Resident Physician Shortage Reduction Act of 2019

II 116TH CONGRESS 1ST SESSION S. 348 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 FEBRUARY 6, 2019 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 2019’’. 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 00:20 Feb 14, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S348.IS S348 pamtmann on DSKBFK8HB2PROD with BILLS 2 •S 348 IS (1) in paragraph (4)(F)(i), by striking ‘‘para- 1 graphs (7) and (8)’’ and inserting ‘‘paragraphs (7), 2 (8), and (9)’’; 3 (2) in paragraph (4)(H)(i), by striking ‘‘para- 4 graphs (7) and (8)’’ and inserting ‘‘paragraphs (7), 5 (8), and (9)’’; 6 (3) in paragraph (7)(E), by inserting ‘‘para- 7 graph (9),’’ after ‘‘paragraph (8),’’; and 8 (4) by adding at the end the following new 9 paragraph: 10 ‘‘(9) DISTRIBUTION OF ADDITIONAL RESIDENCY 11 POSITIONS.— 12 ‘‘(A) ADDITIONAL RESIDENCY POSI- 13 TIONS.— 14 ‘‘(i) IN GENERAL.—For each of fiscal 15 years 2021 through 2025 (and succeeding 16 fiscal years if the Secretary determines 17 that there are additional residency posi- 18 tions available to distribute under clause 19 (iii)(II)), the Secretary shall increase the 20 otherwise applicable resident limit for each 21 qualifying hospital that submits a timely 22 application under this subparagraph by 23 such number as the Secretary may approve 24 for portions of cost reporting periods oc- 25 VerDate Sep 11 2014 00:20 Feb 14, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S348.IS S348 pamtmann on DSKBFK8HB2PROD with BILLS 3 •S 348 IS curring on or after July 1 of the fiscal year 1 of the increase. Except as provided in 2 clause (iii), the aggregate number of in- 3 creases in the otherwise applicable resident 4 limit under this subparagraph shall be 5 equal to 3,000 in each of fiscal years 2021 6 through 2025, of which at least 1,500 in 7 each such fiscal year shall be used for full- 8 time equivalent residents training in a 9 shortage specialty residency program (as 10 defined in subparagraph (F)(iii)). 11 ‘‘(ii) PROCESS FOR DISTRIBUTING PO- 12 SITIONS.— 13 ‘‘(I) ROUNDS OF APPLICA- 14 TIONS.—The Secretary shall initiate 5 15 separate rounds of applications for an 16 increase under clause (i), 1 round 17 with respect to each of fiscal years 18 2021 through 2025. 19 ‘‘(II) NUMBER AVAILABLE.—In 20 each of such rounds, the aggregate 21 number of positions available for dis- 22 tribution in the fiscal year as a result 23 of an increase in the otherwise appli- 24 cable resident limit (as described in 25 VerDate Sep 11 2014 00:20 Feb 14, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S348.IS S348 pamtmann on DSKBFK8HB2PROD with BILLS 4 •S 348 IS clause (i)) shall be distributed, plus 1 any additional positions available 2 under clause (iii). 3 ‘‘(III) TIMING.—The Secretary 4 shall notify hospitals of the number of 5 positions distributed to the hospital 6 under this paragraph as result of an 7 increase in the otherwise applicable 8 resident limit by January 1 of the fis- 9 cal year of the increase. Such increase 10 shall be effective for portions of cost 11 reporting periods beginning on or 12 after July 1 of that fiscal year. 13 ‘‘(iii) POSITIONS NOT DISTRIBUTED 14 DURING THE FISCAL YEAR.— 15 ‘‘(I) IN GENERAL.—If the num- 16 ber of resident full-time equivalent po- 17 sitions distributed under this para- 18 graph in a fiscal year is less than the 19 aggregate number of positions avail- 20 able for distribution in the fiscal year 21 (as described in clause (i), including 22 after application of this subclause), 23 the difference between such number 24 distributed and such number available 25 VerDate Sep 11 2014 00:20 Feb 14, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S348.IS S348 pamtmann on DSKBFK8HB2PROD with BILLS 5 •S 348 IS for distribution shall be added to the 1 aggregate number of positions avail- 2 able for distribution in the following 3 fiscal year. 4 ‘‘(II) EXCEPTION IF POSITIONS 5 NOT DISTRIBUTED BY END OF FISCAL 6 YEAR 2025.—If the aggregate number 7 of positions distributed under this 8 paragraph during the 5-year period of 9 fiscal years 2021 through 2025 is less 10 than 15,000, the Secretary shall, in 11 accordance with the considerations de- 12 scribed in subparagraph (B)(i) and 13 the priority described in subparagraph 14 (B)(ii), conduct an application and 15 distribution process in each subse- 16 quent fiscal year until such time as 17 the aggregate amount of positions dis- 18 tributed under this paragraph is equal 19 to 15,000. 20 ‘‘(B) DISTRIBUTION TO CERTAIN HOS- 21 PITALS.— 22 ‘‘(i) CONSIDERATION IN DISTRIBU- 23 TION.