Resident Physician Shortage Reduction Act of 2021

II 117TH CONGRESS 1ST SESSION S. 834 To amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions, and for other purposes. IN THE SENATE OF THE UNITED STATES MARCH 18, 2021 Mr. MENENDEZ (for himself, Mr. BOOZMAN, and Mr. SCHUMER) introduced the following bill; 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 positions, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Resident Physician 4 Shortage Reduction Act of 2021’’. 5 SEC. 2. DISTRIBUTION OF ADDITIONAL RESIDENCY POSI- 6 TIONS. 7 (a) IN GENERAL.—Section 1886(h) of the Social Se- 8 curity Act (42 U.S.C. 1395ww(h)) is amended— 9 VerDate Sep 11 2014 22:59 Apr 10, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S834.IS S834 pamtmann on DSKBC07HB2PROD with BILLS 2 •S 834 IS (1) in paragraph (4)(F)(i), by striking ‘‘and 1 (9)’’ and inserting ‘‘(9), and (10)’’; 2 (2) in paragraph (4)(H)(i), by striking ‘‘and 3 (9)’’ and inserting ‘‘(9), and (10)’’; 4 (3) in paragraph (7)(E), by inserting ‘‘para- 5 graph (10),’’ after ‘‘paragraph (9),’’; and 6 (4) by adding at the end the following new 7 paragraph: 8 ‘‘(10) DISTRIBUTION OF ADDITIONAL RESI- 9 DENCY POSITIONS.— 10 ‘‘(A) ADDITIONAL RESIDENCY POSI- 11 TIONS.— 12 ‘‘(i) IN GENERAL.—For each of fiscal 13 years 2023 through 2029 (and succeeding 14 fiscal years if the Secretary determines 15 that there are additional residency posi- 16 tions available to distribute under clause 17 (iii)(II)), the Secretary shall increase the 18 otherwise applicable resident limit for each 19 qualifying hospital (as defined in subpara- 20 graph (G)) that submits a timely applica- 21 tion under this subparagraph by such 22 number as the Secretary may approve for 23 portions of cost reporting periods occurring 24 on or after July 1 of the fiscal year of the 25 VerDate Sep 11 2014 22:59 Apr 10, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S834.IS S834 pamtmann on DSKBC07HB2PROD with BILLS 3 •S 834 IS increase. Except as provided in clause (iii), 1 the aggregate number of increases in the 2 otherwise applicable resident limit under 3 this subparagraph shall be equal to 2,000 4 in each of fiscal years 2023 through 2029. 5 ‘‘(ii) PROCESS FOR DISTRIBUTING PO- 6 SITIONS.— 7 ‘‘(I) ROUNDS OF APPLICA- 8 TIONS.—The Secretary shall initiate 7 9 separate rounds of applications for an 10 increase under clause (i), 1 round 11 with respect to each of fiscal years 12 2023 through 2029. 13 ‘‘(II) NUMBER AVAILABLE.—In 14 each of such rounds, the aggregate 15 number of positions available for dis- 16 tribution in the fiscal year as a result 17 of an increase in the otherwise appli- 18 cable resident limit (as described in 19 clause (i)) shall be distributed, plus 20 any additional positions available 21 under clause (iii). 22 ‘‘(III) TIMING.—The Secretary 23 shall notify hospitals of the number of 24 positions distributed to the hospital 25 VerDate Sep 11 2014 22:59 Apr 10, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S834.IS S834 pamtmann on DSKBC07HB2PROD with BILLS 4 •S 834 IS under this paragraph as result of an 1 increase in the otherwise applicable 2 resident limit by January 31 of the 3 fiscal year of the increase. Such in- 4 crease shall be effective for portions of 5 cost reporting periods beginning on or 6 after July 1 of that fiscal year. 7 ‘‘(iii) POSITIONS NOT DISTRIBUTED 8 DURING THE FISCAL YEAR.— 9 ‘‘(I) IN GENERAL.—If the num- 10 ber of resident full-time equivalent po- 11 sitions distributed under this para- 12 graph in a fiscal year is less than the 13 aggregate number of positions avail- 14 able for distribution in the fiscal year 15 (as described in clause (i), including 16 after application of this subclause), 17 the difference between such number 18 distributed and such number available 19 for distribution shall be added to the 20 aggregate number of positions avail- 21 able for distribution in the following 22 fiscal year. 23 ‘‘(II) EXCEPTION IF POSITIONS 24 NOT DISTRIBUTED BY END OF FISCAL 25 VerDate Sep 11 2014 22:59 Apr 10, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S834.IS S834 pamtmann on DSKBC07HB2PROD with BILLS 5 •S 834 IS YEAR 2029.