II 

113TH CONGRESS 

1ST SESSION S. 577 

To amend title XVIII of the Social Security Act to provide for the distribution 

of additional residency positions, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MARCH 14, 2013 

Mr. NELSON (for himself, Mr. REID, and Mr. SCHUMER) 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, 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 ‘‘Resident Physician 

5 Shortage Reduction Act of 2013’’. 

6 SEC. 2. DISTRIBUTION OF ADDITIONAL RESIDENCY POSI7 TIONS. 

8 (a) IN GENERAL.—Section 1886(h) of the Social Se9 curity Act (42 U.S.C. 1395ww(h)) is amended— 


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1 (1) in paragraph (4)(F)(i), by striking ‘‘para2 graphs (7) and (8)’’ and inserting ‘‘paragraphs (7), 

3 (8), and (9)’’; 

4 (2) in paragraph (4)(H)(i), by striking ‘‘para5 graphs (7) and (8)’’ and inserting ‘‘paragraphs (7), 

6 (8), and (9)’’; 

7 (3) in paragraph (7)(E), by inserting ‘‘para8 graph (9),’’ after ‘‘paragraph (8),’’; and 

9 (4) by adding at the end the following new 

10 paragraph: 

11 ‘‘(9) DISTRIBUTION OF ADDITIONAL RESIDENCY

12 POSITIONS.— 

13 ‘‘(A) ADDITIONAL RESIDENCY POSI14 TIONS.— 

15 ‘‘(i) IN GENERAL.—For each of fiscal 

16 years 2015 through 2019 (and succeeding 

17 fiscal years if the Secretary determines 

18 that there are additional residency posi19 tions available to distribute under clause 

20 (iii)(II)), the Secretary shall increase the 

21 otherwise applicable resident limit for each 

22 qualifying hospital that submits a timely 

23 application under this subparagraph by 

24 such number as the Secretary may approve 

25 for portions of cost reporting periods ocVerDate Mar 15 2010 08:50 Mar 21, 2013 Jkt 029200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S577.IS S577

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1 curring on or after July 1 of the fiscal year 

2 of the increase. Except as provided in 

3 clause (iii), the aggregate number of in4 creases in the otherwise applicable resident 

5 limit under this subparagraph shall be 

6 equal to 3,000 in each of fiscal years 2015 

7 through 2019, of which at least 1,500 in 

8 each such fiscal year shall be used for full9 time equivalent residents training in a 

10 shortage specialty residency program (as 

11 defined in subparagraph (F)(iii)). 

12 ‘‘(ii) PROCESS FOR DISTRIBUTING PO13 SITIONS.— 

14 ‘‘(I) ROUNDS OF APPLICA15 TIONS.—The Secretary shall initiate 5 

16 separate rounds of applications for an 

17 increase under clause (i), 1 round 

18 with respect to each of fiscal years 

19 2015 through 2019. 

20 ‘‘(II) NUMBER AVAILABLE.—In 

21 each of such rounds, the aggregate 

22 number of positions available for dis23 tribution in the fiscal year as a result 

24 of an increase in the otherwise appli25 cable resident limit (as described in 


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1 clause (i)) shall be distributed, plus 

2 any additional positions available 

3 under clause (iii). 

4 ‘‘(III) TIMING.—The Secretary 

5 shall notify hospitals of the number of 

6 positions distributed to the hospital 

7 under this paragraph as result of an 

8 increase in the otherwise applicable 

9 resident limit by January 1 of the fis10 cal year of the increase. Such increase 

11 shall be effective for portions of cost 

12 reporting periods beginning on or 

13 after July 1 of that fiscal year. 

14 ‘‘(iii) POSITIONS NOT DISTRIBUTED

15 DURING THE FISCAL YEAR.— 

16 ‘‘(I) IN GENERAL.—If the num17 ber of resident full-time equivalent po18 sitions distributed under this para19 graph in a fiscal year is less than the 

20 aggregate number of positions avail21 able for distribution in the fiscal year 

22 (as described in clause (i), including 

23 after application of this subclause), 

24 the difference between such number 

25 distributed and such number available 


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1 for distribution shall be added to the 

2 aggregate number of positions avail3 able for distribution in the following 

4 fiscal year. 

