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II
118TH CONGRESS
1ST SESSION
S. 1302
To amend title XVIII of the Social Security Act to provide for the distribution
of additional residency positions, and for other purposes.
IN THE SENATE OF THE UNITED STATES
APRIL 26, 2023
Mr. MENENDEZ (for himself, Mr. BOOZMAN, Mr. SCHUMER, and Ms. COL-
LINS) 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 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
SEC. 2. DISTRIBUTION OF ADDITIONAL RESIDENCY POSI-
6
TIONS.
7
(a) IN GENERAL.—Section 1886(h) of the Social Se-
8
curity Act (42 U.S.C. 1395ww(h)) is amended—
9
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•S 1302 IS
(1) in paragraph (4)(F)(i), by striking ‘‘and
1
(10)’’ and inserting ‘‘(10), and (11)’’;
2
(2) in paragraph (4)(H)(i), by striking ‘‘and
3
(10)’’ and inserting ‘‘(10), and (11)’’;
4
(3) in paragraph (7)(E), by inserting ‘‘para-
5
graph (11),’’ after ‘‘paragraph (10),’’; and
6
(4) by adding at the end the following new
7
paragraph:
8
‘‘(11) DISTRIBUTION
OF
ADDITIONAL
RESI-
9
DENCY POSITIONS.—
10
‘‘(A)
ADDITIONAL
RESIDENCY
POSI-
11
TIONS.—
12
‘‘(i) IN GENERAL.—For each of fiscal
13
years 2025 through 2031 (and succeeding
14
fiscal years if the Secretary determines
15
that there are additional residency posi-
16
tions available to distribute under clause
17
(iii)(II)), the Secretary shall increase the
18
otherwise applicable resident limit for each
19
qualifying hospital (as defined in subpara-
20
graph (G)) that submits a timely applica-
21
tion under this subparagraph by such
22
number as the Secretary may approve for
23
portions of cost reporting periods occurring
24
on or after July 1 of the fiscal year of the
25
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•S 1302 IS
increase. Except as provided in clause (iii),
1
the aggregate number of increases in the
2
otherwise applicable resident limit under
3
this subparagraph shall be equal to 2,000
4
in each of fiscal years 2025 through 2031.
5
‘‘(ii) PROCESS FOR DISTRIBUTING PO-
6
SITIONS.—
7
‘‘(I)
ROUNDS
OF
APPLICA-
8
TIONS.—The Secretary shall initiate 7
9
separate rounds of applications for an
10
increase under clause (i), 1 round
11
with respect to each of fiscal years
12
2025 through 2031.
13
‘‘(II) NUMBER
AVAILABLE.—In
14
each of such rounds, the aggregate
15
number of positions available for dis-
16
tribution in the fiscal year as a result
17
of an increase in the otherwise appli-
18
cable resident limit (as described in
19
clause (i)) shall be distributed, plus
20
any
additional
positions
available
21
under clause (iii).
22
‘‘(III) TIMING.—The Secretary
23
shall notify hospitals of the number of
24
positions distributed to the hospital
25
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under this paragraph as result of an
1
increase in the otherwise applicable
2
resident limit by January 31 of the
3
fiscal year of the increase. Such in-
4
crease shall be effective for portions of
5
cost reporting periods beginning on or
6
after July 1 of that fiscal year.
7
‘‘(iii) POSITIONS
NOT
DISTRIBUTED
8
DURING THE FISCAL YEAR.—
9
‘‘(I) IN GENERAL.—If the num-
10
ber of resident full-time equivalent po-
11
sitions distributed under this para-
12
graph in a fiscal year is less than the
13
aggregate number of positions avail-
14
able for distribution in the fiscal year
15
(as described in clause (i), including
16
after application of this subclause),
17
the difference between such number
18
distributed and such number available
19
for distribution shall be added to the
20
aggregate number of positions avail-
21
able for distribution in the following
22
fiscal year.
23
‘‘(II) EXCEPTION
IF
POSITIONS
24
NOT DISTRIBUTED BY END OF FISCAL
25
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YEAR 2031.—If the aggregate number
1
of positions distributed under this
2
paragraph during the 7-year period of
3
fiscal years 2025 through 2031 is less
4
than 14,000, the Secretary shall, in
5
accordance with the considerations de-
6
scribed in subparagraph (B)(i) and
7
the priority described in subparagraph
8
(B)(ii), conduct an application and
9
distribution process in each subse-
10
quent fiscal year until such time as
11
the aggregate amount of positions dis-
12
tributed under this paragraph is equal
13
to 14,000.
