,i  #aae? ,,congress  #a/ ,session  ,h4 
,r4 #ccid  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,july #be1 #bjag,mrs4 
,mc,morris ,rodg]s 7= h]self1 ,mr4 ,c>t]
 ( ,georgia1 ,mr4 ,heck1 ,mr4 ,k5n$y1   
,mr4 ,khanna1 ,mr4 ,la,malfa1 ,mr4      
,mc,govern1 ,mr4 ,o',hall]an1 ,mr4      
,rask91 ,mr4 ,vela1 ,mr4 ,"y ( ,i[a1    
,mr4 ,capuano1 ,mr4 ,c>twright1 ,mr4    
,cr[ley1 ,mr4 ,d5ham1 ,mr4 ,espaillat1  
,mr4 ,faso1 ,ms4 ,j5k9s ( ,kansas1 ,mr4 
,kilm]1 ,mr4 ,m\lton1 ,mr4 ,ne:\se1 ,mr4
 ,takano1 ,mr4 ,valadao1 ,mr4 ,coh51    
,mr4 ,cony]s1 ,mr4 ,c\rtney1 ,mr4 ,danny
 ,k4 ,davis ( ,ill9ois1 ,mr4 ,de,fazio1 
,ms4 ,de,lauro1 ,ms4 ,del,bene1 ,mr4    
,g>am5di1 ,mr4 ,l>s5 ( ,wa%+ton1 ,mr4   
,long1 ,mr4 ,lucas1 ,mr4 ,m>9o1 ,mr4    
,murphy ( ,p5nsylvania1 ,mr4 ,nolan1    
,ms4 ,ros-,leht951 ,mr4 ,ru%1 ,ms4      
,s*ak[sky1 ,ms4 ,sewell ( ,alabama1 ,ms4
 ,wilson ( ,florida1 ,mr4 ,s]rano1 ,ms4 
,tsongas1 ,ms4 ,bonamici1 ,mr4 ,ruiz1   
,ms4 ,cl>k ( ,massa*usetts1 ,mr4 ,cole1 
,mr4 ,rog]s ( ,k5tucky1 & ,mr4 ,l>son ( 

,connecticut7 introduc$ ! foll[+ bill2  
:i* 0 ref]r$ to ! ,committee on ,en]gy &
 ,comm]ce  ,a ,,bill  ,to reau?orize    
section #cdj;,h ( ! ,public ,heal?      
,s]vice ,act to cont9ue to enc\rage !   
expansion1 ma9t5ance1 & e/abli%m5t (    
approv$ graduate m$ical resid5cy        
programs at qualifi$ tea*+ heal? c5t]s1 
& = o!r purposes4  #a4 ,%ort title ,?is 
,act may be cit$ z ! ,tea*+ ,heal?      
,c5t]s ,graduate ,m$ical ,education     
,ext5sion ,act ( #bjag4  #b4 ,f9d+s ,!  
,congress f9ds z foll[s3  7#a7 ,!       
program ( paym5ts to tea*+ heal? c5t]s =
 graduate m$ical education "u section   
#cdj;,h ( ! ,public ,heal? ,s]vice ,act 
7#db ,u4,s4,c4 #bef;h7 0 enact$ 9 #bjaj 
to address ! crisis-level %ortage (     
prim>y c>e physicians1 especially 9     
rural & m$ically und]s]v$ communities4  
7#b7 ,tea*+ heal? c5t] resid5ts &       
faculty w provide m ?an "o million      
prim>y c>e m$ical visits 9 #bjag to     
und]s]v$ communities4  7#c7 ,:5 comp>$ )
 traditional ,m$ic>e ,,gme resid5ts1    

resid5ts :o tra9 at tea*+ heal? c5t]s   
are m likely to practice prim>y c>e &   
rema9 9 und]s]v$ or rural communities4  
7#d7 ,! tea*+ heal? c5t] program n only 
plays a vital role 9 tra9+ ! ,nation's  
next g5]ation ( prim>y c>e physicians   
7includ+ d5ti/s71 b helps bridge !      
,nation's physician %ortfall4  7#e7 ,=  
^! reasons1 x is ( vital importance to  
cont9ue ! program "u section #cdj;,h ( !
 ,public ,heal? ,s]vice ,act 7#db       
,u4,s4,c4 #bef;h7 at a su/a9able level (
 fund+ p] full-"t equival5t resid5t1 z  
recomm5d$ 9 ! fact %eet ( ! ,heal?      
,res\rces & ,s]vices ,adm9i/ration      
entitl$ ,co/ ,e/imates = ,tra9+         
,resid5ts 9 a ,tea*+ ,heal? ,c5t]4  #c4 
,reau?orization ( program ( paym5ts to  
tea*+ heal? c5t]s t op]ate graduate     
m$ical education programs  7a7 ,paym5ts 
,subsection 7a7 ( section #cdj;,h ( !   
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #bef;h7 is am5d$ to read z    
foll[s3  7a7 ,paym5ts  7#a7 ,9 g5]al    
,subject to subsection 7h77#b71 !       

