II 

116TH CONGRESS 

1ST SESSION S. 2116 

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 SENATE OF THE UNITED STATES 

JULY 15, 2019 

Mr. MENENDEZ (for himself and Mr. BOOKER) 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 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’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 


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

2 training programs are of critical importance in de3 veloping the physician workforce. 

4 (2) Current caps on GME training programs 

5 under Medicare have been in place since 1997. 

6 (3) Hospitals seeking to launch GME training 

7 programs face barriers in establishing physician 

8 training programs in community hospitals. 

9 SEC. 3. MEDICARE GME TREATMENT OF HOSPITALS ESTAB10 LISHING NEW MEDICAL RESIDENCY TRAIN11 ING PROGRAMS AFTER HOSTING MEDICAL 

12 RESIDENT ROTATORS FOR SHORT DURA13 TIONS. 

14 (a) REDETERMINATION OF APPROVED FTE RESI15 DENT AMOUNT.—Section 1886(h)(2)(F) of the Social Se16 curity Act (42 U.S.C. 1395ww(h)(2)(F)) is amended— 

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

18 and 

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

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

21 hospital that has not entered into a GME affili22 ation agreement (as defined by the Secretary 

23 for purposes of paragraph (4)(H)(ii)), the Sec24 retary shall not provide for the establishment of 

25 an FTE resident amount until such time as the 


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1 Secretary determines that the hospital has a 

2 medical residency training program that trains 

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

4 cost reporting period. 

5 ‘‘(iii) In the case of a hospital with an ap6 proved FTE resident amount— 

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

8 1.0 full-time-equivalent resident before Oc9 tober 1, 1997; 

10 ‘‘(II) based on the training of— 

11 ‘‘(aa) no more than 6.0 full-time12 equivalent residents in a medical resi13 dency training program in any cost 

14 reporting period during the period be15 tween October 1, 1996, and Sep16 tember 30, 1997; and 

17 ‘‘(bb) no more than 3.0 full-time18 equivalent residents on or after Octo19 ber 1, 1997; or 

20 ‘‘(III) based on the training of no full21 time-equivalent residents in a medical resi22 dency training program for any 20 con23 secutive cost reporting periods beginning 

24 on or after October 1, 1997, 


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1 the Secretary shall provide the hospital an op2 portunity to have a new FTE resident amount 

3 established when the hospital begins training at 

4 least 1.0 full-time equivalent resident (in the 

5 case of a hospital described in subclauses (I or 

6 III)) or more than 3.0 full-time-equivalent resi7 dents (in the case of a hospital described in 

8 subclause (II)) for cost reporting periods begin9 ning on or after the date of the enactment of 

10 this clause and in accordance with the method11 ology under the rules in effect as of October 1, 

12 2015.’’. 

13 (b) REDETERMINATION OF FTE RESIDENT LIMITA14 TION.—Section 1886(h)(4)(H)(i) of the Social Security 

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

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

17 and 

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

19 ‘‘(II) Under this clause the Secretary 

20 shall not determine an adjustment in the 

21 limitation applicable to a hospital under 

22 subparagraph (F) until the hospital trains 

23 more than 1.0 full-time equivalent resident 

24 in a new medical residency training pro25 gram in a cost reporting period. 


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

2 has a limitation under subparagraph (F) of 

3 less than 1.0 full-time-equivalent resident 

4 as of the date of the enactment of this sub5 clause based on training before October 1, 

6 1997, under this clause the Secretary shall 

7 provide the hospital an opportunity to have 

8 a new adjustment in such limitation deter9 mined when such hospital begins training 

10 at least 1.0 full-time equivalent resident in 

11 accordance with the methodology applica12 ble to hospitals under the rules in effect as 

13 of October 1, 2015, and applied for cost 

14 reporting periods beginning on or after the 

15 date of the enactment of this subclause. 

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

17 has not reported full-time-equivalent resi18 dents in 20 consecutive cost reporting peri19 ods subsequent to October 1, 1997, under 

20 this clause the Secretary shall provide the 

21 hospital an opportunity to have a new ad22 justment in such limitation determined 

23 when such hospital begins training at least 

24 1.0 full-time equivalent resident in accord25 ance with the methodology applicable to 


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1 hospitals under the rules in effect as of Oc2 tober 1, 2015, and applied for cost report3 ing periods beginning on or after the date 

4 of the enactment of this subclause. 

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

6 which an adjustment in the limitation ap7 plicable to a hospital under subparagraph 

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

9 than 3.0 full-time-equivalent residents in a 

10 medical residency training program in a 

11 cost reporting period beginning on or after 

12 October 1, 1997, and before the date of 

13 the enactment of this subclause, the Sec14 retary shall provide the hospital an oppor15 tunity to have a new adjustment in such 

16 limitation determined when the hospital be17 gins training more than 3.0 full-time18 equivalent residents in accordance with the 

19 methodology applicable to hospitals under 

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

21 and applied for cost reporting periods be22 ginning on or after the date of the enact23 ment of this subclause.’’. 

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

25 this section shall apply to payment under section 1886 of 


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1 the Social Security Act (42 U.S.C. 1395ww) for cost re2 porting periods beginning on or after the date of the en3 actment of this Act. 

Æ 


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