—In determining for which hospitals 24 the increase in the otherwise applicable 25 VerDate Sep 11 2014 00:20 Feb 14, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S348.IS S348 pamtmann on DSKBFK8HB2PROD with BILLS 6 •S 348 IS resident limit is provided under subpara- 1 graph (A), the Secretary shall take into ac- 2 count the demonstrated likelihood of the 3 hospital filling the positions made available 4 under this paragraph within the first 5 5 cost reporting periods beginning after the 6 date the increase would be effective, as de- 7 termined by the Secretary. 8 ‘‘(ii) PRIORITY FOR CERTAIN HOS- 9 PITALS.—Subject to clause (iii), in deter- 10 mining for which hospitals the increase in 11 the otherwise applicable resident limit is 12 provided under subparagraph (A), the Sec- 13 retary shall distribute the increase in the 14 following priority order: 15 ‘‘(I) First, to hospitals in States 16 with (aa) new medical schools that re- 17 ceived ‘Candidate School’ status from 18 the Liaison Committee on Medical 19 Education or that received ‘Pre-Ac- 20 creditation’ status from the American 21 Osteopathic Association Commission 22 on Osteopathic College Accreditation 23 on or after January 1, 2000, and that 24 have achieved or continue to progress 25 VerDate Sep 11 2014 00:20 Feb 14, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S348.IS S348 pamtmann on DSKBFK8HB2PROD with BILLS 7 •S 348 IS toward ‘Full Accreditation’ status (as 1 such term is defined by the Liaison 2 Committee on Medical Education) or 3 toward ‘Accreditation’ status (as such 4 term is defined by the American Os- 5 teopathic Association Commission on 6 Osteopathic College Accreditation), or 7 (bb) additional locations and branch 8 campuses established on or after Jan- 9 uary 1, 2000, by medical schools with 10 ‘Full Accreditation’ status (as such 11 term is defined by the Liaison Com- 12 mittee on Medical Education) or ‘Ac- 13 creditation’ status (as such term is 14 defined by the American Osteopathic 15 Association Commission on Osteo- 16 pathic College Accreditation). 17 ‘‘(II) Second, to hospitals in 18 which the resident level of the hospital 19 is greater than the otherwise applica- 20 ble resident limit during the most re- 21 cent cost reporting period ending on 22 or before the date of enactment of 23 this paragraph. 24 VerDate Sep 11 2014 00:20 Feb 14, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S348.IS S348 pamtmann on DSKBFK8HB2PROD with BILLS 8 •S 348 IS ‘‘(III) Third, to hospitals with 1 which the Secretary cooperates under 2 section 7302(d) of title 38, United 3 States Code. 4 ‘‘(IV) Fourth, to hospitals that 5 emphasize training in community- 6 based settings or in hospital out- 7 patient departments. 8 ‘‘(V) Fifth, to hospitals that are 9 not located in a rural area and oper- 10 ate an approved medical residency 11 training program (or rural track) in a 12 rural area or an approved medical 13 residency training program with an 14 integrated rural track. 15 ‘‘(VI) Sixth, to all other hos- 16 pitals. 17 ‘‘(iii) DISTRIBUTION TO HOSPITALS IN 18 HIGHER PRIORITY GROUP PRIOR TO DIS- 19 TRIBUTION IN LOWER PRIORITY GROUPS.— 20 The Secretary may only distribute an in- 21 crease under subparagraph (A) to a lower 22 priority group under clause (ii) if all quali- 23 fying hospitals in the higher priority group 24 or groups have received the maximum 25 VerDate Sep 11 2014 00:20 Feb 14, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S348.IS S348 pamtmann on DSKBFK8HB2PROD with BILLS 9 •S 348 IS number of increases under such subpara- 1 graph that the hospital is eligible for under 2 this paragraph for the fiscal year. 3 ‘‘(C) REQUIREMENTS FOR USE OF ADDI- 4 TIONAL POSITIONS.— 5 ‘‘(i) IN GENERAL.—Subject to clause 6 (ii), a hospital that receives an increase in 7 the otherwise applicable resident limit 8 under subparagraph (A) shall ensure, dur- 9 ing the 5-year period beginning on the ef- 10 fective date of such increase, that— 11 ‘‘(I) not less than 50 percent of 12 the positions attributable to such in- 13 crease are used to train full-time 14 equivalent residents in a shortage spe- 15 cialty residency program (as defined 16 in subclause (F)(iii)), as determined 17 by the Secretary at the end of such 5- 18 year period; 19 ‘‘(II) the total number of full- 20 time equivalent residents, excluding 21 any additional positions attributable 22 to such increase, is not less than the 23 average number of full-time equivalent 24 residents during the 3 most recent 25 VerDate Sep 11 2014 00:20 Feb 14, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S348.IS S348 pamtmann on DSKBFK8HB2PROD with BILLS 10 •S 348 IS cost reporting periods ending on or 1 before the effective date of such in- 2 crease; and 3 ‘‘(III) the ratio of full-time equiv- 4 alent residents in a shortage specialty 5 residency program (as so defined) is 6 not less than the average ratio of full- 7 time equivalent residents in such a 8 program during the 3 most recent 9 cost reporting periods ending on or 10 before the effective date of such in- 11 crease. 