Advancing Medical Resident Training in Community Hospitals Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 3425 To amend title XVIII of the Social Security Act to establish rules for payment for graduate medical education (GME) costs for hospitals that establish a new medical residency training program after hosting resident rotators for short durations. IN THE HOUSE OF REPRESENTATIVES JUNE 21, 2019 Mr. KIND (for himself and Mr. HOLDING) 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 provi- sions as fall within the jurisdiction of the committee concerned A BILL To amend title XVIII of the Social Security Act to establish rules for payment for graduate medical education (GME) costs for hospitals that establish a new medical residency training program after hosting resident rotators for short durations. 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 ‘‘Advancing Medical 4 Resident Training in Community Hospitals Act of 2019’’. 5 VerDate Sep 11 2014 04:00 Jun 27, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3425.IH H3425 kjohnson on DSK79L0C42 with BILLS 2 •HR 3425 IH SEC. 2. MEDICARE GME TREATMENT OF HOSPITALS ESTAB- 1 LISHING NEW MEDICAL RESIDENCY TRAIN- 2 ING PROGRAMS AFTER HOSTING MEDICAL 3 RESIDENT ROTATORS FOR SHORT DURA- 4 TIONS. 5 (a) REDETERMINATION OF APPROVED FTE RESI- 6 DENT AMOUNT.—Section 1886(h)(2)(F) of the Social Se- 7 curity Act (42 U.S.C. 1395ww(h)(2)(F)) is amended— 8 (1) by inserting ‘‘(i)’’ before ‘‘In the case of’’; 9 and 10 (2) by adding at the end the following: 11 ‘‘(ii) In applying this subparagraph in the 12 case of a hospital that, on or after the date of 13 the enactment of this clause, begins to train 14 residents and has not entered into a GME af- 15 filiation agreement (as defined by the Secretary 16 for purposes of paragraph (4)(H)(ii)), the Sec- 17 retary shall not establish an FTE resident 18 amount until such time as the Secretary deter- 19 mines that the hospital has trained at least 1.0 20 full-time-equivalent resident in an approved 21 medical residency training program in a cost re- 22 porting period. 23 ‘‘(iii) In applying this subparagraph for 24 cost reporting periods beginning on or after the 25 date of enactment of this clause, in the case of 26 VerDate Sep 11 2014 04:00 Jun 27, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3425.IH H3425 kjohnson on DSK79L0C42 with BILLS 3 •HR 3425 IH a hospital that, as of such date of enactment, 1 has an approved FTE resident amount based 2 on the training in an approved medical resi- 3 dency program of— 4 ‘‘(I) less than 1.0 full-time-equivalent 5 resident in any cost reporting period begin- 6 ning before October 1, 1997, as deter- 7 mined by the Secretary; or 8 ‘‘(II) no more than 3.0 full-time- 9 equivalent residents in any cost reporting 10 period beginning on or after October 1, 11 1997, and before the date of the enactment 12 of this clause, as determined by the Sec- 13 retary, 14 in lieu of such FTE resident amount the Sec- 15 retary shall, in accordance with the method- 16 ology described in section 413.77(e) of title 42 17 of the Code of Federal Regulations (or any suc- 18 cessor regulation), establish a new FTE resi- 19 dent amount if the hospital trains at least 1.0 20 full-time-equivalent resident (in the case of a 21 hospital described in subclause (I)) or more 22 than 3.0 full-time-equivalent residents (in the 23 case of a hospital described in subclause (II)) in 24 a cost reporting period beginning on or after 25 VerDate Sep 11 2014 04:00 Jun 27, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3425.IH H3425 kjohnson on DSK79L0C42 with BILLS 4 •HR 3425 IH such date of enactment and before the date that 1 is 5 years after such date of enactment. 2 ‘‘(iv) For purposes of carrying out this 3 subparagraph for cost reporting periods begin- 4 ning on or after the date of the enactment of 5 this clause, a hospital shall report full-time- 6 equivalent residents on its cost report for a cost 7 reporting period if the hospital trains at least 8 1.0 full-time-equivalent residents in an ap- 9 proved medical residency training program in 10 such period. 11 ‘‘(v) As appropriate, the Secretary may 12 consider information from any cost reporting 13 period necessary to establish a new FTE resi- 14 dent amount as described in clause (iii).’’