,i  #aaith ,,congress  #b;d ,session    
,h4 ,r4 #hidc  ,,in ,,the ,,house ,,of  
,,representatives  ,may #bj1 #bjbf,mr4  
,steube 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 prohibit payments for 
graduate medical education costs        
attributable to individuals who are not 
citizens or nationals of the ,united    
,states under the ,medicare program4    
#a4 ,short title ,this ,act may be cited
 as the ,our ,doctors ,first ,act of    
#bjbf4  #b4 ,prohibiting                
,federally-funded graduate medical      
education for non-citizens under        
,medicare  7a7 ,hospital payments for   
direct graduate medical education costs 

,section #ahhf7;h7 of the ,social       
,security ,act 7#db ,u4,s4,c4           
#acieww7h77 is amended--  7#a7 in       
paragraph 7#a71 by inserting 1 subject  
to paragraph 7#aa7 after of this        
subsection2  7#b7 in paragraph 7#d71 by 
adding at the end the following new     
subparagraph3  7,l7 ,non-citizen        
residents ,such rules shall provide     
that1 effective for cost reporting      
periods beginning on or after the date  
that is #a year after the date of the   
enactment of this subparagraph1 an      
individual shall not be counted as a    
resident unless such individual is a    
citizen or national of the ,united      
,states4  2 and  7#c7 by adding at the  
end the following new paragraph3  7#aa7 
,sanctions for counting non-citizen     
residents  7,a7 ,in general ,effective  
for cost reporting periods beginning on 
or after the date that is #a year after 
the date of the enactment of this       
paragraph1 a hospital that submits a    
cost report counting #a or more         

individuals who such hospital knows or  
should know are not citizens or         
nationals of the ,united ,states as     
interns or residents for purposes of    
payment under this subsection in        
violation of paragraph 7#d77,l7 or      
payment under paragraphs 7#e77;,b7 and  
7#aa7 of subsection 7d7 in violation of 
subsection 7d77#e77;,b77xiv7 shall be   
subject to the following sanctions3 7i7 
,in the case of the first cost reporting
 period for which such hospital submits 
such a cost report1 a civil monetary    
penalty equal to #be percent of the     
payment amount that would be            
attributable to the individuals so      
counted pursuant to such cost report if 
such individuals were permitted to be so
 counted under this subsection and      
subsection 7d77#e77;,b74  7ii7 ,in the  
case of the second cost reporting period
 for which such hospital submits such a 
cost report1 a civil monetary penalty   
equal to #a1jjj1jjj4  7iii7 ,in the case
 of the third cost reporting period for 

which such hospital submits such a cost 
report1 such hospital shall be excluded 
from receiving payments under this      
subsection and paragraphs 7#e77;,b7 and 
7#aa7 of subsection 7d7 for a period of 
#e years4  7iv7 ,in the case of each    
subsequent cost reporting period for    
which such hospital submits such a cost 
report1 such hospital shall be excluded 
from receiving payments under this      
subsection and paragraphs 7#e77;,b7 and 
7#aa7 of subsection 7d7 for a period of 
#aj years4  7,b7 ,procedures  7i7 ,civil
 monetary penalties ,the provisions of  
section #aabh;,a 7other than subsection 
7a7 and 7b7 of such section7 shall apply
 to civil monetary penalties under this 
paragraph in the same manner as such    
provisions apply to a penalty or        
proceeding under subsection 7a7 of such 
section4  7ii7 ,exclusion from payments 
,the provisions of subsections 7c77#a7  
and 7f7 of section #aabh shall apply to 
an exclusion from receiving payments    
under this paragraph in the same manner 

as such provisions apply to exclusions  
from participation under such section4  
4  7b7 ,hospital payments for indirect  
costs of medical education ,section     
#ahhf7;d7 of the ,social ,security ,act 
7#db ,u4,s4,c4 #acieww7d77--  7#a7 in   
paragraph 7#e77;,b7-- 7,a7 by striking  
,the ,secretary and inserting ,subject  
to subsection 7h77#aa71 the ,secretary2 
and  7,b7 by adding at the end the      
following new clause3  7xiv7 ,for       
discharges occurring on or after the    
first ,july #a occurring on or after the
 date that is #a year after the date of 
the enactment of this clause1 an        
individual shall not be counted as an   
intern or a resident under this         
subparagraph unless such individual is a
 citizen or national of the ,united     
,states4  2 and  7#b7 in paragraph      
7#aa77;,a71 by inserting subject to     
subsection 7h77#aa71 before the         
,secretary4  7c7 ,nonhospital provider  
payments for direct costs of medical    
education ,section #ahhf7k7 of the      

,social ,security ,act 7#db ,u4,s4,c4   
#acieww7k77 is amended by adding at the 
end the following new paragraph3  7#c7  
,non-citizen residents  7,a7 ,in general
 ,effective for cost reporting periods  
beginning on or after the date that is  
#a year after the date of the enactment 
of this paragraph1 payment may not be   
made under this subsection for direct   
costs of medical education incurred with
 respect to residents who are not       
citizens or nationals of the ,united    
,states4  7,b7 ,penalties  7i7 ,in      
general ,effective for cost reporting   
periods beginning on or after the date  
that is #a year after the date of the   
enactment of this paragraph1 a qualified
 nonhospital provider that submits a    
cost report requesting payment under    
this subsection for direct costs of     
medical education incurred with respect 
to #a or more residents who such        
qualified nonhospital provider knows or 
should know are not citizens or         
nationals of the ,united ,states in     

violation of subparagraph 7,a7 shall be 
subject to the following sanctions3     
7,i7 ,in the case of the first cost     
reporting period for which such         
qualified nonhospital provider submits  
such a cost report1 a civil monetary    
penalty equal to #be percent of the     
payment amount requested pursuant to    
such cost report for direct costs of    
medical education incurred with respect 
to such residents4  7,,ii7 ,in the case 
of the second cost reporting period for 
which such qualified nonhospital        
provider submits such a cost report1 a  
civil monetary penalty equal to         
#a1jjj1jjj4  7,,iii7 ,in the case of the
 third cost reporting period for which  
such qualified nonhospital provider     
submits such a cost report1 such        
qualified nonhospital provider shall be 
excluded from receiving payments under  
this subsection for a period of #e      
years4  7,,iv7 ,in the case of each     
subsequent cost reporting period for    
which such qualified nonhospital        

provider submits such a cost report1    
such qualified nonhospital provider     
shall be excluded from receiving        
payments under this subsection for a    
period of #aj years4  7ii7 ,procedures  
7,i7 ,civil monetary penalties ,the     
provisions of section #aabh;,a 7other   
than subsection 7a7 and 7b7 of such     
section7 shall apply to civil monetary  
penalties under this subparagraph in the
 same manner as such provisions apply to
 a penalty or proceeding under          
subsection 7a7 of such section4  7,,ii7 
,exclusion from payments ,the provisions
 of subsections 7c77#a7 and 7f7 of      
section #aabh shall apply to an         
exclusion from receiving payments under 
this subparagraph in the same manner as 
such provisions apply to exclusions from
 participation under such section4  4