I 
114TH CONGRESS 
1ST SESSION H. R. 3292 
To amend title XVIII of the Social Security Act to revise Medicare payment 
for indirect medical education (IME) costs in teaching hospitals. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 29, 2015 
Mr. BRADY of Texas introduced the following bill; which was referred to the 
Committee on Ways and Means 
A BILL 
To amend title XVIII of the Social Security Act to revise 
Medicare payment for indirect medical education (IME) 
costs in teaching hospitals. 
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 ‘‘Medicare IME Pool 
Act of 2015’’. 
SEC. 2. REVISION OF MEDICARE PAYMENTS FOR INDIRECT 
MEDICAL EDUCATION (IME) COSTS IN TEACH-
ING HOSPITALS. 
(a) IN GENERAL.—Section 1886 of the Social Secu-
rity Act (42 U.S.C. 1395ww) is amended— 
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(1) in subsection (d)(5)(B)— 
(A) in the clause (x) added by section 
5505(b) of the Patient Protection and Afford-
able Care Act— 
(i) by moving the indentation of each 
provision in such clause 6 ems to the left; 
and 
(ii) by redesignating such clause as 
clause (xi); and 
(B) by adding at the end the following new 
clause: 
‘‘(xii) With respect to discharges occurring in cost re-
porting periods ending during or after fiscal year 2019, 
instead of the additional payment that would have been 
paid under this subparagraph to a subsection (d) hospital 
or a subsection (d) Puerto Rico hospital with indirect costs 
of medical education and notwithstanding the previous 
provisions of this subparagraph, there shall be paid to the 
hospital the payment determined under subsection (t) for 
such hospital and cost reporting period.’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(t) PAYMENT
FOR
INDIRECT
MEDICAL
EDU-
CATION.— 
‘‘(1) IN GENERAL.— 
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‘‘(A) AMOUNT
OF
PAYMENT.—For pur-
poses of subsection (d)(5)(B)(xii), the payment 
under this subsection for a subsection (d) hos-
pital (or a subsection (d) Puerto Rico hospital) 
for a cost reporting period ending during or 
after fiscal year 2019 is the payment of an 
amount equal to the product of— 
‘‘(i) the IME pool amount computed 
under paragraph (2) for the fiscal year; 
and 
‘‘(ii) the allotment factor under para-
graph (3) for such cost reporting period 
and fiscal year. 
‘‘(B) FORM
OF
PAYMENT.—Payments of 
amounts under this subsection shall be made 
from the Federal Hospital Insurance Trust 
Fund with respect to a cost reporting period in 
accordance with such timing as the Secretary 
determines is similar to the timing of additional 
payments that are made under subsection (h). 
‘‘(2) IME POOL AMOUNT.— 
‘‘(A) IN GENERAL.—The IME pool amount 
under this paragraph— 
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‘‘(i) for fiscal year 2019 is equal to 
the base amount computed under subpara-
graph (B); and 
‘‘(ii) for a subsequent fiscal year is 
equal to the sum of— 
‘‘(I) the IME pool amount under 
this paragraph for the previous fiscal 
year increased by the market basket 
percentage increase (as defined in 
subsection (b)(3)(B)(iii)) applicable to 
discharges occurring in such subse-
quent fiscal year; and 
‘‘(II) the new teaching program 
amount computed under subpara-
graph (C) for the fiscal year. 
‘‘(B) BASE
AMOUNT.—The base amount 
computed 
under 
this 
subparagraph 
is 
$9,500,000,000, increased by the sum, for each 
of fiscal years 2015 through 2019, of the prod-
uct of— 
‘‘(i) the weighted average number of 
full-time-equivalent resident positions in 
approved medical residency training pro-
grams (as determined under subsection 
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(h)(4)) for which payment is first made 
under subsection (h) in the fiscal year; and 
‘‘(ii) the Secretary’s estimate of the 
national average expenditures per resident 
position that are attributable to additional 
payments under subsection (d)(5)(B) for 
discharges in such fiscal year. 
‘‘(C) ADJUSTMENT
FOR
NEW
TEACHING 
PROGRAMS.—The 
new 
teaching 
program 
amount computed under this subparagraph for 
a fiscal year is equal to the product of— 
‘‘(i) the weighted average number of 
full-time-equivalent resident positions in 
approved medical residency training pro-
grams (as determined under subsection 
(h)(4)) for which payment is first made 
under subsection (h) in the fiscal year; and 
‘‘(ii) the IME pool amount under this 
paragraph for the fiscal year (determined 
without regard to this subparagraph), di-
vided by the average number of all full- 
time-equivalent resident positions in ap-
proved medical residency training pro-
grams (as determined under subsection 
(h)(4)) for which payment is made under 
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