II 

118TH CONGRESS 

1ST SESSION S. 1302 

To amend title XVIII of the Social Security Act to provide for the distribution 

of additional residency positions, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

APRIL 26, 2023 

Mr. MENENDEZ (for himself, Mr. BOOZMAN, Mr. SCHUMER, and Ms. COLLINS) 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 provide 

for the distribution of additional residency positions, 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 ‘‘Resident Physician 

5 Shortage Reduction Act of 2023’’. 

6 SEC. 2. DISTRIBUTION OF ADDITIONAL RESIDENCY POSI7 TIONS. 

8 (a) IN GENERAL.—Section 1886(h) of the Social Se9 curity Act (42 U.S.C. 1395ww(h)) is amended— 


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

2 (10)’’ and inserting ‘‘(10), and (11)’’; 

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

4 (10)’’ and inserting ‘‘(10), and (11)’’; 

5 (3) in paragraph (7)(E), by inserting ‘‘para6 graph (11),’’ after ‘‘paragraph (10),’’; and 

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

8 paragraph: 

9 ‘‘(11) DISTRIBUTION OF ADDITIONAL RESI10 DENCY POSITIONS.— 

11 ‘‘(A) ADDITIONAL RESIDENCY POSI12 TIONS.— 

13 ‘‘(i) IN GENERAL.—For each of fiscal 

14 years 2025 through 2031 (and succeeding 

15 fiscal years if the Secretary determines 

16 that there are additional residency posi17 tions available to distribute under clause 

18 (iii)(II)), the Secretary shall increase the 

19 otherwise applicable resident limit for each 

20 qualifying hospital (as defined in subpara21 graph (G)) that submits a timely applica22 tion under this subparagraph by such 

23 number as the Secretary may approve for 

24 portions of cost reporting periods occurring 

25 on or after July 1 of the fiscal year of the 


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1 increase. Except as provided in clause (iii), 

2 the aggregate number of increases in the 

3 otherwise applicable resident limit under 

4 this subparagraph shall be equal to 2,000 

5 in each of fiscal years 2025 through 2031. 

6 ‘‘(ii) PROCESS FOR DISTRIBUTING PO7 SITIONS.— 

8 ‘‘(I) ROUNDS OF APPLICA9 TIONS.—The Secretary shall initiate 7 

10 separate rounds of applications for an 

11 increase under clause (i), 1 round 

12 with respect to each of fiscal years 

13 2025 through 2031. 

14 ‘‘(II) NUMBER AVAILABLE.—In 

15 each of such rounds, the aggregate 

16 number of positions available for dis17 tribution in the fiscal year as a result 

18 of an increase in the otherwise appli19 cable resident limit (as described in 

20 clause (i)) shall be distributed, plus 

21 any additional positions available 

22 under clause (iii). 

23 ‘‘(III) TIMING.—The Secretary 

24 shall notify hospitals of the number of 

25 positions distributed to the hospital 


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1 under this paragraph as result of an 

2 increase in the otherwise applicable 

3 resident limit by January 31 of the 

4 fiscal year of the increase. Such in5 crease shall be effective for portions of 

6 cost reporting periods beginning on or 

7 after July 1 of that fiscal year. 

8 ‘‘(iii) POSITIONS NOT DISTRIBUTED

9 DURING THE FISCAL YEAR.— 

10 ‘‘(I) IN GENERAL.—If the num11 ber of resident full-time equivalent po12 sitions distributed under this para13 graph in a fiscal year is less than the 

14 aggregate number of positions avail15 able for distribution in the fiscal year 

16 (as described in clause (i), including 

17 after application of this subclause), 

18 the difference between such number 

19 distributed and such number available 

20 for distribution shall be added to the 

21 aggregate number of positions avail22 able for distribution in the following 

23 fiscal year. 

24 ‘‘(II) EXCEPTION IF POSITIONS

25 NOT DISTRIBUTED BY END OF FISCAL


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1 YEAR 2031.—If the aggregate number 

2 of positions distributed under this 

3 paragraph during the 7-year period of 

4 fiscal years 2025 through 2031 is less 

5 than 14,000, the Secretary shall, in 

6 accordance with the considerations de7 scribed in subparagraph (B)(i) and 

8 the priority described in subparagraph 

9 (B)(ii), conduct an application and 

10 distribution process in each subse11 quent fiscal year until such time as 

12 the aggregate amount of positions dis13 tributed under this paragraph is equal 

14 to 14,000. 

