,,ii  #aafth ,,congress  #b;d ,session  
,s4 #ccij  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,march #d1     
#bjbj,mr4 ,barrasso 7for himself and    
,ms4 ,cortez ,masto7 introduced the     
following bill2 which was read twice and
 referred to the ,committee on ,finance 
,a ,,bill  ,to provide for a new        
building period with respect to the cap 
on full-time equivalent residents for   
purposes of payment for graduate medical
 education costs under the ,medicare    
program for certain hospitals that have 
established a shortage specialty        
program4  #a4 ,short title ,this ,act   
may be cited as the ,physician ,shortage
 ,,gme ,cap ,flex ,act of #bjbj4  #b4   
,providing for a new building period    
with respect to the cap on full-time    
equivalent residents for certain        
hospitals that have established a       
shortage specialty program ,section     
#ahhf7;h77#d7 of the ,social ,security  
,act 7#db ,u4,s4,c4 #acieww7h77#d77 is  
amended by adding at the end the        

following new subparagraph3  7,l7       
,treatment of certain qualifying        
hospitals  7i7 ,in general ,for purposes
 of applying this paragraph and section 
#dac4gi of title #db1 ,code of ,federal 
,regulations 7or a successor            
regulation71 the ,secretary shall treat1
 subject to clause 7ii71 a qualifying   
hospital 7as defined in clause 7iii77   
with an approved medical residency      
training program as if such hospital--  
7,i7 had no allopathic or osteopathic   
residents in its most recent cost       
reporting period ending on or before    
,december #ca1 #aiif2 and  7,,ii7 began 
training residents for the first time in
 a new medical residency training       
program 7as defined in paragraph 7l7 of 
such section7 beginning on the date on  
which such hospital became a qualifying 
hospital4  7ii7 ,special rule for       
qualifying hospitals in cap-building    
period ,in the case of a qualifying     
hospital with an approved medical       
residency training program that1        

excluding the treatment described in    
clause 7i71 is a hospital that had no   
allopathic or osteopathic residents in  
its most recent cost reporting period   
ending on or before ,december #ca1      
#aiif1 and began training residents for 
the first time in a new medical         
residency training program 7as defined  
in paragraph 7l7 of such section7 during
 the #e-year period ending on the date  
described in clause 7i77,,ii7 with      
respect to such hospital1 in lieu of    
applying such clause1 the ,secretary    
shall provide that the provisions of    
subsection 7e7 of section #dac4gi of    
title #db1 ,code of ,federal            
,regulations 7or a successor            
regulation71 shall apply with respect to
 such hospital for an additional #e     
years beyond the period during which    
such provisions would otherwise have    
applied to such hospital4  7iii7        
,definition ,in this subparagraph3 7,i7 
,qualifying hospital ,the term          
qualifying hospital means a hospital    

that-- 7aa7 establishes a shortage      
specialty program 7as defined in        
subclause 7,,ii77 during the #e-year    
period beginning on the date of the     
enactment of this subparagraph2 and     
7bb7 submits an application to the      
,secretary during such period containing
 such information as the ,secretary may 
specify4  7,,ii7 ,shortage specialty    
program ,the term shortage specialty    
program means1 with respect to a        
hospital located in a geographic area   
7as defined by the ,secretary71 any     
approved residency training program in a
 specialty for which the ,secretary     
determines that there is a shortage of  
physicians practicing such specialty in 
such area at the time such program is   
established4 ,in making such a          
determination1 the ,secretary shall take
 into account whether such hospital is  
located in an area-- 7aa7 without       
adequate health care resources 7such as 
in a rural area or a medically          
underserved area 7as defined by the     

,administrator of the ,health ,resources
 and ,services ,administration772  7bb7 
experiencing primary care or specialty  
physician shortages 7such as in a health
 professional shortage area 7as defined 
in section #ccb7;a7 of the ,public      
,health ,service ,act 7#db ,u4,s4,c4    
#bed;e7a77772  7cc7 without an adequate 
number of approved residency training   
programs2  7dd7 struggling to expand or 
keep approved residency training        
programs operational2  7ee7 lacking     
existing medical training infrastructure
 or in the process of building such     
infrastructure2  7ff7 with a low        
resident-to-population ratio2  7gg7 with
 few full-time equivalent resident      
positions2 or  7hh7 with a low          
physician-to-population ratio for       
physicians practicing in the same       
specialty as the shortage specialty     
program concerned4  4