Sec. 3. Community-Based Medical Education Payments
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Title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ) is amended by adding at the end the following new section: The Secretary shall establish a program under which the Secretary makes payments to primary care teaching centers (as defined in subsection (c)) under this section. The Secretary shall establish the program under this section not later than January 1, 2019. In this section, the term primary care teaching center means an entity described in paragraph
(2)that— is accredited by the Accreditation Council on Graduate Medical Education, the American Osteopathic Association, or the Commission on Dental Accreditation; and operates a community-based primary care residency program (as defined in paragraph (5)) in a rural or underserved area. The following entities are described in this paragraph: An entity that received payments under section 340H of the Public Health Service Act for a community based, ambulatory patient care center which operates a primary care residency program or a related consortia recognized by the Health Resources and Services Administration. A community-based, independent corporate entity collaborating with one or more hospitals in operating one or more primary care residency programs. A medical education entity established by one or more hospitals to develop and operate one or more primary care residency programs. The hospital or hospitals may be the sole corporate members of the entity, but the governing board of the entity shall include representatives of the community. A medical education entity that is independent of any hospital but collaborates with a hospital in operating one or more medical residency training programs. The medical education entity may include a university or a school of medicine. A subsidiary of a hospital or independent corporation operating one or more primary care residency programs for the hospital with community participation in the governance of the organization. A rural training track program (as defined in paragraph (6)). The term primary care teaching center includes the following: A Federally qualified health center (as defined in section 1905(l)(2)(B)). A community mental health center (as defined in section 1861(ff)(3)(B)). A rural health clinic, as defined in section 1861(aa). A health center operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization (as defined in section 4 of the Indian Health Care Improvement Act). An entity receiving funds under title X of the Public Health Service Act. A critical access hospital. An entity that collaborates to form a consortium that operates an accredited primary care residency program, so long as the consortium is accredited in the primary care specialty and is listed as the institutional sponsor by the relevant accrediting body. Within the consortium, a community-based ambulatory care center shall play an integral role in the academic, financial, and administrative operations of the primary care residency program. In this section, the term primary care means family medicine, internal medicine, pediatrics, internal medicine-pediatrics, obstetrics and gynecology, psychiatry, general dentistry, pediatric dentistry, or geriatrics. In this section, the term primary care residency program means an approved medical residency training program (as defined in section 1886(h)(5)(A)) in primary care. In this section, the term rural training track program means an alternative training track integrated with a larger more urban or community hospital program and separately accredited as such, with a rural location, a rural mission, or a major rural service area, in which the residents spend approximately two of three years in a place of practice separate and more rural or rurally focused than the larger program. Subject to paragraph (3), the Secretary shall make payments under this section for not more than 1,500 new full-time equivalent resident training positions to be distributed to primary care teaching centers at a rate of not more than 300 per year until expended. Subject to paragraph (3), no single primary care teaching center shall receive a total of more than 50 of the positions distributed under the program, which must be in primary care specialties. The limitation under each of paragraphs
(1)and
(2)shall not apply with respect to a resident training position of a teaching health center that received payments under section 340H of the Public Health Service Act if the resident training position was in a medical residency training program operated by the teaching health center prior to the participation of the teaching health center as a primary care teaching center under this section. The Secretary shall make payments for a resident in a training position described in the preceding center under this section in accordance with subsection (f). The Secretary shall give preference to teaching health centers that received payments under section 340H of the Public Health Service Act that are seeking to participate as a primary care teaching center under this section. Subject to paragraph
(2)and subsection (i), for each year of the program, the Secretary shall develop a methodology to determine the per resident payment amount for each full-time equivalent resident of a primary care teaching center under this section. Subject to subsection (i), the per resident payment amount for each full-time equivalent resident of a primary care teaching center under this section for a year shall be not less than— for 2014, $150,000; and for each subsequent year, the amount determined under this paragraph for the preceding year increased by the percentage increase in the consumer price index for all urban consumers (United States city average) for the 12-month period ending with June of the preceding year. Any payment under this section with respect to a full-time equivalent resident of a primary care teaching center shall be made directly to the primary care teaching center. Nothing in this section shall effect payments under section 1886(d)(5)(B) or section 1886(h) or the application of the limitation on the number of residents under section 1886(h)(4)(F). In the case where a primary care residency program, including a rural training track program, funded by a hospital through payments under subsections (d)(5)(B) and
(h)of section 1886 becomes a primary care teaching center under this section, the hospital shall ensure, during the 10-year period beginning on the date of the transition, that the total number of full-time equivalent residents of the hospital in primary care does not decrease. The transition described in the preceding sentence shall begin on the date when the primary care teaching center receives its first payment under this section. Subject to the succeeding provisions of this subsection, the Secretary shall establish and implement procedures under which the amount of payments that a primary care teaching center would otherwise receive under this section for a year is adjusted based on the reporting of measures and the performance of the primary care teaching center on measures of population health priorities specified by the Secretary. The adjustments shall apply to payments— with respect to the adjustments for reporting under paragraph (7)(A), made for 2021; and with respect to the adjustments for performance under paragraph (7)(B), made for 2022 and subsequent years. The measures of population health priorities specified by the Secretary under this subsection shall be the measures specified by the Secretary under section 1886(t). The Secretary shall establish performance standards with respect to measures specified by the Secretary under this subsection for a performance period for a year (as established under paragraph (5)). The Secretary shall establish the performance period for a year. Such performance period shall begin and end prior to the beginning of such year. The procedures established and implemented under paragraph
(1)shall include a process under which primary care teaching centers shall submit data on the measures specified by the Secretary under this subsection to the Secretary in a form and manner, and at a time, specified by the Secretary for purposes of this subsection. For 2021, in the case of a primary care teaching center that does not submit, to the Secretary in accordance with this subsection, data required to be submitted under paragraph
(6)for a period (determined appropriate by the Secretary) for such year, the total amount that the primary care teaching center would otherwise receive under this section for such year shall be reduced by 1 percent. Subject to clause (ii), based on the performance of each primary care teaching center with respect to compliance with the measures for a performance period for a year (beginning with 2022), the Secretary shall determine the amount of any adjustment under this subparagraph to payments to the primary care teaching center under this section for such year. Such adjustment may not exceed an amount equal to 1 percent of the total amount that the primary care teaching center would otherwise receive under this section for such year. In making adjustments under this subparagraph, the Secretary shall ensure that the total amount of payments made to all primary care teaching centers under this section for a year is equal to the total amount of payments that would have been made to such centers under this section for such year if this subsection had not been enacted. Any adjustment under subparagraph
(A)or
(B)of paragraph
(7)shall apply only with respect to the year involved, and the Secretary shall not take into account any such adjustment in making payments to a primary care teaching center under this section in a subsequent year. Not later than January 1, 2021, and every five years thereafter, the Secretary shall submit to Congress a report on the implementation of the program under this section, including— the measure development procedures under subsection (i), including any barriers to measure development; the compliance with reporting on the performance measures under that subsection, including any barriers to such compliance; and recommendations to address any barriers described in subparagraph
(A)or (B). For purposes of carrying out this section, the Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 and the Federal Supplementary Medical Insurance Trust Fund under section 1841 (in such proportion as the Secretary determines appropriate), of such sums as are necessary to the Centers for Medicare & Medicaid Services Program Management Account for fiscal year 2019 and each succeeding fiscal year. Amounts transferred under the preceding sentence shall remain available until expended. .
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Sec. 3
Community-Based Medical Education Payments
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