```

[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 487 Introduced in House (IH)]

113th CONGRESS
  1st Session
                                H. R. 487

To provide for a Medicare primary care graduate medical education pilot 
   project in order to improve access to the primary care workforce.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                            February 4, 2013

  Mrs. McMorris Rodgers (for herself and Mr. Thompson of California) 
 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 provide for a Medicare primary care graduate medical education pilot 
   project in order to improve access to the primary care workforce.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Primary Care Workforce Access 
Improvement Act of 2013''.

SEC. 2. MEDICARE PRIMARY CARE GRADUATE MEDICAL EDUCATION PILOT PROJECT.

    (a) Establishment.--The Secretary of Health and Human Services (in 
this section referred to as the ``Secretary'') shall conduct a pilot 
project under the Medicare program under title XVIII of the Social 
Security Act, in accordance with the provisions of this section, to 
test models for providing payment under such title for direct graduate 
medical education and indirect medical education to medical education 
entities, which entities are not otherwise eligible to receive such 
payments under the Medicare program, for the costs of training primary 
care residents.
    (b) Duration.--The Secretary shall conduct the pilot project under 
this section over a 5-year period, which shall begin not later than 180 
days after the date of the enactment of this Act.
    (c) Models.--
            (1) Required models.--Under the pilot project, the 
        Secretary shall test two of each of the following models:
                    (A) A model in which the medical education entity 
                receiving funds under the pilot project is a community-
                based independent corporate entity collaborating with 
                two or more hospitals to operate one or more primary 
                care graduate medical residency training programs.
                    (B) A model in which--
                            (i) the medical education entity receiving 
                        funds under the pilot project is established by 
                        two or more hospitals to operate one or more 
                        primary care graduate medical residency 
                        training programs; and
                            (ii) such hospitals may be the sole 
                        corporate members of the entity but the 
                        governing board of the entity shall include at 
                        least one community representative.
                    (C) A model in which the medical education entity 
                receiving funds under the pilot project is a hospital 
                subsidiary or independent corporation that operates one 
                or more primary care graduate medical residency 
                training programs for a hospital with community 
                participation in the governance of the subsidiary or 
                corporation.
                    (D) A model in which--
                            (i) the medical education entity receiving 
                        funds under the pilot project is independent of 
                        any hospital but collaborates with a hospital 
                        in operating one or more primary care graduate 
                        medical residency training programs; and
                            (ii) the medical education entity may 
                        include a university or school of medicine.
            (2) Additional models.--Under the pilot project, the 
        Secretary may test models of medical education entities in 
        addition to those described in paragraph (1).
    (d) Prioritization.--Under the pilot project, the Secretary of 
Health and Human Services may give priority to testing models that 
demonstrate the capability of improving the quality, quantity, and 
distribution of primary care physicians, including the ability to 
enhance primary care delivery in rural and underserved areas.
    (e) Payments.--
            (1) Payments to medical education entities.--Under the 
        pilot project, the Secretary shall establish a process under 
        which payments are made to each medical education entity 
        participating under such project for direct graduate medical 
        education and indirect medical education costs with respect to 
        primary care residents enrolled under a primary care graduate 
        medical residency training program operated pursuant to a model 
        of such entity under subsection (c) instead of any payment or 
        adjustment that would otherwise be made to a participant 
        hospital (as defined in subsection (m)) of such entity for 
        indirect and direct graduate medical education costs under 
        subsections (d)(5)(B) and (h) of section 1886 of the Social 
        Security Act (42 U.S.C. 1395ww) during the period of 
        participation of such entity in such project.
            (2) Calculation of payments.--Payments to a medical 
        education entity under the pilot project, with respect to a 
        primary care graduate medical education residency program, for 
        a cost reporting period during which the entity is 
        participating in such pilot shall be, based on the most 
        recently available data with respect to a previous cost 
        reporting period, equal to the sum of the following:
                    (A) Direct gme.--The amount that, out of all of the 
                payment amounts (determined on a per resident basis) 
                received by hospitals under section 1886(h) of the 
                Social Security Act (42 U.S.C. 1395ww(h)) for such 
                previous cost reporting period, is equal to the 95th 
                percentile of such payment amounts.
                    (B) Indirect gme.--The amount that, out of all of 
                the additional payment amounts (determined on a per 
                resident basis) received by hospitals under section 
                1886(d)(5)(B) of the Social Security Act (42 U.S.C. 
                1395ww(d)(5)(B)) for such previous cost reporting 
                period, is equal to the 95th percentile of such payment 
                amounts.
            (3) Additional payments for programs serving underserved 
        areas.--Payments in addition to the payments described in 
        paragraph (2) may be made under the pilot project for primary 
        care graduate medical residency training programs that--
                    (A) operate in sites and areas that are underserved 
                by primary care physicians; or
                    (B) change their training sites to include those 
                areas.
            (4) Payments from medicare trust funds.--In providing for 
        such payments under this subsection to medical education 
        entities, the Secretary shall provide for an allocation of such 
        payments between part A and part B (and the Federal Hospital 
        Insurance Trust Fund under section 1817 of the Social Security 
        Act (42 U.S.C. 1395i) and the Federal Supplementary Medical 
        Insurance Trust Fund under section 1841 of such Act (42 U.S.C. 
        1395t)) in the same manner as the Secretary provides for an 
        allocation of payments under subsections (d)(5)(B) and (h), 
        respectively, of section 1886 of such Act (42 U.S.C. 1395ww).
