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[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 5041 Introduced in Senate (IS)]

<DOC>

117th CONGRESS
  2d Session
                                S. 5041

  To amend title XVIII of the Social Security Act to provide for the 
   distribution of additional residency positions in psychiatry and 
                            subspecialties.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                           September 29, 2022

Ms. Stabenow (for herself, Mr. Daines, and Mr. Menendez) introduced the 
 following bill; which was read twice and referred to the Committee on 
                                Finance

_______________________________________________________________________

                                 A BILL

 
  To amend title XVIII of the Social Security Act to provide for the 
   distribution of additional residency positions in psychiatry and 
                            subspecialties.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Training Psychiatrists for the 
Future Act''.

SEC. 2. DISTRIBUTION OF ADDITIONAL RESIDENCY POSITIONS IN PSYCHIATRY 
              AND PSYCHIATRY SUBSPECIALTIES.

    (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 ``and (9)'' and 
        inserting ``(9), and (10)'';
            (2) in paragraph (4)(H)(i), by striking ``and (9)'' and 
        inserting ``(9), and (10)''; and
            (3) by adding at the end the following new paragraph:
            ``(10) Distribution of additional residency positions in 
        psychiatry and psychiatry subspecialties.--
                    ``(A) Additional residency positions.--
                            ``(i) In general.--For fiscal year 2025, 
                        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)(I)), 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.
                            ``(ii) Number available for distribution.--
                                    ``(I) Total number available.--The 
                                aggregate number of such positions made 
                                available under this paragraph shall be 
                                equal to 400.
                                    ``(II) Annual limit.--The aggregate 
                                number of such positions so made 
                                available shall not exceed 200 for a 
                                fiscal year.
                            ``(iii) Distribution for psychiatry or 
                        psychiatry subspecialty residencies.--Each of 
                        the positions made available under this 
                        paragraph shall be in a psychiatry or 
                        psychiatry subspecialty residency (as defined 
                        in subparagraph (F)).
                            ``(iv) Process for distributing 
                        positions.--
                                    ``(I) Rounds of applications.--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.
                                    ``(II) Timing.--The Secretary shall 
                                notify hospitals of the number of 
                                positions distributed to the hospital 
                                under this paragraph as a result of an 
                                increase in the otherwise applicable 
                                resident limit by January 31 of the 
                                fiscal year of the increase. Such 
                                increase shall be effective beginning 
                                July 1 of such fiscal year.
                    ``(B) Distribution.--For purposes of providing an 
                increase in the otherwise applicable resident limit 
                under subparagraph (A), the following shall apply:
                            ``(i) Considerations in distribution.--In 
                        determining for which qualifying hospitals such 
                        an increase is provided under subparagraph (A), 
                        the Secretary shall take into account the 
                        demonstrated likelihood of the hospital filling 
                        the positions made available under this 
                        paragraph within the first 5 training years 
                        beginning after the date the increase would be 
                        effective, as determined by the Secretary.
                            ``(ii) Distribution for certain categories 
                        of hospitals.--With respect to the aggregate 
                        number of such positions available for 
                        distribution under this paragraph, the 
                        Secretary shall distribute such aggregate 
                        number to the following categories of 
                        hospitals:
                                    ``(I) To hospitals that are located 
                                in a rural area (as defined in section 
                                1886(d)(2)(D)) or are treated as being 
                                located in a rural area pursuant to 
                                section 1886(d)(8)(E).
                                    ``(II) To hospitals in which the 
                                reference resident level of the 
                                hospital (as specified in subparagraph 
                                (F)(iv)) is greater than the otherwise 
                                applicable resident limit.
                                    ``(III) To hospitals in States 
                                with--
                                            ``(aa) new medical schools 
                                        that received `Candidate 
                                        School' status from the Liaison 
                                        Committee on Medical Education 
                                        or that received `Pre-
                                        Accreditation' status from the 
                                        American Osteopathic 
                                        Association Commission on 
