SEC. 2. FINDINGS.
Congress finds the following:
(1) The Federal government, through its Medi-
care program, pays approximately $8 billion per year
solely to train resident-physicians in the United
States, and as a result, has an interest in assuring
the safety of patients treated by resident-physicians
and the safety of resident-physicians themselves.
(2) Resident-physicians spend a significant
amount of their time performing activities not re-
lated to the educational mission of training com-
petent physicians.
(3) The excessive numbers of hours worked by
resident-physicians is inherently dangerous for pa-
tient care and for the lives of resident-physicians.
(4) The scientific literature has consistently
demonstrated that the sleep deprivation of the mag-
nitude seen in residency training programs leads to
cognitive impairment.
(5) A substantial body of research indicates
that excessive hours worked by resident-physicians
lead to higher rates of medical error, motor vehicle
accidents, depression and pregnancy complications.
(6) The medical community has not adequately
addressed the issue of excessive resident-physician
work hours.
(7) Different medical specialty training pro-
grams have different patient care considerations but
the effects of sleep deprivation on resident-physi-
cians does not change between specialties.
(8) The Federal government has regulated the
work hours of other industries when the safety of
employees or the public is at risk.
SEC. 3. REVISION OF MEDICARE HOSPITAL CONDITIONS OF
PARTICIPATION 
REGARDING 
WORKING
HOURS OF RESIDENTS.
(a) IN GENERAL.—Section 1866 of the Social Secu-
rity Act (42 U.S.C. 1395cc) is amended—
(1) in subsection (a)(1)—
(A) by striking ‘‘and’’ at the end of sub-
paragraph (R);
(B) by striking the period at the end of
subparagraph (S) and inserting ‘‘; and’’; and
(C) by inserting after subparagraph (S)
the following new subparagraph:
‘‘(T) in the case of a hospital that uses the
services of physician residents or postgraduate train-
ees, to meet the requirements of subsection (j).’’;
and
(2) by adding at the end the following new sub-
section:
‘‘(j)(1)(A) In order that the working conditions and
working hours of physicians and postgraduate trainees
promote the provision of quality medical care in hospitals,
as a condition of participation under this title each hos-
pital shall establish the following limits on working hours
for certain members of the medical staff and postgraduate
trainees:
‘‘(i) Subject to subparagraph (C), postgraduate
trainees may work no more than a total of 80 hours
per week and 24 hours per shift.
‘‘(ii) Subject to subparagraph (C), postgraduate
trainees—
‘‘(I) shall have at least 10 hours between
scheduled shifts;
‘‘(II) shall have at least 1 full day out of
every 7 days off and one full weekend off per
month;
‘‘(III) who are assigned to patient care re-
sponsibilities in an emergency department shall
work no more than 12 continuous hours in that
department; and
‘‘(IV) shall not be scheduled to be on call
in the hospital more often than every third
night.
‘‘(B) The Secretary shall promulgate such regulations
as may be necessary to ensure quality of care is main-
tained during the transfer of direct patient care from one
postgraduate trainee to another at the end of each such
24 hour period referred to in subparagraph (A) and shall
take into account cases of individual patient emergencies.
‘‘(C) The work hour limitations under subparagraph
(A) and requirements of subparagraph (B) shall not apply
to a hospital during a state of emergency declared by the
Secretary that applies with respect to that hospital.
‘‘(2) The Secretary shall promulgate such regulations
as may be necessary to monitor and supervise post-
graduate trainees assigned patient care responsibilities as
part of an approved medical training program, as well as
to assure quality patient care.
‘‘(3) Each hospital shall inform postgraduate trainees
of—
‘‘(A) their rights under this subsection, includ-
ing methods to enforce such rights (including so-
called whistle-blower protections); and
‘‘(B) the effects of their acute and chronic sleep
deprivation both on themselves and on their pa-
tients.
‘‘(4) For purposes of this subsection, the term ‘post-
graduate trainee’ includes a postgraduate intern, resident,
or fellow.’’.
(b) DESIGNATION.—
(1) IN GENERAL.—The Secretary of Health and
Human Services shall designate an individual within
the Department of Health and Human Services to
handle all complaints of violations that arise from
residents who report that their programs are in vio-
lation of the requirements of section 1866(j) of the
Social Security Act (as added by subsection (a)).
(2) GRIEVANCE
RIGHTS.—A post graduate
trainee or physician resident may file a complaint
with the Secretary of Health and Human Services
concerning a violation of such requirements. Such a
complaint may be filed anonymously. The Secretary
may conduct an investigation and take such correc-
tive action with respect to such a violation.
(3) CIVIL MONEY PENALTY ENFORCEMENT.—
Any hospital that violates such requirement is sub-
ject to a civil money penalty not to exceed $100,000
for each resident training program in any 6-month
period. The provisions of section 1128A of the Social
Security Act (other than subsections (a) and (b))
shall apply to civil money penalties under this para-
graph in the same manner as they apply to a pen-
alty or proceeding under section 1128A(a) of such
Act.
(4) DISCLOSURE OF VIOLATIONS AND ANNUAL
REPORTS.—The individual designated under para-
graph (1) shall—
(A) provide for annual anonymous surveys
of postgraduate trainees to determine compli-
ance with such requirements and for the disclo-
sure of the results of such surveys to the public
on a residency-program specific basis;
(B) based on such surveys, conduct appro-
priate on-site investigations;
(C) provide for disclosure to the public of
violations and compliance, on a hospital and
residence-program specific basis, of such re-
quirements; and
(D) make an annual report to Congress on
the compliance of hospitals with such require-
ments, including providing a list of hospitals
found to be in violation of such requirements.
(c) WHISTLEBLOWER PROTECTIONS.—
(1) IN GENERAL.— A hospital covered by the
requirements of section 1866(j)(1) of the Social Se-
curity Act (as inserted by subsection (a)) shall not
(2) GOOD FAITH DEFINED.—For purposes of
this subsection, an employee is deemed to act ‘‘in
good faith’’ if the employee reasonably believes—
(A) that the information reported or dis-
closed is true; and
(B) that a violation has occurred or may
occur.
(d) EFFECTIVE DATE.—The amendments made by
subsection (a) shall take effect on the first July 1 that
begins at least 1 year after the date of the enactment of
this Act.
SEC. 4. ADDITIONAL FUNDING FOR HOSPITAL COSTS.
There are hereby appropriated to the Secretary of
Health and Human Services such amounts as may be re-
quired to provide for additional payments to hospitals for
their reasonable additional, incremental costs incurred in
order to comply with the requirements imposed by this Act
(and the amendments made by this Act).
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