,i  #aae? ,,congress  #a/ ,session  ,h4 
,r4 #deeb  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,decemb] #e1 #bjag,mr4
 ,gallagh] 7= himself1 ,mr4 ,k9d1 ,mr4  
,duffy1 ,mr4 ,pocan1 ,mr4 ,s5s5br5n]1   
,mr4 ,gro?man1 ,ms4 ,moore1 ,mr4 ,?omas 
,j4 ,rooney ( ,florida1 & ,mr4 ,ross7   
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 e/abli% rules 
= paym5t = graduate m$ical education    
7,,gme7 co/s = hospitals t e/abli% a new
 m$ical resid5cy tra9+ program aft] ho/+
 resid5t rotators = %ort durations4  #a4
 ,%ort title ,?is ,act may be cit$ z !  
,advanc+ ,m$ical ,resid5t ,tra9+ 9      
,community ,hospitals ,act ( #bjag4  #b4
 ,m$ic>e ,,gme treatm5t ( hospitals     
e/abli%+ new m$ical resid5cy tra9+      

programs aft] ho/+ m$ical resid5t       
rotators = %ort durations  7a7          
,r$et]m9ation ( approv$ ,,fte resid5t   
am\nt ,section #ahhf7;h77#b77;,f7 ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#acieww7h77#b77;,f77 is am5d$--  7#a7 by
 ins]t+ 7i7 be=e ,9 ! case (2 &  7#b7 by
 add+ at ! end ! foll[+3  7ii7 ,9 apply+
 ?is subp>agraph to a hospital t has n  
ent]$ into a ,,gme affiliation agreem5t 
7z def9$ by ! ,secret>y = purposes (    
p>agraph 7#d77;,h77ii771 ! ,secret>y    
%all n provide = ! e/abli%m5t ( an ,,fte
 resid5t am\nt until su* "t z !         
,secret>y det]m9es t ! hospital has a   
m$ical resid5cy tra9+ program t tra9s m 
?an #a4j full-"t-equival5t resid5t 9 a  
co/ report+ p]iod4  7iii7 ,9 ! case ( a 
hospital ) an approv$ ,,fte resid5t     
am\nt-- 7,i7 bas$ on ! tra9+ ( less ?an 
#a4j full-"t-equival5t resid5t be=e     
,octob] #a1 #aiig1 or  7,,ii7 bas$ on ! 
tra9+ ( no m ?an #c4j full-"t-equival5t 
resid5ts 9 a m$ical resid5cy tra9+      
program 9 any co/ report+ p]iod beg9n+  

on or aft] ,octob] #a1 #aiig1 & be=e !  
date ( ! enactm5t ( ?is clause1  !      
,secret>y %all provide ! hospital an    
opportunity to h a new ,,fte resid5t    
am\nt e/abli%$ :5 ! hospital beg9s tra9+
 at lea/ #a4j full-"t-equival5t resid5t 
79 ! case ( a hospital describ$ 9       
subclause 7,i77 or m ?an #c4j           
full-"t-equival5t resid5ts 79 ! case ( a
 hospital describ$ 9 subclause 7,,ii77 =
 co/ report+ p]iods beg9n+ on or aft] ! 
date ( ! enactm5t ( ?is clause & 9      
accordance ) ! me?odology "u ! rules 9  
effect z ( ,octob] #a1 #bjae4  4  7b7   
,r$et]m9ation ( ,,fte resid5t limitation
 ,section #ahhf7;h77#d77;,h77i7 ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acieww7h77#d77;,h77i77 is am5d$-- 7#a7 
by ins]t+ 7,i7 be=e ,! ,secret>y2 &     
7#b7 by add+ at ! end ! foll[+3  7,,ii7 
,"u ?is clause ! ,secret>y %all n       
det]m9e an adju/m5t 9 ! limitation      
applicable to a hospital "u subp>agraph 
7,f7 until ! hospital tra9s m ?an #a4j  
full-"t-equival5t resid5t 9 a new m$ical

 resid5cy tra9+ program 9 a co/ report+ 
p]iod4  7,,iii7 ,9 ! case ( a hospital t
 has a limitation "u subp>agraph 7,f7 ( 
less ?an #a4j full-"t-equival5t resid5t 
z ( ! date ( ! enactm5t ( ?is subclause 
bas$ on tra9+ be=e ,octob] #a1 #aiig1 "u
 ?is clause ! ,secret>y %all provide !  
hospital an opportunity to h a new      
adju/m5t 9 su* limitation det]m9$ :5 su*
 hospital beg9s tra9+ at lea/ #a4j      
full-"t-equival5t resid5t 9 accordance )
 ! me?odology applicable to hospitals "u
 ! rules 9 effect z ( ,octob] #a1 #bjae1
 & appli$ = co/ report+ p]iods beg9n+ on
 or aft] ! date ( ! enactm5t ( ?is      
subclause4  7,,iv7 ,9 ! case ( a        
hospital = :i* an adju/m5t 9 !          
limitation applicable to a hospital "u  
subp>agraph 7,f7 is bas$ on ! tra9+ ( no
 m ?an #c4j full-"t-equival5t resid5ts 9
 a new m$ical resid5cy tra9+ program 9 a
 co/ report+ p]iod beg9n+ on or aft]    
,octob] #a1 #aiig1 & be=e ! date ( !    
enactm5t ( ?is subclause1 ! ,secret>y   
%all provide ! hospital an opportunity  

to h a new adju/m5t 9 su* limitation    
det]m9$ :5 ! hospital beg9s tra9+ m ?an 
#c4j full-"t-equival5t resid5ts 9       
accordance ) ! me?odology applicable to 
hospitals "u ! rules 9 effect z (       
,octob] #a1 #bjae1 & appli$ = co/       
report+ p]iods beg9n+ on or aft] ! date 
( ! enactm5t ( ?is subclause4  4  7c7   
,effective date ,! am5dm5ts made by ?is 
section %all apply to paym5t "u section 
#ahhf ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #acieww7 = co/ report+ p]iods 
beg9n+ on or aft] ! date ( ! enactm5t ( 
?is ,act4