(b) NATIONAL CLEARINGHOUSE.—Not later than 
180 days after the date of enactment of this Act, the Sec-
retary shall establish a national clearinghouse to make 
available to the primary care physicians, primary care pro-
viders, patients, and States translated documents regard-
ing patient care and education under the Medicare pro-
gram, the Medicaid program, and the State Children’s 
Health Insurance Program under titles XVIII, XIX, and 
XXI, respectively, of the Social Security Act. 
(c) GRANTS TO SUPPORT LANGUAGE TRANSLATION 
SERVICES IN UNDERSERVED COMMUNITIES.— 
(1) AUTHORITY TO AWARD GRANTS.—The Sec-
retary shall award grants to support language trans-
lation services for primary care physicians and pri-
mary care providers in medically underserved areas 
(as defined in section 3(c)). 
(2) AUTHORIZATION
OF
APPROPRIATIONS.— 
There are authorized to be appropriated to the Sec-
retary to award grants under this subsection, such 
sums as are necessary for fiscal years beginning with 
fiscal year 2010. 
SEC. 324. HHS STUDY AND REPORT ON USE OF REAL-TIME 
MEDICARE CLAIMS ADJUDICATION. 
(a) STUDY.—The Secretary shall conduct a study to 
assess the ability of the Medicare program under title 
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XVIII of the Social Security Act to engage in real-time 
claims adjudication for items and services furnished to 
Medicare beneficiaries. 
(b) CONSULTATION.—In conducting the study under 
subsection (a), the Secretary consult with stakeholders in 
the private sector, including stakeholders who are using 
or are testing real-time claims adjudication systems. 
(c) REPORT.—Not later than January 1, 2011, the 
Secretary shall submit to Congress a report containing the 
results of the study conducted under subsection (a), to-
gether with recommendations for such legislation and ad-
ministrative action as the Secretary determines appro-
priate. 
SEC. 325. ONGOING ASSESSMENT BY MEDPAC OF THE IM-
PACT OF MEDICARE PAYMENTS ON PRIMARY 
CARE ACCESS AND EQUITY. 
The Medicare Payment Advisory Commission, begin-
ning in 2010 and in each of its subsequent annual reports 
to Congress on Medicare physician payment policies, shall 
provide an assessment of the impact of changes in Medi-
care payment policies in improving access to and equity 
of payments to primary care physicians and primary care 
providers. Such assessment shall include an assessment of 
the effectiveness, once implemented, of the Medicare pay-
ment-related reforms required by this Act to support pri-
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mary care as well as any other payment changes that may 
be required by Congress to improve access to and equity 
of payments to primary care physicians and primary care 
providers. 
SEC. 326. 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-
graph (7)’’ and inserting ‘‘paragraphs (7) and (8)’’; 
(2) in paragraph (4)(H)(i), by striking ‘‘para-
graph (7)’’ and inserting ‘‘paragraphs (7) and (8)’’; 
and 
(3) by adding at the end the following new 
paragraph: 
‘‘(8) DISTRIBUTION OF ADDITIONAL RESIDENCY 
POSITIONS.— 
‘‘(A) 
ADDITIONAL
RESIDENCY
POSI-
TIONS.— 
‘‘(i) REDUCTION IN LIMIT BASED ON 
UNUSED POSITIONS.— 
‘‘(I) IN
GENERAL.—The Sec-
retary shall reduce the otherwise ap-
plicable resident limit for a hospital 
that the Secretary determines had 
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residency positions that were unused 
for all 5 of the most recent cost re-
porting periods ending prior to the 
date of enactment of this paragraph 
by an amount that is equal to the 
number of such unused residency po-
sitions. 
‘‘(II) EXCEPTION
FOR
RURAL 
HOSPITALS AND CERTAIN OTHER HOS-
PITALS.—This subparagraph shall not 
apply to a hospital— 
‘‘(aa) located in a rural area 
(as 
defined 
in 
subsection 
(d)(2)(D)(ii)); 
‘‘(bb) that has participated 
in a voluntary reduction plan 
under paragraph (6); or 
‘‘(cc) that has participated 
in a demonstration project ap-
proved as of October 31, 2003, 
under the authority of section 
402 of Public Law 90–248. 
