Resident Physician Shortage Reduction Act of 2021

I 117TH CONGRESS 1ST SESSION H. R. 2256 To amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions, and for other purposes. IN THE HOUSE OF REPRESENTATIVES MARCH 26, 2021 Ms. SEWELL (for herself, Mr. KATKO, Mr. SUOZZI, Mr. RODNEY DAVIS of Illi- nois, Ms. BARRAGA´N, Mrs. BEATTY, Mr. BRENDAN F. BOYLE of Pennsyl- vania, Mr. CARBAJAL, Mr. CICILLINE, Mr. COHEN, Mr. CONNOLLY, Mr. CROW, Mr. DANNY K. DAVIS of Illinois, Ms. DEGETTE, Mr. MICHAEL F. DOYLE of Pennsylvania, Mr. FITZPATRICK, Ms. HOULAHAN, Mr. JOHNSON of Georgia, Mr. LAWSON of Florida, Ms. LEE of California, Mrs. LEE of Nevada, Ms. MCCOLLUM, Mr. MEEKS, Ms. MENG, Mr. NAD- LER, Mr. PAYNE, Ms. PINGREE, Ms. ROSS, Ms. SCANLON, Ms. STEFANIK, Mr. STEUBE, Ms. STEVENS, Ms. TITUS, Mr. TONKO, Mr. VAN DREW, Ms. VELA´ZQUEZ, Mr. WELCH, Ms. BASS, and Miss RICE of New York) 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 juris- diction of the committee concerned 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 VerDate Sep 11 2014 03:29 May 25, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H2256.IH H2256 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 2256 IH SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Resident Physician 2 Shortage Reduction Act of 2021’’. 3 SEC. 2. DISTRIBUTION OF ADDITIONAL RESIDENCY POSI- 4 TIONS. 5 (a) IN GENERAL.—Section 1886(h) of the Social Se- 6 curity Act (42 U.S.C. 1395ww(h)) is amended— 7 (1) in paragraph (4)(F)(i), by striking ‘‘para- 8 graphs (7), (8), and (9)’’ and inserting ‘‘paragraphs 9 (7), (8), (9), and (10)’’; 10 (2) in paragraph (4)(H)(i), by striking ‘‘para- 11 graphs (7), (8), and (9)’’ and inserting ‘‘paragraphs 12 (7), (8), (9), and (10)’’; 13 (3) in paragraph (7)(E), by inserting ‘‘para- 14 graph (10),’’ after ‘‘paragraph (8),’’; and 15 (4) by adding at the end the following new 16 paragraph: 17 ‘‘(10) DISTRIBUTION OF ADDITIONAL RESI- 18 DENCY POSITIONS.— 19 ‘‘(A) ADDITIONAL RESIDENCY POSI- 20 TIONS.— 21 ‘‘(i) IN GENERAL.—For each of fiscal 22 years 2023 through 2029 (and succeeding 23 fiscal years if the Secretary determines 24 that there are additional residency posi- 25 tions available to distribute under clause 26 VerDate Sep 11 2014 03:29 May 25, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2256.IH H2256 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 2256 IH (iv)(II)), the Secretary shall, subject to 1 clause (ii) and subparagraph (D), increase 2 the otherwise applicable resident limit for 3 each qualifying hospital (as defined in sub- 4 paragraph (H)) that submits a timely ap- 5 plication under this subparagraph by such 6 number as the Secretary may approve for 7 portions of cost reporting periods occurring 8 on or after July 1 of the fiscal year of the 9 increase. 10 ‘‘(ii) NUMBER AVAILABLE FOR DIS- 11 TRIBUTION.—For each such fiscal year, 12 the Secretary shall determine the total 13 number of additional residency positions 14 available for distribution under clause (i) 15 in accordance with the following: 16 ‘‘(I) ALLOCATION TO HOSPITALS 17 ALREADY OPERATING OVER RESIDENT 18 LIMIT.—One-third of such number 19 shall be available for distribution only 20 to hospitals described in subparagraph 21 (B). 22 ‘‘(II) AGGREGATE LIMITATION.— 23 Except as provided in clause (iv)(I), 24 the aggregate number of increases in 25 VerDate Sep 11 2014 03:29 May 25, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2256.IH H2256 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 2256 IH the otherwise applicable resident limit 1 under this subparagraph shall be 2 equal to 2,000 in each such year. 3 ‘‘(iii) PROCESS FOR DISTRIBUTING 4 POSITIONS.