5 ‘‘(II) EXCEPTION IF POSITIONS

6 NOT DISTRIBUTED BY END OF FISCAL

7 YEAR 2019.—If the aggregate number 

8 of positions distributed under this 

9 paragraph during the 5-year period of 

10 fiscal years 2015 through 2019 is less 

11 than 15,000, the Secretary shall, in 

12 accordance with the considerations de13 scribed in subparagraph (B)(i) and 

14 the priority described in subparagraph 

15 (B)(ii), conduct an application and 

16 distribution process in each subse17 quent fiscal year until such time as 

18 the aggregate amount of positions dis19 tributed under this paragraph is equal 

20 to 15,000. 

21 ‘‘(B) DISTRIBUTION TO CERTAIN HOS22 PITALS.— 

23 ‘‘(i) CONSIDERATION IN DISTRIBU24 TION.—In determining for which hospitals 

25 the increase in the otherwise applicable 


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1 resident limit is provided under subpara2 graph (A), the Secretary shall take into ac3 count the demonstrated likelihood of the 

4 hospital filling the positions made available 

5 under this paragraph within the first 5 

6 cost reporting periods beginning after the 

7 date the increase would be effective, as de8 termined by the Secretary. 

9 ‘‘(ii) PRIORITY FOR CERTAIN HOS10 PITALS.—Subject to clause (iii), in deter11 mining for which hospitals the increase in 

12 the otherwise applicable resident limit is 

13 provided under subparagraph (A), the Sec14 retary shall distribute the increase in the 

15 following priority order: 

16 ‘‘(I) First, to hospitals in States 

17 with (aa) new medical schools that re18 ceived ‘Candidate School’ status from 

19 the Liaison Committee on Medical 

20 Education or that received ‘Pre-Ac21 creditation’ status from the American 

22 Osteopathic Association Commission 

23 on Osteopathic College Accreditation 

24 on or after January 1, 2000, and that 

25 have achieved or continue to progress 


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1 toward ‘Full Accreditation’ status (as 

2 such term is defined by the Liaison 

3 Committee on Medical Education) or 

4 toward ‘Accreditation’ status (as such 

5 term is defined by the American Os6 teopathic Association Commission on 

7 Osteopathic College Accreditation), or 

8 (bb) additional locations and branch 

9 campuses established on or after Jan10 uary 1, 2000, by medical schools with 

11 ‘Full Accreditation’ status (as such 

12 term is defined by the Liaison Com13 mittee on Medical Education) or ‘Ac14 creditation’ status (as such term is 

15 defined by the American Osteopathic 

16 Association Commission on Osteo17 pathic College Accreditation). 

18 ‘‘(II) Second, to hospitals in 

19 which the resident level of the hospital 

20 is greater than the otherwise applica21 ble resident limit during the most re22 cent cost reporting period ending on 

23 or before the date of enactment of 

24 this paragraph. 


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1 ‘‘(III) Third, to hospitals that 

2 emphasize training in community 

3 health center or community-based set4 tings or in hospital outpatient depart5 ments. 

6 ‘‘(IV) Fourth, to hospitals that 

7 are eligible for incentive payments 

8 under section 1886(n) or 1903(t) as 

9 of the date the hospital submits an 

10 application for such increase under 

11 subparagraph (A). 

12 ‘‘(V) Fifth, to all other hospitals. 

13 ‘‘(iii) DISTRIBUTION TO HOSPITALS IN

14 HIGHER PRIORITY GROUP PRIOR TO DIS15 TRIBUTION IN LOWER PRIORITY GROUPS.— 

16 The Secretary may only distribute an in17 crease under subparagraph (A) to a lower 

18 priority group under clause (ii) if all quali19 fying hospitals in the higher priority group 

20 or groups have received the maximum 

21 number of increases under such subpara22 graph that the hospital is eligible for under 

23 this paragraph for the fiscal year. 