‘‘(ii) NUMBER
AVAILABLE
FOR
DIS-
TRIBUTION.—The number of additional 
residency positions available for distribu-
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tion under subparagraph (B) shall be an 
amount that the Secretary determines 
would result in a 15 percent increase in 
the aggregate number of full-time equiva-
lent residents in approved medical training 
programs (as determined based on the 
most recent cost reports available at the 
time of distribution). One-third of such 
number shall only be available for distribu-
tion to hospitals described in subclause (I) 
of subparagraph (B)(ii) under such sub-
paragraph. 
‘‘(B) DISTRIBUTION.— 
‘‘(i) IN
GENERAL.—The Secretary 
shall increase the otherwise applicable resi-
dent limit for each qualifying hospital that 
submits an application under this subpara-
graph by such number as the Secretary 
may approve for portions of cost reporting 
periods occurring on or after the date of 
enactment of this paragraph. The aggre-
gate number of increases in the otherwise 
applicable resident limit under this sub-
paragraph shall be equal to the number of 
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additional residency positions available for 
distribution under subparagraph (A)(ii). 
‘‘(ii) DISTRIBUTION
TO
HOSPITALS 
ALREADY
OPERATING
OVER
RESIDENT 
LIMIT.— 
‘‘(I) IN
GENERAL.—Subject to 
subclause (II), in the case of a hos-
pital in which the reference resident 
level of the hospital (as defined in 
clause (ii)) is greater than the other-
wise applicable resident limit, the in-
crease in the otherwise applicable resi-
dent limit under this subparagraph 
shall be an amount equal to the prod-
uct of the total number of additional 
residency positions available for dis-
tribution under subparagraph (A)(ii) 
and the quotient of— 
‘‘(aa) the number of resident 
positions by which the reference 
resident level of the hospital ex-
ceeds the otherwise applicable 
resident limit for the hospital; 
and 
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‘‘(I) IN
GENERAL.—Except as 
otherwise provided in subclause (II), 
the reference resident level specified in 
this clause for a hospital is the resi-
dent level for the most recent cost re-
porting period of the hospital ending 
on or before the date of enactment of 
this paragraph, for which a cost re-
port has been settled (or, if not, sub-
mitted (subject to audit)), as deter-
mined by the Secretary. 
‘‘(II) USE OF MOST RECENT AC-
COUNTING PERIOD TO RECOGNIZE EX-
PANSION OF EXISTING PROGRAM OR 
ESTABLISHMENT
OF
NEW
PRO-
GRAM.—If a hospital submits a timely 
request to increase its resident level 
due to an expansion of an existing 
residency training program or the es-
tablishment of a new residency train-
ing program that is not reflected on 
the most recent cost report that has 
been settled (or, if not, submitted 
(subject to audit)), after audit and 
subject to the discretion of the Sec-
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retary, the reference resident level for 
such hospital is the resident level for 
the cost reporting period that includes 
the additional residents attributable to 
such expansion or establishment, as 
determined by the Secretary. 
‘‘(C) CONSIDERATIONS
IN
REDISTRIBU-
TION.—In determining for which hospitals the 
increase in the otherwise applicable resident 
limit is provided under subparagraph (B) (other 
than an increase under subparagraph (B)(ii)), 
the Secretary shall take into account the dem-
onstrated likelihood of the hospital filling the 
positions within the first 3 cost reporting peri-
ods beginning on or after July 1, 2010, made 
available under this paragraph, as determined 
by the Secretary. 
