I 
118TH CONGRESS 
1ST SESSION H. R. 2389 
To amend title XVIII of the Social Security Act to provide for the distribution 
of additional residency positions, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 29, 2023 
Ms. SEWELL (for herself and Mr. FITZPATRICK) introduced the following bill; 
which was referred to the Committee on Ways and Means, and in addi-
tion to the Committee on Energy and Commerce, for a period to be sub-
sequently determined by the Speaker, in each case for consideration 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 the distribution of additional residency positions, and 
for other purposes. 
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 ‘‘Resident Physician 
Shortage Reduction Act of 2023’’. 
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SEC. 2. DISTRIBUTION OF ADDITIONAL RESIDENCY POSI-
TIONS. 
(a) IN GENERAL.—Section 1886(h) of the Social Se-
curity Act (42 U.S.C. 1395ww(h)) is amended— 
(1) in paragraph (4)(F)(i), by striking ‘‘para-
graphs (7), (8), (9), and (10)’’ and inserting ‘‘para-
graphs (7), (8), (9), (10), and (11)’’; 
(2) in paragraph (4)(H)(i), by striking ‘‘para-
graphs (7), (8), (9), and (10)’’ and inserting ‘‘para-
graphs (7), (8), (9), (10), and (11)’’; 
(3) in paragraph (7)(E), by inserting ‘‘para-
graph (10),’’ after ‘‘paragraph (8),’’; and 
(4) by adding at the end the following new 
paragraph: 
‘‘(11) DISTRIBUTION
OF
ADDITIONAL
RESI-
DENCY POSITIONS.— 
‘‘(A) 
ADDITIONAL
RESIDENCY
POSI-
TIONS.— 
‘‘(i) IN GENERAL.—For each of fiscal 
years 2025 through 2031 (and succeeding 
fiscal years if the Secretary determines 
that there are additional residency posi-
tions available to distribute under clause 
(iv)(II)), the Secretary shall, subject to 
clause (ii) and subparagraph (D), increase 
the otherwise applicable resident limit for 
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each qualifying hospital (as defined in sub-
paragraph (H)) that submits a timely ap-
plication under this subparagraph by such 
number as the Secretary may approve for 
portions of cost reporting periods occurring 
on or after July 1 of the fiscal year of the 
increase. 
‘‘(ii) NUMBER
AVAILABLE
FOR
DIS-
TRIBUTION.—For each such fiscal year, 
the Secretary shall determine the total 
number of additional residency positions 
available for distribution under clause (i) 
in accordance with the following: 
‘‘(I) ALLOCATION TO HOSPITALS 
ALREADY OPERATING OVER RESIDENT 
LIMIT.—One-third of such number 
shall be available for distribution only 
to hospitals described in subparagraph 
(B). 
‘‘(II) AGGREGATE LIMITATION.— 
Except as provided in clause (iv)(I), 
the aggregate number of increases in 
the otherwise applicable resident limit 
under this subparagraph shall be 
equal to 2,000 in each such year. 
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‘‘(iii) PROCESS
FOR
DISTRIBUTING 
POSITIONS.— 
‘‘(I) 
ROUNDS
OF
APPLICA-
TIONS.—The Secretary shall initiate 7 
separate rounds of applications for an 
increase under clause (i), 1 round 
with respect to each of fiscal years 
2025 through 2031. 
‘‘(II) NUMBER
AVAILABLE.—In 
each of such rounds, the aggregate 
number of positions available for dis-
tribution in the fiscal year under 
clause (ii) shall be distributed, plus 
any 
additional 
positions 
available 
under clause (iv). 
‘‘(III) TIMING.—The Secretary 
shall notify hospitals of the number of 
positions distributed to the hospital 
under this paragraph as a result of an 
increase in the otherwise applicable 
resident limit by January 1 of the fis-
cal year of the increase. Such increase 
shall be effective for portions of cost 
reporting periods beginning on or 
after July 1 of that fiscal year. 
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‘‘(iv) POSITIONS
NOT
DISTRIBUTED 
DURING THE FISCAL YEAR.— 
‘‘(I) IN GENERAL.—If the num-
ber of resident full-time equivalent po-
sitions distributed under this para-
graph in a fiscal year is less than the 
aggregate number of positions avail-
able for distribution in the fiscal year 
(as described in clause (ii), including 
after application of this subclause), 
the difference between such number 
distributed and such number available 
for distribution shall be added to the 
aggregate number of positions avail-
able for distribution in the following 
fiscal year. 
‘‘(II) EXCEPTION
IF
POSITIONS 
NOT DISTRIBUTED BY END OF FISCAL 
YEAR 2031.—If the aggregate number 
of positions distributed under this 
paragraph during the 7-year period of 
fiscal years 2025 through 2031 is less 
than 14,000, the Secretary shall, in 
accordance with the provisions of 
clause (ii) and subparagraph (E) and 
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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 are located in 
a rural area (as defined in subsection 
(d)(2)(D)) or are treated as being lo-
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cated in a rural area pursuant to sub-
section (d)(8)(E) or are located in 
Alaska, Hawaii, or a territory of the 
United States. 
‘‘(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— 
‘‘(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’ 
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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-
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 
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