II 

113TH CONGRESS 

2D SESSION S. 2728 

To amend title XVIII of the Social Security Act to provide communitybased medical education payments to primary care teaching centers, 

to provide for a Medicare indirect medical education performance adjustment, and to increase Medicare graduate medical education transparency, 

and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JULY 31, 2014 

Mrs. MURRAY 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 provide 

community-based medical education payments to primary 

care teaching centers, to provide for a Medicare indirect 

medical education performance adjustment, and to increase Medicare graduate medical education transparency, 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 ‘‘Community-Based 

5 Medical Education Act of 2014’’. 


TKELLEY on DSK3SPTVN1PROD with BILLS
2 

•S 2728 IS

1 SEC. 2. TEACHING HEALTH CENTER EXTENSION. 

2 (a) THC PROGRAM.—Section 340H of the Public 

3 Health Service Act (42 U.S.C. 256h) is amended— 

4 (1) in subsection (g)— 

5 (A) by striking ‘‘not to exceed 

6 $230,000,000, for the period of fiscal years 

7 2011 through 2015.’’ and inserting ‘‘not to ex8 ceed—’’; and 

9 (B) by adding at the end the following: 

10 ‘‘(1) $230,000,000, for the period of fiscal 

11 years 2011 through 2015; and 

12 ‘‘(2) $420,000,000, for the period of fiscal 

13 years 2016 through 2019.’’; and 

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

15 ‘‘(k) EVALUATION OF PROGRAM; PARTICIPATION IN

16 PRIMARY CARE TEACHING PROGRAM.—The Secretary 

17 shall— 

18 ‘‘(1) not later than December 31, 2017, con19 duct a comprehensive evaluation of the program 

20 under this section; and 

21 ‘‘(2) establish a process by which qualified 

22 teaching health centers that have received payments 

23 under this section prior to the date on which the pri24 mary care teaching centers program is established 

25 under section 1899B of the Social Security Act may 


TKELLEY on DSK3SPTVN1PROD with BILLS
3 

•S 2728 IS

1 become eligible to participate in such primary care 

2 teaching program.’’. 

3 (b) TEACHING HEALTH CENTERS DEVELOPMENT

4 GRANTS.—Section 749A of the Public Health Service Act 

5 (42 U.S.C. 293l–1) is amended— 

6 (1) in subsection (a), by inserting ‘‘, based on 

7 demonstrated financial need,’’ after ‘‘centers’’; 

8 (2) in subsection (b), by striking ‘‘$500,000’’ 

9 and inserting ‘‘$250,000’’; and 

10 (3) in subsection (g), by striking ‘‘fiscal year 

11 2010, $50,000,000 for fiscal year 2011, 

12 $50,000,000 for fiscal year 2012’’ and inserting 

13 ‘‘each of fiscal years 2016, 2017, and 2018’’. 

14 SEC. 3. COMMUNITY-BASED MEDICAL EDUCATION PAY15 MENTS. 

16 Title XVIII of the Social Security Act (42 U.S.C. 

17 1395 et seq.) is amended by adding at the end the fol18 lowing new section: 

19 ‘‘COMMUNITY-BASED MEDICAL EDUCATION PAYMENTS

20 ‘‘SEC. 1899B. (a) IN GENERAL.—The Secretary shall 

21 establish a program under which the Secretary makes pay22 ments to primary care teaching centers (as defined in sub23 section (c)) under this section. 

24 ‘‘(b) IMPLEMENTATION.—The Secretary shall estab25 lish the program under this section not later than January 

26 1, 2019. 


TKELLEY on DSK3SPTVN1PROD with BILLS
4 

•S 2728 IS

1 ‘‘(c) DEFINITIONS.— 

2 ‘‘(1) DEFINITION OF PRIMARY CARE TEACHING

3 CENTER.—In this section, the term ‘primary care 

4 teaching center’ means an entity described in para5 graph (2) that— 

6 ‘‘(A) is accredited by the Accreditation 

7 Council on Graduate Medical Education, the 

8 American Osteopathic Association, or the Com9 mission on Dental Accreditation; and 

10 ‘‘(B) operates a community-based primary 

11 care residency program (as defined in para12 graph (5)) in a rural or underserved area. 