‘‘(D) PRIORITY FOR CERTAIN AREAS.—In 
determining for which hospitals the increase in 
the otherwise applicable resident limit is pro-
vided under subparagraph (B) (other than an 
increase under subparagraph (B)(ii)), the Sec-
retary shall distribute the increase to hospitals 
based on the following criteria: 
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‘‘(i) The Secretary shall give pref-
erence to hospitals that submit applica-
tions for new primary care and general 
surgery residency positions. In the case of 
any increase based on such preference, a 
hospital shall ensure that— 
‘‘(I) the position made available 
as a result of such increase remains a 
primary care or general surgery resi-
dency position for not less than 10 
years after the date on which the posi-
tion is filled; and 
‘‘(II) the total number of primary 
care and general surgery residency po-
sitions in the hospital (determined 
based on the number of such positions 
as of the date of such increase, includ-
ing any position added as a result of 
such increase) is not decreased during 
such 10-year period. 
In the case where the Secretary determines 
that a hospital no longer meets the re-
quirement of subclause (II), the Secretary 
may reduce the otherwise applicable resi-
dent limit of the hospital by the amount by 
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which such limit was increased under this 
paragraph. 
‘‘(ii) The Secretary shall give pref-
erence to hospitals that emphasizes train-
ing in community health centers and other 
community-based clinical settings. 
‘‘(iii) The Secretary shall give pref-
erence to hospitals in States that have 
more medical students than residency posi-
tions available (including a greater pref-
erence for those States with smaller resi-
dent-to-medical-student ratios). In deter-
mining the number of medical students in 
a State for purposes of the preceding sen-
tence, the Secretary shall include planned 
students at medical schools which have 
provisional accreditation by the Liaison 
Committee on Medical Education or the 
American Osteopathic Association. 
‘‘(iv) The Secretary shall give pref-
erence to hospitals in States that have low 
resident-to-population ratios (including a 
greater preference for those States with 
lower resident-to-population ratios). 
‘‘(E) LIMITATION.— 
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‘‘(i) IN
GENERAL.—Except as pro-
vided in clause (ii), in no case may a hos-
pital (other than a hospital described in 
subparagraph (B)(ii)(I), subject to the lim-
itation under subparagraph (B)(ii)(III)) 
apply for more than 50 full-time equivalent 
additional residency positions under this 
paragraph. 
‘‘(ii) INCREASE IN NUMBER OF ADDI-
TIONAL
POSITIONS
AVAILABLE
FOR
DIS-
TRIBUTION.—The Secretary shall increase 
the number of full-time equivalent addi-
tional residency positions a hospital may 
apply for under this paragraph if the Sec-
retary determines that the number of addi-
tional residency positions available for dis-
tribution under subparagraph (A)(ii) ex-
ceeds the number of such applications ap-
proved. 
‘‘(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 resident amounts are deemed to be 
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equal to the hospital per resident amounts for 
primary care and nonprimary care computed 
under paragraph (2)(D) for that hospital. 
‘‘(G) DISTRIBUTION.—The Secretary shall 
distribute the increase to hospitals under this 
paragraph not later than 2 years after the date 
of enactment of this paragraph.’’. 
(b) IME.— 
(1) IN GENERAL.—Section 1886(d)(5)(B)(v) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395ww(d)(5)(B)(v)), in the second sentence, is 
amended— 
(A) by striking ‘‘subsection (h)(7)’’ and in-
serting ‘‘subsections (h)(7) and (h)(8)’’; and 
(B) by striking ‘‘it applies’’ and inserting 
‘‘they apply’’. 
(2) 
CONFORMING
PROVISION.—Section 
1886(d)(5)(B) of the Social Security Act (42 U.S.C. 
1395ww(d)(5)(B)) is amended by adding at the end 
the following clause: 
‘‘(x) For discharges occurring on or after the 
date of enactment of this clause, insofar as an addi-
tional payment amount under this subparagraph is 
attributable to resident positions distributed to a 
hospital under subsection (h)(8)(B), the indirect 
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teaching adjustment factor shall be computed in the 
same manner as provided under clause (ii) with re-
spect to such resident positions.’’. 
SEC. 327. COUNTING RESIDENT TIME IN OUTPATIENT SET-
TINGS. 
