I

104TH CONGRESS

2D SESSION H. R. 4069

To amend the Social Security Act to establish the Teaching Hospital and

Graduate Medical Education Trust Fund, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

SEPTEMBER 12, 1996

Mr. BENTSEN 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 the Social Security Act to establish the Teaching

Hospital and Graduate Medical Education Trust Fund,

and for other purposes.

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 ‘‘Graduate Medical Edu5 cation Trust Fund Act of 1996’’.
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1 SEC. 2. TEACHING HOSPITAL AND GRADUATE MEDICAL

2 EDUCATION TRUST FUND.

3 (a) IN GENERAL.—The Social Security Act (42

4 U.S.C. 300 et seq.) is amended by adding at the end the

5 following title:

6 ‘‘TITLE XXI—TEACHING HOSPITAL AND

7 GRADUATE MEDICAL EDUCATION TRUST FUND

8 ‘‘PART A—ESTABLISHMENT OF FUND

9 ‘‘SEC. 2101. ESTABLISHMENT OF FUND.

10 ‘‘(a) IN GENERAL.—There is established in the

11 Treasury of the United States a fund to be known as the

12 Teaching Hospital and Graduate Medical Education Trust

13 Fund (in this title referred to as the ‘Fund’), consisting

14 of amounts transferred to the Fund under subsection (c),

15 amounts appropriated to the Fund pursuant to sub16 sections (d) and (e)(3), and such gifts and bequests as

17 may be deposited in the Fund pursuant to subsection (f).

18 Amounts in the Fund are available until expended.

19 ‘‘(b) EXPENDITURES FROM FUND.—Amounts in the

20 Fund are available to the Secretary for making payments

21 under section 2111.

22 ‘‘(c) TRANSFERS TO FUND.—

23 ‘‘(1) IN GENERAL.—From the Federal Hospital

24 Insurance Trust Fund and the Federal Supple25 mentary Medical Insurance Trust Fund, the Sec26 retary shall, for fiscal year 1998 and each subse-
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1 quent fiscal year, transfer to the Fund an amount

2 determined by the Secretary for the fiscal year in3 volved in accordance with paragraph (2).

4 ‘‘(2) DETERMINATION OF AMOUNTS.—For pur5 poses of paragraph (1), the amount determined

6 under this paragraph for a fiscal year is an estimate

7 by the Secretary of an amount equal to 75 percent

8 of the difference between—

9 ‘‘(A) the nationwide total of the amounts

10 that would have been paid under section 1876

11 during the year but for the operation of sub12 section (a)(1)(C)(ii)(II) of such section; and

13 ‘‘(B) the nationwide total of the amounts

14 paid under such section during the year.

15 ‘‘(3) ALLOCATION BETWEEN MEDICARE TRUST

16 FUNDS.—In providing for a transfer under para17 graph (1) for a fiscal year, the Secretary shall pro18 vide for an allocation of the amounts involved be19 tween part A and part B of title XVIII (and the

20 trust funds established under the respective parts)

21 as reasonably reflects the proportion of payments for

22 the indirect costs of medical education and direct

23 graduate medical education costs of hospitals associ24 ated with the provision of services under each re25 spective part.
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1 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There

2 are authorized to be appropriated to the Fund such sums

3 as may be necessary for each of the fiscal years 1997

4 through 2003.

5 ‘‘(e) INVESTMENT.—

6 ‘‘(1) IN GENERAL.—The Secretary of the

7 Treasury shall invest such amounts of the Fund as

8 such Secretary determines are not required to meet

9 current withdrawals from the Fund. Such invest10 ments may be made only in interest-bearing obliga11 tions of the United States. For such purpose, such

12 obligations may be acquired on original issue at the

13 issue price, or by purchase of outstanding obliga14 tions at the market price.

15 ‘‘(2) SALE OF OBLIGATIONS.—Any obligation

16 acquired by the Fund may be sold by the Secretary

17 of the Treasury at the market price.

18 ‘‘(3) AVAILABILITY OF INCOME.—Any interest

19 derived from obligations acquired by the Fund, and

20 proceeds from any sale or redemption of such obliga21 tions, are hereby appropriated to the Fund.

22 ‘‘(f) ACCEPTANCE OF GIFTS AND BEQUESTS.—The

23 Fund may accept on behalf of the United States money

24 gifts and bequests made unconditionally to the Fund for
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1 the benefit of the Fund or any activity financed through

2 the Fund.

3 ‘‘PART B—PAYMENTS TO TEACHING HOSPITALS

4 ‘‘SEC. 2111. FORMULA PAYMENTS TO TEACHING HOS5 PITALS.

6 ‘‘(a) IN GENERAL.—In the case of each teaching hos7 pital that in accordance with subsection (b) submits to the

8 Secretary a payment document for fiscal year 1997 or any

9 subsequent fiscal year, the Secretary shall make payments

10 for the year to the teaching hospital for the direct and

11 indirect costs of operating approved medical residency

12 training programs. Such payments shall be made from the

13 Fund, and shall be made in accordance with a formula

14 established by the Secretary.

