,i  #aac? ,,congress  #a/ ,session  ,h4 
,r4 #dhg  ,,9 ,,! ,,h\se ,,(            
,,repres5tatives  ,febru>y #d1 #bjac    
,mrs4 ,mc,morris ,rodg]s 7= h]self &    
,mr4 ,?ompson ( ,cali=nia7 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 provide = a ,m$ic>e prim>y 
c>e graduate m$ical education pilot     
project 9 ord] to improve access to !   
prim>y c>e work=ce4  #a4 ,%ort title    
,?is ,act may be cit$ z ! ,prim>y ,c>e  
,work=ce ,access ,improvem5t ,act (     
#bjac4  #b4 ,m$ic>e prim>y c>e graduate 
m$ical education pilot project  7a7     
,e/abli%m5t ,! ,secret>y ( ,heal? &     
,human ,s]vices 79 ?is section ref]r$ to
 z ! ,secret>y7 %all conduct a pilot    
project "u ! ,m$ic>e program "u title   
,,xviii ( ! ,social ,security ,act1 9   

accordance ) ! provisions ( ?is section1
 to te/ models = provid+ paym5t "u su*  
title = direct graduate m$ical education
 & indirect m$ical education to m$ical  
education entities1 :i* entities are n  
o!rwise eligible to receive su* paym5ts 
"u ! ,m$ic>e program1 = ! co/s ( tra9+  
prim>y c>e resid5ts4  7b7 ,duration ,!  
,secret>y %all conduct ! pilot project  
"u ?is section ov] a #e-ye> p]iod1 :i*  
%all beg9 n lat] ?an #ahj days aft] !   
date ( ! enactm5t ( ?is ,act4  7c7      
,models  7#a7 ,requir$ models ,"u !     
pilot project1 ! ,secret>y %all te/ two 
( ea* ( ! foll[+ models3  7,a7 ,a model 
9 :i* ! m$ical education entity receiv+ 
funds "u ! pilot project is a           
community-bas$ indep5d5t corporate      
entity collaborat+ ) two or m hospitals 
to op]ate "o or m prim>y c>e graduate   
m$ical resid5cy tra9+ programs4  7,b7 ,a
 model 9 :i*--  7i7 ! m$ical education  
entity receiv+ funds "u ! pilot project 
is e/abli%$ by two or m hospitals to    
op]ate "o or m prim>y c>e graduate      

m$ical resid5cy tra9+ programs2 &  7ii7 
su* hospitals may be ! sole corporate   
memb]s ( ! entity b ! gov]n+ bo>d ( !   
entity %all include at lea/ "o community
 repres5tative4  7,c7 ,a model 9 :i* !  
m$ical education entity receiv+ funds "u
 ! pilot project is a hospital subsidi>y
 or indep5d5t corporation t op]ates "o  
or m prim>y c>e graduate m$ical resid5cy
 tra9+ programs = a hospital ) community
 p>ticipation 9 ! gov]nance ( !         
subsidi>y or corporation4  7,d7 ,a model
 9 :i*--  7i7 ! m$ical education entity 
receiv+ funds "u ! pilot project is     
indep5d5t ( any hospital b collaborates 
) a hospital 9 op]at+ "o or m prim>y c>e
 graduate m$ical resid5cy tra9+         
programs2 &  7ii7 ! m$ical education    
entity may include a univ]sity or s*ool 
( m$ic9e4  7#b7 ,additional models ,"u !
 pilot project1 ! ,secret>y may te/     
models ( m$ical education entities 9    
addition to ^? describ$ 9 p>agraph 7#a74
  7d7 ,prioritization ,"u ! pilot       
project1 ! ,secret>y ( ,heal? & ,human  

