I 

112TH CONGRESS 

1ST SESSION H. R. 2224 

To amend title XVIII of the Social Security Act to provide opportunities 

for additional residency slots in participating teaching hospitals and 

to expand the primary care bonus to certain underserved specialties 

and to amend the Internal Revenue Code of 1986 to provide tax incentives for practicing-teaching physicians. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 16, 2011 

Mr. GRIMM (for himself, Mr. CROWLEY, Mr. ENGEL, Mr. KING of New York, 

Mr. MEEKS, Mr. HANNA, Mrs. MALONEY, Ms. CLARKE of New York, Mr. 

ACKERMAN, and Mrs. MCCARTHY of New York) 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 provide 

opportunities for additional residency slots in participating teaching hospitals and to expand the primary 

care bonus to certain underserved specialties and to 

amend the Internal Revenue Code of 1986 to provide 

tax incentives for practicing-teaching physicians. 

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


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Improving Physician 

3 Access in Teaching Hospitals (PATH) Act of 2011’’. 

4 SEC. 2. DISTRIBUTION OF ADDITIONAL RESIDENCY SLOTS. 

5 Section 1886(h) of the Social Security Act (42 U.S.C. 

6 1395ww(h)) is amended— 

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

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

10 ‘‘(9) DISTRIBUTION OF ADDITIONAL RESIDENCY

11 POSITIONS.— 

12 ‘‘(A) REDUCTIONS IN LIMIT BASED ON UN13 USED POSITIONS.— 

14 ‘‘(i) IN GENERAL.—Except as pro15 vided in clause (ii), if a hospital’s resident 

16 level (as defined in paragraph (7)(C)(i)) 

17 for each of the 5 most recent cost report18 ing periods (ending before the date of the 

19 enactment of this paragraph) of the hos20 pital for which a cost report has been set21 tled (or, if not, submitted subject to audit) 

22 as determined by the Secretary is less than 

23 the otherwise applicable resident limit (as 

24 defined in paragraph (8)(H)(iii)), effective 

25 for portions of cost reporting periods oc26 curring on or after the paragraph (9) efVerDate Mar 15 2010 21:45 Jun 20, 2011 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2224.IH H2224

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1 fective date (as defined in subparagraph 

2 (E)), the otherwise applicable resident 

3 limit shall be reduced by the difference be4 tween such otherwise applicable resident 

5 limit and the highest such reference resi6 dent level for any of such 5 cost reporting 

7 periods. 

8 ‘‘(ii) EXCEPTION.—Clause (i) shall 

9 not apply to— 

10 ‘‘(I) a hospital located in a rural 

11 area with fewer than 250 beds; or 

12 ‘‘(II) a hospital that has had in 

13 effect a voluntary residency reduction 

14 plan under paragraph (6) or pursuant 

15 to section 402 of Public Law 90–248. 

16 ‘‘(B) REQUIREMENTS FOR ADDITIONAL

17 RESIDENCY SLOTS.— 

18 ‘‘(i) IN GENERAL.—The Secretary 

19 shall increase the otherwise applicable resi20 dent limit for hospitals that submit an ap21 plication under this subparagraph by such 

22 number as the Secretary may approve for 

23 portions of cost reporting periods occurring 

24 on or after the paragraph (9) effective 

25 date. The aggregate number of increases in 


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1 the otherwise applicable resident limit 

2 under this subparagraph shall be equal to 

3 the sum of— 

4 ‘‘(I) the aggregate reduction in 

5 such limits attributable to subpara6 graph (A) (as estimated by the Sec7 retary); and 

8 ‘‘(II) 1,000 for portions of cost 

9 reporting periods occurring during the 

10 12-month period beginning on the 

11 paragraph (9) effective date, 1,000 

12 additional positions for portions of 

13 cost reporting periods occurring dur14 ing the 12-month period beginning 1 

15 year after such effective date, 1,000 

16 additional positions for portion of cost 

17 reporting period occurring during the 

18 12-month period beginning 2 years 

19 after such effective date, and such 

20 number of additional positions for 

21 portions of the 2 subsequent cost re22 porting periods as the Secretary may 

23 determine necessary to support resi24 dency training programs in specialities 

25 that exceed 3 years. 


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1 ‘‘(ii) CONSIDERATION IN REDISTRIBU2 TION.—In determining for which hospitals 

3 the increase in the otherwise applicable 

4 resident limit is provided under this sub5 paragraph, the Secretary shall take into 

6 account— 

7 ‘‘(I) data provided by the Health 

8 Resources and Services Administra9 tion as a national standard to exhibit 

10 a specific demand in the health care 

11 workforce, as well as the Administra12 tion’s projected demand and supply 

13 for physicians in the specialty of med14 icine involved; and 

15 ‘‘(II) the demonstrated likelihood 

16 of the hospital filling positions made 

17 available under this paragraph within 

18 the first 3 cost reporting periods be19 ginning on or after the paragraph (9) 

20 effective date. 