15 ‘‘(b) PAYMENT DOCUMENT.—For purposes of sub16 section (a), a payment document is a document containing

17 such information as may be necessary for the Secretary

18 to make payments under such subsection to a teaching

19 hospital for a fiscal year. The document is submitted in

20 accordance with this subsection if the document is submit21 ted not later than the date specified by the Secretary, and

22 the document is in such form and is made in such manner

23 as the Secretary may require. The Secretary may require

24 that information under this subsection be submitted to the

25 Secretary in periodic reports.’’.
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1 (b) ADJUSTMENTS IN MEDICARE PAYMENTS.—

2 (1) REMOVAL OF MEDICAL EDUCATION AND

3 DISPROPORTIONATE SHARE HOSPITAL PAYMENTS

4 FROM CALCULATION OF ADJUSTED AVERAGE PER

5 CAPITA COST.—Section 1876(a)(1)(C) of such Act

6 (42 U.S.C. 1395mm(a)(1)(C)) is amended—

7 (A) by striking ‘‘(C) The annual’’ and in8 serting ‘‘(C)(i) Subject to clause (ii), the an9 nual’’, and

10 (B) by adding at the end the following new

11 clause:

12 ‘‘(ii) In determining the average annual per capita

13 rate of payment for a year (beginning with 1998), such

14 rate shall be determined as though the Secretary had ex15 cluded from such rate any amounts which the Secretary

16 estimated would have been payable under this title during

17 the year for—

18 ‘‘(I) payment adjustments under section

19 1886(d)(5)(F) for hospitals serving a disproportion20 ate share of low-income patients; and

21 ‘‘(II) the indirect costs of medical education

22 under section 1886(d)(5)(B) or for direct graduate

23 medical education costs under section 1886(h).’’.

24 (2) PAYMENTS TO HOSPITALS OF AMOUNTS AT25 TRIBUTABLE TO DSH.—Section 1886 of such Act
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1 (42 U.S.C. 1395ww) is amended by adding at the

2 end the following new subsection:

3 ‘‘(j)(1) In addition to amounts paid under subsection

4 (d)(5)(F), the Secretary is authorized to pay hospitals

5 which are eligible for such payments for a fiscal year (be6 ginning with fiscal year 1998) supplemental amounts that

7 do not exceed the limit provided for in paragraph (2).

8 ‘‘(2) The sum of the aggregate amounts paid pursu9 ant to paragraph (1) for a fiscal year shall not exceed the

10 Secretary’s estimate of 75 percent of the amount of reduc11 tions in payments under section 1876 that are attributable

12 to the operation of subsection (a)(1)(C)(ii)(I) of such sec13 tion during such fiscal year.’’.

14 SEC. 3. NATIONAL ADVISORY COUNCIL ON POSTGRADUATE

15 MEDICAL EDUCATION.

16 (a) IN GENERAL.—There is established within the

17 Department of Health and Human Services an advisory

18 council to be known as the National Advisory Council on

19 Postgraduate Medical Education (in this section referred

20 to as the ‘‘Council’’).

21 (b) DUTIES.—The Council shall provide advice to the

22 Secretary on appropriate policies for making payments for

23 the support of postgraduate medical education in order to

24 assure an adequate supply of physicians trained in various
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1 specialities, consistent with the health care needs of the

2 United States.

3 (c) COMPOSITION.—

4 (1) IN GENERAL.—The Secretary shall appoint

5 to the Council 15 individuals who are not officers or

6 employees of the United States. Such individuals

7 shall include not less than 1 individual from each of

8 the following categories of individuals or entities:

9 (A) Organizations representing consumers

10 of health care services.

11 (B) Physicians who are faculty members of

12 medical schools, or who supervise approved phy13 sician training programs.

14 (C) Physicians in private practice who are

15 not physicians described in subparagraph (B).

16 (D) Practitioners in public health.

17 (E) Advanced-practice nurses.

18 (F) Other health professionals who are not

19 physicians.

20 (G) Medical schools.

21 (I) Teaching hospitals.

22 (J) The Accreditation Council on Graduate

23 Medical Education.

24 (K) The American Board of Medical Speci25 alities.
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1 (L) The Council on Postdoctoral Training

2 of the American Osteopathic Association.

3 (M) The Council on Podiatric Medical

4 Education of the American Podiatric Medical

5 Association.

6 (2) REQUIREMENTS REGARDING REPRESENTA7 TIVE MEMBERSHIP.—To the greatest extent feasible,

8 the membership of the Council shall represent the

9 various geographic regions of the United States,

10 shall reflect the racial, ethnic, and gender composi11 tion of the population of the United States, and

12 shall be broadly representative of medical schools

13 and teaching hospitals in the United States.

14 (3) EX OFFICIO MEMBERS; OTHER FEDERAL

15 OFFICERS OR EMPLOYEES.—The membership of the

16 Council shall include individuals designated by the

17 Secretary to serve as members of the Council from

18 among Federal officers or employees who are ap19 pointed by the President, or by the Secretary (or by

20 other Federal officers who are appointed by the

21 President with the advice and consent of the Sen22 ate). Individuals designated under the preceding sen23 tence shall include each of the following officials (or

24 a designee of the official):
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1 (A) The Secretary of Health and Human

2 Services.

3 (B) The Secretary of Veterans Affairs.

4 (C) The Secretary of Defense.

5 (d) CHAIR.—The Secretary shall, from among mem6 bers of the Council appointed under subsection (c)(1), des7 ignate an individual to serve as the chair of the Council.

8 (e) TERMINATION.—The Council terminates Decem9 ber 31, 2000.

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