,s]vices may give priority to te/+      
models t demon/rate ! capability (      
improv+ ! quality1 quantity1 &          
di/ribution ( prim>y c>e physicians1    
includ+ ! ability to enhance prim>y c>e 
deliv]y 9 rural & und]s]v$ areas4  7e7  
,paym5ts  7#a7 ,paym5ts to m$ical       
education entities ,"u ! pilot project1 
! ,secret>y %all e/abli% a process "u   
:i* paym5ts are made to ea* m$ical      
education entity p>ticipat+ "u su*      
project = direct graduate m$ical        
education & indirect m$ical education   
co/s ) respect to prim>y c>e resid5ts   
enroll$ "u a prim>y c>e graduate m$ical 
resid5cy tra9+ program op]at$ pursuant  
to a model ( su* entity "u subsection   
7c7 in/ead ( any paym5t or adju/m5t t   
w\ld o!rwise be made to a p>ticipant    
hospital 7z def9$ 9 subsection 7m77 (   
su* entity = indirect & direct graduate 
m$ical education co/s "u subsections    
7d77#e77;,b7 & 7h7 ( section #ahhf ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acieww7 dur+ ! p]iod ( p>ticipation (  

su* entity 9 su* project4  7#b7         
,calculation ( paym5ts ,paym5ts to a    
m$ical education entity "u ! pilot      
project1 ) respect to a prim>y c>e      
graduate m$ical education resid5cy      
program1 = a co/ report+ p]iod dur+ :i* 
! entity is p>ticipat+ 9 su* pilot %all 
be1 bas$ on ! mo/ rec5tly available data
 ) respect to a previ\s co/ report+     
p]iod1 equal to ! sum ( ! foll[+3  7,a7 
,direct ,,gme ,! am\nt t1 out ( all ( ! 
paym5t am\nts 7det]m9$ on a p] resid5t  
basis7 receiv$ by hospitals "u section  
#ahhf7;h7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acieww7h77 = su* previ\s
 co/ report+ p]iod1 is equal to ! #ie?  
p]c5tile ( su* paym5t am\nts4  7,b7     
,indirect ,,gme ,! am\nt t1 out ( all ( 
! additional paym5t am\nts 7det]m9$ on a
 p] resid5t basis7 receiv$ by hospitals 
"u section #ahhf7;d77#e77;,b7 ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#acieww7d77#e77;,b77 = su* previ\s co/  
report+ p]iod1 is equal to ! #ie?       
p]c5tile ( su* paym5t am\nts4  7#c7     

,additional paym5ts = programs s]v+     
und]s]v$ areas ,paym5ts 9 addition to ! 
paym5ts describ$ 9 p>agraph 7#b7 may be 
made "u ! pilot project = prim>y c>e    
graduate m$ical resid5cy tra9+ programs 
t--  7,a7 op]ate 9 sites & areas t are  
und]s]v$ by prim>y c>e physicians2 or   
7,b7 *ange _! tra9+ sites to include ^? 
areas4  7#d7 ,paym5ts f ,m$ic>e ,tru/   
,funds ,9 provid+ = su* paym5ts "u ?is  
subsection to m$ical education entities1
 ! ,secret>y %all provide = an          
allocation ( su* paym5ts betwe5 "p ,a & 
"p ,b 7& ! ,f$]al ,hospital ,insurance  
,tru/ ,fund "u section #ahag ( ! ,social
 ,security ,act 7#db ,u4,s4,c4 #acie;i7 
& ! ,f$]al ,supplem5t>y ,m$ical         
,insurance ,tru/ ,fund "u section #ahda 
( su* ,act 7#db ,u4,s4,c4 #aciet77 9 !  
same mann] z ! ,secret>y provides = an  
allocation ( paym5ts "u subsections     
7d77#e77;,b7 & 7h71 respectively1 (     
section #ahhf ( su* ,act 7#db ,u4,s4,c4 
#acieww74  7f7 ,uses ( paym5ts  7#a7 ,9 
g5]al ,a m$ical education entity receiv+

