,i  #aafth ,,congress  #ast ,session    
,h4 ,r4 #cdbe  ,,in ,,the ,,house ,,of  
,,representatives  ,june #ba1 #bjai,mr4 
,kind 7for himself and ,mr4 ,holding7   
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 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 #bjai4  #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 in the case of a hospital  
that1 on or after the date of the       
enactment of this clause1 begins to     
train residents and has not entered into
 a ,,gme affiliation agreement 7as      
defined by the ,secretary for purposes  
of paragraph 7#d77;,h77ii771 the        
,secretary shall not establish an ,,fte 
resident amount until such time as the  
,secretary determines that the hospital 
has trained at least #a4j               
full-time-equivalent resident in an     
approved medical residency training     
program in a cost reporting period4     
7iii7 ,in applying this subparagraph for

 cost reporting periods beginning on or 
after the date of enactment of this     
clause1 in the case of a hospital that1 
as of such date of enactment1 has an    
approved ,,fte resident amount based on 
the training in an approved medical     
residency program of--  7,i7 less than  
#a4j full-time-equivalent resident in   
any cost reporting period beginning     
before ,october #a1 #aiig1 as determined
 by the ,secretary2 or  7,,ii7 no more  
than #c4j full-time-equivalent residents
 in any cost reporting period beginning 
on or after ,october #a1 #aiig1 and     
before the date of the enactment of this
 clause1 as determined by the           
,secretary1  in lieu of such ,,fte      
resident amount the ,secretary shall1 in
 accordance with the methodology        
described in section #dac4gg7;e7 of     
title #db of the ,code of ,federal      
,regulations 7or any successor          
regulation71 establish a new ,,fte      
resident amount if the hospital trains  
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 in a cost reporting  
period beginning on or after such date  
of enactment and before the date that is
 #e years after such date of enactment4 
7iv7 ,for purposes of carrying out this 
subparagraph for cost reporting periods 
beginning on or after the date of the   
enactment of this clause1 a hospital    
shall report full-time-equivalent       
residents on its cost report for a cost 
reporting period if the hospital trains 
at least #a4j full-time-equivalent      
residents in an approved medical        
residency training program in such      
period4  7v7 ,as appropriate1 the       
,secretary may consider information from
 any cost reporting period necessary to 
establish a new ,,fte resident amount as
 described in clause 7iii74  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 ,in applying 
this clause in the case of a hospital   
that1 on or after the date of the       
enactment of this subclause1 begins to  
train residents in a new approved       
medical residency training program 7as  
defined by the ,secretary71 the         
,secretary shall not determine a        
limitation applicable to the hospital   
under subparagraph 7,f7 until such time 
as the ,secretary determines that the   
hospital has trained at least #a4j      
full-time-equivalent resident in such   
new approved medical residency training 
program in a cost reporting period4     
7,,iii7 ,in applying this clause in the 
case of a hospital that1 as of the date 
of the enactment of this subclause1 has 
a limitation under subparagraph 7,f71   
based on a cost reporting period        

beginning before ,october #a1 #aiig1 of 
less than #a4j full-time-equivalent     
resident1 the ,secretary shall adjust   
the limitation in the manner applicable 
to a new approved medical residency     
training program if the ,secretary      
determines the hospital trains at least 
#a4j full-time-equivalent residents in a
 program year beginning on or after such
 date of enactment and before the date  
that is #e years after such date of     
enactment4  7,,iv7 ,in applying this    
clause in the case of a hospital that1  
as of the date of the enactment of this 
subclause1 has a limitation under       
subparagraph 7,f71 based on a cost      
reporting period beginning on or after  
,october #a1 #aiig1 and before such date
 of enactment1 of no more than #c4j     
full-time-equivalent residents1 the     
,secretary shall adjust the limitation  
in the manner applicable to a new       
approved medical residency training     
program if the ,secretary determines the
 hospital begins training more than #c4j

 full-time-equivalent residents in a    
program year beginning on or after such 
date of enactment and before the date   
that is #e years after such date of     
enactment4  7,v7 ,an adjustment to the  
limitation applicable to a hospital made
 pursuant to subclause 7,,iii7 or 7,,iv7
 shall be made in a manner consistent   
with the methodology1 as appropriate1 in
 section #dac4gi7;e7 of title #db1 ,code
 of ,federal ,regulations 7or any       
successor regulation74 ,as appropriate1 
the ,secretary may consider information 
from any cost reporting periods         
necessary to make such an adjustment to 
the limitation4  4  7c7 ,technical and  
conforming amendments ,section #ahhf of 
the ,social ,security ,act 7#db         
,u4,s4,c4 #acieww7 is amended-- 7#a7 in 
subsection 7d77#e77;,b77viii71 by       
striking subsection 7h77#d77;,h7 and    
inserting paragraphs 7#b77;,f77iv7 and  
7#d77;,h7 of subsection 7h72 and  7#b7  
in subsection 7h7-- 7,a7 in paragraph   
7#d77;,h77iv71 by striking an rural area

 and inserting a rural area2 and  7,b7  
in paragraph 7#g77;,e71 by striking     
under this and all that follows through 
the period at the end and inserting the 
following3 under this paragraph1        
paragraph 7#h71 clause 7i71 7ii71 7iii71
 or 7v7 of paragraph 7#b77;,f71 or      
clause 7i7 or 7vi7 of paragraph         
7#d77;,h744  7d7 ,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