21 The Secretary shall give special consider22 ation for up to 25 additional positions in 

23 the case of a hospital that demonstrates 

24 the likelihood of filing such positions durVerDate Mar 15 2010 21:45 Jun 20, 2011 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2224.IH H2224

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1 ing the first cost reporting period begin2 ning on or after such effective date. 

3 ‘‘(iii) LIMITATION.—In no case shall 

4 the number of additional positions made 

5 available to a hospital under this para6 graph exceed 25 in the first cost reporting 

7 period or 75 for all cost reporting periods. 

8 ‘‘(C) PRIORITY FOR ADDITIONAL POSI9 TIONS RESULTING FROM HOSPITAL CLO10 SURES.—With respect to additional positions 

11 described in subparagraph (B)(i)(I) which are 

12 derived from a reduction in limits under sub13 paragraph (A) for a hospital that closed (in this 

14 subparagraph referred to as a ‘closed hospital’), 

15 the Secretary shall distribute the increase to 

16 hospitals in the following priority order: 

17 ‘‘(i) First, to other hospitals for the 

18 program or programs under which the hos19 pital had a cooperative arrangement with 

20 the closed hospital under which residents 

21 in the graduate medical education program 

22 of the closed hospital also rotated through 

23 the other hospital. 


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1 ‘‘(ii) Second, to other hospitals that 

2 are members of the same affiliated group 

3 of hospitals as the closed hospital. 

4 ‘‘(iii) Third, to other hospitals that 

5 are located in the same or contiguous core6 based statistical area as the closed hos7 pital. 

8 ‘‘(D) PREFERENCE.—After applying sub9 paragraph (C) and the special consideration 

10 under subparagraph (B), in determining for 

11 which hospitals the increase in the otherwise 

12 applicable resident limit is provided under sub13 paragraph (B), the Secretary shall give pref14 erence to hospitals— 

15 ‘‘(i) that submit an application for 

16 new residents in primary care and geriatric 

17 medicine and in other specialties as deter18 mined to be in demand under subpara19 graph (B)(ii)(I); and 

20 ‘‘(ii) that emphasize training in com21 munity health centers and other commu22 nity-based or hospital-sponsored clinics, 

23 and private physicians’ offices, including 

24 physician groups. 


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1 ‘‘(E) PARAGRAPH (9) EFFECTIVE DATE DE2 FINED.—In this paragraph, the term ‘para3 graph (9) effective date’ means July 1 of the 

4 year that begins after the date of the enactment 

5 of this paragraph. 

6 ‘‘(F) AFFILIATION.—The provisions of this 

7 paragraph shall be applied to hospitals which 

8 are members of the same affiliated group (as 

9 defined by the Secretary under paragraph 

10 (4)(H)(ii)) and the reference resident level for 

11 each such hospital with respect to the cost re12 porting period that results in the smallest dif13 ference between the reference resident level and 

14 the otherwise applicable resident limit.’’. 

15 SEC. 3. EXPANDING PRIMARY CARE BONUS TO CERTAIN 

16 UNDERSERVED SPECIALTIES. 

17 (a) IN GENERAL.—Section 1833(x)(2)(A) of the So18 cial Security Act (42 U.S.C. 1395l(x)(2)(A)) is amend19 ed— 

20 (1) in clause (i)— 

21 (A) by striking ‘‘or’’ at the end of sub22 clause (I); 

23 (B) by striking ‘‘and’’ at the end of sub24 clause (II) and inserting ‘‘or’’; and 


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1 (C) by adding at the end the following new 

2 subclause: 

3 ‘‘(III) is a physician (as de4 scribed in section 1861(r)(1)) who is 

5 in an underserved specialty, such as 

6 psychiatry or neurology, as specified 

7 by the Secretary, or other specialty 

8 identified by the Secretary to be in 

9 demand; and’’; and 

10 (2) in clause (ii), by inserting after ‘‘(ii)’’ the 

11 following: ‘‘in the case of an individual described in 

12 subclause (I) or (II) of clause (i),’’. 

13 (b) EFFECTIVE DATE.—The amendments made by 

14 subsection (a) shall apply to payments for items and serv15 ices furnished on or after January 1, 2012. 

