,i  #aaeth ,,congress  #ast ,session    
,h4 ,r4 #ccid  ,,in ,,the ,,house ,,of  
,,representatives  ,july #be1 #bjag,mrs4
 ,mc,morris ,rodgers 7for herself1 ,mr4 
,carter of ,georgia1 ,mr4 ,heck1 ,mr4   
,kennedy1 ,mr4 ,khanna1 ,mr4 ,la,malfa1 
,mr4 ,mc,govern1 ,mr4 ,o',halleran1 ,mr4
 ,raskin1 ,mr4 ,vela1 ,mr4 ,young of    
,iowa1 ,mr4 ,capuano1 ,mr4 ,cartwright1 
,mr4 ,crowley1 ,mr4 ,denham1 ,mr4       
,espaillat1 ,mr4 ,faso1 ,ms4 ,jenkins of
 ,kansas1 ,mr4 ,kilmer1 ,mr4 ,moulton1  
,mr4 ,newhouse1 ,mr4 ,takano1 ,mr4      
,valadao1 ,mr4 ,cohen1 ,mr4 ,conyers1   
,mr4 ,courtney1 ,mr4 ,danny ,k4 ,davis  
of ,illinois1 ,mr4 ,de,fazio1 ,ms4      
,de,lauro1 ,ms4 ,del,bene1 ,mr4         
,garamendi1 ,mr4 ,larsen of ,washington1
 ,mr4 ,long1 ,mr4 ,lucas1 ,mr4 ,marino1 
,mr4 ,murphy of ,pennsylvania1 ,mr4     
,nolan1 ,ms4 ,ros-,lehtinen1 ,mr4 ,rush1
 ,ms4 ,schakowsky1 ,ms4 ,sewell of      
,alabama1 ,ms4 ,wilson of ,florida1 ,mr4
 ,serrano1 ,ms4 ,tsongas1 ,ms4          
,bonamici1 ,mr4 ,ruiz1 ,ms4 ,clark of   

,massachusetts1 ,mr4 ,cole1 ,mr4 ,rogers
 of ,kentucky1 and ,mr4 ,larson of      
,connecticut7 introduced the following  
bill2 which was referred to the         
,committee on ,energy and ,commerce  ,a 
,,bill  ,to reauthorize section #cdj;,h 
of the ,public ,health ,service ,act to 
continue to encourage the expansion1    
maintenance1 and establishment of       
approved graduate medical residency     
programs at qualified teaching health   
centers1 and for other purposes4  #a4   
,short title ,this ,act may be cited as 
the ,teaching ,health ,centers ,graduate
 ,medical ,education ,extension ,act of 
#bjag4  #b4 ,findings ,the ,congress    
finds as follows3  7#a7 ,the program of 
payments to teaching health centers for 
graduate medical education under section
 #cdj;,h of the ,public ,health ,service
 ,act 7#db ,u4,s4,c4 #bef;h7 was enacted
 in #bjaj to address the crisis-level   
shortage of primary care physicians1    
especially in rural and medically       
underserved communities4  7#b7 ,teaching

 health center residents and faculty    
will provide more than one million      
primary care medical visits in #bjag to 
underserved communities4  7#c7 ,when    
compared with traditional ,medicare     
,,gme residents1 residents who train at 
teaching health centers are more likely 
to practice primary care and remain in  
underserved or rural communities4  7#d7 
,the teaching health center program not 
only plays a vital role in training the 
,nation's next generation of primary    
care physicians 7including dentists71   
but helps bridge the ,nation's physician
 shortfall4  7#e7 ,for these reasons1 it
 is of vital importance to continue the 
program under section #cdj;,h of the    
,public ,health ,service ,act 7#db      
,u4,s4,c4 #bef;h7 at a sustainable level
 of funding per full-time equivalent    
resident1 as recommended in the fact    
sheet of the ,health ,resources and     
,services ,administration entitled ,cost
 ,estimates for ,training ,residents in 
a ,teaching ,health ,center4  #c4       

,reauthorization of program of payments 
to teaching health centers that operate 
graduate medical education programs  7a7
 ,payments ,subsection 7a7 of section   
#cdj;,h of the ,public ,health ,service 
,act 7#db ,u4,s4,c4 #bef;h7 is amended  
to read as follows3  7a7 ,payments  7#a7
 ,in general ,subject to subsection     
7h77#b71 the ,secretary shall make      
payments under this section for direct  
expenses and indirect expenses to       
qualified teaching health centers that  
are listed as sponsoring institutions by
 the relevant accrediting body for--    
7,a7 maintenance of existing approved   
graduate medical residency training     
programs2  7,b7 expansion of existing   
approved graduate medical residency     
training programs2 and  7,c7            
establishment of new approved graduate  
medical residency training programs4    
7#b7 ,new programs  7,a7 ,payments ,the 
,secretary shall make payments under    
paragraph 7#a77;,c7--  7i7 for fiscal   
year #bjai1 for a total of up to #fj    

