I 
114TH CONGRESS 
2D SESSION 
H. R. 6039 
To amend title XVIII of the Social Security Act to redistribute unused 
residency positions to hospitals in States with shortages of residents 
and health professionals, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 15, 2016 
Mr. HARDY 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 within the juris-
diction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to redis-
tribute unused residency positions to hospitals in States 
with shortages of residents and health professionals, 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 ‘‘Graduate Opportuni-
ties in Medical Education Distribution Act of 2016’’. 
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SEC. 2. REDISTRIBUTING UNUSED RESIDENCY POSITIONS 
TO HOSPITALS IN STATES WITH SHORTAGES 
OF 
RESIDENTS 
AND 
HEALTH 
PROFES-
SIONALS. 
(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 ‘‘(7) and 
(8)’’ and inserting ‘‘(7), (8), and (9)’’; 
(2) in paragraph (4)(H)(i), by striking ‘‘(7) and 
(8)’’ and inserting ‘‘(7), (8), and (9)’’; 
(3) in paragraph (7)(E), by striking ‘‘para-
graph (8)’’ and inserting ‘‘paragraph (8) or (9)’’ be-
fore the period at the end; and 
(4) by adding at the end the following new 
paragraph: 
‘‘(9) DISTRIBUTION OF ADDITIONAL RESIDENCY 
POSITIONS.— 
‘‘(A) REDUCTIONS IN LIMIT BASED ON UN-
USED POSITIONS.— 
‘‘(i) MAKING OF DETERMINATIONS.— 
Not later than 180 days after the date of 
the enactment of this paragraph and each 
four years thereafter, the Secretary shall 
make a set of reduction determinations (as 
defined in clause (ii)). 
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‘‘(ii) SET OF REDUCTION DETERMINA-
TIONS
DEFINED.—For purposes of this 
paragraph, the term ‘set of reduction de-
terminations’ means determinations with 
respect to each hospital of whether, with 
respect to the one-year period ending on 
the date of such set of reduction deter-
minations (referred to in this paragraph as 
the ‘measurement period’ for such set of 
reduction determinations), the hospital’s 
reference resident level (as defined in sub-
paragraph (F)(i)) for such period was less 
than the otherwise applicable resident limit 
(as defined in subparagraph (F)(iii)) for 
such hospital and period. 
‘‘(iii) REDUCTION BASED ON DETER-
MINATION.—In the case that, with respect 
to the measurement period for a set of re-
duction determinations, the Secretary de-
termines under this subparagraph that the 
reference resident level of a hospital for 
such period was less than the otherwise ap-
plicable resident limit for such hospital and 
period, effective for portions of cost report-
ing periods occurring after the date of 
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such set of reduction determinations and 
on or before the date of any subsequent set 
of reduction determinations under clause 
(i) (referred to in this paragraph as the 
‘consequence period’ for such set of reduc-
tion determinations), the otherwise applica-
ble resident limit for such hospital shall be 
reduced by 65 percent of the difference be-
tween such otherwise applicable resident 
limit for the hospital and measurement pe-
riod and such reference resident level for 
the hospital and measurement period (or, 
in the case that the Secretary determines 
that, with respect to the consequence pe-
riod immediately preceding such con-
sequence period, the hospital was a hos-
pital described in clause (ii) of subpara-
graph (B) that did not meet the require-
ments of such clause, by the number de-
scribed in clause (iv)). 
‘‘(iv) 
NUMBER
DESCRIBED.—The 
number described in this clause, with re-
spect to a hospital and consequence period 
(referred to in this clause as the ‘target 
consequence period’), is the greater of— 
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‘‘(I) the number by which the 
otherwise applicable resident limit for 
such hospital would be reduced for the 
target 
consequence 
period 
under 
clause (iii) without the application of 
this clause; and 
‘‘(II) the number by which the 
otherwise applicable resident limit for 
such hospital was increased for the 
consequence period that immediately 
preceded the target consequence pe-
riod. 
‘‘(v) EXCEPTION.—This subparagraph 
shall not apply to a hospital located in a 
rural area (as defined in subsection 
(d)(2)(D)(ii)) with fewer than 250 acute 
care inpatient beds. 
‘‘(vi) DETERMINATION
TIMING.—In 
the case of a reduction determination made 
in a year by the Secretary under clause (i) 
that is not the first such reduction deter-
mination so made, the Secretary shall 
make such determination on a date that is 
not later than March 31 of such year. 
‘‘(B) DISTRIBUTION.— 
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‘‘(i) IN
GENERAL.—With respect to 
each set of reduction determinations under 
subparagraph (A)(i), the Secretary shall, 
in accordance with the succeeding provi-
sions of this paragraph, increase the other-
wise applicable resident limit for each 
qualifying hospital that submits an appli-
cation under this subparagraph by such 
number as the Secretary may approve for 
portions of cost reporting periods occurring 
during the consequence period for such set 
of reduction determinations. The aggregate 
number of increases in the otherwise appli-
cable resident limit under this subpara-
graph for such consequence period shall be 
equal to the aggregate reduction in such 
limits attributable to subparagraph (A) (as 
estimated by the Secretary) for such con-
sequence period. 