12 ‘‘(ii) REDISTRIBUTION OF POSITIONS 13 IF HOSPITAL NO LONGER MEETS CERTAIN 14 REQUIREMENTS.—In the case where the 15 Secretary determines that a hospital de- 16 scribed in clause (i) does not meet the re- 17 quirements of such clause, the Secretary 18 shall— 19 ‘‘(I) reduce the otherwise applica- 20 ble resident limit of the hospital by 21 the amount by which such limit was 22 increased under this paragraph; and 23 ‘‘(II) provide for the distribution 24 of positions attributable to such re- 25 VerDate Sep 11 2014 00:20 Feb 14, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S348.IS S348 pamtmann on DSKBFK8HB2PROD with BILLS 11 •S 348 IS duction in accordance with the re- 1 quirements of this paragraph. 2 ‘‘(D) LIMITATION.— 3 ‘‘(i) IN GENERAL.—Except as pro- 4 vided in clause (ii), a hospital may not re- 5 ceive more than 75 full-time equivalent ad- 6 ditional residency positions in the aggre- 7 gate under this paragraph over the period 8 of fiscal years 2021 through 2025. 9 ‘‘(ii) INCREASE IN NUMBER OF ADDI- 10 TIONAL POSITIONS A HOSPITAL MAY RE- 11 CEIVE.—The Secretary shall increase the 12 aggregate number of full-time equivalent 13 additional residency positions a hospital 14 may receive under this paragraph over 15 such period if the Secretary estimates that 16 the number of positions available for dis- 17 tribution under subparagraph (A) exceeds 18 the number of applications approved under 19 such subparagraph over such period. 20 ‘‘(E) APPLICATION OF PER RESIDENT 21 AMOUNTS FOR PRIMARY CARE AND NONPRI- 22 MARY CARE.—With respect to additional resi- 23 dency positions in a hospital attributable to the 24 increase provided under this paragraph, the ap- 25 VerDate Sep 11 2014 00:20 Feb 14, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S348.IS S348 pamtmann on DSKBFK8HB2PROD with BILLS 12 •S 348 IS proved FTE per resident amounts are deemed 1 to be equal to the hospital per resident amounts 2 for primary care and nonprimary care com- 3 puted under paragraph (2)(D) for that hospital. 4 ‘‘(F) DEFINITIONS.—In this paragraph: 5 ‘‘(i) OTHERWISE APPLICABLE RESI- 6 DENT LIMIT.—The term ‘otherwise appli- 7 cable resident limit’ means, with respect to 8 a hospital, the limit otherwise applicable 9 under subparagraphs (F)(i) and (H) of 10 paragraph (4) on the resident level for the 11 hospital determined without regard to this 12 paragraph but taking into account para- 13 graphs (7)(A), (7)(B), (8)(A), and (8)(B). 14 ‘‘(ii) RESIDENT LEVEL.—The term 15 ‘resident level’ has the meaning given such 16 term in paragraph (7)(C)(i). 17 ‘‘(iii) SHORTAGE SPECIALTY RESI- 18 DENCY PROGRAM.—The term ‘shortage 19 specialty residency program’ means any 20 approved residency training program in a 21 specialty identified in the report entitled 22 ‘The Physician Workforce: Projections and 23 Research into Current Issues Affecting 24 Supply and Demand’, issued in December 25 VerDate Sep 11 2014 00:20 Feb 14, 2019 Jkt 089200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S348.IS S348 pamtmann on DSKBFK8HB2PROD with BILLS 13 •S 348 IS 2008 by the Health Resources and Serv- 1 ices Administration, as a specialty whose 2 baseline physician requirements projections 3 exceed the projected supply of total active 4 physicians for the period of 2005 through 5 2020.’’. 6 (b) IME.— 7 (1) IN GENERAL.—Section 1886(d)(5)(B)(v) of 8 the Social Security Act (42 U.S.C. 9 1395ww(d)(5)(B)(v)), in the third sentence, is 10 amended by striking ‘‘and (h)(8)’’ and inserting 11 ‘‘(h)(8), and (h)(9)’’. 12 (2) CONFORMING PROVISION.—Section 13 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 14 1395ww(d)(5)(B)) is amended— 15 (A) by redesignating clause (x), as added 16 by section 5505(b) of the Patient Protection 17 and Affordable Care Act (Public Law 111– 18 148), as clause (xi) and moving such clause 4 19 ems to the left; and 20 (B) by adding after clause (xi), as redesig- 21 nated by subparagraph (A), the following new 22 clause: 23 ‘‘(xii) For discharges occurring on or after July 24 1, 2021, insofar as an additional payment amount 25 VerDate Sep 11 2014 00:20 Feb 14, 2019 Jkt 089200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\S348.IS S348 pamtmann on DSKBFK8HB2PROD 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