What This Bill Does
This bill allows the federal government to create and distribute 2,000 new doctor training positions each year from 2025 through 2031 to hospitals that apply for them. Hospitals that receive these positions must actually hire and train the doctors they get. The bill also requires a study on how to increase diversity among healthcare professionals from rural, lower-income and underrepresented communities.
##
Who It Affects
- Hospitals that train doctors
- Doctor trainees (residents)
- Healthcare professional training programs
- Congress (receives the diversity study)
##
Key Provisions
- The federal government will distribute 2,000 new doctor training positions per year to qualifying hospitals for fiscal years 2025 through 2031. (Sec. 2(a)(11)(A)(ii)(II))
- One-third of available positions each year go to hospitals where the number of doctors they are actually training exceeds their current limit. These hospitals must train at least 25 percent of their doctors in primary care and general surgery and continue doing so for 5 years. (Sec. 2(a)(11)(B))
- The other two-thirds of positions go to hospitals based on their likelihood of filling positions, with at least 10 percent going to hospitals in rural areas, underserved areas or territories, and hospitals in states with newer medical schools. (Sec. 2(a)(11)(C))
- Hospitals must sign an agreement to actually increase their doctor training positions by the number they receive. (Sec. 2(a)(11)(D))
- No single hospital can receive more than 75 new training positions across the entire 2025 to 2031 period, unless the federal government finds extra positions are available. (Sec. 2(a)(11)(E))
- The Comptroller General (an auditor for Congress) must study strategies for increasing diversity in the healthcare workforce and report back to Congress within 2 years. (Sec. 3)
##
What Changes
If approved, hospitals can apply for new doctor training positions starting in fiscal year 2025. Hospitals that receive positions must hire doctors to fill them. The law increases how many resident positions overall can be distributed through the Medicare program. Rural hospitals and hospitals serving underserved areas will be guaranteed access to at least 10 percent of available positions each year.
##
Important Definitions
- "Otherwise applicable resident limit": The normal limit on how many doctor trainees a hospital is allowed to have under current rules (Sec. 2(a)(11)(H)(i))
- "Reference resident level": The number of doctor trainees a hospital actually had in their most recent cost reporting period before this law passes (Sec. 2(a)(11)(H)(ii))
- "Resident level": Not specified in bill text
- "Historically Black medical school": Howard University College of Medicine, Charles R. Drew University of Medicine and Science, Meharry Medical College, Morehouse School of Medicine, Xavier University Graduate School of Health Sciences and Medical School, and Maryland College of Osteopathic Medicine at Morgan State University (Sec. 2(a)(11)(H)(v))
- "Qualifying hospital": A hospital that meets one of the eligibility categories described in the bill (Sec. 2(a)(11)(H)(iv))
##
Effective Date
New doctor training positions become effective for cost reporting periods beginning on or after July 1 of each fiscal year from 2025 through 2031. (Sec. 2(a)(11)(A)(i)) The diversity study must be completed and reported to Congress within 2 years of the law's enactment. (Sec. 3(b))
I
118TH CONGRESS
1ST SESSION H. R. 2389
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 29, 2023
Ms. SEWELL (for herself and Mr. FITZPATRICK) 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 2023’’.
5
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•HR 2389 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), (8), (9), and (10)’’ and inserting ‘‘para-
6
graphs (7), (8), (9), (10), and (11)’’;
7
(2) in paragraph (4)(H)(i), by striking ‘‘para-
8
graphs (7), (8), (9), and (10)’’ and inserting ‘‘para-
9
graphs (7), (8), (9), (10), and (11)’’;
10
(3) in paragraph (7)(E), by inserting ‘‘para-
11
graph (10),’’ after ‘‘paragraph (8),’’; and
12
(4) by adding at the end the following new
13
paragraph:
14
‘‘(11) DISTRIBUTION
OF
ADDITIONAL
RESI-
15
DENCY POSITIONS.—
16
‘‘(A)
ADDITIONAL
RESIDENCY
POSI-
17
TIONS.—
18
‘‘(i) IN GENERAL.—For each of fiscal
19
years 2025 through 2031 (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
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•HR 2389 IH
each qualifying hospital (as defined in sub-
1
paragraph (H)) that submits a timely ap-
2
plication under this subparagraph by such
3
number as the Secretary may approve for
4
portions of cost reporting periods occurring
5
on or after July 1 of the fiscal year of the
6
increase.
7
‘‘(ii) NUMBER
AVAILABLE
FOR
DIS-
8
TRIBUTION.—For each such fiscal year,
9
the Secretary shall determine the total
10
number of additional residency positions
11
available for distribution under clause (i)
12
in accordance with the following:
13
‘‘(I) ALLOCATION TO HOSPITALS
14
ALREADY OPERATING OVER RESIDENT
15
LIMIT.—One-third of such number
16
shall be available for distribution only
17
to hospitals described in subparagraph
18
(B).
19
‘‘(II) AGGREGATE LIMITATION.—
20
Except as provided in clause (iv)(I),
21
the aggregate number of increases in
22
the otherwise applicable resident limit
23
under this subparagraph shall be
24
equal to 2,000 in each such year.
25
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•HR 2389 IH
‘‘(iii) PROCESS
FOR
DISTRIBUTING
1
POSITIONS.—
2
‘‘(I)
ROUNDS
OF
APPLICA-
3
TIONS.—The Secretary shall initiate 7
4
separate rounds of applications for an
5
increase under clause (i), 1 round
6
with respect to each of fiscal years
7
2025 through 2031.
