Sec. 203. Distribution of additional residency positions
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Section 1886(h) of the Social Security Act ( 42 U.S.C. 1395ww(h) ) is amended— in paragraph (4)(F)(i), by striking and
(8)and inserting , (8), and
(9); in paragraph (4)(H)(i), by striking and
(8)and inserting , (8), and
(9); in paragraph (7)(E), by inserting paragraph (9), after paragraph (8), ; and by adding at the end the following new paragraph: Except as provided in clause (ii), if a hospital's reference resident level (as defined in subparagraph (H)) is less than the otherwise applicable resident limit (as defined in such subparagraph), effective for portions of cost reporting periods occurring on or after July 1, 2020, 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. This subparagraph shall not apply to— a hospital with fewer than 250 acute care inpatient beds that is located in a rural area (as defined in subsection (d)(2)(D)(ii)), including a hospital treated as being located in a rural area under subsection (d)(8)(E); a hospital that was part of a qualifying entity which had a voluntary residency reduction plan approved under paragraph (6)(B) or under the authority of section 402 of Public Law 90–248 , if the hospital demonstrates to the Secretary that it has a specified plan in place for filling the unused positions by not later than 2 years after the date of enactment of this paragraph; or a hospital described in paragraph (4)(H)(v). The Secretary shall 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, 2020. 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). Subject to clause (iii), a hospital that receives an increase in the otherwise applicable resident limit under this subparagraph shall ensure, during the 5-year period beginning on the date of such increase, that— the number of full-time equivalent primary care residents, as defined in paragraph (5)(H) (as determined by the Secretary), excluding any additional positions under subclause (II), is not less than the average number of full-time equivalent primary care residents (as so determined) during the 3 most recent cost reporting periods ending prior to the date of enactment of this paragraph; and not less than 75 percent of the positions attributable to such increase are in a primary care, psychiatry, or general surgery residency (as determined by the Secretary). The Secretary may determine whether a hospital has met the requirements under this clause during such 5-year period in such manner and at such time as the Secretary determines appropriate, including at the end of such 5-year period. In the case where the Secretary determines that a hospital described in clause
(ii)does not meet either of the requirements under subclause
(I)or
(II)of such clause, the Secretary shall— reduce the otherwise applicable resident limit of the hospital by the amount by which such limit was increased under this paragraph; and provide for the distribution of positions attributable to such reduction in accordance with the requirements of this paragraph. 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, 2020, as determined by the Secretary; and whether the hospital has an accredited rural training track (as described in paragraph (4)(H)(iv)). In determining for which hospitals the increase in the otherwise applicable resident limit is provided under subparagraph (B), subject to subparagraph (E), the Secretary shall distribute the increase to hospitals based on the following factors: Whether the hospital and the approved medical residency training program of the hospital have a proven track record of primary care and rural support (as determined by the Secretary). Whether the hospital is located in a State, a territory of the United States, or the District of Columbia that is among the top 20 States, territories, or Districts in terms of the ratio of the geographic area of the State, territory, or District in square miles that is rural compared to the geographic area in each other State, territory, or District in square miles that is rural (as determined by the Secretary based solely on the most recent available population data published by the Bureau of the Census). Whether the hospital is located in a rural area (as defined in subsection (d)(2)(D)(ii)), including a hospital treated as being located in a rural area under subsection (d)(8)(E). Subject to clause (ii), the Secretary shall reserve the positions available for distribution under this paragraph as follows: 70 percent of such positions for distribution to hospitals described in clause
(i)of subparagraph (D). 30 percent of such positions for distribution to hospitals described in clauses
(ii)and
(iii)of such subparagraph. In the case where the Secretary does not distribute positions to hospitals in accordance with clause
(i)by July 1, 2020, the Secretary shall distribute such positions to other hospitals in accordance with the considerations described in subparagraph
(C)and the priority described in subparagraph (D). A hospital may not receive more than 75 full-time equivalent additional residency positions under this paragraph. 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. In this paragraph, the terms reference resident level , resident level , and otherwise applicable resident limit have the meaning given such terms in paragraph (8)(H). 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. . 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 and (h)(8) and inserting , (h)(8), and (h)(9) . 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 new clause: For discharges occurring on or after July 1, 2020, 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. . Section 422(b)(2) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 ( Public Law 108–173 ) is amended by striking and
(8)and inserting , (8), and
(9).
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- Pub. L. 90-248
- Pub. L. 108-173
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Sec. 203
Distribution of additional residency positions
Pub. L.Pub. L. 90-248
Pub. L.Pub. L. 108-173
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