* positions
 to ! limitation am\nt "u p>agraph      
7#d77;,f7 t may be aggregat$ pursuant to
 p>agraph 7#d77;,h7 among memb]s ( !    
same affiliat$ gr\p4  7,g7 ,def9itions  
,9 ?is p>agraph3  7i7 ,o!rwise          
applicable resid5t limit ,! t]m o!rwise 
applicable resid5t limit means1 )       
respect to a hospital1 ! limit o!rwise  
applicable "u subp>agraphs 7,f77i7 &    
7,h7 ( p>agraph 7#d7 on ! resid5t level 
= ! hospital det]m9$ )\t reg>d to ?is   
p>agraph b tak+ into acc\nt p>agraphs   
7#g77;,a71 7#g77;,b71 7#h77;,a71 &      
7#h77;,b74  7ii7 ,ref]5ce resid5t level 
,except z o!rwise provid$ 9 subclause   
7,,ii71 ! t]m ref]5ce resid5t level     
means1 ) respect to a hospital1 !       
resid5t level = ! mo/ rec5t co/ report+ 
p]iod ( ! hospital end+ on or be=e !    

date ( enactm5t ( ?is p>agraph1 = :i* a 
co/ report has be5 settl$ 7or1 if n1    
submitt$ 7subject to audit771 z det]m9$ 
by ! ,secret>y4  7iii7 ,resid5t level ,!
 t]m resid5t level has ! mean+ giv5 su* 
t]m 9 p>agraph 7#g77;,c77i74  7iv7      
,%ortage specialty resid5cy program ,!  
t]m %ortage specialty resid5cy program  
means ! foll[+3  7,i7 ,prior to report  
on %ortage specialties ,prior to ! date 
on :i* ! report ( ! ,national ,heal?    
,c>e ,work=ce ,commission is submitt$ "u
 section #c ( ! ,resid5t ,physician     
,%ortage ,r$uction ,act ( #bjac1 any    
approv$ resid5cy tra9+ program 9 a      
specialty id5tifi$ 9 ! report entitl$ ,!
 ,physician ,work=ce3 ,projections &    
,rese>* into ,curr5t ,issues ,affect+   
,supply & ,dem&1 issu$ 9 ,decemb] #bjjh 
by ! ,heal? ,res\rces & ,s]vices        
,adm9i/ration1 z a specialty ^: basel9e 
physician requirem5ts projections exce$ 
! project$ supply ( total active        
physicians = ! p]iod ( #bjje ?r\gh      
#bjbj4  7,,ii7 ,aft] report on %ortage  

specialties ,on or aft] ! date on :i* ! 
report ( ! ,national ,heal? ,c>e        
,work=ce ,commission is submitt$ "u su* 
section1 any approv$ resid5cy tra9+     
program 9 a physician specialty id5tifi$
 9 su* report z a specialty = :i* !re is
 a %ortage4  4  7b7 ,,ime ,section      
#ahhf7;d77#e77;,b7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#acieww7d77#e77;,b77 is am5d$--  7#a7 9 
clause 7v71 9 ! second s5t5ce1 by /rik+ 
subsections 7h77#g7 & 7h77#h7 & ins]t+  
subsections 7h77#g71 7h77#h71 & 7h77#i72
  7#b7 by r$esignat+ clause 7x71 z add$ 
by section #eeje7;b7 ( ! ,pati5t        
,protection & ,af=dable ,c>e ,act       
7,public ,law #aaa-adh71 z clause 7xi7 &
 mov+ su* clause #d ems to ! left2 &    
7#c7 by add+ aft] clause 7xi71 z        
r$esignat$ by subp>agraph 7,a71 ! foll[+
 new clause3  7xii7 ,= dis*>ges occurr+ 
on or aft] ,july #a1 #bjae1 ins(> z an  
additional paym5t am\nt "u ?is          
subp>agraph is attributable to resid5t  
positions di/ribut$ to a hospital "u    

subsection 7h77#i71 ! indirect tea*+    
adju/m5t factor %all be comput$ 9 ! same
 mann] z provid$ "u clause 7ii7 )       
respect to su* resid5t positions4  4    
#c4 ,/udy & report by national heal? c>e
 work=ce commission  7a7 ,/udy ,!       
,national ,heal? ,c>e ,work=ce          
,commission e/abli%$ "u section #eaja ( 
! ,pati5t ,protection & ,af=dable ,c>e  
,act 7,public ,law #aaa-adh7 %all       
conduct a /udy ( ! physician work=ce4   
,su* /udy %all include ! id5tification (
 physician specialties = :i* !re is a   
%ortage1 z def9$ by ! ,commission4  7b7 
,report ,n lat] ?an ,janu>y #a1 #bjaf1 !
 ,national ,heal? ,c>e ,work=ce         
,commission %all submit to ,congress a  
report on ! /udy conduct$ "u subsection 
7a71 toge!r ) recomm5dations = su*      
legislation & adm9i/rative action z !   
,commission det]m9es appropriate4  #d4  
,/udy & report on /rategies = increas+  
div]sity  7a7 ,/udy ,! ,comptroll]      
,g5]al ( ! ,unit$ ,/ates 79 ?is section 
ref]r$ to z ! ,comptroll] ,g5]al7 %all  

conduct a /udy on /rategies = increas+ !
 div]sity ( ! heal? pr(essional work=ce4
 ,su* /udy %all include an analysis (   
/rategies = increas+ ! numb] ( heal?    
pr(essionals f rural1 l[] income1 &     
und]repres5t$ m9ority communities1      
includ+ :i* /rategies are mo/ effective 
= a*iev+ su* goal4  7b7 ,report ,n lat] 
?an #b ye>s aft] ! date ( enactm5t ( ?is
 ,act1 ! ,comptroll] ,g5]al %all submit 
to ,congress a report on ! /udy conduct$
 "u subsection 7a71 toge!r )            
recomm5dations = su* legislation &      
adm9i/rative action z ! ,comptroll]     
,g5]al det]m9es appropriate4