,i  #aai? ,,congress  #b;d ,session  ,h4
 ,r4 #hidc  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,may #bj1 #bjbf,mr4   
,/eube introduc$ ! foll[+ bill2 :i* 0   
ref]r$ to ! ,committee on ,ways &       
,means1 & 9 addition to ! ,committee on 
,en]gy & ,comm]ce1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
prohibit paym5ts = graduate m$ical      
education co/s attributable to          
individuals :o are n citiz5s or         
nationals ( ! ,unit$ ,/ates "u ! ,m$ic>e
 program4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,our ,doctors ,fir/ ,act ( 
#bjbf4  #b4 ,prohibit+ ,f$]ally-fund$   
graduate m$ical education = non-citiz5s 
"u ,m$ic>e  7a7 ,hospital paym5ts =     
direct graduate m$ical education co/s   
,section #ahhf7;h7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acieww7h77 is     
am5d$--  7#a7 9 p>agraph 7#a71 by ins]t+

 1 subject to p>agraph 7#aa7 aft] ( ?is 
subsection2  7#b7 9 p>agraph 7#d71 by   
add+ at ! end ! foll[+ new subp>agraph3 
7,l7 ,non-citiz5 resid5ts ,su* rules    
%all provide t1 effective = co/ report+ 
p]iods beg9n+ on or aft] ! date t is #a 
ye> aft] ! date ( ! enactm5t ( ?is      
subp>agraph1 an individual %all n be    
c\nt$ z a resid5t unless su* individual 
is a citiz5 or national ( ! ,unit$      
,/ates4  2 &  7#c7 by add+ at ! end !   
foll[+ new p>agraph3  7#aa7 ,sanctions =
 c\nt+ non-citiz5 resid5ts  7,a7 ,9     
g5]al ,effective = co/ report+ p]iods   
beg9n+ on or aft] ! date t is #a ye>    
aft] ! date ( ! enactm5t ( ?is p>agraph1
 a hospital t submits a co/ report c\nt+
 #a or m individuals :o su* hospital    
kn[s or %\ld "k are n citiz5s or        
nationals ( ! ,unit$ ,/ates z int]ns or 
resid5ts = purposes ( paym5t "u ?is     
subsection 9 violation ( p>agraph       
7#d77,l7 or paym5t "u p>agraphs         
7#e77;,b7 & 7#aa7 ( subsection 7d7 9    
violation ( subsection 7d77#e77;,b77xiv7

 %all be subject to ! foll[+ sanctions3 
7i7 ,9 ! case ( ! fir/ co/ report+ p]iod
 = :i* su* hospital submits su* a co/   
report1 a civil monet>y p5alty equal to 
#be p]c5t ( ! paym5t am\nt t w\ld be    
attributable to ! individuals s c\nt$   
pursuant to su* co/ report if su*       
individuals 7 p]mitt$ to be s c\nt$ "u  
?is subsection & subsection             
7d77#e77;,b74  7ii7 ,9 ! case ( ! second
 co/ report+ p]iod = :i* su* hospital   
submits su* a co/ report1 a civil       
monet>y p5alty equal to #a1jjj1jjj4     
7iii7 ,9 ! case ( ! ?ird co/ report+    
p]iod = :i* su* hospital submits su* a  
co/ report1 su* hospital %all be exclud$
 f receiv+ paym5ts "u ?is subsection &  
p>agraphs 7#e77;,b7 & 7#aa7 ( subsection
 7d7 = a p]iod ( #e ye>s4  7iv7 ,9 !    
case ( ea* subsequ5t co/ report+ p]iod =
 :i* su* hospital submits su* a co/     
report1 su* hospital %all be exclud$ f  
receiv+ paym5ts "u ?is subsection &     
p>agraphs 7#e77;,b7 & 7#aa7 ( subsection
 7d7 = a p]iod ( #aj ye>s4  7,b7        

