I
106TH CONGRESS
1ST SESSION
H. R. 1645
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 des-
ignates as critical need specialty or subspecialty training programs.
IN THE HOUSE OF REPRESENTATIVES
APRIL 29, 1999
Mr. STARK (for himself, Mr. MCDERMOTT, Mr. LEWIS of Georgia, Mrs.
THURMAN, Ms. KAPTUR, Ms. JACKSON-LEE of Texas, Mr. FILNER, Mr.
CUMMINGS, Ms. BROWN of Florida, Mr. FROST, and Mr. HILLIARD) in-
troduced 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 subsequently determined by the Speaker, in each case for consider-
ation 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 sub-
specialties which the Secretary of Health and Human
Services designates as critical need specialty or sub-
specialty training programs.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
HR 1645 IH
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Medicare Critical Need
GME Protection Act of 1999’’.
SEC. 2. FULL FTE PAYMENT FOR RESIDENTS IN CRITICAL
NEED SPECIALTY OR SUBSPECIALTY TRAIN-
ING PROGRAMS.
(a) TREATMENT AS INITIAL RESIDENCY PERIOD.—
(1) IN
GENERAL.—Section 1886(h)(5)(F) of
the 
Social 
Security 
Act 
(42 
U.S.C.
1395ww(h)(5)(F)) is amended—
(A) in clause (i)—
(i) by striking ‘‘clause (ii)’’ and in-
serting ‘‘clause (ii) or (iii)’’; and
(ii) by striking ‘‘and’’ at the end;
(B) in clause (ii), by striking the period at
the end and inserting ‘‘, and’’; and
(C) by inserting after clause (ii), the fol-
lowing new clause:
‘‘(iii) subject to the requirement for
budget neutrality under paragraph (7), a
period of years, determined by the Sec-
retary under subparagraph (K)(iv), during
which an individual is in a residency train-
ing program designated by the Secretary
as a critical need specialty or subspecialty,
as defined in subparagraph (K), shall be
HR 1645 IH
treated as part of the initial residency pe-
riod, but shall not be counted against any
limitation on the initial residency period.’’.
(2) DETERMINATION OF CRITICAL NEED SPE-
CIALTY OR SUBSPECIALTY.—Section 1886(h)(5) of
such Act (42 U.S.C. 1395ww(h)(5)) is amended by
adding at the end the following new subparagraph:
‘‘(K) CRITICAL NEED SPECIALITY.—
‘‘(i) DEFINITION.—The term ‘critical
need specialty or subspecialty’ means a
specialty or subspecialty designated by the
Secretary under this subparagraph with a
current or imminent critical shortage of
physicians.
‘‘(ii) CRITERIA.—For purposes of des-
ignating a critical need specialty or sub-
specialty under this subparagraph, the Sec-
retary shall prescribe criteria for deter-
mining critical shortages of physicians or
residents in approved medical residency
training programs. The Secretary shall
publish in the Federal Register the criteria
established under this clause and the form
and manner by which data is submitted for