 paym5ts "u ! pilot project %all use su*
 paym5ts = ! tra9+ ( prim>y c>e         
resid5ts1 includ+ tra9+ activities 9    
appropriate inpati5t & outpati5t sett+s 
9 prim>y c>e graduate m$ical resid5cy   
tra9+ programs accr$it$ by !            
,accr$itation ,c\ncil = ,graduate       
,m$ical ,education or ! ,am]ican        
,o/eopa?ic ,association & = all relevant
 topics includ+ pati5t c>e1 c>e         
managem5t1 work+ 9 teams1 sup]vision1 & 
quality improvem5t4  7#b7 ,limitations  
,paym5ts %all only be made = tra9+      
prim>y c>e resid5ts up to ! initial bo>d
 c]tification ( su* resid5ts1 except t )
 respect to tra9+ 9 g]iatric m$ic9e1    
paym5ts may also be made = a fell[%ip   
aft] initial bo>d c]tification4  7g7    
,expansion dur+ pilot project ,a m$ical 
education entity receiv+ funds "u !     
pilot project1 ) respect to a prim>y c>e
 graduate m$ical resid5cy tra9+ program1
 %all be all[$ to increase by up to #ej 
p]c5t ! numb] ( full-"t equival5t prim>y
 c>e resid5ts enroll$ 9 ! su* program   

7det]m9$ 9 accordance ) ! process "u    
subsection 7e77#a77 dur+ ! duration ( ! 
p>ticipation ( su* entity 9 su* project4
  7h7 ,treatm5t aft] project  7#a7 ,9   
g5]al ,subject to p>agraphs 7#b7 & 7#c71
 aft] ! la/ day ( ! pilot project1 :i*  
may be ext5d$ at ! discretion ( !       
,secret>y1 any p>ticipant hospital ( a  
m$ical education entity "u ! pilot      
project1 %all receive paym5ts "u        
subsection 7d77#e77;,b7 & 7h7 ( section 
#ahhf ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #acieww7 9 ! same mann] & to !
 same ext5t su* hospital w\ld receive   
su* paym5ts )\t application ( ?is ,act &
 su* paym5ts %all be calculat$ bas$ on !
 numb] ( full-"t equival5t resid5ts     
enroll$ 9 su* program )\t reg>d to any  
increase made pursuant to subsection    
7g74  7#b7 ,exception to ensure resid5ts
 enroll$ dur+ pilot are able to complete
 tra9+ ,subject to p>agraph 7#c71 a     
m$ical education entity receiv+ funds "u
 ! pilot project1 ) respect to a prim>y 
c>e graduate m$ical resid5cy tra9+      

program1 %all cont9ue to receive fund+  
"u ?is section 7ev5 aft] ! la/ day ( !  
project71 ) respect to ea* prim>y c>e   
resid5t :o is enroll$ "u su* program    
:ile ! entity is p>ticipat+ 9 su*       
project1 to ! ext5t & 9 su* am\nts      
necess>y to all[ = ! full duration (    
tra9+1 subject to subsection 7f77#b71 ( 
su* prim>y c>e resid5t4 ,any su* paym5ts
 made pursuant to ?is subp>agraph %all  
be deem$ to be a paym5t made "u ! pilot 
project4  7#c7 ,limitation ,9 no case   
may ! total duration ( ! pilot project  
exce$ sev5 ye>s & 9 no case may paym5ts 
be made "u ?is section to a m$ical      
education entity = a p]iod exce$+ sev5  
ye>s4  7i7 ,budget neutrality ,= ea* ye>
 t ! pilot project "u ?is section is be+
 conduct$ 7& = any subsequ5t ye> to !   
ext5t subsection 7h77#b7 applies71 !    
,secret>y %all r$uce paym5ts "u         
subsections 7d77#e77;,b7 & 7h7 ( section
 #ahhf ( ! ,social ,security ,act 7#db  
,u4,s4,c4 #acieww7 by su* am\nt z !     
,secret>y det]m9es to be necess>y to    

