,,ii  #aag? ,,congress  #b;d ,session   
,s4 #ejda  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,septemb] #bi1         
#bjbb,ms4 ,/ab5[ 7= h]self1 ,mr4 ,da9es1
 & ,mr4 ,m55dez7 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 positions 9         
psy*iatry & subspecialties4  #a4 ,%ort  
title ,?is ,act may be cit$ z ! ,tra9+  
,psy*iatri/s = ! ,future ,act4  #b4     
,di/ribution ( additional resid5cy      
positions 9 psy*iatry & psy*iatry       
subspecialties  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+ &
 7#i7 & ins]t+ 7#i71 & 7#aj72  7#b7 9   
p>agraph 7#d77;,h77i71 by /rik+ & 7#i7 &
 ins]t+ 7#i71 & 7#aj72 &  7#c7 by add+  
at ! end ! foll[+ new p>agraph3  7#aj7  
,di/ribution ( additional resid5cy      
positions 9 psy*iatry & psy*iatry       

subspecialties  7,a7 ,additional        
resid5cy positions  7i7 ,9 g5]al ,=     
fiscal ye> #bjbe1 & = ea* succe$+ fiscal
 ye> until ! aggregate numb] ( full-"t  
equival5t resid5cy positions di/ribut$  
"u ?is p>agraph is equal to ! aggregate 
numb] ( su* positions made available 7z 
specifi$ 9 clause 7ii77,i771 ! ,secret>y
 %all1 subject to ! succe$+ provisions (
 ?is p>agraph1 increase ! o!rwise       
applicable resid5t limit = ea* qualify+ 
hospital 7z def9$ 9 subp>agraph 7,f77 t 
submits a timely application "u ?is     
subp>agraph by su* numb] z ! ,secret>y  
may approve effective beg9n+ ,july #a ( 
! fiscal ye> ( ! increase4  7ii7 ,numb] 
available = di/ribution  7,i7 ,total    
numb] available ,! aggregate numb] ( su*
 positions made available "u ?is        
p>agraph %all be equal to #djj4  7,,ii7 
,annual limit ,! aggregate numb] ( su*  
positions s made available %all n exce$ 
#bjj = a fiscal ye>4  7iii7 ,di/ribution
 = psy*iatry or psy*iatry subspecialty  
resid5cies ,ea* ( ! positions made      

available "u ?is p>agraph %all be 9 a   
psy*iatry or psy*iatry subspecialty     
resid5cy 7z def9$ 9 subp>agraph 7,f774  
7iv7 ,process = di/ribut+ positions     
7,i7 ,r\nds ( applications ,! ,secret>y 
%all initiate a sep>ate r\nd (          
applications = an increase "u clause 7i7
 = ea* fiscal ye> = :i* su* an increase 
is to be provid$4  7,,ii7 ,tim+ ,!      
,secret>y %all notify hospitals ( !     
numb] ( positions di/ribut$ to !        
hospital "u ?is p>agraph z a result ( an
 increase 9 ! o!rwise applicable resid5t
 limit by ,janu>y #ca ( ! fiscal ye> ( !
 increase4 ,su* increase %all be        
effective beg9n+ ,july #a ( su* fiscal  
ye>4  7,b7 ,di/ribution ,= purposes (   
provid+ an increase 9 ! o!rwise         
applicable resid5t limit "u subp>agraph 
7,a71 ! foll[+ %all apply3 7i7          
,consid]ations 9 di/ribution ,9 det]m9+ 
= :i* qualify+ hospitals su* an increase
 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 tra9+ ye>s beg9n+ 
aft] ! date ! increase w\ld be          
effective1 z det]m9$ by ! ,secret>y4    
7ii7 ,di/ribution = c]ta9 categories (  
hospitals ,) respect to ! aggregate     
numb] ( su* positions available =       
di/ribution "u ?is p>agraph1 ! ,secret>y
 %all di/ribute su* aggregate numb] to !
 foll[+ categories ( hospitals3 7,i7 ,to
 hospitals t are locat$ 9 a rural area  
7z def9$ 9 section #ahhf7;d77#b77;,d77  
or are treat$ z be+ locat$ 9 a rural    
area pursuant to section                
#ahhf7;d77#h77;,e74  7,,ii7 ,to         
hospitals 9 :i* ! ref]5ce resid5t level 
( ! hospital 7z specifi$ 9 subp>agraph  
7,f77iv77 is great] ?an ! o!rwise       
applicable resid5t limit4  7,,iii7 ,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$itation72 or  
7bb7 additional locations & bran*       
campuses e/abli%$ 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$itation74     
7,,iv7 ,to hospitals t s]ve areas       
designat$ z heal? pr(essional %ortage   
areas "u section #ccb7;a77#a77;,a7 ( !  
,public ,heal? ,s]vice ,act1 z det]m9$  
by ! ,secret>y4  7,v7 ,to hospitals     
locat$ 9 ,/ates ) less ?an #bg resid5ts 
p] #ajj1jjj p4  7,c7 ,requirem5ts  7i7  

