,,ii #aacth ,,congress #ast ,session ,s4 #egg ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #ad1 #bjac ,mr4 ,nelson 7for himself1 ,mr4 ,reid1 and ,mr4 ,schumer7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,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 7iii77,,ii771 the ,secretary shall 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 ,except as provided in clause 7iii71 the aggregate number of increases in the otherwise applicable resident limit under this subparagraph shall be equal to #c1jjj in each of fiscal years #bjae through #bjai1 of which at least #a1ejj in each such fiscal year shall be used for full-time equivalent residents training in a shortage specialty residency program 7as defined in subparagraph 7,f77iii774 7ii7 ,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 as a result of an increase in the otherwise applicable resident limit 7as described in clause 7i77 shall be distributed1 plus any additional positions available under clause 7iii74 7,,iii7 ,timing ,the ,secretary shall notify hospitals of the number of positions distributed to the hospital under this paragraph as 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 7iii7 ,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 7i71 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 considerations described in subparagraph 7,b77i7 and the priority described in subparagraph 7,b77ii71 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 ,distribution to certain hospitals 7i7 ,consideration in distribution ,in determining for which hospitals the increase in the otherwise applicable resident limit 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 the increase in the otherwise applicable resident limit is provided under subparagraph 7,a71 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 in which the resident level of the hospital is greater than the otherwise applicable resident limit during the most recent cost reporting period ending on or before the date of enactment of this paragraph4 7,,iii7 ,third1 to hospitals that emphasize training in community health center or community-based settings or in hospital outpatient departments4 7,,iv7 ,fourth1 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,v7 ,fifth1 to all other hospitals4 7iii7 ,distribution to hospitals in higher priority group prior to distribution in lower priority groups ,the ,secretary may only distribute an increase under subparagraph 7,a7 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 7,c7 ,requirements for use of additional positions 7i7 ,in general ,subject to clause 7ii71 a hospital that receives an increase in the otherwise applicable resident limit under subparagraph 7,a7 shall ensure1 during the #e-year period beginning on the effective date of such increase1 that-- 7,i7 not less than #ej percent of the positions attributable to such increase are used to train full-time equivalent residents in a shortage specialty residency program 7as defined in subclause 7,f77iii771 as determined by the ,secretary at the end of such #e-year period2 7,,ii7 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 7,,iii7 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 7ii7 ,redistribution of positions if hospital no longer meets certain requirements ,in the case where the ,secretary determines that a hospital described in clause 7i7 does not meet the requirements of such clause1 the ,secretary shall-- 7,i7 reduce the otherwise applicable resident limit of the hospital by the amount by which such limit was increased under this paragraph2 and 7,,ii7 provide for the distribution of positions attributable to such reduction in accordance with the requirements of this paragraph4 7,d7 ,limitation 7i7 ,in general ,except as provided in clause 7ii71 a hospital may not receive more than #ge full-time equivalent additional residency positions in the aggregate under this paragraph over the period of fiscal years #bjae through #bjai4 7ii7 ,increase in number of additional positions a hospital may receive ,the ,secretary shall increase the aggregate number of full-time equivalent additional residency positions a hospital may receive under this paragraph over such period if the ,secretary estimates that the number of positions available for distribution under subparagraph 7,a7 exceeds the number of applications approved under such subparagraph over such period4 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 ,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 ,resident level ,the term resident level has the meaning given such term in paragraph 7#g77;,c77i74 7iii7 ,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 7#a7 ,in general ,section #ahhf7;d77#e77;,b77v7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,b77v771 in the second sentence1 is amended by striking subsections 7h77#g7 and 7h77#h7 and inserting 8subsections 7h77#g71 7h77#h71 and 7h77#i74 7#b7 ,conforming provision ,section #ahhf7;d77#e77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,b77 is amended-- 7,a7 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,b7 by adding after clause 7xi71 as redesignated by subparagraph 7,a71 the following 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 the 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