13 ‘‘(2) ENTITY DESCRIBED.—The following enti14 ties are described in this paragraph: 

15 ‘‘(A) An entity that received payments 

16 under section 340H of the Public Health Serv17 ice Act for a community based, ambulatory pa18 tient care center which operates a primary care 

19 residency program or a related consortia recog20 nized by the Health Resources and Services Ad21 ministration. 

22 ‘‘(B) A community-based, independent cor23 porate entity collaborating with one or more 

24 hospitals in operating one or more primary care 

25 residency programs. 


TKELLEY on DSK3SPTVN1PROD with BILLS
5 

•S 2728 IS

1 ‘‘(C) A medical education entity estab2 lished by one or more hospitals to develop and 

3 operate one or more primary care residency 

4 programs. The hospital or hospitals may be the 

5 sole corporate members of the entity, but the 

6 governing board of the entity shall include rep7 resentatives of the community. 

8 ‘‘(D) A medical education entity that is 

9 independent of any hospital but collaborates 

10 with a hospital in operating one or more med11 ical residency training programs. The medical 

12 education entity may include a university or a 

13 school of medicine. 

14 ‘‘(E) A subsidiary of a hospital or inde15 pendent corporation operating one or more pri16 mary care residency programs for the hospital 

17 with community participation in the governance 

18 of the organization. 

19 ‘‘(F) A rural training track program (as 

20 defined in paragraph (6)). 

21 ‘‘(3) INCLUSION OF CERTAIN ENTITIES.—The 

22 term ‘primary care teaching center’ includes the fol23 lowing: 

24 ‘‘(A) A Federally qualified health center 

25 (as defined in section 1905(l)(2)(B)). 


TKELLEY on DSK3SPTVN1PROD with BILLS
6 

•S 2728 IS

1 ‘‘(B) A community mental health center 

2 (as defined in section 1861(ff)(3)(B)). 

3 ‘‘(C) A rural health clinic, as defined in 

4 section 1861(aa). 

5 ‘‘(D) A health center operated by the In6 dian Health Service, an Indian tribe or tribal 

7 organization, or an urban Indian organization 

8 (as defined in section 4 of the Indian Health 

9 Care Improvement Act). 

10 ‘‘(E) An entity receiving funds under title 

11 X of the Public Health Service Act. 

12 ‘‘(F) A critical access hospital. 

13 ‘‘(G) An entity that collaborates to form a 

14 consortium that operates an accredited primary 

15 care residency program, so long as the consor16 tium is accredited in the primary care specialty 

17 and is listed as the institutional sponsor by the 

18 relevant accrediting body. Within the consor19 tium, a community-based ambulatory care cen20 ter shall play an integral role in the academic, 

21 financial, and administrative operations of the 

22 primary care residency program. 

23 ‘‘(4) DEFINITION OF PRIMARY CARE.—In this 

24 section, the term ‘primary care’ means family medi25 cine, internal medicine, pediatrics, internal medicineVerDate Mar 15 2010 22:45 Aug 07, 2014 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S2728.IS S2728

TKELLEY on DSK3SPTVN1PROD with BILLS
7 

•S 2728 IS

1 pediatrics, obstetrics and gynecology, psychiatry, 

2 general dentistry, pediatric dentistry, or geriatrics. 

3 ‘‘(5) DEFINITION OF PRIMARY CARE RESIDENCY

4 PROGRAM.—In this section, the term ‘primary care 

5 residency program’ means an approved medical resi6 dency training program (as defined in section 

7 1886(h)(5)(A)) in primary care. 

8 ‘‘(6) DEFINITION OF RURAL TRAINING TRACK

9 PROGRAM.—In this section, the term ‘rural training 

10 track program’ means an alternative training track 

11 integrated with a larger more urban or community 

12 hospital program and separately accredited as such, 

13 with a rural location, a rural mission, or a major 

14 rural service area, in which the residents spend ap15 proximately two of three years in a place of practice 

16 separate and more rural or rurally focused than the 

17 larger program. 