,9 g5]al ,subject to clause 7ii71 a     
hospital t receives an increase 9 !     
o!rwise applicable resid5t limit "u ?is 
p>agraph %all ensure1 dur+ ! #e-ye>     
p]iod beg9n+ on ! date ( su* increase1  
t-- 7,i7 ! numb] ( full-"t equival5t    
resid5ts 9 a psy*iatry or psy*iatry     
subspecialty resid5cy 7z def9$ 9        
subp>agraph 7,f771 exclud+ any          
additional positions attributable to an 
increase "u ?is p>agraph1 is n less ?an 
! av]age numb] ( full-"t equival5t      
resid5ts 9 su* a resid5cy dur+ ! #c mo/ 
rec5t co/ report+ p]iods end+ prior to !
 date ( enactm5t ( ?is p>agraph2 &      
7,,ii7 all ( ! positions attributable to
 su* increase are 9 a psy*iatry or      
psy*iatry subspecialty resid5cy 7z      
det]m9$ by ! ,secret>y74  ,! ,secret>y  
may det]m9e :e!r a hospital has met !   
requirem5ts "u ?is clause dur+ su*      
#e-ye> p]iod 9 su* mann] & at su* "t z !
 ,secret>y det]m9es appropriate1 includ+
 at ! end ( su* #e-ye> p]iod4  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 ei!r (
 ! requirem5ts "u subclause 7,i7 or     
7,,ii7 ( 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$uction 9
 accordance ) ! requirem5ts ( ?is       
p>agraph4  7iii7 ,limitation ,a hospital
 may n receive m ?an #aj additional     
full-"t equival5t resid5cy positions "u 
?is p>agraph4  7iv7 ,prohibition on     
di/ribution to hospitals )\t an increase
 agreem5t ,no increase 9 ! o!rwise      
applicable resid5t limit ( a hospital   
may be made "u ?is p>agraph unless su*  
hospital agrees to increase ! total     
numb] ( full-"t equival5t resid5cy      
positions "u ! approv$ m$ical resid5cy  
tra9+ program ( su* hospital by ! numb] 
( su* positions made available by su*   
increase "u ?is p>agraph4  7,d7         

,application ( p] resid5t am\nts =      
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 = nonprim>y  
c>e comput$ "u p>agraph 7#b77;,d7 = t   
hospital4  7,e7 ,p]mitt+ facilities to  
apply aggregation rules ,! ,secret>y    
%all p]mit hospitals receiv+ additional 
resid5cy positions attributable to !    
increase provid$ "u ?is p>agraph to1    
beg9n+ 9 ! fif? ye> aft] ! effective    
date ( su* increase1 apply su* positions
 to ! limitation am\nt "u p>agraph      
7#d77;,f7 t may be aggregat$ pursuant to
 p>agraph 7#d77;,h7 among memb]s ( !    
same affiliat$ gr\p4  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;,b71 &      
7#i77;,a74  7ii7 ,psy*iatry or psy*iatry
 subspecialty resid5cy ,! t]m psy*iatry 
or psy*iatry subspecialty resid5cy means
 a resid5cy 9 psy*iatry z accr$it$ by ! 
,accr$itation ,c\ncil = ,graduate       
,m$ical ,education = ! purpose (        
prev5t+1 diagnos+1 & treat+ m5tal heal? 
disord]s4  7iii7 ,qualify+ hospital ,!  
t]m qualify+ hospital means a hospital  
describ$ 9 any ( subclauses 7,i7 ?r\gh  
7,v7 ( subp>agraph 7,b77ii74  7iv7      
,ref]5ce resid5t level ,! t]m ref]5ce   
resid5t level means1 ) respect to a     
hospital1 ! resid5t level = ! mo/ rec5t 
co/ report+ p]iod ( ! hospital end+ on  
or be=e ! date ( enactm5t ( ?is         
p>agraph1 = :i* a co/ report has be5    
settl$ 7or1 if n1 submitt$ 7subject to  
audit771 z det]m9$ by ! ,secret>y4  7v7 
,resid5t level ,! t]m resid5t level has 
! mean+ giv5 su* t]m 9 p>agraph         
7#g77;,c77i74  4  7b7 ,,ime ,section    

#ahhf7;d77#e77;,b7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#acieww7d77#e77;,b77 is am5d$-- 7#a7 9  
clause 7v71 9 ! ?ird s5t5ce1 by /rik+ & 
7h77#i7 & ins]t+ 7h77#i71 & 7h77#aj72   
7#b7 by mov+ clause 7xii7 #d ems to !   
left2 &  7#c7 by add+ at ! end ! foll[+ 
new clause3  7xiii7 ,= dis*>ges occurr+ 
on or aft] ,july #a1 #bjbd1 ins(> z an  
additional paym5t am\nt "u ?is          
subp>agraph is attributable to resid5t  
positions di/ribut$ to a hospital "u    
subsection 7h77#aj71 ! indirect tea*+   
adju/m5t factor %all be comput$ 9 ! same
 mann] z provid$ "u clause 7ii7 )       
respect to su* resid5t positions4  4    
7c7 ,prohibition on judicial review     
,section #ahhf7;h77#g77;,e7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#acieww--#d7;h77#g77;,e77 is am5d$ by   
ins]t+ p>agraph 7#aj71 aft] p>agraph    
7#h714