,i  #aaf? ,,congress  #b;d ,session  ,h4
 ,r4 #fjij  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,m>* #d1 #bjbj,mr4    
,ruiz 7= himself1 ,mr4 ,buc%on1 ,ms4    
,sewell ( ,alabama1 & ,mr4 ,w5/rup7     
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 provide = a new build+     
p]iod ) respect to ! cap on full-"t     
equival5t resid5ts = purposes ( paym5t =
 graduate m$ical education co/s "u !    
,m$ic>e program = c]ta9 hospitals t h   
e/abli%$ a %ortage specialty program4   
#a4 ,%ort title ,?is ,act may be cit$ z 
! ,physician ,%ortage ,,gme ,cap ,flex  
,act ( #bjbj4  #b4 ,provid+ = a new     
build+ p]iod ) respect to ! cap on      
full-"t equival5t resid5ts = c]ta9      
hospitals t h e/abli%$ a %ortage        
specialty program ,section #ahhf7;h77#d7

 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acieww7h77#d77 is am5d$ by   
add+ at ! end ! foll[+ new subp>agraph3 
7,l7 ,treatm5t ( c]ta9 qualify+         
hospitals  7i7 ,9 g5]al ,= purposes (   
apply+ ?is p>agraph & section #dac4gi ( 
title #db1 ,code ( ,f$]al ,regulations  
7or a successor regulation71 ! ,secret>y
 %all treat1 subject to clause 7ii71 a  
qualify+ hospital 7z def9$ 9 clause     
7iii77 ) an approv$ m$ical resid5cy     
tra9+ program z if su* hospital-- 7,i7  
_h no allopa?ic or o/eopa?ic resid5ts 9 
its mo/ rec5t co/ report+ p]iod end+ on 
or be=e ,decemb] #ca1 #aiif2 &  7,,ii7  
began tra9+ resid5ts = ! fir/ "t 9 a new
 m$ical resid5cy tra9+ program 7z def9$ 
9 p>agraph 7l7 ( su* section7 beg9n+ on 
! date on :i* su* hospital became a     
qualify+ hospital4  7ii7 ,special rule =
 qualify+ hospitals 9 cap-build+ p]iod  
,9 ! case ( a qualify+ hospital ) an    
approv$ m$ical resid5cy tra9+ program t1
 exclud+ ! treatm5t describ$ 9 clause   
7i71 is a hospital t _h no allopa?ic or 

o/eopa?ic resid5ts 9 its mo/ rec5t co/  
report+ p]iod end+ on or be=e ,decemb]  
#ca1 #aiif1 & began tra9+ resid5ts = !  
fir/ "t 9 a new m$ical resid5cy tra9+   
program 7z def9$ 9 p>agraph 7l7 ( su*   
section7 dur+ ! #e-ye> p]iod end+ on !  
date describ$ 9 clause 7i77,,ii7 )      
respect to su* hospital1 9 lieu ( apply+
 su* clause1 ! ,secret>y %all provide t 
! provisions ( subsection 7e7 ( section 
#dac4gi ( title #db1 ,code ( ,f$]al     
,regulations 7or a successor            
regulation71 %all apply ) respect to su*
 hospital = an additional #e ye>s beyond
 ! p]iod dur+ :i* su* provisions w\ld   
o!rwise h appli$ to su* hospital4  7iii7
 ,def9ition ,9 ?is subp>agraph3 7,i7    
,qualify+ hospital ,! t]m qualify+      
hospital means a hospital t-- 7aa7      
e/abli%es a %ortage specialty program 7z
 def9$ 9 subclause 7,,ii77 dur+ ! #e-ye>
 p]iod beg9n+ on ! date ( ! enactm5t (  
?is subp>agraph2 &  7bb7 submits an     
application to ! ,secret>y dur+ su*     
p]iod conta9+ su* in=mation z !         

,secret>y may specify4  7,,ii7 ,%ortage 
specialty program ,! t]m %ortage        
specialty program means1 ) respect to a 
hospital locat$ 9 a geographic area 7z  
def9$ by ! ,secret>y71 any approv$      
resid5cy tra9+ program 9 a specialty =  
:i* ! ,secret>y det]m9es t !re is a     
%ortage ( physicians practic+ su*       
specialty 9 su* area at ! "t su* program
 is e/abli%$4 ,9 mak+ su* a det]m9ation1
 ! ,secret>y %all take into acc\nt :e!r 
su* hospital is locat$ 9 an area-- 7aa7 
)\t adequate heal? c>e res\rces 7su* z 9
 a rural area or a m$ically und]s]v$    
area 7z def9$ by ! ,adm9i/rator ( !     
,heal? ,res\rces & ,s]vices             
,adm9i/ration772  7bb7 exp]i5c+ prim>y  
c>e or specialty physician %ortages 7su*
 z 9 a heal? pr(essional %ortage area 7z
 def9$ 9 section #ccb7;a7 ( ! ,public   
,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#bed;e7a77772  7cc7 )\t an adequate     
numb] ( approv$ resid5cy tra9+ programs2
  7dd7 /ruggl+ to exp& or keep approv$  
resid5cy tra9+ programs op]ational2     

7ee7 lack+ exi/+ m$ical tra9+           
infra/ructure or 9 ! process ( build+   
su* infra/ructure2  7ff7 ) a l[         
resid5t-to-population ratio2  7gg7 ) few
 full-"t equival5t resid5t positions2 or
  7hh7 ) a l[ physician-to-population   
ratio = physicians practic+ 9 ! same    
specialty z ! %ortage specialty program 
conc]n$4  4