(a) D–GME.—Section 1886(h)(4)(E) of the Social 
Security Act (42 U.S.C. 1395ww(h)(4)(E)) is amended— 
(1) by striking ‘‘under an approved medical 
residency training program’’; and 
(2) by striking ‘‘if the hospital incurs all, or 
substantially all, of the costs for the training pro-
gram in that setting’’ and inserting ‘‘if the hospital 
continues to incur the costs of the stipends and 
fringe benefits of the resident during the time the 
resident spends in that setting’’. 
(b) IME.—Section 1886(d)(5)(B)(iv) of the Social 
Security Act (42 U.S.C. 1395ww(d)(5)(B)(iv)) is amend-
ed— 
(1) by striking ‘‘under an approved medical 
residency training program’’; and 
(2) by striking ‘‘if the hospital incurs all, or 
substantially all, of the costs for the training pro-
gram in that setting’’ and inserting ‘‘if the hospital 
continues to incur the costs of the stipends and 
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fringe benefits of the intern or resident during the 
time the intern or resident spends in that setting’’. 
(c) EFFECTIVE DATES; APPLICATION.— 
(1) IN GENERAL.—Effective for cost reporting 
periods beginning on or after July 1, 2009, the Sec-
retary of Health and Human Services shall imple-
ment the amendments made by this section in a 
manner so as to apply to cost reporting periods be-
ginning on or after July 1, 2009. 
(2) APPLICATION.—The amendments made by 
this section shall not be applied in a manner that re-
quires reopening of any settled hospital cost reports 
as to which there is not a jurisdictionally proper ap-
peal pending as of the date of the enactment of this 
Act on the issue of payment for indirect costs of 
medical education under section 1886(d)(5)(B) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395ww(d)(5)(B)) or for direct graduate medical 
education costs under section 1886(h) of such Act 
(42 U.S.C. 1395ww(h)). 
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SEC. 328. RULES FOR COUNTING RESIDENT TIME FOR DI-
DACTIC AND SCHOLARLY ACTIVITIES AND 
OTHER ACTIVITIES. 
(a) GME.—Section 1886(h) of the Social Security 
Act (42 U.S.C. 1395ww(h)), as amended by section 
327(a), is amended— 
(1) in paragraph (4)(E)— 
(A) by designating the first sentence as a 
clause (i) with the heading ‘‘IN GENERAL’’ and 
appropriate indentation and by striking ‘‘Such 
rules’’ and inserting ‘‘Subject to clause (ii), 
such rules’’; and 
(B) by adding at the end the following new 
clause: 
‘‘(ii) TREATMENT OF CERTAIN NON-
HOSPITAL
AND
DIDACTIC
ACTIVITIES.— 
Such rules shall provide that all time spent 
by an intern or resident in an approved 
medical residency training program in a 
nonhospital setting that is primarily en-
gaged in furnishing patient care (as de-
fined in paragraph (5)(K)) in non-patient 
care activities, such as didactic conferences 
and seminars, but not including research 
not associated with the treatment or diag-
nosis of a particular patient, as such time 
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and activities are defined by the Secretary, 
shall be counted toward the determination 
of full-time equivalency.’’; 
(2) in paragraph (4), by adding at the end the 
following new subparagraph: 
‘‘(I) In determining the hospital’s number 
of full-time equivalent residents for purposes of 
this subsection, all the time that is spent by an 
intern or resident in an approved medical resi-
dency training program on vacation, sick leave, 
or other approved leave, as such time is defined 
by the Secretary, and that does not prolong the 
total time the resident is participating in the 
approved program beyond the normal duration 
of the program shall be counted toward the de-
termination of full-time equivalency.’’; and 
(3) in paragraph (5), by adding at the end the 
following new subparagraph: 
‘‘(M) NONHOSPITAL SETTING THAT IS PRI-
MARILY
ENGAGED
IN
FURNISHING
PATIENT 
CARE.—The term ‘nonhospital setting that is 
primarily engaged in furnishing patient care’ 
means a nonhospital setting in which the pri-
mary activity is the care and treatment of pa-
tients, as defined by the Secretary.’’. 
