II 

115TH CONGRESS 

1ST SESSION S. 1754 

To reauthorize section 340H of the Public Health Service Act to continue 

to encourage the expansion, maintenance, and establishment of approved 

graduate medical residency programs at qualified teaching health centers, 

and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

AUGUST 3, 2017 

Ms. COLLINS (for herself, Mr. TESTER, Mr. COCHRAN, Mr. MANCHIN, Mr. 

DAINES, Ms. HARRIS, and Mr. BOOZMAN) introduced the following bill; 

which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To reauthorize section 340H of the Public Health Service 

Act to continue to encourage the expansion, maintenance, 

and establishment of approved graduate medical residency programs at qualified teaching health centers, 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 ‘‘Training the Next 

5 Generation of Primary Care Doctors Act of 2017’’. 

mstockstill on DSK30JT082PROD with BILLS

2 

•S 1754 IS

1 SEC. 2. FINDINGS. 

2 The Congress finds as follows: 

3 (1) The program of payments to teaching 

4 health centers for graduate medical education under 

5 section 340H of the Public Health Service Act (42 

6 U.S.C. 256h) was enacted in 2010 to address the 

7 crisis-level shortage of primary care physicians, espe8 cially in rural and medically underserved commu9 nities. 

10 (2) Teaching health center residents and faculty 

11 will provide more than one million primary care 

12 medical visits in 2017 to underserved communities. 

13 (3) When compared with traditional Medicare 

14 GME residents, residents who train at teaching 

15 health centers are more likely to practice primary 

16 care and remain in underserved or rural commu17 nities. 

18 (4) The teaching health center program not 

19 only plays a vital role in training the Nation’s next 

20 generation of primary care physicians (including 

21 dentists), but helps bridge the Nation’s physician 

22 shortfall. 

23 (5) For these reasons, it is of vital importance 

24 to continue the program under section 340H of the 

25 Public Health Service Act (42 U.S.C. 256h) at a 

26 sustainable level of funding per full-time equivalent 

mstockstill on DSK30JT082PROD with BILLS

3 

•S 1754 IS

1 resident, as recommended in the fact sheet of the 

2 Health Resources and Services Administration enti3 tled ‘‘Cost Estimates for Training Residents in a 

4 Teaching Health Center’’. 

5 SEC. 3. REAUTHORIZATION OF PROGRAM OF PAYMENTS TO 

6 TEACHING HEALTH CENTERS THAT OPERATE 

7 GRADUATE MEDICAL EDUCATION PRO8 GRAMS. 

9 (a) PAYMENTS.—Subsection (a) of section 340H of 

10 the Public Health Service Act (42 U.S.C. 256h) is amend11 ed to read as follows: 

12 ‘‘(a) PAYMENTS.— 

13 ‘‘(1) IN GENERAL.—Subject to subsection 

14 (h)(2), the Secretary shall make payments under 

15 this section for direct expenses and indirect expenses 

16 to qualified teaching health centers that are listed as 

17 sponsoring institutions by the relevant accrediting 

18 body for— 

19 ‘‘(A) maintenance of existing approved 

20 graduate medical residency training programs; 

21 ‘‘(B) expansion of existing approved grad22 uate medical residency training programs; and 

23 ‘‘(C) establishment of new approved grad24 uate medical residency training programs. 

25 ‘‘(2) NEW PROGRAMS.— 

mstockstill on DSK30JT082PROD with BILLS

4 

•S 1754 IS

1 ‘‘(A) PAYMENTS.—The Secretary shall 

2 make payments under paragraph (1)(C)— 

3 ‘‘(i) for fiscal year 2019, for a total of 

4 up to 60 full-time equivalent residents at 

5 new approved graduate medical residency 

6 programs; and 

7 ‘‘(ii) for fiscal year 2020, for a total 

8 of up to 120 full-time equivalent residents 

9 at new approved graduate medical resi10 dency programs. 

11 ‘‘(B) PRIORITY.—Subject to subparagraph 

12 (C), in making payments pursuant to para13 graph (1)(C), the Secretary shall give priority 

14 to qualified teaching health centers that— 

15 ‘‘(i) serve a health professional short16 age area with a designation in effect under 

17 section 332 or a medically underserved 

18 community (as defined in section 799B); 

19 or 

20 ‘‘(ii) are located in a rural area (as 

21 defined in section 1886(d)(2)(D) of the So22 cial Security Act). 

23 ‘‘(C) LIMITATIONS.—The number of full24 time equivalent residents for which a qualified 

25 teaching health center receives payments pursumstockstill on DSK30JT082PROD with BILLS

5 

•S 1754 IS

1 ant to paragraph (1)(C) for a fiscal year shall 

2 not exceed by more than 6 the number of full3 time equivalent residents for which the center 

4 received such payments for the preceding fiscal 

5 year. The total number of full-time equivalent 

6 residents at all qualified teaching health centers 

7 for which payments are made by the Secretary 

8 under subparagraphs (A) and (B) of subsection 

9 (a)(1) shall not exceed the total number of full10 time equivalent residents at all qualified teach11 ing health centers for which payments were 

12 made by the Secretary as of January 1, 2017, 

13 pursuant to this section.’’. 