—If the aggregate number 1 of positions distributed under this 2 paragraph during the 7-year period of 3 fiscal years 2023 through 2029 is less 4 than 14,000, the Secretary shall, in 5 accordance with the considerations de- 6 scribed in subparagraph (B)(i) and 7 the priority described in subparagraph 8 (B)(ii), conduct an application and 9 distribution process in each subse- 10 quent fiscal year until such time as 11 the aggregate amount of positions dis- 12 tributed under this paragraph is equal 13 to 14,000. 14 ‘‘(B) DISTRIBUTION TO CERTAIN HOS- 15 PITALS.— 16 ‘‘(i) CONSIDERATION IN DISTRIBU- 17 TION.—In determining for which hospitals 18 the increase in the otherwise applicable 19 resident limit is provided under subpara- 20 graph (A), the Secretary shall take into ac- 21 count the demonstrated likelihood of the 22 hospital filling the positions made available 23 under this paragraph within the first 5 24 cost reporting periods beginning after the 25 VerDate Sep 11 2014 22:59 Apr 10, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S834.IS S834 pamtmann on DSKBC07HB2PROD with BILLS 6 •S 834 IS date the increase would be effective, as de- 1 termined by the Secretary. 2 ‘‘(ii) MINIMUM DISTRIBUTION FOR 3 CERTAIN CATEGORIES OF HOSPITALS.— 4 With respect to the aggregate number of 5 such positions available for distribution 6 under this paragraph, the Secretary shall 7 distribute not less than 10 percent of such 8 aggregate number to each of the following 9 categories of hospitals: 10 ‘‘(I) Hospitals that are located in 11 a rural area (as defined in subsection 12 (d)(2)(D)) or are treated as being lo- 13 cated in a rural area pursuant to sub- 14 section (d)(8)(E). 15 ‘‘(II) Hospitals in which the ref- 16 erence resident level of the hospital 17 (as specified in subparagraph (G)(iii)) 18 is greater than the otherwise applica- 19 ble resident limit. 20 ‘‘(III) Hospitals in States with— 21 ‘‘(aa) new medical schools 22 that received ‘Candidate School’ 23 status from the Liaison Com- 24 mittee on Medical Education or 25 VerDate Sep 11 2014 22:59 Apr 10, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S834.IS S834 pamtmann on DSKBC07HB2PROD with BILLS 7 •S 834 IS that received ‘Pre-Accreditation’ 1 status from the American Osteo- 2 pathic Association Commission 3 on Osteopathic College Accredita- 4 tion on or after January 1, 2000, 5 and that have achieved or con- 6 tinue to progress toward ‘Full 7 Accreditation’ status (as such 8 term is defined by the Liaison 9 Committee on Medical Edu- 10 cation) or toward ‘Accreditation’ 11 status (as such term is defined 12 by the American Osteopathic As- 13 sociation Commission on Osteo- 14 pathic College Accreditation); or 15 ‘‘(bb) additional locations 16 and branch campuses established 17 on or after January 1, 2000, by 18 medical schools with ‘Full Ac- 19 creditation’ status (as such term 20 is defined by the Liaison Com- 21 mittee on Medical Education) or 22 ‘Accreditation’ status (as such 23 term is defined by the American 24 Osteopathic Association Commis- 25 VerDate Sep 11 2014 22:59 Apr 10, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S834.IS S834 pamtmann on DSKBC07HB2PROD with BILLS 8 •S 834 IS sion on Osteopathic College Ac- 1 creditation). 2 ‘‘(IV) Hospitals that serve areas 3 designated as health professional 4 shortage areas under section 5 332(a)(1)(A) of the Public Health 6 Service Act, as determined by the Sec- 7 retary. 8 ‘‘(C) PROHIBITION ON DISTRIBUTION TO 9 HOSPITALS WITHOUT AN INCREASE AGREE- 10 MENT.—No increase in the otherwise applicable 11 resident limit of a hospital may be made under 12 this paragraph unless such hospital agrees to 13 increase the total number of full-time equivalent 14 residency positions under the approved medical 15 residency training program of such hospital by 16 the number of such positions made available by 17 such increase under this paragraph. 18 ‘‘(D) LIMITATION.— 19 ‘‘(i) IN GENERAL.—Except as pro- 20 vided in clause (ii), a hospital may not re- 21 ceive more than 75 full-time equivalent ad- 22 ditional residency positions in the aggre- 23 gate under this paragraph and paragraph 24 VerDate Sep 11 2014 22:59 Apr 10, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S834.IS S834 pamtmann on DSKBC07HB2PROD with BILLS 9 •S 834 IS (9) over the period of fiscal years 2023 1 through 2029. 2 ‘‘(ii) INCREASE IN NUMBER OF ADDI- 3 TIONAL POSITIONS A HOSPITAL MAY RE- 4 CEIVE.—The Secretary shall increase the 5 aggregate number of full-time equivalent 6 additional residency positions a hospital 7 may receive under this paragraph over 8 such period if the Secretary estimates that 9 the number of positions available for dis- 10 tribution under subparagraph (A) exceeds 11 the number of applications approved under 12 such subparagraph over such period. 