I 
110TH CONGRESS 
1ST SESSION H. R. 2583 
To amend title VII of the Public Health Service Act to establish a loan 
program for eligible hospitals to establish residency training programs. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 6, 2007 
Mr. BURGESS (for himself and Mr. MATHESON) introduced the following bill; 
which was referred to the Committee on Energy and Commerce 
A BILL 
To amend title VII of the Public Health Service Act to 
establish a loan program for eligible hospitals to establish 
residency training programs. 
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 ‘‘Physician Workforce 
and Graduate Medical Education Enhancement Act of 
2007’’. 
SEC. 2. HOSPITAL RESIDENCY LOAN PROGRAM. 
Subpart 2 of part E of title VII of the Public Health 
Service Act is amended by adding at the end the following 
new section: 
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‘‘SEC. 771. HOSPITAL RESIDENCY LOAN PROGRAM. 
‘‘(a) ESTABLISHMENT.—Not later than January 1, 
2008, the Secretary, acting through the Administrator of 
the Health Resources and Services Administration, shall 
establish a loan program that provides loans to eligible 
hospitals to establish residency training programs. 
‘‘(b) APPLICATION.—No loan may be provided under 
this section to an eligible hospital except pursuant to an 
application that is submitted and approved in a time, man-
ner, and form specified by the Administrator of the Health 
Resources and Services Administration. A loan under this 
section shall be on such terms and conditions and meet 
such requirements as the Administrator determines appro-
priate, in accordance with the provisions of this section. 
‘‘(c) ELIGIBILITY; PREFERENCE FOR RURAL AND 
SMALL URBAN AREAS.— 
‘‘(1) ELIGIBLE HOSPITAL DEFINED.—For pur-
poses of this section, an ‘eligible hospital’ means, 
with respect to a loan under this section, a hospital 
that, as of the date of the submission of an applica-
tion under subsection (b), meets, to the satisfaction 
of the Administrator of the Health Resources and 
Services Administration, each of the following cri-
teria: 
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‘‘(A) The hospital does not operate a resi-
dency training program and has not previously 
operated such a program. 
‘‘(B) The hospital has secured initial ac-
creditation by the American Council for Grad-
uate Medical Education or the American Osteo-
pathic Association. 
‘‘(C) The hospital provides assurances to 
the satisfaction of the Administrator that such 
loan shall be used, consistent with subsection 
(d), only for the purposes of establishing and 
conducting an allopathic or osteopathic resi-
dency program in at least one of the following 
medical specialities (or a combination of such 
specialties): 
‘‘(i) Family medicine. 
‘‘(ii) Internal medicine. 
‘‘(iii) Emergency medicine. 
‘‘(iv) Obstetrics or gynecology. 
‘‘(v) General surgery. 
‘‘(D) The hospital enters into an agree-
ment with the Administrator that certifies the 
hospital will provide for the repayment of the 
loan in accordance with subsection (e). 
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‘‘(2) PREFERENCE
FOR
RURAL
AND
SMALL 
URBAN AREAS.—In making loans under this section, 
the Administrator of the Health Resources and Serv-
ices Administration shall give preference to any ap-
plicant for such a loan that is a hospital located in 
a rural area (as such term is defined in section 
1886(d)(2)(D) of the Social Security Act) or an 
urban area that is not a large urban area (as such 
terms are respectively defined in such section). 
‘‘(d) PERMISSIBLE USES OF LOAN FUNDS.—A loan 
provided under this section shall be used, with respect to 
a residency training program, for only the following pur-
poses: 
‘‘(1) Stipends and benefits available to resi-
dents. 
‘‘(2) Salaries of faculty. 
‘‘(3) Any other costs directly attributable to the 
residency training program, as specified by the Ad-
ministrator of the Health Resources and Services 
Administration. 
‘‘(e) REPAYMENT OF LOANS.— 
‘‘(1) REPAYMENT
PLANS.—Under the agree-
ment described in subsection (c)(1)(D), with respect 
to a loan under this section provided to an eligible 
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hospital, the hospital may select one of the following 
repayment plans: 
‘‘(A) DIRECT PAYMENTS ON INSTALLMENT 
BASIS PLAN.—The repayment plan under this 
subparagraph is a plan under which the eligible 
hospital provides for the repayment of the loan 
amount in installments, in accordance with a 
schedule agreed to by the Administrator and 
the hospital. 
