[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1167 Introduced in House (IH)]
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115th CONGRESS
1st Session
H. R. 1167
To amend title XVIII of the Social Security Act to promote physician
training in newly recognized primary medical specialties, and for other
purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 16, 2017
Mrs. Love (for herself, Mr. Rush, and Mrs. McMorris Rodgers) 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 concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to promote physician
training in newly recognized primary medical specialties, and for other
purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Enhancing Opportunities for Medical
Doctors Act of 2017''.
SEC. 2. REDISTRIBUTING UNUSED RESIDENCY POSITIONS TO PROMOTE THE
ESTABLISHMENT OF RESIDENCY PROGRAMS FOR NEWLY RECOGNIZED
PRIMARY MEDICAL SPECIALTIES.
(a) In General.--Section 1886(h) of the Social Security Act (42
U.S.C. 1395ww(h)) is amended--
(1) in paragraph (4)(F)(i), by striking ``(7) and (8)'' and
inserting ``(7), (8), and (9)'';
(2) in paragraph (4)(H)(i), by striking ``(7) and (8)'' and
inserting ``(7), (8), and (9)'';
(3) in paragraph (7)(E), by striking ``paragraph (8)'' and
inserting ``paragraph (8) or (9)'' before the period at the
end; and
(4) by adding at the end the following new paragraph:
``(9) Distribution of additional residency positions.--
``(A) Reductions in limit based on unused
positions.--
``(i) In general.--If a hospital's
reference resident level (as defined in
subparagraph (G)(i)) is less than the otherwise
applicable resident limit (as defined in
subparagraph (G)(iii)), effective for portions
of cost reporting periods occurring on or after
July 1, 2018, the otherwise applicable resident
limit shall be reduced by 65 percent of the
difference between such otherwise applicable
resident limit and such reference resident
level.
``(ii) Exception.--This subparagraph shall
not apply to a hospital located in a rural area
(as defined in subsection (d)(2)(D)(ii)) with
fewer than 250 acute care inpatient beds.
``(B) Distribution.--
``(i) In general.--The Secretary shall, in
accordance with the succeeding provisions of
this paragraph, increase the otherwise
applicable resident limit for each qualifying
hospital that submits an application under this
subparagraph by such number as the Secretary
may approve for portions of cost reporting
periods occurring on or after July 1, 2018. The
aggregate number of increases in the otherwise
applicable resident limit under this
subparagraph shall be equal to the aggregate
reduction in such limits attributable to
subparagraph (A) (as estimated by the
Secretary).
``(ii) Requirements.--Subject to clause
(iii), a hospital that receives an increase in
the otherwise applicable resident limit under
this subparagraph shall ensure, during the 3-
year period beginning on the date of such
increase, that the positions resulting from the
increase under this paragraph will be filled.
The Secretary may determine whether a hospital
has met the requirements under this clause
during such 3-year period in such manner and at
such time as the Secretary determines
appropriate, including at the end of such 3-
year period.
``(iii) Redistribution of positions if
hospital no longer meets certain
requirements.--In the case where the Secretary
determines that a hospital described in clause
(ii) does not meet the requirements of such
clause, the Secretary shall--
``(I) reduce the otherwise
applicable resident limit of the
hospital by the amount by which such
limit was increased under this
paragraph; and
``(II) provide for the distribution
of positions attributable to such
reduction in accordance with the
requirements of this paragraph.
``(C) Capacity considerations in redistribution.--
In determining for which hospitals the increase in the
otherwise applicable resident limit is provided under
subparagraph (B), the Secretary shall take into account
the demonstration likelihood of the hospital filling
the positions made available under this paragraph
within the first 3 cost reporting periods beginning on
or after July 1, 2018, as determined by the Secretary.
``(D) Priority in redistribution.--Subject to
subparagraphs (C) and (E), the Secretary shall
determine which qualifying hospitals receive increases
under subparagraph (B) in the otherwise applicable
resident limits for such hospitals in a manner that
distributes the positions made available to hospitals
under this paragraph in accordance with the following:
``(i) The Secretary shall make such
positions available to hospitals with
applicable residency training programs.
