II 

114TH CONGRESS 

2D SESSION S. 3522 

To amend title XVIII of the Social Security Act to modify the payment 

amount for direct graduate medical education costs for certain hospitals. 

IN THE SENATE OF THE UNITED STATES 

DECEMBER 8, 2016 

Mr. WHITEHOUSE 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 modify 

the payment amount for direct graduate medical education costs for certain hospitals. 

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 Equity Act’’. 

6 SEC. 2. PAYMENT AMOUNT FOR DIRECT GRADUATE MED7 ICAL EDUCATION COSTS FOR CERTAIN HOS8 PITALS. 

9 Section 1886(h)(3) of the Social Security Act (42 

10 U.S.C. 1395ww(h)(3)) is amended— 


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1 (1) in subparagraph (A), by striking ‘‘The pay2 ment’’ and inserting ‘‘Subject to subparagraph (E), 

3 the payment’’; and 

4 (2) by adding at the end the following new sub5 paragraph: 

6 ‘‘(E) PAYMENT AMOUNT FOR CERTAIN

7 HOSPITALS.— 

8 ‘‘(i) IN GENERAL.—Beginning on or 

9 after the date of enactment of this sub10 paragraph, the payment amount for a 

11 qualified hospital (as defined in clause (ii)) 

12 for the hospital’s cost reporting period be13 ginning during the fiscal year that imme14 diately follows the date on which the quali15 fied hospital submits a letter of intent de16 scribed in clause (iv) is equal to the prod17 uct of— 

18 ‘‘(I) the aggregate approved 

19 amount (as defined in subparagraph 

20 (B)) for that period, and 

21 ‘‘(II) the hospital’s Medicaid in22 patient utilization rate (as defined in 

23 section 1923(b)(2)) for that period. 

24 ‘‘(ii) QUALIFIED HOSPITAL DE25 FINED.—In this subparagraph, the term 


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1 ‘qualified hospital’ means, with respect to 

2 a hospital cost reporting period, a hospital 

3 that— 

4 ‘‘(I) is determined by the Sec5 retary to meet the requirements de6 scribed in clause (iii) for the pre7 ceding hospital cost reporting period; 

8 and 

9 ‘‘(II) submits to the Secretary a 

10 letter of intent described in clause (iv) 

11 as part of its annual cost report for 

12 such preceding period. 

13 ‘‘(iii) REQUIREMENTS DESCRIBED.— 

14 With respect to a qualified hospital, the 

15 following requirements are described in 

16 this clause: 

17 ‘‘(I) The hospital has a participa18 tion agreement under this title. 

19 ‘‘(II) The hospital has an ap20 proved medical residency training pro21 gram (as defined in paragraph 

22 (5)(A)). 

23 ‘‘(III) With respect to the hos24 pital cost reporting period involved, 

25 the aggregate Medicare fee-for-service 


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1 and managed care inpatient load of 

2 the hospital does not exceed 10 per3 cent of the total inpatient days of the 

4 hospital. 

5 ‘‘(IV) With respect to such pe6 riod, the hospital does not receive pay7 ments for graduate medical education 

8 under either of the following: 

9 ‘‘(aa) A State plan under 

10 title XIX. 

11 ‘‘(bb) The Children’s Hos12 pitals Graduate Medical Edu13 cation Payment Program under 

14 section 340E of the Public 

15 Health Service Act. 

16 ‘‘(iv) LETTER OF INTENT DE17 SCRIBED.—Not later than 6 months after 

18 the date of enactment of this subpara19 graph, the Secretary shall make available a 

20 model letter of intent on the Internet 

21 website of the Centers for Medicare & 

22 Medicaid Services. Such letter shall require 

23 the following information with respect to a 

24 hospital for the hospital cost reporting pe25 riod involved: 


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1 ‘‘(I) A statement of intent for the 

2 hospital to be a qualified hospital 

3 under this subparagraph. 

4 ‘‘(II) An attestation that the hos5 pital does not receive payments for 

6 graduate medical education under a 

7 State plan under title XIX. 

8 ‘‘(v) FAILURE TO MEET REQUIRE9 MENTS.—If a hospital does not meet one 

10 or more of the requirements described in 

11 clause (iii), the Secretary shall notify the 

12 hospital in writing not later than 60 days 

13 following the receipt of the hospital’s letter 

14 of intent. 

15 ‘‘(vi) ENSURING NO DUPLICATE PAY16 MENTS.—With respect to a qualified hos17 pital, the payment amount under this sub18 paragraph for a hospital cost reporting pe19 riod shall be in lieu of any other payment 

20 amount that would otherwise be applicable 

21 for direct graduate medical education costs 

22 for such period under this subsection.’’. 

Æ 


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