— 5 ‘‘(I) ROUNDS OF APPLICA- 6 TIONS.—The Secretary shall initiate 7 7 separate rounds of applications for an 8 increase under clause (i), 1 round 9 with respect to each of fiscal years 10 2023 through 2029. 11 ‘‘(II) NUMBER AVAILABLE.—In 12 each of such rounds, the aggregate 13 number of positions available for dis- 14 tribution in the fiscal year under 15 clause (ii) shall be distributed, plus 16 any additional positions available 17 under clause (iv). 18 ‘‘(III) TIMING.—The Secretary 19 shall notify hospitals of the number of 20 positions distributed to the hospital 21 under this paragraph as a result of an 22 increase in the otherwise applicable 23 resident limit by January 1 of the fis- 24 cal year of the increase. Such increase 25 VerDate Sep 11 2014 03:29 May 25, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2256.IH H2256 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 2256 IH shall be effective for portions of cost 1 reporting periods beginning on or 2 after July 1 of that fiscal year. 3 ‘‘(iv) POSITIONS NOT DISTRIBUTED 4 DURING THE FISCAL YEAR.— 5 ‘‘(I) IN GENERAL.—If the num- 6 ber of resident full-time equivalent po- 7 sitions distributed under this para- 8 graph in a fiscal year is less than the 9 aggregate number of positions avail- 10 able for distribution in the fiscal year 11 (as described in clause (ii), including 12 after application of this subclause), 13 the difference between such number 14 distributed and such number available 15 for distribution shall be added to the 16 aggregate number of positions avail- 17 able for distribution in the following 18 fiscal year. 19 ‘‘(II) EXCEPTION IF POSITIONS 20 NOT DISTRIBUTED BY END OF FISCAL 21 YEAR 2029.—If the aggregate number 22 of positions distributed under this 23 paragraph during the 7-year period of 24 fiscal years 2023 through 2029 is less 25 VerDate Sep 11 2014 03:29 May 25, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2256.IH H2256 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 2256 IH than 14,000, the Secretary shall, in 1 accordance with the provisions of 2 clause (ii) and subparagraph (E) and 3 the considerations and priority de- 4 scribed in subparagraph (C), conduct 5 an application and distribution proc- 6 ess in each subsequent fiscal year 7 until such time as the aggregate 8 amount of positions distributed under 9 this paragraph is equal to 14,000. 10 ‘‘(B) ALLOCATION OF DISTRIBUTION FOR 11 POSITIONS TO HOSPITALS ALREADY OPERATING 12 OVER RESIDENT LIMIT.— 13 ‘‘(i) IN GENERAL.—Subject to clauses 14 (ii) and (iii), in the case of a hospital in 15 which the reference resident level of the 16 hospital (as specified in subparagraph 17 (G)(iii)) is greater than the otherwise ap- 18 plicable resident limit, the increase in the 19 otherwise applicable resident limit under 20 subparagraph (A) for a fiscal year de- 21 scribed in such subparagraph shall be an 22 amount equal to the product of the total 23 number of additional residency positions 24 available for distribution under subpara- 25 VerDate Sep 11 2014 03:29 May 25, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2256.IH H2256 kjohnson on DSK79L0C42PROD with BILLS 7 •HR 2256 IH graph (A)(ii)(I) for such fiscal year and 1 the quotient of— 2 ‘‘(I) the number of resident posi- 3 tions by which the reference resident 4 level of the hospital exceeds the other- 5 wise applicable resident limit for the 6 hospital; and 7 ‘‘(II) the number of resident po- 8 sitions by which the reference resident 9 level of all such hospitals with respect 10 to which an application is approved 11 under this paragraph exceeds the oth- 12 erwise applicable resident limit for 13 such hospitals. 