,,ii  #aah? ,,congress  #a/ ,session    
,s4 #acjb  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,april #bf1 #bjbc,mr4  
,m55dez 7= himself1 ,mr4 ,boozman1 ,mr4 
,s*um]1 & ,ms4 ,coll9s7 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$uction ,act (   
#bjbc4  #b4 ,di/ribution ( additional   
resid5cy positions  7a7 ,9 g5]al        
,section #ahhf7;h7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acieww7h77 is     
am5d$-- 7#a7 9 p>agraph 7#d77;,f77i71 by
 /rik+ & 7#aj7 & ins]t+ 7#aj71 & 7#aa72 
7#b7 9 p>agraph 7#d77;,h77i71 by /rik+ &
 7#aj7 & ins]t+ 7#aj71 & 7#aa72  7#c7 9 
p>agraph 7#g77;,e71 by ins]t+ p>agraph  
7#aa71 aft] p>agraph 7#aj712 &  7#d7 by 
add+ at ! end ! foll[+ new p>agraph3    
7#aa7 ,di/ribution ( additional resid5cy

 positions  7,a7 ,additional resid5cy   
positions  7i7 ,9 g5]al ,= ea* ( fiscal 
ye>s #bjbe ?r\gh #bjca 7& succe$+ fiscal
 ye>s if ! ,secret>y det]m9es t !re are 
additional resid5cy positions available 
to di/ribute "u clause 7iii77,,ii771 !  
,secret>y %all increase ! o!rwise       
applicable resid5t limit = ea* qualify+ 
hospital 7z def9$ 9 subp>agraph 7,g77 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 #b1jjj 9 ea* ( fiscal ye>s  
#bjbe ?r\gh #bjca4  7ii7 ,process =     
di/ribut+ positions  7,i7 ,r\nds (      
applications ,! ,secret>y %all initiate 
#g sep>ate r\nds ( applications = an    
increase "u clause 7i71 #a r\nd )       
respect to ea* ( fiscal ye>s #bjbe ?r\gh
 #bjca4  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 #ca ( ! 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> #bjca ,if 
! aggregate numb] ( positions di/ribut$ 
"u ?is p>agraph dur+ ! #g-ye> p]iod (   
fiscal ye>s #bjbe ?r\gh #bjca is less   
?an #ad1jjj1 ! ,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 #ad1jjj4    
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 ,m9imum di/ribution = c]ta9        
categories ( hospitals ,) respect to !  
aggregate numb] ( su* positions         
available = di/ribution "u ?is p>agraph1
 ! ,secret>y %all di/ribute n less ?an  
#aj p]c5t ( su* aggregate numb] to ea* (
 ! foll[+ categories ( hospitals3 7,i7  
,hospitals t are locat$ 9 a rural area  
7z def9$ 9 subsection 7d77#b77;,d77 or  
are treat$ z be+ locat$ 9 a rural area  
pursuant to subsection 7d77#h77;,e74    
7,,ii7 ,hospitals 9 :i* ! ref]5ce       
resid5t level ( ! hospital 7z specifi$ 9
 subp>agraph 7,g77iii77 is great] ?an ! 
o!rwise applicable resid5t limit4       
7,,iii7 ,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$itation74     
7,,iv7 ,hospitals t s]ve areas designat$
 z heal? pr(essional %ortage areas "u   
section #ccb7;a77#a77;,a7 ( ! ,public   
,heal? ,s]vice ,act1 z det]m9$ by !     
,secret>y4  7iii7 ,special rule ,9      
di/ribut+ positions "u clause 7ii71 !   
,secret>y %all n prioritize hospitals 9 
multiple categories ov] hospitals 9 an  
individual category or bas$ on section  

#ccb ( ! ,public ,heal? ,s]vice ,act4   
7,c7 ,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$ical resid5cy tra9+ program ( 
su* hospital by ! numb] ( su* positions 
made available by su* increase "u ?is   
p>agraph4  7,d7 ,limitation  7i7 ,9     
g5]al ,except z provid$ 9 clause 7ii71 a
 hospital may n receive m ?an #ge       
full-"t equival5t additional resid5cy   
positions 9 ! aggregate "u ?is p>agraph 
& p>agraphs 7#i7 & 7#aj7 ov] ! p]iod (  
fiscal ye>s #bjbe ?r\gh #bjca4  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  
,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,g7 ,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;,a71        
7#i77;,b71 7#aj77;,a71 & 7#aj77;,b74    
7ii7 ,qualify+ hospital ,! t]m qualify+ 
hospital means a hospital describ$ 9 any
 ( subclauses 7,i7 ?r\gh 7,,iv7 (       
subp>agraph 7,b77ii74  7iii7 ,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  7iv7 ,resid5t level ,! 
t]m resid5t level has ! mean+ giv5 su*  
t]m 9 p>agraph 7#g77;,c77i74  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#aj7 &  
ins]t+ 7h77#aj71 & 7h77#aa74  7#b7      
,con=m+ provision ,section              
#ahhf7;d77#e77;,b7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#acieww7d77#e77;,b77 is am5d$ by add+   
aft] clause 7xiii7 ! foll[+ new clause3 
7ix7 ,= dis*>ges occurr+ on or aft]     
,july #a1 #bjbe1 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  #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