I 

116TH CONGRESS 

1ST SESSION H. R. 3753 

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 

JULY 15, 2019 

Mr. GOTTHEIMER (for himself and Mr. PASCRELL) 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 ‘‘Supporting Graduate 

5 Medical Education at Community Hospitals Act of 2019’’. 


Pbinns on DSK79D2C42PROD with BILLS
2 

•HR 3753 IH

1 SEC. 2. FINDINGS. 

2 Congress makes the following findings: 

3 (1) Graduate Medical Education or ‘‘GME’’ 

4 training programs are of critical importance in de5 veloping the physician workforce. 

6 (2) Current caps on GME training programs 

7 under Medicare have been in place since 1997. 

8 (3) Hospitals seeking to launch GME training 

9 programs face barriers in establishing physician 

10 training programs in community hospitals. 

11 SEC. 3. MEDICARE GME TREATMENT OF HOSPITALS ESTAB12 LISHING NEW MEDICAL RESIDENCY TRAIN13 ING PROGRAMS AFTER HOSTING MEDICAL 

14 RESIDENT ROTATORS FOR SHORT DURA15 TIONS. 

16 (a) REDETERMINATION OF APPROVED FTE RESI17 DENT AMOUNT.—Section 1886(h)(2)(F) of the Social Se18 curity Act (42 U.S.C. 1395ww(h)(2)(F)) is amended— 

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

20 and 

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

22 ‘‘(ii) In applying this subparagraph to a 

23 hospital that has not entered into a GME affili24 ation agreement (as defined by the Secretary 

25 for purposes of paragraph (4)(H)(ii)), the Sec26 retary shall not provide for the establishment of 


Pbinns on DSK79D2C42PROD with BILLS
3 

•HR 3753 IH

1 an FTE resident amount until such time as the 

2 Secretary determines that the hospital has a 

3 medical residency training program that trains 

4 more than 1.0 full-time-equivalent resident in a 

5 cost reporting period. 

6 ‘‘(iii) In the case of a hospital with an ap7 proved FTE resident amount— 

8 ‘‘(I) based on the training of less than 

9 1.0 full-time-equivalent resident before Oc10 tober 1, 1997, or 

11 ‘‘(II) based on the training of no more 

12 than 6.0 full-time-equivalent residents in a 

13 medical residency training program in any 

14 cost reporting period between October 1, 

15 1996 and September 30, 1997 and no 

16 more than 3.0 full-time-equivalent resi17 dents on and after October 1, 1997, or 

18 ‘‘(III) based on the training of no full19 time-equivalent residents in a medical resi20 dency training program for any twenty 

21 consecutive cost reporting periods begin22 ning on or after October 1, 1997, 

23 the Secretary shall provide the hospital an op24 portunity to have a new FTE resident amount 

25 established when the hospital begins training at 


Pbinns on DSK79D2C42PROD with BILLS
4 

•HR 3753 IH

1 least 1.0 full-time-equivalent resident (in the 

2 case of a hospital described in subclauses (I or 

3 III)) or more than 3.0 full-time-equivalent resi4 dents (in the case of a hospital described in 

5 subclause (II)) for cost reporting periods begin6 ning on or after the date of the enactment of 

7 this clause and in accordance with the method8 ology under the rules in effect as of October 1, 

9 2015.’’. 

10 (b) REDETERMINATION OF FTE RESIDENT LIMITA11 TION.—Section 1886(h)(4)(H)(i) of the Social Security 

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

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

14 and 

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

16 ‘‘(II) Under this clause the Secretary 

17 shall not determine an adjustment in the 

18 limitation applicable to a hospital under 

19 subparagraph (F) until the hospital trains 

20 more than 1.0 full-time-equivalent resident 

21 in a new medical residency training pro22 gram in a cost reporting period. 

23 ‘‘(III) In the case of a hospital that 

24 has a limitation under subparagraph (F) of 

25 less than 1.0 full-time-equivalent resident 


Pbinns on DSK79D2C42PROD with BILLS
5 

•HR 3753 IH

1 as of the date of the enactment of this sub2 clause based on training before October 1, 

3 1997, under this clause the Secretary shall 

4 provide the hospital an opportunity to have 

5 a new adjustment in such limitation deter6 mined when such hospital begins training 

7 at least 1.0 full-time-equivalent resident in 

8 accordance with the methodology applica9 ble to hospitals under the rules in effect as 

10 of October 1, 2015, and applied for cost 

11 reporting periods beginning on or after the 

12 date of the enactment of this subclause. 

13 ‘‘(IV) In the case of a hospital that 

14 has not reported full-time-equivalent resi15 dents in twenty consecutive cost reporting 

16 periods subsequent to October 1, 1997, 

17 under this clause the Secretary shall pro18 vide the hospital an opportunity to have a 

19 new adjustment in such limitation deter20 mined when such hospital begins training 

21 at least 1.0 full-time-equivalent resident in 

22 accordance with the methodology applica23 ble to hospitals under the rules in effect as 

24 of October 1, 2015, and applied for cost 


Pbinns on DSK79D2C42PROD with BILLS
6 

•HR 3753 IH

1 reporting periods beginning on or after the 

2 date of the enactment of this subclause. 

3 ‘‘(V) In the case of a hospital for 

4 which an adjustment in the limitation ap5 plicable to a hospital under subparagraph 

6 (F) is based on the training of no more 

7 than 3.0 full-time-equivalent residents in a 

8 medical residency training program in a 

9 cost reporting period beginning on or after 

10 October 1, 1997, and before the date of 

11 the enactment of this subclause, the Sec12 retary shall provide the hospital an oppor13 tunity to have a new adjustment in such 

14 limitation determined when the hospital be15 gins training more than 3.0 full-time16 equivalent residents in accordance with the 

17 methodology applicable to hospitals under 

18 the rules in effect as of October 1, 2015, 

19 and applied for cost reporting periods be20 ginning on or after the date of the enact21 ment of this subclause.’’. 

22 (c) EFFECTIVE DATE.—The amendments made by 

23 this section shall apply to payment under section 1886 of 

24 the Social Security Act (42 U.S.C. 1395ww) for cost reVerDate Sep 11 2014 02:55 Jul 26, 2019 Jkt 034408 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3753.IH H3753

Pbinns on DSK79D2C42PROD with BILLS
7 

•HR 3753 IH

1 porting periods beginning on or after the date of the en2 actment of this Act. 

Æ 


Pbinns on DSK79D2C42PROD with BILLS