I 
115TH CONGRESS 
1ST SESSION H. R. 3451 
To amend title III of the Public Health Service Act to expand the program 
for payments to teaching health centers with GME programs, and for 
other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 27, 2017 
Mr. DENHAM (for himself and Mr. VALADAO) introduced the following bill; 
which was referred to the Committee on Energy and Commerce 
A BILL 
To amend title III of the Public Health Service Act to 
expand the program for payments to teaching health 
centers with GME programs, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Creating Additional 
Residency Expansion Act’’ or the ‘‘CARE Act’’. 
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SEC. 2. EXPANSION OF PROGRAM FOR PAYMENTS TO 
TEACHING 
HEALTH 
CENTERS 
WITH 
GME 
PROGRAMS. 
Section 340H of the Public Health Service Act (42 
U.S.C. 256h) is amended— 
(1) in subsection (g), by inserting ‘‘(other than 
subsection (k))’’ after ‘‘section’’; 
(2) in subsection (j)(3)— 
(A) by striking ‘‘CENTER.—The’’ and in-
serting ‘‘CENTER.— 
‘‘(i) IN GENERAL.—Subject to clause 
(ii), the’’; and 
(B) by adding at the end the following new 
clause: 
‘‘(ii) CARVE-OUT OF CENTERS FUND-
ED
UNDER
SUBSECTION (k).—The term 
‘qualified teaching health center’ shall not 
include, with respect to a fiscal year, a 
center that is a additional qualified teach-
ing health center (as defined in subsection 
(k)(5)) for such fiscal year.’’; and 
(3) by adding at the end the following new sub-
section: 
‘‘(k) FUNDING FOR ADDITIONAL QUALIFIED TEACH-
ING HEALTH CENTERS.— 
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‘‘(1) PAYMENTS.—In addition to making pay-
ments pursuant to subsection (a), the Secretary 
shall make payments under this subsection for direct 
expenses and for indirect expenses to additional 
qualified teaching health centers (as defined in para-
graph (5)) that are listed as sponsoring institutions 
by the relevant accrediting body for expansion of ex-
isting or establishment of additional approved grad-
uate medical residency training programs. 
‘‘(2) APPLICATION OF PROGRAM RULES.—Ex-
cept as otherwise provided in the succeeding para-
graphs of this subsection, subsections (b), (c), (d), 
(e), (f), (h), and (i) shall apply to payments made 
pursuant to this subsection in the same manner, and 
to the same extent, that such subsections apply with 
respect to payments made pursuant to subsection 
(a). 
‘‘(3) LIMITATION.—The number of full-time 
equivalent residents for which a qualified teaching 
health center receives payments pursuant to this 
subsection for a fiscal year shall not exceed by more 
than six the number of full-time equivalent residents 
for which the center received such payments for the 
preceding fiscal year. 
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‘‘(4) APPROPRIATIONS.—To carry out this sub-
section, there are appropriated such sums as may be 
necessary, not to exceed— 
‘‘(A) $19,000,000 for fiscal year 2019; and 
‘‘(B) $38,000,000 for fiscal year 2020. 
‘‘(5) 
ADDITIONAL
QUALIFIED
TEACHING 
HEALTH CENTER DEFINED.— 
‘‘(A) IN GENERAL.—For purposes of this 
subsection, the term ‘additional qualified teach-
ing health center’ means an entity that is se-
lected by the Secretary pursuant to subpara-
graph (B) and that, but for the application of 
subsection (j)(3)(ii), would, with respect to a 
fiscal year, be a qualified teaching health center 
with respect to such fiscal year. 
‘‘(B) SELECTION BY SECRETARY.— 
‘‘(i) IN
GENERAL.—For purposes of 
subparagraph (A), the Secretary shall se-
lect 20 centers, at least ten of which the 
Secretary did not make payments to under 
this section in fiscal year 2017. 
‘‘(ii) PRIORITY
TO
HIGH-MEDICAID 
COUNTIES.—In making selections under 
clause (i), the Secretary shall give priority 
to centers that are located in counties in 
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which greater than 35 percent of the popu-
lation is enrolled in the Medicaid program 
under title XIX of the Social Security Act. 
‘‘(6) RULE
OF
CONSTRUCTION.—Nothing in 
this subsection may be construed as limiting the 
number of qualified teaching health centers to which 
the Secretary may make payments for a fiscal year 
with funds appropriated under subsection (g).’’. 
Æ 
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