. 15 (b) REDETERMINATION OF FTE RESIDENT LIMITA- 16 TION.—Section 1886(h)(4)(H)(i) of the Social Security 17 Act (42 U.S.C. 1395ww(h)(4)(H)(i)) is amended— 18 (1) by inserting ‘‘(I)’’ before ‘‘The Secretary’’; 19 and 20 (2) by adding at the end the following: 21 ‘‘(II) In applying this clause in the 22 case of a hospital that, on or after the date 23 of the enactment of this subclause, begins 24 to train residents in a new approved med- 25 VerDate Sep 11 2014 04:00 Jun 27, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3425.IH H3425 kjohnson on DSK79L0C42 with BILLS 5 •HR 3425 IH ical residency training program (as defined 1 by the Secretary), the Secretary shall not 2 determine a limitation applicable to the 3 hospital under subparagraph (F) until 4 such time as the Secretary determines that 5 the hospital has trained at least 1.0 full- 6 time-equivalent resident in such new ap- 7 proved medical residency training program 8 in a cost reporting period. 9 ‘‘(III) In applying this clause in the 10 case of a hospital that, as of the date of 11 the enactment of this subclause, has a lim- 12 itation under subparagraph (F), based on 13 a cost reporting period beginning before 14 October 1, 1997, of less than 1.0 full-time- 15 equivalent resident, the Secretary shall ad- 16 just the limitation in the manner applica- 17 ble to a new approved medical residency 18 training program if the Secretary deter- 19 mines the hospital trains at least 1.0 full- 20 time-equivalent residents in a program 21 year beginning on or after such date of en- 22 actment and before the date that is 5 years 23 after such date of enactment. 24 VerDate Sep 11 2014 04:00 Jun 27, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3425.IH H3425 kjohnson on DSK79L0C42 with BILLS 6 •HR 3425 IH ‘‘(IV) In applying this clause in the 1 case of a hospital that, as of the date of 2 the enactment of this subclause, has a lim- 3 itation under subparagraph (F), based on 4 a cost reporting period beginning on or 5 after October 1, 1997, and before such 6 date of enactment, of no more than 3.0 7 full-time-equivalent residents, the Sec- 8 retary shall adjust the limitation in the 9 manner applicable to a new approved med- 10 ical residency training program if the Sec- 11 retary determines the hospital begins train- 12 ing more than 3.0 full-time-equivalent resi- 13 dents in a program year beginning on or 14 after such date of enactment and before 15 the date that is 5 years after such date of 16 enactment. 17 ‘‘(V) An adjustment to the limitation 18 applicable to a hospital made pursuant to 19 subclause (III) or (IV) shall be made in a 20 manner consistent with the methodology, 21 as appropriate, in section 413.79(e) of title 22 42, Code of Federal Regulations (or any 23 successor regulation). As appropriate, the 24 Secretary may consider information from 25 VerDate Sep 11 2014 04:00 Jun 27, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3425.IH H3425 kjohnson on DSK79L0C42 with BILLS 7 •HR 3425 IH any cost reporting periods necessary to 1 make such an adjustment to the limita- 2 tion.’’. 3 (c) TECHNICAL AND CONFORMING AMENDMENTS.— 4 Section 1886 of the Social Security Act (42 U.S.C. 5 1395ww) is amended— 6 (1) in subsection (d)(5)(B)(viii), by striking 7 ‘‘subsection (h)(4)(H)’’ and inserting ‘‘paragraphs 8 (2)(F)(iv) and (4)(H) of subsection (h)’’; and 9 (2) in subsection (h)— 10 (A) in paragraph (4)(H)(iv), by striking 11 ‘‘an rural area’’ and inserting ‘‘a rural area’’; 12 and 13 (B) in paragraph (7)(E), by striking 14 ‘‘under this’’ and all that follows through the 15 period at the end and inserting the following: 16 ‘‘under this paragraph, paragraph (8), clause 17 (i), (ii), (iii), or (v) of paragraph (2)(F), or 18 clause (i) or (vi) of paragraph (4)(H).’’. 19 (d) EFFECTIVE DATE.—The amendments made by 20 this section shall apply to payment under section 1886 of 21 the Social Security Act (42 U.S.C. 1395ww) for cost re- 22 porting periods beginning on or after the date of the en- 23 actment of this Act. 24 Æ VerDate Sep 11 2014 04:00 Jun 27, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6301 E:\BILLS\H3425.IH H3425 kjohnson on DSK79L0C42 with BILLS