I
105TH CONGRESS
1ST SESSION
H. R. 106
To amend the Social Security Act to establish the Teaching Hospital and
Graduate Medical Education Trust Fund, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
JANUARY 7, 1997
Mr. BENTSEN introduced the following bill; which was referred to the Commit-
tee on Ways and Means, and in addition to the Committee on 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 concerned
A BILL
To amend the Social Security Act to establish the Teaching
Hospital and Graduate Medical Education Trust Fund,
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 ‘‘Graduate Medical Edu-
cation Trust Fund Act of 1997’’.
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as the Secretary may require. The Secretary may require
that information under this subsection be submitted to the
Secretary in periodic reports.’’.
(b) ADJUSTMENTS IN MEDICARE PAYMENTS.—
(1) REMOVAL
OF
MEDICAL
EDUCATION
AND
DISPROPORTIONATE
SHARE
HOSPITAL
PAYMENTS
FROM
CALCULATION
OF
ADJUSTED
AVERAGE
PER
CAPITA COST.—Section 1876(a)(1)(C) of such Act
(42 U.S.C. 1395mm(a)(1)(C)) is amended—
(A) by striking ‘‘(C) The annual’’ and in-
serting ‘‘(C)(i) Subject to clause (ii), the an-
nual’’, and
(B) by adding at the end the following new
clause:
‘‘(ii) In determining the average annual per capita
rate of payment for a year (beginning with 1998), such
rate shall be determined as though the Secretary had ex-
cluded from such rate any amounts which the Secretary
estimated would have been payable under this title during
the year for—
‘‘(I) 
payment 
adjustments 
under 
section
1886(d)(5)(F) for hospitals serving a disproportion-
ate share of low-income patients; and
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‘‘(II) the indirect costs of medical education
under section 1886(d)(5)(B) or for direct graduate
medical education costs under section 1886(h).’’.
(2) PAYMENTS TO HOSPITALS OF AMOUNTS AT-
TRIBUTABLE TO DSH.—Section 1886 of such Act
(42 U.S.C. 1395ww) is amended by adding at the
end the following new subsection:
‘‘(j)(1) In addition to amounts paid under subsection
(d)(5)(F), the Secretary is authorized to pay hospitals
which are eligible for such payments for a fiscal year (be-
ginning with fiscal year 1998) supplemental amounts that
do not exceed the limit provided for in paragraph (2).
‘‘(2) The sum of the aggregate amounts paid pursu-
ant to paragraph (1) for a fiscal year shall not exceed the
Secretary’s estimate of 75 percent of the amount of reduc-
tions in payments under section 1876 that are attributable
to the operation of subsection (a)(1)(C)(ii)(I) of such sec-
tion during such fiscal year.’’.
SEC. 3. NATIONAL ADVISORY COUNCIL ON POSTGRADUATE
MEDICAL EDUCATION.
(a) IN GENERAL.—There is established within the
Department of Health and Human Services an advisory
council to be known as the National Advisory Council on
Postgraduate Medical Education (in this section referred
to as the ‘‘Council’’).
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(b) DUTIES.—The Council shall provide advice to the
Secretary on appropriate policies for making payments for
the support of postgraduate medical education in order to
assure an adequate supply of physicians trained in various
specialities, consistent with the health care needs of the
United States.
(c) COMPOSITION.—
(1) IN GENERAL.—The Secretary shall appoint
to the Council 15 individuals who are not officers or
employees of the United States. Such individuals
shall include not less than 1 individual from each of
the following categories of individuals or entities:
(A) Organizations representing consumers
of health care services.
(B) Physicians who are faculty members of
medical schools, or who supervise approved phy-
sician training programs.
(C) Physicians in private practice who are
not physicians described in subparagraph (B).
(D) Practitioners in public health.
(E) Advanced-practice nurses.
(F) Other health professionals who are not
physicians.
(G) Medical schools.
(I) Teaching hospitals.
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(J) The Accreditation Council on Graduate
Medical Education.
(K) The American Board of Medical Speci-
alities.
(L) The Council on Postdoctoral Training
of the American Osteopathic Association.
(M) The Council on Podiatric Medical
Education of the American Podiatric Medical
Association.
(2) REQUIREMENTS REGARDING REPRESENTA-
TIVE MEMBERSHIP.—To the greatest extent feasible,
the membership of the Council shall represent the
various geographic regions of the United States,
shall reflect the racial, ethnic, and gender composi-
tion of the population of the United States, and
shall be broadly representative of medical schools
and teaching hospitals in the United States.
(3) EX
OFFICIO
MEMBERS; OTHER
FEDERAL
OFFICERS OR EMPLOYEES.—The membership of the
Council shall include individuals designated by the
Secretary to serve as members of the Council from
among Federal officers or employees who are ap-
pointed by the President, or by the Secretary (or by
other Federal officers who are appointed by the
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President with the advice and consent of the Sen-
ate). Individuals designated under the preceding sen-
tence shall include each of the following officials (or
a designee of the official):
(A) The Secretary of Health and Human
Services.
(B) The Secretary of Veterans Affairs.
(C) The Secretary of Defense.
(d) CHAIR.—The Secretary shall, from among mem-
bers of the Council appointed under subsection (c)(1), des-
ignate an individual to serve as the chair of the Council.
(e) TERMINATION.—The Council terminates Decem-
ber 31, 2001.
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