Supporting Graduate Medical Education at Community Hospitals Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 3753 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 JULY 15, 2019 Mr. GOTTHEIMER (for himself and Mr. PASCRELL) 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 provisions as fall within the jurisdiction of the committee con- cerned 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 VerDate Sep 11 2014 02:55 Jul 26, 2019 Jkt 034408 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3753.IH H3753 Pbinns on DSK79D2C42PROD with BILLS 2 •HR 3753 IH SEC. 2. FINDINGS. 1 Congress makes the following findings: 2 (1) Graduate Medical Education or ‘‘GME’’ 3 training programs are of critical importance in de- 4 veloping the physician workforce. 5 (2) Current caps on GME training programs 6 under Medicare have been in place since 1997. 7 (3) Hospitals seeking to launch GME training 8 programs face barriers in establishing physician 9 training programs in community hospitals. 10 SEC. 3. MEDICARE GME TREATMENT OF HOSPITALS ESTAB- 11 LISHING NEW MEDICAL RESIDENCY TRAIN- 12 ING PROGRAMS AFTER HOSTING MEDICAL 13 RESIDENT ROTATORS FOR SHORT DURA- 14 TIONS. 15 (a) REDETERMINATION OF APPROVED FTE RESI- 16 DENT AMOUNT.—Section 1886(h)(2)(F) of the Social Se- 17 curity Act (42 U.S.C. 1395ww(h)(2)(F)) is amended— 18 (1) by inserting ‘‘(i)’’ before ‘‘In the case of’’; 19 and 20 (2) by adding at the end the following: 21 ‘‘(ii) In applying this subparagraph to a 22 hospital that has not entered into a GME affili- 23 ation agreement (as defined by the Secretary 24 for purposes of paragraph (4)(H)(ii)), the Sec- 25 retary shall not provide for the establishment of 26 VerDate Sep 11 2014 02:55 Jul 26, 2019 Jkt 034408 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3753.IH H3753 Pbinns on DSK79D2C42PROD with BILLS 3 •HR 3753 IH an FTE resident amount until such time as the 1 Secretary determines that the hospital has a 2 medical residency training program that trains 3 more than 1.0 full-time-equivalent resident in a 4 cost reporting period. 5 ‘‘(iii) In the case of a hospital with an ap- 6 proved FTE resident amount— 7 ‘‘(I) based on the training of less than 8 1.0 full-time-equivalent resident before Oc- 9 tober 1, 1997, or 10 ‘‘(II) based on the training of no more 11 than 6.0 full-time-equivalent residents in a 12 medical residency training program in any 13 cost reporting period between October 1, 14 1996 and September 30, 1997 and no 15 more than 3.0 full-time-equivalent resi- 16 dents on and after October 1, 1997, or 17 ‘‘(III) based on the training of no full- 18 time-equivalent residents in a medical resi- 19 dency training program for any twenty 20 consecutive cost reporting periods begin- 21 ning on or after October 1, 1997, 22 the Secretary shall provide the hospital an op- 23 portunity to have a new FTE resident amount 24 established when the hospital begins training at 25 VerDate Sep 11 2014 02:55 Jul 26, 2019 Jkt 034408 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3753.IH H3753 Pbinns on DSK79D2C42PROD with BILLS 4 •HR 3753 IH least 1.0 full-time-equivalent resident (in the 1 case of a hospital described in subclauses (I or 2 III)) or more than 3.0 full-time-equivalent resi- 3 dents (in the case of a hospital described in 4 subclause (II)) for cost reporting periods begin- 5 ning on or after the date of the enactment of 6 this clause and in accordance with the method- 7 ology under the rules in effect as of October 1, 8 2015.’’. 9 (b) REDETERMINATION OF FTE RESIDENT LIMITA- 10 TION.—Section 1886(h)(4)(H)(i) of the Social Security 11 Act (42 U.S.C. 1395ww(h)(4)(H)(i)) is amended— 12 (1) by inserting ‘‘(I)’’ before ‘‘The Secretary’’; 13 and 14 (2) by adding at the end the following: 15 ‘‘(II) Under this clause the Secretary 16 shall not determine an adjustment in the 17 limitation applicable to a hospital under 18 subparagraph (F) until the hospital trains 19 more than 1.0 full-time-equivalent resident 20 in a new medical residency training pro- 21 gram in a cost reporting period. 22 ‘‘(III) In the case of a hospital that 23 has a limitation under subparagraph (F) of 24 less than 1.0 full-time-equivalent resident 25 VerDate Sep 11 2014 02:55 Jul 26, 2019 Jkt 034408 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3753.IH H3753 Pbinns on DSK79D2C42PROD with BILLS 5 •HR 3753 IH as of the date of the enactment of this sub- 1 clause based on training before October 1, 2 1997, under this clause the Secretary shall 3 provide the hospital an opportunity to have 4 a new adjustment in such limitation deter- 5 mined when such hospital begins training 6 at least 1.0 full-time-equivalent resident in 7 accordance with the methodology applica- 8 ble to hospitals under the rules in effect as 9 of October 1, 2015, and applied for cost 10 reporting periods beginning on or after the 11 date of the enactment of this subclause. 12 ‘‘(IV) In the case of a hospital that 13 has not reported full-time-equivalent resi- 14 dents in twenty consecutive cost reporting 15 periods subsequent to October 1, 1997, 16 under this clause the Secretary shall pro- 17 vide the hospital an opportunity to have a 18 new adjustment in such limitation deter- 19 mined when such hospital begins training 20 at least 1.0 full-time-equivalent resident in 21 accordance with the methodology applica- 22 ble to hospitals under the rules in effect as 23 of October 1, 2015, and applied for cost 24 VerDate Sep 11 2014 02:55 Jul 26, 2019 Jkt 034408 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3753.IH H3753 Pbinns on DSK79D2C42PROD with BILLS 6 •HR 3753 IH reporting periods beginning on or after the 1 date of the enactment of this subclause. 2 ‘‘(V) In the case of a hospital for 3 which an adjustment in the limitation ap- 4 plicable to a hospital under subparagraph 5 (F) is based on the training of no more 6 than 3.0 full-time-equivalent residents in a 7 medical residency training program in a 8 cost reporting period beginning on or after 9 October 1, 1997, and before the date of 10 the enactment of this subclause, the Sec- 11 retary shall provide the hospital an oppor- 12 tunity to have a new adjustment in such 13 limitation determined when the hospital be- 14 gins training more than 3.0 full-time- 15 equivalent residents in accordance with the 16 methodology applicable to hospitals under 17 the rules in effect as of October 1, 2015, 18 and applied for cost reporting periods be- 19 ginning on or after the date of the enact- 20 ment of this subclause.’’. 21 (c) EFFECTIVE DATE.—The amendments made by 22 this section shall apply to payment under section 1886 of 23 the Social Security Act (42 U.S.C. 1395ww) for cost re- 24 VerDate Sep 11 2014 02:55 Jul 26, 2019 Jkt 034408 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3753.IH H3753 Pbinns on DSK79D2C42PROD with BILLS 7 •HR 3753 IH porting periods beginning on or after the date of the en- 1 actment of this Act. 2 Æ VerDate Sep 11 2014 02:55 Jul 26, 2019 Jkt 034408 PO 00000 Frm 00007 Fmt 6652 Sfmt 6301 E:\BILLS\H3753.IH H3753 Pbinns on DSK79D2C42PROD with BILLS