,,ii #aafth ,,congress #ast ,session ,s4 #bhi ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,january #ca1 #bjai,mr4 ,gardner 7for himself1 ,mr4 ,tester1 and ,mrs4 ,hyde-,smith7 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 support rural residency training funding that is equitable for all ,states1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,rural ,physician ,workforce ,production ,act of #bjai4 #b4 ,alternative national per resident payment for residents training in rural training locations 7a7 ,in general ,section #ahhf of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7 is amended by adding at the end the following new subsection3 7u7 ,alternative national per resident payment amount for residents training in rural training locations 7#a7 ,in general 7,a7 ,establishment ,the ,secretary shall establish a national per resident payment 7,,nprp7 amount for time spent by residents training in rural training locations in accordance with paragraph 7#b74 7,b7 ,election ,for cost reporting periods beginning on or after the date that is #a year after the date of enactment of this subsection1 an applicable hospital 7as defined in paragraph 7#f77;,a771 may elect to receive the payment amount under this subsection for each full-time-equivalent resident in an approved medical residency training program that receives training in a rural training location in accordance with paragraph 7#b74 ,an applicable hospital may make an election under the preceding sentence regardless of whether the applicable hospital is otherwise eligible for a payment or adjustment for indirect and direct graduate medical education costs under subsections 7d77#e77;,b7 and 7h7 or section #ahad7l71 as applicable1 with respect to such residents4 ,if the applicable hospital is otherwise eligible for such a payment or adjustment1 the national per resident payment amount under this subsection shall be in lieu of such payment or adjustment4 7,c7 ,application ,the provisions of this subsection1 or the application of such provisions to an applicable hospital1 shall not result in or otherwise effect the following3 7i7 ,the establishment of a limitation on the number of residents in allopathic or osteopathic medicine for purposes of subsections 7d77#e77;,b7 and 7h7 with respect to an approved medical residency training program of an applicable hospital 7or be taken into account in determining such a limitation during the cap building period of an applicable hospital74 7ii7 ,the determination of-- 7,i7 the additional payment amount under subsection 7d77#e77;,b72 or 7,,ii7 hospital-specific approved ,,fte resident amounts under subsection 7h74 7iii7 ,the counting of any resident with respect to which the applicable hospital receives a national per resident payment under this subsection towards the application of the limitation described in clause 7i7 for purposes of subsections 7d77#e77;,b7 and 7h74 7#b7 ,payment amount 7,a7 ,base amount ,the national per resident payment amount1 with respect to full-time equivalent residents training in rural training locations1 for cost reporting periods beginning during the first year beginning on or after the date of enactment of this subsection shall be1 based on the most recently available data with respect to cost reporting periods beginning during a preceding year 7referred to in this subparagraph as the base cost reporting period71 equal to the sum of the following3 7i7 ,direct ,,gme ,the amount that1 out of all of the payment amounts 7determined on a per resident basis7 received by hospitals under subsection 7h7 for such base cost reporting period1 is equal to the national #heth percentile of such payment amounts4 7ii7 ,indirect ,,gme ,the amount that1 out of all of the additional payment amounts 7determined on a per resident basis7 received by hospitals under subsection 7d77#e77;,b7 for such base cost reporting period1 is equal to the national #heth percentile of such payment amounts4 7,b7 ,updating for subsequent cost reporting periods ,for each subsequent cost reporting period1 the national per resident payment amount is equal to such amount determined under this paragraph for the previous cost reporting period updated1 through the midpoint of the period1 by projecting the estimated percentage change in the consumer price index during the #ab-month period ending at that midpoint1 with appropriate adjustments to reflect previous under- or over-estimations under this subparagraph in the projected percentage change in the consumer price index4 7,c7 ,clarification ,the national per resident payment amount shall not be discounted or otherwise adjusted based on the ,medicare patient load 7as defined in subsection 7h77#c77;,c77 of an applicable hospital or discharges in a diagnosis-related group4 7#c7 ,allocation of payments ,in providing for payments under this subsection1 the ,secretary shall provide for an allocation of such payments between parts ,a and part ,b 7and the trust funds established under the respective parts7 as reasonably reflects the proportion of such costs associated with the provision of services under each respective part4 7#d7 ,eligibility for payment 7,a7 ,in general ,an applicable hospital shall be eligible for payment of the national per resident payment amount under this subsection for time spent by a resident training in a rural training location if the following requirements are met3 7i7 ,the resident spends the equivalent of at least #h weeks over the course of their training in a rural training location4 7ii7 ,the hospital pays the salary and benefits of the resident for the time spent training in a rural training location4 7,b7 ,treatment of time spent in rural tracks ,an applicable hospital shall be eligible for payment of the national per resident payment amount under this subsection for all time spent by residents in an approved medical residency program 7or separately defined track within a program7 that provides #ej percent or more of the total residency training time in rural training locations 7as defined in paragraph 7#f77;,c771 regardless of where the training occurs and regardless of specialty4 7#e7 ,determination of full-time-equivalent residents ,the determination of full-time-equivalent residents for purposes of this subsection shall be made in the same manner as the determination of full-time-equivalent residents under subsection 7h77#d74 7#f7 ,definitions ,in this subsection3 7,a7 ,applicable hospital ,the term applicable hospital means a hospital or critical access hospital4 7,b7 ,approved medical residency training program2 direct graduate medical education costs2 resident ,the terms approved medical residency training program1 direct graduate medical