18 ‘‘(d) LIMITATIONS ON NUMBER OF RESIDENT

19 TRAINING POSITIONS.— 

20 ‘‘(1) LIMITATION ON TOTAL NUMBER UNDER

21 PROGRAM.—Subject to paragraph (3), the Secretary 

22 shall make payments under this section for not more 

23 than 1,500 new full-time equivalent resident training 

24 positions to be distributed to primary care teaching 


TKELLEY on DSK3SPTVN1PROD with BILLS
8 

•S 2728 IS

1 centers at a rate of not more than 300 per year 

2 until expended. 

3 ‘‘(2) LIMITATION ON TOTAL NUMBER FOR EACH

4 PRIMARY CARE TEACHING CENTER.—Subject to 

5 paragraph (3), no single primary care teaching cen6 ter shall receive a total of more than 50 of the posi7 tions distributed under the program, which must be 

8 in primary care specialties. 

9 ‘‘(3) EXCEPTION FOR EXISTING RESIDENTS OF

10 TEACHING HEALTH CENTERS.—The limitation under 

11 each of paragraphs (1) and (2) shall not apply with 

12 respect to a resident training position of a teaching 

13 health center that received payments under section 

14 340H of the Public Health Service Act if the resi15 dent training position was in a medical residency 

16 training program operated by the teaching health 

17 center prior to the participation of the teaching 

18 health center as a primary care teaching center 

19 under this section. The Secretary shall make pay20 ments for a resident in a training position described 

21 in the preceding center under this section in accord22 ance with subsection (f). 

23 ‘‘(e) PREFERENCE FOR TEACHING HEALTH CEN24 TERS.—The Secretary shall give preference to teaching 

25 health centers that received payments under section 340H 


TKELLEY on DSK3SPTVN1PROD with BILLS
9 

•S 2728 IS

1 of the Public Health Service Act that are seeking to par2 ticipate as a primary care teaching center under this sec3 tion. 

4 ‘‘(f) PAYMENT OF ANNUAL PER RESIDENT PAYMENT

5 AMOUNT.— 

6 ‘‘(1) METHODOLOGY.—Subject to paragraph 

7 (2) and subsection (i), for each year of the program, 

8 the Secretary shall develop a methodology to deter9 mine the per resident payment amount for each full10 time equivalent resident of a primary care teaching 

11 center under this section. 

12 ‘‘(2) MINIMUM PAYMENT AMOUNT.—Subject to 

13 subsection (i), the per resident payment amount for 

14 each full-time equivalent resident of a primary care 

15 teaching center under this section for a year shall be 

16 not less than— 

17 ‘‘(A) for 2014, $150,000; and 

18 ‘‘(B) for each subsequent year, the amount 

19 determined under this paragraph for the pre20 ceding year increased by the percentage in21 crease in the consumer price index for all urban 

22 consumers (United States city average) for the 

23 12-month period ending with June of the pre24 ceding year. 


TKELLEY on DSK3SPTVN1PROD with BILLS
10 

•S 2728 IS

1 ‘‘(3) DIRECT PAYMENT.—Any payment under 

2 this section with respect to a full-time equivalent 

3 resident of a primary care teaching center shall be 

4 made directly to the primary care teaching center. 

5 ‘‘(g) NO EFFECT ON OTHER PAYMENTS OR LIMITA6 TION ON NUMBER OF RESIDENTS UNDER SECTION

7 1886.—Nothing in this section shall effect payments 

8 under section 1886(d)(5)(B) or section 1886(h) or the ap9 plication of the limitation on the number of residents 

10 under section 1886(h)(4)(F). 

