II 

110TH CONGRESS 

1ST SESSION S. 588 

To amend title XVIII of the Social Security Act to increase the Medicare 

caps on graduate medical education positions for States with a shortage 

of residents. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 14, 2007 

Mr. NELSON of Florida (for himself, Mr. REID, and Mr. BIDEN) 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 increase 

the Medicare caps on graduate medical education positions for States with a shortage of residents. 

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 2007’’. 


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1 SEC. 2. INCREASING THE MEDICARE CAPS ON GRADUATE 

2 MEDICAL EDUCATION POSITIONS FOR 

3 STATES WITH A SHORTAGE OF RESIDENTS. 

4 (a) DIRECT GRADUATE MEDICAL EDUCATION.—Sec5 tion 1886(h)(4)(F) of the Social Security Act (42 U.S.C. 

6 1395ww(h)(4)(F)) is amended— 

7 (1) in clause (i), by inserting ‘‘clause (iii) and’’ 

8 after ‘‘subject to’’; and 

9 (2) by adding at the end the following new 

10 clause: 

11 ‘‘(iii) INCREASE IN CAPS ON GRAD12 UATE MEDICAL EDUCATION POSITIONS FOR

13 STATES WITH A SHORTAGE OF RESI14 DENTS.— 

15 ‘‘(I) IN GENERAL.—For cost re16 porting periods beginning on or after 

17 the date that is 16 months after the 

18 date of enactment of the Resident 

19 Physician Shortage Reduction Act of 

20 2007, the Secretary shall increase the 

21 otherwise applicable limit on the total 

22 number of full-time equivalent resi23 dents in the field of allopathic or os24 teopathic medicine determined under 

25 clause (i) with respect to a qualifying 

26 hospital in an eligible State by an 


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1 amount determined appropriate by the 

2 Secretary. Such increase shall be 

3 phased-in over a period of 5 cost re4 porting periods beginning with the 

5 first cost reporting period in which 

6 the increase is applied under the pre7 vious sentence to the hospital. For 

8 each eligible State the aggregate num9 ber of such increases shall be— 

10 ‘‘(aa) not less than 15; and 

11 ‘‘(bb) not greater than the 

12 State resident cap increase. 

13 ‘‘(II) QUALIFYING HOSPITAL.— 

14 In this clause, the term ‘qualifying 

15 hospital’ means a hospital located in 

16 an eligible State that the Secretary 

17 determines should receive an increase 

18 under this clause in the otherwise ap19 plicable limit on the total number of 

20 full-time equivalent residents in the 

21 field of allopathic or osteopathic medi22 cine. 

23 ‘‘(III) ELIGIBLE STATE.—In this 

24 clause, the term ‘eligible State’ means 

25 a State for which the National median 


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1 medical resident ratio exceeds the 

2 State medical resident ratio. 

3 ‘‘(IV) STATE RESIDENT CAP IN4 CREASE.—In this clause, the term 

5 ‘State resident cap increase’ means, 

with respect to a State, 1 6 ⁄4 of the 

7 product of— 

8 ‘‘(aa) the difference between 

9 the National median medical resi10 dent ratio and the State medical 

11 resident ratio; and 

12 ‘‘(bb) the State population 

13 (as determined for purposes of 

14 subclause (VI)). 

15 ‘‘(V) NATIONAL MEDIAN MED16 ICAL RESIDENT RATIO.—In this 

17 clause, the term ‘National median 

18 medical resident ratio’ means the me19 dian of all State medical resident ra20 tios. 

21 ‘‘(VI) STATE MEDICAL RESIDENT

22 RATIO.—In this clause, the term 

23 ‘State medical resident ratio’ means, 

24 with respect to any State, the ratio of 

25 full-time equivalent residents in the 


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1 State in approved medical residency 

2 training programs as of the date of 

3 enactment of the Resident Physician 

4 Shortage Reduction Act of 2007 to 

5 the population of the State as of such 

6 date, as determined by the Secretary. 

7 ‘‘(VII) STATE.—In this clause, 

8 the term ‘State’ means a State and 

9 the District of Columbia. 

10 ‘‘(VIII) CONSIDERATIONS IN DE11 TERMINING RESIDENT CAP IN12 CREASES.—In determining whether a 

13 hospital is a qualifying hospital, and 

14 how much of an increase in the resi15 dent cap a qualifying hospital shall re16 ceive under subclause (I), the Sec17 retary shall take into consideration 

18 the demonstrated likelihood of the 

19 hospital filling resident positions that 

20 would be made available as a result of 

21 such increase within the first 3 cost 

22 reporting periods beginning on or 

23 after the date that is 16 months after 

24 the date of enactment of the Resident 

25 Physician Shortage Reduction Act of 


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1 2007. The Secretary shall also take 

2 into consideration whether the new 

3 resident positions will be in primary 

4 care, preventive medicine, or geriatrics 

5 programs.’’. 

6 (b) INDIRECT MEDICAL EDUCATION.—Section 

7 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 

8 1395ww(d)(5)(B)) is amended by adding at the end the 

9 following new clause: 

10 ‘‘(x) Clause (iii) of subsection (h)(4)(F) shall 

11 apply to clause (v) in the same manner and for the 

12 same period as such clause (iii) applies to clause (i) 

13 of such subsection.’’. 

Æ 


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