I 

114TH CONGRESS 

2D SESSION H. R. 6039 

To amend title XVIII of the Social Security Act to redistribute unused 

residency positions to hospitals in States with shortages of residents 

and health professionals, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 15, 2016 

Mr. HARDY 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 redistribute unused residency positions to hospitals in States 

with shortages of residents and health professionals, 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 ‘‘Graduate Opportuni5 ties in Medical Education Distribution Act of 2016’’. 


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1 SEC. 2. REDISTRIBUTING UNUSED RESIDENCY POSITIONS 

2 TO HOSPITALS IN STATES WITH SHORTAGES 

3 OF RESIDENTS AND HEALTH PROFES4 SIONALS. 

5 (a) IN GENERAL.—Section 1886(h) of the Social Se6 curity Act (42 U.S.C. 1395ww(h)) is amended— 

7 (1) in paragraph (4)(F)(i), by striking ‘‘(7) and 

8 (8)’’ and inserting ‘‘(7), (8), and (9)’’; 

9 (2) in paragraph (4)(H)(i), by striking ‘‘(7) and 

10 (8)’’ and inserting ‘‘(7), (8), and (9)’’; 

11 (3) in paragraph (7)(E), by striking ‘‘para12 graph (8)’’ and inserting ‘‘paragraph (8) or (9)’’ be13 fore the period at the end; and 

14 (4) by adding at the end the following new 

15 paragraph: 

16 ‘‘(9) DISTRIBUTION OF ADDITIONAL RESIDENCY

17 POSITIONS.— 

18 ‘‘(A) REDUCTIONS IN LIMIT BASED ON UN19 USED POSITIONS.— 

20 ‘‘(i) MAKING OF DETERMINATIONS.— 

21 Not later than 180 days after the date of 

22 the enactment of this paragraph and each 

23 four years thereafter, the Secretary shall 

24 make a set of reduction determinations (as 

25 defined in clause (ii)). 


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1 ‘‘(ii) SET OF REDUCTION DETERMINA2 TIONS DEFINED.—For purposes of this 

3 paragraph, the term ‘set of reduction de4 terminations’ means determinations with 

5 respect to each hospital of whether, with 

6 respect to the one-year period ending on 

7 the date of such set of reduction deter8 minations (referred to in this paragraph as 

9 the ‘measurement period’ for such set of 

10 reduction determinations), the hospital’s 

11 reference resident level (as defined in sub12 paragraph (F)(i)) for such period was less 

13 than the otherwise applicable resident limit 

14 (as defined in subparagraph (F)(iii)) for 

15 such hospital and period. 

16 ‘‘(iii) REDUCTION BASED ON DETER17 MINATION.—In the case that, with respect 

18 to the measurement period for a set of re19 duction determinations, the Secretary de20 termines under this subparagraph that the 

21 reference resident level of a hospital for 

22 such period was less than the otherwise ap23 plicable resident limit for such hospital and 

24 period, effective for portions of cost report25 ing periods occurring after the date of 


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1 such set of reduction determinations and 

2 on or before the date of any subsequent set 

3 of reduction determinations under clause 

4 (i) (referred to in this paragraph as the 

5 ‘consequence period’ for such set of reduc6 tion determinations), the otherwise applica7 ble resident limit for such hospital shall be 

8 reduced by 65 percent of the difference be9 tween such otherwise applicable resident 

10 limit for the hospital and measurement pe11 riod and such reference resident level for 

12 the hospital and measurement period (or, 

13 in the case that the Secretary determines 

14 that, with respect to the consequence pe15 riod immediately preceding such con16 sequence period, the hospital was a hos17 pital described in clause (ii) of subpara18 graph (B) that did not meet the require19 ments of such clause, by the number de20 scribed in clause (iv)). 

21 ‘‘(iv) NUMBER DESCRIBED.—The 

22 number described in this clause, with re23 spect to a hospital and consequence period 

24 (referred to in this clause as the ‘target 

25 consequence period’), is the greater of— 


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1 ‘‘(I) the number by which the 

2 otherwise applicable resident limit for 

3 such hospital would be reduced for the 

4 target consequence period under 

5 clause (iii) without the application of 

6 this clause; and 

7 ‘‘(II) the number by which the 

8 otherwise applicable resident limit for 

9 such hospital was increased for the 

10 consequence period that immediately 

11 preceded the target consequence pe12 riod. 

