the considerations and priority de-
scribed in subparagraph (C), conduct 
an application and distribution proc-
ess in each subsequent fiscal year 
until such time as the aggregate 
amount of positions distributed under 
this paragraph is equal to 14,000. 
‘‘(B) ALLOCATION OF DISTRIBUTION FOR 
POSITIONS TO HOSPITALS ALREADY OPERATING 
OVER RESIDENT LIMIT.— 
‘‘(i) IN GENERAL.—Subject to clauses 
(ii) and (iii), in the case of a hospital in 
which the reference resident level of the 
hospital (as specified in subparagraph 
(H)(ii)) is greater than the otherwise appli-
cable resident limit, the increase in the 
otherwise applicable resident limit under 
subparagraph (A) for a fiscal year de-
scribed in such subparagraph shall be an 
amount equal to the product of the total 
number of additional residency positions 
available for distribution under subpara-
graph (A)(ii)(I) for such fiscal year and 
the quotient of— 
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‘‘(I) the number of resident posi-
tions by which the reference resident 
level of the hospital exceeds the other-
wise applicable resident limit for the 
hospital; and 
‘‘(II) the number of resident po-
sitions by which the reference resident 
level of all such hospitals with respect 
to which an application is approved 
under this paragraph exceeds the oth-
erwise applicable resident limit for 
such hospitals. 
‘‘(ii) REQUIREMENTS.—A hospital de-
scribed in clause (i)— 
‘‘(I) is not eligible for an increase 
in the otherwise applicable resident 
limit under this subparagraph unless 
the amount by which the reference 
resident level of the hospital exceeds 
the otherwise applicable resident limit 
is not less than 10 and the hospital 
trains at least 25 percent of the full- 
time equivalent residents of the hos-
pital in primary care and general sur-
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gery (as of the date of enactment of 
this paragraph); and 
‘‘(II) shall continue to train at 
least 25 percent of the full-time equiv-
alent residents of the hospital in pri-
mary care and general surgery for the 
5-year period beginning on such date. 
In the case where the Secretary determines 
that a hospital described in clause (i) no 
longer meets the requirement of subclause 
(II), the Secretary may reduce the other-
wise applicable resident limit of the hos-
pital by the amount by which such limit 
was increased under this subparagraph. 
‘‘(iii) CLARIFICATION REGARDING ELI-
GIBILITY
FOR
OTHER
ADDITIONAL
RESI-
DENCY POSITIONS.—Nothing in this sub-
paragraph shall be construed as preventing 
a hospital described in clause (i) from ap-
plying for and receiving additional resi-
dency positions under this paragraph that 
are not reserved for distribution under this 
subparagraph. 
‘‘(C) DISTRIBUTION
OF
OTHER
POSI-
TIONS.—For purposes of determining an in-
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crease in the otherwise applicable resident limit 
under subparagraph (A) (other than such an in-
crease described in subparagraph (B)), the fol-
lowing shall apply: 
‘‘(i) CONSIDERATIONS
IN
DISTRIBU-
TION.—In determining for which hospitals 
such an increase is provided under sub-
paragraph (A), the Secretary shall take 
into account the demonstrated likelihood of 
the hospital filling the positions made 
available under this paragraph within the 
first 5 cost reporting periods beginning 
after the date the increase would be effec-
tive, as determined by the Secretary. 
‘‘(ii) MINIMUM
DISTRIBUTION
FOR 
CERTAIN
CATEGORIES
OF
HOSPITALS.— 
With respect to the aggregate number of 
such positions available for distribution 
under this paragraph, the Secretary shall 
distribute not less than 10 percent of such 
aggregate number to each of the following 
categories of hospitals: 
‘‘(I) Hospitals that— 
‘‘(aa) are located in a rural 
area (as defined in subsection 
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(d)(2)(D)), excluding hospitals 
that are treated as being located 
in a rural area pursuant to sub-
section (d)(8)(E); 
‘‘(bb) are located in an area 
that has a rural-urban com-
muting code equal to or great 
than 4.0; 
‘‘(cc) are sole community 
hospitals (as defined in sub-
section (d)(5)(D)(iii)); 
‘‘(dd) are located within 10 
miles of a sole community hos-
pital; or 
‘‘(ee) for fiscal years after 
fiscal year 2031, have an accred-
ited rural training track (as de-
scribed in paragraph (4)(H)(iv)). 