‘‘(ii) 
REQUIREMENTS.—A 
hospital 
that receives an increase in the otherwise 
applicable resident limit under this sub-
paragraph for a consequence period shall 
ensure that, during such consequence pe-
riod, the positions resulting from the in-
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crease under this paragraph will be filled. 
The Secretary may determine whether a 
hospital has met the requirements under 
this clause during such consequence period 
in such manner and at such time as the 
Secretary determines appropriate, includ-
ing at the end of such period. 
‘‘(C) CAPACITY
CONSIDERATIONS
IN
RE-
DISTRIBUTION.—In determining which hospitals 
are to receive increases in their otherwise appli-
cable resident limits under subparagraph (B) 
for a consequence period for a set of reduction 
determinations, the Secretary shall take into ac-
count the demonstrated likelihood of each such 
hospital filling the positions made available 
under this paragraph within such consequence 
period, as determined by the Secretary. 
‘‘(D) PRIORITY
IN
REDISTRIBUTION.— 
Subject to subparagraph (C), the Secretary 
shall select, with respect to a set of reduction 
determinations under subparagraph (A)(i), the 
qualifying hospitals that will receive increases 
under subparagraph (B) in the otherwise appli-
cable resident limits for such hospitals for the 
consequence period for such set of reduction de-
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‘‘(E) 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 per resident amounts are deemed 
to be equal to the hospital per resident amounts 
for primary care and nonprimary care com-
puted under paragraph (2)(D) for that hospital. 
‘‘(F) DEFINITIONS.—In this paragraph: 
‘‘(i) REFERENCE RESIDENT LEVEL.— 
The term ‘reference resident level’ means, 
with respect to a hospital and measure-
ment period, the resident level for the cost 
reporting periods of the hospital occurring 
during such measurement period and for 
which a cost report has been settled (or, if 
not, submitted (subject to audit)), as de-
termined by the Secretary. 
‘‘(ii) RESIDENT
LEVEL.—The term 
‘resident level’ has the meaning given such 
term in paragraph (7)(C)(i). 
‘‘(iii) OTHERWISE APPLICABLE RESI-
DENT LIMIT.—The term ‘otherwise appli-
cable resident limit’ means, with respect to 
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a hospital and period, the limit otherwise 
applicable under subparagraphs (F)(i) and 
(H) of paragraph (4) on the resident level 
of the hospital for such period, determined 
without regard to this paragraph but tak-
ing into account paragraph (7)(A). 
‘‘(iv) LOW RESIDENT-TO-POPULATION 
STATES.— 
‘‘(I) IN
GENERAL.—The term 
‘low 
resident-to-population 
State’ 
means a State that has a smaller ap-
plicable number than do at least 75 
percent of all States. 
‘‘(II) APPLICABLE
NUMBER.— 
For purposes of subclause (I), the 
term ‘applicable number’ means, with 
respect to a State, the number that 
results from dividing the number of 
residents in the State by the number 
of individuals residing in the State. 
‘‘(v) 
HIGH
HPSA-TO-POPULATION 
STATES.— 
‘‘(I) IN
GENERAL.—The term 
‘high 
HPSA-to-population 
State’ 
means a State that has a larger appli-
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cable number than do at least 90 per-
cent of all States. 
‘‘(II) APPLICABLE
NUMBER.— 
For purposes of subclause (I), the 
term ‘applicable number’ means, with 
respect to a State, the number that 
results from dividing the number of 
areas in the State designated by the 
Health Resources & Services Adminis-
tration of the Department of Health 
and Human Services as Health Pro-
fessional Shortage Areas by the num-
ber of individuals residing in the 
State. 
‘‘(G) AFFILIATION.—The provisions of this 
paragraph shall be applied to hospitals which 
are members of the same affiliated group (as 
defined by the Secretary under paragraph 
(4)(H)(ii)).’’. 
(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 by striking ‘‘subsections (h)(7) and (h)(8)’’ 
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and inserting ‘‘subsections (h)(7), (h)(8), and 
(h)(9)’’. 
(2) 
CONFORMING
AMENDMENT.—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: 
‘‘(xii) For discharges occurring on or 
after the date that is 180 days after the 
date of the enactment of this clause, inso-
far as an additional payment amount 
under this subparagraph is attributable to 
resident positions distributed to a hospital 
under subsection (h)(9)(B), the indirect 
teaching adjustment factor shall be com-
puted in the same manner as provided 
under clause (ii) with respect to such resi-
dent positions.’’. 
(c) CONFORMING AMENDMENT.—Section 422(b)(2) 
of the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (Public Law 108–173), as 
amended by section 5503 of the Patient Protection and 
Affordable Care Act (Public Law 111–148), is amended 
by striking ‘‘paragraphs (7) and (8)’’ and inserting ‘‘para-
graphs (7), (8), and (9).’’. 
Æ 
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