13 ‘‘(v) EXCEPTION.—This subparagraph 

14 shall not apply to a hospital located in a 

15 rural area (as defined in subsection 

16 (d)(2)(D)(ii)) with fewer than 250 acute 

17 care inpatient beds. 

18 ‘‘(vi) DETERMINATION TIMING.—In 

19 the case of a reduction determination made 

20 in a year by the Secretary under clause (i) 

21 that is not the first such reduction deter22 mination so made, the Secretary shall 

23 make such determination on a date that is 

24 not later than March 31 of such year. 

25 ‘‘(B) DISTRIBUTION.— 


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1 ‘‘(i) IN GENERAL.—With respect to 

2 each set of reduction determinations under 

3 subparagraph (A)(i), the Secretary shall, 

4 in accordance with the succeeding provi5 sions of this paragraph, increase the other6 wise applicable resident limit for each 

7 qualifying hospital that submits an appli8 cation under this subparagraph by such 

9 number as the Secretary may approve for 

10 portions of cost reporting periods occurring 

11 during the consequence period for such set 

12 of reduction determinations. The aggregate 

13 number of increases in the otherwise appli14 cable resident limit under this subpara15 graph for such consequence period shall be 

16 equal to the aggregate reduction in such 

17 limits attributable to subparagraph (A) (as 

18 estimated by the Secretary) for such con19 sequence period. 

20 ‘‘(ii) REQUIREMENTS.—A hospital 

21 that receives an increase in the otherwise 

22 applicable resident limit under this sub23 paragraph for a consequence period shall 

24 ensure that, during such consequence pe25 riod, the positions resulting from the inVerDate Sep 11 2014 03:44 Sep 16, 2016 Jkt 059200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H6039.IH H6039

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1 crease under this paragraph will be filled. 

2 The Secretary may determine whether a 

3 hospital has met the requirements under 

4 this clause during such consequence period 

5 in such manner and at such time as the 

6 Secretary determines appropriate, includ7 ing at the end of such period. 

8 ‘‘(C) CAPACITY CONSIDERATIONS IN RE9 DISTRIBUTION.—In determining which hospitals 

10 are to receive increases in their otherwise appli11 cable resident limits under subparagraph (B) 

12 for a consequence period for a set of reduction 

13 determinations, the Secretary shall take into ac14 count the demonstrated likelihood of each such 

15 hospital filling the positions made available 

16 under this paragraph within such consequence 

17 period, as determined by the Secretary. 

18 ‘‘(D) PRIORITY IN REDISTRIBUTION.— 

19 Subject to subparagraph (C), the Secretary 

20 shall select, with respect to a set of reduction 

21 determinations under subparagraph (A)(i), the 

22 qualifying hospitals that will receive increases 

23 under subparagraph (B) in the otherwise appli24 cable resident limits for such hospitals for the 

25 consequence period for such set of reduction deVerDate Sep 11 2014 03:44 Sep 16, 2016 Jkt 059200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H6039.IH H6039

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1 terminations. The Secretary shall make such se2 lection in a manner that distributes the posi3 tions made available to hospitals for such con4 sequence period under this paragraph in ac5 cordance with the following: 

6 ‘‘(i) The Secretary shall, with respect 

7 to such positions that are so made avail8 able for such consequence period, make— 

9 ‘‘(I) 70 percent of such positions 

10 available to hospitals located in low 

11 resident-to-population States (as de12 fined in subparagraph (F)(iv)); and 

13 ‘‘(II) 30 percent of such positions 

14 available to hospitals located in high 

15 HPSA-to-population States (as de16 fined in subparagraph (F)(v)). 

17 ‘‘(ii) The Secretary shall, in accord18 ance with clause (i), make such positions 

19 available for such consequence period in a 

20 manner that prioritizes the distribution of 

21 such positions to hospitals that are antici22 pated to fill such positions with individuals 

23 from residence programs located in the 

24 State in which such hospitals are located. 


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1 ‘‘(E) APPLICATION OF PER RESIDENT

2 AMOUNTS FOR PRIMARY CARE AND NONPRI3 MARY CARE.—With respect to additional resi4 dency positions in a hospital attributable to the 

5 increase provided under this paragraph, the ap6 proved FTE per resident amounts are deemed 

7 to be equal to the hospital per resident amounts 

8 for primary care and nonprimary care com9 puted under paragraph (2)(D) for that hospital. 

