,,ii  #aaf? ,,congress  #a/ ,session    
,s4 #cdh  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,febru>y #f1 #bjai,mr4 
,m55dez 7= himself1 ,mr4 ,boozman1 &    
,mr4 ,s*um]7 introduc$ ! foll[+ bill2   
:i* 0 read twice & ref]r$ to !          
,committee on ,f9ance  ,a ,,bill  ,to   
am5d title ,,xviii ( ! ,social ,security
 ,act to provide = ! di/ribution (      
additional resid5cy positions1 & = o!r  
purposes4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,resid5t ,physician        
,%ortage ,r$uction ,act ( #bjai4  #b4   
,di/ribution ( additional resid5cy      
positions  7a7 ,9 g5]al ,section        
#ahhf7;h7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acieww7h77 is am5d$--   
7#a7 9 p>agraph 7#d77;,f77i71 by /rik+  
p>agraphs 7#g7 & 7#h7 & ins]t+ p>agraphs
 7#g71 7#h71 & 7#i72  7#b7 9 p>agraph   
7#d77;,h77i71 by /rik+ p>agraphs 7#g7 & 
7#h7 & ins]t+ p>agraphs 7#g71 7#h71 &   
7#i72  7#c7 9 p>agraph 7#g77;,e71 by    
ins]t+ p>agraph 7#i71 aft] p>agraph     
7#h712 &  7#d7 by add+ at ! end ! foll[+

 new p>agraph3  7#i7 ,di/ribution (     
additional resid5cy positions  7,a7     
,additional resid5cy positions  7i7 ,9  
g5]al ,= ea* ( fiscal ye>s #bjba ?r\gh  
#bjbe 7& succe$+ fiscal ye>s if !       
,secret>y det]m9es t !re are additional 
resid5cy positions available to         
di/ribute "u clause 7iii77,,ii771 !     
,secret>y %all increase ! o!rwise       
applicable resid5t limit = ea* qualify+ 
hospital t submits a timely application 
"u ?is subp>agraph by su* numb] z !     
,secret>y may approve = portions ( co/  
report+ p]iods occurr+ on or aft] ,july 
#a ( ! fiscal ye> ( ! increase4 ,except 
z provid$ 9 clause 7iii71 ! aggregate   
numb] ( increases 9 ! o!rwise applicable
 resid5t limit "u ?is subp>agraph %all  
be equal to #c1jjj 9 ea* ( fiscal ye>s  
#bjba ?r\gh #bjbe1 ( :i* at lea/ #a1ejj 
9 ea* su* fiscal ye> %all be us$ =      
full-"t equival5t resid5ts tra9+ 9 a    
%ortage specialty resid5cy program 7z   
def9$ 9 subp>agraph 7,f77iii774  7ii7   
,process = di/ribut+ positions  7,i7    

,r\nds ( applications ,! ,secret>y %all 
initiate #e sep>ate r\nds ( applications
 = an increase "u clause 7i71 #a r\nd ) 
respect to ea* ( fiscal ye>s #bjba ?r\gh
 #bjbe4  7,,ii7 ,numb] available ,9 ea* 
( su* r\nds1 ! aggregate numb] (        
positions available = di/ribution 9 !   
fiscal ye> z a result ( an increase 9 ! 
o!rwise applicable resid5t limit 7z     
describ$ 9 clause 7i77 %all be          
di/ribut$1 plus any additional positions
 available "u clause 7iii74  7,,iii7    
,tim+ ,! ,secret>y %all notify hospitals
 ( ! numb] ( positions di/ribut$ to !   
hospital "u ?is p>agraph z result ( an  
increase 9 ! o!rwise applicable resid5t 
limit by ,janu>y #a ( ! fiscal ye> ( !  
increase4 ,su* increase %all be         
effective = portions ( co/ report+      
p]iods beg9n+ on or aft] ,july #a ( t   
fiscal ye>4  7iii7 ,positions n         
di/ribut$ dur+ ! fiscal ye>  7,i7 ,9    
g5]al ,if ! numb] ( resid5t full-"t     
equival5t positions di/ribut$ "u ?is    
p>agraph 9 a fiscal ye> is less ?an !   