11 ‘‘(h) REQUIREMENTS FOR ENTITIES RECEIVING

12 MEDICARE GRADUATE MEDICAL EDUCATION PAY13 MENTS.—In the case where a primary care residency pro14 gram, including a rural training track program, funded 

15 by a hospital through payments under subsections 

16 (d)(5)(B) and (h) of section 1886 becomes a primary care 

17 teaching center under this section, the hospital shall en18 sure, during the 10-year period beginning on the date of 

19 the transition, that the total number of full-time equiva20 lent residents of the hospital in primary care does not de21 crease. The transition described in the preceding sentence 

22 shall begin on the date when the primary care teaching 

23 center receives its first payment under this section. 

24 ‘‘(i) PERFORMANCE ADJUSTMENTS.— 


TKELLEY on DSK3SPTVN1PROD with BILLS
11 

•S 2728 IS

1 ‘‘(1) IN GENERAL.—Subject to the succeeding 

2 provisions of this subsection, the Secretary shall es3 tablish and implement procedures under which the 

4 amount of payments that a primary care teaching 

5 center would otherwise receive under this section for 

6 a year is adjusted based on the reporting of meas7 ures and the performance of the primary care teach8 ing center on measures of population health prior9 ities specified by the Secretary. 

10 ‘‘(2) ADJUSTMENTS TO BEGIN IN 2021.—The 

11 adjustments shall apply to payments— 

12 ‘‘(A) with respect to the adjustments for 

13 reporting under paragraph (7)(A), made for 

14 2021; and 

15 ‘‘(B) with respect to the adjustments for 

16 performance under paragraph (7)(B), made for 

17 2022 and subsequent years. 

18 ‘‘(3) MEASURES.—The measures of population 

19 health priorities specified by the Secretary under 

20 this subsection shall be the measures specified by 

21 the Secretary under section 1886(t). 

22 ‘‘(4) PERFORMANCE STANDARDS.—The Sec23 retary shall establish performance standards with re24 spect to measures specified by the Secretary under 


TKELLEY on DSK3SPTVN1PROD with BILLS
12 

•S 2728 IS

1 this subsection for a performance period for a year 

2 (as established under paragraph (5)). 

3 ‘‘(5) PERFORMANCE PERIOD.—The Secretary 

4 shall establish the performance period for a year. 

5 Such performance period shall begin and end prior 

6 to the beginning of such year. 

7 ‘‘(6) REPORTING OF MEASURES.—The proce8 dures established and implemented under paragraph 

9 (1) shall include a process under which primary care 

10 teaching centers shall submit data on the measures 

11 specified by the Secretary under this subsection to 

12 the Secretary in a form and manner, and at a time, 

13 specified by the Secretary for purposes of this sub14 section. 

15 ‘‘(7) ADJUSTMENTS.— 

16 ‘‘(A) REPORTING FOR 2021.—For 2021, in 

17 the case of a primary care teaching center that 

18 does not submit, to the Secretary in accordance 

19 with this subsection, data required to be sub20 mitted under paragraph (6) for a period (deter21 mined appropriate by the Secretary) for such 

22 year, the total amount that the primary care 

23 teaching center would otherwise receive under 

24 this section for such year shall be reduced by 1 

25 percent. 


TKELLEY on DSK3SPTVN1PROD with BILLS
13 

•S 2728 IS

1 ‘‘(B) PERFORMANCE FOR 2022 AND SUBSE2 QUENT YEARS.— 

3 ‘‘(i) IN GENERAL.—Subject to clause 

4 (ii), based on the performance of each pri5 mary care teaching center with respect to 

6 compliance with the measures for a per7 formance period for a year (beginning with 

8 2022), the Secretary shall determine the 

9 amount of any adjustment under this sub10 paragraph to payments to the primary care 

11 teaching center under this section for such 

12 year. Such adjustment may not exceed an 

13 amount equal to 1 percent of the total 

14 amount that the primary care teaching 

15 center would otherwise receive under this 

16 section for such year. 

17 ‘‘(ii) BUDGET NEUTRAL.—In making 

18 adjustments under this subparagraph, the 

19 Secretary shall ensure that the total 

20 amount of payments made to all primary 

21 care teaching centers under this section for 

22 a year is equal to the total amount of pay23 ments that would have been made to such 

24 centers under this section for such year if 

25 this subsection had not been enacted. 


