I 
112TH CONGRESS 
1ST SESSION H. R. 2224 
To amend title XVIII of the Social Security Act to provide opportunities 
for additional residency slots in participating teaching hospitals and 
to expand the primary care bonus to certain underserved specialties 
and to amend the Internal Revenue Code of 1986 to provide tax incen-
tives for practicing-teaching physicians. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 16, 2011 
Mr. GRIMM (for himself, Mr. CROWLEY, Mr. ENGEL, Mr. KING of New York, 
Mr. MEEKS, Mr. HANNA, Mrs. MALONEY, Ms. CLARKE of New York, Mr. 
ACKERMAN, and Mrs. MCCARTHY of New York) 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 provide 
opportunities for additional residency slots in partici-
pating teaching hospitals and to expand the primary 
care bonus to certain underserved specialties and to 
amend the Internal Revenue Code of 1986 to provide 
tax incentives for practicing-teaching physicians. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Improving Physician 
Access in Teaching Hospitals (PATH) Act of 2011’’. 
SEC. 2. DISTRIBUTION OF ADDITIONAL RESIDENCY SLOTS. 
Section 1886(h) of the Social Security Act (42 U.S.C. 
1395ww(h)) is amended— 
(1) in paragraph (7)(E), by inserting ‘‘para-
graph (9),’’ after ‘‘paragraph (8),’’; and 
(2) by adding at the end the following: 
‘‘(9) DISTRIBUTION OF ADDITIONAL RESIDENCY 
POSITIONS.— 
‘‘(A) REDUCTIONS IN LIMIT BASED ON UN-
USED POSITIONS.— 
‘‘(i) IN
GENERAL.—Except as pro-
vided in clause (ii), if a hospital’s resident 
level (as defined in paragraph (7)(C)(i)) 
for each of the 5 most recent cost report-
ing periods (ending before the date of the 
enactment of this paragraph) of the hos-
pital for which a cost report has been set-
tled (or, if not, submitted subject to audit) 
as determined by the Secretary is less than 
the otherwise applicable resident limit (as 
defined in paragraph (8)(H)(iii)), effective 
for portions of cost reporting periods oc-
curring on or after the paragraph (9) ef-
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fective date (as defined in subparagraph 
(E)), the otherwise applicable resident 
limit shall be reduced by the difference be-
tween such otherwise applicable resident 
limit and the highest such reference resi-
dent level for any of such 5 cost reporting 
periods. 
‘‘(ii) EXCEPTION.—Clause (i) shall 
not apply to— 
‘‘(I) a hospital located in a rural 
area with fewer than 250 beds; or 
‘‘(II) a hospital that has had in 
effect a voluntary residency reduction 
plan under paragraph (6) or pursuant 
to section 402 of Public Law 90–248. 
‘‘(B) REQUIREMENTS
FOR
ADDITIONAL 
RESIDENCY SLOTS.— 
‘‘(i) IN
GENERAL.—The Secretary 
shall increase the otherwise applicable resi-
dent limit for hospitals that submit an ap-
plication under this subparagraph by such 
number as the Secretary may approve for 
portions of cost reporting periods occurring 
on or after the paragraph (9) effective 
date. The aggregate number of increases in 
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the otherwise applicable resident limit 
under this subparagraph shall be equal to 
the sum of— 
‘‘(I) the aggregate reduction in 
such limits attributable to subpara-
graph (A) (as estimated by the Sec-
retary); and 
‘‘(II) 1,000 for portions of cost 
reporting periods occurring during the 
12-month period beginning on the 
paragraph (9) effective date, 1,000 
additional positions for portions of 
cost reporting periods occurring dur-
ing the 12-month period beginning 1 
year after such effective date, 1,000 
additional positions for portion of cost 
reporting period occurring during the 
12-month period beginning 2 years 
after such effective date, and such 
number of additional positions for 
portions of the 2 subsequent cost re-
porting periods as the Secretary may 
determine necessary to support resi-
dency training programs in specialities 
that exceed 3 years. 
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‘‘(ii) CONSIDERATION IN REDISTRIBU-
TION.—In determining for which hospitals 
the increase in the otherwise applicable 
resident limit is provided under this sub-
paragraph, the Secretary shall take into 
account— 
‘‘(I) data provided by the Health 
Resources and Services Administra-
tion as a national standard to exhibit 
a specific demand in the health care 
workforce, as well as the Administra-
tion’s projected demand and supply 
for physicians in the specialty of med-
icine involved; and 
‘‘(II) the demonstrated likelihood 
of the hospital filling positions made 
available under this paragraph within 
the first 3 cost reporting periods be-
ginning on or after the paragraph (9) 
effective date. 
The Secretary shall give special consider-
ation for up to 25 additional positions in 
the case of a hospital that demonstrates 
the likelihood of filing such positions dur-
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ing the first cost reporting period begin-
ning on or after such effective date. 
‘‘(iii) LIMITATION.—In no case shall 
the number of additional positions made 
available to a hospital under this para-
graph exceed 25 in the first cost reporting 
period or 75 for all cost reporting periods. 
‘‘(C) PRIORITY
FOR
ADDITIONAL
POSI-
TIONS
RESULTING
FROM
HOSPITAL
CLO-
SURES.—With respect to additional positions 
described in subparagraph (B)(i)(I) which are 
derived from a reduction in limits under sub-
paragraph (A) for a hospital that closed (in this 
subparagraph referred to as a ‘closed hospital’), 
the Secretary shall distribute the increase to 
hospitals in the following priority order: 
‘‘(i) First, to other hospitals for the 
program or programs under which the hos-
pital had a cooperative arrangement with 
the closed hospital under which residents 
in the graduate medical education program 
of the closed hospital also rotated through 
the other hospital. 
