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107TH CONGRESS

1ST SESSION H. R. 1928

To amend title XVIII of the Social Security Act to provide for full payment

rates under Medicare to hospitals for costs of direct graduate medical

education of residents for residency training programs in specialties or

subspecialties which the Secretary of Health and Human Services designates as critical need specialty or subspecialty training programs.

IN THE HOUSE OF REPRESENTATIVES

MAY 21, 2001

Mr. STARK (for himself, Mr. RANGEL, Mr. MATSUI, Mr. MCDERMOTT, Mr.

LEWIS of Georgia, Mrs. THURMAN, Mr. WAXMAN, Mr. BONIOR, Mr.

FROST, Ms. KAPTUR, Mr. FILNER, Mr. HILLIARD, Mr. RUSH, Mr. BENTSEN, Mr. CUMMINGS, Ms. JACKSON-LEE of Texas, Mr. DAVIS of Illinois,

and Ms. BERKLEY) 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 provide

for full payment rates under Medicare to hospitals for

costs of direct graduate medical education of residents

for residency training programs in specialties or subspecialties which the Secretary of Health and Human

Services designates as critical need specialty or subspecialty training programs.
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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 ‘‘Medicare Critical Need

5 GME Protection Act of 2001’’.

6 SEC. 2. FULL FTE PAYMENT FOR RESIDENTS IN CRITICAL

7 NEED SPECIALTY OR SUBSPECIALTY TRAIN8 ING PROGRAMS.

9 (a) TREATMENT AS INITIAL RESIDENCY PERIOD.—

10 (1) IN GENERAL.—Section 1886(h)(5)(F) of

11 the Social Security Act (42 U.S.C.

12 1395ww(h)(5)(F)) is amended—

13 (A) in clause (i)—

14 (i) by striking ‘‘clause (ii)’’ and in15 serting ‘‘clauses (ii) and (iii)’’; and

16 (ii) by striking ‘‘and’’ at the end;

17 (B) in clause (ii), by striking the period at

18 the end and inserting ‘‘, and’’; and

19 (C) by inserting after clause (ii) the fol20 lowing new clause:

21 ‘‘(iii) subject to the requirement for

22 budget neutrality under paragraph (7), a

23 period of years during which an individual

24 is in a residency training program des25 ignated by the Secretary as a critical need
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1 specialty or subspecialty, as defined in sub2 paragraph (K)(i), shall be treated as part

3 of the initial residency period, but shall not

4 be counted against any limitation on the

5 initial residency period.’’.

6 (2) DETERMINATION OF CRITICAL NEED SPE7 CIALTY OR SUBSPECIALTY.—Section 1886(h)(5) of

8 such Act (42 U.S.C. 1395ww(h)(5)) is amended by

9 adding at the end the following new subparagraph:

10 ‘‘(K) CRITICAL NEED SPECIALITY.—

11 ‘‘(i) DEFINITION.—The term ‘critical

12 need specialty or subspecialty’ means a

13 specialty or subspecialty designated by the

14 Secretary under this subparagraph with a

15 current or imminent critical shortage of

16 physicians.

17 ‘‘(ii) CRITERIA.—For purposes of des18 ignating a critical need specialty or sub19 specialty under this subparagraph, the Sec20 retary shall prescribe criteria for deter21 mining critical shortages of physicians or

22 residents in approved medical residency

23 training programs. The Secretary shall

24 publish in the Federal Register the criteria

25 established under this clause and the form
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1 and manner by which data are submitted

2 for the Secretary’s review under this sub3 paragraph.

4 ‘‘(iii) PERIOD OF DESIGNATION.—

5 ‘‘(I) IN GENERAL.—A designa6 tion of a critical need specialty or sub7 specialty under this subparagraph

8 shall apply beginning with the first

9 residency training year in which it is

10 effective and shall continue until the

11 first residency training year for which

12 Secretary determines the specialty or

13 subspecialty does not meet the criteria

14 for designation as a critical need spe15 cialty or subspecialty.

16 ‘‘(II) REPORT.—If the Secretary

17 determines that a specialty or sub18 specialty no longer meets the criteria

19 for being a critical need specialty or

20 subspecialty, the Secretary shall sub21 mit a report to Congress describing

22 the reasons for discontinuing the des23 ignation.’’.
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1 (b) MAINTAINING BUDGET NEUTRALITY.—Section

2 1886(h) of such Act (42 U.S.C. 1395ww(h)) is amended

3 by adding at the end the following new paragraph:

4 ‘‘(7) BUDGET NEUTRALITY ADJUSTMENT FOR CRIT5 ICAL NEED SPECIALTY OR SUBSPECIALTY DESIGNA6 TION.—If the Secretary designates a critical need specialty

7 or subspecialty for a residency training year, the Secretary

8 shall make a proportional adjustment to payment amounts

9 under this subsection for such residency training year so

10 that the aggregate of the payments under this subsection

11 for the portions of such residency training year occurring

12 in any fiscal year shall equal the aggregate payments that

13 would have been made under this subsection for such por14 tions of the fiscal year if the Secretary had not designated

15 a critical need specialty or subspecialty.’’.

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

17 this section shall apply with respect to payments under

18 section 1886(h) of the Social Security Act (42 U.S.C.

19 1395ww(h)) made for periods in a residency training pro20 gram for residency training years beginning on or after

21 on or after July 1, 2002.

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