II 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Training Psychiatrists 

5 for the Future Act’’. 

6 SEC. 2. DISTRIBUTION OF ADDITIONAL RESIDENCY POSI7 TIONS IN PSYCHIATRY AND PSYCHIATRY SUB8 SPECIALTIES. 

9 (a) IN GENERAL.—Section 1886(h) of the Social Se10 curity Act (42 U.S.C. 1395ww(h)) is amended— 


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1 (1) in paragraph (4)(F)(i), by striking ‘‘and 

2 (9)’’ and inserting ‘‘(9), and (10)’’; 

3 (2) in paragraph (4)(H)(i), by striking ‘‘and 

4 (9)’’ and inserting ‘‘(9), and (10)’’; and 

5 (3) by adding at the end the following new 

6 paragraph: 

7 ‘‘(10) DISTRIBUTION OF ADDITIONAL RESI8 DENCY POSITIONS IN PSYCHIATRY AND PSYCHIATRY

9 SUBSPECIALTIES.— 

10 ‘‘(A) ADDITIONAL RESIDENCY POSI11 TIONS.— 

12 ‘‘(i) IN GENERAL.—For fiscal year 

13 2025, and for each succeeding fiscal year 

14 until the aggregate number of full-time 

15 equivalent residency positions distributed 

16 under this paragraph is equal to the aggre17 gate number of such positions made avail18 able (as specified in clause (ii)(I)), the Sec19 retary shall, subject to the succeeding pro20 visions of this paragraph, increase the oth21 erwise applicable resident limit for each 

22 qualifying hospital (as defined in subpara23 graph (F)) that submits a timely applica24 tion under this subparagraph by such 

25 number as the Secretary may approve efVerDate Sep 11 2014 23:06 Oct 14, 2022 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S5041.IS S5041

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1 fective beginning July 1 of the fiscal year 

2 of the increase. 

3 ‘‘(ii) NUMBER AVAILABLE FOR DIS4 TRIBUTION.— 

5 ‘‘(I) TOTAL NUMBER AVAIL6 ABLE.—The aggregate number of 

7 such positions made available under 

8 this paragraph shall be equal to 400. 

9 ‘‘(II) ANNUAL LIMIT.—The ag10 gregate number of such positions so 

11 made available shall not exceed 200 

12 for a fiscal year. 

13 ‘‘(iii) DISTRIBUTION FOR PSYCHIATRY

14 OR PSYCHIATRY SUBSPECIALTY

15 RESIDENCIES.—Each of the positions 

16 made available under this paragraph shall 

17 be in a psychiatry or psychiatry sub18 specialty residency (as defined in subpara19 graph (F)). 

20 ‘‘(iv) PROCESS FOR DISTRIBUTING PO21 SITIONS.— 

22 ‘‘(I) ROUNDS OF APPLICA23 TIONS.—The Secretary shall initiate a 

24 separate round of applications for an 

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1 cal year for which such an increase is 

2 to be provided. 

3 ‘‘(II) TIMING.—The Secretary 

4 shall notify hospitals of the number of 

5 positions distributed to the hospital 

6 under this paragraph as a result of an 

7 increase in the otherwise applicable 

8 resident limit by January 31 of the 

9 fiscal year of the increase. Such in10 crease shall be effective beginning 

11 July 1 of such fiscal year. 

12 ‘‘(B) DISTRIBUTION.—For purposes of 

13 providing an increase in the otherwise applica14 ble resident limit under subparagraph (A), the 

15 following shall apply: 

16 ‘‘(i) CONSIDERATIONS IN DISTRIBU17 TION.—In determining for which qualifying 

18 hospitals such an increase is provided 

19 under subparagraph (A), the Secretary 

20 shall take into account the demonstrated 

21 likelihood of the hospital filling the posi22 tions made available under this paragraph 

23 within the first 5 training years beginning 

24 after the date the increase would be effec25 tive, as determined by the Secretary. 


