Resident Physician Shortage Reduction and Graduate Medical Education Accountability and Transparency Act - Amends title XVIII (Medicare) of the Social Security Act with respect to distribution of additional resident positions as they affect calculation of payments for direct graduate medical education (DME) costs.
Directs the Secretary of Health and Human Services (HHS), for each of FY2013-FY2017 (and each succeeding fiscal year if additional residency positions are available to distribute), to increase the otherwise applicable resident limit for each qualifying hospital.
Directs the Secretary to determine the total number of additional residency positions available for distribution, in accordance with guidelines for allocating 33% to hospitals already operating over the resident limit, and generally setting the aggregate number of increases in the resident limit to 3,000 in each year.
Specifies the process for distributing positions.
Directs the Secretary to establish and implement procedures under which the amount of payments that a hospital would otherwise receive for indirect medical education (IME) costs for discharges occurring during a fiscal year is adjusted based on the reporting of measures and the performance of the hospital on measures of patient care priorities specified by the Secretary.
Directs the Secretary to report to Congress and the National Health Care Workforce Commission on the graduate medical education (GME) payments, including both direct GME payments and IME payments, that hospitals receive under the Medicare program.
Directs the Comptroller General to study: (1) the physician workforce, and (2) strategies for increasing the diversity of the health profession workforce.
[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6352 Introduced in House (IH)]
112th CONGRESS
2d Session
H. R. 6352
To amend title XVIII of the Social Security Act to provide for the
distribution of additional residency positions, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
August 2, 2012
Mr. Schock (for himself and Ms. Schwartz) introduced the following
bill; which was referred to the Committee on Ways and Means, and in
addition to the Committee on Energy and Commerce, for a period to be
subsequently determined by the Speaker, 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 provide for the
distribution of additional residency positions, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Resident Physician Shortage
Reduction and Graduate Medical Education Accountability and
Transparency Act''.
SEC. 2. DISTRIBUTION OF ADDITIONAL RESIDENCY POSITIONS.
(a) In General.--Section 1886(h) of the Social Security Act (42
U.S.C. 1395ww(h)) is amended--
(1) in paragraph (4)(F)(i), by striking ``paragraphs (7)
and (8)'' and inserting ``paragraphs (7), (8), and (9)'';
(2) in paragraph (4)(H)(i), by striking ``paragraphs (7)
and (8)'' and inserting ``paragraphs (7), (8), and (9)'';
(3) in paragraph (7)(E), by inserting ``paragraph (9),''
after ``paragraph (8),''; and
(4) by adding at the end the following new paragraph:
``(9) Distribution of additional residency positions.--
``(A) Additional residency positions.--
``(i) In general.--For each of fiscal years
2013 through 2017 (and succeeding fiscal years
if the Secretary determines that there are
additional residency positions available to
distribute under clause (iv)(II)), the
Secretary shall, subject to clause (ii) and
subparagraph (D), increase the otherwise
applicable resident limit for each qualifying
hospital 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 1
of the fiscal year of the increase.
``(ii) Number available for distribution.--
For each such fiscal year, the Secretary shall
determine the total number of additional
residency positions available for distribution
under clause (i) in accordance with the
following:
``(I) Allocation to hospitals
already operating over resident
limit.--One-third of such number shall
be available for distribution only to
hospitals described in subparagraph
(B).
``(II) Aggregate limitation.--
Except as provided in clause (iv)(I),
the aggregate number of increases in
the otherwise applicable resident limit
under this subparagraph shall be equal
to 3,000 in each such year.
``(iii) Process for distributing
positions.--
``(I) Rounds of applications.--The
Secretary shall initiate 5 separate
rounds of applications for an increase
under clause (i), 1 round with respect
to each of fiscal years 2013 through
2017.
``(II) Number available.--In each
of such rounds, the aggregate number of
positions available for distribution in
the fiscal year under clause (ii) shall
be distributed, plus any additional
positions available under clause (iv).
``(III) Timing.--The Secretary
shall notify hospitals of the number of
positions distributed to the hospital
under this paragraph as a result of an
increase in the otherwise applicable
resident limit by January 1 of the
fiscal year of the increase. Such
increase shall be effective for
portions of cost reporting periods
beginning on or after July 1 of that
fiscal year.
``(iv) Positions not distributed during the
fiscal year.--
``(I) 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 (as
described in clause (ii), including
after application of this subclause),
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 year.