14 ‘‘(ii) REQUIREMENTS.—A hospital de- 15 scribed in clause (i)— 16 ‘‘(I) is not eligible for an increase 17 in the otherwise applicable resident 18 limit under this subparagraph unless 19 the amount by which the reference 20 resident level of the hospital exceeds 21 the otherwise applicable resident limit 22 is not less than 10 and the hospital 23 trains at least 25 percent of the full- 24 time equivalent residents of the hos- 25 VerDate Sep 11 2014 03:29 May 25, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H2256.IH H2256 kjohnson on DSK79L0C42PROD with BILLS 8 •HR 2256 IH pital in primary care and general sur- 1 gery (as of the date of enactment of 2 this paragraph); and 3 ‘‘(II) shall continue to train at 4 least 25 percent of the full-time equiv- 5 alent residents of the hospital in pri- 6 mary care and general surgery for the 7 5-year period beginning on such date. 8 In the case where the Secretary determines 9 that a hospital described in clause (i) no 10 longer meets the requirement of subclause 11 (II), the Secretary may reduce the other- 12 wise applicable resident limit of the hos- 13 pital by the amount by which such limit 14 was increased under this subparagraph. 15 ‘‘(iii) CLARIFICATION REGARDING ELI- 16 GIBILITY FOR OTHER ADDITIONAL RESI- 17 DENCY POSITIONS.—Nothing in this sub- 18 paragraph shall be construed as preventing 19 a hospital described in clause (i) from ap- 20 plying for and receiving additional resi- 21 dency positions under this paragraph that 22 are not reserved for distribution under this 23 subparagraph. 24 VerDate Sep 11 2014 03:29 May 25, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2256.IH H2256 kjohnson on DSK79L0C42PROD with BILLS 9 •HR 2256 IH ‘‘(C) DISTRIBUTION OF OTHER POSI- 1 TIONS.—For purposes of determining an in- 2 crease in the otherwise applicable resident limit 3 under subparagraph (A) (other than such an in- 4 crease described in subparagraph (B)), the fol- 5 lowing shall apply: 6 ‘‘(i) CONSIDERATIONS IN DISTRIBU- 7 TION.—In determining for which hospitals 8 such an increase is provided under sub- 9 paragraph (A), the Secretary shall take 10 into account the demonstrated likelihood of 11 the hospital filling the positions made 12 available under this paragraph within the 13 first 5 cost reporting periods beginning 14 after the date the increase would be effec- 15 tive, as determined by the Secretary. 16 ‘‘(ii) MINIMUM DISTRIBUTION FOR 17 CERTAIN CATEGORIES OF HOSPITALS.— 18 With respect to the aggregate number of 19 such positions available for distribution 20 under this paragraph, the Secretary shall 21 distribute not less than 10 percent of such 22 aggregate number to each of the following 23 categories of hospitals: 24 VerDate Sep 11 2014 03:29 May 25, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H2256.IH H2256 kjohnson on DSK79L0C42PROD with BILLS 10 •HR 2256 IH ‘‘(I) Hospitals that are located in 1 a rural area (as defined in subsection 2 (d)(2)(D)) or are treated as being lo- 3 cated in a rural area pursuant to sub- 4 section (d)(8)(E). 5 ‘‘(II) Hospitals in which the ref- 6 erence resident level of the hospital 7 (as specified in subparagraph (F)(iii)) 8 is greater than the otherwise applica- 9 ble resident limit. 