aggregate numb] ( positions available = 
di/ribution 9 ! fiscal ye> 7z describ$ 9
 clause 7i71 includ+ aft] application ( 
?is subclause71 ! diff]5ce betwe5 su*   
numb] di/ribut$ & su* numb] available = 
di/ribution %all be add$ to ! aggregate 
numb] ( positions available =           
di/ribution 9 ! foll[+ fiscal ye>4      
7,,ii7 ,exception if positions n        
di/ribut$ by end ( fiscal ye> #bjbe ,if 
! aggregate numb] ( positions di/ribut$ 
"u ?is p>agraph dur+ ! #e-ye> p]iod (   
fiscal ye>s #bjba ?r\gh #bjbe is less   
?an #ae1jjj1 ! ,secret>y %all1 9        
accordance ) ! consid]ations describ$ 9 
subp>agraph 7,b77i7 & ! priority        
describ$ 9 subp>agraph 7,b77ii71 conduct
 an application & di/ribution process 9 
ea* subsequ5t fiscal ye> until su* "t z 
! aggregate am\nt ( positions di/ribut$ 
"u ?is p>agraph is equal to #ae1jjj4    
7,b7 ,di/ribution to c]ta9 hospitals    
7i7 ,consid]ation 9 di/ribution ,9      
det]m9+ = :i* hospitals ! increase 9 !  
o!rwise applicable resid5t limit is     

provid$ "u subp>agraph 7,a71 ! ,secret>y
 %all take into acc\nt ! demon/rat$     
likelihood ( ! hospital fill+ !         
positions made available "u ?is p>agraph
 )9 ! fir/ #e co/ report+ p]iods beg9n+ 
aft] ! date ! increase w\ld be          
effective1 z det]m9$ by ! ,secret>y4    
7ii7 ,priority = c]ta9 hospitals        
,subject to clause 7iii71 9 det]m9+ =   
:i* hospitals ! increase 9 ! o!rwise    
applicable resid5t limit is provid$ "u  
subp>agraph 7,a71 ! ,secret>y %all      
di/ribute ! increase 9 ! foll[+ priority
 ord]3  7,i7 ,fir/1 to hospitals 9      
,/ates ) 7aa7 new m$ical s*ools t       
receiv$ ,c&idate ,s*ool /atus f !       
,liaison ,committee on ,m$ical          
,education or t receiv$                 
,pre-,accr$itation /atus f ! ,am]ican   
,o/eopa?ic ,association ,commission on  
,o/eopa?ic ,college ,accr$itation on or 
aft] ,janu>y #a1 #bjjj1 & t h a*iev$ or 
cont9ue to progress t[>d ,full          
,accr$itation /atus 7z su* t]m is def9$ 
by ! ,liaison ,committee on ,m$ical     

,education7 or t[>d ,accr$itation /atus 
7z su* t]m is def9$ by ! ,am]ican       
,o/eopa?ic ,association ,commission on  
,o/eopa?ic ,college ,accr$itation71 or  
7bb7 additional locations & bran*       
campuses e/abli%$ on or aft] ,janu>y #a1
 #bjjj1 by m$ical s*ools ) ,full        
,accr$itation /atus 7z su* t]m is def9$ 
by ! ,liaison ,committee on ,m$ical     
,education7 or ,accr$itation /atus 7z   
su* t]m is def9$ by ! ,am]ican          
,o/eopa?ic ,association ,commission on  
,o/eopa?ic ,college ,accr$itation74     
7,,ii7 ,second1 to hospitals 9 :i* !    
resid5t level ( ! hospital is great] ?an
 ! o!rwise applicable resid5t limit dur+
 ! mo/ rec5t co/ report+ p]iod end+ on  
or be=e ! date ( enactm5t ( ?is         
p>agraph4  7,,iii7 ,?ird1 to hospitals )
 :i* ! ,secret>y coop]ates "u section   
#gcjb7;d7 ( title #ch1 ,unit$ ,/ates    
,code4  7,,iv7 ,f\r?1 to hospitals t    
emphasize tra9+ 9 community-bas$ sett+s 
or 9 hospital outpati5t dep>tm5ts4  7,v7
 ,fif?1 to hospitals t are n locat$ 9 a 

