,,ii #aafth ,,congress #ast ,session ,s4 #baaf ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,july #ae1 #bjai,mr4 ,menendez 7for himself and ,mr4 ,booker7 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 ,supporting ,graduate ,medical ,education at ,community ,hospitals ,act of #bjai4 #b4 ,findings ,congress makes the following findings3 7#a7 ,graduate ,medical ,education or ,,gme training programs are of critical importance in developing the physician workforce4 7#b7 ,current caps on ,,gme training programs under ,medicare have been in place since #aiig4 7#c7 ,hospitals seeking to launch ,,gme training programs face barriers in establishing physician training programs in community hospitals4 #c4 ,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 #aiig2 7,,ii7 based on the training of-- 7aa7 no more than #f4j full-time-equivalent residents in a medical residency training program in any cost reporting period during the period between ,october #a1 #aiif1 and ,september #cj1 #aiig2 and 7bb7 no more than #c4j full-time-equivalent residents on or after ,october #a1 #aiig2 or 7,,iii7 based on the training of no full-time-equivalent residents in a medical residency training program for any #bj consecutive cost reporting periods beginning on or after ,october #a1 #aiig1 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 subclauses 7,i or ,,iii77 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 that has not reported full-time-equivalent residents in #bj consecutive cost reporting periods subsequent to ,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,v7 ,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 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