I 

115TH CONGRESS 

2D SESSION H. R. 6056 

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 

JUNE 8, 2018 

Mr. GOTTHEIMER (for himself, Mr. MACARTHUR, Mr. PASCRELL, Mr. NORCROSS, Mrs. WATSON COLEMAN, and Mr. LANCE) 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 ‘‘Advancing Medical 

5 Resident Training in Community Hospitals Act of 2018’’. 


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1 SEC. 2. MEDICARE GME TREATMENT OF HOSPITALS ESTAB2 LISHING NEW MEDICAL RESIDENCY TRAIN3 ING PROGRAMS AFTER HOSTING MEDICAL 

4 RESIDENT ROTATORS FOR SHORT DURA5 TIONS. 

6 (a) REDETERMINATION OF APPROVED FTE RESI7 DENT AMOUNT.—Section 1886(h)(2)(F) of the Social Se8 curity Act (42 U.S.C. 1395ww(h)(2)(F)) is amended— 

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

10 and 

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

12 ‘‘(ii) In applying this subparagraph to 

13 a hospital that has not entered into a 

14 GME affiliation agreement (as defined by 

15 the Secretary for purposes of paragraph 

16 (4)(H)(ii)), the Secretary shall not provide 

17 for the establishment of an FTE resident 

18 amount until such time as the Secretary 

19 determines that the hospital has a medical 

20 residency training program that trains 

21 more than 1.0 full-time-equivalent resident 

22 in a cost reporting period. 

23 ‘‘(iii) In the case of a hospital with an 

24 approved FTE resident amount— 


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1 ‘‘(I) based on the training of less 

2 than 1.0 full-time-equivalent resident 

3 before October 1, 1997, or 

4 ‘‘(II) based on the training of no 

5 more than 3.0 full-time-equivalent 

6 residents in a new medical residency 

7 training program in any cost report8 ing period beginning on or after Octo9 ber 1, 1997, and before the date of 

10 the enactment of this clause, or 

11 ‘‘(III) based on the training of no 

12 full-time-equivalent residents in a 

13 medical residency training program 

14 for any ten consecutive cost reporting 

15 periods beginning on or after October 

16 1, 1997, 

17 the Secretary shall provide the hospital an 

18 opportunity to have a new FTE resident 

19 amount established when the hospital be20 gins training at least 1.0 full-time equiva21 lent resident (in the case of a hospital de22 scribed in subclauses (I or III)) or more 

23 than 3.0 full-time-equivalent residents (in 

24 the case of a hospital described in sub25 clause (II)) for cost reporting periods beVerDate Sep 11 2014 00:19 Jun 12, 2018 Jkt 079200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H6056.IH H6056

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1 ginning on or after the date of the enact2 ment of this clause and in accordance with 

3 the methodology under the rules in effect 

4 as of October 1, 2015.’’. 

5 (b) REDETERMINATION OF FTE RESIDENT LIMITA6 TION.—Section 1886(h)(4)(H)(i) of the Social Security 

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

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

9 and 

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

11 ‘‘(II) Under this clause the Sec12 retary shall not determine an adjust13 ment in the limitation applicable to a 

14 hospital under subparagraph (F) until 

15 the hospital trains more than 1.0 full16 time equivalent resident in a new 

17 medical residency training program in 

18 a cost reporting period. 

19 ‘‘(III) In the case of a hospital 

20 that has a limitation under subpara21 graph (F) of less than 1.0 full-time22 equivalent resident as of the date of 

23 the enactment of this subclause based 

24 on training before October 1, 1997, 

25 under this clause the Secretary shall 


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1 provide the hospital an opportunity to 

2 have a new adjustment in such limita3 tion determined when such hospital 

4 begins training at least 1.0 full-time 

5 equivalent resident in accordance with 

6 the methodology applicable to hos7 pitals under the rules in effect as of 

8 October 1, 2015, and applied for cost 

9 reporting periods beginning on or 

10 after the date of the enactment of this 

11 subclause. 

12 ‘‘(IV) In the case of a hospital 

13 that has not reported full-time-equiva14 lent residents in ten consecutive cost 

15 reporting periods subsequent to Octo16 ber 1, 1997, under this clause the 

17 Secretary shall provide the hospital an 

18 opportunity to have a new adjustment 

19 in such limitation determined when 

20 such hospital begins training at least 

21 1.0 full-time equivalent resident in ac22 cordance with the methodology appli23 cable to hospitals under the rules in 

24 effect as of October 1, 2015, and ap25 plied for cost reporting periods beginVerDate Sep 11 2014 00:19 Jun 12, 2018 Jkt 079200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H6056.IH H6056

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1 ning on or after the date of the enact2 ment of this subclause. 

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

4 which an adjustment in the limitation 

5 applicable to a hospital under sub6 paragraph (F) is based on the train7 ing of no more than 3.0 full-time8 equivalent residents in a new medical 

9 residency training program in a cost 

10 reporting period beginning on or after 

11 October 1, 1997, and before the date 

12 of the enactment of this subclause, 

13 the Secretary shall provide the hos14 pital an opportunity to have a new ad15 justment in such limitation deter16 mined when the hospital begins train17 ing more than 3.0 full-time-equivalent 

18 residents in accordance with the meth19 odology applicable to hospitals under 

20 the rules in effect as of October 1, 

21 2015, and applied for cost reporting 

22 periods beginning on or after the date 

23 of the enactment 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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