I 

116TH CONGRESS 

1ST SESSION H. R. 1358 

To amend title XVIII of the Social Security Act to establish rules for payment 

for graduate medical education (GME) costs for hospitals that establish 

a new medical residency training program after hosting resident rotators 

for short durations. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 26, 2019 

Mr. KIND (for himself, Mr. GALLAGHER, Mr. SENSENBRENNER, Ms. MOORE, 

Mr. DUFFY, Mr. POCAN, Mr. GROTHMAN, and Mr. STEIL) introduced the 

following bill; which was referred to the Committee on Ways and Means, 

and in addition to the Committee on Energy and Commerce, for a period 

to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee 

concerned 

A BILL 

To amend title XVIII of the Social Security Act to establish 

rules for payment for graduate medical education (GME) 

costs for hospitals that establish a new medical residency 

training program after hosting resident rotators for short 

durations. 

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 ‘‘Advancing Medical 

5 Resident Training in Community Hospitals Act of 2019’’. 


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1 SEC. 2. MEDICARE GME TREATMENT OF HOSPITALS ESTAB2 LISHING NEW MEDICAL RESIDENCY TRAIN3 ING PROGRAMS AFTER HOSTING MEDICAL 

4 RESIDENT ROTATORS FOR SHORT DURA5 TIONS. 

6 (a) REDETERMINATION OF APPROVED FTE RESI7 DENT AMOUNT.—Section 1886(h)(2)(F) of the Social Se8 curity Act (42 U.S.C. 1395ww(h)(2)(F)) is amended— 

9 (1) by inserting ‘‘(i)’’ before ‘‘In the case of’’; 

10 and 

11 (2) by adding at the end the following: 

12 ‘‘(ii) In applying this subparagraph to a 

13 hospital that has not entered into a GME affili14 ation agreement (as defined by the Secretary 

15 for purposes of paragraph (4)(H)(ii)), the Sec16 retary shall not provide for the establishment of 

17 an FTE resident amount until such time as the 

18 Secretary determines that the hospital has a 

19 medical residency training program that trains 

20 more than 1.0 full-time-equivalent resident in a 

21 cost reporting period. 

22 ‘‘(iii) In the case of a hospital with an ap23 proved FTE resident amount— 

24 ‘‘(I) based on the training of less than 

25 1.0 full-time-equivalent resident before Oc26 tober 1, 1997, or 


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1 ‘‘(II) based on the training of no more 

2 than 3.0 full-time-equivalent residents in a 

3 medical residency training program in any 

4 cost reporting period beginning on or after 

5 October 1, 1997, and before the date of 

6 the enactment of this clause, 

7 the Secretary shall provide the hospital an op8 portunity to have a new FTE resident amount 

9 established when the hospital begins training at 

10 least 1.0 full-time-equivalent resident (in the 

11 case of a hospital described in subclause (I)) or 

12 more than 3.0 full-time-equivalent residents (in 

13 the case of a hospital described in subclause 

14 (II)) for cost reporting periods beginning on or 

15 after the date of the enactment of this clause 

16 and in accordance with the methodology under 

17 the rules in effect as of October 1, 2015.’’. 

18 (b) REDETERMINATION OF FTE RESIDENT LIMITA19 TION.—Section 1886(h)(4)(H)(i) of the Social Security 

20 Act (42 U.S.C. 1395ww(h)(4)(H)(i)) is amended— 

21 (1) by inserting ‘‘(I)’’ before ‘‘The Secretary’’; 

22 and 

23 (2) by adding at the end the following: 

24 ‘‘(II) Under this clause the Secretary 

25 shall not determine an adjustment in the 


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1 limitation applicable to a hospital under 

2 subparagraph (F) until the hospital trains 

3 more than 1.0 full-time-equivalent resident 

4 in a new medical residency training pro5 gram in a cost reporting period. 

6 ‘‘(III) In the case of a hospital that 

7 has a limitation under subparagraph (F) of 

8 less than 1.0 full-time-equivalent resident 

9 as of the date of the enactment of this sub10 clause based on training before October 1, 

11 1997, under this clause the Secretary shall 

12 provide the hospital an opportunity to have 

13 a new adjustment in such limitation deter14 mined when such hospital begins training 

15 at least 1.0 full-time-equivalent resident in 

16 accordance with the methodology applica17 ble to hospitals under the rules in effect as 

18 of October 1, 2015, and applied for cost 

19 reporting periods beginning on or after the 

20 date of the enactment of this subclause. 

21 ‘‘(IV) In the case of a hospital for 

22 which an adjustment in the limitation ap23 plicable to a hospital under subparagraph 

24 (F) is based on the training of no more 

25 than 3.0 full-time-equivalent residents in a 


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1 new medical residency training program in 

2 a cost reporting period beginning on or 

3 after October 1, 1997, and before the date 

4 of the enactment of this subclause, the 

5 Secretary shall provide the hospital an op6 portunity to have a new adjustment in 

7 such limitation determined when the hos8 pital begins training more than 3.0 full9 time-equivalent residents in accordance 

10 with the methodology applicable to hos11 pitals under the rules in effect as of Octo12 ber 1, 2015, and applied for cost reporting 

13 periods beginning on or after the date of 

14 the enactment of this subclause.’’. 

15 (c) EFFECTIVE DATE.—The amendments made by 

16 this section shall apply to payment under section 1886 of 

17 the Social Security Act (42 U.S.C. 1395ww) for cost re18 porting periods beginning on or after the date of the en19 actment of this Act. 

Æ 


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