``(ii) In the case that the application of
clause (i) does not result in the distribution
of all positions made available under this
paragraph, the Secretary shall make any
positions that remain undistributed after the
application of such clause available to
hospitals that are located in--
``(I) a State with a resident-to-
population ratio in the lowest quartile
(as determined by the Secretary);
``(II) a State, a territory of the
United States, or the District of
Columbia that is among the top 10
States, territories, or Districts in
terms of the ratio of the total
population of the State, territory, or
District living in an area designated
(under such section 332(a)(1)(A)) as a
health professional shortage area (as
of the date of enactment of this
paragraph), to the total population of
the State, territory, or District (as
determined by the Secretary based on
the most recent available population
data published by the Bureau of the
Census); or
``(III) a rural area (as defined in
subsection (d)(2)(D)(ii)).
``(iii) In the case that the application of
clauses (i) and (ii) does not result in the
distribution of all positions made available
under this paragraph, the Secretary shall make
any positions that remain undistributed after
the application of such clauses available to
hospitals that establish a medical residency
program that is sponsored by, or affiliated
with, a medical school that was first
accredited during the cost reporting period
prior to the cost reporting period with respect
to which such application applies.
``(E) Limitation.--A hospital may not receive more
than 75 full-time equivalent additional residency
positions under this paragraph.
``(F) Application of per resident amounts for
primary care and nonprimary care.--With respect to
additional residency positions in a hospital
attributable to the increase provided under this
paragraph, the approved FTE per resident amounts are
deemed to be equal to the hospital per resident amounts
for primary care and nonprimary care computed under
paragraph (2)(D) for that hospital.
``(G) Definitions.--In this paragraph:
``(i) Reference resident level.--The term
`reference resident level' means, with respect
to a hospital, the highest resident level for
any of the 3 most recent cost reporting periods
(ending before the date of the enactment of
this paragraph) of the hospital for which a
cost report has been settled (or, if not,
submitted (subject to audit)), as determined by
the Secretary.
``(ii) Resident level.--The term `resident
level' has the meaning given such term in
paragraph (7)(C)(i).
``(iii) Otherwise applicable resident
limit.--The term `otherwise applicable resident
limit' means, with respect to a hospital, the
limit otherwise applicable under subparagraphs
(F)(i) and (H) of paragraph (4) on the resident
level for the hospital determined without
regard to this paragraph but taking into
account paragraph (7)(A).
``(iv) Applicable residency training
program.--
``(I) In general.--The term
`applicable residency training program'
means a medical residency training
program that is for the applicable
primary specialty that, as of the date
of the enactment of this paragraph, is
the applicable primary specialty that
has most recently been designated as a
primary specialty by the American Board
of Medical Specialties.
``(II) Applicable primary
specialty.--The term `applicable
primary specialty' means a primary
specialty a resident of which is not,
as of the date of the enactment of this
paragraph, counted as an FTE resident
for purposes of this subsection. For
purposes of the preceding sentence, the
term `primary specialty' does not
include a subspecialty.
``(H) Affiliation.--The provisions of this
paragraph shall be applied to hospitals which are
members of the same affiliated group (as defined by the
Secretary under paragraph (4)(H)(ii)) and the reference
resident level for each such hospital shall be the
reference resident level with respect to the cost
reporting period that results in the smallest
difference between the reference resident level and the
otherwise applicable resident limit.''.
(b) IME.--
(1) In general.--Section 1886(d)(5)(B)(v) of the Social
Security Act (42 U.S.C. 1395ww(d)(5)(B)(v)), in the second
sentence, is amended by striking ``subsections (h)(7) and
(h)(8)'' and inserting ``subsections (h)(7), (h)(8), and
(h)(9)''.
(2) Conforming amendment.--Section 1886(d)(5)(B) of the
Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) is amended by
adding at the end the following clause:
``(xii) For discharges occurring on or
after July 1, 2018, insofar as an additional
payment amount under this subparagraph is
attributable to resident positions distributed
to a hospital under subsection (h)(9)(B), the
indirect teaching adjustment factor shall be
computed in the same manner as provided under
clause (ii) with respect to such resident
positions.''.
(c) Conforming Amendment.--Section 422(b)(2) of the Medicare
Prescription Drug, Improvement, and Modernization Act of 2003 (Public
Law 108-173), as amended by section 5503 of the Patient Protection and
Affordable Care Act (Public Law 111-148), is amended by striking
``paragraphs (7) and (8)'' and inserting ``paragraphs (7), (8), and
(9).''.
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