II

106TH CONGRESS

1ST SESSION S. 541

To amend title XVIII of the Social Security Act to make certain changes

related to payments for graduate medical education under the Medicare

Program.

IN THE SENATE OF THE UNITED STATES

MARCH 4, 1999

Ms. COLLINS (for herself, Mr. MURKOWSKI, and Mr. ROBERTS) 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 make

certain changes related to payments for graduate medical

education under the Medicare Program.

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 ‘‘Graduate Medical Edu5 cation Technical Amendments of 1999’’.

6 SEC. 2. INDIRECT GRADUATE MEDICAL EDUCATION AD7 JUSTMENT.

8 (a) IN GENERAL.—Section 1886(d)(5)(B)(v) of the

9 Social Security Act (42 U.S.C. 1395ww(d)(5)(B)(v)) (as
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•S 541 IS

1 added by section 4621(b) of the Balanced Budget Act of

2 1997) is amended—

3 (1) by striking ‘‘(v) In determining’’ and insert4 ing ‘‘(v)(I) Subject to subclause (II), in determin5 ing’’;

6 (2) by striking ‘‘in the hospital with respect to

7 the hospital’s most recent cost reporting period end8 ing on or before December 31, 1996’’; and inserting

9 ‘‘who were appointed by the hospital’s approved

10 medical residency training programs for the hos11 pital’s most recent cost reporting period ending on

12 or before December 31, 1996’’; and

13 (3) by adding at the end the following:

14 ‘‘(II) Beginning on or after January 1, 1997, in the

15 case of a hospital that sponsors only 1 allopathic or osteo16 pathic residency program, the limit determined for such

17 hospital under subclause (I) may, at the hospital’s discre18 tion, be increased by 1 for each calendar year but shall

19 not exceed a total of 3 more than the limit determined

20 for the hospital under subclause (I).’’.

21 (b) TECHNICAL AMENDMENTS.—Section

22 1886(d)(5)(B) of the Social Security Act (42 U.S.C.

23 1395ww(d)(5)(B)) is amended by moving clauses (ii), (v),

24 and (vi) 2 ems to the left.
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•S 541 IS

1 SEC. 3. DIRECT GRADUATE MEDICAL EDUCATION ADJUST2 MENT.

3 (a) LIMITATION ON NUMBER OF RESIDENTS.—Sec4 tion 1886(h)(4)(F) of the Social Security Act (42 U.S.C.

5 1395ww(h)(4)(F)) (as added by section 4623 of the Bal6 anced Budget Act of 1997) is amended by inserting ‘‘who

7 were appointed by the hospital’s approved medical resi8 dency training programs’’ after ‘‘may not exceed the num9 ber of such full-time equivalent residents’’.

10 (b) FUNDING FOR NEW PROGRAMS.—The first sen11 tence of section 1886(h)(4)(H)(i) of the Social Security

12 Act (42 U.S.C. 1395ww(h)(4)(H)(i)) (as added by section

13 4623 of the Balanced Budget Act of 1997) is amended

14 by inserting ‘‘and before September 30, 1999’’ after ‘‘Jan15 uary 1, 1995’’.

16 (c) FUNDING FOR PROGRAMS MEETING RURAL

17 NEEDS.—The second sentence of section 1886(h)(4)(H)(i)

18 of the Social Security Act (42 U.S.C.

19 1395ww(h)(4)(H)(i)) (as added by section 4623 of the

20 Balanced Budget Act of 1997) is amended by striking the

21 period at the end and inserting ‘‘, including facilities that

22 are not located in an underserved rural area but have es23 tablished separately accredited rural training tracks.’’.
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•S 541 IS

1 SEC. 4. EFFECTIVE DATE.

2 The amendments made by this Act shall take effect

3 as if included in the enactment of the Balanced Budget

4 Act of 1997.

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