Physician Shortage GME Cap Flex Act of 2021

I 117TH CONGRESS 1ST SESSION H. R. 4014 To provide for a new building period with respect to the cap on full-time equivalent residents for purposes of payment for graduate medical edu- cation costs under the Medicare program for certain hospitals that have established a shortage specialty program. IN THE HOUSE OF REPRESENTATIVES JUNE 17, 2021 Mr. RUIZ (for himself, Mr. BUCSHON, Ms. SEWELL, and Mr. WENSTRUP) in- troduced 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 provide for a new building period with respect to the cap on full-time equivalent residents for purposes of pay- ment for graduate medical education costs under the Medicare program for certain hospitals that have estab- lished a shortage specialty program. 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 ‘‘Physician Shortage 4 GME Cap Flex Act of 2021’’. 5 VerDate Sep 11 2014 04:00 Jul 09, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H4014.IH H4014 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 4014 IH SEC. 2. PROVIDING FOR A NEW BUILDING PERIOD WITH 1 RESPECT TO THE CAP ON FULL-TIME EQUIV- 2 ALENT RESIDENTS FOR CERTAIN HOSPITALS 3 THAT HAVE ESTABLISHED A SHORTAGE SPE- 4 CIALTY PROGRAM. 5 Section 1886(h)(4) of the Social Security Act (42 6 U.S.C. 1395ww(h)(4)) is amended by adding at the end 7 the following new subparagraph: 8 ‘‘(L) TREATMENT OF CERTAIN QUALI- 9 FYING HOSPITALS.— 10 ‘‘(i) IN GENERAL.—For purposes of 11 applying this paragraph and section 12 413.79 of title 42, Code of Federal Regula- 13 tions (or a successor regulation), the Sec- 14 retary shall treat, subject to clause (ii), a 15 qualifying hospital (as defined in clause 16 (iii)) with an approved medical residency 17 training program as if such hospital— 18 ‘‘(I) had no allopathic or osteo- 19 pathic residents in its most recent 20 cost reporting period ending on or be- 21 fore December 31, 1996; and 22 ‘‘(II) began training residents for 23 the first time in a new medical resi- 24 dency training program (as defined in 25 paragraph (l) of such section) begin- 26 VerDate Sep 11 2014 04:00 Jul 09, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4014.IH H4014 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 4014 IH ning on the date on which such hos- 1 pital became a qualifying hospital. 2 ‘‘(ii) SPECIAL RULE FOR QUALIFYING 3 HOSPITALS IN CAP-BUILDING PERIOD.—In 4 the case of a qualifying hospital with an 5 approved medical residency training pro- 6 gram that, excluding the treatment de- 7 scribed in clause (i), is a hospital that had 8 no allopathic or osteopathic residents in its 9 most recent cost reporting period ending 10 on or before December 31, 1996, and 11 began training residents for the first time 12 in a new medical residency training pro- 13 gram (as defined in paragraph (l) of such 14 section) during the 5-year period ending on 15 the date described in clause (i)(II) with re- 16 spect to such hospital, in lieu of applying 17 such clause, the Secretary shall provide 18 that the provisions of subsection (e) of sec- 19 tion 413.79 of title 42, Code of Federal 20 Regulations (or a successor regulation), 21 shall apply with respect to such hospital 22 for an additional 5 years beyond the period 23 during which such provisions would other- 24 wise have applied to such hospital. 25 VerDate Sep 11 2014 04:00 Jul 09, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4014.IH H4014 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 4014 IH ‘‘(iii) DEFINITION.—In this subpara- 1 graph: 2 ‘‘(I) QUALIFYING HOSPITAL.— 3 The term ‘qualifying hospital’ means 4 a hospital that— 5 ‘‘(aa) establishes a shortage 6 specialty program (as defined in 7 subclause (II)) during the 5-year 8 period beginning on the date of 9 the enactment of this subpara- 10 graph; and 11 ‘‘(bb) submits an application 12 to the Secretary during such pe- 13 riod containing such information 14 as the Secretary may specify. 15 ‘‘(II) SHORTAGE SPECIALTY PRO- 16 GRAM.—The term ‘shortage specialty 17 program’ means, with respect to a 18 hospital located in a geographic area 19 (as defined by the Secretary), any ap- 20 proved residency training program in 21 a specialty for which the Secretary de- 22 termines that there is a shortage of 23 physicians practicing such specialty in 24 such area at the time such program is 25 VerDate Sep 11 2014 04:00 Jul 09, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4014.IH H4014 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 4014 IH established. In making such a deter- 1 mination, the Secretary shall take into 2 account whether such hospital is lo- 3 cated in an area— 4 ‘‘(aa) without adequate 5 health care resources (such as in 6 a rural area or a medically un- 7 derserved area (as defined by the 8 Administrator of the Health Re- 9 sources and Services Administra- 10 tion)); 11 ‘‘(bb) experiencing primary 12 care or specialty physician short- 13 ages (such as in a health profes- 14 sional shortage area (as defined 15 in section 332(a) of the Public 16 Health Service Act (42 U.S.C. 17 254e(a)))); 18 ‘‘(cc) without an adequate 19 number of approved residency 20 training programs; 21 ‘‘(dd) struggling to expand 22 or keep approved residency train- 23 ing programs operational; 24 VerDate Sep 11 2014 04:00 Jul 09, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4014.IH H4014 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 4014 IH ‘‘(ee) lacking existing med- 1 ical training infrastructure or in 2 the process of building such in- 3 frastructure; 4 ‘‘(ff) with a low resident-to- 5 population ratio; 6 ‘‘(gg) with few full-time 7 equivalent resident positions; or 8 ‘‘(hh) with a low physician- 9 to-population ratio for physicians 10 practicing in the same specialty 11 as the shortage specialty program 12 concerned.’’. 13 Æ VerDate Sep 11 2014 04:00 Jul 09, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6301 E:\BILLS\H4014.IH H4014 kjohnson on DSK79L0C42PROD with BILLS