,i #aagth ,,congress #ast ,session ,h4 ,r4 #bbef ,,in ,,the ,,house ,,of ,,representatives ,march #bf1 #bjba,ms4 ,sewell 7for herself1 ,mr4 ,katko1 ,mr4 ,suozzi1 ,mr4 ,rodney ,davis of ,illinois1 ,ms4 ,barragn1 ,mrs4 ,beatty1 ,mr4 ,brendan ,f4 ,boyle of ,pennsylvania1 ,mr4 ,carbajal1 ,mr4 ,cicilline1 ,mr4 ,cohen1 ,mr4 ,connolly1 ,mr4 ,crow1 ,mr4 ,danny ,k4 ,davis of ,illinois1 ,ms4 ,de,gette1 ,mr4 ,michael ,f4 ,doyle of ,pennsylvania1 ,mr4 ,fitzpatrick1 ,ms4 ,houlahan1 ,mr4 ,johnson of ,georgia1 ,mr4 ,lawson of ,florida1 ,ms4 ,lee of ,california1 ,mrs4 ,lee of ,nevada1 ,ms4 ,mc,collum1 ,mr4 ,meeks1 ,ms4 ,meng1 ,mr4 ,nadler1 ,mr4 ,payne1 ,ms4 ,pingree1 ,ms4 ,ross1 ,ms4 ,scanlon1 ,ms4 ,stefanik1 ,mr4 ,steube1 ,ms4 ,stevens1 ,ms4 ,titus1 ,mr4 ,tonko1 ,mr4 ,van ,drew1 ,ms4 ,velzquez1 ,mr4 ,welch1 ,ms4 ,bass1 and ,miss ,rice of ,new ,york7 introduced the following bill2 which was referred to the ,committee on ,ways and ,means1 and in addition to the ,committee on ,energy and ,commerce1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to provide for the distribution of additional residency positions1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,resident ,physician ,shortage ,reduction ,act of #bjba4 #b4 ,distribution of additional residency positions 7a7 ,in general ,section #ahhf7;h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7h77 is amended-- 7#a7 in paragraph 7#d77;,f77i71 by striking paragraphs 7#g71 7#h71 and 7#i7 and inserting paragraphs 7#g71 7#h71 7#i71 and 7#aj72 7#b7 in paragraph 7#d77;,h77i71 by striking paragraphs 7#g71 7#h71 and 7#i7 and inserting paragraphs 7#g71 7#h71 7#i71 and 7#aj72 7#c7 in paragraph 7#g77;,e71 by inserting paragraph 7#aj71 after paragraph 7#h712 and 7#d7 by adding at the end the following new paragraph3 7#aj7 ,distribution of additional residency positions 7,a7 ,additional residency positions 7i7 ,in general ,for each of fiscal years #bjbc through #bjbi 7and succeeding fiscal years if the ,secretary determines that there are additional residency positions available to distribute under clause 7iv77,,ii771 the ,secretary shall1 subject to clause 7ii7 and subparagraph 7,d71 increase the otherwise applicable resident limit for each qualifying hospital 7as defined in subparagraph 7,h77 that submits a timely application under this subparagraph by such number as the ,secretary may approve for portions of cost reporting periods occurring on or after ,july #a of the fiscal year of the increase4 7ii7 ,number available for distribution ,for each such fiscal year1 the ,secretary shall determine the total number of additional residency positions available for distribution under clause 7i7 in accordance with the following3 7,i7 ,allocation to hospitals already operating over resident limit ,one-third of such number shall be available for distribution only to hospitals described in subparagraph 7,b74 7,,ii7 ,aggregate limitation ,except as provided in clause 7iv77,i71 the aggregate number of increases in the otherwise applicable resident limit under this subparagraph shall be equal to #b1jjj in each such year4 7iii7 ,process for distributing positions 7,i7 ,rounds of applications ,the ,secretary shall initiate #g separate rounds of applications for an increase under clause 7i71 #a round with respect to each of fiscal years #bjbc through #bjbi4 7,,ii7 ,number available ,in each of such rounds1 the aggregate number of positions available for distribution in the fiscal year under clause 7ii7 shall be distributed1 plus any additional positions available under clause 7iv74 7,,iii7 ,timing ,the ,secretary shall notify hospitals of the number of positions distributed to the hospital under this paragraph as a result of an increase in the otherwise applicable resident limit by ,january #a of the fiscal year of the increase4 ,such increase shall be effective for portions of cost reporting periods beginning on or after ,july #a of that fiscal year4 7iv7 ,positions not distributed during the fiscal year 7,i7 ,in general ,if the number of resident full-time equivalent positions distributed under this paragraph in a fiscal year is less than the aggregate number of positions available for distribution in the fiscal year 7as described in clause 7ii71 including after application of this subclause71 the difference between such number distributed and such number available for distribution shall be added to the aggregate number of positions available for distribution in the following fiscal year4 7,,ii7 ,exception if positions not distributed by end of fiscal year #bjbi ,if the aggregate number of positions distributed under this paragraph during the #g-year period of fiscal years #bjbc through #bjbi is less than #ad1jjj1 the ,secretary shall1 in accordance with the provisions of clause 7ii7 and subparagraph 7,e7 and the