    (f) Uses of Payments.--
            (1) In general.--A medical education entity receiving 
        payments under the pilot project shall use such payments for 
        the training of primary care residents, including training 
        activities in appropriate inpatient and outpatient settings in 
        primary care graduate medical residency training programs 
        accredited by the Accreditation Council for Graduate Medical 
        Education or the American Osteopathic Association and for all 
        relevant topics including patient care, care management, 
        working in teams, supervision, and quality improvement.
            (2) Limitations.--Payments shall only be made for training 
        primary care residents up to the initial board certification of 
        such residents, except that with respect to training in 
        geriatric medicine, payments may also be made for a fellowship 
        after initial board certification.
    (g) Expansion During Pilot Project.--A medical education entity 
receiving funds under the pilot project, with respect to a primary care 
graduate medical residency training program, shall be allowed to 
increase by up to 50 percent the number of full-time equivalent primary 
care residents enrolled in the such program (determined in accordance 
with the process under subsection (e)(1)) during the duration of the 
participation of such entity in such project.
    (h) Treatment After Project.--
            (1) In general.--Subject to paragraphs (2) and (3), after 
        the last day of the pilot project, which may be extended at the 
        discretion of the Secretary, any participant hospital of a 
        medical education entity under the pilot project, shall receive 
        payments under subsection (d)(5)(B) and (h) of section 1886 of 
        the Social Security Act (42 U.S.C. 1395ww) in the same manner 
        and to the same extent such hospital would receive such 
        payments without application of this Act and such payments 
        shall be calculated based on the number of full-time equivalent 
        residents enrolled in such program without regard to any 
        increase made pursuant to subsection (g).
            (2) Exception to ensure residents enrolled during pilot are 
        able to complete training.--Subject to paragraph (3), a medical 
        education entity receiving funds under the pilot project, with 
        respect to a primary care graduate medical residency training 
        program, shall continue to receive funding under this section 
        (even after the last day of the project), with respect to each 
        primary care resident who is enrolled under such program while 
        the entity is participating in such project, to the extent and 
        in such amounts necessary to allow for the full duration of 
        training, subject to subsection (f)(2), of such primary care 
        resident. Any such payments made pursuant to this subparagraph 
        shall be deemed to be a payment made under the pilot project.
            (3) Limitation.--In no case may the total duration of the 
        pilot project exceed seven years and in no case may payments be 
        made under this section to a medical education entity for a 
        period exceeding seven years.
    (i) Budget Neutrality.--For each year that the pilot project under 
this section is being conducted (and for any subsequent year to the 
extent subsection (h)(2) applies), the Secretary shall reduce payments 
under subsections (d)(5)(B) and (h) of section 1886 of the Social 
Security Act (42 U.S.C. 1395ww) by such amount as the Secretary 
determines to be necessary to ensure that carrying out the pilot 
project under this section during such year does not result in 
expenditures under title XVIII of the Social Security Act for such year 
that exceed the amount of such expenditures that would have been made 
for such year without application of this section.
    (j) Waiver Authority.--The Secretary may waive such requirements of 
titles XI and XVIII of the Social Security Act as may be necessary to 
carry out the purpose of the pilot project under this section.
    (k) Report to Congress.--The Secretary is authorized to enter into 
an agreement with the Institute of Medicine to conduct a study on the 
results of the pilot project. Such agreement shall provide for the 
Institute of Medicine to submit, not later than 1 year after the 
completion of the pilot project under this section (or, if sooner, 
January 1, 2021), to Congress a report on the results of such study, 
including--
            (1) a detailed analysis of the effects of the pilot, 
        including the quality, quantity, and distribution of primary 
        care physicians during and after the pilot project compared to 
        the quality, quantity, and distribution of such physicians 
        before the pilot project; and the governance, administration 
        and financial strength of the medical educational entities that 
        participated in the pilot project;
            (2) recommendations on the extent to which the pilot 
        project should be expanded to all primary care residents; and
            (3) recommendations for such legislation and administrative 
        actions as needed.
    (l) Expansion.--If the Secretary determines that any of the models 
tested under the pilot project under this section enhance the quality, 
quantity, and distribution of primary care physicians for Medicare 
beneficiaries, the Secretary may initiate comparable primary care 
training projects.
    (m) Definitions.--For purposes of this section:
            (1) Direct graduate medical education costs; indirect 
        graduate medical education costs.--The terms ``direct graduate 
        medical education costs'' and ``indirect graduate medical 
        education'' have the meanings given such terms for purposes of 
        subsections (h) and (d)(5)(B), respectively, of section 1886 of 
        the Social Security Act (42 U.S.C. 1395ww).
            (2) Medical education entity.--The term ``medical education 
        entity'' means a corporate, nonprofit, or academic entity that 
        has as its principal mission the education and training of 
        primary care residents.
            (3) Medicare beneficiary.--The term ``Medicare 
        beneficiary'' means an individual entitled to benefits under 
        part A of title XVIII of the Social Security Act or enrolled 
        under part B of such title.
            (4) Participant hospital.--The term ``participant 
        hospital'' means, with respect to a medical education entity, 
        any hospital that establishes, is collaborating with, a 
        component of, or otherwise associated with, such entity to 
        operate a primary care graduate medical residency training 
        program under a model described in subsection (c).
            (5) Primary care graduate medical residency training 
        program.--The term ``primary care graduate medical residency 
        training program'' means an approved medical residency training 
        program (as defined in section 1886(h)(5)(A) of the Social 
        Security Act (42 U.S.C. 1395ww(h)(5)(A))) for training primary 
        care residents.
            (6) Primary care resident.--The term ``primary care 
        resident'' means a resident enrolled in an approved medical 
        residency training program in family medicine, general internal 
        medicine, general pediatrics, or geriatric medicine.
                                 <all>
```