Enhancing Opportunities for Medical Doctors Act of 2016

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Enhancing Opportunities for Medical 
Doctors Act of 2016''.

SEC. 2. REDISTRIBUTING UNUSED RESIDENCY POSITIONS TO PROMOTE THE 
              ESTABLISHMENT OF RESIDENCY PROGRAMS FOR NEWLY RECOGNIZED 
              PRIMARY MEDICAL SPECIALTIES.

    (a) In General.--Section 1886(h) of the Social Security Act (42 
U.S.C. 1395ww(h)) is amended--
            (1) in paragraph (4)(F)(i), by striking ``(7) and (8)'' and 
        inserting ``(7), (8), and (9)'';
            (2) in paragraph (4)(H)(i), by striking ``(7) and (8)'' and 
        inserting ``(7), (8), and (9)'';
            (3) in paragraph (7)(E), by striking ``paragraph (8)'' and 
        inserting ``paragraphs (8) or (9)'' before the period at the 
        end; and
            (4) by adding at the end the following new paragraph:
            ``(9) Distribution of additional residency positions.--
                    ``(A) Reductions in limit based on unused 
                positions.--
                            ``(i) In general.--If a hospital's 
                        reference resident level (as defined in 
                        subparagraph (G)(i)) is less than the otherwise 
                        applicable resident limit (as defined in 
                        subparagraph (G)(iii)), effective for portions 
                        of cost reporting periods occurring on or after 
                        July 1, 2017, 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.
                            ``(ii) Exception.--This subparagraph shall 
                        not apply to a hospital located in a rural area 
                        (as defined in subsection (d)(2)(D)(ii)) with 
                        fewer than 250 acute care inpatient beds.
                    ``(B) Distribution.--
                            ``(i) In general.--The Secretary shall, in 
                        accordance with the succeeding provisions of 
                        this paragraph, 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, 2017. 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).
                            ``(ii) Requirements.--Subject to clause 
                        (iii), a hospital that receives an increase in 
                        the otherwise applicable resident limit under 
                        this subparagraph shall ensure, during the 3-
                        year period beginning on the date of such 
                        increase, that the positions resulting from the 
                        increase under this paragraph will be filled. 
                        The Secretary may determine whether a hospital 
                        has met the requirements under this clause 
                        during such 3-year period in such manner and at 
                        such time as the Secretary determines 
                        appropriate, including at the end of such 3-
                        year period.
                            ``(iii) Redistribution of positions if 
                        hospital no longer meets certain 
                        requirements.--In the case where the Secretary 
                        determines that a hospital described in clause 
                        (ii) does not meet the requirements of such 
                        clause, the Secretary shall--
                                    ``(I) reduce the otherwise 
                                applicable resident limit of the 
                                hospital by the amount by which such 
                                limit was increased under this 
                                paragraph; and
                                    ``(II) provide for the distribution 
                                of positions attributable to such 
                                reduction in accordance with the 
                                requirements of this paragraph.
                    ``(C) Capacity considerations in redistribution.--
                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, 2017, as determined by the Secretary.
                    ``(D) Priority in redistribution.--Subject to 
                subparagraphs (C) and (E), the Secretary shall 
                determine which qualifying hospitals receive increases 
                under subparagraph (B) in the otherwise applicable 
                resident limits for such hospitals in a manner that 
                distributes the positions made available to hospitals 
                under this paragraph in accordance with the following:
                            ``(i) The Secretary shall make such 
                        positions available to hospitals with 
                        applicable residency training programs.
                            ``(ii) In the case that the application of 
                        clause (i) does not result in the distribution 
                        of all positions made available under this 
                        paragraph, the Secretary shall make any 
                        positions that remain undistributed after the 
                        application of such clause available to 
                        hospitals that are located in--
                                    ``(I) a State with a resident-to-
                                population ratio in the lowest quartile 
                                (as determined by the Secretary);
                                    ``(II) a State, a territory of the 
                                United States, or the District of 
                                Columbia that is among the top 10 
                                States, territories, or Districts in 
                                terms of the ratio of the total 
                                population of the State, territory, or 
                                District living in an area designated 
                                (under such section 332(a)(1)(A)) as a 