14
‘‘(B) DISTRIBUTION
TO
CERTAIN
HOS-
15
PITALS.—
16
‘‘(i) CONSIDERATION
IN
DISTRIBU-
17
TION.—In determining for which hospitals
18
the increase in the otherwise applicable
19
resident limit is provided under subpara-
20
graph (A), the Secretary shall take into ac-
21
count the demonstrated likelihood of the
22
hospital filling the positions made available
23
under this paragraph within the first 5
24
cost reporting periods beginning after the
25
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date the increase would be effective, as de-
1
termined by the Secretary.
2
‘‘(ii) MINIMUM
DISTRIBUTION
FOR
3
CERTAIN
CATEGORIES
OF
HOSPITALS.—
4
With respect to the aggregate number of
5
such positions available for distribution
6
under this paragraph, the Secretary shall
7
distribute not less than 10 percent of such
8
aggregate number to each of the following
9
categories of hospitals:
10
‘‘(I) Hospitals that are located in
11
a rural area (as defined in subsection
12
(d)(2)(D)) or are treated as being lo-
13
cated in a rural area pursuant to sub-
14
section (d)(8)(E).
15
‘‘(II) Hospitals in which the ref-
16
erence resident level of the hospital
17
(as specified in subparagraph (G)(iii))
18
is greater than the otherwise applica-
19
ble resident limit.
20
‘‘(III) Hospitals in States with—
21
‘‘(aa) new medical schools
22
that received ‘Candidate School’
23
status from the Liaison Com-
24
mittee on Medical Education or
25
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that received ‘Pre-Accreditation’
1
status from the American Osteo-
2
pathic Association Commission
3
on Osteopathic College Accredita-
4
tion on or after January 1, 2000,
5
and that have achieved or con-
6
tinue to progress toward ‘Full
7
Accreditation’ status (as such
8
term is defined by the Liaison
9
Committee
on
Medical
Edu-
10
cation) or toward ‘Accreditation’
11
status (as such term is defined
12
by the American Osteopathic As-
13
sociation Commission on Osteo-
14
pathic College Accreditation); or
15
‘‘(bb)
additional
locations
16
and branch campuses established
17
on or after January 1, 2000, by
18
medical schools with ‘Full Ac-
19
creditation’ status (as such term
20
is defined by the Liaison Com-
21
mittee on Medical Education) or
22
‘Accreditation’ status (as such
23
term is defined by the American
24
Osteopathic Association Commis-
25
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sion on Osteopathic College Ac-
1
creditation).
2
‘‘(IV) Hospitals that serve areas
3
designated
as
health
professional
4
shortage
areas
under
section
5
332(a)(1)(A) of the Public Health
6
Service Act, as determined by the Sec-
7
retary.
8
‘‘(iii) SPECIAL RULE.—In distributing
9
positions under clause (ii), the Secretary
10
shall not prioritize hospitals in multiple
11
categories over hospitals in an individual
12
category or based on section 332 of the
13
Public Health Service Act.
14
‘‘(C) PROHIBITION ON DISTRIBUTION TO
15
HOSPITALS
WITHOUT
AN
INCREASE
AGREE-
16
MENT.—No increase in the otherwise applicable
17
resident limit of a hospital may be made under
18
this paragraph unless such hospital agrees to
19
increase the total number of full-time equivalent
20
residency positions under the approved medical
21
residency training program of such hospital by
22
the number of such positions made available by
23
such increase under this paragraph.
24
‘‘(D) LIMITATION.—
25
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‘‘(i) IN
GENERAL.—Except as pro-
1
vided in clause (ii), a hospital may not re-
2
ceive more than 75 full-time equivalent ad-
3
ditional residency positions in the aggre-
4
gate under this paragraph and paragraphs
5
(9) and (10) over the period of fiscal years
6
2025 through 2031.
7
‘‘(ii) INCREASE IN NUMBER OF ADDI-
8
TIONAL POSITIONS A HOSPITAL MAY RE-
9
CEIVE.—The Secretary shall increase the
10
aggregate number of full-time equivalent
11
additional residency positions a hospital
12
may receive under this paragraph over
13
such period if the Secretary estimates that
14
the number of positions available for dis-
15
tribution under subparagraph (A) exceeds
16
the number of applications approved under
17
such subparagraph over such period.
