II 

117TH CONGRESS 

1ST SESSION S. 834 

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 

MARCH 18, 2021 

Mr. MENENDEZ (for himself, Mr. BOOZMAN, and Mr. SCHUMER) 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 2021’’. 

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

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

4 (9)’’ and inserting ‘‘(9), and (10)’’; 

5 (3) in paragraph (7)(E), by inserting ‘‘para6 graph (10),’’ after ‘‘paragraph (9),’’; and 

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

8 paragraph: 

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

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

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

14 years 2023 through 2029 (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 2023 through 2029. 

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 2023 through 2029. 

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 2029.—If the aggregate number 

2 of positions distributed under this 

3 paragraph during the 7-year period of 

4 fiscal years 2023 through 2029 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 

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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 ‘‘(C) PROHIBITION ON DISTRIBUTION TO

10 HOSPITALS WITHOUT AN INCREASE AGREE11 MENT.—No increase in the otherwise applicable 

12 resident limit of a hospital may be made under 

13 this paragraph unless such hospital agrees to 

14 increase the total number of full-time equivalent 

15 residency positions under the approved medical 

16 residency training program of such hospital by 

17 the number of such positions made available by 

18 such increase under this paragraph. 

19 ‘‘(D) LIMITATION.— 

20 ‘‘(i) IN GENERAL.—Except as pro21 vided in clause (ii), a hospital may not re22 ceive more than 75 full-time equivalent ad23 ditional residency positions in the aggre24 gate under this paragraph and paragraph 


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1 (9) over the period of fiscal years 2023 

2 through 2029. 

3 ‘‘(ii) INCREASE IN NUMBER OF ADDI4 TIONAL POSITIONS A HOSPITAL MAY RE5 CEIVE.—The Secretary shall increase the 

6 aggregate number of full-time equivalent 

7 additional residency positions a hospital 

8 may receive under this paragraph over 

9 such period if the Secretary estimates that 

10 the number of positions available for dis11 tribution under subparagraph (A) exceeds 

12 the number of applications approved under 

13 such subparagraph over such period. 

14 ‘‘(E) APPLICATION OF PER RESIDENT

15 AMOUNTS FOR PRIMARY CARE AND NONPRI16 MARY CARE.—With respect to additional resi17 dency positions in a hospital attributable to the 

18 increase provided under this paragraph, the ap19 proved FTE per resident amounts are deemed 

20 to be equal to the hospital per resident amounts 

21 for primary care and nonprimary care com22 puted under paragraph (2)(D) for that hospital. 

23 ‘‘(F) PERMITTING FACILITIES TO APPLY

24 AGGREGATION RULES.—The Secretary shall 

25 permit hospitals receiving additional residency 


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1 positions attributable to the increase provided 

2 under this paragraph to, beginning in the fifth 

3 year after the effective date of such increase, 

4 apply such positions to the limitation amount 

5 under paragraph (4)(F) that may be aggre6 gated pursuant to paragraph (4)(H) among 

7 members of the same affiliated group. 

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

9 ‘‘(i) OTHERWISE APPLICABLE RESI10 DENT LIMIT.—The term ‘otherwise appli11 cable resident limit’ means, with respect to 

12 a hospital, the limit otherwise applicable 

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

14 paragraph (4) on the resident level for the 

15 hospital determined without regard to this 

16 paragraph but taking into account para17 graphs (7)(A), (7)(B), (8)(A), and (8)(B). 

18 ‘‘(ii) QUALIFYING HOSPITAL.—The 

19 term ‘qualifying hospital’ means a hospital 

20 described in any of subclauses (I) through 

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

22 ‘‘(iii) REFERENCE RESIDENT

23 LEVEL.—The term ‘reference resident 

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

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1 porting period of the hospital ending on or 

2 before the date of enactment of this para3 graph, for which a cost report has been 

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

5 audit)), as determined by the Secretary. 

6 ‘‘(iv) RESIDENT LEVEL.—The term 

7 ‘resident level’ has the meaning given such 

8 term in paragraph (7)(C)(i).’’. 

9 (b) IME.— 

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

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

12 1395ww(d)(5)(B)(v)), in the third sentence, is 

13 amended by striking ‘‘and (h)(9)’’and inserting 

14 ‘‘(h)(9), and (h)(10)’’. 

15 (2) CONFORMING PROVISION.—Section 

16 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 

17 1395ww(d)(5)(B)) is amended by adding after 

18 clause (xii) the following new clause: 

19 ‘‘(xiii) For discharges occurring on or after 

20 July 1, 2023, insofar as an additional payment 

21 amount under this subparagraph is attributable to 

22 resident positions distributed to a hospital under 

23 subsection (h)(10), the indirect teaching adjustment 

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1 vided under clause (ii) with respect to such resident 

2 positions.’’. 

3 SEC. 3. STUDY AND REPORT ON STRATEGIES FOR INCREAS4 ING DIVERSITY. 

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

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

7 General’’) shall conduct a study on strategies for increas8 ing the diversity of the health professional workforce. Such 

9 study shall include an analysis of strategies for increasing 

10 the number of health professionals from rural, lower in11 come, and underrepresented minority communities, includ12 ing which strategies are most effective for achieving such 

13 goal. 

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

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

16 submit to Congress a report on the study conducted under 

17 subsection (a), together with recommendations for such 

18 legislation and administrative action as the Comptroller 

19 General determines appropriate. 

Æ 


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