‘‘(B) DEDUCTION
IN
MEDICARE
REIM-
BURSEMENT PLAN.— 
‘‘(i) IN GENERAL.—Subject to clause 
(ii), the repayment plan under this sub-
paragraph is a plan established by the Ad-
ministrator of the Health Resources and 
Services Administration, in consultation 
with the Administrator of the Centers for 
Medicare & Medicaid Services, with respect 
to an eligible hospital receiving a loan 
under this section, under which the loan is 
repaid 
through 
deductions 
from 
the 
amounts otherwise payable to the hospital 
under title XVIII of the Social Security 
Act, in accordance with a formula and 
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schedule agreed to by the Administrator 
and the hospital. 
‘‘(ii) LIMITATION.—A deduction de-
scribed in clause (i) applicable to an eligi-
ble hospital for a fiscal year may not ex-
ceed 2 percent of the total amounts other-
wise payable to the hospital under title 
XVIII of the Social Security Act during 
such year. 
‘‘(C) COMBINATION
PLAN.—The repay-
ment plan under this subparagraph is a plan, 
agreed to by the Administrator and the eligible 
hospital involved, that provides for a combina-
tion of the repayment elements of the plans de-
scribed in subparagraphs (A) and (B), in ac-
cordance with the provisions of this subsection. 
‘‘(2) CHANGES IN SELECTION.—An eligible hos-
pital that borrows a loan made under this section 
may change the selection made by the hospital of a 
repayment plan under paragraph (1) under such 
terms and conditions as may be established by the 
Administrator of the Health Resources and Services 
Administration and with the approval of the Admin-
istrator. 
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‘‘(3) COMMENCEMENT
OF
REPAYMENT.—Re-
payment by an eligible hospital of a loan under this 
section shall commence not later than the date that 
is 24 months after the date on which the loan 
amount is disbursed to such hospital. 
‘‘(4) REPAYMENT PERIOD.—A loan made under 
this section shall be fully repaid not later than the 
date that is five years after the date on which the 
repayment is required to commence under paragraph 
(3). 
‘‘(5) LOAN PAYABLE IN FULL IF RESIDENCY 
TRAINING PROGRAM CANCELED.—In the case that 
an eligible hospital borrows a loan under this sec-
tion, with respect to a residency training program, 
and terminates such program before the date on 
which such loan has been fully repaid in accordance 
with a plan under paragraph (1), such loan shall be 
payable by the hospital within 90 days of the date 
of such termination. 
‘‘(f) NO INTEREST CHARGED.—The Administrator of 
the Health Resources and Services Administration may 
not charge or collect interest on any loan made under this 
section. 
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‘‘(g) LIMITATION ON TOTAL AMOUNT OF LOAN.— 
The cumulative dollar amount of a loan made to an eligible 
hospital under this section may not exceed $1,000,000. 
‘‘(h) PENALTIES.—The Administrator of the Health 
Resources and Services Administration shall establish pen-
alties to which an eligible hospital receiving a loan under 
this section would be subject if such hospital is in violation 
of any of the criteria described in subsection (c)(1). 
‘‘(i) REPORTS.—Not later than January 1, 2012, and 
annually thereafter (before January 2, 2018), the Admin-
istrator of the Health Resources and Services Administra-
tion shall submit to Congress a report on the efficacy of 
the program under this section in increasing the number 
of residents practicing in each medical specialty described 
in subsection (c)(1)(C) during such year and the extent 
to which the program resulted in an increase in the num-
ber of available practitioners in each of such medical spe-
cialties that serve medically underserved populations. 
‘‘(j) FUNDING.— 
‘‘(1) AUTHORIZATION FOR APPROPRIATIONS.— 
For the purpose of carrying out the loan program 
under this section, there are authorized to be appro-
priated $25,000,000 for the period of fiscal years 
2008 through 2018. 
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‘‘(2) 
AVAILABILITY.—Amounts 
appropriated 
under paragraph (1) shall remain available until ex-
pended. 
‘‘(3) REPAID LOAN AMOUNTS.—Any amount re-
paid by, or recovered from, an eligible hospital under 
this section on or before the date of termination de-
scribed in subsection (j) shall be credited to the ap-
propriation account from which the loan amount in-
volved was originally paid. Any amount so credited 
shall be available only for the purpose of carrying 
out the loan program under this section. Any 
amount repaid by, or recovered from, such a hospital 
under this section after such date shall be credited 
to the general fund in the Treasury. 
‘‘(k) TERMINATION OF PROGRAM.—No loan may be 
made under this section after December 31, 2017.’’. 
Æ 
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