10 ‘‘(F) DEFINITIONS.—In this paragraph: 

11 ‘‘(i) REFERENCE RESIDENT LEVEL.— 

12 The term ‘reference resident level’ means, 

13 with respect to a hospital and measure14 ment period, the resident level for the cost 

15 reporting periods of the hospital occurring 

16 during such measurement period and for 

17 which a cost report has been settled (or, if 

18 not, submitted (subject to audit)), as de19 termined by the Secretary. 

20 ‘‘(ii) RESIDENT LEVEL.—The term 

21 ‘resident level’ has the meaning given such 

22 term in paragraph (7)(C)(i). 

23 ‘‘(iii) OTHERWISE APPLICABLE RESI24 DENT LIMIT.—The term ‘otherwise appli25 cable resident limit’ means, with respect to 


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1 a hospital and period, the limit otherwise 

2 applicable under subparagraphs (F)(i) and 

3 (H) of paragraph (4) on the resident level 

4 of the hospital for such period, determined 

5 without regard to this paragraph but tak6 ing into account paragraph (7)(A). 

7 ‘‘(iv) LOW RESIDENT-TO-POPULATION

8 STATES.— 

9 ‘‘(I) IN GENERAL.—The term 

10 ‘low resident-to-population State’ 

11 means a State that has a smaller ap12 plicable number than do at least 75 

13 percent of all States. 

14 ‘‘(II) APPLICABLE NUMBER.— 

15 For purposes of subclause (I), the 

16 term ‘applicable number’ means, with 

17 respect to a State, the number that 

18 results from dividing the number of 

19 residents in the State by the number 

20 of individuals residing in the State. 

21 ‘‘(v) HIGH HPSA-TO-POPULATION

22 STATES.— 

23 ‘‘(I) IN GENERAL.—The term 

24 ‘high HPSA-to-population State’ 

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1 cable number than do at least 90 per2 cent of all States. 

3 ‘‘(II) APPLICABLE NUMBER.— 

4 For purposes of subclause (I), the 

5 term ‘applicable number’ means, with 

6 respect to a State, the number that 

7 results from dividing the number of 

8 areas in the State designated by the 

9 Health Resources & Services Adminis10 tration of the Department of Health 

11 and Human Services as Health Pro12 fessional Shortage Areas by the num13 ber of individuals residing in the 

14 State. 

15 ‘‘(G) AFFILIATION.—The provisions of this 

16 paragraph shall be applied to hospitals which 

17 are members of the same affiliated group (as 

18 defined by the Secretary under paragraph 

19 (4)(H)(ii)).’’. 

20 (b) IME.— 

21 (1) IN GENERAL.—Section 1886(d)(5)(B)(v) of 

22 the Social Security Act (42 U.S.C. 

23 1395ww(d)(5)(B)(v)), in the second sentence, is 

24 amended by striking ‘‘subsections (h)(7) and (h)(8)’’ 


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1 and inserting ‘‘subsections (h)(7), (h)(8), and 

2 (h)(9)’’. 

3 (2) CONFORMING AMENDMENT.—Section 

4 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 

5 1395ww(d)(5)(B)) is amended by adding at the end 

6 the following clause: 

7 ‘‘(xii) For discharges occurring on or 

8 after the date that is 180 days after the 

9 date of the enactment of this clause, inso10 far as an additional payment amount 

11 under this subparagraph is attributable to 

12 resident positions distributed to a hospital 

13 under subsection (h)(9)(B), the indirect 

14 teaching adjustment factor shall be com15 puted in the same manner as provided 

16 under clause (ii) with respect to such resi17 dent positions.’’. 

18 (c) CONFORMING AMENDMENT.—Section 422(b)(2) 

19 of the Medicare Prescription Drug, Improvement, and 

20 Modernization Act of 2003 (Public Law 108–173), as 

21 amended by section 5503 of the Patient Protection and 

22 Affordable Care Act (Public Law 111–148), is amended 

23 by striking ‘‘paragraphs (7) and (8)’’ and inserting ‘‘para24 graphs (7), (8), and (9).’’. 

Æ 


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