,i #aaeth ,,congress #ast ,session ,h4 ,r4 #aafg ,,in ,,the ,,house ,,of ,,representatives ,february #af1 #bjag,mrs4 ,love 7for herself1 ,mr4 ,rush1 and ,mrs4 ,mc,morris ,rodgers7 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 amend title ,,xviii of the ,social ,security ,act to promote physician training in newly recognized primary medical specialties1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,enhancing ,opportunities for ,medical ,doctors ,act of #bjag4 #b4 ,redistributing unused residency positions to promote the establishment of residency programs for newly recognized primary medical specialties 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 7#g7 and 7#h7 and inserting 7#g71 7#h71 and 7#i72 7#b7 in paragraph 7#d77;,h77i71 by striking 7#g7 and 7#h7 and inserting 7#g71 7#h71 and 7#i72 7#c7 in paragraph 7#g77;,e71 by striking paragraph 7#h7 and inserting paragraph 7#h7 or 7#i7 before the period at the end2 and 7#d7 by adding at the end the following new paragraph3 7#i7 ,distribution of additional residency positions 7,a7 ,reductions in limit based on unused positions 7i7 ,in general ,if a hospital's reference resident level 7as defined in subparagraph 7,g77i77 is less than the otherwise applicable resident limit 7as defined in subparagraph 7,g77iii771 effective for portions of cost reporting periods occurring on or after ,july #a1 #bjah1 the otherwise applicable resident limit shall be reduced by #fe percent of the difference between such otherwise applicable resident limit and such reference resident level4 7ii7 ,exception ,this subparagraph shall not apply to a hospital located in a rural area 7as defined in subsection 7d77#b77;,d77ii77 with fewer than #bej acute care inpatient beds4 7,b7 ,distribution 7i7 ,in general ,the ,secretary shall1 in accordance with the succeeding provisions of this paragraph1 increase the otherwise applicable resident limit for each qualifying hospital that submits an application under this subparagraph by such number as the ,secretary may approve for portions of cost reporting periods occurring on or after ,july #a1 #bjah4 ,the aggregate number of increases in the otherwise applicable resident limit under this subparagraph shall be equal to the aggregate reduction in such limits attributable to subparagraph 7,a7 7as estimated by the ,secretary74 7ii7 ,requirements ,subject to clause 7iii71 a hospital that receives an increase in the otherwise applicable resident limit under this subparagraph shall ensure1 during the #c-year period beginning on the date of such increase1 that the positions resulting from the increase under this paragraph will be filled4 ,the ,secretary may determine whether a hospital has met the requirements under this clause during such #c-year period in such manner and at such time as the ,secretary determines appropriate1 including at the end of such #c-year period4 7iii7 ,redistribution of positions if hospital no longer meets certain requirements ,in the case where the ,secretary determines that a hospital described in clause 7ii7 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,c7 ,capacity considerations in redistribution ,in determining for which hospitals the increase in the otherwise applicable resident limit is provided under subparagraph 7,b71 the ,secretary shall take into account the demonstration likelihood of the hospital filling the positions made available under this paragraph within the first #c cost reporting periods beginning on or after ,july #a1 #bjah1 as determined by the ,secretary4 7,d7 ,priority in redistribution ,subject to subparagraphs 7,c7 and 7,e71 the ,secretary shall determine which qualifying hospitals receive increases under subparagraph 7,b7 in the otherwise applicable resident limits for such hospitals in a manner that distributes the positions made available to hospitals under this paragraph in accordance with the following3 7i7 ,the ,secretary shall make such positions available to hospitals with applicable residency training programs4 7ii7 ,in the case that the application of clause 7i7 does not result in the distribution of all positions made available under this paragraph1 the ,secretary shall make any positions that remain undistributed after the application of such clause available to hospitals that are located in-- 7,i7 a ,state with a resident-to-population ratio in the lowest quartile 7as determined by the ,secretary72 7,,ii7 a ,state1 a territory of the ,united ,states1 or the ,district of ,columbia that is among the top #aj ,states1 territories1 or ,districts in terms of the ratio of the total population of the ,state1 territory1 or ,district living in an area designated 7under such section #ccb7;a77#a77;,a77 as a health professional shortage area 7as of the date of enactment of this paragraph71 to the total population of the ,state1 territory1 or ,district 7as determined by the ,secretary based on the most recent available population data published by the ,bureau of the ,census72 or 7,,iii7 a rural area 7as defined in subsection 7d77#b77;,d77ii774 7iii7 ,in the case that the application of clauses 7i7 and 7ii7 does not result in the distribution of all positions made available under this paragraph1 the ,secretary shall make any positions that remain undistributed after the application of such clauses available to hospitals that establish a medical residency program that is sponsored by1 or affiliated with1 a medical school that was first accredited during the cost reporting period prior to the cost reporting period with respect to which such application applies4 7,e7 ,limitation ,a hospital may not receive more than #ge full-time equivalent additional residency positions under this paragraph4 7,f7 ,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,g7 ,definitions ,in this paragraph3 7i7 ,reference resident level ,the term reference resident level means1 with respect to a hospital1 the highest resident level for any of the #c most recent cost reporting periods 7ending before the date of the enactment of this paragraph7 of the hospital for which a cost report has been settled 7or1 if not1 submitted 7subject to audit771 as determined by the ,secretary4 7ii7 ,resident level ,the term resident level has the meaning given such term in paragraph 7#g77;,c77i74 7iii7 ,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 paragraph 7#g77;,a74 7iv7 ,applicable residency training program 7,i7 ,in general ,the term applicable residency training program means a medical residency training program that is for the applicable primary specialty that1 as of the date of the enactment of this paragraph1 is the applicable primary specialty that has most recently been designated as a primary specialty by the ,american ,board of ,medical ,specialties4 7,,ii7 ,applicable primary specialty ,the term applicable primary specialty means a primary specialty a resident of which is not1 as of the date of the enactment of this paragraph1 counted as an ,,fte resident for purposes of this subsection4 ,for purposes of the preceding sentence1 the term primary specialty does not include a subspecialty4 7,h7 ,affiliation ,the provisions of this paragraph shall be applied to hospitals which are members of the same affiliated group 7as defined by the ,secretary under paragraph 7#d77;,h77ii77 and the reference resident level for each such hospital shall be the reference resident level with respect to the cost reporting period that results in the smallest difference between the reference resident level and the otherwise applicable resident limit4 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 subsections 7h77#g71 7h77#h71 and 7h77#i74 7#b7 ,conforming amendment ,section #ahhf7;d77#e77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,b77 is amended by adding at the end the following clause3 7xii7 ,for discharges occurring on or after ,july #a1 #bjah1 insofar as an additional payment amount under this subparagraph is attributable to resident positions distributed to a hospital under subsection 7h77#i77;,b71 the indirect teaching adjustment factor shall be computed in the same manner as provided under clause 7ii7 with respect to such resident positions4 4 7c7 ,conforming amendment ,section #dbb7;b77#b7 of the ,medicare ,prescription ,drug1 ,improvement1 and ,modernization ,act of #bjjc 7,public ,law #ajh-agc71 as amended by section #eejc of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh71 is amended by striking paragraphs 7#g7 and 7#h7 and inserting paragraphs 7#g71 7#h71 and 7#i744