costs under subsections (h) and (d)(5)(B), respec-
tively.’’. 
(b) TREATMENT OF CRITICAL ACCESS HOSPITALS 
AND SOLE COMMUNITY HOSPITALS.— 
(1) CRITICAL
ACCESS
HOSPITALS.—Section 
1814(l) of the Social Security Act (42 U.S.C. 
1395f(l)) is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(6) For cost reporting periods beginning on or after 
the date that is 1 year after the date of enactment of this 
paragraph, the following shall apply: 
‘‘(A) A critical access hospital may elect to be 
treated as a hospital or as a non-provider setting for 
purposes of counting resident time for indirect med-
ical education costs and direct graduate medical edu-
cation costs for the time spent by the resident in 
that setting under subsections (d)(5)(B) and (h), re-
spectively, of section 1886. 
‘‘(B) Direct medical education costs shall not be 
considered reasonable costs of a critical access hos-
pital for purposes of payment under paragraph (1), 
to the extent that the critical access hospital is 
treated as a non-provider setting of another hospital 
or another hospital receives payment for such costs 
for the time spent by the resident in that setting 
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pursuant to subsection (d)(5)(B), subsection (h), or 
subsection (u) of section 1886.’’. 
(2) SOLE
COMMUNITY
HOSPITALS.—Section 
1886(d)(5)(D) of the Social Security Act (42 U.S.C. 
1395ww(d)(5)(D)) is amended by adding at the end 
the following new clause: 
‘‘(vi) For cost reporting periods beginning on or after 
the date that is 1 year after the date of enactment of this 
paragraph, the hospital-specific payment amount deter-
mined under clause (i)(I) with respect to a sole community 
hospital shall not include direct medical education costs, 
to the extent that the sole community hospital receives 
payment for such costs for the time spent by the resident 
in that setting pursuant to subsection (u).’’. 
(c) CONFORMING AMENDMENTS.— 
(1) Section 1886 of the Social Security Act (42 
U.S.C. 1395ww) is amended— 
(A) in subsection (d)(5)(B), in the matter 
preceding clause (i), by striking ‘‘The Sec-
retary’’ and inserting ‘‘Subject to subsection 
(u), the Secretary’’; and 
(B) in subsection (h)— 
(i) in paragraph (1), by inserting 
‘‘subject 
to 
subsection 
(u)’’ 
after 
‘‘1861(v),’’; and 
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(ii) in paragraph (3), in the flush 
matter following subparagraph (B), by 
striking ‘‘subsection (k)’’ and inserting 
‘‘subsection (k) or subsection (u)’’. 
SEC. 3. SUPPORTING NEW, EXPANDING, AND EXISTING 
RURAL TRAINING TRACKS. 
(a) DIRECT GRADUATE MEDICAL EDUCATION.—Sec-
tion 1886(h) of the Social Security Act (42 U.S.C. 
1395ww(h)) is amended— 
(1) in paragraph (4)— 
(A) in subparagraph (F)(i)— 
(i) by striking ‘‘130 percent’’ and in-
serting ‘‘for cost reporting periods begin-
ning on or after October 1, 1997, and be-
fore the date that is 1 year after the date 
of enactment of the Rural Physician Work-
force Production Act of 2025, 130 per-
cent’’; and 
(ii) by adding at the end the fol-
lowing: ‘‘For cost reporting periods begin-
ning on or after the date that is 1 year 
after the date of enactment of the Rural 
Physician Workforce Production Act of 
2025, such rules shall provide that any 
full-time-equivalent resident in an ap-
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proved medical residency program (or sep-
arately defined track within a program) 
that provides more than 50 percent of the 
total residency training time in rural train-
ing locations (as defined in subsection 
(u)(6)(C)), regardless of where the training 
occurs and regardless of specialty, shall 
not be taken into account for purposes of 
applying the limitation under this subpara-
graph.’’; and 
(B) in subparagraph (H)— 
(i) in clause (i), in the second sen-
tence, by inserting the following before the 
period: ‘‘, in accordance with the second 
sentence of clause (i) of such subpara-
graph’’; and 
(ii) in clause (iv), by inserting the fol-
lowing before the period: ‘‘, in accordance 
with the second sentence of clause (i) of 
such subparagraph’’; and 
(2) in paragraph (5), by adding at the end the 
following new subparagraph: 
‘‘(L) SPECIAL RULES REGARDING APPLICA-
TION OF ELECTIVE RURAL SUSTAINABILITY PER 
RESIDENT
PAYMENT
AMOUNT.—For special 
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rules regarding application of the elective rural 
sustainability per resident payment amount 
under subsection (u), see paragraph (3) of such 
subsection.’’. 
(b) 
INDIRECT
MEDICAL
EDUCATION.—Section 
1886(d)(5)(B)(v) is amended— 
(1) by striking ‘‘130 percent’’ and inserting 
‘‘for cost reporting periods beginning on or after Oc-
tober 1, 1997, and before the date that is 1 year 
after the date of enactment of the Rural Physician 
Workforce Production Act of 2025, 130 percent’’; 
and 
(2) by adding at the end the following: ‘‘For 
cost reporting periods beginning on or after the date 
that is 1 year after the date of enactment of the 
Rural Physician Workforce Production Act of 2025, 
such rules shall provide that any full-time-equivalent 
resident in an approved medical residency program 
(or separately defined track within a program) that 
provides more than 50 percent of the total residency 
training time in rural training locations (as defined 
in subsection (u)(6)(C)), regardless of where the 
training occurs and regardless of specialty, shall not 
be taken into account for purposes of applying the 
limitation under this subparagraph. For special rules 
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regarding application of the elective rural sustain-
ability per resident payment amount under sub-
section (u), see paragraph (3) of such subsection.’’. 
Æ 
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