I
103D CONGRESS
1ST SESSION
H. R. 945
To amend the Public Health Service Act and the Social Security Act to
increase the availability of primary and preventive health care, and for
other purposes.
IN THE HOUSE OF REPRESENTATIVES
FEBRUARY 17, 1993
Mr. DICKS introduced the following bill; which was referred jointly to the
Committees on Ways and Means and Energy and Commerce
A BILL
To amend the Public Health Service Act and the Social
Security Act to increase the availability of primary and
preventive health care, 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 ‘‘Primary Health Care
Investment Act of 1993’’.
SEC. 2. PUBLIC HEALTH SERVICE PRIMARY CARE PROVI-
SIONS.
(a) 
MIGRANT
HEALTH
CENTERS.—Section
329(h)(1)(A) of the Public Health Service Act (42 U.S.C.
254b(h)(1)(A)) is amended by striking ‘‘and’’ after
‘‘1991,’’, and by striking ‘‘through 1994.’’ and inserting
the following: ‘‘and 1993, $68,790,000 for fiscal year
1994, $80,255,000 for fiscal year 1995, $91,720,000 for
fiscal year 1996, $103,185,000 for fiscal year 1997, and
$114,650,000 for fiscal year 1998.’’.
(b) 
COMMUNITY
HEALTH
CENTERS.—Section
330(g)(1)(A) of the Public Health Service Act (42 U.S.C.
254c(g)(1)(A)) is amended by striking ‘‘and’’ after
‘‘1991,’’, and by striking ‘‘through 1994.’’ and inserting
the following: ‘‘and 1993, $670,780,800 for fiscal year
1994, $782,577,000 for fiscal year 1995, $894,374,400
for fiscal year 1996, $1,006,171,200 for fiscal year 1997,
and $1,117,968,000 for fiscal year 1998.’’.
(c) NATIONAL HEALTH SERVICE CORPS SCHOLAR-
SHIP
AND
LOAN
REPAYMENT
PROGRAMS.—Section
338H(b)(1) of the Public Health Service Act (42 U.S.C.
254q(b)(1)) is amended by striking ‘‘and’’ after ‘‘1991,’’,
and by striking ‘‘through 2000.’’ and inserting the follow-
ing: ‘‘and 1993, $91,155,600 for fiscal year 1994,
$106,348,200 for fiscal year 1995, $121,540,800 for fis-
cal year 1996, $136,733,400 for fiscal year 1997, and
$151,926,000 for fiscal year 1998.’’.
(d) HEALTH SERVICES FOR THE HOMELESS.—Sec-
tion 340(q)(1) of the Public Health Service Act (42 U.S.C.
256(q)(1)) is amended by striking ‘‘and such sums’’ and
all that follows and inserting the following: ‘‘such sums
as may be necessary for fiscal year 1993, $69,638,400 for
fiscal year 1994, $81,244,800 for fiscal year 1995,
$92,851,200 for fiscal year 1996, $104,457,600 for fiscal
year 1997, and $116,064,000 for fiscal year 1998.’’.
SEC. 3. PAYMENTS FOR DIRECT GRADUATE MEDICAL EDU-
CATION COSTS OF PRIMARY CARE RESI-
DENTS INCREASED.
(a) IN GENERAL.—Section 1886(h) of the Social Se-
curity Act (42 U.S.C. 1395 ww(h)) is amended—
(1) by amending paragraph (2) to read as fol-
lows:
‘‘(2) DETERMINATION OF APPROVED FTE RESI-
DENT AMOUNTS.—The Secretary shall determine an
approved FTE resident amount for each cost report-
ing period beginning after October 1, 1993, as fol-
lows:
‘‘(A) DETERMINING
NATIONAL
AVERAGE
SALARY PER FTE RESIDENT IN FISCAL YEAR
1989.—The Secretary shall determine the na-
tional average salary for fiscal year 1991 for a
full-time-equivalent resident in an approved
medical residency training program.
‘‘(B) UPDATING
TO
A
COST
REPORTING
PERIOD THAT BEGINS IN FISCAL YEAR 1994.—
The Secretary shall update the amount deter-
mined under subparagraph (A) by the esti-
mated percentage change in the consumer price
index from the midpoint of fiscal year 1989 to
the midpoint of each cost reporting period that
begins in fiscal year 1994.
‘‘(C) UPDATING TO SUBSEQUENT COST RE-
PORTING PERIODS.—For each subsequent cost
reporting period, the Secretary shall update the
amount determined under subparagraph (B) or
this subparagraph for an immediately preceding
cost reporting period by the estimated percent-
age change in the consumer price index from
the midpoint of that preceding period to the
midpoint of that subsequent period, with appro-
priate adjustments to reflect previous under- or
over-estimations in the estimated percentage
change in that index.’’;
(2) in paragraph (3)(B)(i), by striking ‘‘hos-
pital’s’’; and
(3) in paragraph (4), by amending subpara-
graph (C) to read as follows:
‘‘(C) WEIGHTING
FACTOR
FOR
CERTAIN
RESIDENTS.—Such rules shall provide, in cal-
culating the number of full-time-equivalent resi-
dents in an approved residency program—
‘‘(i) that the weighting factor for a
primary care (as defined by the Secretary)
resident, or for an intern, is 2.2,
‘‘(ii) that the weighting factor for a
nonprimary care resident who is in the
resident’s initial residency period is 2.0,
and
‘‘(iii) that the weighting factor for a
nonprimary care resident who is not in the
resident’s initial residency period is 1.2.
The Secretary shall make such adjustments as
are necessary to the weighting factors to main-
tain aggregate payments under this section to
all hospitals at the same level that such pay-
ments would have been made under this section
prior to enactment of the amendments made to
this section by the Primary Health Care Invest-
ment Act of 1993.’’.
(b) EFFECTIVE DATE.—(1) Except as otherwise pro-
vided by paragraph (2), the amendments made by this sec-
tion shall apply to cost reporting periods beginning after
October 1, 1993.
(2) For a cost reporting period that falls partly in
fiscal year 1993 and partly in fiscal year 1994, the provi-
sions of section 1886(h), as in effect before the date of
enactment of this Act, shall apply proportionally to that
part of the cost reporting period that occurs before fiscal
year 1994.
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