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(b) IME DETERMINATIONS.—Section 1886(d)(5)(B) 
of such Act (42 U.S.C. 1395ww(d)(5)(B)), as amended by 
section 326(b), is amended by adding at the end the fol-
lowing new clause: 
‘‘(xi)(I) The provisions of subparagraph (I) of 
subsection (h)(4) shall apply under this subpara-
graph in the same manner as they apply under such 
subsection. 
‘‘(II) In determining the hospital’s number of 
full-time equivalent residents for purposes of this 
subparagraph, all the time spent by an intern or 
resident in an approved medical residency training 
program in non-patient care activities, such as di-
dactic conferences and seminars, as such time and 
activities are defined by the Secretary, that occurs in 
the hospital shall be counted toward the determina-
tion of full-time equivalency if the hospital— 
‘‘(aa) is recognized as a subsection (d) hos-
pital; 
‘‘(bb) is recognized as a subsection (d) 
Puerto Rico hospital; 
‘‘(cc) is reimbursed under a reimbursement 
system authorized under section 1814(b)(3); or 
‘‘(dd) is a provider-based hospital out-
patient department. 
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‘‘(III) In determining the hospital’s number of 
full-time equivalent residents for purposes of this 
subparagraph, all the time spent by an intern or 
resident in an approved medical residency training 
program in research activities that are not associ-
ated with the treatment or diagnosis of a particular 
patient, as such time and activities are defined by 
the Secretary, shall not be counted toward the deter-
mination of full-time equivalency.’’. 
(c) EFFECTIVE DATES; APPLICATION.— 
(1) IN
GENERAL.—Except as otherwise pro-
vided, the Secretary of Health and Human Services 
shall implement the amendments made by this sec-
tion in a manner so as to apply to cost reporting pe-
riods beginning on or after January 1, 1983. 
(2) DIRECT GME.—Section 1886(h)(4)(E)(ii) of 
the Social Security Act, as added by subsection 
(a)(1)(B), shall apply to cost reporting periods be-
ginning on or after July 1, 2009. 
(3) IME.—Section 1886(d)(5)(B)(xi)(III) of 
the Social Security Act, as added by subsection (b), 
shall apply to cost reporting periods beginning on or 
after October 1, 2001. Such section, as so added, 
shall not give rise to any inference on how the law 
in effect prior to such date should be interpreted. 
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(4) APPLICATION.—The amendments made by 
this section shall not be applied in a manner that re-
quires reopening of any settled hospital cost reports 
as to which there is not a jurisdictionally proper ap-
peal pending as of the date of the enactment of this 
Act on the issue of payment for indirect costs of 
medical education under section 1886(d)(5)(B) of 
the Social Security Act or for direct graduate med-
ical education costs under section 1886(h) of such 
Act. 
SEC. 329. PRESERVATION OF RESIDENT CAP POSITIONS 
FROM CLOSED AND ACQUIRED HOSPITALS. 
(a) GME.—Section 1886(h)(4)(H) of the Social Se-
curity Act (42 U.S.C. Section 1395ww(h)(4)(H)) is 
amended by adding at the end the following new clauses: 
‘‘(vi) REDISTRIBUTION OF RESIDENCY 
SLOTS AFTER A HOSPITAL CLOSES.— 
‘‘(I) IN
GENERAL.—Subject to 
the succeeding provisions of this 
clause, the Secretary shall, by regula-
tion, establish a process under which, 
in the case where a hospital with an 
approved medical residency program 
closes on or after the date of enact-
ment of the Balanced Budget Act of 
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1997, the Secretary shall increase the 
otherwise applicable resident limit 
under this paragraph for other hos-
pitals in accordance with this clause. 
