Sec. 137405. 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
(9)and inserting (9), and
(10); in paragraph (4)(H)(i), by striking and
(9)and inserting (9), and
(10); and by adding at the end the following new paragraph: For fiscal years 2025 and 2026, and for each succeeding fiscal year until the aggregate number of full-time equivalent residency positions distributed under this paragraph is equal to the aggregate number of such positions made available (as specified in clause (ii)), the Secretary shall, subject to the succeeding provisions of this paragraph, increase the otherwise applicable resident limit for each qualifying hospital (as defined in subparagraph (F)) that submits a timely application under this subparagraph by such number as the Secretary may approve effective beginning July 1 of the fiscal year of the increase. The aggregate number of such positions made available under this paragraph shall be equal to 4,000. The aggregate number of such positions so made available shall not exceed 2,000 for a fiscal year. The Secretary shall initiate a separate round of applications for an increase under clause
(i)for each fiscal year for which such an increase is to be provided. Except as provided under subclause (II), of the positions made available under this paragraph— not less than 25 percent shall be in a primary care residency (as defined in subparagraph (F)) or obstetrics and gynecology residency; and not less than 15 percent shall be in a psychiatry residency (as defined in such subparagraph). The requirement under subclause
(I)shall not apply with respect to any positions made available under this paragraph that are not distributed to a qualifying hospital by July 1, 2027, and such positions shall be distributed to hospitals in accordance with subparagraph (B), without regard to specialty. A qualifying hospital may apply for, and receive, an increase under this paragraph and paragraph
(9)for a fiscal year. For purposes of providing an increase in the otherwise applicable resident limit under subparagraph (A), the following shall apply: With respect to the aggregate number of such positions available for distribution under this paragraph, the Secretary shall distribute 30 percent of such aggregate number to the category of hospitals described in subclause
(II)of clause (ii), 20 percent of such aggregate number to each of the categories of hospitals described in subclauses (I), (III), and
(IV)of such clause, and 10 percent of such aggregate number to the category of hospitals described in subclause
(V)of such clause, subject to clauses
(iii)and (iv). The following categories of hospitals are described in this clause: Hospitals that are located in a rural area (as defined in subsection (d)(2)(D)) or are treated as being located in a rural area pursuant to subsection (d)(8)(E), hospitals that are located in a census tract assigned a rural-urban commuting area code of 4 or greater, and hospitals that are a sole community hospital (as defined in subsection (d)(5)(D)(iii)). Hospitals in which the reference resident level of the hospital (as specified in subparagraph (F)(v)) is greater than the otherwise applicable resident limit. Hospitals in States with— a new medical school that received Candidate School status from the Liaison Committee on Medical Education or Pre-Accreditation status from the American Osteopathic Association Commission on Osteopathic College Accreditation on or after January 1, 2000, and achieved or continued to progress toward Full Accreditation status (as such term is defined by the Liaison Committee on Medical Education) or toward Accreditation status (as such term is defined by the American Osteopathic Association Commission on Osteopathic College Accreditation); or an additional location or branch campus established on or after January 1, 2000, by a medical school with Full Accreditation status (as such term is defined by the Liaison Committee on Medical Education) or Accreditation status (as such term is defined by the American Osteopathic Association Commission on Osteopathic College Accreditation). Hospitals that are located in or serve an area designated as a health professional shortage area under section 332(a)(1)(A) of the Public Health Service Act or serve a population group designated under section 332(a)(1)(B) of such Act, as determined by the Secretary. Hospitals located in States in the lowest quartile for resident-to-population ratios, as defined by the Secretary. Any positions made available under this paragraph that are not distributed to a qualifying hospital in accordance with clause
(i)by July 1, 2027, shall be distributed to other hospitals, subject to the requirement under clause (iv). In carrying out the preceding sentence, the Secretary shall ensure that such positions are first offered to qualifying hospitals in categories described in clause
