,i  #aad? ,,congress  #b;d ,session  ,h4
 ,r4 #fjci  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,septemb] #ae1        
#bjaf,mr4 ,h>dy 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   
r$i/ribute unus$ resid5cy positions to  
hospitals 9 ,/ates ) %ortages ( resid5ts
 & heal? pr(essionals1 & = o!r purposes4
  #a4 ,%ort title ,?is ,act may be cit$ 
z ! ,graduate ,opportunities 9 ,m$ical  
,education ,di/ribution ,act ( #bjaf4   
#b4 ,r$i/ribut+ unus$ resid5cy positions
 to hospitals 9 ,/ates ) %ortages (     
resid5ts & heal? pr(essionals  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+ 7#g7 & 7#h7 &    

ins]t+ 7#g71 7#h71 & 7#i72  7#b7 9      
p>agraph 7#d77;,h77i71 by /rik+ 7#g7 &  
7#h7 & ins]t+ 7#g71 7#h71 & 7#i72  7#c7 
9 p>agraph 7#g77;,e71 by /rik+ p>agraph 
7#h7 & ins]t+ p>agraph 7#h7 or 7#i7 be=e
 ! p]iod at ! end2 &  7#d7 by add+ at ! 
end ! foll[+ new p>agraph3  7#i7        
,di/ribution ( additional resid5cy      
positions  7,a7 ,r$uctions 9 limit bas$ 
on unus$ positions  7i7 ,mak+ (         
det]m9ations ,n lat] ?an #ahj days aft] 
! date ( ! enactm5t ( ?is p>agraph & ea*
 f\r ye>s !reaft]1 ! ,secret>y %all make
 a set ( r$uction det]m9ations 7z def9$ 
9 clause 7ii774  7ii7 ,set ( r$uction   
det]m9ations def9$ ,= purposes ( ?is    
p>agraph1 ! t]m set ( r$uction          
det]m9ations means det]m9ations )       
respect to ea* hospital ( :e!r1 )       
respect to ! "o-ye> p]iod end+ on ! date
 ( su* set ( r$uction det]m9ations      
7ref]r$ to 9 ?is p>agraph z ! measurem5t
 p]iod = su* set ( r$uction             
det]m9ations71 ! hospital's ref]5ce     
resid5t level 7z def9$ 9 subp>agraph    

7,f77i77 = su* p]iod 0 less ?an !       
o!rwise applicable resid5t limit 7z     
def9$ 9 subp>agraph 7,f77iii77 = su*    
hospital & p]iod4  7iii7 ,r$uction bas$ 
on det]m9ation ,9 ! case t1 ) respect to
 ! measurem5t p]iod = a set ( r$uction  
det]m9ations1 ! ,secret>y det]m9es "u   
?is subp>agraph t ! ref]5ce resid5t     
level ( a hospital = su* p]iod 0 less   
?an ! o!rwise applicable resid5t limit =
 su* hospital & p]iod1 effective =      
portions ( co/ report+ p]iods occurr+   
aft] ! date ( su* set ( r$uction        
det]m9ations & on or be=e ! date ( any  
subsequ5t set ( r$uction det]m9ations "u
 clause 7i7 7ref]r$ to 9 ?is p>agraph z 
! consequ5ce p]iod = su* set ( r$uction 
det]m9ations71 ! o!rwise applicable     
resid5t limit = su* hospital %all be    
r$uc$ by #fe p]c5t ( ! diff]5ce betwe5  
su* o!rwise applicable resid5t limit = !
 hospital & measurem5t p]iod & su*      
ref]5ce resid5t level = ! hospital &    
measurem5t p]iod 7or1 9 ! case t !      
,secret>y det]m9es t1 ) respect to !    

consequ5ce p]iod imm$iately prec$+ su*  
consequ5ce p]iod1 ! hospital 0 a        
hospital describ$ 9 clause 7ii7 (       
subp>agraph 7,b7 t did n meet !         
requirem5ts ( su* clause1 by ! numb]    
describ$ 9 clause 7iv774  7iv7 ,numb]   
describ$ ,! numb] describ$ 9 ?is clause1
 ) respect to a hospital & consequ5ce   
p]iod 7ref]r$ to 9 ?is clause z ! t>get 
consequ5ce p]iod71 is ! great] (--  7,i7
 ! numb] by :i* ! o!rwise applicable    
resid5t limit = su* hospital w\ld be    
r$uc$ = ! t>get consequ5ce p]iod "u     
clause 7iii7 )\t ! application ( ?is    
clause2 &  7,,ii7 ! numb] by :i* !      
o!rwise applicable resid5t limit = su*  
hospital 0 increas$ = ! consequ5ce p]iod
 t imm$iately prec$$ ! t>get consequ5ce 
p]iod4  7v7 ,exception ,?is subp>agraph 
%all n apply to a hospital locat$ 9 a   
rural area 7z def9$ 9 subsection        
7d77#b77;,d77ii77 ) few] ?an #bej acute 
c>e inpati5t b$s4  7vi7 ,det]m9ation    
tim+ ,9 ! case ( a r$uction det]m9ation 
made 9 a ye> by ! ,secret>y "u clause   

