I 
117TH CONGRESS 
1ST SESSION H. R. 4014 
To provide for a new building period with respect to the cap on full-time 
equivalent residents for purposes of payment for graduate medical edu-
cation costs under the Medicare program for certain hospitals that have 
established a shortage specialty program. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 17, 2021 
Mr. RUIZ (for himself, Mr. BUCSHON, Ms. SEWELL, and Mr. WENSTRUP) in-
troduced 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 within the jurisdiction of the 
committee concerned 
A BILL 
To provide for a new building period with respect to the 
cap on full-time equivalent residents for purposes of pay-
ment for graduate medical education costs under the 
Medicare program for certain hospitals that have estab-
lished a shortage specialty 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 ‘‘Physician Shortage 
GME Cap Flex Act of 2021’’. 
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SEC. 2. PROVIDING FOR A NEW BUILDING PERIOD WITH 
RESPECT TO THE CAP ON FULL-TIME EQUIV-
ALENT RESIDENTS FOR CERTAIN HOSPITALS 
THAT HAVE ESTABLISHED A SHORTAGE SPE-
CIALTY PROGRAM. 
Section 1886(h)(4) of the Social Security Act (42 
U.S.C. 1395ww(h)(4)) is amended by adding at the end 
the following new subparagraph: 
‘‘(L) TREATMENT
OF
CERTAIN
QUALI-
FYING HOSPITALS.— 
‘‘(i) IN
GENERAL.—For purposes of 
applying 
this 
paragraph 
and 
section 
413.79 of title 42, Code of Federal Regula-
tions (or a successor regulation), the Sec-
retary shall treat, subject to clause (ii), a 
qualifying hospital (as defined in clause 
(iii)) with an approved medical residency 
training program as if such hospital— 
‘‘(I) had no allopathic or osteo-
pathic residents in its most recent 
cost reporting period ending on or be-
fore December 31, 1996; and 
‘‘(II) began training residents for 
the first time in a new medical resi-
dency training program (as defined in 
paragraph (l) of such section) begin-
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ning on the date on which such hos-
pital became a qualifying hospital. 
‘‘(ii) SPECIAL RULE FOR QUALIFYING 
HOSPITALS IN CAP-BUILDING PERIOD.—In 
the case of a qualifying hospital with an 
approved medical residency training pro-
gram that, excluding the treatment de-
scribed in clause (i), is a hospital that had 
no allopathic or osteopathic residents in its 
most recent cost reporting period ending 
on or before December 31, 1996, and 
began training residents for the first time 
in a new medical residency training pro-
gram (as defined in paragraph (l) of such 
section) during the 5-year period ending on 
the date described in clause (i)(II) with re-
spect to such hospital, in lieu of applying 
such clause, the Secretary shall provide 
that the provisions of subsection (e) of sec-
tion 413.79 of title 42, Code of Federal 
Regulations (or a successor regulation), 
shall apply with respect to such hospital 
for an additional 5 years beyond the period 
during which such provisions would other-
wise have applied to such hospital. 
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‘‘(iii) DEFINITION.—In this subpara-
graph: 
‘‘(I) QUALIFYING
HOSPITAL.— 
The term ‘qualifying hospital’ means 
a hospital that— 
‘‘(aa) establishes a shortage 
specialty program (as defined in 
subclause (II)) during the 5-year 
period beginning on the date of 
the enactment of this subpara-
graph; and 
‘‘(bb) submits an application 
to the Secretary during such pe-
riod containing such information 
as the Secretary may specify. 
‘‘(II) SHORTAGE SPECIALTY PRO-
GRAM.—The term ‘shortage specialty 
program’ means, with respect to a 
hospital located in a geographic area 
(as defined by the Secretary), any ap-
proved residency training program in 
a specialty for which the Secretary de-
termines that there is a shortage of 
physicians practicing such specialty in 
such area at the time such program is 
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established. In making such a deter-
mination, the Secretary shall take into 
account whether such hospital is lo-
cated in an area— 
‘‘(aa) 
without 
adequate 
health care resources (such as in 
a rural area or a medically un-
derserved area (as defined by the 
Administrator of the Health Re-
sources and Services Administra-
tion)); 
‘‘(bb) experiencing primary 
care or specialty physician short-
ages (such as in a health profes-
sional shortage area (as defined 
in section 332(a) of the Public 
Health Service Act (42 U.S.C. 
254e(a)))); 
‘‘(cc) without an adequate 
number of approved residency 
training programs; 
‘‘(dd) struggling to expand 
or keep approved residency train-
ing programs operational; 
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‘‘(ee) lacking existing med-
ical training infrastructure or in 
the process of building such in-
frastructure; 
‘‘(ff) with a low resident-to- 
population ratio; 
‘‘(gg) 
with 
few 
full-time 
equivalent resident positions; or 
‘‘(hh) with a low physician- 
to-population ratio for physicians 
practicing in the same specialty 
as the shortage specialty program 
concerned.’’. 
Æ 
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