Resident Physician Shortage Reduction Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 1763 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 MARCH 14, 2019 Ms. SEWELL of Alabama (for herself, Mr. KATKO, Ms. TORRES SMALL of New Mexico, and Mr. RODNEY DAVIS of Illinois) introduced the following bill; which was referred to the Committee on Ways and Means, and in addi- tion to the Committee on Energy and Commerce, for a period to be sub- sequently 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 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 VerDate Sep 11 2014 02:31 Mar 29, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1763.IH H1763 kjohnson on DSK79L0C42 with BILLS 2 •HR 1763 IH SEC. 2. DISTRIBUTION OF ADDITIONAL RESIDENCY POSI- 1 TIONS. 2 (a) IN GENERAL.—Section 1886(h) of the Social Se- 3 curity Act (42 U.S.C. 1395ww(h)) is amended— 4 (1) in paragraph (4)(F)(i), by striking ‘‘para- 5 graphs (7) and (8)’’ and inserting ‘‘paragraphs (7), 6 (8), and (9)’’; 7 (2) in paragraph (4)(H)(i), by striking ‘‘para- 8 graphs (7) and (8)’’ and inserting ‘‘paragraphs (7), 9 (8), and (9)’’; 10 (3) in paragraph (7)(E), by inserting ‘‘para- 11 graph (9),’’ after ‘‘paragraph (8),’’; and 12 (4) by adding at the end the following new 13 paragraph: 14 ‘‘(9) DISTRIBUTION OF ADDITIONAL RESIDENCY 15 POSITIONS.— 16 ‘‘(A) ADDITIONAL RESIDENCY POSI- 17 TIONS.— 18 ‘‘(i) IN GENERAL.—For each of fiscal 19 years 2021 through 2025 (and succeeding 20 fiscal years if the Secretary determines 21 that there are additional residency posi- 22 tions available to distribute under clause 23 (iv)(II)), the Secretary shall, subject to 24 clause (ii) and subparagraph (D), increase 25 the otherwise applicable resident limit for 26 VerDate Sep 11 2014 02:31 Mar 29, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1763.IH H1763 kjohnson on DSK79L0C42 with BILLS 3 •HR 1763 IH each qualifying hospital that submits a 1 timely application under this subparagraph 2 by such number as the Secretary may ap- 3 prove for portions of cost reporting periods 4 occurring on or after July 1 of the fiscal 5 year of the increase. 6 ‘‘(ii) NUMBER AVAILABLE FOR DIS- 7 TRIBUTION.—For each such fiscal year, 8 the Secretary shall determine the total 9 number of additional residency positions 10 available for distribution under clause (i) 11 in accordance with the following: 12 ‘‘(I) ALLOCATION TO HOSPITALS 13 ALREADY OPERATING OVER RESIDENT 14 LIMIT.—One-third of such number 15 shall be available for distribution only 16 to hospitals described in subparagraph 17 (B). 18 ‘‘(II) AGGREGATE LIMITATION.— 19 Except as provided in clause (iv)(I), 20 the aggregate number of increases in 21 the otherwise applicable resident limit 22 under this subparagraph shall be 23 equal to 3,000 in each such year. 24 VerDate Sep 11 2014 02:31 Mar 29, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1763.IH H1763 kjohnson on DSK79L0C42 with BILLS 4 •HR 1763 IH ‘‘(iii) PROCESS FOR DISTRIBUTING 1 POSITIONS.— 2 ‘‘(I) ROUNDS OF APPLICA- 3 TIONS.—The Secretary shall initiate 5 4 separate rounds of applications for an 5 increase under clause (i), 1 round 6 with respect to each of fiscal years 7 2021 through 2025. 8 ‘‘(II) NUMBER AVAILABLE.—In 9 each of such rounds, the aggregate 10 number of positions available for dis- 11 tribution in the fiscal year under 12 clause (ii) shall be distributed, plus 13 any additional positions available 14 under clause (iv). 15 ‘‘(III) TIMING.—The Secretary 16 shall notify hospitals of the number of 17 positions distributed to the hospital 18 under this paragraph as a result of an 19 increase in the otherwise applicable 20 resident limit by January 1 of the fis- 21 cal year of the increase. Such increase 22 shall be effective for portions of cost 23 reporting periods beginning on or 24 after July 1 of that fiscal year. 25 VerDate Sep 11 2014 02:31 Mar 29, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1763.IH H1763 kjohnson on DSK79L0C42 with BILLS 5 •HR 1763 IH ‘‘(iv) POSITIONS NOT DISTRIBUTED 1 DURING THE FISCAL YEAR.— 2 ‘‘(I) IN GENERAL.—If the num- 3 ber of resident full-time equivalent po- 4 sitions distributed under this para- 5 graph in a fiscal year is less than the 6 aggregate number of positions avail- 7 able for distribution in the fiscal year 8 (as described in clause (ii), including 9 after application of this subclause), 10 the difference between such number 11 distributed and such number available 12 for distribution shall be added to the 13 aggregate number of positions avail- 14 able for distribution in the following 15 fiscal year. 16 ‘‘(II) EXCEPTION IF POSITIONS 17 NOT DISTRIBUTED BY END OF FISCAL 18 YEAR 2025.