24 ‘‘(C) REQUIREMENTS FOR USE OF ADDI25 TIONAL POSITIONS.— 


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

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

3 the otherwise applicable resident limit 

4 under subparagraph (A) shall ensure, dur5 ing the 5-year period beginning on the ef6 fective date of such increase, that— 

7 ‘‘(I) not less than 50 percent of 

8 the positions attributable to such in9 crease are used to train full-time 

10 equivalent residents in a shortage spe11 cialty residency program (as defined 

12 in subclause (F)(iii)), as determined 

13 by the Secretary at the end of such 5- 

14 year period; 

15 ‘‘(II) the total number of full16 time equivalent residents, excluding 

17 any additional positions attributable 

18 to such increase, is not less than the 

19 average number of full-time equivalent 

20 residents during the 3 most recent 

21 cost reporting periods ending on or 

22 before the effective date of such in23 crease; and 

24 ‘‘(III) the ratio of full-time equiv25 alent residents in a shortage specialty 


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1 residency program (as so defined) is 

2 not less than the average ratio of full3 time equivalent residents in such a 

4 program during the 3 most recent 

5 cost reporting periods ending on or 

6 before the effective date of such in7 crease. 

8 ‘‘(ii) REDISTRIBUTION OF POSITIONS

9 IF HOSPITAL NO LONGER MEETS CERTAIN

10 REQUIREMENTS.—In the case where the 

11 Secretary determines that a hospital de12 scribed in clause (i) does not meet the re13 quirements of such clause, the Secretary 

14 shall— 

15 ‘‘(I) reduce the otherwise applica16 ble resident limit of the hospital by 

17 the amount by which such limit was 

18 increased under this paragraph; and 

19 ‘‘(II) provide for the distribution 

20 of positions attributable to such re21 duction in accordance with the re22 quirements of this paragraph. 

23 ‘‘(D) LIMITATION.— 

24 ‘‘(i) IN GENERAL.—Except as pro25 vided in clause (ii), a hospital may not reVerDate Mar 15 2010 08:50 Mar 21, 2013 Jkt 029200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S577.IS S577

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1 ceive more than 75 full-time equivalent ad2 ditional residency positions in the aggre3 gate under this paragraph over the period 

4 of fiscal years 2015 through 2019. 

5 ‘‘(ii) INCREASE IN NUMBER OF ADDI6 TIONAL POSITIONS A HOSPITAL MAY RE7 CEIVE.—The Secretary shall increase the 

8 aggregate number of full-time equivalent 

9 additional residency positions a hospital 

10 may receive under this paragraph over 

11 such period if the Secretary estimates that 

12 the number of positions available for dis13 tribution under subparagraph (A) exceeds 

14 the number of applications approved under 

15 such subparagraph over such period. 

16 ‘‘(E) APPLICATION OF PER RESIDENT

17 AMOUNTS FOR PRIMARY CARE AND NONPRI18 MARY CARE.—With respect to additional resi19 dency positions in a hospital attributable to the 

20 increase provided under this paragraph, the ap21 proved FTE per resident amounts are deemed 

22 to be equal to the hospital per resident amounts 

23 for primary care and nonprimary care com24 puted under paragraph (2)(D) for that hospital. 

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


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1 ‘‘(i) OTHERWISE APPLICABLE RESI2 DENT LIMIT.—The term ‘otherwise appli3 cable resident limit’ means, with respect to 

4 a hospital, the limit otherwise applicable 

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

6 paragraph (4) on the resident level for the 

7 hospital determined without regard to this 

8 paragraph but taking into account para9 graphs (7)(A), (7)(B), (8)(A), and (8)(B). 

10 ‘‘(ii) RESIDENT LEVEL.—The term 

11 ‘resident level’ has the meaning given such 

12 term in paragraph (7)(C)(i). 