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1 ‘‘(ii) DISTRIBUTION FOR CERTAIN

2 CATEGORIES OF HOSPITALS.—With respect 

3 to the aggregate number of such positions 

4 available for distribution under this para5 graph, the Secretary shall distribute such 

6 aggregate number to the following cat7 egories of hospitals: 

8 ‘‘(I) To hospitals that are located 

9 in a rural area (as defined in section 

10 1886(d)(2)(D)) or are treated as 

11 being located in a rural area pursuant 

12 to section 1886(d)(8)(E). 

13 ‘‘(II) To hospitals in which the 

14 reference resident level of the hospital 

15 (as specified in subparagraph (F)(iv)) 

16 is greater than the otherwise applica17 ble resident limit. 

18 ‘‘(III) To hospitals in States 

19 with— 

20 ‘‘(aa) new medical schools 

21 that received ‘Candidate School’ 

22 status from the Liaison Com23 mittee on Medical Education or 

24 that received ‘Pre-Accreditation’ 

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1 pathic Association Commission 

2 on Osteopathic College Accredita3 tion on or after January 1, 2000, 

4 and that have achieved or con5 tinue to progress toward ‘Full 

6 Accreditation’ status (as such 

7 term is defined by the Liaison 

8 Committee on Medical Edu9 cation) or toward ‘Accreditation’ 

10 status (as such term is defined 

11 by the American Osteopathic As12 sociation Commission on Osteo13 pathic College Accreditation); or 

14 ‘‘(bb) additional locations 

15 and branch campuses established 

16 on or after January 1, 2000, by 

17 medical schools with ‘Full Ac18 creditation’ status (as such term 

19 is defined by the Liaison Com20 mittee on Medical Education) or 

21 ‘Accreditation’ status (as such 

22 term is defined by the American 

23 Osteopathic Association Commis24 sion on Osteopathic College Ac25 creditation). 


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1 ‘‘(IV) To hospitals that serve 

2 areas designated as health profes3 sional shortage areas under section 

4 332(a)(1)(A) of the Public Health 

5 Service Act, as determined by the Sec6 retary. 

7 ‘‘(V) To hospitals located in 

8 States with less than 27 residents per 

9 100,000 people. 

10 ‘‘(C) REQUIREMENTS.— 

11 ‘‘(i) IN GENERAL.—Subject to clause 

12 (ii), a hospital that receives an increase in 

13 the otherwise applicable resident limit 

14 under this paragraph shall ensure, during 

15 the 5-year period beginning on the date of 

16 such increase, that— 

17 ‘‘(I) the number of full-time 

18 equivalent residents in a psychiatry or 

19 psychiatry subspecialty residency (as 

20 defined in subparagraph (F)), exclud21 ing any additional positions attrib22 utable to an increase under this para23 graph, is not less than the average 

24 number of full-time equivalent resi25 dents in such a residency during the 


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1 3 most recent cost reporting periods 

2 ending prior to the date of enactment 

3 of this paragraph; and 

4 ‘‘(II) all of the positions attrib5 utable to such increase are in a psy6 chiatry or psychiatry subspecialty resi7 dency (as determined by the Sec8 retary). 

9 The Secretary may determine whether a 

10 hospital has met the requirements under 

11 this clause during such 5-year period in 

12 such manner and at such time as the Sec13 retary determines appropriate, including at 

14 the end of such 5-year period. 

15 ‘‘(ii) REDISTRIBUTION OF POSITIONS

16 IF HOSPITAL NO LONGER MEETS CERTAIN

17 REQUIREMENTS.—In the case where the 

18 Secretary determines that a hospital de19 scribed in clause (i) does not meet either 

20 of the requirements under subclause (I) or 

21 (II) of such clause, the Secretary shall— 

22 ‘‘(I) reduce the otherwise applica23 ble resident limit of the hospital by 

24 the amount by which such limit was 

25 increased under this paragraph; and 


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1 ‘‘(II) provide for the distribution 

2 of positions attributable to such re3 duction in accordance with the re4 quirements of this paragraph. 

5 ‘‘(iii) LIMITATION.—A hospital may 

6 not receive more than 10 additional full7 time equivalent residency positions under 

8 this paragraph. 