full-time equivalent residents at new   
approved graduate medical residency     
programs2 and  7ii7 for fiscal year     
#bjbj1 for a total of up to #abj        
full-time equivalent residents at the   
new approved graduate medical residency 
programs that received payments pursuant
 to clause 7i74  7,b7 ,priority ,subject
 to subparagraph 7,c71 in making        
payments pursuant to paragraph          
7#a77;,c71 the ,secretary shall give    
priority to qualified teaching health   
centers that--  7i7 serve a health      
professional shortage area with a       
designation in effect under section #ccb
 or a medically underserved community   
7as defined in section #gii;,b72 or     
7ii7 are located in a rural area 7as    
defined in section #ahhf7;d77#b77;,d7 of
 the ,social ,security ,act74  7,c7     
,limitation ,the number of full-time    
equivalent residents for which a        
qualified teaching health center        
receives payments pursuant to paragraph 
7#a77;,c7 for a fiscal year shall not   

exceed by more than six the number of   
full-time equivalent residents for which
 the center received such payments for  
the preceding fiscal year4  4  7b7      
,funding ,subsection 7g7 of the first   
section #cdj;,h of the ,public ,health  
,service ,act 7#db ,u4,s4,c4 #bef;h7 is 
amended to read as follows3  7g7        
,funding  7#a7 ,existing programs ,out  
of any money in the ,treasury not       
otherwise appropriated1 there are       
appropriated for payments under         
subparagraphs 7,a7 and 7,b7 of          
subsection 7a77#a7 #aaf1ejj1jjj for each
 of fiscal years #bjah1 #bjai1 and      
#bjbj1 to remain available until        
expended4  7#b7 ,incentive for new      
programs ,out of any money in the       
,treasury not otherwise appropriated1   
there are appropriated for payments     
under subsection 7a77#a77;,c71          
#aj1jjj1jjj for fiscal year #bjai and   
#ai1jjj1jjj for fiscal year #bjbj1 to   
remain available until expended4  7#c7  
,administrative expenses ,of the amount 

made available to carry out this section
 for any fiscal year1 the ,secretary may
 not use more than #e percent of such   
amount for the expenses of administering
 this section4  4  7c7 ,annual reporting
 ,paragraph 7#a7 of subsection 7h7 of   
the first section #cdj;,h of the ,public
 ,health ,service ,act 7#db ,u4,s4,c4   
#bef;h7 is amended--  7#a7 by           
redesignating subparagraph 7,d7 as      
subparagraph 7,h72 and  7#b7 by         
inserting after subparagraph 7,c7 the   
following3  7,d7 ,the number of patients
 treated by residents described in      
paragraph 7#d74  7,e7 ,the number of    
visits by patients treated by residents 
described in paragraph 7#d74  7,f7 ,of  
the number of residents described in    
paragraph 7#d7 who completed their      
residency training at the end of such   
residency academic year1 the number and 
percentage of such residents entering   
primary care practice 7meaning any of   
the areas of practice listed in the     
definition of a primary care residency  

program in section #gdi;,a74  7,g7 ,of  
the number of residents described in    
paragraph 7#d7 who completed their      
residency training at the end of such   
residency academic year1 the number and 
percentage of such residents who entered
 practice at a health care facility--   
7i7 primarily serving a health          
professional shortage area with a       
designation in effect under section #ccb
 or a medically underserved community   
7as defined in section #gii;,b72 or     
7ii7 located in a rural area 7as defined
 in section #ahhf7;d77#b77;,d7 of the   
,social ,security ,act74  4  7d7 ,report
 on training costs ,not later than      
,march #ca1 #bjbj1 the ,secretary of    
,health and ,human ,services shall      
submit to the ,congress a report on the 
direct graduate expenses of approved    
graduate medical residency training     
programs1 and the indirect expenses     
associated with the additional costs of 
teaching residents1 of qualified        
teaching health centers 7as such terms  

are used or defined in section #cdj;,h  
of the ,public ,health ,service ,act    
7#db ,u4,s4,c4 #bef;h774  7e7           
,definition ,subsection 7j7 of the first
 section #cdj;,h of the ,public ,health 
,service ,act 7#db ,u4,s4,c4 #bef;h7 is 
amended--  7#a7 by redesignating        
paragraphs 7#b7 and 7#c7 as paragraphs  
7#c7 and 7#d71 respectively2 and  7#b7  
by inserting after paragraph 7#a7 the   
following3  7#b7 ,new approved graduate 
medical residency training program ,the 
term new approved graduate medical      
residency training program means an     
approved graduate medical residency     
training program for which the          
sponsoring qualified teaching health    
center has not received a payment under 
this section for a previous fiscal year 
7other than pursuant to subsection      
7a77#a77;,c774  4  7f7 ,technical       
corrections ,part ,d of title ,,iii of  
the ,public ,health ,service ,act 7#db  
,u4,s4,c4 #bed;b et seq47 is amended--  
7#a7 in subsection 7f7 of the first     

section #cdj;,h 7#db ,u4,s4,c4 #bef;h71 
by striking hospital each place it      
appears and inserting teaching health   
center2  7#b7 by redesignating the      
second subpart ,,xi 7relating to a      
community-based collaborative care      
network program7 as subpart ,,xii2 and  
7#c7 by redesignating the second section
 #cdj;,h 7#db ,u4,s4,c4 #bef;i7 as      
section #cdj;,i4  7g7 ,payments for     
previous fiscal years ,the provisions of
 the first section #cdj;,h of the       
,public ,health ,service ,act 7#db      
,u4,s4,c4 #bef;h71 as in effect on the  
day before the date of enactment of this
 ,act1 shall continue to apply with     
respect to payments under such section  
for fiscal years before fiscal year     
#bjah4