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
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•HR 2389 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 2031.—If the aggregate number
19
of positions distributed under this
20
paragraph during the 7-year period of
21
fiscal years 2025 through 2031 is less
22
than 14,000, the Secretary shall, in
23
accordance with the provisions of
24
clause (ii) and subparagraph (E) and
25
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•HR 2389 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 14,000.
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
(H)(ii)) is greater than the otherwise appli-
15
cable 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
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•HR 2389 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
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•HR 2389 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
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•HR 2389 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) MINIMUM
DISTRIBUTION
FOR
15
CERTAIN
CATEGORIES
OF
HOSPITALS.—
16
With respect to the aggregate number of
17
such positions available for distribution
18
under this paragraph, the Secretary shall
19
distribute not less than 10 percent of such
20
aggregate number to each of the following
21
categories of hospitals:
22
‘‘(I) Hospitals that are located in
23
a rural area (as defined in subsection
24
(d)(2)(D)) or are treated as being lo-
25
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•HR 2389 IH
cated in a rural area pursuant to sub-
1
section (d)(8)(E) or are located in
2
Alaska, Hawaii, or a territory of the
3
United States.
4
‘‘(II) Hospitals in which the ref-
5
erence resident level of the hospital
6
(as specified in subparagraph (H)(ii))
7
is greater than the otherwise applica-
8
ble resident limit.
9
‘‘(III) Hospitals in States with—
10
‘‘(aa) new medical schools
11
that received ‘Candidate School’
12
status from the Liaison Com-
13
mittee on Medical Education or
14
that received ‘Pre-Accreditation’
15
status from the American Osteo-
16
pathic Association Commission
17
on Osteopathic College Accredita-
18
tion on or after January 1, 2000,
19
and that have achieved or con-
20
tinue to progress toward ‘Full
21
Accreditation’ status (as such
22
term is defined by the Liaison
23
Committee
on
Medical
Edu-
24
cation) or toward ‘Accreditation’
25
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•HR 2389 IH
status (as such term is defined
1
by the American Osteopathic As-
2
sociation Commission on Osteo-
3
pathic College Accreditation); or
4
‘‘(bb)
additional
locations
5
and branch campuses established
6
on or after January 1, 2000, by
7
medical schools with ‘Full Ac-
8
creditation’ status (as such term
9
is defined by the Liaison Com-
10
mittee on Medical Education) or
11
‘Accreditation’ status (as such
12
term is defined by the American
13
Osteopathic Association Commis-
14
sion on Osteopathic College Ac-
15
creditation).
16
‘‘(IV) Hospitals that serve areas
17
designated
as
health
professional
18
shortage
areas
under
section
19
332(a)(1)(A) of the Public Health
20
Service Act, as determined by the Sec-
21
retary.
22
‘‘(iii) PRIORITIZATION
IN
DISTRIBU-
23
TION
TO
HPSA
HOSPITALS.—In distrib-
24
uting positions to a hospital described in
25
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•HR 2389 IH
clause (ii)(IV), the Secretary shall give pri-
1
ority to hospitals that are affiliated with—
2
‘‘(I) a historically Black medical
3
school (as defined in subparagraph
4
(H)); or
5
‘‘(II) any other school listed in
6
section 326(e)(1) of the Higher Edu-
7
cation Act of 1965 that establishes a
8
medical college.
9
‘‘(D) PROHIBITION ON DISTRIBUTION TO
10
HOSPITALS
WITHOUT
AN
INCREASE
AGREE-
11
MENT.—No increase in the otherwise applicable
12
resident limit of a hospital may be made under
13
subparagraph (C) unless such hospital agrees to
14
increase the total number of full-time equivalent
15
residency positions under the approved medical
16
residency training program of such hospital by
17
the number of such positions made available by
18
such increase under the subparagraph.
19
‘‘(E) LIMITATION.—
20
‘‘(i) IN
GENERAL.—Except as pro-
21
vided in clause (ii), a hospital may not re-
22
ceive more than 75 full-time equivalent ad-
23
ditional residency positions in the aggre-
24
gate under this paragraph, paragraph (9),
25
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•HR 2389 IH
and paragraph (10) over the period of fis-
1
cal years 2025 through 2031.
2
‘‘(ii) INCREASE IN NUMBER OF ADDI-
3
TIONAL POSITIONS A HOSPITAL MAY RE-
4
CEIVE.—The Secretary shall increase the
5
aggregate number of full-time equivalent
6
additional residency positions a hospital
7
may receive under this paragraph over
8
such period if the Secretary estimates that
9
the number of positions available for dis-
10
tribution under subparagraph (A) exceeds
11
the number of applications approved under
12
such subparagraph over such period.
13
‘‘(F) APPLICATION
OF
PER
RESIDENT
14
AMOUNTS
FOR
PRIMARY
CARE
AND
NONPRI-
15
MARY CARE.—With respect to additional resi-
16
dency positions in a hospital attributable to the
17
increase provided under this paragraph, the ap-
18
proved FTE per resident amounts are deemed
19
to be equal to the hospital per resident amounts
20
for primary care and nonprimary care com-
21
puted under paragraph (2)(D) for that hospital.
22
‘‘(G) PERMITTING
FACILITIES
TO
APPLY
23
AGGREGATION
RULES.—The Secretary shall
24
permit hospitals receiving additional residency
25
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H
[Text truncated for display. Full text available on Congress.gov.]