(ii)before being distributed to other hospitals. A hospital shall only be eligible to receive positions made available under this paragraph if the hospital demonstrates to the Secretary that the hospital is likely to— fill such positions within the first 5 training years beginning after the date the increase would be effective, as determined by the Secretary; and use some portion (as specified by the Secretary) of such positions for the residencies described in (A)(iv). Subject to clause (iv), a hospital that receives an increase in the otherwise applicable resident limit under this paragraph shall ensure, during the 5-year period beginning on the date of such increase, that the numbers of full-time equivalent residents in a primary care or psychiatry residency (as those terms are defined in subparagraph (F)), excluding any additional positions attributable to an increase under this paragraph, are not less than the average numbers of full-time equivalent residents in a primary care or psychiatry residency (as so defined) during the 3 most recent cost reporting periods ending prior to the date of enactment of this paragraph. Subject to clause (iv), a hospital that receives an increase in the otherwise applicable resident limit under this paragraph shall, after making a good faith attempt to collect information from former residents, report to the Secretary in a time and manner specified by the Secretary the following information for each year (beginning with the first year for which the hospital receives an increase in the otherwise applicable resident limit under this paragraph), as applicable: Race and ethnicity of residents. The practice patterns of residents one and two years after completion of their residency, including the number and percent of residents who— practice in a primary care, psychiatry, or other specialty; primarily serve or are located in a health professional shortage area with a designation in effect under section 332 of the Public Health Service Act; or primarily serve or are located in a rural area (as defined in subsection (d)(2)(D)). Subject to clause (iv), if a hospital that receives an increase in the otherwise applicable resident limit under this paragraph would be eligible for an adjustment to the otherwise applicable resident limit for participation in a new medical residency training program under section 413.79(e)(3) of title 42, Code of Federal Regulations (or any successor regulation), the hospital shall ensure that any positions made available under this paragraph are used to expand an existing program of the hospital, and not for participation in a new medical residency training program. In the case where the Secretary determines that a hospital that receives an increase in the otherwise applicable resident limit under this paragraph does not meet either of the requirements under clause (i), the reporting requirements under clause (ii), or, if applicable, the requirement under clause (iii), 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 to other qualifying hospitals in accordance with the requirements of this paragraph. A hospital may not receive more than 25 additional full-time equivalent 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. The Secretary shall permit hospitals receiving additional residency positions attributable to the increase provided under this paragraph to, beginning in the fifth year after the effective date of such increase, apply such positions to the limitation amount under paragraph (4)(F) that may be aggregated pursuant to paragraph (4)(H) among members of the same affiliated group. In this paragraph: 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 paragraphs (7)(A), (7)(B), (8)(A), (8)(B), or (9)(A). The term primary care residency means a residency training program described in paragraph (5)(H). The term psychiatry residency means a residency in psychiatry, addiction medicine, addiction psychiatry, pain medicine, child and adolescent psychiatry, consultation-liaison psychiatry, geriatric psychiatry, brain injury medicine, forensic psychiatry, hospice and palliative medicine, and sleep medicine. Such term includes a residency in a program that is a prerequisite (as determined by the Secretary) for a residency described in the preceding sentence. The term qualifying hospital means a hospital described in any of subclauses
(I)through
(V)of subparagraph (B)(ii). The term reference resident level means, with respect to a hospital, the resident level for the most recent cost reporting period of the hospital ending on or before the date of enactment of this paragraph, for which a cost report has been settled (or, if not, submitted (subject to audit)), as determined by the Secretary. The term resident level has the meaning given such term in paragraph (7)(C)(i). There is appropriated to the Secretary, out of any amounts in the Treasury not otherwise appropriated, $10,000,000, to remain available until expended, for purposes of carrying out this paragraph and subsection (d)(5)(B)(xiii). . Section 1886(d)(5)(B) of the Social Security Act ( 42 U.S.C. 1395ww(d)(5)(B) ) is amended— in clause (v), in the third sentence, by striking and (h)(9) and inserting (h)(9), and (h)(10) ; by adding at the end the following new clause: For discharges occurring on or after July 1, 2024, insofar as an additional payment amount under this subparagraph is attributable to resident positions distributed to a hospital under subsection (h)(10), the indirect teaching adjustment factor shall be computed in the same manner as provided under clause
(ii)with respect to such resident positions. .
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Sec. 137405
Distribution of additional residency positions
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