I 
115TH CONGRESS 
1ST SESSION H. R. 4552 
To amend title XVIII of the Social Security Act to establish rules for payment 
for graduate medical education (GME) costs for hospitals that establish 
a new medical residency training program after hosting resident rotators 
for short durations. 
IN THE HOUSE OF REPRESENTATIVES 
DECEMBER 5, 2017 
Mr. GALLAGHER (for himself, Mr. KIND, Mr. DUFFY, Mr. POCAN, Mr. SEN-
SENBRENNER, Mr. GROTHMAN, Ms. MOORE, Mr. THOMAS J. ROONEY of 
Florida, and Mr. ROSS) introduced the following bill; which was referred 
to the Committee on Ways and Means, and in addition to the Committee 
on Energy and Commerce, for a period to be subsequently determined by 
the Speaker, in each case for consideration of such provisions as fall with-
in the jurisdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to establish 
rules for payment for graduate medical education (GME) 
costs for hospitals that establish a new medical residency 
training program after hosting resident rotators for short 
durations. 
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 ‘‘Advancing Medical 
Resident Training in Community Hospitals Act of 2017’’. 
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SEC. 2. MEDICARE GME TREATMENT OF HOSPITALS ESTAB-
LISHING NEW MEDICAL RESIDENCY TRAIN-
ING PROGRAMS AFTER HOSTING MEDICAL 
RESIDENT ROTATORS FOR SHORT DURA-
TIONS. 
(a) REDETERMINATION OF APPROVED FTE RESI-
DENT AMOUNT.—Section 1886(h)(2)(F) of the Social Se-
curity Act (42 U.S.C. 1395ww(h)(2)(F)) is amended— 
(1) by inserting ‘‘(i)’’ before ‘‘In the case of’’; 
and 
(2) by adding at the end the following: 
‘‘(ii) In applying this subparagraph to a 
hospital that has not entered into a GME affili-
ation agreement (as defined by the Secretary 
for purposes of paragraph (4)(H)(ii)), the Sec-
retary shall not provide for the establishment of 
an FTE resident amount until such time as the 
Secretary determines that the hospital has a 
medical residency training program that trains 
more than 1.0 full-time-equivalent resident in a 
cost reporting period. 
‘‘(iii) In the case of a hospital with an ap-
proved FTE resident amount— 
‘‘(I) based on the training of less than 
1.0 full-time-equivalent resident before Oc-
tober 1, 1997, or 
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‘‘(II) based on the training of no more 
than 3.0 full-time-equivalent residents in a 
medical residency training program in any 
cost reporting period beginning on or after 
October 1, 1997, and before the date of 
the enactment of this clause, 
the Secretary shall provide the hospital an op-
portunity to have a new FTE resident amount 
established when the hospital begins training at 
least 1.0 full-time-equivalent resident (in the 
case of a hospital described in subclause (I)) or 
more than 3.0 full-time-equivalent residents (in 
the case of a hospital described in subclause 
(II)) for cost reporting periods beginning on or 
after the date of the enactment of this clause 
and in accordance with the methodology under 
the rules in effect as of October 1, 2015.’’. 
(b) REDETERMINATION OF FTE RESIDENT LIMITA-
TION.—Section 1886(h)(4)(H)(i) of the Social Security 
Act (42 U.S.C. 1395ww(h)(4)(H)(i)) is amended— 
(1) by inserting ‘‘(I)’’ before ‘‘The Secretary’’; 
and 
(2) by adding at the end the following: 
‘‘(II) Under this clause the Secretary 
shall not determine an adjustment in the 
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limitation applicable to a hospital under 
subparagraph (F) until the hospital trains 
more than 1.0 full-time-equivalent resident 
in a new medical residency training pro-
gram in a cost reporting period. 
‘‘(III) In the case of a hospital that 
has a limitation under subparagraph (F) of 
less than 1.0 full-time-equivalent resident 
as of the date of the enactment of this sub-
clause based on training before October 1, 
1997, under this clause the Secretary shall 
provide the hospital an opportunity to have 
a new adjustment in such limitation deter-
mined when such hospital begins training 
at least 1.0 full-time-equivalent resident in 
accordance with the methodology applica-
ble to hospitals under the rules in effect as 
of October 1, 2015, and applied for cost 
reporting periods beginning on or after the 
date of the enactment of this subclause. 
‘‘(IV) In the case of a hospital for 
which an adjustment in the limitation ap-
plicable to a hospital under subparagraph 
(F) is based on the training of no more 
than 3.0 full-time-equivalent residents in a 
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new medical residency training program in 
a cost reporting period beginning on or 
after October 1, 1997, and before the date 
of the enactment of this subclause, the 
Secretary shall provide the hospital an op-
portunity to have a new adjustment in 
such limitation determined when the hos-
pital begins training more than 3.0 full- 
time-equivalent residents in accordance 
with the methodology applicable to hos-
pitals under the rules in effect as of Octo-
ber 1, 2015, and applied for cost reporting 
periods beginning on or after the date of 
the enactment of this subclause.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to payment under section 1886 of 
the Social Security Act (42 U.S.C. 1395ww) for cost re-
porting periods beginning on or after the date of the en-
actment of this Act. 
Æ 
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