10 ‘‘(III) Hospitals in States with— 11 ‘‘(aa) new medical schools 12 that received ‘Candidate School’ 13 status from the Liaison Com- 14 mittee on Medical Education or 15 that received ‘Pre-Accreditation’ 16 status from the American Osteo- 17 pathic Association Commission 18 on Osteopathic College Accredita- 19 tion on or after January 1, 2000, 20 and that have achieved or con- 21 tinue to progress toward ‘Full 22 Accreditation’ status (as such 23 term is defined by the Liaison 24 Committee on Medical Edu- 25 VerDate Sep 11 2014 03:29 May 25, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H2256.IH H2256 kjohnson on DSK79L0C42PROD with BILLS 11 •HR 2256 IH cation) or toward ‘Accreditation’ 1 status (as such term is defined 2 by the American Osteopathic As- 3 sociation Commission on Osteo- 4 pathic College Accreditation); or 5 ‘‘(bb) additional locations 6 and branch campuses established 7 on or after January 1, 2000, by 8 medical schools with ‘Full Ac- 9 creditation’ status (as such term 10 is defined by the Liaison Com- 11 mittee on Medical Education) or 12 ‘Accreditation’ status (as such 13 term is defined by the American 14 Osteopathic Association Commis- 15 sion on Osteopathic College Ac- 16 creditation). 17 ‘‘(IV) Hospitals that serve areas 18 designated as health professional 19 shortage areas under section 20 332(a)(1)(A) of the Public Health 21 Service Act, as determined by the Sec- 22 retary. 23 ‘‘(D) PROHIBITION ON DISTRIBUTION TO 24 HOSPITALS WITHOUT AN INCREASE AGREE- 25 VerDate Sep 11 2014 03:29 May 25, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H2256.IH H2256 kjohnson on DSK79L0C42PROD with BILLS 12 •HR 2256 IH MENT.—No increase in the otherwise applicable 1 resident limit of a hospital may be made under 2 subparagraph (C) unless such hospital agrees to 3 increase the total number of full-time equivalent 4 residency positions under the approved medical 5 residency training program of such hospital by 6 the number of such positions made available by 7 such increase under the subparagraph. 8 ‘‘(E) LIMITATION.— 9 ‘‘(i) IN GENERAL.—Except as pro- 10 vided in clause (ii), a hospital may not re- 11 ceive more than 75 full-time equivalent ad- 12 ditional residency positions in the aggre- 13 gate under this paragraph and paragraph 14 (9) over the period of fiscal years 2023 15 through 2029. 16 ‘‘(ii) INCREASE IN NUMBER OF ADDI- 17 TIONAL POSITIONS A HOSPITAL MAY RE- 18 CEIVE.—The Secretary shall increase the 19 aggregate number of full-time equivalent 20 additional residency positions a hospital 21 may receive under this paragraph over 22 such period if the Secretary estimates that 23 the number of positions available for dis- 24 tribution under subparagraph (A) exceeds 25 VerDate Sep 11 2014 03:29 May 25, 2021 Jkt 019200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H2256.IH H2256 kjohnson on DSK79L0C42PROD with BILLS 13 •HR 2256 IH the number of applications approved under 1 such subparagraph over such period. 2 ‘‘(F) APPLICATION OF PER RESIDENT 3 AMOUNTS FOR PRIMARY CARE AND NONPRI- 4 MARY CARE.—With respect to additional resi- 5 dency positions in a hospital attributable to the 6 increase provided under this paragraph, the ap- 7 proved FTE per resident amounts are deemed 8 to be equal to the hospital per resident amounts 9 for primary care and nonprimary care com- 10 puted under paragraph (2)(D) for that hospital. 11 ‘‘(G) PERMITTING FACILITIES TO APPLY 12 AGGREGATION RULES.—The Secretary shall 13 permit hospitals receiving additional residency 14 positions attributable to the increase provided 15 under [Text truncated for display. 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