ensure t c>ry+ out ! pilot project "u   
?is section dur+ su* ye> does n result 9
 exp5ditures "u title ,,xviii ( !       
,social ,security ,act = su* ye> t exce$
 ! am\nt ( su* exp5ditures t w\ld h be5 
made = su* ye> )\t application ( ?is    
section4  7j7 ,waiv] au?ority ,!        
,secret>y may waive su* requirem5ts (   
titles ,,xi & ,,xviii ( ! ,social       
,security ,act z may be necess>y to c>ry
 out ! purpose ( ! pilot project "u ?is 
section4  7k7 ,report to ,congress ,!   
,secret>y is au?oriz$ to ent] into an   
agreem5t ) ! ,in/itute ( ,m$ic9e to     
conduct a /udy on ! results ( ! pilot   
project4 ,su* agreem5t %all provide = ! 
,in/itute ( ,m$ic9e to submit1 n lat]   
?an #a ye> aft] ! completion ( ! pilot  
project "u ?is section 7or1 if soon]1   
,janu>y #a1 #bjba71 to ,congress a      
report on ! results ( su* /udy1         
includ+--  7#a7 a detail$ analysis ( !  
effects ( ! pilot1 includ+ ! quality1   
quantity1 & di/ribution ( prim>y c>e    
physicians dur+ & aft] ! pilot project  

comp>$ to ! quality1 quantity1 &        
di/ribution ( su* physicians be=e !     
pilot project2 & ! gov]nance1           
adm9i/ration & f9ancial /r5g? ( ! m$ical
 educational entities t p>ticipat$ 9 !  
pilot project2  7#b7 recomm5dations on !
 ext5t to :i* ! pilot project %\ld be   
exp&$ to all prim>y c>e resid5ts2 &     
7#c7 recomm5dations = su* legislation & 
adm9i/rative actions z ne$$4  7l7       
,expansion ,if ! ,secret>y det]m9es t   
any ( ! models te/$ "u ! pilot project  
"u ?is section enhance ! quality1       
quantity1 & di/ribution ( prim>y c>e    
physicians = ,m$ic>e b5efici>ies1 !     
,secret>y may initiate comp>able prim>y 
c>e tra9+ projects4  7m7 ,def9itions ,= 
purposes ( ?is section3  7#a7 ,direct   
graduate m$ical education co/s2 indirect
 graduate m$ical education co/s ,! t]ms 
direct graduate m$ical education co/s & 
indirect graduate m$ical education h !  
mean+s giv5 su* t]ms = purposes (       
subsections 7h7 & 7d77#e77;,b71         
respectively1 ( section #ahhf ( !       

,social ,security ,act 7#db ,u4,s4,c4   
#acieww74  7#b7 ,m$ical education entity
 ,! t]m m$ical education entity means a 
corporate1 nonpr(it1 or academic entity 
t has z its pr9cipal mission ! education
 & tra9+ ( prim>y c>e resid5ts4  7#c7   
,m$ic>e b5efici>y ,! t]m ,m$ic>e        
b5efici>y means an individual entitl$ to
 b5efits "u "p ,a ( title ,,xviii ( !   
,social ,security ,act or enroll$ "u "p 
,b ( su* title4  7#d7 ,p>ticipant       
hospital ,! t]m p>ticipant hospital     
means1 ) respect to a m$ical education  
entity1 any hospital t e/abli%es1 is    
collaborat+ )1 a compon5t (1 or o!rwise 
associat$ )1 su* entity to op]ate a     
prim>y c>e graduate m$ical resid5cy     
tra9+ program "u a model describ$ 9     
subsection 7c74  7#e7 ,prim>y c>e       
graduate m$ical resid5cy tra9+ program  
,! t]m prim>y c>e graduate m$ical       
resid5cy tra9+ program means an approv$ 
m$ical resid5cy tra9+ program 7z def9$ 9
 section #ahhf7;h77#e77;,a7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           

#acieww7h77#e77;,a777 = tra9+ prim>y c>e
 resid5ts4  7#f7 ,prim>y c>e resid5t ,! 
t]m prim>y c>e resid5t means a resid5t  
enroll$ 9 an approv$ m$ical resid5cy    
tra9+ program 9 family m$ic9e1 g5]al    
int]nal m$ic9e1 g5]al p$iatrics1 or     
g]iatric m$ic9e4