,proc$ures  7i7 ,civil monet>y p5alties 
,! provisions ( section #aabh;,a 7o!r   
?an subsection 7a7 & 7b7 ( su* section7 
%all apply to civil monet>y p5alties "u 
?is p>agraph 9 ! same mann] z su*       
provisions apply to a p5alty or proce$+ 
"u subsection 7a7 ( su* section4  7ii7  
,exclusion f paym5ts ,! provisions (    
subsections 7c77#a7 & 7f7 ( section     
#aabh %all apply to an exclusion f      
receiv+ paym5ts "u ?is p>agraph 9 ! same
 mann] z su* provisions apply to        
exclusions f p>ticipation "u su*        
section4  4  7b7 ,hospital paym5ts =    
indirect co/s ( m$ical education        
,section #ahhf7;d7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acieww7d77--  7#a7
 9 p>agraph 7#e77;,b7-- 7,a7 by /rik+ ,!
 ,secret>y & ins]t+ ,subject to         
subsection 7h77#aa71 ! ,secret>y2 &     
7,b7 by add+ at ! end ! foll[+ new      
clause3  7xiv7 ,= dis*>ges occurr+ on or
 aft] ! fir/ ,july #a occurr+ on or aft]
 ! date t is #a ye> aft] ! date ( !     
enactm5t ( ?is clause1 an individual    

%all n be c\nt$ z an int]n or a resid5t 
"u ?is subp>agraph unless su* individual
 is a citiz5 or national ( ! ,unit$     
,/ates4  2 &  7#b7 9 p>agraph           
7#aa77;,a71 by ins]t+ subject to        
subsection 7h77#aa71 be=e ! ,secret>y4  
7c7 ,nonhospital provid] paym5ts =      
direct co/s ( m$ical education ,section 
#ahhf7k7 ( ! ,social ,security ,act 7#db
 ,u4,s4,c4 #acieww7k77 is am5d$ by add+ 
at ! end ! foll[+ new p>agraph3  7#c7   
,non-citiz5 resid5ts  7,a7 ,9 g5]al     
,effective = co/ report+ p]iods beg9n+  
on or aft] ! date t is #a ye> aft] !    
date ( ! enactm5t ( ?is p>agraph1 paym5t
 may n be made "u ?is subsection =      
direct co/s ( m$ical education incurr$ )
 respect to resid5ts :o are n citiz5s or
 nationals ( ! ,unit$ ,/ates4  7,b7     
,p5alties  7i7 ,9 g5]al ,effective = co/
 report+ p]iods beg9n+ on or aft] ! date
 t is #a ye> aft] ! date ( ! enactm5t ( 
?is p>agraph1 a qualifi$ nonhospital    
provid] t submits a co/ report reque/+  
paym5t "u ?is subsection = direct co/s (

 m$ical education incurr$ ) respect to  
#a or m resid5ts :o su* qualifi$        
nonhospital provid] kn[s or %\ld "k are 
n citiz5s or nationals ( ! ,unit$ ,/ates
 9 violation ( subp>agraph 7,a7 %all be 
subject to ! foll[+ sanctions3  7,i7 ,9 
! case ( ! fir/ co/ report+ p]iod = :i* 
su* qualifi$ nonhospital provid] submits
 su* a co/ report1 a civil monet>y      
p5alty equal to #be p]c5t ( ! paym5t    
am\nt reque/$ pursuant to su* co/ report
 = direct co/s ( m$ical education       
incurr$ ) respect to su* resid5ts4      
7,,ii7 ,9 ! case ( ! second co/ report+ 
p]iod = :i* su* qualifi$ nonhospital    
provid] submits su* a co/ report1 a     
civil monet>y p5alty equal to           
#a1jjj1jjj4  7,,iii7 ,9 ! case ( ! ?ird 
co/ report+ p]iod = :i* su* qualifi$    
nonhospital provid] submits su* a co/   
report1 su* qualifi$ nonhospital provid]
 %all be exclud$ f receiv+ paym5ts "u   
?is subsection = a p]iod ( #e ye>s4     
7,,iv7 ,9 ! case ( ea* subsequ5t co/    
report+ p]iod = :i* su* qualifi$        

nonhospital provid] submits su* a co/   
report1 su* qualifi$ nonhospital provid]
 %all be exclud$ f receiv+ paym5ts "u   
?is subsection = a p]iod ( #aj ye>s4    
7ii7 ,proc$ures  7,i7 ,civil monet>y    
p5alties ,! provisions ( section        
#aabh;,a 7o!r ?an subsection 7a7 & 7b7 (
 su* section7 %all apply to civil       
monet>y p5alties "u ?is subp>agraph 9 ! 
same mann] z su* provisions apply to a  
p5alty or proce$+ "u subsection 7a7 (   
su* section4  7,,ii7 ,exclusion f       
paym5ts ,! provisions ( subsections     
7c77#a7 & 7f7 ( section #aabh %all apply
 to an exclusion f receiv+ paym5ts "u   
?is subp>agraph 9 ! same mann] z su*    
provisions apply to exclusions f        
p>ticipation "u su* section4  4