—If the aggregate number 19 of positions distributed under this 20 paragraph during the 5-year period of 21 fiscal years 2021 through 2025 is less 22 than 15,000, the Secretary shall, in 23 accordance with the provisions of 24 clause (ii) and subparagraph (D) and 25 VerDate Sep 11 2014 02:31 Mar 29, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1763.IH H1763 kjohnson on DSK79L0C42 with BILLS 6 •HR 1763 IH the considerations and priority de- 1 scribed in subparagraph (C), conduct 2 an application and distribution proc- 3 ess in each subsequent fiscal year 4 until such time as the aggregate 5 amount of positions distributed under 6 this paragraph is equal to 15,000. 7 ‘‘(B) ALLOCATION OF DISTRIBUTION FOR 8 POSITIONS TO HOSPITALS ALREADY OPERATING 9 OVER RESIDENT LIMIT.— 10 ‘‘(i) IN GENERAL.—Subject to clauses 11 (ii) and (iii), in the case of a hospital in 12 which the reference resident level of the 13 hospital (as specified in subparagraph 14 (G)(iii)) is greater than the otherwise ap- 15 plicable resident limit, the increase in the 16 otherwise applicable resident limit under 17 subparagraph (A) for a fiscal year de- 18 scribed in such subparagraph shall be an 19 amount equal to the product of the total 20 number of additional residency positions 21 available for distribution under subpara- 22 graph (A)(ii)(I) for such fiscal year and 23 the quotient of— 24 VerDate Sep 11 2014 02:31 Mar 29, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H1763.IH H1763 kjohnson on DSK79L0C42 with BILLS 7 •HR 1763 IH ‘‘(I) the number of resident posi- 1 tions by which the reference resident 2 level of the hospital exceeds the other- 3 wise applicable resident limit for the 4 hospital; and 5 ‘‘(II) the number of resident po- 6 sitions by which the reference resident 7 level of all such hospitals with respect 8 to which an application is approved 9 under this paragraph exceeds the oth- 10 erwise applicable resident limit for 11 such hospitals. 12 ‘‘(ii) REQUIREMENTS.—A hospital de- 13 scribed in clause (i)— 14 ‘‘(I) is not eligible for an increase 15 in the otherwise applicable resident 16 limit under this subparagraph unless 17 the amount by which the reference 18 resident level of the hospital exceeds 19 the otherwise applicable resident limit 20 is not less than 10 and the hospital 21 trains at least 25 percent of the full- 22 time equivalent residents of the hos- 23 pital in primary care and general sur- 24 VerDate Sep 11 2014 02:31 Mar 29, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1763.IH H1763 kjohnson on DSK79L0C42 with BILLS 8 •HR 1763 IH gery (as of the date of enactment of 1 this paragraph); and 2 ‘‘(II) shall continue to train at 3 least 25 percent of the full-time equiv- 4 alent residents of the hospital in pri- 5 mary care and general surgery for the 6 5-year period beginning on such date. 7 In the case where the Secretary determines 8 that a hospital described in clause (i) no 9 longer meets the requirement of subclause 10 (II), the Secretary may reduce the other- 11 wise applicable resident limit of the hos- 12 pital by the amount by which such limit 13 was increased under this subparagraph. 14 ‘‘(iii) CLARIFICATION REGARDING ELI- 15 GIBILITY FOR OTHER ADDITIONAL RESI- 16 DENCY POSITIONS.—Nothing in this sub- 17 paragraph shall be construed as preventing 18 a hospital described in clause (i) from ap- 19 plying for and receiving additional resi- 20 dency positions under this paragraph that 21 are not reserved for distribution under this 22 subparagraph. 23 ‘‘(C) DISTRIBUTION OF OTHER POSI- 24 TIONS.—For purposes of determining an in- 25 VerDate Sep 11 2014 02:31 Mar 29, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H1763.IH H1763 kjohnson on DSK79L0C42 with BILLS 9 •HR 1763 IH crease in the otherwise applicable resident limit 1 under subparagraph (A) (other than such an in- 2 crease described in subparagraph (B)), the fol- 3 lowing shall apply: 4 ‘‘(i) CONSIDERATIONS IN DISTRIBU- 5 TION.—In determining for which hospitals 6 such an increase is provided under sub- 7 paragraph (A), the Secretary shall take 8 into account the demonstrated likelihood of 9 the hospital filling the positions made 10 available under this paragraph within the 11 first 5 cost reporting periods beginning 12 after the date the increase would be effec- 13 tive, as determined by the Secretary. 14 ‘‘(ii) PRIORITY FOR CERTAIN HOS- 15 PITALS.