``(II) Exception if positions not
distributed by end of fiscal year
2017.--If the aggregate number of
positions distributed under this
paragraph during the 5-year period of
fiscal years 2013 through 2017 is less
than 15,000, the Secretary shall, in
accordance with the provisions of
clause (ii) and subparagraph (D) and
the considerations and priority
described in subparagraph (C), 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 15,000.
``(B) Allocation of distribution for positions to
hospitals already operating over resident limit.--
``(i) In general.--Subject to clauses (ii)
and (iii), in the case of a hospital in which
the reference resident level of the hospital
(as specified in subparagraph (G)(iii)) is
greater than the otherwise applicable resident
limit, the increase in the otherwise applicable
resident limit under subparagraph (A) for a
fiscal year described in such subparagraph
shall be an amount equal to the product of the
total number of additional residency positions
available for distribution under subparagraph
(A)(ii)(I) for such fiscal year and the
quotient of--
``(I) the number of resident
positions by which the reference
resident level of the hospital exceeds
the otherwise applicable resident limit
for the hospital; and
``(II) the number of resident
positions by which the reference
resident level of all such hospitals
with respect to which an application is
approved under this paragraph exceeds
the otherwise applicable resident limit
for such hospitals.
``(ii) Requirements.--A hospital described
in clause (i)--
``(I) is not eligible for an
increase in the otherwise applicable
resident limit under this subparagraph
unless the amount by which the
reference resident level of the
hospital exceeds the otherwise
applicable resident limit is not less
than 10 and the hospital trains at
least 25 percent of the full-time
equivalent residents of the hospital in
primary care and general surgery (as of
the date of enactment of this
paragraph); and
``(II) shall continue to train at
least 25 percent of the full-time
equivalent residents of the hospital in
primary care and general surgery for
the 5-year period beginning on such
date.
In the case where the Secretary determines that
a hospital described in clause (i) no longer
meets the requirement of subclause (II), the
Secretary may reduce the otherwise applicable
resident limit of the hospital by the amount by
which such limit was increased under this
subparagraph.
``(iii) Clarification regarding eligibility
for other additional residency positions.--
Nothing in this subparagraph shall be construed
as preventing a hospital described in clause
(i) from applying for and receiving additional
residency positions under this paragraph that
are not reserved for distribution under this
subparagraph.
``(C) Distribution of other positions.--For
purposes of determining an increase in the otherwise
applicable resident limit under subparagraph (A) (other
than such an increase described in subparagraph (B)),
the following shall apply:
``(i) Considerations in distribution.--In
determining for which hospitals such an
increase is provided under subparagraph (A),
the Secretary shall take into account the
demonstrated likelihood of the hospital filling
the positions made available under this
paragraph within the first 5 cost reporting
periods beginning after the date the increase
would be effective, as determined by the
Secretary.
``(ii) Priority for certain hospitals.--
Subject to clause (iii), in determining for
which hospitals such an increase is provided,
the Secretary shall distribute the increase in
the following priority order:
``(I) First, to hospitals in States
with (aa) 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 1, 2000, and that have
achieved or continue to progress toward
`Full Accreditation' status (as such
term is defined by the Liaison
Committee on Medical Education) or
toward `Accreditation' status (as such
term is defined by the American
Osteopathic Association Commission on
Osteopathic College Accreditation), or
(bb) additional locations and branch
campuses established on or after
January 1, 2000, by medical schools
with `Full Accreditation' status (as
such term is defined by the Liaison
Committee on Medical Education) or
`Accreditation' status (as such term is
defined by the American Osteopathic
Association Commission on Osteopathic
College Accreditation).
``(II) Second, to hospitals that
emphasize training in community health
center or community-based settings or
in hospital outpatient departments.
``(III) Third, to hospitals that
are eligible for incentive payments
under section 1886(n) or 1903(t) as of
the date the hospital submits an
application for such increase under
subparagraph (A).
``(IV) Fourth, to all other
hospitals.
``(iii) Distribution to hospitals in higher
priority group prior to distribution in lower
priority groups.--The Secretary may only
distribute such an increase to a lower priority
group under clause (ii) if all qualifying
hospitals in the higher priority group or
groups have received the maximum number of
increases under such subparagraph that the
hospital is eligible for under this paragraph
for the fiscal year.
