SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Medicare Critical Need
GME Protection Act of 1998’’.
SEC. 2. FULL FTE PAYMENT FOR RESIDENTS IN CRITICAL
NEED SPECIALTY OR SUBSPECIALTY TRAIN-
ING PROGRAMS.
(a) TREATMENT AS INITIAL RESIDENCY PERIOD.—
(1) IN
GENERAL.—Section 1886(h)(5)(F) of
the 
Social 
Security 
Act 
(42 
U.S.C.
1395ww(h)(5)(F)) is amended—
(A) in clause (i)—
(i) by striking ‘‘clause (ii)’’ and in-
serting ‘‘clause (ii) or (iii)’’; and
(ii) by striking ‘‘and’’ at the end;
(B) in clause (ii), by striking the period at
the end and inserting ‘‘, and’’; and
(C) by inserting after clause (ii), the fol-
lowing new clause:
‘‘(iii) subject to the requirement for
budget neutrality under paragraph (7), a
period of years, determined by the Sec-
retary under subparagraph (K)(iv), during
which an individual is in a residency train-
ing program designated by the Secretary
as a critical need specialty or subspecialty,
as defined in subparagraph (K), shall be
treated as part of the initial residency pe-
riod, but shall not be counted against any
limitation on the initial residency period.’’.
(2) DETERMINATION OF CRITICAL NEED SPE-
CIALTY OR SUBSPECIALTY.—Section 1886(h)(5) of
such Act (42 U.S.C. 1395ww(h)(5)) is amended by
adding at the end the following new subparagraph:
‘‘(K) CRITICAL NEED SPECIALITY.—
‘‘(i) DEFINITION.—The term ‘critical
need specialty or subspecialty’ means a
specialty or subspecialty designated by the
Secretary under this subparagraph with a
current or imminent critical shortage of
physicians.
‘‘(ii) CRITERIA.—For purposes of des-
ignating a critical need specialty or sub-
specialty under this subparagraph, the Sec-
retary shall prescribe criteria for determin-
ing critical shortages of physicians or resi-
dents in approved medical residency train-
ing programs. The Secretary shall publish
in the Federal Register the criteria estab-
lished under this clause and the form and
manner by which data is submitted for the
Secretary’s review under this subpara-
graph.
‘‘(iii) PERIOD OF DESIGNATION.—
‘‘(I) IN
GENERAL.—A designa-
tion of a critical need specialty or sub-
specialty under this subparagraph
shall apply until the Secretary deter-
mines the specialty or subspecialty
does not meet the criteria for designa-
tion as a critical need specialty or
subspecialty.
‘‘(II) REPORT.—In the event the
Secretary determines that a specialty
or subspecialty no longer meets the
criteria for being a critical need spe-
cialty or subspecialty, the Secretary
shall submit a report to Congress de-
scribing the reasons for discontinuing
the designation.’’.
(b) MAINTAINING BUDGET NEUTRALITY.—Section
1886(h) of such Act (42 U.S.C. 1395ww(h)) is amended
by adding at the end the following new paragraph:
‘‘(7) BUDGET NEUTRALITY ADJUSTMENT FOR CRITI-
CAL
NEED
SPECIALTY
OR
SUBSPECIALTY
DESIGNA-
TION.—If the Secretary designates a critical need specialty
or subspecialty for a fiscal year, the Secretary shall make
a proportional adjustment to payment amounts under this
subsection for such fiscal year so that the aggregate of
the payments under this subsection for such fiscal year
shall equal the aggregate payments that would have been
made under this subsection for such fiscal year if the Sec-
retary had not designated a critical need specialty or sub-
specialty.’’.
(c) EFFECTIVE DATE.—The amendments made by
this Act shall apply with respect to payments under sec-
tion 1886(h) of the Social Security Act (42 U.S.C.
1395ww(h)) made for residents in, or beginning training
in, a critical need specialty or subspecialty on or after July
1, 1999.
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