rural area & op]ate an approv$ m$ical   
resid5cy tra9+ program 7or rural track7 
9 a rural area or an approv$ m$ical     
resid5cy tra9+ program ) an integrat$   
rural track4  7,,vi7 ,six?1 to all o!r  
hospitals4  7iii7 ,di/ribution to       
hospitals 9 high] priority gr\p prior to
 di/ribution 9 l[] priority gr\ps ,!    
,secret>y may only di/ribute an increase
 "u subp>agraph 7,a7 to a l[] priority  
gr\p "u clause 7ii7 if all qualify+     
hospitals 9 ! high] priority gr\p or    
gr\ps h receiv$ ! maximum numb] (       
increases "u su* subp>agraph t !        
hospital is eligible = "u ?is p>agraph =
 ! fiscal ye>4  7,c7 ,requirem5ts = use 
( additional positions  7i7 ,9 g5]al    
,subject to clause 7ii71 a hospital t   
receives an increase 9 ! o!rwise        
applicable resid5t limit "u subp>agraph 
7,a7 %all ensure1 dur+ ! #e-ye> p]iod   
beg9n+ on ! effective date ( su*        
increase1 t--  7,i7 n less ?an #ej p]c5t
 ( ! positions attributable to su*      
increase are us$ to tra9 full-"t        

equival5t resid5ts 9 a %ortage specialty
 resid5cy program 7z def9$ 9 subclause  
7,f77iii771 z det]m9$ by ! ,secret>y at 
! end ( su* #e-ye> p]iod2  7,,ii7 !     
total numb] ( full-"t equival5t         
resid5ts1 exclud+ any additional        
positions attributable to su* increase1 
is n less ?an ! av]age numb] ( full-"t  
equival5t resid5ts dur+ ! #c mo/ rec5t  
co/ report+ p]iods end+ on or be=e !    
effective date ( su* increase2 &        
7,,iii7 ! ratio ( full-"t equival5t     
resid5ts 9 a %ortage specialty resid5cy 
program 7z s def9$7 is n less ?an !     
av]age ratio ( full-"t equival5t        
resid5ts 9 su* a program dur+ ! #c mo/  
rec5t co/ report+ p]iods end+ on or be=e
 ! effective date ( su* increase4  7ii7 
,r$i/ribution ( positions if hospital no
 long] meets c]ta9 requirem5ts ,9 ! case
 :]e ! ,secret>y det]m9es t a hospital  
describ$ 9 clause 7i7 does n meet !     
requirem5ts ( su* clause1 ! ,secret>y   
%all--  7,i7 r$uce ! o!rwise applicable 
resid5t limit ( ! hospital by ! am\nt by

 :i* su* limit 0 increas$ "u ?is        
p>agraph2 &  7,,ii7 provide = !         
di/ribution ( positions attributable to 
su* r$uction 9 accordance ) !           
requirem5ts ( ?is p>agraph4  7,d7       
,limitation  7i7 ,9 g5]al ,except z     
provid$ 9 clause 7ii71 a hospital may n 
receive m ?an #ge full-"t equival5t     
additional resid5cy positions 9 !       
aggregate "u ?is p>agraph ov] ! p]iod ( 
fiscal ye>s #bjba ?r\gh #bjbe4  7ii7    
,increase 9 numb] ( additional positions
 a hospital may receive ,! ,secret>y    
%all increase ! aggregate numb] (       
full-"t equival5t additional resid5cy   
positions a hospital may receive "u ?is 
p>agraph ov] su* p]iod if ! ,secret>y   
e/imates t ! numb] ( positions available
 = di/ribution "u subp>agraph 7,a7      
exce$s ! numb] ( applications approv$ "u
 su* subp>agraph ov] su* p]iod4  7,e7   
,application ( p] resid5t am\nts =      
prim>y c>e & nonprim>y c>e ,) respect to
 additional resid5cy positions 9 a      
hospital attributable to ! increase     

