II 

117TH CONGRESS 

1ST SESSION S. 2094 

To provide for a new building period with respect to the cap on full-time 

equivalent residents for purposes of payment for graduate medical education costs under the Medicare program for certain hospitals that have 

established a shortage specialty program. 

IN THE SENATE OF THE UNITED STATES 

JUNE 17, 2021 

Mr. BARRASSO (for himself and Ms. CORTEZ MASTO) introduced the following 

bill; which was read twice and referred to the Committee on Finance 

A BILL 

To provide for a new building period with respect to the 

cap on full-time equivalent residents for purposes of payment for graduate medical education costs under the 

Medicare program for certain hospitals that have established a shortage specialty 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 ‘‘Physician Shortage 

5 GME Cap Flex Act of 2021’’. 


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1 SEC. 2. PROVIDING FOR A NEW BUILDING PERIOD WITH 

2 RESPECT TO THE CAP ON FULL-TIME EQUIV3 ALENT RESIDENTS FOR CERTAIN HOSPITALS 

4 THAT HAVE ESTABLISHED A SHORTAGE SPE5 CIALTY PROGRAM. 

6 Section 1886(h)(4) of the Social Security Act (42 

7 U.S.C. 1395ww(h)(4)) is amended by adding at the end 

8 the following new subparagraph: 

9 ‘‘(L) TREATMENT OF CERTAIN QUALI10 FYING HOSPITALS.— 

11 ‘‘(i) IN GENERAL.—For purposes of 

12 applying this paragraph and section 

13 413.79 of title 42, Code of Federal Regula14 tions (or a successor regulation), the Sec15 retary shall treat, subject to clause (ii), a 

16 qualifying hospital (as defined in clause 

17 (iii)) with an approved medical residency 

18 training program as if such hospital— 

19 ‘‘(I) had no allopathic or osteo20 pathic residents in its most recent 

21 cost reporting period ending on or be22 fore December 31, 1996; and 

23 ‘‘(II) began training residents for 

24 the first time in a new medical resi25 dency training program (as defined in 

26 paragraph (l) of such section) beginVerDate Sep 11 2014 05:19 Jun 24, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S2094.IS S2094

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1 ning on the date on which such hos2 pital became a qualifying hospital. 

3 ‘‘(ii) SPECIAL RULE FOR QUALIFYING

4 HOSPITALS IN CAP-BUILDING PERIOD.—In 

5 the case of a qualifying hospital with an 

6 approved medical residency training pro7 gram that, excluding the treatment de8 scribed in clause (i), is a hospital that had 

9 no allopathic or osteopathic residents in its 

10 most recent cost reporting period ending 

11 on or before December 31, 1996, and 

12 began training residents for the first time 

13 in a new medical residency training pro14 gram (as defined in paragraph (l) of such 

15 section) during the 5-year period ending on 

16 the date described in clause (i)(II) with re17 spect to such hospital, in lieu of applying 

18 such clause, the Secretary shall provide 

19 that the provisions of subsection (e) of sec20 tion 413.79 of title 42, Code of Federal 

21 Regulations (or a successor regulation), 

22 shall apply with respect to such hospital 

23 for an additional 5 years beyond the period 

24 during which such provisions would other25 wise have applied to such hospital. 


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1 ‘‘(iii) DEFINITION.—In this subpara2 graph: 

3 ‘‘(I) QUALIFYING HOSPITAL.— 

4 The term ‘qualifying hospital’ means 

5 a hospital that— 

6 ‘‘(aa) establishes a shortage 

7 specialty program (as defined in 

8 subclause (II)) during the 5-year 

9 period beginning on the date of 

10 the enactment of this subpara11 graph; and 

12 ‘‘(bb) submits an application 

13 to the Secretary during such pe14 riod containing such information 

15 as the Secretary may specify. 

16 ‘‘(II) SHORTAGE SPECIALTY PRO17 GRAM.—The term ‘shortage specialty 

18 program’ means, with respect to a 

19 hospital located in a geographic area 

20 (as defined by the Secretary), any ap21 proved residency training program in 

22 a specialty for which the Secretary de23 termines that there is a shortage of 

24 physicians practicing such specialty in 

25 such area at the time such program is 


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1 established. In making such a deter2 mination, the Secretary shall take into 

3 account whether such hospital is lo4 cated in an area— 

5 ‘‘(aa) without adequate 

6 health care resources (such as in 

7 a rural area or a medically un8 derserved area (as defined by the 

9 Administrator of the Health Re10 sources and Services Administra11 tion)); 

12 ‘‘(bb) experiencing primary 

13 care or specialty physician short14 ages (such as in a health profes15 sional shortage area (as defined 

16 in section 332(a) of the Public 

17 Health Service Act (42 U.S.C. 

18 254e(a)))); 

19 ‘‘(cc) without an adequate 

20 number of approved residency 

21 training programs; 

22 ‘‘(dd) struggling to expand 

23 or keep approved residency train24 ing programs operational; 


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1 ‘‘(ee) lacking existing med2 ical training infrastructure or in 

3 the process of building such in4 frastructure; 

5 ‘‘(ff) with a low resident-to6 population ratio; 

7 ‘‘(gg) with few full-time 

8 equivalent resident positions; or 

9 ‘‘(hh) with a low physician10 to-population ratio for physicians 

11 practicing in the same specialty 

12 as the shortage specialty program 

13 concerned.’’. 

Æ 


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