9 ‘‘(iv) PROHIBITION ON DISTRIBUTION

10 TO HOSPITALS WITHOUT AN INCREASE

11 AGREEMENT.—No increase in the other12 wise applicable resident limit of a hospital 

13 may be made under this paragraph unless 

14 such hospital agrees to increase the total 

15 number of full-time equivalent residency 

16 positions under the approved medical resi17 dency training program of such hospital by 

18 the number of such positions made avail19 able by such increase under this para20 graph. 

21 ‘‘(D) APPLICATION OF PER RESIDENT

22 AMOUNTS FOR NONPRIMARY CARE.—With re23 spect to additional residency positions in a hos24 pital attributable to the increase provided under 

25 this paragraph, the approved FTE per resident 


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1 amounts are deemed to be equal to the hospital 

2 per resident amounts for nonprimary care com3 puted under paragraph (2)(D) for that hospital. 

4 ‘‘(E) PERMITTING FACILITIES TO APPLY

5 AGGREGATION RULES.—The Secretary shall 

6 permit hospitals receiving additional residency 

7 positions attributable to the increase provided 

8 under this paragraph to, beginning in the fifth 

9 year after the effective date of such increase, 

10 apply such positions to the limitation amount 

11 under paragraph (4)(F) that may be aggre12 gated pursuant to paragraph (4)(H) among 

13 members of the same affiliated group. 

14 ‘‘(F) DEFINITIONS.—In this paragraph: 

15 ‘‘(i) OTHERWISE APPLICABLE RESI16 DENT LIMIT.—The term ‘otherwise appli17 cable resident limit’ means, with respect to 

18 a hospital, the limit otherwise applicable 

19 under subparagraphs (F)(i) and (H) of 

20 paragraph (4) on the resident level for the 

21 hospital determined without regard to this 

22 paragraph but taking into account para23 graphs (7)(A), (7)(B), (8)(A), (8)(B), and 

24 (9)(A). 


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1 ‘‘(ii) PSYCHIATRY OR PSYCHIATRY

2 SUBSPECIALTY RESIDENCY.—The term 

3 ‘psychiatry or psychiatry subspecialty resi4 dency’ means a residency in psychiatry as 

5 accredited by the Accreditation Council for 

6 Graduate Medical Education for the pur7 pose of preventing, diagnosing, and treat8 ing mental health disorders. 

9 ‘‘(iii) QUALIFYING HOSPITAL.—The 

10 term ‘qualifying hospital’ means a hospital 

11 described in any of subclauses (I) through 

12 (V) of subparagraph (B)(ii). 

13 ‘‘(iv) REFERENCE RESIDENT

14 LEVEL.—The term ‘reference resident 

15 level’ means, with respect to a hospital, the 

16 resident level for the most recent cost re17 porting period of the hospital ending on or 

18 before the date of enactment of this para19 graph, for which a cost report has been 

20 settled (or, if not, submitted (subject to 

21 audit)), as determined by the Secretary. 

22 ‘‘(v) RESIDENT LEVEL.—The term 

23 ‘resident level’ has the meaning given such 

24 term in paragraph (7)(C)(i).’’. 


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1 (b) IME.—Section 1886(d)(5)(B) of the Social Secu2 rity Act (42 U.S.C. 1395ww(d)(5)(B)) is amended— 

3 (1) in clause (v), in the third sentence, by strik4 ing ‘‘and (h)(9)’’ and inserting ‘‘(h)(9), and 

5 (h)(10)’’; 

6 (2) by moving clause (xii) 4 ems to the left; and 

7 (3) by adding at the end the following new 

8 clause: 

9 ‘‘(xiii) For discharges occurring on or after 

10 July 1, 2024, insofar as an additional payment 

11 amount under this subparagraph is attributable to 

12 resident positions distributed to a hospital under 

13 subsection (h)(10), the indirect teaching adjustment 

14 factor shall be computed in the same manner as pro15 vided under clause (ii) with respect to such resident 

16 positions.’’. 

17 (c) PROHIBITION ON JUDICIAL REVIEW.—Section 

18 1886(h)(7)(E) of the Social Security Act (42 U.S.C. 

19 1395ww—4(h)(7)(E)) is amended by inserting ‘‘para20 graph (10),’’ after ‘‘paragraph (8),’’. 

Æ 


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