‘‘(II) Hospitals in which the ref-
erence resident level of the hospital 
(as specified in subparagraph (H)(ii)) 
is greater than the otherwise applica-
ble resident limit. 
‘‘(III) Hospitals in States with— 
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‘‘(aa) new medical schools 
that received ‘Candidate School’ 
status from the Liaison Com-
mittee on Medical Education or 
that received ‘Pre-Accreditation’ 
status from the American Osteo-
pathic Association Commission 
on Osteopathic College Accredita-
tion on or after January 1, 2000, 
and that have achieved or con-
tinue to progress toward ‘Full 
Accreditation’ status (as such 
term is defined by the Liaison 
Committee 
on 
Medical 
Edu-
cation) or toward ‘Accreditation’ 
status (as such term is defined 
by the American Osteopathic As-
sociation Commission on Osteo-
pathic College Accreditation); or 
‘‘(bb) 
additional 
locations 
and branch campuses established 
on or after January 1, 2000, by 
medical schools with ‘Full Ac-
creditation’ status (as such term 
is defined by the Liaison Com-
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mittee on Medical Education) or 
‘Accreditation’ status (as such 
term is defined by the American 
Osteopathic Association Commis-
sion on Osteopathic College Ac-
creditation). 
‘‘(IV) Hospitals that serve areas 
designated 
as 
health 
professional 
shortage 
areas 
under 
section 
332(a)(1)(A) of the Public Health 
Service Act, as determined by the Sec-
retary. 
‘‘(iii) PRIORITIZATION
IN
DISTRIBU-
TION
TO
HPSA
HOSPITALS.—In distrib-
uting positions to a hospital described in 
clause (ii)(IV), the Secretary shall give pri-
ority to hospitals that are affiliated with— 
‘‘(I) a historically Black medical 
school (as defined in subparagraph 
(H)); or 
‘‘(II) any other school listed in 
section 326(e)(1) of the Higher Edu-
cation Act of 1965 that establishes a 
medical college. 
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‘‘(D) PROHIBITION ON DISTRIBUTION TO 
HOSPITALS
WITHOUT
AN
INCREASE
AGREE-
MENT.—No increase in the otherwise applicable 
resident limit of a hospital may be made under 
subparagraph (C) unless such hospital agrees to 
increase the total number of full-time equivalent 
residency positions under the approved medical 
residency training program of such hospital by 
the number of such positions made available by 
such increase under the subparagraph. 
‘‘(E) LIMITATION.— 
‘‘(i) IN
GENERAL.—Except as pro-
vided in clause (ii), a hospital may not re-
ceive more than 75 full-time equivalent ad-
ditional residency positions in the aggre-
gate under this paragraph, paragraph (9), 
and paragraph (10) over the period of fis-
cal years 2026 through 2032. 
‘‘(ii) INCREASE IN NUMBER OF ADDI-
TIONAL POSITIONS A HOSPITAL MAY RE-
CEIVE.—The Secretary shall increase the 
aggregate number of full-time equivalent 
additional residency positions a hospital 
may receive under this paragraph over 
such period if the Secretary estimates that 
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the number of positions available for dis-
tribution under subparagraph (A) exceeds 
the number of applications approved under 
such subparagraph over such period. 
‘‘(F) APPLICATION
OF
PER
RESIDENT 
AMOUNTS
FOR
PRIMARY
CARE
AND
NONPRI-
MARY CARE.—With respect to additional resi-
dency positions in a hospital attributable to the 
increase provided under this paragraph, the ap-
proved FTE per resident amounts are deemed 
to be equal to the hospital per resident amounts 
for primary care and nonprimary care com-
puted under paragraph (2)(D) for that hospital. 
‘‘(G) PERMITTING
FACILITIES
TO
APPLY 
AGGREGATION
RULES.—The Secretary shall 
permit hospitals receiving additional residency 
positions attributable to the increase provided 
under this paragraph to, beginning in the fifth 
year after the effective date of such increase, 
apply such positions to the limitation amount 
under paragraph (4)(F) that may be aggre-
gated pursuant to paragraph (4)(H) among 
members of the same affiliated group. 