,secret>y %all make paym5ts "u ?is      
section = direct exp5ses & indirect     
exp5ses to qualifi$ tea*+ heal? c5t]s t 
are li/$ z sponsor+ in/itutions by !    
relevant accr$it+ body =--  7,a7        
ma9t5ance ( exi/+ approv$ graduate      
m$ical resid5cy tra9+ programs2  7,b7   
expansion ( exi/+ approv$ graduate      
m$ical resid5cy tra9+ programs2 &  7,c7 
e/abli%m5t ( new approv$ graduate m$ical
 resid5cy tra9+ programs4  7#b7 ,new    
programs  7,a7 ,paym5ts ,! ,secret>y    
%all make paym5ts "u p>agraph           
7#a77;,c7--  7i7 = fiscal ye> #bjai1 = a
 total ( up to #fj full-"t equival5t    
resid5ts at new approv$ graduate m$ical 
resid5cy programs2 &  7ii7 = fiscal ye> 
#bjbj1 = a total ( up to #abj full-"t   
equival5t resid5ts at ! new approv$     
graduate m$ical resid5cy programs t     
receiv$ paym5ts pursuant to clause 7i74 
7,b7 ,priority ,subject to subp>agraph  
7,c71 9 mak+ paym5ts pursuant to        
p>agraph 7#a77;,c71 ! ,secret>y %all    
give priority to qualifi$ tea*+ heal?   

c5t]s t--  7i7 s]ve a heal? pr(essional 
%ortage area ) a designation 9 effect "u
 section #ccb or a m$ically und]s]v$    
community 7z def9$ 9 section #gii;,b72  
or  7ii7 are locat$ 9 a rural area 7z   
def9$ 9 section #ahhf7;d77#b77;,d7 ( !  
,social ,security ,act74  7,c7          
,limitation ,! numb] ( full-"t equival5t
 resid5ts = :i* a qualifi$ tea*+ heal?  
c5t] receives paym5ts pursuant to       
p>agraph 7#a77;,c7 = a fiscal ye> %all n
 exce$ by m ?an six ! numb] ( full-"t   
equival5t resid5ts = :i* ! c5t] receiv$ 
su* paym5ts = ! prec$+ fiscal ye>4  4   
7b7 ,fund+ ,subsection 7g7 ( ! fir/     
section #cdj;,h ( ! ,public ,heal?      
,s]vice ,act 7#db ,u4,s4,c4 #bef;h7 is  
am5d$ to read z foll[s3  7g7 ,fund+     
7#a7 ,exi/+ programs ,out ( any money 9 
! ,treasury n o!rwise appropriat$1 !re  
are appropriat$ = paym5ts "u            
subp>agraphs 7,a7 & 7,b7 ( subsection   
7a77#a7 #aaf1ejj1jjj = ea* ( fiscal ye>s
 #bjah1 #bjai1 & #bjbj1 to rema9        
available until exp5d$4  7#b7 ,inc5tive 

= new programs ,out ( any money 9 !     
,treasury n o!rwise appropriat$1 !re are
 appropriat$ = paym5ts "u subsection    
7a77#a77;,c71 #aj1jjj1jjj = fiscal ye>  
#bjai & #ai1jjj1jjj = fiscal ye> #bjbj1 
to rema9 available until exp5d$4  7#c7  
,adm9i/rative exp5ses ,( ! am\nt made   
available to c>ry out ?is section = any 
fiscal ye>1 ! ,secret>y may n use m ?an 
#e p]c5t ( su* am\nt = ! exp5ses (      
adm9i/]+ ?is section4  4  7c7 ,annual   
report+ ,p>agraph 7#a7 ( subsection 7h7 
( ! fir/ section #cdj;,h ( ! ,public    
,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#bef;h7 is am5d$--  7#a7 by r$esignat+  
subp>agraph 7,d7 z subp>agraph 7,h72 &  
7#b7 by ins]t+ aft] subp>agraph 7,c7 !  
foll[+3  7,d7 ,! numb] ( pati5ts treat$ 
by resid5ts describ$ 9 p>agraph 7#d74   
7,e7 ,! numb] ( visits by pati5ts treat$
 by resid5ts describ$ 9 p>agraph 7#d74  
7,f7 ,( ! numb] ( resid5ts describ$ 9   
p>agraph 7#d7 :o complet$ _! resid5cy   
tra9+ at ! end ( su* resid5cy academic  
ye>1 ! numb] & p]c5tage ( su* resid5ts  

