,,ii  #aaf? ,,congress  #a/ ,session    
,s4 #baaf  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,july #ae1 #bjai,mr4   
,m55dez 7= himself & ,mr4 ,book]7       
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,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 ! ,support+ ,graduate
 ,m$ical ,education at ,community       
,hospitals ,act ( #bjai4  #b4 ,f9d+s    
,congress makes ! foll[+ f9d+s3  7#a7   
,graduate ,m$ical ,education or ,,gme   
tra9+ programs are ( critical importance
 9 develop+ ! physician work=ce4  7#b7  
,curr5t caps on ,,gme tra9+ programs "u 
,m$ic>e h be5 9 place s9ce #aiig4  7#c7 
,hospitals seek+ to laun* ,,gme tra9+   
programs face b>ri]s 9 e/abli%+         
physician tra9+ programs 9 community    

hospitals4  #c4 ,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$-- 7#a7 by 
ins]t+ 7i7 be=e ,9 ! case (2 &  7#b7 by 
add+ at ! end ! foll[+3  7ii7 ,9 apply+ 
?is subp>agraph to a hospital t has n   
ent]$ into a ,,gme affiliation agreem5t 
7z def9$ by ! ,secret>y = purposes (    
p>agraph 7#d77;,h77ii771 ! ,secret>y    
%all n provide = ! e/abli%m5t ( an ,,fte
 resid5t am\nt until su* "t z !         
,secret>y det]m9es t ! hospital has a   
m$ical resid5cy tra9+ program t tra9s m 
?an #a4j full-"t-equival5t resid5t 9 a  
co/ report+ p]iod4  7iii7 ,9 ! case ( a 
hospital ) an approv$ ,,fte resid5t     
am\nt-- 7,i7 bas$ on ! tra9+ ( less ?an 
#a4j full-"t-equival5t resid5t be=e     
,octob] #a1 #aiig2  7,,ii7 bas$ on !    
tra9+ (-- 7aa7 no m ?an #f4j            

full-"t-equival5t resid5ts 9 a m$ical   
resid5cy tra9+ program 9 any co/ report+
 p]iod dur+ ! p]iod betwe5 ,octob] #a1  
#aiif1 & ,septemb] #cj1 #aiig2 &  7bb7  
no m ?an #c4j full-"t-equival5t resid5ts
 on or aft] ,octob] #a1 #aiig2 or       
7,,iii7 bas$ on ! tra9+ ( no            
full-"t-equival5t resid5ts 9 a m$ical   
resid5cy tra9+ program = any #bj        
consecutive co/ report+ p]iods beg9n+ on
 or aft] ,octob] #a1 #aiig1  ! ,secret>y
 %all provide ! hospital an opportunity 
to h a new ,,fte resid5t am\nt e/abli%$ 
:5 ! hospital beg9s tra9+ at lea/ #a4j  
full-"t equival5t resid5t 79 ! case ( a 
hospital describ$ 9 subclauses 7,i or   
,,iii77 or m ?an #c4j full-"t-equival5t 
resid5ts 79 ! case ( a hospital describ$
 9 subclause 7,,ii77 = co/ report+      
p]iods beg9n+ on or aft] ! date ( !     
enactm5t ( ?is clause & 9 accordance ) !
 me?odology "u ! rules 9 effect z (     
,octob] #a1 #bjae4  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$-- 7#a7 
by ins]t+ 7,i7 be=e ,! ,secret>y2 &     
7#b7 by add+ at ! end ! foll[+3  7,,ii7 
,"u ?is clause ! ,secret>y %all n       
det]m9e an adju/m5t 9 ! limitation      
applicable to a hospital "u subp>agraph 
7,f7 until ! hospital tra9s m ?an #a4j  
full-"t equival5t resid5t 9 a new m$ical
 resid5cy tra9+ program 9 a co/ report+ 
p]iod4  7,,iii7 ,9 ! case ( a hospital t
 has a limitation "u subp>agraph 7,f7 ( 
less ?an #a4j full-"t-equival5t resid5t 
z ( ! date ( ! enactm5t ( ?is subclause 
bas$ on tra9+ be=e ,octob] #a1 #aiig1 "u
 ?is clause ! ,secret>y %all provide !  
hospital an opportunity to h a new      
adju/m5t 9 su* limitation det]m9$ :5 su*
 hospital beg9s tra9+ at lea/ #a4j      
full-"t equival5t resid5t 9 accordance )
 ! me?odology applicable to hospitals "u
 ! rules 9 effect z ( ,octob] #a1 #bjae1
 & appli$ = co/ report+ p]iods beg9n+ on
 or aft] ! date ( ! enactm5t ( ?is      
subclause4  7,,iv7 ,9 ! case ( a        

hospital t has n report$                
full-"t-equival5t resid5ts 9 #bj        
consecutive co/ report+ p]iods subsequ5t
 to ,octob] #a1 #aiig1 "u ?is clause !  
,secret>y %all provide ! hospital an    
opportunity to h a new adju/m5t 9 su*   
limitation det]m9$ :5 su* hospital beg9s
 tra9+ at lea/ #a4j full-"t equival5t   
resid5t 9 accordance ) ! me?odology     
applicable to hospitals "u ! rules 9    
effect z ( ,octob] #a1 #bjae1 & appli$ =
 co/ report+ p]iods beg9n+ on or aft] ! 
date ( ! enactm5t ( ?is subclause4  7,v7
 ,9 ! case ( a hospital = :i* an        
adju/m5t 9 ! limitation applicable to a 
hospital "u subp>agraph 7,f7 is bas$ on 
! tra9+ ( no m ?an #c4j                 
full-"t-equival5t resid5ts 9 a m$ical   
resid5cy tra9+ program 9 a co/ report+  
p]iod beg9n+ on or aft] ,octob] #a1     
#aiig1 & be=e ! date ( ! enactm5t ( ?is 
subclause1 ! ,secret>y %all provide !   
hospital an opportunity to h a new      
adju/m5t 9 su* limitation det]m9$ :5 !  
hospital beg9s tra9+ m ?an #c4j         

full-"t-equival5t resid5ts 9 accordance 
) ! me?odology applicable to hospitals  
"u ! rules 9 effect z ( ,octob] #a1     
#bjae1 & appli$ = co/ report+ p]iods    
beg9n+ on or aft] ! date ( ! enactm5t ( 
?is subclause4  4  7c7 ,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