‘‘(H) DEFINITIONS.—In this paragraph: 
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‘‘(i) OTHERWISE
APPLICABLE
RESI-
DENT LIMIT.—The term ‘otherwise appli-
cable resident limit’ means, with respect to 
a hospital, the limit otherwise applicable 
under subparagraphs (F)(i) and (H) of 
paragraph (4) on the resident level for the 
hospital determined without regard to this 
paragraph but taking into account para-
graphs (7)(A), (7)(B), (8)(A), (8)(B), (9), 
(10)(A). and (10)(B). 
‘‘(ii) REFERENCE RESIDENT LEVEL.— 
Except as otherwise provided in subclause 
(II), the term ‘reference resident level’ 
means, with respect to a hospital, the resi-
dent level for the most recent cost report-
ing period of the hospital ending on or be-
fore the date of enactment of this para-
graph, for which a cost report has been 
settled (or, if not, submitted (subject to 
audit)), as determined by the Secretary. 
‘‘(iii) RESIDENT
LEVEL.—The term 
‘resident level’ has the meaning given such 
term in paragraph (7)(C)(i). 
‘‘(iv) QUALIFYING
HOSPITAL.—The 
term ‘qualifying hospital’ means a hospital 
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described in subparagraph (B)(i) or any of 
subclauses (I) through (IV) of subpara-
graph (C)(ii). 
‘‘(v) HISTORICALLY BLACK MEDICAL 
SCHOOL.—The term ‘historically Black 
medical school’ means Howard University 
College of Medicine, Charles R. Drew Uni-
versity of Medicine and Science, Meharry 
Medical College, Morehouse School of Med-
icine, Xavier University Graduate School 
of Health Sciences and Medical School, 
and Maryland College of Osteopathic Medi-
cine at Morgan State University.’’. 
(b) IME.—Section 1886(d)(5)(B) of the Social Secu-
rity Act (42 U.S.C. 1395ww(d)(5)(B)) is amended— 
(1) in clause (v), in the third sentence, by strik-
ing ‘‘subsections (h)(7), (h)(8), (h)(9), and (h)(10)’’ 
and inserting ‘‘subsections (h)(7), (h)(8), (h)(9), 
(h)(10), and (h)(11)’’; and 
(2) by adding after clause (xiii) the following 
new clause: 
‘‘(xiv) For discharges occurring on or 
after July 1, 2027, insofar as an additional 
payment amount under this subparagraph 
is attributable to resident positions distrib-
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uted to a hospital under subsection 
(h)(11), the indirect teaching adjustment 
factor shall be computed in the same man-
ner as provided under clause (ii) with re-
spect to such resident positions.’’. 
SEC. 3. STUDY AND REPORT ON STRATEGIES FOR INCREAS-
ING DIVERSITY. 
(a) STUDY.—The Comptroller General of the United 
States (in this section referred to as the ‘‘Comptroller 
General’’) shall conduct a study on strategies for increas-
ing the diversity of the health professional workforce. Such 
study shall include an analysis of strategies for increasing 
the number of health professionals from rural, lower in-
come, and underrepresented minority communities, includ-
ing which strategies are most effective for achieving such 
goal. 
(b) REPORT.—Not later than 2 years after the date 
of enactment of this Act, the Comptroller General shall 
submit to Congress a report on the study conducted under 
subsection (a), together with recommendations for such 
legislation and administrative action as the Comptroller 
General determines appropriate. 
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SEC. 4. RURAL RESIDENCY PLANNING AND DEVELOPMENT 
PROGRAMS. 
Title III of the Public Health Service Act (42 U.S.C. 
241 et seq.) is amended by inserting after section 330A– 
2 the following: 
‘‘SEC. 330A–3. RURAL RESIDENCY PLANNING AND DEVELOP-
MENT PROGRAM AND RURAL RESIDENCY 
PLANNING AND DEVELOPMENT TECHNICAL 
ASSISTANCE PROGRAM. 
