I 
116TH CONGRESS 
1ST SESSION H. R. 3753 
To amend title XVIII of the Social Security Act to establish rules for payment 
for graduate medical education (GME) costs for hospitals that establish 
a new medical residency training program after hosting resident rotators 
for short durations. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 15, 2019 
Mr. GOTTHEIMER (for himself and Mr. PASCRELL) 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 jurisdiction of the committee con-
cerned 
A BILL 
To amend title XVIII of the Social Security Act to establish 
rules for payment for graduate medical education (GME) 
costs for hospitals that establish a new medical residency 
training program after hosting resident rotators for short 
durations. 
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 ‘‘Supporting Graduate 
Medical Education at Community Hospitals Act of 2019’’. 
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SEC. 2. FINDINGS. 
Congress makes the following findings: 
(1) Graduate Medical Education or ‘‘GME’’ 
training programs are of critical importance in de-
veloping the physician workforce. 
(2) Current caps on GME training programs 
under Medicare have been in place since 1997. 
(3) Hospitals seeking to launch GME training 
programs face barriers in establishing physician 
training programs in community hospitals. 
SEC. 3. MEDICARE GME TREATMENT OF HOSPITALS ESTAB-
LISHING NEW MEDICAL RESIDENCY TRAIN-
ING PROGRAMS AFTER HOSTING MEDICAL 
RESIDENT ROTATORS FOR SHORT DURA-
TIONS. 
(a) REDETERMINATION OF APPROVED FTE RESI-
DENT AMOUNT.—Section 1886(h)(2)(F) of the Social Se-
curity Act (42 U.S.C. 1395ww(h)(2)(F)) is amended— 
(1) by inserting ‘‘(i)’’ before ‘‘In the case of’’; 
and 
(2) by adding at the end the following: 
‘‘(ii) In applying this subparagraph to a 
hospital that has not entered into a GME affili-
ation agreement (as defined by the Secretary 
for purposes of paragraph (4)(H)(ii)), the Sec-
retary shall not provide for the establishment of 
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an FTE resident amount until such time as the 
Secretary determines that the hospital has a 
medical residency training program that trains 
more than 1.0 full-time-equivalent resident in a 
cost reporting period. 
‘‘(iii) In the case of a hospital with an ap-
proved FTE resident amount— 
‘‘(I) based on the training of less than 
1.0 full-time-equivalent resident before Oc-
tober 1, 1997, or 
‘‘(II) based on the training of no more 
than 6.0 full-time-equivalent residents in a 
medical residency training program in any 
cost reporting period between October 1, 
1996 and September 30, 1997 and no 
more than 3.0 full-time-equivalent resi-
dents on and after October 1, 1997, or 
‘‘(III) based on the training of no full- 
time-equivalent residents in a medical resi-
dency training program for any twenty 
consecutive cost reporting periods begin-
ning on or after October 1, 1997, 
the Secretary shall provide the hospital an op-
portunity to have a new FTE resident amount 
established when the hospital begins training at 
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least 1.0 full-time-equivalent resident (in the 
case of a hospital described in subclauses (I or 
III)) or more than 3.0 full-time-equivalent resi-
dents (in the case of a hospital described in 
subclause (II)) for cost reporting periods begin-
ning on or after the date of the enactment of 
this clause and in accordance with the method-
ology under the rules in effect as of October 1, 
2015.’’. 
(b) REDETERMINATION OF FTE RESIDENT LIMITA-
TION.—Section 1886(h)(4)(H)(i) of the Social Security 
Act (42 U.S.C. 1395ww(h)(4)(H)(i)) is amended— 
(1) by inserting ‘‘(I)’’ before ‘‘The Secretary’’; 
and 
(2) by adding at the end the following: 
‘‘(II) Under this clause the Secretary 
shall not determine an adjustment in the 
limitation applicable to a hospital under 
subparagraph (F) until the hospital trains 
more than 1.0 full-time-equivalent resident 
in a new medical residency training pro-
gram in a cost reporting period. 
‘‘(III) In the case of a hospital that 
has a limitation under subparagraph (F) of 
less than 1.0 full-time-equivalent resident 
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as of the date of the enactment of this sub-
clause based on training before October 1, 
1997, under this clause the Secretary shall 
provide the hospital an opportunity to have 
a new adjustment in such limitation deter-
mined when such hospital begins training 
at least 1.0 full-time-equivalent resident in 
accordance with the methodology applica-
ble to hospitals under the rules in effect as 
of October 1, 2015, and applied for cost 
reporting periods beginning on or after the 
date of the enactment of this subclause. 
‘‘(IV) In the case of a hospital that 
has not reported full-time-equivalent resi-
dents in twenty consecutive cost reporting 
periods subsequent to October 1, 1997, 
under this clause the Secretary shall pro-
vide the hospital an opportunity to have a 
new adjustment in such limitation deter-
mined when such hospital begins training 
at least 1.0 full-time-equivalent resident in 
accordance with the methodology applica-
ble to hospitals under the rules in effect as 
of October 1, 2015, and applied for cost 
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reporting periods beginning on or after the 
date of the enactment of this subclause. 
‘‘(V) In the case of a hospital for 
which an adjustment in the limitation ap-
plicable to a hospital under subparagraph 
(F) is based on the training of no more 
than 3.0 full-time-equivalent residents in a 
medical residency training program in a 
cost reporting period beginning on or after 
October 1, 1997, and before the date of 
the enactment of this subclause, the Sec-
retary shall provide the hospital an oppor-
tunity to have a new adjustment in such 
limitation determined when the hospital be-
gins training more than 3.0 full-time- 
equivalent residents in accordance with the 
methodology applicable to hospitals under 
the rules in effect as of October 1, 2015, 
and applied for cost reporting periods be-
ginning on or after the date of the enact-
ment of this subclause.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to payment under section 1886 of 
the Social Security Act (42 U.S.C. 1395ww) for cost re-
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