provid$ "u ?is p>agraph1 ! approv$ ,,fte
 p] resid5t am\nts are deem$ to be equal
 to ! hospital p] resid5t am\nts =      
prim>y c>e & nonprim>y c>e comput$ "u   
p>agraph 7#b77;,d7 = t hospital4  7,f7  
,def9itions ,9 ?is p>agraph3  7i7       
,o!rwise applicable resid5t limit ,! t]m
 o!rwise applicable resid5t limit means1
 ) respect to a hospital1 ! limit       
o!rwise applicable "u subp>agraphs      
7,f77i7 & 7,h7 ( p>agraph 7#d7 on !     
resid5t level = ! hospital det]m9$ )\t  
reg>d to ?is p>agraph b tak+ into acc\nt
 p>agraphs 7#g77;,a71 7#g77;,b71        
7#h77;,a71 & 7#h77;,b74  7ii7 ,resid5t  
level ,! t]m resid5t level has ! mean+  
giv5 su* t]m 9 p>agraph 7#g77;,c77i74   
7iii7 ,%ortage specialty resid5cy       
program ,! t]m %ortage specialty        
resid5cy program means any approv$      
resid5cy tra9+ program 9 a specialty    
id5tifi$ 9 ! report entitl$ ,!          
,physician ,work=ce3 ,projections &     
,rese>* into ,curr5t ,issues ,affect+   
,supply & ,dem&1 issu$ 9 ,decemb] #bjjh 

by ! ,heal? ,res\rces & ,s]vices        
,adm9i/ration1 z a specialty ^: basel9e 
physician requirem5ts projections exce$ 
! project$ supply ( total active        
physicians = ! p]iod ( #bjje ?r\gh      
#bjbj4  4  7b7 ,,ime  7#a7 ,9 g5]al     
,section #ahhf7;d77#e77;,b77v7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#acieww7d77#e77;,b77v771 9 ! ?ird       
s5t5ce1 is am5d$ by /rik+ & 7h77#h7 &   
ins]t+ 7h77#h71 & 7h77#i74  7#b7 ,con=m+
 provision ,section #ahhf7;d77#e77;,b7 (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #acieww7d77#e77;,b77 is am5d$--  7,a7  
by r$esignat+ clause 7x71 z add$ by     
section #eeje7;b7 ( ! ,pati5t           
,protection & ,af=dable ,c>e ,act       
7,public ,law #aaa-adh71 z clause 7xi7 &
 mov+ su* clause #d ems to ! left2 &    
7,b7 by add+ aft] clause 7xi71 z        
r$esignat$ by subp>agraph 7,a71 ! foll[+
 new clause3  7xii7 ,= dis*>ges occurr+ 
on or aft] ,july #a1 #bjba1 ins(> z an  
additional paym5t am\nt "u ?is          
subp>agraph is attributable to resid5t  

positions di/ribut$ to a hospital "u    
subsection 7h77#i71 ! indirect tea*+    
adju/m5t factor %all be comput$ 9 ! same
 mann] z provid$ "u clause 7ii7 )       
respect to su* resid5t positions4  4    
#c4 ,/udy & report on /rategies =       
increas+ div]sity  7a7 ,/udy ,!         
,comptroll] ,g5]al ( ! ,unit$ ,/ates 79 
?is section ref]r$ to z ! ,comptroll]   
,g5]al7 %all conduct a /udy on /rategies
 = increas+ ! div]sity ( ! heal?        
pr(essional work=ce4 ,su* /udy %all     
include an analysis ( /rategies =       
increas+ ! numb] ( heal? pr(essionals f 
rural1 l[] income1 & und]repres5t$      
m9ority communities1 includ+ :i*        
/rategies are mo/ effective = a*iev+ su*
 goal4  7b7 ,report ,n lat] ?an #b ye>s 
aft] ! date ( ! enactm5t ( ?is ,act1 !  
,comptroll] ,g5]al %all submit to       
,congress a report on ! /udy conduct$ "u
 subsection 7a71 toge!r ) recomm5dations
 = su* legislation & adm9i/rative action
 z ! ,comptroll] ,g5]al det]m9es        
appropriate4