15 ‘‘(B) DISTRIBUTION TO CERTAIN HOS16 PITALS.— 

17 ‘‘(i) CONSIDERATION IN DISTRIBU18 TION.—In determining for which hospitals 

19 the increase in the otherwise applicable 

20 resident limit is provided under subpara21 graph (A), the Secretary shall take into ac22 count the demonstrated likelihood of the 

23 hospital filling the positions made available 

24 under this paragraph within the first 5 

25 cost reporting periods beginning after the 


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1 date the increase would be effective, as de2 termined by the Secretary. 

3 ‘‘(ii) MINIMUM DISTRIBUTION FOR

4 CERTAIN CATEGORIES OF HOSPITALS.— 

5 With respect to the aggregate number of 

6 such positions available for distribution 

7 under this paragraph, the Secretary shall 

8 distribute not less than 10 percent of such 

9 aggregate number to each of the following 

10 categories of hospitals: 

11 ‘‘(I) Hospitals that are located in 

12 a rural area (as defined in subsection 

13 (d)(2)(D)) or are treated as being lo14 cated in a rural area pursuant to sub15 section (d)(8)(E). 

16 ‘‘(II) Hospitals in which the ref17 erence resident level of the hospital 

18 (as specified in subparagraph (G)(iii)) 

19 is greater than the otherwise applica20 ble resident limit. 

21 ‘‘(III) Hospitals in States with— 

22 ‘‘(aa) new medical schools 

23 that received ‘Candidate School’ 

24 status from the Liaison Com25 mittee on Medical Education or 


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1 that received ‘Pre-Accreditation’ 

2 status from the American Osteo3 pathic Association Commission 

4 on Osteopathic College Accredita5 tion on or after January 1, 2000, 

6 and that have achieved or con7 tinue to progress toward ‘Full 

8 Accreditation’ status (as such 

9 term is defined by the Liaison 

10 Committee on Medical Edu11 cation) or toward ‘Accreditation’ 

12 status (as such term is defined 

13 by the American Osteopathic As14 sociation Commission on Osteo15 pathic College Accreditation); or 

16 ‘‘(bb) additional locations 

17 and branch campuses established 

18 on or after January 1, 2000, by 

19 medical schools with ‘Full Ac20 creditation’ status (as such term 

21 is defined by the Liaison Com22 mittee on Medical Education) or 

23 ‘Accreditation’ status (as such 

24 term is defined by the American 

25 Osteopathic Association CommisVerDate Sep 11 2014 04:44 May 03, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1302.IS S1302

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1 sion on Osteopathic College Ac2 creditation). 

3 ‘‘(IV) Hospitals that serve areas 

4 designated as health professional 

5 shortage areas under section 

6 332(a)(1)(A) of the Public Health 

7 Service Act, as determined by the Sec8 retary. 

9 ‘‘(iii) SPECIAL RULE.—In distributing 

10 positions under clause (ii), the Secretary 

11 shall not prioritize hospitals in multiple 

12 categories over hospitals in an individual 

13 category or based on section 332 of the 

14 Public Health Service Act. 

15 ‘‘(C) PROHIBITION ON DISTRIBUTION TO

16 HOSPITALS WITHOUT AN INCREASE AGREE17 MENT.—No increase in the otherwise applicable 

18 resident limit of a hospital may be made under 

19 this paragraph unless such hospital agrees to 

20 increase the total number of full-time equivalent 

21 residency positions under the approved medical 

22 residency training program of such hospital by 

23 the number of such positions made available by 

24 such increase under this paragraph. 

25 ‘‘(D) LIMITATION.— 


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1 ‘‘(i) IN GENERAL.—Except as pro2 vided in clause (ii), a hospital may not re3 ceive more than 75 full-time equivalent ad4 ditional residency positions in the aggre5 gate under this paragraph and paragraphs 

6 (9) and (10) over the period of fiscal years 

7 2025 through 2031. 