13 ‘‘(iii) SHORTAGE SPECIALTY RESI14 DENCY PROGRAM.—The term ‘shortage 

15 specialty residency program’ means the fol16 lowing: 

17 ‘‘(I) PRIOR TO REPORT ON

18 SHORTAGE SPECIALTIES.—Prior to 

19 the date on which the report of the 

20 National Health Care Workforce 

21 Commission is submitted under sec22 tion 3 of the Resident Physician 

23 Shortage Reduction Act of 2013, any 

24 approved residency training program 

25 in a specialty identified in the report 


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1 entitled ‘The Physician Workforce: 

2 Projections and Research into Current 

3 Issues Affecting Supply and Demand’, 

4 issued in December 2008 by the 

5 Health Resources and Services Ad6 ministration, as a specialty whose 

7 baseline physician requirements pro8 jections exceed the projected supply of 

9 total active physicians for the period 

10 of 2005 through 2020. 

11 ‘‘(II) AFTER REPORT ON SHORT12 AGE SPECIALTIES.—On or after the 

13 date on which the report of the Na14 tional Health Care Workforce Com15 mission is submitted under such sec16 tion, any approved residency training 

17 program in a physician specialty iden18 tified in such report as a specialty for 

19 which there is a shortage.’’. 

20 (b) IME.— 

21 (1) IN GENERAL.—Section 1886(d)(5)(B)(v) of 

22 the Social Security Act (42 U.S.C. 

23 1395ww(d)(5)(B)(v)), in the second sentence, is 

24 amended by striking ‘‘subsections (h)(7) and (h)(8)’’ 

25 and inserting ‘‘subsections (h)(7), (h)(8), and (h)(9). 


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1 (2) CONFORMING PROVISION.—Section 

2 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 

3 1395ww(d)(5)(B)) is amended— 

4 (A) by redesignating clause (x), as added 

5 by section 5505(b) of the Patient Protection 

6 and Affordable Care Act (Public Law 111– 

7 148), as clause (xi) and moving such clause 4 

8 ems to the left; and 

9 (B) by adding after clause (xi), as redesig10 nated by subparagraph (A), the following 

11 clause: 

12 ‘‘(xii) For discharges occurring on or after July 

13 1, 2015, insofar as an additional payment amount 

14 under this subparagraph is attributable to resident 

15 positions distributed to a hospital under subsection 

16 (h)(9), the indirect teaching adjustment factor shall 

17 be computed in the same manner as provided under 

18 clause (ii) with respect to such resident positions.’’. 

19 SEC. 3. STUDY AND REPORT BY NATIONAL HEALTH CARE 

20 WORKFORCE COMMISSION. 

21 (a) STUDY.—The National Health Care Workforce 

22 Commission established under section 5101 of the Patient 

23 Protection and Affordable Care Act (Public Law 111– 

24 148) shall conduct a study of the physician workforce. 

25 Such study shall include the identification of physician 


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1 specialties for which there is a shortage, as defined by the 

2 Commission. 

3 (b) REPORT.—Not later than January 1, 2016, the 

4 National Health Care Workforce Commission shall submit 

5 to Congress a report on the study conducted under sub6 section (a), together with recommendations for such legis7 lation and administrative action as the Commission deter8 mines appropriate. 

9 SEC. 4. STUDY AND REPORT ON STRATEGIES FOR INCREAS10 ING DIVERSITY. 

11 (a) STUDY.—The Comptroller General of the United 

12 States (in this section referred to as the ‘‘Comptroller 

13 General’’) shall conduct a study on strategies for increas14 ing the diversity of the health professional workforce. Such 

15 study shall include an analysis of strategies for increasing 

16 the number of health professionals from rural, lower in17 come, and underrepresented minority communities, includ18 ing which strategies are most effective for achieving such 

19 goal. 

20 (b) REPORT.—Not later than 2 years after the date 

21 of the enactment of this Act, the Comptroller General shall 

22 submit to Congress a report on the study conducted under 

23 subsection (a), together with recommendations for such 


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1 legislation and administrative action as the Comptroller 

2 General determines appropriate. 

Æ 


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