I 

114TH CONGRESS 

1ST SESSION H. R. 3292 

To amend title XVIII of the Social Security Act to revise Medicare payment 

for indirect medical education (IME) costs in teaching hospitals. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 29, 2015 

Mr. BRADY of Texas introduced the following bill; which was referred to the 

Committee on Ways and Means 

A BILL 

To amend title XVIII of the Social Security Act to revise 

Medicare payment for indirect medical education (IME) 

costs in teaching hospitals. 

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 ‘‘Medicare IME Pool 

5 Act of 2015’’. 

6 SEC. 2. REVISION OF MEDICARE PAYMENTS FOR INDIRECT 

7 MEDICAL EDUCATION (IME) COSTS IN TEACH8 ING HOSPITALS. 

9 (a) IN GENERAL.—Section 1886 of the Social Secu10 rity Act (42 U.S.C. 1395ww) is amended— 


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1 (1) in subsection (d)(5)(B)— 

2 (A) in the clause (x) added by section 

3 5505(b) of the Patient Protection and Afford4 able Care Act— 

5 (i) by moving the indentation of each 

6 provision in such clause 6 ems to the left; 

7 and 

8 (ii) by redesignating such clause as 

9 clause (xi); and 

10 (B) by adding at the end the following new 

11 clause: 

12 ‘‘(xii) With respect to discharges occurring in cost re13 porting periods ending during or after fiscal year 2019, 

14 instead of the additional payment that would have been 

15 paid under this subparagraph to a subsection (d) hospital 

16 or a subsection (d) Puerto Rico hospital with indirect costs 

17 of medical education and notwithstanding the previous 

18 provisions of this subparagraph, there shall be paid to the 

19 hospital the payment determined under subsection (t) for 

20 such hospital and cost reporting period.’’; and 

21 (2) by adding at the end the following new sub22 section: 

23 ‘‘(t) PAYMENT FOR INDIRECT MEDICAL EDU24 CATION.— 

25 ‘‘(1) IN GENERAL.— 


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1 ‘‘(A) AMOUNT OF PAYMENT.—For pur2 poses of subsection (d)(5)(B)(xii), the payment 

3 under this subsection for a subsection (d) hos4 pital (or a subsection (d) Puerto Rico hospital) 

5 for a cost reporting period ending during or 

6 after fiscal year 2019 is the payment of an 

7 amount equal to the product of— 

8 ‘‘(i) the IME pool amount computed 

9 under paragraph (2) for the fiscal year; 

10 and 

11 ‘‘(ii) the allotment factor under para12 graph (3) for such cost reporting period 

13 and fiscal year. 

14 ‘‘(B) FORM OF PAYMENT.—Payments of 

15 amounts under this subsection shall be made 

16 from the Federal Hospital Insurance Trust 

17 Fund with respect to a cost reporting period in 

18 accordance with such timing as the Secretary 

19 determines is similar to the timing of additional 

20 payments that are made under subsection (h). 

21 ‘‘(2) IME POOL AMOUNT.— 

22 ‘‘(A) IN GENERAL.—The IME pool amount 

23 under this paragraph— 


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1 ‘‘(i) for fiscal year 2019 is equal to 

2 the base amount computed under subpara3 graph (B); and 

4 ‘‘(ii) for a subsequent fiscal year is 

5 equal to the sum of— 

6 ‘‘(I) the IME pool amount under 

7 this paragraph for the previous fiscal 

8 year increased by the market basket 

9 percentage increase (as defined in 

10 subsection (b)(3)(B)(iii)) applicable to 

11 discharges occurring in such subse12 quent fiscal year; and 

13 ‘‘(II) the new teaching program 

14 amount computed under subpara15 graph (C) for the fiscal year. 

16 ‘‘(B) BASE AMOUNT.—The base amount 

17 computed under this subparagraph is 

18 $9,500,000,000, increased by the sum, for each 

19 of fiscal years 2015 through 2019, of the prod20 uct of— 

21 ‘‘(i) the weighted average number of 

22 full-time-equivalent resident positions in 

23 approved medical residency training pro24 grams (as determined under subsection 


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1 (h)(4)) for which payment is first made 

2 under subsection (h) in the fiscal year; and 

3 ‘‘(ii) the Secretary’s estimate of the 

4 national average expenditures per resident 

5 position that are attributable to additional 

6 payments under subsection (d)(5)(B) for 

7 discharges in such fiscal year. 

8 ‘‘(C) ADJUSTMENT FOR NEW TEACHING

9 PROGRAMS.—The new teaching program 

10 amount computed under this subparagraph for 

11 a fiscal year is equal to the product of— 

12 ‘‘(i) the weighted average number of 

13 full-time-equivalent resident positions in 

14 approved medical residency training pro15 grams (as determined under subsection 

16 (h)(4)) for which payment is first made 

17 under subsection (h) in the fiscal year; and 

18 ‘‘(ii) the IME pool amount under this 

19 paragraph for the fiscal year (determined 

20 without regard to this subparagraph), di21 vided by the average number of all full22 time-equivalent resident positions in ap23 proved medical residency training pro24 grams (as determined under subsection 

25 (h)(4)) for which payment is made under 


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1 subsection (h) in the fiscal year (as esti2 mated by the Secretary). 

3 ‘‘(3) ALLOTMENT BASED ON FTE RESIDENT

4 COUNT.—The allotment factor under this paragraph 

5 for a hospital eligible to receive payment under this 

6 subsection with respect to a cost reporting period 

7 ending in a fiscal year is equal to the ratio (as esti8 mated by the Secretary) of— 

9 ‘‘(A) the weighted average number of full10 time-equivalent residents for the hospital for 

11 the cost reporting period (as determined under 

12 subsection (h)(4)); to 

13 ‘‘(B) the total of the weighted average 

14 numbers of full-time-equivalent residents, as de15 termined under subparagraph (A), for all such 

16 hospitals for cost reporting periods ending in 

17 such fiscal year. 

18 The Secretary shall make such adjustments in such 

19 allotment factor for subsequent cost reporting peri20 ods as the Secretary determines necessary to ac21 count for errors in the Secretary’s estimation of 

22 such allotment factor under this paragraph for pre23 vious cost reporting periods.’’. 

Æ 


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