SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Primary Health Care Investment Act 
of 1993''.

SEC. 2. PUBLIC HEALTH SERVICE PRIMARY CARE PROVISIONS.

    (a) Migrant Health Centers.--Section 329(h)(1)(A) of the Public 
Health Service Act (42 U.S.C. 254b(h)(1)(A)) is amended by striking 
``and'' after ``1991,'', and by striking ``through 1994.'' and 
inserting the following: ``and 1993, $68,790,000 for fiscal year 1994, 
$80,255,000 for fiscal year 1995, $91,720,000 for fiscal year 1996, 
$103,185,000 for fiscal year 1997, and $114,650,000 for fiscal year 
1998.''.
    (b) Community Health Centers.--Section 330(g)(1)(A) of the Public 
Health Service Act (42 U.S.C. 254c(g)(1)(A)) is amended by striking 
``and'' after ``1991,'', and by striking ``through 1994.'' and 
inserting the following: ``and 1993, $670,780,800 for fiscal year 1994, 
$782,577,000 for fiscal year 1995, $894,374,400 for fiscal year 1996, 
$1,006,171,200 for fiscal year 1997, and $1,117,968,000 for fiscal year 
1998.''.
    (c) National Health Service Corps Scholarship and Loan Repayment 
Programs.--Section 338H(b)(1) of the Public Health Service Act (42 
U.S.C. 254q(b)(1)) is amended by striking ``and'' after ``1991,'', and 
by striking ``through 2000.'' and inserting the following: ``and 1993, 
$91,155,600 for fiscal year 1994, $106,348,200 for fiscal year 1995, 
$121,540,800 for fiscal year 1996, $136,733,400 for fiscal year 1997, 
and $151,926,000 for fiscal year 1998.''.
    (d) Health Services for the Homeless.--Section 340(q)(1) of the 
Public Health Service Act (42 U.S.C. 256(q)(1)) is amended by striking 
``and such sums'' and all that follows and inserting the following: 
``such sums as may be necessary for fiscal year 1993, $69,638,400 for 
fiscal year 1994, $81,244,800 for fiscal year 1995, $92,851,200 for 
fiscal year 1996, $104,457,600 for fiscal year 1997, and $116,064,000 
for fiscal year 1998.''.

SEC. 3. PAYMENTS FOR DIRECT GRADUATE MEDICAL EDUCATION COSTS OF PRIMARY 
              CARE RESIDENTS INCREASED.

    (a) In General.--Section 1886(h) of the Social Security Act (42 
U.S.C. 1395 ww(h)) is amended--
            (1) by amending paragraph (2) to read as follows:
            ``(2) Determination of approved fte resident amounts.--The 
        Secretary shall determine an approved FTE resident amount for 
        each cost reporting period beginning after October 1, 1993, as 
        follows:
                    ``(A) Determining national average salary per fte 
                resident in fiscal year 1989.--The Secretary shall 
                determine the national average salary for fiscal year 
                1991 for a full-time-equivalent resident in an approved 
                medical residency training program.
                    ``(B) Updating to a cost reporting period that 
                begins in fiscal year 1994.--The Secretary shall update 
                the amount determined under subparagraph (A) by the 
                estimated percentage change in the consumer price index 
                from the midpoint of fiscal year 1989 to the midpoint 
                of each cost reporting period that begins in fiscal 
                year 1994.
                    ``(C) Updating to subsequent cost reporting 
                periods.--For each subsequent cost reporting period, 
                the Secretary shall update the amount determined under 
                subparagraph (B) or this subparagraph for an 
                immediately preceding cost reporting period by the 
                estimated percentage change in the consumer price index 
                from the midpoint of that preceding period to the 
                midpoint of that subsequent period, with appropriate 
                adjustments to reflect previous under- or over-
                estimations in the estimated percentage change in that 
                index.'';
            (2) in paragraph (3)(B)(i), by striking ``hospital's''; and
            (3) in paragraph (4), by amending subparagraph (C) to read 
        as follows:
                    ``(C) Weighting factor for certain residents.--Such 
                rules shall provide, in calculating the number of full-
                time-equivalent residents in an approved residency 
                program--
                            ``(i) that the weighting factor for a 
                        primary care (as defined by the Secretary) 
                        resident, or for an intern, is 2.2,
                            ``(ii) that the weighting factor for a 
                        nonprimary care resident who is in the 
                        resident's initial residency period is 2.0, and
                            ``(iii) that the weighting factor for a 
                        nonprimary care resident who is not in the 
                        resident's initial residency period is 1.2.
                The Secretary shall make such adjustments as are 
                necessary to the weighting factors to maintain 
                aggregate payments under this section to all hospitals 
                at the same level that such payments would have been 
                made under this section prior to enactment of the 
                amendments made to this section by the Primary Health 
                Care Investment Act of 1993.''.
    (b) Effective Date.--(1) Except as otherwise provided by paragraph 
(2), the amendments made by this section shall apply to cost reporting 
periods beginning after October 1, 1993.
    (2) For a cost reporting period that falls partly in fiscal year 
1993 and partly in fiscal year 1994, the provisions of section 1886(h), 
as in effect before the date of enactment of this Act, shall apply 
proportionally to that part of the cost reporting period that occurs 
before fiscal year 1994.
Primary Health Care Investment Act of 1993 - Amends the Public Health Service Act to authorize appropriations to carry out specified provisions relating to migrant and community health centers, the National Health Service Corps scholarship and loan repayment programs, and health services for the homeless. 
Amends provisions of title XVIII (Medicare) of the Social Security Act relating to payment to hospitals for inpatient services to modify requirements regarding the determination of approved FTE (Full-Time Equivalent) resident amounts.
Primary Health Care Investment Act of 1993