Supporting Graduate Medical Education at Community Hospitals Act of 2019

II 116TH CONGRESS 1ST SESSION S. 2116 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 SENATE OF THE UNITED STATES JULY 15, 2019 Mr. MENENDEZ (for himself and Mr. BOOKER) 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 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 ‘‘Supporting Graduate 4 Medical Education at Community Hospitals Act of 2019’’. 5 SEC. 2. FINDINGS. 6 Congress makes the following findings: 7 VerDate Sep 11 2014 00:25 Jul 18, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S2116.IS S2116 kjohnson on DSK79L0C42 with BILLS 2 •S 2116 IS (1) Graduate Medical Education or ‘‘GME’’ 1 training programs are of critical importance in de- 2 veloping the physician workforce. 3 (2) Current caps on GME training programs 4 under Medicare have been in place since 1997. 5 (3) Hospitals seeking to launch GME training 6 programs face barriers in establishing physician 7 training programs in community hospitals. 8 SEC. 3. MEDICARE GME TREATMENT OF HOSPITALS ESTAB- 9 LISHING NEW MEDICAL RESIDENCY TRAIN- 10 ING PROGRAMS AFTER HOSTING MEDICAL 11 RESIDENT ROTATORS FOR SHORT DURA- 12 TIONS. 13 (a) REDETERMINATION OF APPROVED FTE RESI- 14 DENT AMOUNT.—Section 1886(h)(2)(F) of the Social Se- 15 curity Act (42 U.S.C. 1395ww(h)(2)(F)) is amended— 16 (1) by inserting ‘‘(i)’’ before ‘‘In the case of’’; 17 and 18 (2) by adding at the end the following: 19 ‘‘(ii) In applying this subparagraph to a 20 hospital that has not entered into a GME affili- 21 ation agreement (as defined by the Secretary 22 for purposes of paragraph (4)(H)(ii)), the Sec- 23 retary shall not provide for the establishment of 24 an FTE resident amount until such time as the 25 VerDate Sep 11 2014 00:25 Jul 18, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S2116.IS S2116 kjohnson on DSK79L0C42 with BILLS 3 •S 2116 IS Secretary determines that the hospital has a 1 medical residency training program that trains 2 more than 1.0 full-time-equivalent resident in a 3 cost reporting period. 4 ‘‘(iii) In the case of a hospital with an ap- 5 proved FTE resident amount— 6 ‘‘(I) based on the training of less than 7 1.0 full-time-equivalent resident before Oc- 8 tober 1, 1997; 9 ‘‘(II) based on the training of— 10 ‘‘(aa) no more than 6.0 full-time- 11 equivalent residents in a medical resi- 12 dency training program in any cost 13 reporting period during the period be- 14 tween October 1, 1996, and Sep- 15 tember 30, 1997; and 16 ‘‘(bb) no more than 3.0 full-time- 17 equivalent residents on or after Octo- 18 ber 1, 1997; or 19 ‘‘(III) based on the training of no full- 20 time-equivalent residents in a medical resi- 21 dency training program for any 20 con- 22 secutive cost reporting periods beginning 23 on or after October 1, 1997, 24 VerDate Sep 11 2014 00:25 Jul 18, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S2116.IS S2116 kjohnson on DSK79L0C42 with BILLS 4 •S 2116 IS the Secretary shall provide the hospital an op- 1 portunity to have a new FTE resident amount 2 established when the hospital begins training at 3 least 1.0 full-time equivalent resident (in the 4 case of a hospital described in subclauses (I or 5 III)) or more than 3.0 full-time-equivalent resi- 6 dents (in the case of a hospital described in 7 subclause (II)) for cost reporting periods begin- 8 ning on or after the date of the enactment of 9 this clause and in accordance with the method- 10 ology under the rules in effect as of October 1, 11 2015.’’. 12 (b) REDETERMINATION OF FTE RESIDENT LIMITA- 13 TION.—Section 1886(h)(4)(H)(i) of the Social Security 14 Act (42 U.S.C. 1395ww(h)(4)(H)(i)) is amended— 15 (1) by inserting ‘‘(I)’’ before ‘‘The Secretary’’; 16 and 17 (2) by adding at the end the following: 18 ‘‘(II) Under this clause the Secretary 19 shall not determine an adjustment in the 20 limitation applicable to a hospital under 21 subparagraph (F) until the hospital trains 22 more than 1.0 full-time equivalent resident 23 in a new medical residency training pro- 24 gram in a cost reporting period. 25 VerDate Sep 11 2014 00:25 Jul 18, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S2116.IS S2116 kjohnson on DSK79L0C42 with BILLS 5 •S 2116 IS ‘‘(III) In the case of a hospital that 1 has a limitation under subparagraph (F) of 2 less than 1.0 full-time-equivalent resident 3 as of the date of the enactment of this sub- 4 clause based on training before October 1, 5 1997, under this clause the Secretary shall 6 provide the hospital an opportunity to have 7 a new adjustment in such limitation deter- 8 mined when such hospital begins training 9 at least 1.0 full-time equivalent resident in 10 accordance with the methodology applica- 11 ble to hospitals under the rules in effect as 12 of October 1, 2015, and applied for cost 13 reporting periods beginning on or after the 14 date of the enactment of this subclause. 15 ‘‘(IV) In the case of a hospital that 16 has not reported full-time-equivalent resi- 17 dents in 20 consecutive cost reporting peri- 18 ods subsequent to October 1, 1997, under 19 this clause the Secretary shall provide the 20 hospital an opportunity to have a new ad- 21 justment in such limitation determined 22 when such hospital begins training at least 23 1.0 full-time equivalent resident in accord- 24 ance with the methodology applicable to 25 VerDate Sep 11 2014 00:25 Jul 18, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S2116.IS S2116 kjohnson on DSK79L0C42 with BILLS 6 •S 2116 IS hospitals under the rules in effect as of Oc- 1 tober 1, 2015, and applied for cost report- 2 ing periods beginning on or after the date 3 of the enactment of this subclause. 4 ‘‘(V) In the case of a hospital for 5 which an adjustment in the limitation ap- 6 plicable to a hospital under subparagraph 7 (F) is based on the training of no more 8 than 3.0 full-time-equivalent residents in a 9 medical residency training program in a 10 cost reporting period beginning on or after 11 October 1, 1997, and before the date of 12 the enactment of this subclause, the Sec- 13 retary shall provide the hospital an oppor- 14 tunity to have a new adjustment in such 15 limitation determined when the hospital be- 16 gins training more than 3.0 full-time- 17 equivalent residents in accordance with the 18 methodology applicable to hospitals under 19 the rules in effect as of October 1, 2015, 20 and applied for cost reporting periods be- 21 ginning on or after the date of the enact- 22 ment of this subclause.’’. 23 (c) EFFECTIVE DATE.—The amendments made by 24 this section shall apply to payment under section 1886 of 25 VerDate Sep 11 2014 00:25 Jul 18, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S2116.IS S2116 kjohnson on DSK79L0C42 with BILLS 7 •S 2116 IS the Social Security Act (42 U.S.C. 1395ww) for cost re- 1 porting periods beginning on or after the date of the en- 2 actment of this Act. 3 Æ VerDate Sep 11 2014 00:25 Jul 18, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6301 E:\BILLS\S2116.IS S2116 kjohnson on DSK79L0C42 with BILLS