I

106TH CONGRESS

1ST SESSION H. R. 1645

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

rates under Medicare to hospitals for costs of direct graduate medical

education of residents for residency training programs in specialties or

subspecialties which the Secretary of Health and Human Services designates as critical need specialty or subspecialty training programs.

IN THE HOUSE OF REPRESENTATIVES

APRIL 29, 1999

Mr. STARK (for himself, Mr. MCDERMOTT, Mr. LEWIS of Georgia, Mrs.

THURMAN, Ms. KAPTUR, Ms. JACKSON-LEE of Texas, Mr. FILNER, Mr.

CUMMINGS, Ms. BROWN of Florida, Mr. FROST, and Mr. HILLIARD) introduced the following bill; which was referred to the Committee on Ways

and Means, and in addition to the Committee on 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 full payment rates under Medicare to hospitals for

costs of direct graduate medical education of residents

for residency training programs in specialties or subspecialties which the Secretary of Health and Human

Services designates as critical need specialty or subspecialty training programs.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,
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1 SECTION 1. SHORT TITLE.

2 This Act may be cited as the ‘‘Medicare Critical Need

3 GME Protection Act of 1999’’.

4 SEC. 2. FULL FTE PAYMENT FOR RESIDENTS IN CRITICAL

5 NEED SPECIALTY OR SUBSPECIALTY TRAIN6 ING PROGRAMS.

7 (a) TREATMENT AS INITIAL RESIDENCY PERIOD.—

8 (1) IN GENERAL.—Section 1886(h)(5)(F) of

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

10 1395ww(h)(5)(F)) is amended—

11 (A) in clause (i)—

12 (i) by striking ‘‘clause (ii)’’ and in13 serting ‘‘clause (ii) or (iii)’’; and

14 (ii) by striking ‘‘and’’ at the end;

15 (B) in clause (ii), by striking the period at

16 the end and inserting ‘‘, and’’; and

17 (C) by inserting after clause (ii), the fol18 lowing new clause:

19 ‘‘(iii) subject to the requirement for

20 budget neutrality under paragraph (7), a

21 period of years, determined by the Sec22 retary under subparagraph (K)(iv), during

23 which an individual is in a residency train24 ing program designated by the Secretary

25 as a critical need specialty or subspecialty,

26 as defined in subparagraph (K), shall be
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1 treated as part of the initial residency pe2 riod, but shall not be counted against any

3 limitation on the initial residency period.’’.

4 (2) DETERMINATION OF CRITICAL NEED SPE5 CIALTY OR SUBSPECIALTY.—Section 1886(h)(5) of

6 such Act (42 U.S.C. 1395ww(h)(5)) is amended by

7 adding at the end the following new subparagraph:

8 ‘‘(K) CRITICAL NEED SPECIALITY.—

9 ‘‘(i) DEFINITION.—The term ‘critical

10 need specialty or subspecialty’ means a

11 specialty or subspecialty designated by the

12 Secretary under this subparagraph with a

13 current or imminent critical shortage of

14 physicians.

15 ‘‘(ii) CRITERIA.—For purposes of des16 ignating a critical need specialty or sub17 specialty under this subparagraph, the Sec18 retary shall prescribe criteria for deter19 mining critical shortages of physicians or

20 residents in approved medical residency

21 training programs. The Secretary shall

22 publish in the Federal Register the criteria

23 established under this clause and the form

24 and manner by which data is submitted for
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1 the Secretary’s review under this subpara2 graph.

3 ‘‘(iii) PERIOD OF DESIGNATION.—

4 ‘‘(I) IN GENERAL.—A designa5 tion of a critical need specialty or sub6 specialty under this subparagraph

7 shall apply until the Secretary deter8 mines the specialty or subspecialty

9 does not meet the criteria for designa10 tion as a critical need specialty or

11 subspecialty.

12 ‘‘(II) REPORT.—In the event the

13 Secretary determines that a specialty

14 or subspecialty no longer meets the

15 criteria for being a critical need spe16 cialty or subspecialty, the Secretary

17 shall submit a report to Congress de18 scribing the reasons for discontinuing

19 the designation.’’.

20 (b) MAINTAINING BUDGET NEUTRALITY.—Section

21 1886(h) of such Act (42 U.S.C. 1395ww(h)) is amended

22 by adding at the end the following new paragraph:

23 ‘‘(7) BUDGET NEUTRALITY ADJUSTMENT FOR CRIT24 ICAL NEED SPECIALTY OR SUBSPECIALTY DESIGNA25 TION.—If the Secretary designates a critical need specialty
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1 or subspecialty for a fiscal year, the Secretary shall make

2 a proportional adjustment to payment amounts under this

3 subsection for such fiscal year so that the aggregate of

4 the payments under this subsection for such fiscal year

5 shall equal the aggregate payments that would have been

6 made under this subsection for such fiscal year if the Sec7 retary had not designated a critical need specialty or sub8 specialty.’’.

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

10 this Act shall apply with respect to payments under sec11 tion 1886(h) of the Social Security Act (42 U.S.C.

12 1395ww(h)) made for residents in, or beginning training

13 in, a critical need specialty or subspecialty on or after July

14 1, 2000.

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