7i7 t is n ! fir/ su* r$uction          
det]m9ation s made1 ! ,secret>y %all    
make su* det]m9ation on a date t is n   
lat] ?an ,m>* #ca ( su* ye>4  7,b7      
,di/ribution  7i7 ,9 g5]al ,) respect to
 ea* set ( r$uction det]m9ations "u     
subp>agraph 7,a77i71 ! ,secret>y %all1 9
 accordance ) ! succe$+ provisions ( ?is
 p>agraph1 increase ! o!rwise applicable
 resid5t limit = ea* qualify+ hospital t
 submits an application "u ?is          
subp>agraph by su* numb] z ! ,secret>y  
may approve = portions ( co/ report+    
p]iods occurr+ dur+ ! consequ5ce p]iod =
 su* set ( r$uction det]m9ations4 ,!    
aggregate numb] ( increases 9 ! o!rwise 
applicable resid5t limit "u ?is         
subp>agraph = su* consequ5ce p]iod %all 
be equal to ! aggregate r$uction 9 su*  
limits attributable to subp>agraph 7,a7 
7z e/imat$ by ! ,secret>y7 = su*        
consequ5ce p]iod4  7ii7 ,requirem5ts ,a 
hospital t receives an increase 9 !     
o!rwise applicable resid5t limit "u ?is 
subp>agraph = a consequ5ce p]iod %all   

ensure t1 dur+ su* consequ5ce p]iod1 !  
positions result+ f ! increase "u ?is   
p>agraph w be fill$4 ,! ,secret>y may   
det]m9e :e!r a hospital has met !       
requirem5ts "u ?is clause dur+ su*      
consequ5ce p]iod 9 su* mann] & at su* "t
 z ! ,secret>y det]m9es appropriate1    
includ+ at ! end ( su* p]iod4  7,c7     
,capacity consid]ations 9 r$i/ribution  
,9 det]m9+ :i* hospitals are to receive 
increases 9 _! o!rwise applicable       
resid5t limits "u subp>agraph 7,b7 = a  
consequ5ce p]iod = a set ( r$uction     
det]m9ations1 ! ,secret>y %all take into
 acc\nt ! demon/rat$ likelihood ( ea*   
su* hospital fill+ ! positions made     
available "u ?is p>agraph )9 su*        
consequ5ce p]iod1 z det]m9$ by !        
,secret>y4  7,d7 ,priority 9            
r$i/ribution ,subject to subp>agraph    
7,c71 ! ,secret>y %all select1 ) respect
 to a set ( r$uction det]m9ations "u    
subp>agraph 7,a77i71 ! qualify+         
hospitals t w receive increases "u      
subp>agraph 7,b7 9 ! o!rwise applicable 

resid5t limits = su* hospitals = !      
consequ5ce p]iod = su* set ( r$uction   
det]m9ations4 ,! ,secret>y %all make su*
 selection 9 a mann] t di/ributes !     
positions made available to hospitals = 
su* consequ5ce p]iod "u ?is p>agraph 9  
accordance ) ! foll[+3  7i7 ,! ,secret>y
 %all1 ) respect to su* positions t are 
s made available = su* consequ5ce p]iod1
 make--  7,i7 #gj p]c5t ( su* positions 
available to hospitals locat$ 9 l[      
resid5t-to-population ,/ates 7z def9$ 9 
subp>agraph 7,f77iv772 &  7,,ii7 #cj    
p]c5t ( su* positions available to      
hospitals locat$ 9 high                 
,,hpsa-to-population ,/ates 7z def9$ 9  
subp>agraph 7,f77v774  7ii7 ,! ,secret>y
 %all1 9 accordance ) clause 7i71 make  
su* positions available = su* consequ5ce
 p]iod 9 a mann] t prioritizes !        
di/ribution ( su* positions to hospitals
 t are anticipat$ to fill su* positions 
) individuals f resid5ce programs locat$
 9 ! ,/ate 9 :i* su* hospitals are      
locat$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  
,def9itions ,9 ?is p>agraph3 7i7        
,ref]5ce resid5t level ,! t]m ref]5ce   
resid5t level means1 ) respect to a     
hospital & measurem5t p]iod1 ! resid5t  
level = ! co/ report+ p]iods ( !        
hospital occurr+ dur+ su* measurem5t    
p]iod & = :i* a co/ report has be5      
settl$ 7or1 if n1 submitt$ 7subject to  
audit771 z det]m9$ by ! ,secret>y4  7ii7
 ,resid5t level ,! t]m resid5t level has
 ! mean+ giv5 su* t]m 9 p>agraph        
7#g77;,c77i74  7iii7 ,o!rwise applicable
 resid5t limit ,! t]m o!rwise applicable
 resid5t limit means1 ) respect to a    
hospital & p]iod1 ! limit o!rwise       
applicable "u subp>agraphs 7,f77i7 &    
7,h7 ( p>agraph 7#d7 on ! resid5t level 