TKELLEY on DSK3SPTVN1PROD with BILLS
14 

•S 2728 IS

1 ‘‘(8) NO EFFECT IN SUBSEQUENT YEARS.—Any 

2 adjustment under subparagraph (A) or (B) of para3 graph (7) shall apply only with respect to the year 

4 involved, and the Secretary shall not take into ac5 count any such adjustment in making payments to 

6 a primary care teaching center under this section in 

7 a subsequent year. 

8 ‘‘(j) EVALUATION AND REPORT.—Not later than 

9 January 1, 2021, and every five years thereafter, the Sec10 retary shall submit to Congress a report on the implemen11 tation of the program under this section, including— 

12 ‘‘(1) the measure development procedures under 

13 subsection (i), including any barriers to measure de14 velopment; 

15 ‘‘(2) the compliance with reporting on the per16 formance measures under that subsection, including 

17 any barriers to such compliance; and 

18 ‘‘(3) recommendations to address any barriers 

19 described in subparagraph (A) or (B). 

20 ‘‘(k) FUNDING.—For purposes of carrying out this 

21 section, the Secretary shall provide for the transfer, from 

22 the Federal Hospital Insurance Trust Fund under section 

23 1817 and the Federal Supplementary Medical Insurance 

24 Trust Fund under section 1841 (in such proportion as the 

25 Secretary determines appropriate), of such sums as are 


TKELLEY on DSK3SPTVN1PROD with BILLS
15 

•S 2728 IS

1 necessary to the Centers for Medicare & Medicaid Services 

2 Program Management Account for fiscal year 2019 and 

3 each succeeding fiscal year. Amounts transferred under 

4 the preceding sentence shall remain available until ex5 pended.’’. 

6 SEC. 4. MEDICARE INDIRECT MEDICAL EDUCATION PER7 FORMANCE ADJUSTMENT. 

8 Section 1886 of the Social Security Act (42 U.S.C. 

9 1395ww) is amended— 

10 (1) in subsection (d)(5)(B), in the matter pre11 ceding clause (i), by inserting ‘‘subject to subsection 

12 (t) and’’ before ‘‘except as follows’’; and 

13 (2) by adding at the end the following new sub14 section: 

15 ‘‘(t) INDIRECT MEDICAL EDUCATION PERFORMANCE

16 ADJUSTMENTS.— 

17 ‘‘(1) IN GENERAL.—Subject to the succeeding 

18 provisions of this subsection, the Secretary shall es19 tablish and implement procedures under which the 

20 amount of payments that a hospital (as defined in 

21 paragraph (11)) would otherwise receive for indirect 

22 medical education costs under subsection (d)(5)(B) 

23 for discharges occurring during a fiscal year is ad24 justed based on the reporting of measures and the 


TKELLEY on DSK3SPTVN1PROD with BILLS
16 

•S 2728 IS

1 performance of the hospital on measures of popu2 lation health priorities specified by the Secretary. 

3 ‘‘(2) ADJUSTMENTS TO BEGIN IN FISCAL YEAR

4 2018.—The adjustments shall apply to payments for 

5 discharges occurring— 

6 ‘‘(A) with respect to the adjustments for 

7 reporting under paragraph (8)(A), during fiscal 

8 year 2018; and 

9 ‘‘(B) with respect to the adjustments for 

10 performance under paragraph (8)(B), on or 

11 after October 1, 2018. 

12 ‘‘(3) MEASURES.—The measures of population 

13 health priorities specified by the Secretary under 

14 this subsection shall include measures relating to— 

15 ‘‘(A) the extent of training provided in— 

16 ‘‘(i) shortage specialties; 

17 ‘‘(ii) a variety of settings and systems; 

18 ‘‘(iii) the coordination of patient care 

19 across settings; 

20 ‘‘(iv) interprofessional and multidisci21 plinary care teams; 

22 ‘‘(v) methods for identifying system 

23 errors and implementing system solutions; 

24 and 


TKELLEY on DSK3SPTVN1PROD with BILLS
17 

•S 2728 IS

1 ‘‘(vi) the use of health information 

2 technology; and 

3 ‘‘(B) the number of graduates practicing in 

4 shortage specialties 5 years after graduation, 

5 including in shortage specialties in health pro6 fessional shortage areas. 