``(iv) Requirements for use of additional
positions.--
``(I) In general.--Subject to
subclause (II), a hospital that
receives such an increase shall ensure,
during the 5-year period beginning on
the effective date of such increase,
that--
``(aa) not less than 50
percent of the positions
attributable to such increase
that are used in a given year
during such 5-year period are
used to train full-time
equivalent residents in a
shortage specialty residency
program (as defined in
subparagraph (G)(v)), as
determined by the Secretary at
the end of such 5-year period;
``(bb) the total number of
full-time equivalent residents,
excluding any additional
positions attributable to such
increase, is not less than the
average number of full-time
equivalent residents during the
3 most recent cost reporting
periods ending on or before the
effective date of such
increase; and
``(cc) the ratio of full-
time equivalent residents in a
shortage specialty residency
program (as so defined) is not
less than the average ratio of
full-time equivalent residents
in such a program during the 3
most recent cost reporting
periods ending on or before the
effective date of such
increase.
``(II) Redistribution of positions
if hospital no longer meets certain
requirements.--With respect to each
fiscal year described in subparagraph
(A), the Secretary shall determine
whether or not a hospital described in
subclause (I) meets the requirements of
such subclause. In the case that the
Secretary determines that such a
hospital does not meet such
requirements, the Secretary shall--
``(aa) reduce the otherwise
applicable resident limit of
the hospital by the amount by
which such limit was increased
under this paragraph; and
``(bb) provide for the
distribution of positions
attributable to such reduction
in accordance with the
requirements of this paragraph.
``(D) Limitation.--A hospital may not receive more
than 75 full-time equivalent additional residency
positions under this paragraph for any fiscal year.
``(E) 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
paragraph, 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 (2)(D) for that hospital.
``(F) Permitting facilities to apply aggregation
rules.--The Secretary shall permit hospitals receiving
additional residency positions attributable to the
increase provided under this paragraph to, beginning in
the fifth year after the effective date of such
increase, apply such positions to the limitation amount
under paragraph (4)(F) that may be aggregated pursuant
to paragraph (4)(H) among members of the same
affiliated group.
``(G) Definitions.--In this paragraph:
``(i) Otherwise applicable resident
limit.--The term `otherwise applicable resident
limit' means, with respect to a hospital, the
limit otherwise applicable under subparagraphs
(F)(i) and (H) of paragraph (4) on the resident
level for the hospital determined without
regard to this paragraph but taking into
account paragraphs (7)(A), (7)(B), (8)(A), and
(8)(B).
``(ii) Primary care.--The term `primary
care' means family medicine, general internal
medicine, general pediatrics, preventive
medicine, obstetrics and gynecology, general
surgery, and psychiatry.
``(iii) Reference resident level.--Except
as otherwise provided in subclause (II), the
term `reference resident level' means, with
respect to a hospital, the resident level for
the most recent cost reporting period of the
hospital ending on or before the date of
enactment of this paragraph, for which a cost
report has been settled (or, if not, submitted
(subject to audit)), as determined by the
Secretary.
``(iv) Resident level.--The term `resident
level' has the meaning given such term in
paragraph (7)(C)(i).
``(v) Shortage specialty residency
program.--The term `shortage specialty
residency program' means the following:
``(I) Prior to report on shortage
specialties.--Prior to the date on
which the report is submitted under
section 5 of the Resident Physician
Shortage Reduction and Graduate Medical
Education Accountability and
Transparency Act, any approved
residency training program in a
specialty identified in the report
entitled `The Physician Workforce:
Projections and Research into Current
Issues Affecting Supply and Demand',
issued in December 2008 by the Health
Resources and Services Administration,
as a specialty whose baseline physician
requirements projections exceed the
projected supply of total active
physicians for the period of 2005
through 2020.
``(II) After report on shortage
specialities.--On or after the date on
which the report is submitted under
such section 5, any approved residency
training program in a physician
specialty identified in such report as
a specialty for which there is a
shortage.''.
