I 

116TH CONGRESS 

1ST SESSION H. R. 3425 

To amend title XVIII of the Social Security Act to establish rules for payment 

for graduate medical education (GME) costs for hospitals that establish 

a new medical residency training program after hosting resident rotators 

for short durations. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 21, 2019 

Mr. KIND (for himself and Mr. HOLDING) 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 establish 

rules for payment for graduate medical education (GME) 

costs for hospitals that establish a new medical residency 

training program after hosting resident rotators for short 

durations. 

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 ‘‘Advancing Medical 

5 Resident Training in Community Hospitals Act of 2019’’. 


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1 SEC. 2. MEDICARE GME TREATMENT OF HOSPITALS ESTAB2 LISHING NEW MEDICAL RESIDENCY TRAIN3 ING PROGRAMS AFTER HOSTING MEDICAL 

4 RESIDENT ROTATORS FOR SHORT DURA5 TIONS. 

6 (a) REDETERMINATION OF APPROVED FTE RESI7 DENT AMOUNT.—Section 1886(h)(2)(F) of the Social Se8 curity Act (42 U.S.C. 1395ww(h)(2)(F)) is amended— 

9 (1) by inserting ‘‘(i)’’ before ‘‘In the case of’’; 

10 and 

11 (2) by adding at the end the following: 

12 ‘‘(ii) In applying this subparagraph in the 

13 case of a hospital that, on or after the date of 

14 the enactment of this clause, begins to train 

15 residents and has not entered into a GME af16 filiation agreement (as defined by the Secretary 

17 for purposes of paragraph (4)(H)(ii)), the Sec18 retary shall not establish an FTE resident 

19 amount until such time as the Secretary deter20 mines that the hospital has trained at least 1.0 

21 full-time-equivalent resident in an approved 

22 medical residency training program in a cost re23 porting period. 

24 ‘‘(iii) In applying this subparagraph for 

25 cost reporting periods beginning on or after the 

26 date of enactment of this clause, in the case of 


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1 a hospital that, as of such date of enactment, 

2 has an approved FTE resident amount based 

3 on the training in an approved medical resi4 dency program of— 

5 ‘‘(I) less than 1.0 full-time-equivalent 

6 resident in any cost reporting period begin7 ning before October 1, 1997, as deter8 mined by the Secretary; or 

9 ‘‘(II) no more than 3.0 full-time10 equivalent residents in any cost reporting 

11 period beginning on or after October 1, 

12 1997, and before the date of the enactment 

13 of this clause, as determined by the Sec14 retary, 

15 in lieu of such FTE resident amount the Sec16 retary shall, in accordance with the method17 ology described in section 413.77(e) of title 42 

18 of the Code of Federal Regulations (or any suc19 cessor regulation), establish a new FTE resi20 dent amount if the hospital trains at least 1.0 

21 full-time-equivalent resident (in the case of a 

22 hospital described in subclause (I)) or more 

23 than 3.0 full-time-equivalent residents (in the 

24 case of a hospital described in subclause (II)) in 

25 a cost reporting period beginning on or after 


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1 such date of enactment and before the date that 

2 is 5 years after such date of enactment. 

3 ‘‘(iv) For purposes of carrying out this 

4 subparagraph for cost reporting periods begin5 ning on or after the date of the enactment of 

6 this clause, a hospital shall report full-time7 equivalent residents on its cost report for a cost 

8 reporting period if the hospital trains at least 

9 1.0 full-time-equivalent residents in an ap10 proved medical residency training program in 

11 such period. 

12 ‘‘(v) As appropriate, the Secretary may 

13 consider information from any cost reporting 

14 period necessary to establish a new FTE resi15 dent amount as described in clause (iii).’’. 

16 (b) REDETERMINATION OF FTE RESIDENT LIMITA17 TION.—Section 1886(h)(4)(H)(i) of the Social Security 

18 Act (42 U.S.C. 1395ww(h)(4)(H)(i)) is amended— 

19 (1) by inserting ‘‘(I)’’ before ‘‘The Secretary’’; 

20 and 

21 (2) by adding at the end the following: 

22 ‘‘(II) In applying this clause in the 

23 case of a hospital that, on or after the date 

24 of the enactment of this subclause, begins 

25 to train residents in a new approved medVerDate Sep 11 2014 04:00 Jun 27, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3425.IH H3425

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1 ical residency training program (as defined 

2 by the Secretary), the Secretary shall not 

3 determine a limitation applicable to the 

4 hospital under subparagraph (F) until 

5 such time as the Secretary determines that 

6 the hospital has trained at least 1.0 full7 time-equivalent resident in such new ap8 proved medical residency training program 

9 in a cost reporting period. 

10 ‘‘(III) In applying this clause in the 

11 case of a hospital that, as of the date of 

12 the enactment of this subclause, has a lim13 itation under subparagraph (F), based on 

14 a cost reporting period beginning before 

15 October 1, 1997, of less than 1.0 full-time16 equivalent resident, the Secretary shall ad17 just the limitation in the manner applica18 ble to a new approved medical residency 

19 training program if the Secretary deter20 mines the hospital trains at least 1.0 full21 time-equivalent residents in a program 

22 year beginning on or after such date of en23 actment and before the date that is 5 years 

24 after such date of enactment. 


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1 ‘‘(IV) In applying this clause in the 

2 case of a hospital that, as of the date of 

3 the enactment of this subclause, has a lim4 itation under subparagraph (F), based on 

5 a cost reporting period beginning on or 

6 after October 1, 1997, and before such 

7 date of enactment, of no more than 3.0 

8 full-time-equivalent residents, the Sec9 retary shall adjust the limitation in the 

10 manner applicable to a new approved med11 ical residency training program if the Sec12 retary determines the hospital begins train13 ing more than 3.0 full-time-equivalent resi14 dents in a program year beginning on or 

15 after such date of enactment and before 

16 the date that is 5 years after such date of 

17 enactment. 

18 ‘‘(V) An adjustment to the limitation 

19 applicable to a hospital made pursuant to 

20 subclause (III) or (IV) shall be made in a 

21 manner consistent with the methodology, 

22 as appropriate, in section 413.79(e) of title 

23 42, Code of Federal Regulations (or any 

24 successor regulation). As appropriate, the 

25 Secretary may consider information from 


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1 any cost reporting periods necessary to 

2 make such an adjustment to the limita3 tion.’’. 

4 (c) TECHNICAL AND CONFORMING AMENDMENTS.— 

5 Section 1886 of the Social Security Act (42 U.S.C. 

6 1395ww) is amended— 

7 (1) in subsection (d)(5)(B)(viii), by striking 

8 ‘‘subsection (h)(4)(H)’’ and inserting ‘‘paragraphs 

9 (2)(F)(iv) and (4)(H) of subsection (h)’’; and 

10 (2) in subsection (h)— 

11 (A) in paragraph (4)(H)(iv), by striking 

12 ‘‘an rural area’’ and inserting ‘‘a rural area’’; 

13 and 

14 (B) in paragraph (7)(E), by striking 

15 ‘‘under this’’ and all that follows through the 

16 period at the end and inserting the following: 

17 ‘‘under this paragraph, paragraph (8), clause 

18 (i), (ii), (iii), or (v) of paragraph (2)(F), or 

19 clause (i) or (vi) of paragraph (4)(H).’’. 

20 (d) EFFECTIVE DATE.—The amendments made by 

21 this section shall apply to payment under section 1886 of 

22 the Social Security Act (42 U.S.C. 1395ww) for cost re23 porting periods beginning on or after the date of the en24 actment of this Act. 

Æ 


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