,i #aaf? ,,congress #a/ ,session ,h4 ,r4 #cdbe ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,june #ba1 #bjai,mr4 ,k9d 7= himself & ,mr4 ,hold+7 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$ical ,resid5t ,tra9+ 9 ,community ,hospitals ,act ( #bjai4 #b4 ,m$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$-- 7#a7 by ins]t+ 7i7 be=e ,9 ! case (2 & 7#b7 by add+ at ! end ! foll[+3 7ii7 ,9 apply+ ?is subp>agraph 9 ! case ( a hospital t1 on or aft] ! date ( ! enactm5t ( ?is clause1 beg9s to tra9 resid5ts & has n ent]$ into a ,,gme affiliation agreem5t 7z def9$ by ! ,secret>y = purposes ( p>agraph 7#d77;,h77ii771 ! ,secret>y %all n e/abli% an ,,fte resid5t am\nt until su* "t z ! ,secret>y det]m9es t ! hospital has tra9$ at lea/ #a4j full-"t-equival5t resid5t 9 an approv$ m$ical resid5cy tra9+ program 9 a co/ report+ p]iod4 7iii7 ,9 apply+ ?is subp>agraph = co/ report+ p]iods beg9n+ on or aft] ! date ( enactm5t ( ?is clause1 9 ! case ( a hospital t1 z ( su* date ( enactm5t1 has an approv$ ,,fte resid5t am\nt bas$ on ! tra9+ 9 an approv$ m$ical resid5cy program (-- 7,i7 less ?an #a4j full-"t-equival5t resid5t 9 any co/ report+ p]iod beg9n+ be=e ,octob] #a1 #aiig1 z det]m9$ by ! ,secret>y2 or 7,,ii7 no m ?an #c4j full-"t-equival5t resid5ts 9 any co/ report+ p]iod beg9n+ on or aft] ,octob] #a1 #aiig1 & be=e ! date ( ! enactm5t ( ?is clause1 z det]m9$ by ! ,secret>y1 9 lieu ( su* ,,fte resid5t am\nt ! ,secret>y %all1 9 accordance ) ! me?odology describ$ 9 section #dac4gg7;e7 ( title #db ( ! ,code ( ,f$]al ,regulations 7or any successor regulation71 e/abli% a new ,,fte resid5t am\nt if ! hospital tra9s at lea/ #a4j full-"t-equival5t resid5t 79 ! case ( a hospital describ$ 9 subclause 7,i77 or m ?an #c4j full-"t-equival5t resid5ts 79 ! case ( a hospital describ$ 9 subclause 7,,ii77 9 a co/ report+ p]iod beg9n+ on or aft] su* date ( enactm5t & be=e ! date t is #e ye>s aft] su* date ( enactm5t4 7iv7 ,= purposes ( c>ry+ out ?is subp>agraph = co/ report+ p]iods beg9n+ on or aft] ! date ( ! enactm5t ( ?is clause1 a hospital %all report full-"t-equival5t resid5ts on its co/ report = a co/ report+ p]iod if ! hospital tra9s at lea/ #a4j full-"t-equival5t resid5ts 9 an approv$ m$ical resid5cy tra9+ program 9 su* p]iod4 7v7 ,z appropriate1 ! ,secret>y may consid] in=mation f any co/ report+ p]iod necess>y to e/abli% a new ,,fte resid5t am\nt z describ$ 9 clause 7iii74 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 ,9 apply+ ?is clause 9 ! case ( a hospital t1 on or aft] ! date ( ! enactm5t ( ?is subclause1 beg9s to tra9 resid5ts 9 a new approv$ m$ical resid5cy tra9+ program 7z def9$ by ! ,secret>y71 ! ,secret>y %all n det]m9e a limitation applicable to ! hospital "u subp>agraph 7,f7 until su* "t z ! ,secret>y det]m9es t ! hospital has tra9$ at lea/ #a4j full-"t-equival5t resid5t 9 su* new approv$ m$ical resid5cy tra9+ program 9 a co/ report+ p]iod4 7,,iii7 ,9 apply+ ?is clause 9 ! case ( a hospital t1 z ( ! date ( ! enactm5t ( ?is subclause1 has a limitation "u subp>agraph 7,f71 bas$ on a co/ report+ p]iod beg9n+ be=e ,octob] #a1 #aiig1 ( less ?an #a4j full-"t-equival5t resid5t1 ! ,secret>y %all adju/ ! limitation 9 ! mann] applicable to a new approv$ m$ical resid5cy tra9+ program if ! ,secret>y det]m9es ! hospital tra9s at lea/ #a4j full-"t-equival5t resid5ts 9 a program ye> beg9n+ on or aft] su* date ( enactm5t & be=e ! date t is #e ye>s aft] su* date ( enactm5t4 7,,iv7 ,9 apply+ ?is clause 9 ! case ( a hospital t1 z ( ! date ( ! enactm5t ( ?is subclause1 has a limitation "u subp>agraph 7,f71 bas$ on a co/ report+ p]iod beg9n+ on or aft] ,octob] #a1 #aiig1 & be=e su* date ( enactm5t1 ( no m ?an #c4j full-"t-equival5t resid5ts1 ! ,secret>y %all adju/ ! limitation 9 ! mann] applicable to a new approv$ m$ical resid5cy tra9+ program if ! ,secret>y det]m9es ! hospital beg9s tra9+ m ?an #c4j full-"t-equival5t resid5ts 9 a program ye> beg9n+ on or aft] su* date ( enactm5t & be=e ! date t is #e ye>s aft] su* date ( enactm5t4 7,v7 ,an adju/m5t to ! limitation applicable to a hospital made pursuant to subclause 7,,iii7 or 7,,iv7 %all be made 9 a mann] consi/5t ) ! me?odology1 z appropriate1 9 section #dac4gi7;e7 ( title #db1 ,code ( ,f$]al ,regulations 7or any successor regulation74 ,z appropriate1 ! ,secret>y may consid] in=mation f any co/ report+ p]iods necess>y to make su* an adju/m5t to ! limitation4 4 7c7 ,te*nical & con=m+ am5dm5ts ,section #ahhf ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7 is am5d$-- 7#a7 9 subsection 7d77#e77;,b77viii71 by /rik+ subsection 7h77#d77;,h7 & ins]t+ p>agraphs 7#b77;,f77iv7 & 7#d77;,h7 ( subsection 7h72 & 7#b7 9 subsection 7h7-- 7,a7 9 p>agraph 7#d77;,h77iv71 by /rik+ an rural area & ins]t+ a rural area2 & 7,b7 9 p>agraph 7#g77;,e71 by /rik+ "u ?is & all t foll[s ?r\gh ! p]iod at ! end & ins]t+ ! foll[+3 "u ?is p>agraph1 p>agraph 7#h71 clause 7i71 7ii71 7iii71 or 7v7 ( p>agraph 7#b77;,f71 or clause 7i7 or 7vi7 ( p>agraph 7#d77;,h744 7d7 ,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