(b) IME.--Section 1886(d)(5)(B) of the Social Security Act (42
U.S.C. 1395ww(d)(5)(B)) is amended--
(1) in clause (v), in the second sentence, by striking
``subsections (h)(7) and (h)(8)'' and inserting ``subsections
(h)(7), (h)(8), and (h)(9)'';
(2) by redesignating clause (x), as added by section
5505(b) of the Patient Protection and Affordable Care Act
(Public Law 111-148), as clause (xi) and moving such clause 4
ems to the left; and
(3) by adding after clause (xi), as redesignated by
subparagraph (A), the following new clause:
``(xii) For discharges occurring on or after July 1, 2013,
insofar as an additional payment amount under this subparagraph
is attributable to resident positions distributed to a hospital
under subsection (h)(9), the indirect teaching adjustment
factor shall be computed in the same manner as provided under
clause (ii) with respect to such resident positions.''.
SEC. 3. MEDICARE INDIRECT MEDICAL EDUCATION PERFORMANCE ADJUSTMENT.
Section 1886 of the Social Security Act (42 U.S.C. 1395ww) is
amended--
(1) in subsection (d)(5)(B), in the matter preceding clause
(i), by inserting ``subject to subsection (t) and'' before
``except as follows''; and
(2) by adding at the end the following new subsection:
``(t) Indirect Medical Education Performance Adjustments.--
``(1) In general.--Subject to the succeeding provisions of
this subsection, the Secretary shall establish and implement
procedures under which the amount of payments that a hospital
(as defined in paragraph (11)) would otherwise receive for
indirect medical education costs under subsection (d)(5)(B) for
discharges occurring during a fiscal year is adjusted based on
the reporting of measures and the performance of the hospital
on measures of patient care priorities specified by the
Secretary.
``(2) Adjustments to begin in fiscal year 2017.--The
adjustments shall apply to payments for discharges occurring--
``(A) with respect to the adjustments for reporting
under paragraph (8)(A), during fiscal year 2017; and
``(B) with respect to the adjustments for
performance under paragraph (8)(B), on or after October
1, 2017.
``(3) Measures.--The measures of patient care priorities
specified by the Secretary under this subsection shall include
the extent of training provided in--
``(A) the delivery of services categorized as
evaluation and management codes by the Centers for
Medicare & Medicaid Services;
``(B) a variety of settings and systems;
``(C) the coordination of patient care across
settings;
``(D) the relevant cost and value of various
diagnostic and treatment options;
``(E) interprofessional and multidisciplinary care
teams;
``(F) methods for identifying system errors and
implementing system solutions; and
``(G) the use of health information technology.
``(4) Measure development process.--
``(A) In general.--The measures of patient care
specified by the Secretary under this subsection--
``(i) shall--
``(I) be measures that have been
adopted or endorsed by an accrediting
organization (such as the Accreditation
Council for Graduate Medical Education
or American Osteopathic Association);
and
``(II) be measures that the
Secretary identifies as having used a
consensus-based process for developing
such measures; and
``(ii) may include measures that have been
submitted by teaching hospitals and medical
schools.
``(B) Proposed set of initial measures.--Not later
than July 1, 2014, the Secretary shall publish in the
Federal Register a proposed initial set of measures for
use under this subsection. The Secretary shall provide
for a period of public comment on such measures.
``(C) Final set of initial measures.--Not later
than January 1, 2015, the Secretary shall publish in
the Federal Register the set of initial measures to be
specified by the Secretary for use under this
subsection.
``(D) Update of measures.--The Secretary may,
through notice and comment rulemaking, periodically
update the measures specified under this subsection
pursuant to the requirements under subparagraph (A).
``(5) Performance standards.--The Secretary shall establish
performance standards with respect to measures specified by the
Secretary under this subsection for a performance period for a
fiscal year (as established under paragraph (6)).
``(6) Performance period.--The Secretary shall establish
the performance period for a fiscal year. Such performance
period shall begin and end prior to the beginning of such
fiscal year.
``(7) Reporting of measures.--The procedures established
and implemented under paragraph (1) shall include a process
under which hospitals shall submit data on the measures
specified by the Secretary under this subsection to the
Secretary in a form and manner, and at a time, specified by the
Secretary for purposes of this subsection.
``(8) Adjustments.--
``(A) Reporting for fiscal year 2017.--For fiscal
year 2017, in the case of a hospital that does not
submit, to the Secretary in accordance with this
subsection, data required to be submitted under
paragraph (7) for a period (determined appropriate by
the Secretary) for such fiscal year, the total amount
that the hospital would otherwise receive under
subsection (d)(5)(B) for discharges in such fiscal year
shall be reduced by 0.5 percent.