8 ‘‘(ii) INCREASE IN NUMBER OF ADDI9 TIONAL POSITIONS A HOSPITAL MAY RE10 CEIVE.—The Secretary shall increase the 

11 aggregate number of full-time equivalent 

12 additional residency positions a hospital 

13 may receive under this paragraph over 

14 such period if the Secretary estimates that 

15 the number of positions available for dis16 tribution under subparagraph (A) exceeds 

17 the number of applications approved under 

18 such subparagraph over such period. 

19 ‘‘(E) APPLICATION OF PER RESIDENT

20 AMOUNTS FOR PRIMARY CARE AND NONPRI21 MARY CARE.—With respect to additional resi22 dency positions in a hospital attributable to the 

23 increase provided under this paragraph, the ap24 proved FTE per resident amounts are deemed 

25 to be equal to the hospital per resident amounts 


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1 for primary care and nonprimary care com2 puted under paragraph (2)(D) for that hospital. 

3 ‘‘(F) PERMITTING FACILITIES TO APPLY

4 AGGREGATION RULES.—The Secretary shall 

5 permit hospitals receiving additional residency 

6 positions attributable to the increase provided 

7 under this paragraph to, beginning in the fifth 

8 year after the effective date of such increase, 

9 apply such positions to the limitation amount 

10 under paragraph (4)(F) that may be aggre11 gated pursuant to paragraph (4)(H) among 

12 members of the same affiliated group. 

13 ‘‘(G) DEFINITIONS.—In this paragraph: 

14 ‘‘(i) OTHERWISE APPLICABLE RESI15 DENT LIMIT.—The term ‘otherwise appli16 cable resident limit’ means, with respect to 

17 a hospital, the limit otherwise applicable 

18 under subparagraphs (F)(i) and (H) of 

19 paragraph (4) on the resident level for the 

20 hospital determined without regard to this 

21 paragraph but taking into account para22 graphs (7)(A), (7)(B), (8)(A), (8)(B), 

23 (9)(A), (9)(B), (10)(A), and (10)(B). 

24 ‘‘(ii) QUALIFYING HOSPITAL.—The 

25 term ‘qualifying hospital’ means a hospital 


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1 described in any of subclauses (I) through 

2 (IV) of subparagraph (B)(ii). 

3 ‘‘(iii) REFERENCE RESIDENT

4 LEVEL.—The term ‘reference resident 

5 level’ means, with respect to a hospital, the 

6 resident level for the most recent cost re7 porting period of the hospital ending on or 

8 before the date of enactment of this para9 graph, for which a cost report has been 

10 settled (or, if not, submitted (subject to 

11 audit)), as determined by the Secretary. 

12 ‘‘(iv) RESIDENT LEVEL.—The term 

13 ‘resident level’ has the meaning given such 

14 term in paragraph (7)(C)(i).’’. 

15 (b) IME.— 

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

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

18 1395ww(d)(5)(B)(v)), in the third sentence, is 

19 amended by striking ‘‘and (h)(10)’’ and inserting 

20 ‘‘(h)(10), and (h)(11)’’. 

21 (2) CONFORMING PROVISION.—Section 

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

23 1395ww(d)(5)(B)) is amended by adding after 

24 clause (xiii) the following new clause: 


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1 ‘‘(ix) For discharges occurring on or after July 

2 1, 2025, insofar as an additional payment amount 

3 under this subparagraph is attributable to resident 

4 positions distributed to a hospital under subsection 

5 (h)(10), the indirect teaching adjustment factor shall 

6 be computed in the same manner as provided under 

7 clause (ii) with respect to such resident positions.’’. 

8 SEC. 3. STUDY AND REPORT ON STRATEGIES FOR INCREAS9 ING DIVERSITY. 

10 (a) STUDY.—The Comptroller General of the United 

11 States (in this section referred to as the ‘‘Comptroller 

12 General’’) shall conduct a study on strategies for increas13 ing the diversity of the health professional workforce. Such 

14 study shall include an analysis of strategies for increasing 

15 the number of health professionals from rural, lower in16 come, and underrepresented minority communities, includ17 ing which strategies are most effective for achieving such 

18 goal. 

19 (b) REPORT.—Not later than 2 years after the date 

20 of the enactment of this Act, the Comptroller General shall 

21 submit to Congress a report on the study conducted under 

22 subsection (a), together with recommendations for such 

23 legislation and administrative action as the Comptroller 

24 General determines appropriate. 

Æ 


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