14 (b) FUNDING.—Subsection (g) of the first section 

15 340H of the Public Health Service Act (42 U.S.C. 256h) 

16 is amended to read as follows: 

17 ‘‘(g) FUNDING.— 

18 ‘‘(1) EXISTING PROGRAMS.—Out of any money 

19 in the Treasury not otherwise appropriated, there 

20 are appropriated for payments under subparagraphs 

21 (A) and (B) of subsection (a)(1) $116,500,000 for 

22 each of fiscal years 2018, 2019, and 2020, to re23 main available until expended. 

24 ‘‘(2) INCENTIVE FOR NEW PROGRAMS.—Out of 

25 any money in the Treasury not otherwise appromstockstill on DSK30JT082PROD with BILLS

6 

•S 1754 IS

1 priated, there are appropriated for payments under 

2 subsection (a)(1)(C), $10,000,000 for fiscal year 

3 2019 and $19,000,000 for fiscal year 2020, to re4 main available until expended. 

5 ‘‘(3) ADMINISTRATIVE EXPENSES.—Of the 

6 amount made available to carry out this section for 

7 any fiscal year, the Secretary may not use more 

8 than 5 percent of such amount for the expenses of 

9 administering this section.’’. 

10 (c) ANNUAL REPORTING.—Paragraph (1) of sub11 section (h) of the first section 340H of the Public Health 

12 Service Act (42 U.S.C. 256h) is amended— 

13 (1) by redesignating subparagraph (D) as sub14 paragraph (H); and 

15 (2) by inserting after subparagraph (C) the fol16 lowing: 

17 ‘‘(D) The number of patients treated by 

18 residents described in paragraph (4). 

19 ‘‘(E) The number of visits by patients 

20 treated by residents described in paragraph (4). 

21 ‘‘(F) Of the number of residents described 

22 in paragraph (4) who completed their residency 

23 training at the end of such residency academic 

24 year, the number and percentage of such resi25 dents entering primary care practice (meaning 

mstockstill on DSK30JT082PROD with BILLS

7 

•S 1754 IS

1 any of the areas of practice listed in the defini2 tion of a primary care residency program in 

3 section 749A). 

4 ‘‘(G) Of the number of residents described 

5 in paragraph (4) who completed their residency 

6 training at the end of such residency academic 

7 year, the number and percentage of such resi8 dents who entered practice at a health care fa9 cility— 

10 ‘‘(i) primarily serving a health profes11 sional shortage area with a designation in 

12 effect under section 332 or a medically un13 derserved community (as defined in section 

14 799B); or 

15 ‘‘(ii) located in a rural area (as de16 fined in section 1886(d)(2)(D) of the So17 cial Security Act).’’. 

18 (d) REPORT ON TRAINING COSTS.—Not later than 

19 March 31, 2020, the Secretary of Health and Human 

20 Services shall submit to the Congress a report on the di21 rect graduate expenses of approved graduate medical resi22 dency training programs, and the indirect expenses associ23 ated with the additional costs of teaching residents, of 

24 qualified teaching health centers (as such terms are used 

mstockstill on DSK30JT082PROD with BILLS

8 

•S 1754 IS

1 or defined in section 340H of the Public Health Service 

2 Act (42 U.S.C. 256h)). 

3 (e) DEFINITION.—Subsection (j) of the first section 

4 340H of the Public Health Service Act (42 U.S.C. 256h) 

5 is amended— 

6 (1) by redesignating paragraphs (2) and (3) as 

7 paragraphs (3) and (4), respectively; and 

8 (2) by inserting after paragraph (1) the fol9 lowing: 

10 ‘‘(2) NEW APPROVED GRADUATE MEDICAL

11 RESIDENCY TRAINING PROGRAM.—The term ‘new 

12 approved graduate medical residency training pro13 gram’ means an approved graduate medical resi14 dency training program for which the sponsoring 

15 qualified teaching health center has not received a 

16 payment under this section for a previous fiscal year 

17 (other than pursuant to subsection (a)(1)(C)).’’. 

18 (f) TECHNICAL CORRECTIONS.—Part D of title III 

19 of the Public Health Service Act (42 U.S.C. 254b et seq.) 

20 is amended— 

21 (1) in subsection (f) of the first section 340H 

22 (42 U.S.C. 256h), by striking ‘‘hospital’’ each place 

23 it appears and inserting ‘‘teaching health center’’; 

mstockstill on DSK30JT082PROD with BILLS

9 

•S 1754 IS

1 (2) by redesignating the second subpart XI (re2 lating to a community-based collaborative care net3 work program) as subpart XII; and 

4 (3) by redesignating the second section 340H 

5 (42 U.S.C. 256i) as section 340I. 

6 (g) PAYMENTS FOR PREVIOUS FISCAL YEARS.—The 

7 provisions of the first section 340H of the Public Health 

8 Service Act (42 U.S.C. 256h), as in effect on the day be9 fore the date of enactment of this Act, shall continue to 

10 apply with respect to payments under such section for fis11 cal years before fiscal year 2018. 

Æ 

mstockstill on DSK30JT082PROD with BILLS