``(B) Performance for fiscal year 2018 and
subsequent fiscal years.--
``(i) In general.--Subject to clause (ii),
based on the performance of each hospital with
respect to compliance with the measures for a
performance period for a fiscal year (beginning
with fiscal year 2018), the Secretary shall
determine the amount of any adjustment under
this subparagraph to payments to the hospital
under subsection (d)(5)(B) for discharges in
such fiscal year. Such adjustment may not
exceed an amount equal to 2 percent of the
total amount that the hospital would otherwise
receive under such subsection for discharges in
such fiscal year.
``(ii) Budget neutral.--In making
adjustments under this subparagraph, the
Secretary shall ensure that the total amount of
payments made to all hospitals under subsection
(d)(5)(B) for discharges in a fiscal year is
equal to the total amount of payments that
would have been made to such hospitals under
such subsection for discharges in such fiscal
year if this subsection had not been enacted.
``(9) No effect in subsequent fiscal years.--Any adjustment
under subparagraph (A) or (B) of paragraph (8) shall apply only
with respect to the fiscal year involved, and the Secretary
shall not take into account any such adjustment in making
payments to a hospital under this section in a subsequent
fiscal year.
``(10) Evaluation of submission of performance measures.--
Not later than January 1, 2017, the Secretary shall submit to
Congress a report on the implementation of this subsection,
including--
``(A) the measure development procedures, including
any barriers to measure development;
``(B) the compliance with reporting on the
performance measures, including any barriers to such
compliance; and
``(C) recommendations to address any barriers
described in subparagraph (A) or (B).
``(11) Definition of hospital.--In this subsection, the
term `hospital' means a hospital that receives payments under
subsection (d)(5)(B).''.
SEC. 4. INCREASING GRADUATE MEDICAL EDUCATION TRANSPARENCY.
(a) In General.--Not later than 2 years after the date of the
enactment of this Act, and annually thereafter, the Secretary of Health
and Human Services shall submit to Congress and the National Health
Care Workforce Commission a report on the graduate medical education
payments that hospitals receive under the Medicare program. The report
shall include the following information with respect to each hospital
that receives such payments:
(1) The direct graduate medical education payments made to
the hospital under section 1886(h) of the Social Security Act
(42 U.S.C. 1395ww(h)).
(2) The total costs of direct graduate medical education to
the hospital as reported on the annual Medicare Cost Reports.
(3) The indirect medical education payments made to the
hospital under section 1886(d)(5)(B) of such Act (42 U.S.C.
1395ww(d)(1)(B)).
(4) The number of full-time-equivalent residents counted
for purposes of making the payments described in paragraph (1).
(5) The number of full-time-equivalent residents counted
for purposes of making the payments described in paragraph (3).
(6) The number of full-time-equivalent residents, if any,
that are not counted for purposes of making payments described
in paragraph (1).
(7) The number of full-time-equivalent residents, if any,
that are not counted for purposes of making payments described
in paragraph (3).
(8) The factors contributing to the higher costs of patient
care provided by the hospital, including--
(A) the costs of trauma, burn, other standby
services;
(B) translation services for disabled or non-
English speaking patients;
(C) the cost of uncompensated care;
(D) financial losses with respect to Medicaid
patients; and
(E) uncompensated costs of clinical research.
SEC. 5. GAO STUDY AND REPORT ON PHYSICIAN WORKFORCE.
(a) Study.--The Comptroller General of the United States shall
conduct a study on the physician workforce. Such study shall include
the identification of physician specialties for which there is a
shortage, as defined by the Comptroller General.
(b) Report.--Not later than January 1, 2014, the Comptroller
General shall submit to Congress a report on the study conducted under
subsection (a), together with recommendations for such legislation and
administrative action as the Comptroller General determines
appropriate.
SEC. 6. STUDY AND REPORT ON STRATEGIES FOR INCREASING DIVERSITY.
(a) Study.--The Comptroller General of the United States shall
conduct a study on strategies for increasing the diversity of the
health professional workforce. Such study shall include an analysis of
strategies for increasing the number of health professionals from
rural, lower income, and under-represented minority communities,
including which strategies are most effective for achieving such goal.
(b) Report.--Not later than 2 years after the date of enactment of
this Act, the Comptroller General shall submit to Congress a report on
the study conducted under subsection (a), together with recommendations
for such legislation and administrative action as the Comptroller
General determines appropriate.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
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