,,ii  #aaeth ,,congress  #ast ,session  
,s4 #abia  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,june #f1      
#bjag,mr4 ,nelson 7for himself1 ,mr4    
,johnson1 ,mr4 ,brown1 ,mr4 ,portman1   
,ms4 ,baldwin1 and ,mr4 ,heller7        
introduced the following bill2 which was
 read twice and referred to the         
,committee on ,finance  ,a ,,bill  ,to  
amend title ,,xviii of the ,social      
,security ,act to establish rules for   
payment for graduate medical education  
7,,gme7 costs for hospitals that        
establish a new medical residency       
training program after hosting resident 
rotators for short durations4  #a4      
,short title ,this ,act may be cited as 
the ,advancing ,medical ,resident       
,training in ,community ,hospitals ,act 
of #bjag4  #b4 ,medicare ,,gme treatment
 of hospitals establishing new medical  
residency training programs after       
hosting medical resident rotators for   
short durations  7a7 ,redetermination of
 approved ,,fte resident amount ,section

 #ahhf7;h77#b77;,f7 of the ,social      
,security ,act 7#db ,u4,s4,c4           
#acieww7h77#b77;,f77 is amended--  7#a7 
by inserting 7i7 before ,in the case of2
 and  7#b7 by adding at the end the     
following3  7ii7 ,in applying this      
subparagraph to a hospital that has not 
entered into a ,,gme affiliation        
agreement 7as defined by the ,secretary 
for purposes of paragraph               
7#d77;,h77ii771 the ,secretary shall not
 provide for the establishment of an    
,,fte resident amount until such time as
 the ,secretary determines that the     
hospital has a medical residency        
training program that trains more than  
#a4j full-time-equivalent resident in a 
cost reporting period4  7iii7 ,in the   
case of a hospital with an approved     
,,fte resident amount-- 7,i7 based on   
the training of less than #a4j          
full-time-equivalent resident before    
,october #a1 #aiig1 or  7,,ii7 based on 
the training of no more than #c4j       
full-time-equivalent residents in a     

medical residency training program in   
any cost reporting period beginning on  
or after ,october #a1 #aiig1 and before 
the date of the enactment of this       
clause1  the ,secretary shall provide   
the hospital an opportunity to have a   
new ,,fte resident amount established   
when the hospital begins training at    
least #a4j full-time-equivalent resident
 7in the case of a hospital described in
 subclause 7,i77 or more than #c4j      
full-time-equivalent residents 7in the  
case of a hospital described in         
subclause 7,,ii77 for cost reporting    
periods beginning on or after the date  
of the enactment of this clause and in  
accordance with the methodology under   
the rules in effect as of ,october #a1  
#bjae4  4  7b7 ,redetermination of ,,fte
 resident limitation ,section           
#ahhf7;h77#d77;,h77i7 of the ,social    
,security ,act 7#db ,u4,s4,c4           
#acieww7h77#d77;,h77i77 is amended--    
7#a7 by inserting 7,i7 before ,the      
,secretary2 and  7#b7 by adding at the  

end the following3  7,,ii7 ,under this  
clause the ,secretary shall not         
determine an adjustment in the          
limitation applicable to a hospital     
under subparagraph 7,f7 until the       
hospital trains more than #a4j          
full-time-equivalent resident in a new  
medical residency training program in a 
cost reporting period4  7,,iii7 ,in the 
case of a hospital that has a limitation
 under subparagraph 7,f7 of less than   
#a4j full-time-equivalent resident as of
 the date of the enactment of this      
subclause based on training before      
,october #a1 #aiig1 under this clause   
the ,secretary shall provide the        
hospital an opportunity to have a new   
adjustment in such limitation determined
 when such hospital begins training at  
least #a4j full-time-equivalent resident
 in accordance with the methodology     
applicable to hospitals under the rules 
in effect as of ,october #a1 #bjae1 and 
applied for cost reporting periods      
beginning on or after the date of the   

enactment of this subclause4  7,,iv7 ,in
 the case of a hospital for which an    
adjustment in the limitation applicable 
to a hospital under subparagraph 7,f7 is
 based on the training of no more than  
#c4j full-time-equivalent residents in a
 new medical residency training program 
in a cost reporting period beginning on 
or after ,october #a1 #aiig1 and before 
the date of the enactment of this       
subclause1 the ,secretary shall provide 
the hospital an opportunity to have a   
new adjustment in such limitation       
determined when the hospital begins     
training more than #c4j                 
full-time-equivalent residents in       
accordance with the methodology         
applicable to hospitals under the rules 
in effect as of ,october #a1 #bjae1 and 
applied for cost reporting periods      
beginning on or after the date of the   
enactment of this subclause4  4  7c7    
,effective date ,the amendments made by 
this section shall apply to payment     
under section #ahhf of the ,social      

,security ,act 7#db ,u4,s4,c4 #acieww7  
for cost reporting periods beginning on 
or after the date of the enactment of   
this ,act4