,i #aacth ,,congress #ast ,session ,h4 ,r4 #dhg ,,in ,,the ,,house ,,of ,,representatives ,february #d1 #bjac ,mrs4 ,mc,morris ,rodgers 7for herself and ,mr4 ,thompson of ,california7 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 provide for a ,medicare primary care graduate medical education pilot project in order to improve access to the primary care workforce4 #a4 ,short title ,this ,act may be cited as the ,primary ,care ,workforce ,access ,improvement ,act of #bjac4 #b4 ,medicare primary care graduate medical education pilot project 7a7 ,establishment ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall conduct a pilot project under the ,medicare program under title ,,xviii of the ,social ,security ,act1 in accordance with the provisions of this section1 to test models for providing payment under such title for direct graduate medical education and indirect medical education to medical education entities1 which entities are not otherwise eligible to receive such payments under the ,medicare program1 for the costs of training primary care residents4 7b7 ,duration ,the ,secretary shall conduct the pilot project under this section over a #e-year period1 which shall begin not later than #ahj days after the date of the enactment of this ,act4 7c7 ,models 7#a7 ,required models ,under the pilot project1 the ,secretary shall test two of each of the following models3 7,a7 ,a model in which the medical education entity receiving funds under the pilot project is a community-based independent corporate entity collaborating with two or more hospitals to operate one or more primary care graduate medical residency training programs4 7,b7 ,a model in which-- 7i7 the medical education entity receiving funds under the pilot project is established by two or more hospitals to operate one or more primary care graduate medical residency training programs2 and 7ii7 such hospitals may be the sole corporate members of the entity but the governing board of the entity shall include at least one community representative4 7,c7 ,a model in which the medical education entity receiving funds under the pilot project is a hospital subsidiary or independent corporation that operates one or more primary care graduate medical residency training programs for a hospital with community participation in the governance of the subsidiary or corporation4 7,d7 ,a model in which-- 7i7 the medical education entity receiving funds under the pilot project is independent of any hospital but collaborates with a hospital in operating one or more primary care graduate medical residency training programs2 and 7ii7 the medical education entity may include a university or school of medicine4 7#b7 ,additional models ,under the pilot project1 the ,secretary may test models of medical education entities in addition to those described in paragraph 7#a74 7d7 ,prioritization ,under the pilot project1 the ,secretary of ,health and ,human ,services may give priority to testing models that demonstrate the capability of improving the quality1 quantity1 and distribution of primary care physicians1 including the ability to enhance primary care delivery in rural and underserved areas4 7e7 ,payments 7#a7 ,payments to medical education entities ,under the pilot project1 the ,secretary shall establish a process under which payments are made to each medical education entity participating under such project for direct graduate medical education and indirect medical education costs with respect to primary care residents enrolled under a primary care graduate medical residency training program operated pursuant to a model of such entity under subsection 7c7 instead of any payment or adjustment that would otherwise be made to a participant hospital 7as defined in subsection 7m77 of such entity for indirect and direct graduate medical education costs under subsections 7d77#e77;,b7 and 7h7 of section #ahhf of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7 during the period of participation of such entity in such project4 7#b7 ,calculation of payments ,payments to a medical education entity under the pilot project1 with respect to a primary care graduate medical education residency program1 for a cost reporting period during which the entity is participating in such pilot shall be1 based on the most recently available data with respect to a previous cost reporting period1 equal to the sum of the following3 7,a7 ,direct ,,gme ,the amount that1 out of all of the payment amounts 7determined on a per resident basis7 received by hospitals under section #ahhf7;h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7h77 for such previous cost reporting period1 is equal to the #ieth percentile of such payment amounts4 7,b7 ,indirect ,,gme ,the amount that1 out of all of the additional payment amounts 7determined on a per resident basis7 received by hospitals under section #ahhf7;d77#e77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,b77 for such previous cost reporting period1 is equal to the #ieth percentile of such payment amounts4 7#c7 ,additional payments for programs serving underserved areas ,payments in addition to the payments described in paragraph 7#b7 may be made under the pilot project for primary care graduate medical residency training programs that-- 7,a7 operate in sites and areas that are underserved by primary care physicians2 or 7,b7 change their training sites to include those areas4 7#d7 ,payments from ,medicare ,trust ,funds ,in providing for such payments under this subsection to medical education entities1 the ,secretary shall provide for an allocation of such payments between part ,a and part ,b 7and the ,federal ,hospital ,insurance ,trust ,fund under section #ahag of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i7 and the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda of such ,act 7#db ,u4,s4,c4 #aciet77 in the same manner as the ,secretary provides for an allocation of payments under subsections 7d77#e77;,b7 and 7h71 respectively1 of section #ahhf of such ,act 7#db ,u4,s4,c4 #acieww74 7f7 ,uses of payments 7#a7 ,in general ,a medical education entity receiving payments under the pilot project shall use such payments for the training of primary care residents1 including training activities in appropriate inpatient and outpatient settings in primary care graduate medical residency training programs accredited by the ,accreditation ,council for ,graduate ,medical ,education or the ,american ,osteopathic ,association and for all relevant topics including patient care1 care management1 working in teams1 supervision1 and quality improvement4 7#b7 ,limitations ,payments shall only be made for training primary care residents up to the initial board certification of such residents1 except that with respect to training in geriatric medicine1 payments may also be made for a fellowship after initial board certification4 7g7 ,expansion during pilot project ,a medical education entity receiving funds under the pilot project1 with respect to a primary care graduate medical residency training program1 shall be allowed to increase by up to #ej percent the number of full-time equivalent primary care residents enrolled in the such program 7determined in accordance with the process under subsection 7e77#a77 during the duration of the participation of such entity in such project4 7h7 ,treatment after project 7#a7 ,in general ,subject to paragraphs 7#b7 and 7#c71 after the last day of the pilot project1 which may be extended at the discretion of the ,secretary1 any participant hospital of a medical education entity under the pilot project1 shall receive payments under subsection 7d77#e77;,b7 and 7h7 of section #ahhf of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7 in the same manner and to the same extent such hospital would receive such payments without application of this ,act and such payments shall be calculated based on the number of full-time equivalent residents enrolled in such program without regard to any increase made pursuant to subsection 7g74 7#b7 ,exception to ensure residents enrolled during pilot are able to complete training ,subject to paragraph 7#c71 a medical education entity receiving funds under the pilot project1 with respect to a primary care graduate medical residency training program1 shall continue to receive funding under this section 7even after the last day of the project71 with respect to each primary care resident who is enrolled under such program while the entity is participating in such project1 to the extent and in such amounts necessary to allow for the full duration of training1 subject to subsection 7f77#b71 of such primary care resident4 ,any such payments made pursuant to this subparagraph shall be deemed to be a payment made under the pilot project4 7#c7 ,limitation ,in no case may the total duration of the pilot project exceed seven years and in no case may payments be made under this section to a medical education entity for a period exceeding seven years4 7i7 ,budget neutrality ,for each year that the pilot project under this section is being conducted 7and for any subsequent year to the extent subsection 7h77#b7 applies71 the ,secretary shall reduce payments under subsections 7d77#e77;,b7 and 7h7 of section #ahhf of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7 by such amount as the ,secretary determines to be necessary to ensure that carrying out the pilot project under this section during such year does not result in expenditures under title ,,xviii of the ,social ,security ,act for such year that exceed the amount of such expenditures that would have been made for such year without application of this section4 7j7 ,waiver authority ,the ,secretary may waive such requirements of titles ,,xi and ,,xviii of the ,social ,security ,act as may be necessary to carry out the purpose of the pilot project under this section4 7k7 ,report to ,congress ,the ,secretary is authorized to enter into an agreement with the ,institute of ,medicine to conduct a study on the results of the pilot project4 ,such agreement shall provide for the ,institute of ,medicine to submit1 not later than #a year after the completion of the pilot project under this section 7or1 if sooner1 ,january #a1 #bjba71 to ,congress a report on the results of such study1 including-- 7#a7 a detailed analysis of the effects of the pilot1 including the quality1 quantity1 and distribution of primary care physicians during and after the pilot project compared to the quality1 quantity1 and distribution of such physicians before the pilot project2 and the governance1 administration and financial strength of the medical educational entities that participated in the pilot project2 7#b7 recommendations on the extent to which the pilot project should be expanded to all primary care residents2 and 7#c7 recommendations for such legislation and administrative actions as needed4 7l7 ,expansion ,if the ,secretary determines that any of the models tested under the pilot project under this section enhance the quality1 quantity1 and distribution of primary care physicians for ,medicare beneficiaries1 the ,secretary may initiate comparable primary care training projects4 7m7 ,definitions ,for purposes of this section3 7#a7 ,direct graduate medical education costs2 indirect graduate medical education costs ,the terms direct graduate medical education costs and indirect graduate medical education have the meanings given such terms for purposes of subsections 7h7 and 7d77#e77;,b71 respectively1 of section #ahhf of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww74 7#b7 ,medical education entity ,the term medical education entity means a corporate1 nonprofit1 or academic entity that has as its principal mission the education and training of primary care residents4 7#c7 ,medicare beneficiary ,the term ,medicare beneficiary means an individual entitled to benefits under part ,a of title ,,xviii of the ,social ,security ,act or enrolled under part ,b of such title4 7#d7 ,participant hospital ,the term participant hospital means1 with respect to a medical education entity1 any hospital that establishes1 is collaborating with1 a component of1 or otherwise associated with1 such entity to operate a primary care graduate medical residency training program under a model described in subsection 7c74 7#e7 ,primary care graduate medical residency training program ,the term primary care graduate medical residency training program means an approved medical residency training program 7as defined in section #ahhf7;h77#e77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7h77#e77;,a777 for training primary care residents4 7#f7 ,primary care resident ,the term primary care resident means a resident enrolled in an approved medical residency training program in family medicine1 general internal medicine1 general pediatrics1 or geriatric medicine4