                                health professional shortage area (as 
                                of the date of enactment of this 
                                paragraph), to the total population of 
                                the State, territory, or District (as 
                                determined by the Secretary based on 
                                the most recent available population 
                                data published by the Bureau of the 
                                Census); or
                                    ``(III) a rural area (as defined in 
                                subsection (d)(2)(D)(ii)).
                            ``(iii) In the case that the application of 
                        clauses (i) and (ii) does not result in the 
                        distribution of all positions made available 
                        under this paragraph, the Secretary shall make 
                        any positions that remain undistributed after 
                        the application of such clauses available to 
                        hospitals that establish a medical residency 
                        program that is sponsored by, or affiliated 
                        with, a medical school that was first 
                        accredited during the cost reporting period 
                        prior to the cost reporting period with respect 
                        to which such application applies.
                    ``(E) Limitation.--A hospital may not receive more 
                than 75 full-time equivalent additional residency 
                positions under this paragraph.
                    ``(F) Application of per resident amounts for 
                primary care and nonprimary care.--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.
                    ``(G) Definitions.--In this paragraph:
                            ``(i) Reference resident level.--The term 
                        `reference resident level' means, with respect 
                        to a hospital, the highest resident level for 
                        any of the 3 most recent cost reporting periods 
                        (ending before the date of the enactment of 
                        this paragraph) of the hospital for which a 
                        cost report has been settled (or, if not, 
                        submitted (subject to audit)), as determined by 
                        the Secretary.
                            ``(ii) Resident level.--The term `resident 
                        level' has the meaning given such term in 
                        paragraph (7)(C)(i).
                            ``(iii) Otherwise applicable resident 
                        limit.--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 paragraph (7)(A).
                            ``(iv) Applicable residency training 
                        program.--
                                    ``(I) In general.--The term 
                                `applicable residency training program' 
                                means a medical residency training 
                                program that is for the applicable 
                                primary specialty that, as of the date 
                                of the enactment of this paragraph, is 
                                the applicable primary specialty that 
                                has most recently been designated as a 
                                primary specialty by the American Board 
                                of Medical Specialties.
                                    ``(II) Applicable primary 
                                specialty.--The term `applicable 
                                primary specialty' means a primary 
                                specialty a resident of which is not, 
                                as of the date of the enactment of this 
                                paragraph, counted as an FTE resident 
                                for purposes of this subsection. For 
                                purposes of the preceding sentence, the 
                                term `primary specialty' does not 
                                include a subspecialty.
                    ``(H) Affiliation.--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.''.
    (b) IME.--
            (1) In general.--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 ``subsections (h)(7) and 
        (h)(8)'' and inserting ``subsections (h)(7), (h)(8), and 
        (h)(9)''.
            (2) Conforming amendment.--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 clause:
                            ``(xii) For discharges occurring on or 
                        after July 1, 2017, 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.''.
    (c) Conforming Amendment.--Section 422(b)(2) of the Medicare 
Prescription Drug, Improvement, and Modernization Act of 2003 (Public 
Law 108-173), as amended by section 5503 of the Patient Protection and 
Affordable Care Act (Public Law 111-148), is amended by striking 
``paragraphs (7) and (8)'' and inserting ``paragraphs (7), (8), and 
(9).''.

Summary: Enhancing Opportunities for Medical Doctors Act of 2016 This bill amends title XVIII (Medicare) of the Social Security Act to redistribute unused residency positions for which graduate medical education costs are paid under Medicare. Specifically, the Centers for Medicare amp. Medicaid Services must: (1) reduce a hospital's resident limit by a specified amount if the hospital has unused residency positions and is not a rural hospital with fewer than 250 acute care inpatient beds, and (2) increase the resident limit for each qualifying hospital that applies for an increase. In aggregate, the number of increased positions shall equal the number of reduced positions. The bill establishes specified priorities, limitations, and capacity considerations with respect to redistribution.