( ! hospital = su* p]iod1 det]m9$ )\t   
reg>d to ?is p>agraph b tak+ into acc\nt
 p>agraph 7#g77;,a74  7iv7 ,l[          
resid5t-to-population ,/ates  7,i7 ,9   
g5]al ,! t]m l[ resid5t-to-population   
,/ate means a ,/ate t has a small]      
applicable numb] ?an d at lea/ #ge p]c5t
 ( all ,/ates4  7,,ii7 ,applicable numb]
 ,= purposes ( subclause 7,i71 ! t]m    
applicable numb] means1 ) respect to a  
,/ate1 ! numb] t results f divid+ !     
numb] ( resid5ts 9 ! ,/ate by ! numb] ( 
individuals resid+ 9 ! ,/ate4  7v7 ,high
 ,,hpsa-to-population ,/ates  7,i7 ,9   
g5]al ,! t]m high ,,hpsa-to-population  
,/ate means a ,/ate t has a l>g]        
applicable numb] ?an d at lea/ #ij p]c5t
 ( all ,/ates4  7,,ii7 ,applicable numb]
 ,= purposes ( subclause 7,i71 ! t]m    
applicable numb] means1 ) respect to a  
,/ate1 ! numb] t results f divid+ !     
numb] ( areas 9 ! ,/ate designat$ by !  
,heal? ,res\rces  ,s]vices ,adm9i/ration
 ( ! ,dep>tm5t ( ,heal? & ,human        
,s]vices z ,heal? ,pr(essional ,%ortage 

,areas by ! numb] ( individuals resid+ 9
 ! ,/ate4  7,g7 ,affiliation ,!         
provisions ( ?is p>agraph %all be appli$
 to hospitals :i* are memb]s ( ! same   
affiliat$ gr\p 7z def9$ by ! ,secret>y  
"u p>agraph 7#d77;,h77ii774  4  7b7     
,,ime  7#a7 ,9 g5]al ,section           
#ahhf7;d77#e77;,b77v7 ( ! ,social       
,security ,act 7#db ,u4,s4,c4           
#acieww7d77#e77;,b77v771 9 ! second     
s5t5ce1 is am5d$ by /rik+ subsections   
7h77#g7 & 7h77#h7 & ins]t+ subsections  
7h77#g71 7h77#h71 & 7h77#i74  7#b7      
,con=m+ am5dm5t ,section                
#ahhf7;d77#e77;,b7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#acieww7d77#e77;,b77 is am5d$ by add+ at
 ! end ! foll[+ clause3  7xii7 ,=       
dis*>ges occurr+ on or aft] ! date t is 
#ahj days aft] ! date ( ! enactm5t ( ?is
 clause1 ins(> z an additional paym5t   
am\nt "u ?is subp>agraph is attributable
 to resid5t positions di/ribut$ to a    
hospital "u subsection 7h77#i77;,b71 !  
indirect tea*+ adju/m5t factor %all be  

comput$ 9 ! same mann] z provid$ "u     
clause 7ii7 ) respect to su* resid5t    
positions4  4  7c7 ,con=m+ am5dm5t      
,section #dbb7;b77#b7 ( ! ,m$ic>e       
,prescription ,drug1 ,improvem5t1 &     
,mod]nization ,act ( #bjjc 7,public ,law
 #ajh-agc71 z am5d$ by section #eejc ( !
 ,pati5t ,protection & ,af=dable ,c>e   
,act 7,public ,law #aaa-adh71 is am5d$  
by /rik+ p>agraphs 7#g7 & 7#h7 & ins]t+ 
p>agraphs 7#g71 7#h71 & 7#i744