7 ‘‘(4) MEASURE DEVELOPMENT PROCESS.— 

8 ‘‘(A) IN GENERAL.—The measures of pa9 tient care specified by the Secretary under this 

10 subsection— 

11 ‘‘(i) shall— 

12 ‘‘(I) be measures that have been 

13 adopted or endorsed by an accrediting 

14 organization (such as the Accredita15 tion Council for Graduate Medical 

16 Education or American Osteopathic 

17 Association); and 

18 ‘‘(II) be measures that the Sec19 retary identifies as having used a con20 sensus-based process for developing 

21 such measures; and 

22 ‘‘(ii) may include measures that have 

23 been submitted by teaching hospitals and 

24 medical schools (allopathic and osteo25 pathic). 


TKELLEY on DSK3SPTVN1PROD with BILLS
18 

•S 2728 IS

1 ‘‘(B) PROPOSED SET OF INITIAL MEAS2 URES.—Not later than July 1, 2015, the Sec3 retary shall publish in the Federal Register a 

4 proposed initial set of measures for use under 

5 this subsection. The Secretary shall provide for 

6 a period of public comment on such measures. 

7 ‘‘(C) FINAL SET OF INITIAL MEASURES.— 

8 Not later than January 1, 2016, the Secretary 

9 shall publish in the Federal Register the set of 

10 initial measures to be specified by the Secretary 

11 for use under this subsection. 

12 ‘‘(D) UPDATE OF MEASURES.—The Sec13 retary may, through notice and comment rule14 making, periodically update the measures speci15 fied under this subsection pursuant to the re16 quirements under subparagraph (A). 

17 ‘‘(5) PERFORMANCE STANDARDS.—The Sec18 retary shall establish performance standards with re19 spect to measures specified by the Secretary under 

20 this subsection for a performance period for a fiscal 

21 year (as established under paragraph (6)). 

22 ‘‘(6) PERFORMANCE PERIOD.—The Secretary 

23 shall establish the performance period for a fiscal 

24 year. Such performance period shall begin and end 

25 prior to the beginning of such fiscal year. 


TKELLEY on DSK3SPTVN1PROD with BILLS
19 

•S 2728 IS

1 ‘‘(7) REPORTING OF MEASURES.—The proce2 dures established and implemented under paragraph 

3 (1) shall include a process under which hospitals 

4 shall submit data on the measures specified by the 

5 Secretary under this subsection to the Secretary in 

6 a form and manner, and at a time, specified by the 

7 Secretary for purposes of this subsection. 

8 ‘‘(8) ADJUSTMENTS.— 

9 ‘‘(A) REPORTING FOR FISCAL YEAR 2018.— 

10 For fiscal year 2018, in the case of a hospital 

11 that does not submit, to the Secretary in ac12 cordance with this subsection, data required to 

13 be submitted under paragraph (7) for a period 

14 (determined appropriate by the Secretary) for 

15 such fiscal year, the total amount that the hos16 pital would otherwise receive under subsection 

17 (d)(5)(B) for discharges in such fiscal year 

18 shall be reduced by 1 percent. 

19 ‘‘(B) PERFORMANCE FOR FISCAL YEAR

20 2019 AND SUBSEQUENT FISCAL YEARS.— 

21 ‘‘(i) IN GENERAL.—Subject to clause 

22 (ii), based on the performance of each hos23 pital with respect to compliance with the 

24 measures for a performance period for a 

25 fiscal year (beginning with fiscal year 


TKELLEY on DSK3SPTVN1PROD with BILLS
20 

•S 2728 IS

1 2019), the Secretary shall determine the 

2 amount of any adjustment under this sub3 paragraph to payments to the hospital 

4 under subsection (d)(5)(B) for discharges 

5 in such fiscal year. Such adjustment may 

6 not exceed an amount equal to 2 percent 

7 of the total amount that the hospital would 

8 otherwise receive under such subsection for 

9 discharges in such fiscal year. 