considerations and priority described in subparagraph 7,c71 conduct an application and distribution process in each subsequent fiscal year until such time as the aggregate amount of positions distributed under this paragraph is equal to #ad1jjj4 7,b7 ,allocation of distribution for positions to hospitals already operating over resident limit 7i7 ,in general ,subject to clauses 7ii7 and 7iii71 in the case of a hospital in which the reference resident level of the hospital 7as specified in subparagraph 7,g77iii77 is greater than the otherwise applicable resident limit1 the increase in the otherwise applicable resident limit under subparagraph 7,a7 for a fiscal year described in such subparagraph shall be an amount equal to the product of the total number of additional residency positions available for distribution under subparagraph 7,a77ii77,i7 for such fiscal year and the quotient of-- 7,i7 the number of resident positions by which the reference resident level of the hospital exceeds the otherwise applicable resident limit for the hospital2 and 7,,ii7 the number of resident positions by which the reference resident level of all such hospitals with respect to which an application is approved under this paragraph exceeds the otherwise applicable resident limit for such hospitals4 7ii7 ,requirements ,a hospital described in clause 7i7-- 7,i7 is not eligible for an increase in the otherwise applicable resident limit under this subparagraph unless the amount by which the reference resident level of the hospital exceeds the otherwise applicable resident limit is not less than #aj and the hospital trains at least #be percent of the full-time equivalent residents of the hospital in primary care and general surgery 7as of the date of enactment of this paragraph72 and 7,,ii7 shall continue to train at least #be percent of the full-time equivalent residents of the hospital in primary care and general surgery for the #e-year period beginning on such date4 ,in the case where the ,secretary determines that a hospital described in clause 7i7 no longer meets the requirement of subclause 7,,ii71 the ,secretary may reduce the otherwise applicable resident limit of the hospital by the amount by which such limit was increased under this subparagraph4 7iii7 ,clarification regarding eligibility for other additional residency positions ,nothing in this subparagraph shall be construed as preventing a hospital described in clause 7i7 from applying for and receiving additional residency positions under this paragraph that are not reserved for distribution under this subparagraph4 7,c7 ,distribution of other positions ,for purposes of determining an increase in the otherwise applicable resident limit under subparagraph 7,a7 7other than such an increase described in subparagraph 7,b771 the following shall apply3 7i7 ,considerations in distribution ,in determining for which hospitals such an increase is provided under subparagraph 7,a71 the ,secretary shall take into account the demonstrated likelihood of the hospital filling the positions made available under this paragraph within the first #e cost reporting periods beginning after the date the increase would be effective1 as determined by the ,secretary4 7ii7 ,minimum distribution for certain categories of hospitals ,with respect to the aggregate number of such positions available for distribution under this paragraph1 the ,secretary shall distribute not less than #aj percent of such aggregate number to each of the following categories of hospitals3 7,i7 ,hospitals that are located in a rural area 7as defined in subsection 7d77#b77;,d77 or are treated as being located in a rural area pursuant to subsection 7d77#h77;,e74 7,,ii7 ,hospitals in which the reference resident level of the hospital 7as specified in subparagraph 7,f77iii77 is greater than the otherwise applicable resident limit4 7,,iii7 ,hospitals in ,states with-- 7aa7 new medical schools that received ,candidate ,school status from the ,liaison ,committee on ,medical ,education or that received ,pre-,accreditation status from the ,american ,osteopathic ,association ,commission on ,osteopathic ,college ,accreditation on or after ,january #a1 #bjjj1 and that have achieved or continue to progress toward ,full ,accreditation status 7as such term is defined by the ,liaison ,committee on ,medical ,education7 or toward ,accreditation status 7as such term is defined by the ,american ,osteopathic ,association ,commission on ,osteopathic ,college ,accreditation72 or 7bb7 additional locations and branch campuses established on or after ,january #a1 #bjjj1 by medical schools with ,full ,accreditation status 7as such term is defined by the ,liaison ,committee on ,medical ,education7 or ,accreditation status 7as such term is defined by the ,american ,osteopathic ,association ,commission on ,osteopathic ,college ,accreditation74 7,,iv7 ,hospitals that serve areas designated as health professional shortage areas under section #ccb7;a77#a77;,a7 of the ,public ,health ,service ,act1 as determined by the ,secretary4 7,d7 ,prohibition on distribution to hospitals without an increase agreement ,no increase in the otherwise applicable resident limit of a hospital may be made under subparagraph 7,c7 unless such hospital agrees to increase the total number of full-time equivalent residency positions under the approved medical residency training program of such hospital by the number of such positions made available by such increase under the subparagraph4 7,e7 ,limitation 7i7 ,in general ,except as provided in clause 7ii71 a hospital may not receive more than #ge full-time equivalent additional residency positions in the aggregate under this paragraph and paragraph 7#i7 over the period of fiscal years #bjbc through #bjbi4 7ii7 ,increase in number of additional positions a hospital may receive ,the ,secretary shall increase the aggregate number of full-time equivalent additional residency positions a hospital may receive under this paragraph over such period if the ,secretary estimates that the number of positions available for distribution under subparagraph 7,a7 exceeds the number of applications approved under such subparagraph over such period4 7,f7 ,application of per resident amounts for primary care and nonprimary care ,with respect to additional residency positions in a hospital attributable to the increase provided under this paragraph1 the approved ,,fte per resident amounts are deemed to be equal to the hospital per resident amounts for primary care and nonprimary care computed under paragraph 7#b77;,d7 for that hospital4 7,g7 ,permitting facilities to apply aggregation rules ,the ,secretary shall permit hospitals receiving additional residency positions attributable to the increase provided under this paragraph to1 beginning in the fifth year after the effective date of such increase1 apply such positions to the limitation amount under paragraph 7#d77;,f7 that may be aggregated pursuant to paragraph 7#d77;,h7 among members of the same affiliated group4 7,h7 ,definitions ,in this paragraph3 7i7 ,otherwise applicable resident limit ,the term otherwise applicable resident limit means1 with respect to a hospital1 the limit otherwise applicable under subparagraphs 7,f77i7 and 7,h7 of paragraph 7#d7 on the resident level for the hospital determined without regard to this paragraph but taking into account paragraphs 7#g77;,a71 7#g77;,b71 7#h77;,a71 and 7#h77;,b74 7ii7 ,reference resident level ,except as otherwise provided in subclause 7,,ii71 the term reference resident level means1 with respect to a hospital1 the resident level for the most recent cost reporting period of the hospital ending on or before the date of enactment of this paragraph1 for which a cost report has been settled 7or1 if not1 submitted 7subject to audit771 as determined by the ,secretary4 7iii7 ,resident level ,the term resident level has the meaning given such term in paragraph 7#g77;,c77i74 7iv7 ,qualifying hospital ,the term qualifying hospital means a hospital described in subparagraph 7,b77i7 or any of subclauses 7,i7 through 7,,iv7 of subparagraph 7,c77ii74 4 7b7 ,,ime ,section #ahhf7;d77#e77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,b77 is amended-- 7#a7 in clause 7v71 in the third sentence1 by striking subsections 7h77#g71 7h77#h71 and 7h77#i7 and inserting subsections 7h77#g71 7h77#h71 7h77#i71 and 7h77#aj72 and 7#b7 by adding after clause 7xii71 as redesignated by subparagraph 7,a71 the following new clause3 7xiii7 ,for discharges occurring on or after ,july #a1 #bjbc1 insofar as an additional payment amount under this subparagraph is attributable to resident positions distributed to a hospital under subsection 7h77#aj71 the indirect teaching adjustment factor shall be computed in the same manner as provided under clause 7ii7 with respect to such resident positions4 4 #c4 ,study and report on strategies for increasing diversity 7a7 ,study ,the ,comptroller ,general of the ,united ,states 7in this section referred to as the ,comptroller ,general7 shall conduct a study on strategies for increasing the diversity of the health professional workforce4 ,such study shall include an analysis of strategies for increasing the number of health professionals from rural1 lower income1 and underrepresented minority communities1 including which strategies are most effective for achieving such goal4 7b7 ,report ,not later than #b years after the date of enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report on the study conducted under subsection 7a71 together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate4