I 

114TH CONGRESS 

1ST SESSION H. R. 2124 

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

of additional residency positions, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 30, 2015 

Mr. CROWLEY (for himself and Mr. BOUSTANY) 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 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 2015’’. 


emcdonald on DSK67QTVN1PROD with BILLS
2 

•HR 2124 IH

1 SEC. 2. DISTRIBUTION OF ADDITIONAL RESIDENCY POSI2 TIONS. 

3 (a) IN GENERAL.—Section 1886(h) of the Social Se4 curity Act (42 U.S.C. 1395ww(h)) is amended— 

5 (1) in paragraph (4)(F)(i), by striking ‘‘para6 graphs (7) and (8)’’ and inserting ‘‘paragraphs (7), 

7 (8), and (9)’’; 

8 (2) in paragraph (4)(H)(i), by striking ‘‘para9 graphs (7) and (8)’’ and inserting ‘‘paragraphs (7), 

10 (8), and (9)’’; 

11 (3) in paragraph (7)(E), by inserting ‘‘para12 graph (9),’’ after ‘‘paragraph (8),’’; and 

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

14 paragraph: 

15 ‘‘(9) DISTRIBUTION OF ADDITIONAL RESIDENCY

16 POSITIONS.— 

17 ‘‘(A) ADDITIONAL RESIDENCY POSI18 TIONS.— 

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

20 years 2017 through 2021 (and succeeding 

21 fiscal years if the Secretary determines 

22 that there are additional residency posi23 tions available to distribute under clause 

24 (iv)(II)), the Secretary shall, subject to 

25 clause (ii) and subparagraph (D), increase 

26 the otherwise applicable resident limit for 


emcdonald on DSK67QTVN1PROD with BILLS
3 

•HR 2124 IH

1 each qualifying hospital that submits a 

2 timely application under this subparagraph 

3 by such number as the Secretary may ap4 prove for portions of cost reporting periods 

5 occurring on or after July 1 of the fiscal 

6 year of the increase. 

7 ‘‘(ii) NUMBER AVAILABLE FOR DIS8 TRIBUTION.—For each such fiscal year, 

9 the Secretary shall determine the total 

10 number of additional residency positions 

11 available for distribution under clause (i) 

12 in accordance with the following: 

13 ‘‘(I) ALLOCATION TO HOSPITALS

14 ALREADY OPERATING OVER RESIDENT

15 LIMIT.—One-third of such number 

16 shall be available for distribution only 

17 to hospitals described in subparagraph 

18 (B). 

19 ‘‘(II) AGGREGATE LIMITATION.— 

20 Except as provided in clause (iv)(I), 

21 the aggregate number of increases in 

22 the otherwise applicable resident limit 

23 under this subparagraph shall be 

24 equal to 3,000 in each such year. 


emcdonald on DSK67QTVN1PROD with BILLS
4 

•HR 2124 IH

1 ‘‘(iii) PROCESS FOR DISTRIBUTING

2 POSITIONS.— 

3 ‘‘(I) ROUNDS OF APPLICA4 TIONS.—The Secretary shall initiate 5 

5 separate rounds of applications for an 

6 increase under clause (i), 1 round 

7 with respect to each of fiscal years 

8 2017 through 2021. 

9 ‘‘(II) NUMBER AVAILABLE.—In 

10 each of such rounds, the aggregate 

11 number of positions available for dis12 tribution in the fiscal year under 

13 clause (ii) shall be distributed, plus 

14 any additional positions available 

15 under clause (iv). 

16 ‘‘(III) TIMING.—The Secretary 

17 shall notify hospitals of the number of 

18 positions distributed to the hospital 

19 under this paragraph as a result of an 

20 increase in the otherwise applicable 

21 resident limit by January 1 of the fis22 cal year of the increase. Such increase 

23 shall be effective for portions of cost 

24 reporting periods beginning on or 

25 after July 1 of that fiscal year. 


emcdonald on DSK67QTVN1PROD with BILLS
5 

•HR 2124 IH

1 ‘‘(iv) POSITIONS NOT DISTRIBUTED

2 DURING THE FISCAL YEAR.— 

3 ‘‘(I) IN GENERAL.—If the num4 ber of resident full-time equivalent po5 sitions distributed under this para6 graph in a fiscal year is less than the 

7 aggregate number of positions avail8 able for distribution in the fiscal year 

9 (as described in clause (ii), including 

10 after application of this subclause), 

11 the difference between such number 

12 distributed and such number available 

13 for distribution shall be added to the 

14 aggregate number of positions avail15 able for distribution in the following 

16 fiscal year. 

17 ‘‘(II) EXCEPTION IF POSITIONS

18 NOT DISTRIBUTED BY END OF FISCAL

19 YEAR 2021.—If the aggregate number 

20 of positions distributed under this 

21 paragraph during the 5-year period of 

22 fiscal years 2017 through 2021 is less 

23 than 15,000, the Secretary shall, in 

24 accordance with the provisions of 

25 clause (ii) and subparagraph (D) and 


emcdonald on DSK67QTVN1PROD with BILLS
6 

•HR 2124 IH

1 the considerations and priority de2 scribed in subparagraph (C), conduct 

3 an application and distribution proc4 ess in each subsequent fiscal year 

5 until such time as the aggregate 

6 amount of positions distributed under 

7 this paragraph is equal to 15,000. 

8 ‘‘(B) ALLOCATION OF DISTRIBUTION FOR

9 POSITIONS TO HOSPITALS ALREADY OPERATING

10 OVER RESIDENT LIMIT.— 

11 ‘‘(i) IN GENERAL.—Subject to clauses 

12 (ii) and (iii), in the case of a hospital in 

13 which the reference resident level of the 

14 hospital (as specified in subparagraph 

15 (G)(iii)) is greater than the otherwise ap16 plicable resident limit, the increase in the 

17 otherwise applicable resident limit under 

18 subparagraph (A) for a fiscal year de19 scribed in such subparagraph shall be an 

20 amount equal to the product of the total 

21 number of additional residency positions 

22 available for distribution under subpara23 graph (A)(ii)(I) for such fiscal year and 

24 the quotient of— 


emcdonald on DSK67QTVN1PROD with BILLS
7 

•HR 2124 IH

1 ‘‘(I) the number of resident posi2 tions by which the reference resident 

3 level of the hospital exceeds the other4 wise applicable resident limit for the 

5 hospital; and 

6 ‘‘(II) the number of resident po7 sitions by which the reference resident 

8 level of all such hospitals with respect 

9 to which an application is approved 

10 under this paragraph exceeds the oth11 erwise applicable resident limit for 

12 such hospitals. 

13 ‘‘(ii) REQUIREMENTS.—A hospital de14 scribed in clause (i)— 

15 ‘‘(I) is not eligible for an increase 

16 in the otherwise applicable resident 

17 limit under this subparagraph unless 

18 the amount by which the reference 

19 resident level of the hospital exceeds 

20 the otherwise applicable resident limit 

21 is not less than 10 and the hospital 

22 trains at least 25 percent of the full23 time equivalent residents of the hos24 pital in primary care and general surVerDate Sep 11 2014 00:03 May 12, 2015 Jkt 049200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H2124.IH H2124

emcdonald on DSK67QTVN1PROD with BILLS
8 

•HR 2124 IH

1 gery (as of the date of enactment of 

2 this paragraph); and 

3 ‘‘(II) shall continue to train at 

4 least 25 percent of the full-time equiv5 alent residents of the hospital in pri6 mary care and general surgery for the 

7 5-year period beginning on such date. 

8 In the case where the Secretary determines 

9 that a hospital described in clause (i) no 

10 longer meets the requirement of subclause 

11 (II), the Secretary may reduce the other12 wise applicable resident limit of the hos13 pital by the amount by which such limit 

14 was increased under this subparagraph. 

15 ‘‘(iii) CLARIFICATION REGARDING ELI16 GIBILITY FOR OTHER ADDITIONAL RESI17 DENCY POSITIONS.—Nothing in this sub18 paragraph shall be construed as preventing 

19 a hospital described in clause (i) from ap20 plying for and receiving additional resi21 dency positions under this paragraph that 

22 are not reserved for distribution under this 

23 subparagraph. 

24 ‘‘(C) DISTRIBUTION OF OTHER POSI25 TIONS.—For purposes of determining an inVerDate Sep 11 2014 00:03 May 12, 2015 Jkt 049200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2124.IH H2124

emcdonald on DSK67QTVN1PROD with BILLS
9 

•HR 2124 IH

1 crease in the otherwise applicable resident limit 

2 under subparagraph (A) (other than such an in3 crease described in subparagraph (B)), the fol4 lowing shall apply: 

5 ‘‘(i) CONSIDERATIONS IN DISTRIBU6 TION.—In determining for which hospitals 

7 such an increase is provided under sub8 paragraph (A), the Secretary shall take 

9 into account the demonstrated likelihood of 

10 the hospital filling the positions made 

11 available under this paragraph within the 

12 first 5 cost reporting periods beginning 

13 after the date the increase would be effec14 tive, as determined by the Secretary. 

15 ‘‘(ii) PRIORITY FOR CERTAIN HOS16 PITALS.—Subject to clause (iii), in deter17 mining for which hospitals such an in18 crease is provided, the Secretary shall dis19 tribute the increase in the following pri20 ority order: 

21 ‘‘(I) First, to hospitals in States 

22 with— 

23 ‘‘(aa) new medical schools 

24 that received ‘Candidate School’ 

25 status from the Liaison ComVerDate Sep 11 2014 00:03 May 12, 2015 Jkt 049200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H2124.IH H2124

emcdonald on DSK67QTVN1PROD with BILLS
10 

•HR 2124 IH

1 mittee on Medical Education or 

2 that received ‘Pre-Accreditation’ 

3 status from the American Osteo4 pathic Association Commission 

5 on Osteopathic College Accredita6 tion on or after January 1, 2000, 

7 and that have achieved or con8 tinue to progress toward ‘Full 

9 Accreditation’ status (as such 

10 term is defined by the Liaison 

11 Committee on Medical Edu12 cation) or toward ‘Accreditation’ 

13 status (as such term is defined 

14 by the American Osteopathic As15 sociation Commission on Osteo16 pathic College Accreditation); 

17 ‘‘(bb) additional locations 

18 and branch campuses established 

19 on or after January 1, 2000, by 

20 medical schools with ‘Full Ac21 creditation’ status (as such term 

22 is defined by the Liaison Com23 mittee on Medical Education) or 

24 ‘Accreditation’ status (as such 

25 term is defined by the American 


emcdonald on DSK67QTVN1PROD with BILLS
11 

•HR 2124 IH

1 Osteopathic Association Commis2 sion on Osteopathic College Ac3 creditation); or 

4 ‘‘(cc) the highest ratio of the 

5 total population of the State liv6 ing in an area designated (under 

7 such section 332(a)(1)(A)) as a 

8 health professional shortage area, 

9 using data from March 23, 2010, 

10 to the total population of the 

11 State, using census data from 

12 July 1, 2009. 

13 ‘‘(II) Second, to hospitals with 

14 which the Secretary cooperates under 

15 section 7302(d) of title 38, United 

16 States Code. 

17 ‘‘(III) Third, to hospitals that 

18 emphasize training in community19 based settings or in hospital out20 patient departments. 

21 ‘‘(IV) Fourth, to hospitals that 

22 are meaningful EHR users (as de23 fined in subsection (n)(3)) for the fis24 cal year which includes the date the 

25 hospital submits an application for 


emcdonald on DSK67QTVN1PROD with BILLS
12 

•HR 2124 IH

1 such increase under subparagraph 

2 (A). 

3 ‘‘(V) Fifth, to all other hospitals. 

4 ‘‘(iii) DISTRIBUTION TO HOSPITALS IN

5 HIGHER PRIORITY GROUP PRIOR TO DIS6 TRIBUTION IN LOWER PRIORITY GROUPS.— 

7 The Secretary may only distribute such an 

8 increase to a lower priority group under 

9 clause (ii) if all qualifying hospitals in the 

10 higher priority group or groups have re11 ceived the maximum number of increases 

12 under such subparagraph that the hospital 

13 is eligible for under this paragraph for the 

14 fiscal year. 

15 ‘‘(iv) REQUIREMENTS FOR USE OF AD16 DITIONAL POSITIONS.— 

17 ‘‘(I) IN GENERAL.—Subject to 

18 subclause (II), a hospital that receives 

19 such an increase shall ensure, during 

20 the 5-year period beginning on the ef21 fective date of such increase, that— 

22 ‘‘(aa) not less than 50 per23 cent of the positions attributable 

24 to such increase that are used in 

25 a given year during such 5-year 


emcdonald on DSK67QTVN1PROD with BILLS
13 

•HR 2124 IH

1 period are used to train full-time 

2 equivalent residents in a shortage 

3 specialty residency program (as 

4 defined in subparagraph (G)(v)), 

5 as determined by the Secretary 

6 at the end of such 5-year period; 

7 ‘‘(bb) the total number of 

8 full-time equivalent residents, ex9 cluding any additional positions 

10 attributable to such increase, is 

11 not less than the average number 

12 of full-time equivalent residents 

13 during the 3 most recent cost re14 porting periods ending on or be15 fore the effective date of such in16 crease; and 

17 ‘‘(cc) the ratio of full-time 

18 equivalent residents in a shortage 

19 specialty residency program (as 

20 so defined) is not less than the 

21 average ratio of full-time equiva22 lent residents in such a program 

23 during the 3 most recent cost re24 porting periods ending on or beVerDate Sep 11 2014 00:03 May 12, 2015 Jkt 049200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H2124.IH H2124

emcdonald on DSK67QTVN1PROD with BILLS
14 

•HR 2124 IH

1 fore the effective date of such in2 crease. 

3 ‘‘(II) REDISTRIBUTION OF POSI4 TIONS IF HOSPITAL NO LONGER

5 MEETS CERTAIN REQUIREMENTS.— 

6 With respect to each fiscal year de7 scribed in subparagraph (A), the Sec8 retary shall determine whether or not 

9 a hospital described in subclause (I) 

10 meets the requirements of such sub11 clause. In the case that the Secretary 

12 determines that such a hospital does 

13 not meet such requirements, the Sec14 retary shall— 

15 ‘‘(aa) reduce the otherwise 

16 applicable resident limit of the 

17 hospital by the amount by which 

18 such limit was increased under 

19 this paragraph; and 

20 ‘‘(bb) provide for the dis21 tribution of positions attributable 

22 to such reduction in accordance 

23 with the requirements of this 

24 paragraph. 


emcdonald on DSK67QTVN1PROD with BILLS
15 

•HR 2124 IH

1 ‘‘(D) LIMITATION.—A hospital may not re2 ceive more than 75 full-time equivalent addi3 tional residency positions under this paragraph 

4 for any fiscal year. 

5 ‘‘(E) APPLICATION OF PER RESIDENT

6 AMOUNTS FOR PRIMARY CARE AND NONPRI7 MARY CARE.—With respect to additional resi8 dency positions in a hospital attributable to the 

9 increase provided under this paragraph, the ap10 proved FTE per resident amounts are deemed 

11 to be equal to the hospital per resident amounts 

12 for primary care and nonprimary care com13 puted under paragraph (2)(D) for that hospital. 

14 ‘‘(F) PERMITTING FACILITIES TO APPLY

15 AGGREGATION RULES.—The Secretary shall 

16 permit hospitals receiving additional residency 

17 positions attributable to the increase provided 

18 under this paragraph to, beginning in the fifth 

19 year after the effective date of such increase, 

20 apply such positions to the limitation amount 

21 under paragraph (4)(F) that may be aggre22 gated pursuant to paragraph (4)(H) among 

23 members of the same affiliated group. 

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


emcdonald on DSK67QTVN1PROD with BILLS
16 

•HR 2124 IH

1 ‘‘(i) OTHERWISE APPLICABLE RESI2 DENT LIMIT.—The term ‘otherwise appli3 cable resident limit’ means, with respect to 

4 a hospital, the limit otherwise applicable 

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

6 paragraph (4) on the resident level for the 

7 hospital determined without regard to this 

8 paragraph but taking into account para9 graphs (7)(A), (7)(B), (8)(A), and (8)(B). 

10 ‘‘(ii) REFERENCE RESIDENT LEVEL.— 

11 Except as otherwise provided in subclause 

12 (II), the term ‘reference resident level’ 

13 means, with respect to a hospital, the resi14 dent level for the most recent cost report15 ing period of the hospital ending on or be16 fore the date of enactment of this para17 graph, for which a cost report has been 

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

19 audit)), as determined by the Secretary. 

20 ‘‘(iii) RESIDENT LEVEL.—The term 

21 ‘resident level’ has the meaning given such 

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

23 ‘‘(iv) SHORTAGE SPECIALTY RESI24 DENCY PROGRAM.—The term ‘shortage 


emcdonald on DSK67QTVN1PROD with BILLS
17 

•HR 2124 IH

1 specialty residency program’ means the fol2 lowing: 

3 ‘‘(I) PRIOR TO REPORT ON

4 SHORTAGE SPECIALTIES.—Prior to 

5 the date on which the report of the 

6 National Health Care Workforce 

7 Commission is submitted under sec8 tion 3 of the Resident Physician 

9 Shortage Reduction Act of 2015, any 

10 approved residency training program 

11 in a specialty identified in the report 

12 entitled ‘The Physician Workforce: 

13 Projections and Research into Current 

14 Issues Affecting Supply and Demand’, 

15 issued in December 2008 by the 

16 Health Resources and Services Ad17 ministration, as a specialty whose 

18 baseline physician requirements pro19 jections exceed the projected supply of 

20 total active physicians for the period 

21 of 2005 through 2020. 

22 ‘‘(II) AFTER REPORT ON SHORT23 AGE SPECIALTIES.—On or after the 

24 date on which the report of the Na25 tional Health Care Workforce ComVerDate Sep 11 2014 00:03 May 12, 2015 Jkt 049200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\H2124.IH H2124

emcdonald on DSK67QTVN1PROD with BILLS
18 

•HR 2124 IH

1 mission is submitted under such sec2 tion, any approved residency training 

3 program in a physician specialty iden4 tified in such report as a specialty for 

5 which there is a shortage.’’. 

6 (b) IME.—Section 1886(d)(5)(B) of the Social Secu7 rity Act (42 U.S.C. 1395ww(d)(5)(B)) is amended— 

8 (1) in clause (v), in the second sentence, by 

9 striking ‘‘subsections (h)(7) and (h)(8)’’ and insert10 ing ‘‘subsections (h)(7), (h)(8), and (h)(9)’’; 

11 (2) by redesignating clause (x), as added by 

12 section 5505(b) of the Patient Protection and Af13 fordable Care Act (Public Law 111–148), as clause 

14 (xi) and moving such clause 4 ems to the left; and 

15 (3) by adding after clause (xi), as redesignated 

16 by subparagraph (A), the following new clause: 

17 ‘‘(xii) For discharges occurring on or 

18 after July 1, 2017, insofar as an additional 

19 payment amount under this subparagraph 

20 is attributable to resident positions distrib21 uted to a hospital under subsection (h)(9), 

22 the indirect teaching adjustment factor 

23 shall be computed in the same manner as 

24 provided under clause (ii) with respect to 

25 such resident positions.’’. 


emcdonald on DSK67QTVN1PROD with BILLS
19 

•HR 2124 IH

1 SEC. 3. STUDY AND REPORT BY NATIONAL HEALTH CARE 

2 WORKFORCE COMMISSION. 

3 (a) STUDY.—The National Health Care Workforce 

4 Commission established under section 5101 of the Patient 

5 Protection and Affordable Care Act (Public Law 111– 

6 148) shall conduct a study of the physician workforce. 

7 Such study shall include the identification of physician 

8 specialties for which there is a shortage, as defined by the 

9 Commission. 

10 (b) REPORT.—Not later than January 1, 2018, the 

11 National Health Care Workforce Commission shall submit 

12 to Congress a report on the study conducted under sub13 section (a), together with recommendations for such legis14 lation and administrative action as the Commission deter15 mines appropriate. 

16 SEC. 4. STUDY AND REPORT ON STRATEGIES FOR INCREAS17 ING DIVERSITY. 

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

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

20 General’’) shall conduct a study on strategies for increas21 ing the diversity of the health professional workforce. Such 

22 study shall include an analysis of strategies for increasing 

23 the number of health professionals from rural, lower in24 come, and underrepresented minority communities, includ25 ing which strategies are most effective for achieving such 

26 goal. 


emcdonald on DSK67QTVN1PROD with BILLS
20 

•HR 2124 IH

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

2 of enactment of this Act, the Comptroller General shall 

3 submit to Congress a report on the study conducted under 

4 subsection (a), together with recommendations for such 

5 legislation and administrative action as the Comptroller 

6 General determines appropriate. 

Æ 


emcdonald on DSK67QTVN1PROD with BILLS