Graduate Opportunities in Medical Education Distribution Act of 2016
This bill amends title XVIII (Medicare) of the Social Security Act to redistribute unused residency positions for which graduate medical education costs are paid under Medicare. Specifically, the Centers for Medicare & Medicaid Services must: (1) reduce a hospital's resident limit by a specified amount if the hospital has unused residency positions and is not a rural hospital with fewer than 250 acute care inpatient beds, and (2) increase the resident limit for each qualifying hospital that applies for an increase. In aggregate, the number of increased positions shall equal the number of reduced positions. The bill establishes specified priorities and capacity considerations with respect to redistribution.
[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6039 Introduced in House (IH)]
<DOC>
114th CONGRESS
2d Session
H. R. 6039
To amend title XVIII of the Social Security Act to redistribute unused
residency positions to hospitals in States with shortages of residents
and health professionals, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 15, 2016
Mr. Hardy 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 redistribute unused
residency positions to hospitals in States with shortages of residents
and health professionals, 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 ``Graduate Opportunities in Medical
Education Distribution Act of 2016''.
SEC. 2. REDISTRIBUTING UNUSED RESIDENCY POSITIONS TO HOSPITALS IN
STATES WITH SHORTAGES OF RESIDENTS AND HEALTH
PROFESSIONALS.
(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 ``(7) and (8)'' and
inserting ``(7), (8), and (9)'';
(2) in paragraph (4)(H)(i), by striking ``(7) and (8)'' and
inserting ``(7), (8), and (9)'';
(3) in paragraph (7)(E), by striking ``paragraph (8)'' and
inserting ``paragraph (8) or (9)'' before the period at the
end; and
(4) by adding at the end the following new paragraph:
``(9) Distribution of additional residency positions.--
``(A) Reductions in limit based on unused
positions.--
``(i) Making of determinations.--Not later
than 180 days after the date of the enactment
of this paragraph and each four years
thereafter, the Secretary shall make a set of
reduction determinations (as defined in clause
(ii)).
``(ii) Set of reduction determinations
defined.--For purposes of this paragraph, the
term `set of reduction determinations' means
determinations with respect to each hospital of
whether, with respect to the one-year period
ending on the date of such set of reduction
determinations (referred to in this paragraph
as the `measurement period' for such set of
reduction determinations), the hospital's
reference resident level (as defined in
subparagraph (F)(i)) for such period was less
than the otherwise applicable resident limit
(as defined in subparagraph (F)(iii)) for such
hospital and period.
``(iii) Reduction based on determination.--
In the case that, with respect to the
measurement period for a set of reduction
determinations, the Secretary determines under
this subparagraph that the reference resident
level of a hospital for such period was less
than the otherwise applicable resident limit
for such hospital and period, effective for
portions of cost reporting periods occurring
after the date of such set of reduction
determinations and on or before the date of any
subsequent set of reduction determinations
under clause (i) (referred to in this paragraph
as the `consequence period' for such set of
reduction determinations), the otherwise
applicable resident limit for such hospital
shall be reduced by 65 percent of the
difference between such otherwise applicable
resident limit for the hospital and measurement
period and such reference resident level for
the hospital and measurement period (or, in the
case that the Secretary determines that, with
respect to the consequence period immediately
preceding such consequence period, the hospital
was a hospital described in clause (ii) of
subparagraph (B) that did not meet the
requirements of such clause, by the number
described in clause (iv)).
``(iv) Number described.--The number
described in this clause, with respect to a
hospital and consequence period (referred to in
this clause as the `target consequence
period'), is the greater of--
``(I) the number by which the
otherwise applicable resident limit for
such hospital would be reduced for the
target consequence period under clause
(iii) without the application of this
clause; and
``(II) the number by which the
otherwise applicable resident limit for
such hospital was increased for the
consequence period that immediately
preceded the target consequence period.
``(v) Exception.--This subparagraph shall
not apply to a hospital located in a rural area
(as defined in subsection (d)(2)(D)(ii)) with
fewer than 250 acute care inpatient beds.
``(vi) Determination timing.--In the case
of a reduction determination made in a year by
the Secretary under clause (i) that is not the
first such reduction determination so made, the
Secretary shall make such determination on a
date that is not later than March 31 of such
year.
``(B) Distribution.--
``(i) In general.--With respect to each set
of reduction determinations under subparagraph
(A)(i), the Secretary shall, in accordance with
the succeeding provisions of this paragraph,
increase the otherwise applicable resident
limit for each qualifying hospital that submits
an application under this subparagraph by such
number as the Secretary may approve for
portions of cost reporting periods occurring
during the consequence period for such set of
reduction determinations. The aggregate number
of increases in the otherwise applicable
resident limit under this subparagraph for such
consequence period shall be equal to the
aggregate reduction in such limits attributable
to subparagraph (A) (as estimated by the
Secretary) for such consequence period.
