I

103D CONGRESS

1ST SESSION H. R. 945

To amend the Public Health Service Act and the Social Security Act to

increase the availability of primary and preventive health care, and for

other purposes.

IN THE HOUSE OF REPRESENTATIVES

FEBRUARY 17, 1993

Mr. DICKS introduced the following bill; which was referred jointly to the

Committees on Ways and Means and Energy and Commerce

A BILL

To amend the Public Health Service Act and the Social

Security Act to increase the availability of primary and

preventive health care, and for other purposes.

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 ‘‘Primary Health Care

5 Investment Act of 1993’’.

6 SEC. 2. PUBLIC HEALTH SERVICE PRIMARY CARE PROVI7 SIONS.

8 (a) MIGRANT HEALTH CENTERS.—Section

9 329(h)(1)(A) of the Public Health Service Act (42 U.S.C.
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1 254b(h)(1)(A)) is amended by striking ‘‘and’’ after

2 ‘‘1991,’’, and by striking ‘‘through 1994.’’ and inserting

3 the following: ‘‘and 1993, $68,790,000 for fiscal year

4 1994, $80,255,000 for fiscal year 1995, $91,720,000 for

5 fiscal year 1996, $103,185,000 for fiscal year 1997, and

6 $114,650,000 for fiscal year 1998.’’.

7 (b) COMMUNITY HEALTH CENTERS.—Section

8 330(g)(1)(A) of the Public Health Service Act (42 U.S.C.

9 254c(g)(1)(A)) is amended by striking ‘‘and’’ after

10 ‘‘1991,’’, and by striking ‘‘through 1994.’’ and inserting

11 the following: ‘‘and 1993, $670,780,800 for fiscal year

12 1994, $782,577,000 for fiscal year 1995, $894,374,400

13 for fiscal year 1996, $1,006,171,200 for fiscal year 1997,

14 and $1,117,968,000 for fiscal year 1998.’’.

15 (c) NATIONAL HEALTH SERVICE CORPS SCHOLAR16 SHIP AND LOAN REPAYMENT PROGRAMS.—Section

17 338H(b)(1) of the Public Health Service Act (42 U.S.C.

18 254q(b)(1)) is amended by striking ‘‘and’’ after ‘‘1991,’’,

19 and by striking ‘‘through 2000.’’ and inserting the follow20 ing: ‘‘and 1993, $91,155,600 for fiscal year 1994,

21 $106,348,200 for fiscal year 1995, $121,540,800 for fis22 cal year 1996, $136,733,400 for fiscal year 1997, and

23 $151,926,000 for fiscal year 1998.’’.

24 (d) HEALTH SERVICES FOR THE HOMELESS.—Sec25 tion 340(q)(1) of the Public Health Service Act (42 U.S.C.
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1 256(q)(1)) is amended by striking ‘‘and such sums’’ and

2 all that follows and inserting the following: ‘‘such sums

3 as may be necessary for fiscal year 1993, $69,638,400 for

4 fiscal year 1994, $81,244,800 for fiscal year 1995,

5 $92,851,200 for fiscal year 1996, $104,457,600 for fiscal

6 year 1997, and $116,064,000 for fiscal year 1998.’’.

7 SEC. 3. PAYMENTS FOR DIRECT GRADUATE MEDICAL EDU8 CATION COSTS OF PRIMARY CARE RESI9 DENTS INCREASED.

10 (a) IN GENERAL.—Section 1886(h) of the Social Se11 curity Act (42 U.S.C. 1395 ww(h)) is amended—

12 (1) by amending paragraph (2) to read as fol13 lows:

14 ‘‘(2) DETERMINATION OF APPROVED FTE RESI15 DENT AMOUNTS.—The Secretary shall determine an

16 approved FTE resident amount for each cost report17 ing period beginning after October 1, 1993, as fol18 lows:

19 ‘‘(A) DETERMINING NATIONAL AVERAGE

20 SALARY PER FTE RESIDENT IN FISCAL YEAR

21 1989.—The Secretary shall determine the na22 tional average salary for fiscal year 1991 for a

23 full-time-equivalent resident in an approved

24 medical residency training program.
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1 ‘‘(B) UPDATING TO A COST REPORTING

2 PERIOD THAT BEGINS IN FISCAL YEAR 1994.—

3 The Secretary shall update the amount deter4 mined under subparagraph (A) by the esti5 mated percentage change in the consumer price

6 index from the midpoint of fiscal year 1989 to

7 the midpoint of each cost reporting period that

8 begins in fiscal year 1994.

9 ‘‘(C) UPDATING TO SUBSEQUENT COST RE10 PORTING PERIODS.—For each subsequent cost

11 reporting period, the Secretary shall update the

12 amount determined under subparagraph (B) or

13 this subparagraph for an immediately preceding

14 cost reporting period by the estimated percent15 age change in the consumer price index from

16 the midpoint of that preceding period to the

17 midpoint of that subsequent period, with appro18 priate adjustments to reflect previous under- or

19 over-estimations in the estimated percentage

20 change in that index.’’;

21 (2) in paragraph (3)(B)(i), by striking ‘‘hos22 pital’s’’; and

23 (3) in paragraph (4), by amending subpara24 graph (C) to read as follows:
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1 ‘‘(C) WEIGHTING FACTOR FOR CERTAIN

2 RESIDENTS.—Such rules shall provide, in cal3 culating the number of full-time-equivalent resi4 dents in an approved residency program—

5 ‘‘(i) that the weighting factor for a

6 primary care (as defined by the Secretary)

7 resident, or for an intern, is 2.2,

8 ‘‘(ii) that the weighting factor for a

9 nonprimary care resident who is in the

10 resident’s initial residency period is 2.0,

11 and

12 ‘‘(iii) that the weighting factor for a

13 nonprimary care resident who is not in the

14 resident’s initial residency period is 1.2.

15 The Secretary shall make such adjustments as

16 are necessary to the weighting factors to main17 tain aggregate payments under this section to

18 all hospitals at the same level that such pay19 ments would have been made under this section

20 prior to enactment of the amendments made to

21 this section by the Primary Health Care Invest22 ment Act of 1993.’’.

23 (b) EFFECTIVE DATE.—(1) Except as otherwise pro24 vided by paragraph (2), the amendments made by this sec-
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1 tion shall apply to cost reporting periods beginning after

2 October 1, 1993.

3 (2) For a cost reporting period that falls partly in

4 fiscal year 1993 and partly in fiscal year 1994, the provi5 sions of section 1886(h), as in effect before the date of

6 enactment of this Act, shall apply proportionally to that

7 part of the cost reporting period that occurs before fiscal

8 year 1994.

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