,,ii #aaith ,,congress #ast ,session ,s4 #bdci ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,july #bd1 #bjbe ,mr4 ,boozman 7for himself1 ,mr4 ,warnock1 ,ms4 ,collins1 ,mr4 ,schumer1 ,mrs4 ,gillibrand1 ,ms4 ,rosen1 ,ms4 ,klobuchar1 ,mr4 ,king1 ,mr4 ,gallego1 ,mr4 ,welch1 ,ms4 ,slotkin1 and ,mr4 ,durbin7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,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 #bjbe4 #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 and 7#aj7 and inserting 7#aj71 and 7#aa72 7#b7 in paragraph 7#d77;,h77i71 by striking and 7#aj7 and inserting 7#aj71 and 7#aa72 7#c7 in paragraph 7#g77;,e71 by inserting paragraph 7#aa71 after paragraph 7#aj712 and 7#d7 by adding at the end the following new paragraph3 7#aa7 ,distribution of additional residency positions 7,a7 ,additional residency positions 7i7 ,in general ,for each of fiscal years #bjbg through #bjcc 7and succeeding fiscal years if the ,secretary determines that there are additional residency positions available to distribute under clause 7iii77,,ii771 the ,secretary shall increase the otherwise applicable resident limit for each qualifying hospital 7as defined in subparagraph 7,g77 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 ,except as provided in clause 7iii71 the aggregate number of increases in the otherwise applicable resident limit under this subparagraph shall be equal to #b1jjj in each of fiscal years #bjbg through #bjcc4 7ii7 ,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 #bjbg through #bjcc4 7,,ii7 ,number available ,in each of such rounds1 the aggregate number of positions available for distribution in the fiscal year as a result of an increase in the otherwise applicable resident limit 7as described in clause 7i77 shall be distributed1 plus any additional positions available under clause 7iii74 7,,iii7 ,timing ,the ,secretary shall notify hospitals of the number of positions distributed to the hospital under this paragraph as result of an increase in the otherwise applicable resident limit by ,january #ca 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 7iii7 ,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 7i71 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 #bjcc ,if the aggregate number of positions distributed under this paragraph during the #g-year period of fiscal years #bjbg through #bjcc is less than #ad1jjj1 the ,secretary shall1 in accordance with the considerations described in subparagraph 7,b77i7 and the priority described in subparagraph 7,b77ii71 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 ,distribution to certain hospitals 7i7 ,consideration in distribution ,in determining for which hospitals the increase in the otherwise applicable resident limit 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-- 7aa7 are located in a rural area 7as defined in section #ahhf7;d77#b77;,d771 excluding hospitals that are treated as being located in a rural area pursuant to section #ahhf7;d77#h77;,e72 7bb7 are located in an area that has a rural-urban commuting code equal to or great than #d4j2 7cc7 are sole community hospitals 7as defined in section #ahff7;d77#e77;,d77iii772 7dd7 are located within #aj miles of a sole community hospital2 or 7ee7 for fiscal years after fiscal year #bjca1 have an accredited rural training track 7as described in paragraph 7#d77;,h77iv774 7,,ii7 ,hospitals in which the reference resident level of the hospital 7as specified in subparagraph 7,g77iv77 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 7iii7 ,special rules 7,i7 ,in general ,in distributing positions under clause 7ii71 the ,secretary shall not prioritize hospitals in multiple categories over hospitals in an individual category or based on section #ccb of the ,public ,health ,service ,act4 7,,ii7 ,prioritization in distribution to ,,hpsa hospitals ,in distributing positions to a hospital described in clause 7ii77,,iv71 the ,secretary shall give priority to hospitals that are affiliated with-- 7aa7 a historically ,black medical school 7as defined in subparagraph 7,g772 or 7bb7 any other school listed in section #cbf7;e77#a7 of the ,higher ,education ,act of #aife that establishes a medical college4 7,c7 ,prohibition on distribution to hospitals without an increase agreement ,no increase in the otherwise applicable resident limit of a hospital may be made under this paragraph 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 this paragraph4 7,d7 ,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 paragraphs 7#i7 and 7#aj7 over the period of fiscal years #bjbg through #bjcc4 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,e7 ,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,f7 ,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,g7 ,definitions ,in this paragraph3 7i7 ,historically black medical school ,the term historically ,black medical school means ,howard ,university ,college of ,medicine1 ,charles ,r4 ,drew ,university of ,medicine and ,science1 ,meharry ,medical ,college1 ,morehouse ,school of ,medicine1 ,xavier ,university ,graduate ,school of ,health ,sciences and ,medical ,school1 and ,maryland ,college of ,osteopathic ,medicine at ,morgan ,state ,university4 7ii7 ,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 7#h77;,b71 7#i77;,a71 7#i77;,b71 7#aj77;,a71 and 7#aj77;,b74 7iii7 ,qualifying hospital ,the term qualifying hospital means a hospital described in any of subclauses 7,i7 through 7,,iv7 of subparagraph 7,b77ii74 7iv7 ,reference resident level ,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 7v7 ,resident level ,the term resident level has the meaning given such term in paragraph 7#g77;,c77i74 4 7b7 ,,ime 7#a7 ,in general ,section #ahhf7;d77#e77;,b77v7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,b77v771 in the third sentence1 is amended by striking and 7h77#aj7 and inserting 7h77#aj71 and 7h77#aa74 7#b7 ,conforming provision ,section #ahhf7;d77#e77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,b77 is amended by adding at the end the following new clause3 7xiv7 ,for discharges occurring on or after ,july #a1 #bjbg insofar as an additional payment amount under this subparagraph is attributable to resident positions distributed to a hospital under subsection 7h77#aa71 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 the 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