``(ii) Requirements.--A hospital that
receives an increase in the otherwise
applicable resident limit under this
subparagraph for a consequence period shall
ensure that, during such consequence period,
the positions resulting from the increase under
this paragraph will be filled. The Secretary
may determine whether a hospital has met the
requirements under this clause during such
consequence period in such manner and at such
time as the Secretary determines appropriate,
including at the end of such period.
``(C) Capacity considerations in redistribution.--
In determining which hospitals are to receive increases
in their otherwise applicable resident limits under
subparagraph (B) for a consequence period for a set of
reduction determinations, the Secretary shall take into
account the demonstrated likelihood of each such
hospital filling the positions made available under
this paragraph within such consequence period, as
determined by the Secretary.
``(D) Priority in redistribution.--Subject to
subparagraph (C), the Secretary shall select, with
respect to a set of reduction determinations under
subparagraph (A)(i), the qualifying hospitals that will
receive increases under subparagraph (B) in the
otherwise applicable resident limits for such hospitals
for the consequence period for such set of reduction
determinations. The Secretary shall make such selection
in a manner that distributes the positions made
available to hospitals for such consequence period
under this paragraph in accordance with the following:
``(i) The Secretary shall, with respect to
such positions that are so made available for
such consequence period, make--
``(I) 70 percent of such positions
available to hospitals located in low
resident-to-population States (as
defined in subparagraph (F)(iv)); and
``(II) 30 percent of such positions
available to hospitals located in high
HPSA-to-population States (as defined
in subparagraph (F)(v)).
``(ii) The Secretary shall, in accordance
with clause (i), make such positions available
for such consequence period in a manner that
prioritizes the distribution of such positions
to hospitals that are anticipated to fill such
positions with individuals from residence
programs located in the State in which such
hospitals are located.
``(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) Definitions.--In this paragraph:
``(i) Reference resident level.--The term
`reference resident level' means, with respect
to a hospital and measurement period, the
resident level for the cost reporting periods
of the hospital occurring during such
measurement period and for which a cost report
has been settled (or, if not, submitted
(subject to audit)), as determined by the
Secretary.
``(ii) Resident level.--The term `resident
level' has the meaning given such term in
paragraph (7)(C)(i).
``(iii) Otherwise applicable resident
limit.--The term `otherwise applicable resident
limit' means, with respect to a hospital and
period, the limit otherwise applicable under
subparagraphs (F)(i) and (H) of paragraph (4)
on the resident level of the hospital for such
period, determined without regard to this
paragraph but taking into account paragraph
(7)(A).
``(iv) Low resident-to-population states.--
``(I) In general.--The term `low
resident-to-population State' means a
State that has a smaller applicable
number than do at least 75 percent of
all States.
``(II) Applicable number.--For
purposes of subclause (I), the term
`applicable number' means, with respect
to a State, the number that results
from dividing the number of residents
in the State by the number of
individuals residing in the State.
``(v) High hpsa-to-population states.--
``(I) In general.--The term `high
HPSA-to-population State' means a State
that has a larger applicable number
than do at least 90 percent of all
States.
``(II) Applicable number.--For
purposes of subclause (I), the term
`applicable number' means, with respect
to a State, the number that results
from dividing the number of areas in
the State designated by the Health
Resources & Services Administration of
the Department of Health and Human
Services as Health Professional
Shortage Areas by the number of
individuals residing in the State.
``(G) Affiliation.--The provisions of this
paragraph shall be applied to hospitals which are
members of the same affiliated group (as defined by the
Secretary under paragraph (4)(H)(ii)).''.
(b) IME.--
(1) In general.--Section 1886(d)(5)(B)(v) of the Social
Security Act (42 U.S.C. 1395ww(d)(5)(B)(v)), in the second
sentence, is amended by striking ``subsections (h)(7) and
(h)(8)'' and inserting ``subsections (h)(7), (h)(8), and
(h)(9)''.
(2) Conforming amendment.--Section 1886(d)(5)(B) of the
Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) is amended by
adding at the end the following clause:
``(xii) For discharges occurring on or
after the date that is 180 days after the date
of the enactment of this clause, insofar as an
additional payment amount under this
subparagraph is attributable to resident
positions distributed to a hospital under
subsection (h)(9)(B), the indirect teaching
adjustment factor shall be computed in the same
manner as provided under clause (ii) with
respect to such resident positions.''.
(c) Conforming Amendment.--Section 422(b)(2) of the Medicare
Prescription Drug, Improvement, and Modernization Act of 2003 (Public
Law 108-173), as amended by section 5503 of the Patient Protection and
Affordable Care Act (Public Law 111-148), is amended by striking
``paragraphs (7) and (8)'' and inserting ``paragraphs (7), (8), and
(9).''.
<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 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.
Sponsor introductory remarks on measure. (CR H5504)
Referred to the Subcommittee on Health.
Llama 3.2 · runs locally in your browser
Ask anything about this bill. The AI reads the full text to answer.
Enter to send · Shift+Enter for new line