10 ‘‘(ii) BUDGET NEUTRAL.—In making 

11 adjustments under this subparagraph, the 

12 Secretary shall ensure that the total 

13 amount of payments made to all hospitals 

14 under subsection (d)(5)(B) for discharges 

15 in a fiscal year is equal to the total amount 

16 of payments that would have been made to 

17 such hospitals under such subsection for 

18 discharges in such fiscal year if this sub19 section had not been enacted. 

20 ‘‘(9) NO EFFECT IN SUBSEQUENT FISCAL

21 YEARS.—Any adjustment under subparagraph (A) 

22 or (B) of paragraph (8) shall apply only with respect 

23 to the fiscal year involved, and the Secretary shall 

24 not take into account any such adjustment in makVerDate Mar 15 2010 22:45 Aug 07, 2014 Jkt 039200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6201 E:\BILLS\S2728.IS S2728

TKELLEY on DSK3SPTVN1PROD with BILLS
21 

•S 2728 IS

1 ing payments to a hospital under this section in a 

2 subsequent fiscal year. 

3 ‘‘(10) EVALUATION OF SUBMISSION OF PER4 FORMANCE MEASURES.—Not later than January 1, 

5 2018, and every five years thereafter, the Secretary 

6 shall submit to Congress a report on the implemen7 tation of this subsection, including— 

8 ‘‘(A) the measure development procedures, 

9 including any barriers to measure development; 

10 ‘‘(B) the compliance with reporting on the 

11 performance measures, including any barriers 

12 to such compliance; and 

13 ‘‘(C) recommendations to address any bar14 riers described in subparagraph (A) or (B). 

15 ‘‘(11) DEFINITIONS.—In this subsection: 

16 ‘‘(A) HOSPITAL.—The term ‘hospital’ 

17 means a hospital that receives payments under 

18 subsection (d)(5)(B). 

19 ‘‘(B) SHORTAGE SPECIALTY.—The term 

20 ‘shortage specialty’ means the following special21 ties and subspecialties: 

22 ‘‘(i) Family medicine. 

23 ‘‘(ii) Geriatric medicine. 

24 ‘‘(iii) General internal medicine. 

25 ‘‘(iv) General surgery. 


TKELLEY on DSK3SPTVN1PROD with BILLS
22 

•S 2728 IS

1 ‘‘(v) High priority pediatric sub2 specialties. 

3 ‘‘(vi) Psychiatry. 

4 ‘‘(vii) Other specialties and subspecial5 ties determined appropriate by the Sec6 retary.’’. 

7 SEC. 5. INCREASING MEDICARE GRADUATE MEDICAL EDU8 CATION TRANSPARENCY. 

9 (a) IN GENERAL.—Not later than 2 years after the 

10 date of the enactment of this Act, and annually thereafter, 

11 the Secretary of Health and Human Services shall submit 

12 to Congress and the National Health Care Workforce 

13 Commission a report on the graduate medical education 

14 payments that hospitals and primary health training pro15 grams receive under the Medicare program. 

16 (b) REQUIREMENTS.—The report under subsection 

17 (a) shall include the following information with respect to 

18 each hospital or primary health training program that re19 ceives such payments: 

20 (1) The direct graduate medical education pay21 ments made to the hospital under section 1886(h) of 

22 the Social Security Act (42 U.S.C. 1395ww(h)). 

23 (2) The total costs of direct graduate medical 

24 education to the hospital as reported on the annual 

25 Medicare Cost Reports. 


TKELLEY on DSK3SPTVN1PROD with BILLS
23 

•S 2728 IS

1 (3) The indirect medical education payments 

2 made to the hospital under section 1886(d)(5)(B) of 

3 such Act (42 U.S.C. 1395ww(d)(1)(B)). 

4 (4) The number of full-time-equivalent residents 

5 counted for purposes of making the payments de6 scribed in paragraph (1). 