                                        Osteopathic College 
                                        Accreditation on or after 
                                        January 1, 2000, and that have 
                                        achieved or continue 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
                                            ``(bb) additional locations 
                                        and branch campuses established 
                                        on or after January 1, 2000, by 
                                        medical schools 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).
                                    ``(IV) To hospitals that serve 
                                areas designated as health professional 
                                shortage areas under section 
                                332(a)(1)(A) of the Public Health 
                                Service Act, as determined by the 
                                Secretary.
                                    ``(V) To hospitals located in 
                                States with less than 27 residents per 
                                100,000 people.
                    ``(C) Requirements.--
                            ``(i) In general.--Subject to clause (ii), 
                        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--
                                    ``(I) the number of full-time 
                                equivalent residents in a psychiatry or 
                                psychiatry subspecialty residency (as 
                                defined in subparagraph (F)), excluding 
                                any additional positions attributable 
                                to an increase under this paragraph, is 
                                not less than the average number of 
                                full-time equivalent residents in such 
                                a residency during the 3 most recent 
                                cost reporting periods ending prior to 
                                the date of enactment of this 
                                paragraph; and
                                    ``(II) all of the positions 
                                attributable to such increase are in a 
                                psychiatry or psychiatry subspecialty 
                                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.
                            ``(ii) Redistribution of positions if 
                        hospital no longer meets certain 
                        requirements.--In the case where the Secretary 
                        determines that a hospital described in clause 
                        (i) does not meet either of the requirements 
                        under subclause (I) or (II) 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.
                            ``(iii) Limitation.--A hospital may not 
                        receive more than 10 additional full-time 
                        equivalent residency positions under this 
                        paragraph.
                            ``(iv) Prohibition on distribution to 
                        hospitals without an increase agreement.--No 
                        increase in the otherwise applicable resident 
                        limit of a hospital may be made under this 
                        paragraph unless such hospital agrees to 
                        increase the total number of full-time 
                        equivalent residency positions under the 
                        approved medical residency training program of 
                        such hospital by the number of such positions 
                        made available by such increase under this 
                        paragraph.
                    ``(D) Application of per resident amounts for 
                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 nonprimary care computed under 
                paragraph (2)(D) for that hospital.
                    ``(E) Permitting facilities to apply aggregation 
                rules.--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.
                    ``(F) Definitions.--In this paragraph:
                            ``(i) 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 paragraphs (7)(A), (7)(B), (8)(A), 
                        (8)(B), and (9)(A).
                            ``(ii) Psychiatry or psychiatry 
                        subspecialty residency.--The term `psychiatry 
                        or psychiatry subspecialty residency' means a 
                        residency in psychiatry as accredited by the 
                        Accreditation Council for Graduate Medical 
                        Education for the purpose of preventing, 
                        diagnosing, and treating mental health 
                        disorders.
                            ``(iii) Qualifying hospital.--The term 
                        `qualifying hospital' means a hospital 
                        described in any of subclauses (I) through (V) 
                        of subparagraph (B)(ii).
                            ``(iv) Reference resident level.--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.
                            ``(v) Resident level.--The term `resident 
                        level' has the meaning given such term in 
                        paragraph (7)(C)(i).''.
    (b) IME.--Section 1886(d)(5)(B) of the Social Security Act (42 
U.S.C. 1395ww(d)(5)(B)) is amended--
            (1) in clause (v), in the third sentence, by striking ``and 
        (h)(9)'' and inserting ``(h)(9), and (h)(10)'';
            (2) by moving clause (xii) 4 ems to the left; and
            (3) by adding at the end the following new clause:
            ``(xiii) 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.''.
    (c) Prohibition on Judicial Review.--Section 1886(h)(7)(E) of the 
Social Security Act (42 U.S.C. 1395ww--4(h)(7)(E)) is amended by 
inserting ``paragraph (10),'' after ``paragraph (8),''.
                                 <all>
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