education costs1 and resident have the meanings given those terms in subsection 7h77#e74 7,c7 ,rural training location ,the term rural training location means a location in which training occurs that1 based on the #bjaj census or any subsequent census adjustment1 meets one or more of the following criteria3 7i7 ,the training occurs in a location that is a rural area 7as defined in section #ahhf7;d77#b77;,d774 7ii7 ,the training occurs in a location that has a rural-urban commuting area code equal to or greater than #d4j4 7iii7 ,the training occurs in a location that is within #aj miles of a sole community hospital 7as defined in subsection 7d77#e77;,d77iii7774 7#g7 ,budget neutrality requirement ,the ,secretary shall ensure that aggregate payments for direct medical education costs and indirect medical education costs under this title1 including any payments under this subsection1 for each year 7effective beginning on or after the date that is #a year after the date of enactment of this subsection7 are not greater than the aggregate payments for such costs that would have been made under this title for the year without the application of this subsection4 ,for purposes of carrying out the budget neutrality requirement under the preceding sentence1 the ,secretary may make appropriate adjustments to the amount of such payments for direct graduate medical education costs and indirect medical education costs under subsections 7h7 and 7d77#e77;,b71 respectively4 4 7b7 ,treatment of critical access hospitals and sole community hospitals 7#a7 ,critical access hospitals ,section #ahad7l7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7l77 is amended by adding at the end the following new paragraph3 7#f7 ,for cost reporting periods beginning on or after the date that is #a year after the date of enactment of this paragraph1 the following shall apply3 7,a7 ,a critical access hospital may elect to be treated as a hospital or as a non-provider setting for purposes of counting resident time for indirect medical education costs and direct graduate medical education costs for the time spent by the resident in that setting under subsections 7d77#e77;,b7 and 7h71 respectively1 of section #ahhf4 7,b7 ,medical education costs shall not be considered reasonable costs of a critical access hospital for purposes of payment under paragraph 7#a71 to the extent that the critical access hospital or another hospital receives payment for such costs for the time spent by the resident in that setting pursuant to subsection 7d77#e77;,b71 subsection 7h71 or subsection 7u7 of section #ahhf4 4 7#b7 ,sole community hospitals ,section #ahhf7;d77#e77;,d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,d77 is amended by adding at the end the following new clause3 7vi7 ,for cost reporting periods beginning on or after the date that is #a year after the date of enactment of this paragraph1 the hospital-specific payment amount determined under clause 7i77,i7 with respect to a sole community hospital shall not include medical education costs1 to the extent that the sole community hospital receives payment for such costs for the time spent by the resident in that setting pursuant to subsection 7u74 4 7c7 ,conforming amendments 7#a7 ,section #ahhf of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7 is amended-- 7,a7 in subsection 7d77#e77;,b71 in the matter preceding clause 7i71 by striking ,the ,secretary and inserting ,subject to subsection 7u71 the ,secretary2 and 7,b7 in subsection 7h7-- 7i7 in paragraph 7#a71 by inserting subject to subsection 7u7 after #ahfa7v712 and 7ii7 in paragraph 7#c71 in the flush matter following subparagraph 7,b71 by striking subsection 7k7 and inserting subsection 7k7 or subsection 7u74 #c4 ,supporting new1 expanding1 and existing rural training track residencies 7a7 ,direct graduate medical education ,section #ahhf7;h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7h77 is amended-- 7#a7 in paragraph 7#d7-- 7,a7 in subparagraph 7,f77i7-- 7i7 by striking #acj percent and inserting for cost reporting periods beginning on or after ,october #a1 #aiig1 and before the date that is #a year after the date of enactment of the ,rural ,physician ,workforce ,production ,act of #bjai1 #acj percent2 and 7ii7 by adding at the end the following3 ,for cost reporting periods beginning on or after the date that is #a year after the date of enactment of the ,rural ,physician ,workforce ,production ,act of #bjai1 such rules shall provide that any full-time-equivalent resident in an approved medical residency program 7or separately defined track within a program7 that provides #ej percent or more of the total residency training time in rural training locations 7as defined in subsection 7u77#f77;,c771 regardless of where the training occurs and regardless of specialty1 shall not be taken into account for purposes of applying the limitation under this subparagraph42 and 7,b7 in subparagraph 7,h7-- 7i7 in clause 7i71 in the second sentence1 by inserting the following before the period3 1 in accordance with the second sentence of clause 7i7 of such subparagraph2 and 7ii7 in clause 7iv71 by inserting the following before the period3 1 in accordance with the second sentence of clause 7i7 of such subparagraph2 and 7#b7 in paragraph 7#e71 by adding at the end the following new subparagraph3 7,l7 ,special rules regarding application of national per resident payment amount ,for special rules regarding application of the national per resident payment amount under subsection 7u71 see paragraph 7#a77;,c7 of such subsection4 4 7b7 ,indirect medical education ,section #ahhf7;d77#e77;,b77v7 is amended-- 7#a7 by striking #acj percent and inserting for cost reporting periods beginning on or after ,october #a1 #aiig1 and before the date that is #a year after the date of enactment of the ,rural ,physician ,workforce ,production ,act of #bjai1 #acj percent2 and 7#b7 by adding at the end the following3 ,for cost reporting periods beginning on or after the date that is #a year after the date of enactment of the ,rural ,physician ,workforce ,production ,act of #bjai1 such rules shall provide that any full-time-equivalent resident in an approved medical residency program 7or separately defined track within a program7 that provides #ej percent or more of the total residency training time in rural training locations 7as defined in subsection 7u77#f77;,c771 regardless of where the training occurs and regardless of specialty1 shall not be taken into account for purposes of applying the limitation under this subparagraph4 ,for special rules regarding application of the national per resident payment amount under subsection 7u71 see paragraph 7#a77;,c7 of such subsection44