7 (5) The number of full-time-equivalent residents 

8 counted for purposes of making the payments de9 scribed in paragraph (3). 

10 (6) The number of full-time-equivalent resi11 dents, if any, that are not counted for purposes of 

12 making payments described in paragraph (1). 

13 (7) The number of full-time-equivalent resi14 dents, if any, that are not counted for purposes of 

15 making payments described in paragraph (3). 

16 (8) The payments made to primary care teach17 ing centers under section 1899B of the Social Secu18 rity Act, as added by section 3. 

19 (9) The number of full-time-equivalent residents 

20 counted for purposes of making the payments de21 scribed in paragraph (8). 

22 (10) The percentage of all graduates of a pro23 gram for which payments described in paragraph (1) 

24 or (3) were made to the hospital that are practicing 

25 primary care 5 years after graduation. 


TKELLEY on DSK3SPTVN1PROD with BILLS
24 

•S 2728 IS

1 (11) The percentage of all graduates of a pro2 gram for which payments described in paragraph (1) 

3 or (3) were made to the hospital that are practicing 

4 primary care in health professional shortage areas 5 

5 years after graduation. 

6 (12) The percentage of all graduates of a pri7 mary care teaching center for which payments de8 scribed in paragraph (8) were made to the primary 

9 care teaching center that are practicing primary care 

10 5 years after graduation. 

11 (13) The percentage of all graduates of a pri12 mary care teaching center for which payments de13 scribed in paragraph (8) were made to the primary 

14 care teaching center that are practicing primary care 

15 in health professional shortage areas 5 years after 

16 graduation. 

17 (14) Other information determined appropriate 

18 by the Secretary. 

19 SEC. 6. REAUTHORIZATION OF THE HEALTH CARE WORK20 FORCE COMMISSION. 

21 Section 5101(h)(2) of the Patient Protection and Af22 fordable Care Act (42 U.S.C. 294q(h)(2)) is amended to 

23 read as follows: 

24 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.— 

25 To carry out this section, there are authorized to be 


TKELLEY on DSK3SPTVN1PROD with BILLS
25 

•S 2728 IS

1 appropriated $14,000,000 for the period of fiscal 

2 years 2015 through 2019, and such sums as may be 

3 necessary for each subsequent fiscal year.’’. 

4 SEC. 7. REDUCTION IN MEDICARE INDIRECT GRADUATE 

5 MEDICAL EDUCATION (IME) PAYMENTS. 

6 (a) IN GENERAL.—Section 1886(d)(5)(B)(ii) of the 

7 Social Security Act (42 U.S.C. 1395ww(d)(5)(B)(ii)) is 

8 amended— 

9 (1) in subclause (XI), by striking ‘‘and’’ at the 

10 end; 

11 (2) in subclause (XII)— 

12 (A) by inserting ‘‘and before October 1, 

13 2016,’’ after ‘‘2007,’’; and 

14 (B) by striking the period at the end and 

15 inserting ‘‘; and’’; and 

16 (3) by adding at the end the following new sub17 clause: 

18 ‘‘(XIII) on or after October 1, 2016, ‘c’ is 

19 equal to 1.32.’’. 

20 (b) CONFORMING AMENDMENT RELATING TO DE21 TERMINATION OF STANDARDIZED AMOUNT.—Section 

22 1886(d)(2)(C)(i) of the Social Security Act (42 U.S.C. 

23 1395ww(d)(2)(C)(i)) is amended by inserting ‘‘or of secVerDate Mar 15 2010 23:25 Aug 07, 2014 Jkt 039200 PO 00000 Frm 00025 Fmt 6652 Sfmt 6201 E:\BILLS\S2728.IS S2728

TKELLEY on DSK3SPTVN1PROD with BILLS
26 

•S 2728 IS

1 tion 7(a) of the Community-Based Medical Education Act 

2 of 2014’’ after ‘‘Act of 1997’’. 

Æ 


TKELLEY on DSK3SPTVN1PROD with BILLS