‘‘(II) PRIORITY FOR HOSPITALS 
IN
CERTAIN
AREAS.—Subject to the 
succeeding provisions of this clause, in 
determining for which hospitals the 
increase in the otherwise applicable 
resident limit is provided under such 
process, the Secretary shall distribute 
the increase to hospitals located in the 
following priority order (with pref-
erence given within each category to 
hospitals that are members of the 
same affiliated group (as defined by 
the Secretary under clause (ii)) as the 
closed hospital): 
‘‘(aa) First, to hospitals lo-
cated in the same core-based sta-
tistical area as, or a core-based 
statistical area contiguous to, the 
hospital that closed. 
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‘‘(bb) Second, to hospitals 
located in the same State as the 
hospital that closed. 
‘‘(cc) Third, to hospitals lo-
cated in the same region of the 
country as the hospital that 
closed. 
‘‘(dd) Fourth, to all other 
hospitals. 
‘‘(III) REQUIREMENT
HOSPITAL 
LIKELY
TO
FILL
POSITION
WITHIN 
CERTAIN
TIME
PERIOD.—The Sec-
retary may only increase the otherwise 
applicable resident limit of a hospital 
under such process if the Secretary 
determines the hospital has dem-
onstrated a likelihood of filling the po-
sitions made available under this 
clause within 3 years. 
‘‘(IV) LIMITATION.—The aggre-
gate number of increases in the other-
wise applicable resident limits for hos-
pitals under this clause shall be equal 
to the number of resident positions in 
the approved medical residency pro-
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grams that closed on or after the date 
described in subclause (I). 
‘‘(vii) SPECIAL RULE FOR ACQUIRED 
HOSPITALS.— 
‘‘(I) IN GENERAL.—In the case 
of a hospital that is acquired (through 
any mechanism) by another entity 
with the approval of a bankruptcy 
court, during a period determined by 
the Secretary (but not less than 3 
years), the applicable resident limit of 
the acquired hospital shall, except as 
provided in subclause (II), be the ap-
plicable resident limit of the hospital 
that was acquired (as of the date im-
mediately 
before 
the 
acquisition), 
without regard to whether the acquir-
ing entity accepts assignment of the 
Medicare provider agreement of the 
hospital that was acquired, so long as 
the acquiring entity continues to oper-
ate the hospital that was acquired and 
to furnish services, medical residency 
programs, and volume of patients 
similar to the services, medical resi-
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dency programs, and volume of pa-
tients of the hospital that was ac-
quired (as determined by the Sec-
retary) during such period. 
‘‘(II) 
LIMITATION.—Subclause 
(I) shall only apply in the case where 
an acquiring entity waives the right as 
a new provider under the program 
under this title to have the otherwise 
applicable resident limit of the ac-
quired hospital re-established or in-
creased.’’. 
(b) IME.—Section 1886(d)(5)(B)(v) of the Social Se-
curity Act (42 U.S.C. 1395ww(d)(5)(B)(v)), in the second 
sentence, as amended by section 326(b), is amended by 
striking ‘‘subsections (h)(7) and (h)(8)’’ and inserting 
‘‘subsections (h)(4)(H)(vi), (h)(4)(H)(vii), (h)(7), and 
(h)(8)’’. 
(c) APPLICATION.—The amendments made by this 
section shall not be applied in a manner that requires re-
opening of any settled hospital cost reports as to which 
there is not a jurisdictionally proper appeal pending as 
of the date of the enactment of this Act on the issue of 
payment for indirect costs of medical education under sec-
tion 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 
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1395ww(d)(5)(B)) or for direct graduate medical edu-
cation costs under section 1886(h) of such Act (42 U.S.C. 
1395ww(h)). 
(d) NO AFFECT ON TEMPORARY FTE CAP ADJUST-
MENTS.—The amendments made by this section shall not 
affect any temporary adjustment to a hospital’s FTE cap 
under section 413.79(h) of title 42, Code of Federal Regu-
lations (as in effect on the date of enactment of this Act). 
