I
106TH CONGRESS
1ST SESSION
H. R. 1222
To amend title XVIII of the Social Security Act to make certain changes
related to payments for graduate medical education under the Medicare
Program.
IN THE HOUSE OF REPRESENTATIVES
MARCH 23, 1999
Mr. BALDACCI (for himself, Mr. KLECZKA, and Mr. SANDERS) 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 subse-
quently 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 make
certain changes related to payments for graduate medical
education under the Medicare Program.
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 ‘‘Graduate Medical Edu-
cation Technical Amendments of 1999’’.
SEC. 2. INDIRECT GRADUATE MEDICAL EDUCATION AD-
JUSTMENT.
(a) IN GENERAL.—Section 1886(d)(5)(B)(v) of the
Social Security Act (42 U.S.C. 1395ww(d)(5)(B)(v)) (as
added by section 4621(b) of the Balanced Budget Act of
1997) is amended—
(1) by striking ‘‘(v) In determining’’ and insert-
ing ‘‘(v)(I) Subject to subclause (II), in deter-
mining’’;
(2) by striking ‘‘in the hospital with respect to
the hospital’s most recent cost reporting period end-
ing on or before December 31, 1996’’; and inserting
‘‘who were appointed by the hospital’s approved
medical residency training programs for the hos-
pital’s most recent cost reporting period ending on
or before December 31, 1996’’; and
(3) by adding at the end the following:
‘‘(II) Beginning on or after January 1, 1997, in the
case of a hospital that sponsors only 1 allopathic or osteo-
pathic residency program, the limit determined for such
hospital under subclause (I) may, at the hospital’s discre-
tion, be increased by 1 for each calendar year but shall
not exceed a total of 3 more than the limit determined
for the hospital under subclause (I).’’.
(b) 
TECHNICAL
AMENDMENTS.—Section
1886(d)(5)(B) of the Social Security Act (42 U.S.C.
1395ww(d)(5)(B)) is amended by moving clauses (ii), (v),
and (vi) 2 ems to the left.
SEC. 3. DIRECT GRADUATE MEDICAL EDUCATION ADJUST-
MENT.
(a) LIMITATION ON NUMBER OF RESIDENTS.—Sec-
tion 1886(h)(4)(F) of the Social Security Act (42 U.S.C.
1395ww(h)(4)(F)) (as added by section 4623 of the
Balanced Budget Act of 1997) is amended by inserting
‘‘who were appointed by the hospital’s approved medical
residency training programs’’ after ‘‘may not exceed the
number of such full-time equivalent residents’’.
(b) FUNDING FOR NEW PROGRAMS.—The first sen-
tence of section 1886(h)(4)(H)(i) of the Social Security
Act (42 U.S.C. 1395ww(h)(4)(H)(i)) (as added by section
4623 of the Balanced Budget Act of 1997) is amended
by inserting ‘‘and before September 30, 1999’’ after ‘‘Jan-
uary 1, 1995’’.
(c) FUNDING
FOR PROGRAMS MEETING RURAL
NEEDS.—The second sentence of section 1886(h)(4)(H)(i)
of 
the 
Social 
Security 
Act 
(42 
U.S.C.
1395ww(h)(4)(H)(i)) (as added by section 4623 of the
Balanced Budget Act of 1997) is amended by striking the
period at the end and inserting ‘‘, including facilities that
are not located in an underserved rural area but have es-
tablished separately accredited rural training tracks.’’.
SEC. 4. EFFECTIVE DATE.
The amendments made by this Act shall take effect
as if included in the enactment of the Balanced Budget
Act of 1997.
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