13 ‘‘(E) APPLICATION OF PER RESIDENT 14 AMOUNTS FOR PRIMARY CARE AND NONPRI- 15 MARY CARE.—With respect to additional resi- 16 dency positions in a hospital attributable to the 17 increase provided under this paragraph, the ap- 18 proved FTE per resident amounts are deemed 19 to be equal to the hospital per resident amounts 20 for primary care and nonprimary care com- 21 puted under paragraph (2)(D) for that hospital. 22 ‘‘(F) PERMITTING FACILITIES TO APPLY 23 AGGREGATION RULES.—The Secretary shall 24 permit hospitals receiving additional residency 25 VerDate Sep 11 2014 22:59 Apr 10, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S834.IS S834 pamtmann on DSKBC07HB2PROD with BILLS 10 •S 834 IS positions attributable to the increase provided 1 under this paragraph to, beginning in the fifth 2 year after the effective date of such increase, 3 apply such positions to the limitation amount 4 under paragraph (4)(F) that may be aggre- 5 gated pursuant to paragraph (4)(H) among 6 members of the same affiliated group. 7 ‘‘(G) DEFINITIONS.—In this paragraph: 8 ‘‘(i) OTHERWISE APPLICABLE RESI- 9 DENT LIMIT.—The term ‘otherwise appli- 10 cable resident limit’ means, with respect to 11 a hospital, the limit otherwise applicable 12 under subparagraphs (F)(i) and (H) of 13 paragraph (4) on the resident level for the 14 hospital determined without regard to this 15 paragraph but taking into account para- 16 graphs (7)(A), (7)(B), (8)(A), and (8)(B). 17 ‘‘(ii) QUALIFYING HOSPITAL.—The 18 term ‘qualifying hospital’ means a hospital 19 described in any of subclauses (I) through 20 (IV) of subparagraph (B)(ii). 21 ‘‘(iii) REFERENCE RESIDENT 22 LEVEL.—The term ‘reference resident 23 level’ means, with respect to a hospital, the 24 resident level for the most recent cost re- 25 VerDate Sep 11 2014 22:59 Apr 10, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S834.IS S834 pamtmann on DSKBC07HB2PROD with BILLS 11 •S 834 IS porting period of the hospital ending on or 1 before the date of enactment of this para- 2 graph, for which a cost report has been 3 settled (or, if not, submitted (subject to 4 audit)), as determined by the Secretary. 5 ‘‘(iv) RESIDENT LEVEL.—The term 6 ‘resident level’ has the meaning given such 7 term in paragraph (7)(C)(i).’’. 8 (b) IME.— 9 (1) IN GENERAL.—Section 1886(d)(5)(B)(v) of 10 the Social Security Act (42 U.S.C. 11 1395ww(d)(5)(B)(v)), in the third sentence, is 12 amended by striking ‘‘and (h)(9)’’and inserting 13 ‘‘(h)(9), and (h)(10)’’. 14 (2) CONFORMING PROVISION.—Section 15 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 16 1395ww(d)(5)(B)) is amended by adding after 17 clause (xii) the following new clause: 18 ‘‘(xiii) For discharges occurring on or after 19 July 1, 2023, insofar as an additional payment 20 amount under this subparagraph is attributable to 21 resident positions distributed to a hospital under 22 subsection (h)(10), the indirect teaching adjustment 23 factor shall be computed in the same manner as pro- 24 VerDate Sep 11 2014 22:59 Apr 10, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S834.IS S834 pamtmann on DSKBC07HB2PROD with BILLS 12 •S 834 IS vided under clause (ii) with respect to such resident 1 positions.’’. 2 SEC. 3. STUDY AND REPORT ON STRATEGIES FOR INCREAS- 3 ING DIVERSITY. 4 (a) STUDY.—The Comptroller General of the United 5 States (in this section referred to as the ‘‘Comptroller 6 General’’) shall conduct a study on strategies for increas- 7 ing the diversity of the health professional workforce. Such 8 study shall include an analysis of strategies for increasing 9 the number of health professionals from rural, lower in- 10 come, and underrepresented minority communities, includ- 11 ing which strategies are most effective for achieving such 12 goal. 13 (b) REPORT.—Not later than 2 years after the date 14 of the enactment of this Act, the Comptroller General shall 15 submit to Congress a report on the study conducted under 16 subsection (a), together with recommendations for such 17 legislation and administrative action as the Comptroller 18 General determines appropriate. 19 Æ VerDate Sep 11 2014 22:59 Apr 10, 2021 Jkt 019200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6301 E:\BILLS\S834.IS S834 pamtmann on DSKBC07HB2PROD with BILLS