‘‘(a) DEFINITION
OF
RURAL
RESIDENCY
PRO-
GRAM.—In this section, the term ‘rural residency pro-
gram’ means a physician residency program, including a 
rural track program, accredited by the Accreditation 
Council for Graduate Medical Education (or a similar 
body) that— 
‘‘(1) trains residents in rural areas (as defined 
by the Secretary) for more than 50 percent of the 
total time of their residency; and 
‘‘(2) primarily focuses on producing physicians 
who will practice in rural areas, as defined by the 
Secretary. 
‘‘(b) RURAL RESIDENCY PLANNING AND DEVELOP-
MENT PROGRAM.— 
‘‘(1) DEFINITION
OF
ELIGIBLE
ENTITY.—In 
this subsection, the term ‘eligible entity’— 
‘‘(A) means— 
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‘‘(i) a domestic public or private non-
profit or for-profit entity; or 
‘‘(ii) an Indian Tribe or Tribal organi-
zation; and 
‘‘(B) may include faith-based or commu-
nity-based organizations, rural hospitals, rural 
community-based ambulatory patient care cen-
ters (including rural health clinics), health cen-
ters operated by an Indian Tribe, Tribal organi-
zation, or urban Indian organization, graduate 
medical education consortiums (including insti-
tutions of higher education, such as schools of 
allopathic medicine, schools of osteopathic medi-
cine, or historically Black colleges or univer-
sities), or other organizations as determined ap-
propriate by the Secretary. 
‘‘(2) GRANTS.— 
‘‘(A) IN
GENERAL.—The Secretary may 
award grants to eligible entities to create new 
rural residency programs (including adding new 
rural training sites to existing rural track pro-
grams). 
‘‘(B) FUNDING.—Grants awarded under 
this subsection may be fully funded at the time 
of the award. 
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‘‘(C) TERM.—The term of a grant under 
this subsection shall be 3 years and may be ex-
tended at the discretion of the Secretary. 
‘‘(3) APPLICATIONS.— 
‘‘(A) IN GENERAL.—To be eligible to re-
ceive a grant under this subsection, an eligible 
entity shall prepare and submit to the Secretary 
an application at such time, in such manner, 
and containing such information as the Sec-
retary may require, including a description of 
the pathway of the rural residency program as 
described in subparagraph (B). 
‘‘(B) PATHWAY.—A pathway of a rural 
residency program supported under this sub-
section shall be for— 
‘‘(i) general primary care and high- 
need specialty care, including family medi-
cine, internal medicine, preventive medi-
cine, psychiatry, or general surgery; 
‘‘(ii) maternal health and obstetrics, 
which may be obstetrics and gynecology or 
family medicine with enhanced obstetrical 
training; or 
‘‘(iii) any other pathway as deter-
mined appropriate by the Secretary. 
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‘‘(c) RURAL RESIDENCY PLANNING AND DEVELOP-
MENT TECHNICAL ASSISTANCE PROGRAM.— 
‘‘(1) DEFINITION
OF
ELIGIBLE
ENTITY.—In 
this subsection, the term ‘eligible entity’ means— 
‘‘(A) a domestic public or private nonprofit 
or for-profit entity; or 
‘‘(B) an Indian Tribe or Tribal organiza-
tion. 
‘‘(2) GRANTS.— 
‘‘(A) IN
GENERAL.—The Secretary may 
award grants to eligible entities to provide tech-
nical assistance to awardees of and potential 
applicants of the program described in sub-
section (b). 
‘‘(B) FUNDING.—Grants awarded under 
this subsection may be fully funded at the time 
of the award. 
‘‘(C) TERM.—The term of a grant under 
this subsection shall be 4 years and may be ex-
tended at the discretion of the Secretary. 
‘‘(3) APPLICATIONS.—To be eligible to receive a 
grant under this subsection, an eligible entity shall 
prepare and submit to the Secretary an application 
at such time, in such manner, and containing such 
information as the Secretary may require. 
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‘‘(d) AUTHORIZATION OF APPROPRIATIONS.— 
‘‘(1) IN GENERAL.—There is authorized to be 
appropriated to carry out this section $12,700,000 
for each of fiscal years 2026 through 2030. 
‘‘(2) 
AVAILABILITY.—Any 
amounts 
appro-
priated under paragraph (1) shall remain available 
to the Secretary until expended.’’. 
Æ 
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