16 SEC. 4. SMALL PHYSICIAN PRACTICE RESIDENCY CREDIT. 

17 (a) IN GENERAL.—Subpart D of part IV of sub18 chapter A of chapter 1 of the Internal Revenue Code of 

19 1986 (relating to business related credits) is amended by 

20 adding at the end the following new section: 

21 ‘‘SEC. 45S. SMALL PHYSICIAN PRACTICE RESIDENCY CRED22 IT. 

23 ‘‘(a) IN GENERAL.—For purposes of section 38, the 

24 amount of the small physician practice residency credit de25 termined under this section for any taxable year with reVerDate Mar 15 2010 21:45 Jun 20, 2011 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H2224.IH H2224

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1 spect to a qualified small physician practice is the sum 

2 of the following: 

3 ‘‘(1) OVERALL AMOUNT.—The per resident dol4 lar amount multiplied by the number of qualified 

5 teaching hospital residents who provide services to, 

6 and are trained by, such practice during the taxable 

7 year and who are in their first, second, or third 

8 post-graduate year of medical residency. 

9 ‘‘(2) BONUS.—The sum of— 

10 ‘‘(A) 50 percent of the per resident dollar 

11 amount multiplied by the number of such resi12 dents who are in their first post-graduate year 

13 of medical residency during the taxable year; 

14 and 

15 ‘‘(B) 25 percent of the per resident dollar 

16 amount multiplied by the average number of 

17 such residents who are not counted under sub18 paragraph (A) and are in their second post19 graduate year during the taxable year. 

20 ‘‘(b) QUALIFIED SMALL PHYSICIAN PRACTICE.—For 

21 purposes of this section, the term ‘qualified small physi22 cian practice’ means any trade or business of providing 

23 physicians’ services (as defined in section 1861(q) of the 

24 Social Security Act), which may be a community health 

25 center, that is owned and operated by a doctor of medicine 


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1 or osteopathy if fewer than 50 individuals are employed 

2 in such trade or business (including new training sites) 

3 and the trade or business includes as part of the practice 

4 the training of doctors of medicine or osteopathy in a rota5 tion covering at least 6 months in the taxable year. All 

6 persons treated as a single employer under subsection (a) 

7 or (b) or section 52 or subsection (m) or (o) of section 

8 414 shall be treated as a single trade or business for pur9 poses of the preceding sentence. 

10 ‘‘(c) QUALIFIED TEACHING HOSPITAL RESIDENTS.— 

11 For purposes of this section, the term ‘qualified teaching 

12 hospital resident’ means any resident (within the meaning 

13 of subparagraph (I) of section 1886(h)(5) of the Social 

14 Security Act) in an approved medical residency training 

15 program (as defined in subparagraph (A) of such section) 

16 which provides services to the qualified small physician 

17 practice (while utilizing the technologies and supplies of 

18 such practice) for a period not less than— 

19 ‘‘(1) 4 weeks in the case of a primary care resi20 dent (as defined in subparagraph (H) of such sec21 tion); or 

22 ‘‘(2) 2 weeks in the case of any other resident. 

23 ‘‘(d) PER RESIDENT DOLLAR AMOUNT.—For pur24 poses of this section, the term ‘per resident dollar amount’ 

25 means, in the case of a qualified small physician practice 


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1 that includes as part of the practice the training of doctors 

2 of medicine or osteopathy in a rotation covering— 

3 ‘‘(1) at least 6 months but less than 9 months 

4 in the taxable year, $2,500; or 

5 ‘‘(2) at least 9 months in the taxable year, 

6 $3,000. 

7 ‘‘(e) RESIDENTS NOT TAKEN INTO ACCOUNT MORE

8 THAN ONCE.—A qualified teaching hospital resident shall 

9 be taken into account under subsection (a) for the taxable 

10 in which the period described in subsection (c) ends and 

11 shall not be so taken into account for any other taxable 

12 year.’’. 

13 (b) CREDIT ALLOWED AS PART OF GENERAL BUSI14 NESS CREDIT.—Section 38(b) of such Code (defining cur15 rent year business credit) is amended by striking ‘‘plus’’ 

16 at the end of paragraph (35), by striking the period at 

17 the end of paragraph (36) and inserting ‘‘, plus’’, and by 

18 adding at the end the following new paragraph: 

19 ‘‘(37) the small physician practice residency 

20 credit determined under section 45S(a).’’. 

21 (c) CONFORMING AMENDMENT.—The table of sec22 tions for subpart D of part IV of subchapter A of chapter 

23 1 of such Code is amended by adding at the end the fol24 lowing new item: 

‘‘Sec. 45S. Small physician practice residency credit.’’. 


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1 (d) EFFECTIVE DATE.—The amendments made by 

2 this section shall apply to taxable years beginning after 

3 the date of the enactment of this Act. 

Æ 


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