ent]+ prim>y c>e practice 7mean+ any ( !
 areas ( practice li/$ 9 ! def9ition ( a
 prim>y c>e resid5cy program 9 section  
#gdi;,a74  7,g7 ,( ! numb] ( resid5ts   
describ$ 9 p>agraph 7#d7 :o complet$ _! 
resid5cy tra9+ at ! end ( su* resid5cy  
academic ye>1 ! numb] & p]c5tage ( su*  
resid5ts :o ent]$ practice at a heal?   
c>e facility--  7i7 prim>ily s]v+ a     
heal? pr(essional %ortage area ) a      
designation 9 effect "u section #ccb or 
a m$ically und]s]v$ community 7z def9$ 9
 section #gii;,b72 or  7ii7 locat$ 9 a  
rural area 7z def9$ 9 section           
#ahhf7;d77#b77;,d7 ( ! ,social ,security
 ,act74  4  7d7 ,report on tra9+ co/s ,n
 lat] ?an ,m>* #ca1 #bjbj1 ! ,secret>y (
 ,heal? & ,human ,s]vices %all submit to
 ! ,congress a report on ! direct       
graduate exp5ses ( approv$ graduate     
m$ical resid5cy tra9+ programs1 & !     
indirect exp5ses associat$ ) !          
additional co/s ( tea*+ resid5ts1 (     
qualifi$ tea*+ heal? c5t]s 7z su* t]ms  
are us$ or def9$ 9 section #cdj;,h ( !  

,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #bef;h774  7e7 ,def9ition     
,subsection 7j7 ( ! fir/ section #cdj;,h
 ( ! ,public ,heal? ,s]vice ,act 7#db   
,u4,s4,c4 #bef;h7 is am5d$--  7#a7 by   
r$esignat+ p>agraphs 7#b7 & 7#c7 z      
p>agraphs 7#c7 & 7#d71 respectively2 &  
7#b7 by ins]t+ aft] p>agraph 7#a7 !     
foll[+3  7#b7 ,new approv$ graduate     
m$ical resid5cy tra9+ program ,! t]m new
 approv$ graduate m$ical resid5cy tra9+ 
program means an approv$ graduate m$ical
 resid5cy tra9+ program = :i* ! sponsor+
 qualifi$ tea*+ heal? c5t] has n receiv$
 a paym5t "u ?is section = a previ\s    
fiscal ye> 7o!r ?an pursuant to         
subsection 7a77#a77;,c774  4  7f7       
,te*nical corrections ,"p ,d ( title    
,,iii ( ! ,public ,heal? ,s]vice ,act   
7#db ,u4,s4,c4 #bed;b et seq47 is       
am5d$-- 7#a7 9 subsection 7f7 ( ! fir/  
section #cdj;,h 7#db ,u4,s4,c4 #bef;h71 
by /rik+ hospital ea* place x appe>s &  
ins]t+ tea*+ heal? c5t]2  7#b7 by       
r$esignat+ ! second subp>t ,,xi 7relat+ 

to a community-bas$ collaborative c>e   
network program7 z subp>t ,,xii2 &  7#c7
 by r$esignat+ ! second section #cdj;,h 
7#db ,u4,s4,c4 #bef;i7 z section        
#cdj;,i4  7g7 ,paym5ts = previ\s fiscal 
ye>s ,! provisions ( ! fir/ section     
#cdj;,h ( ! ,public ,heal? ,s]vice ,act 
7#db ,u4,s4,c4 #bef;h71 z 9 effect on ! 
day be=e ! date ( enactm5t ( ?is ,act1  
%all cont9ue to apply ) respect to      
paym5ts "u su* section = fiscal ye>s    
be=e fiscal ye> #bjah4