18
‘‘(E) APPLICATION
OF
PER
RESIDENT
19
AMOUNTS
FOR
PRIMARY
CARE
AND
NONPRI-
20
MARY CARE.—With respect to additional resi-
21
dency positions in a hospital attributable to the
22
increase provided under this paragraph, the ap-
23
proved FTE per resident amounts are deemed
24
to be equal to the hospital per resident amounts
25
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for primary care and nonprimary care com-
1
puted under paragraph (2)(D) for that hospital.
2
‘‘(F) PERMITTING
FACILITIES
TO
APPLY
3
AGGREGATION
RULES.—The Secretary shall
4
permit hospitals receiving additional residency
5
positions attributable to the increase provided
6
under this paragraph to, beginning in the fifth
7
year after the effective date of such increase,
8
apply such positions to the limitation amount
9
under paragraph (4)(F) that may be aggre-
10
gated pursuant to paragraph (4)(H) among
11
members of the same affiliated group.
12
‘‘(G) DEFINITIONS.—In this paragraph:
13
‘‘(i) OTHERWISE
APPLICABLE
RESI-
14
DENT LIMIT.—The term ‘otherwise appli-
15
cable resident limit’ means, with respect to
16
a hospital, the limit otherwise applicable
17
under subparagraphs (F)(i) and (H) of
18
paragraph (4) on the resident level for the
19
hospital determined without regard to this
20
paragraph but taking into account para-
21
graphs (7)(A), (7)(B), (8)(A), (8)(B),
22
(9)(A), (9)(B), (10)(A), and (10)(B).
23
‘‘(ii)
QUALIFYING
HOSPITAL.—The
24
term ‘qualifying hospital’ means a hospital
25
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described in any of subclauses (I) through
1
(IV) of subparagraph (B)(ii).
2
‘‘(iii)
REFERENCE
RESIDENT
3
LEVEL.—The
term
‘reference
resident
4
level’ means, with respect to a hospital, the
5
resident level for the most recent cost re-
6
porting period of the hospital ending on or
7
before the date of enactment of this para-
8
graph, for which a cost report has been
9
settled (or, if not, submitted (subject to
10
audit)), as determined by the Secretary.
11
‘‘(iv) RESIDENT
LEVEL.—The term
12
‘resident level’ has the meaning given such
13
term in paragraph (7)(C)(i).’’.
14
(b) IME.—
15
(1) IN GENERAL.—Section 1886(d)(5)(B)(v) of
16
the
Social
Security
Act
(42
U.S.C.
17
1395ww(d)(5)(B)(v)), in the third sentence, is
18
amended by striking ‘‘and (h)(10)’’ and inserting
19
‘‘(h)(10), and (h)(11)’’.
20
(2)
CONFORMING
PROVISION.—Section
21
1886(d)(5)(B) of the Social Security Act (42 U.S.C.
22
1395ww(d)(5)(B)) is amended by adding after
23
clause (xiii) the following new clause:
24
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‘‘(ix) For discharges occurring on or after July
1
1, 2025, insofar as an additional payment amount
2
under this subparagraph is attributable to resident
3
positions distributed to a hospital under subsection
4
(h)(10), the indirect teaching adjustment factor shall
5
be computed in the same manner as provided under
6
clause (ii) with respect to such resident positions.’’.
7
SEC. 3. STUDY AND REPORT ON STRATEGIES FOR INCREAS-
8
ING DIVERSITY.
9
(a) STUDY.—The Comptroller General of the United
10
States (in this section referred to as the ‘‘Comptroller
11
General’’) shall conduct a study on strategies for increas-
12
ing the diversity of the health professional workforce. Such
13
study shall include an analysis of strategies for increasing
14
the number of health professionals from rural, lower in-
15
come, and underrepresented minority communities, includ-
16
ing which strategies are most effective for achieving such
17
goal.
18
(b) REPORT.—Not later than 2 years after the date
19
of the enactment of this Act, the Comptroller General shall
20
submit to Congress a report on the study conducted under
21
subsection (a), together with recommendations for such
22
legislation and administrative action as the Comptroller
23
General determines appropriate.
24
Æ
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