SEC. 330. QUALITY IMPROVEMENT ORGANIZATION ASSIST-
ANCE FOR PHYSICIAN PRACTICES SEEKING 
TO BE PATIENT CENTERED MEDICAL HOME 
PRACTICES. 
Not later than 90 days after the date of enactment 
of this Act, the Secretary of Health and Human Services 
shall revise the 9th Statement of Work under the Quality 
Improvement Program under part B of title XI of the So-
cial Security Act to include a requirement that, in order 
to be an eligible Quality Improvement Organization (in 
this section referred to as a ‘‘QIO’’) for the 9th Statement 
of Work contract cycle, a QIO shall provide assistance, 
including technical assistance, to physicians under the 
Medicare program under title XVIII of the Social Security 
Act that seek to acquire the elements necessary to be rec-
ognized as a patient centered medical home practice under 
the National Committee for Quality Assurance’s Physician 
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Practice Connections—PCMH module (or any successor 
module issued by such Committee). 
TITLE IV—STUDIES 
SEC. 401. STUDY CONCERNING THE DESIGNATION OF PRI-
MARY CARE AS A SHORTAGE PROFESSION. 
(a) IN GENERAL.—Not later than June 30, 2010, the 
Secretary of Labor shall conduct a study and submit to 
the Committee on Education and Labor of the House of 
Representatives and the Committee on Health, Education, 
Labor, and Pensions a report that contains— 
(1) a description of the criteria for the designa-
tion of primary care physicians as professions in 
shortage as defined by the Secretary under section 
212(a)(5)(A) of the Immigration and Nationality 
Act; 
(2) the findings of the Secretary on whether 
primary care physician professions will, on the date 
on which the report is submitted, or within the 5- 
year period beginning on such date, satisfy the cri-
teria referred to in paragraph (1); and 
(3) if the Secretary finds that such professions 
will not satisfy such criteria, recommendations for 
modifications to such criteria to enable primary care 
physicians to be so designated as a profession in 
shortage. 
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(b) REQUIREMENTS.—In conducting the study under 
subsection (a), the Secretary of Labor shall consider work-
force data from the Health Resources and Services Admin-
istration, the Council on Graduate Medical Education, the 
Association of American Medical Colleges, and input from 
physician membership organizations that represent pri-
mary care physicians. 
SEC. 402. STUDY CONCERNING THE EDUCATION DEBT OF 
MEDICAL SCHOOL GRADUATES. 
(a) STUDY.—The Comptroller General of the United 
States shall conduct a study to evaluate the higher edu-
cation-related indebtedness of medical school graduates in 
the United States at the time of graduation from medical 
school, and the impact of such indebtedness on specialty 
choice, including the impact on the field of primary care. 
(b) REPORT.— 
(1) SUBMISSION AND DISSEMINATION OF RE-
PORT.—Not later than 1 year after the date of en-
actment of this Act, the Comptroller General shall 
submit a report on the study required by subsection 
(a) to the Committee on Health, Education, Labor, 
and Pensions of the Senate and the Committee on 
Education and Labor of the House of Representa-
tives, and shall make such report widely available to 
the public. 
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(2) ADDITIONAL
REPORTS.—The Comptroller 
General may periodically prepare and release as nec-
essary additional reports on the topic described in 
subsection (a). 
SEC. 403. STUDY ON MINORITY REPRESENTATION IN PRI-
MARY CARE. 
(a) STUDY.—The Secretary of Health and Human 
Services, acting through the Administrator of the Health 
Resources and Services Administration, shall conduct a 
study of minority representation in training, and in prac-
tice, in primary care specialties. 
(b) REPORT.—Not later than 1 year after the date 
of enactment of this Act, the Secretary of Health and 
Human Services, acting through the Administrator of the 
Health Resources and Services Administration, shall sub-
mit to the appropriate committees of Congress a report 
concerning the study conducted under subsection (a), in-
cluding recommendations for achieving a primary care 
workforce that is more representative of the population of 
the United States. 
Æ 
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