I 

114TH CONGRESS 

2D SESSION H. R. 5188 

To amend title XVIII of the Social Security Act to promote physician training 

in newly recognized primary medical specialties, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 11, 2016 

Mrs. LOVE 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 promote 

physician training in newly recognized primary medical 

specialties, 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 ‘‘Enhancing Opportuni5 ties for Medical Doctors Act of 2016’’. 


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1 SEC. 2. REDISTRIBUTING UNUSED RESIDENCY POSITIONS 

2 TO PROMOTE THE ESTABLISHMENT OF RESI3 DENCY PROGRAMS FOR NEWLY RECOGNIZED 

4 PRIMARY MEDICAL SPECIALTIES. 

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 ‘‘paragraphs (8) or (9)’’ 

13 before 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) IN GENERAL.—If a hospital’s ref21 erence resident level (as defined in sub22 paragraph (G)(i)) is less than the other23 wise applicable resident limit (as defined in 

24 subparagraph (G)(iii)), effective for por25 tions of cost reporting periods occurring on 

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1 cable resident limit shall be reduced by 65 

2 percent of the difference between such oth3 erwise applicable resident limit and such 

4 reference resident level. 

5 ‘‘(ii) EXCEPTION.—This subpara6 graph shall not apply to a hospital located 

7 in a rural area (as defined in subsection 

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

9 care inpatient beds. 

10 ‘‘(B) DISTRIBUTION.— 

11 ‘‘(i) IN GENERAL.—The Secretary 

12 shall, in accordance with the succeeding 

13 provisions of this paragraph, increase the 

14 otherwise applicable resident limit for each 

15 qualifying hospital that submits an appli16 cation under this subparagraph by such 

17 number as the Secretary may approve for 

18 portions of cost reporting periods occurring 

19 on or after July 1, 2017. The aggregate 

20 number of increases in the otherwise appli21 cable resident limit under this subpara22 graph shall be equal to the aggregate re23 duction in such limits attributable to sub24 paragraph (A) (as estimated by the Sec25 retary). 


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1 ‘‘(ii) REQUIREMENTS.—Subject to 

2 clause (iii), a hospital that receives an in3 crease in the otherwise applicable resident 

4 limit under this subparagraph shall ensure, 

5 during the 3-year period beginning on the 

6 date of such increase, that the positions re7 sulting from the increase under this para8 graph will be filled. The Secretary may de9 termine whether a hospital has met the re10 quirements under this clause during such 

11 3-year period in such manner and at such 

12 time as the Secretary determines appro13 priate, including at the end of such 3-year 

14 period. 

15 ‘‘(iii) REDISTRIBUTION OF POSITIONS

16 IF HOSPITAL NO LONGER MEETS CERTAIN

17 REQUIREMENTS.—In the case where the 

18 Secretary determines that a hospital de19 scribed in clause (ii) does not meet the re20 quirements of such clause, the Secretary 

21 shall— 

22 ‘‘(I) reduce the otherwise applica23 ble resident limit of the hospital by 

24 the amount by which such limit was 

25 increased under this paragraph; and 


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1 ‘‘(II) provide for the distribution 

2 of positions attributable to such re3 duction in accordance with the re4 quirements of this paragraph. 

5 ‘‘(C) CAPACITY CONSIDERATIONS IN RE6 DISTRIBUTION.—In determining for which hos7 pitals the increase in the otherwise applicable 

8 resident limit is provided under subparagraph 

9 (B), the Secretary shall take into account the 

10 demonstration likelihood of the hospital filling 

11 the positions made available under this para12 graph within the first 3 cost reporting periods 

13 beginning on or after July 1, 2017, as deter14 mined by the Secretary. 

15 ‘‘(D) PRIORITY IN REDISTRIBUTION.— 

16 Subject to subparagraphs (C) and (E), the Sec17 retary shall determine which qualifying hos18 pitals receive increases under subparagraph (B) 

19 in the otherwise applicable resident limits for 

20 such hospitals in a manner that distributes the 

21 positions made available to hospitals under this 

22 paragraph in accordance with the following: 

23 ‘‘(i) The Secretary shall make such 

24 positions available to hospitals with appli25 cable residency training programs. 


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1 ‘‘(ii) In the case that the application 

2 of clause (i) does not result in the distribu3 tion of all positions made available under 

4 this paragraph, the Secretary shall make 

5 any positions that remain undistributed 

6 after the application of such clause avail7 able to hospitals that are located in— 

8 ‘‘(I) a State with a resident-to9 population ratio in the lowest quartile 

10 (as determined by the Secretary); 

11 ‘‘(II) a State, a territory of the 

12 United States, or the District of Co13 lumbia that is among the top 10 

14 States, territories, or Districts in 

15 terms of the ratio of the total popu16 lation of the State, territory, or Dis17 trict living in an area designated 

18 (under such section 332(a)(1)(A)) as 

19 a health professional shortage area 

20 (as of the date of enactment of this 

21 paragraph), to the total population of 

22 the State, territory, or District (as de23 termined by the Secretary based on 

24 the most recent available population 


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1 data published by the Bureau of the 

2 Census); or 

3 ‘‘(III) a rural area (as defined in 

4 subsection (d)(2)(D)(ii)). 

5 ‘‘(iii) In the case that the application 

6 of clauses (i) and (ii) does not result in the 

7 distribution of all positions made available 

8 under this paragraph, the Secretary shall 

9 make any positions that remain undistrib10 uted after the application of such clauses 

11 available to hospitals that establish a med12 ical residency program that is sponsored 

13 by, or affiliated with, a medical school that 

14 was first accredited during the cost report15 ing period prior to the cost reporting pe16 riod with respect to which such application 

17 applies. 

18 ‘‘(E) LIMITATION.—A hospital may not re19 ceive more than 75 full-time equivalent addi20 tional residency positions under this paragraph. 

21 ‘‘(F) APPLICATION OF PER RESIDENT

22 AMOUNTS FOR PRIMARY CARE AND NONPRI23 MARY CARE.—With respect to additional resi24 dency positions in a hospital attributable to the 

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1 proved FTE per resident amounts are deemed 

2 to be equal to the hospital per resident amounts 

3 for primary care and nonprimary care com4 puted under paragraph (2)(D) for that hospital. 

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

6 ‘‘(i) REFERENCE RESIDENT LEVEL.— 

7 The term ‘reference resident level’ means, 

8 with respect to a hospital, the highest resi9 dent level for any of the 3 most recent cost 

10 reporting periods (ending before the date 

11 of the enactment of this paragraph) of the 

12 hospital for which a cost report has been 

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

14 audit)), as determined by the Secretary. 

15 ‘‘(ii) RESIDENT LEVEL.—The term 

16 ‘resident level’ has the meaning given such 

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

18 ‘‘(iii) OTHERWISE APPLICABLE RESI19 DENT LIMIT.—The term ‘otherwise appli20 cable resident limit’ means, with respect to 

21 a hospital, the limit otherwise applicable 

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

23 paragraph (4) on the resident level for the 

24 hospital determined without regard to this 


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1 paragraph but taking into account para2 graph (7)(A). 

3 ‘‘(iv) APPLICABLE RESIDENCY TRAIN4 ING PROGRAM.— 

5 ‘‘(I) IN GENERAL.—The term 

6 ‘applicable residency training pro7 gram’ means a medical residency 

8 training program that is for the appli9 cable primary specialty that, as of the 

10 date of the enactment of this para11 graph, is the applicable primary spe12 cialty that has most recently been des13 ignated as a primary specialty by the 

14 American Board of Medical Special15 ties. 

16 ‘‘(II) APPLICABLE PRIMARY SPE17 CIALTY.—The term ‘applicable pri18 mary specialty’ means a primary spe19 cialty a resident of which is not, as of 

20 the date of the enactment of this 

21 paragraph, counted as an FTE resi22 dent for purposes of this subsection. 

23 For purposes of the preceding sen24 tence, the term ‘primary specialty’ 

25 does not include a subspecialty. 


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1 ‘‘(H) AFFILIATION.—The provisions of this 

2 paragraph shall be applied to hospitals which 

3 are members of the same affiliated group (as 

4 defined by the Secretary under paragraph 

5 (4)(H)(ii)) and the reference resident level for 

6 each such hospital shall be the reference resi7 dent level with respect to the cost reporting pe8 riod that results in the smallest difference be9 tween the reference resident level and the other10 wise applicable resident limit.’’. 

11 (b) IME.— 

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

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

14 1395ww(d)(5)(B)(v)), in the second sentence, is 

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

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

17 (h)(9)’’. 

18 (2) CONFORMING AMENDMENT.—Section 

19 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 

20 1395ww(d)(5)(B)) is amended by adding at the end 

21 the following clause: 

22 ‘‘(xii) For discharges occurring on or 

23 after July 1, 2017, insofar as an additional 

24 payment amount under this subparagraph 

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1 uted to a hospital under subsection 

2 (h)(9)(B), the indirect teaching adjustment 

3 factor shall be computed in the same man4 ner as provided under clause (ii) with re5 spect to such resident positions.’’. 

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

7 of the Medicare Prescription Drug, Improvement, and 

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

9 amended by section 5503 of the Patient Protection and 

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

11 by striking ‘‘paragraphs (7) and (8)’’ and inserting ‘‘para12 graphs (7), (8), and (9).’’. 

Æ 


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