—Subject to clause (iii), in deter- 16 mining for which hospitals such an in- 17 crease is provided, the Secretary shall dis- 18 tribute the increase in the following pri- 19 ority order: 20 ‘‘(I) First, to hospitals in States 21 with— 22 ‘‘(aa) new medical schools 23 that received ‘Candidate School’ 24 status from the Liaison Com- 25 VerDate Sep 11 2014 02:31 Mar 29, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H1763.IH H1763 kjohnson on DSK79L0C42 with BILLS 10 •HR 1763 IH mittee on Medical Education or 1 that received ‘Pre-Accreditation’ 2 status from the American Osteo- 3 pathic Association Commission 4 on Osteopathic College Accredita- 5 tion on or after January 1, 2000, 6 and that have achieved or con- 7 tinue to progress toward ‘Full 8 Accreditation’ status (as such 9 term is defined by the Liaison 10 Committee on Medical Edu- 11 cation) or toward ‘Accreditation’ 12 status (as such term is defined 13 by the American Osteopathic As- 14 sociation Commission on Osteo- 15 pathic College Accreditation); or 16 ‘‘(bb) additional locations 17 and branch campuses established 18 on or after January 1, 2000, by 19 medical schools with ‘Full Ac- 20 creditation’ status (as such term 21 is defined by the Liaison Com- 22 mittee on Medical Education) or 23 ‘Accreditation’ status (as such 24 term is defined by the American 25 VerDate Sep 11 2014 02:31 Mar 29, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H1763.IH H1763 kjohnson on DSK79L0C42 with BILLS 11 •HR 1763 IH Osteopathic Association Commis- 1 sion on Osteopathic College Ac- 2 creditation). 3 ‘‘(II) Second, to hospitals with 4 which the Secretary cooperates under 5 section 7302(d) of title 38, United 6 States Code. 7 ‘‘(III) Third, to hospitals that 8 emphasize training in community- 9 based settings or in hospital out- 10 patient departments. 11 ‘‘(IV) Fourth, to hospitals that 12 are not located in a rural area and op- 13 erate an approved medical residency 14 training program (or rural track) in a 15 rural area or an approved medical 16 residency training program with an 17 integrated rural track. 18 ‘‘(V) Fifth, to all other hospitals. 19 ‘‘(iii) DISTRIBUTION TO HOSPITALS IN 20 HIGHER PRIORITY GROUP PRIOR TO DIS- 21 TRIBUTION IN LOWER PRIORITY GROUPS.— 22 The Secretary may only distribute such an 23 increase to a lower priority group under 24 clause (ii) if all qualifying hospitals in the 25 VerDate Sep 11 2014 02:31 Mar 29, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H1763.IH H1763 kjohnson on DSK79L0C42 with BILLS 12 •HR 1763 IH higher priority group or groups have re- 1 ceived the maximum number of increases 2 under such subparagraph that the hospital 3 is eligible for under this paragraph for the 4 fiscal year. 5 ‘‘(iv) REQUIREMENTS FOR USE OF AD- 6 DITIONAL POSITIONS.— 7 ‘‘(I) IN GENERAL.—Subject to 8 subclause (II), a hospital that receives 9 such an increase shall ensure, during 10 the 5-year period beginning on the ef- 11 fective date of such increase, that— 12 ‘‘(aa) not less than 50 per- 13 cent of the positions attributable 14 to such increase that are used in 15 a given year during such 5-year 16 period are used to train full-time 17 equivalent residents in a shortage 18 specialty residency program (as 19 defined in subparagraph (G)(iv)), 20 as determined by the Secretary 21 at the end of such 5-year period; 22 ‘‘(bb) the total number of 23 full-time equivalent residents, ex- 24 cluding any additional positions 25 VerDate Sep 11 2014 02:31 Mar 29, 2019 Jkt 089200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H1763.IH H1763 kjohnson on DSK79L0C42 with BILLS 13 •HR 1763 IH attributable to such increase, is 1 not less than the average number 2 of full-time equivalent residents 3 during the 3 most recent cost re- 4 porting periods ending on or be- 5 fore the effective date of such in- 6 crease; and 7 ‘‘(cc) the ratio of full-time 8 equivalent residents in a shortage 9 specialty residency program (as 10 so defined) is not less than the 11 average ratio of full-time equiva- 12 lent residents in such a program 13 during the 3 most recent cost re- 14 porting periods ending on or be- 15 fore the effective date of such in- 16 crease. 17 ‘‘(II) REDISTRIBUTION OF POSI- 18 TIONS IF HOSPITAL NO LONGER 19 MEETS CERTAIN REQUIREMENTS.— 20 With respect to each fiscal year de- 21 scribed in subparagraph (A), the Sec- 22 retary shall determine whether or not 23 a hospital described in subclause (I) 24 meets the requirements of such sub- 25 VerDate Sep 11 2014 02:31 Mar 29, 2019 Jkt 089200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H1763.IH H1763 kjohnson on DSK79L0C42 with BILLS 14 •HR 1763 IH clause. In the case that the Secretary 1 determines that such a hospital does 2 not meet such requirements, the Sec- 3 retary shall— 4 ‘‘(aa) reduce the otherwise 5 applicable resident limit of the 6 hospital by the amount by which 7 such limit was increased under 8 this paragraph; and 9 ‘‘(bb) provide for the dis- 10 tribution of positions attributable 11 to such reducti [Text truncated for display. Full text available on Congress.gov.]