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‘‘(ii) Second, to other hospitals that 
are members of the same affiliated group 
of hospitals as the closed hospital. 
‘‘(iii) Third, to other hospitals that 
are located in the same or contiguous core- 
based statistical area as the closed hos-
pital. 
‘‘(D) PREFERENCE.—After applying sub-
paragraph (C) and the special consideration 
under subparagraph (B), in determining for 
which hospitals the increase in the otherwise 
applicable resident limit is provided under sub-
paragraph (B), the Secretary shall give pref-
erence to hospitals— 
‘‘(i) that submit an application for 
new residents in primary care and geriatric 
medicine and in other specialties as deter-
mined to be in demand under subpara-
graph (B)(ii)(I); and 
‘‘(ii) that emphasize training in com-
munity health centers and other commu-
nity-based or hospital-sponsored clinics, 
and private physicians’ offices, including 
physician groups. 
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‘‘(E) PARAGRAPH (9) EFFECTIVE DATE DE-
FINED.—In this paragraph, the term ‘para-
graph (9) effective date’ means July 1 of the 
year that begins after the date of the enactment 
of this paragraph. 
‘‘(F) AFFILIATION.—The provisions of this 
paragraph shall be applied to hospitals which 
are members of the same affiliated group (as 
defined by the Secretary under paragraph 
(4)(H)(ii)) and the reference resident level for 
each such hospital with respect to the cost re-
porting period that results in the smallest dif-
ference between the reference resident level and 
the otherwise applicable resident limit.’’. 
SEC. 3. EXPANDING PRIMARY CARE BONUS TO CERTAIN 
UNDERSERVED SPECIALTIES. 
(a) IN GENERAL.—Section 1833(x)(2)(A) of the So-
cial Security Act (42 U.S.C. 1395l(x)(2)(A)) is amend-
ed— 
(1) in clause (i)— 
(A) by striking ‘‘or’’ at the end of sub-
clause (I); 
(B) by striking ‘‘and’’ at the end of sub-
clause (II) and inserting ‘‘or’’; and 
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(C) by adding at the end the following new 
subclause: 
‘‘(III) is a physician (as de-
scribed in section 1861(r)(1)) who is 
in an underserved specialty, such as 
psychiatry or neurology, as specified 
by the Secretary, or other specialty 
identified by the Secretary to be in 
demand; and’’; and 
(2) in clause (ii), by inserting after ‘‘(ii)’’ the 
following: ‘‘in the case of an individual described in 
subclause (I) or (II) of clause (i),’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to payments for items and serv-
ices furnished on or after January 1, 2012. 
SEC. 4. SMALL PHYSICIAN PRACTICE RESIDENCY CREDIT. 
(a) IN GENERAL.—Subpart D of part IV of sub-
chapter A of chapter 1 of the Internal Revenue Code of 
1986 (relating to business related credits) is amended by 
adding at the end the following new section: 
‘‘SEC. 45S. SMALL PHYSICIAN PRACTICE RESIDENCY CRED-
IT. 
‘‘(a) IN GENERAL.—For purposes of section 38, the 
amount of the small physician practice residency credit de-
termined under this section for any taxable year with re-
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spect to a qualified small physician practice is the sum 
of the following: 
‘‘(1) OVERALL AMOUNT.—The per resident dol-
lar amount multiplied by the number of qualified 
teaching hospital residents who provide services to, 
and are trained by, such practice during the taxable 
year and who are in their first, second, or third 
post-graduate year of medical residency. 
‘‘(2) BONUS.—The sum of— 
‘‘(A) 50 percent of the per resident dollar 
amount multiplied by the number of such resi-
dents who are in their first post-graduate year 
of medical residency during the taxable year; 
and 
‘‘(B) 25 percent of the per resident dollar 
amount multiplied by the average number of 
such residents who are not counted under sub-
paragraph (A) and are in their second post- 
graduate year during the taxable year. 
‘‘(b) QUALIFIED SMALL PHYSICIAN PRACTICE.—For 
purposes of this section, the term ‘qualified small physi-
cian practice’ means any trade or business of providing 
physicians’ services (as defined in section 1861(q) of the 
Social Security Act), which may be a community health 
center, that is owned and operated by a doctor of medicine 
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or osteopathy if fewer than 50 individuals are employed 
in such trade or business (including new training sites) 
and the trade or business includes as part of the practice 
the training of doctors of medicine or osteopathy in a rota-
tion covering at least 6 months in the taxable year. All 
persons treated as a single employer under subsection (a) 
or (b) or section 52 or subsection (m) or (o) of section 
414 shall be treated as a single trade or business for pur-
poses of the preceding sentence. 
‘‘(c) QUALIFIED TEACHING HOSPITAL RESIDENTS.— 
For purposes of this section, the term ‘qualified teaching 
hospital resident’ means any resident (within the meaning 
of subparagraph (I) of section 1886(h)(5) of the Social 
Security Act) in an approved medical residency training 
program (as defined in subparagraph (A) of such section) 
which provides services to the qualified small physician 
practice (while utilizing the technologies and supplies of 
such practice) for a period not less than— 
‘‘(1) 4 weeks in the case of a primary care resi-
dent (as defined in subparagraph (H) of such sec-
tion); or 
‘‘(2) 2 weeks in the case of any other resident. 
‘‘(d) PER RESIDENT DOLLAR AMOUNT.—For pur-
poses of this section, the term ‘per resident dollar amount’ 
means, in the case of a qualified small physician practice 
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that includes as part of the practice the training of doctors 
of medicine or osteopathy in a rotation covering— 
‘‘(1) at least 6 months but less than 9 months 
in the taxable year, $2,500; or 
‘‘(2) at least 9 months in the taxable year, 
$3,000. 
‘‘(e) RESIDENTS NOT TAKEN INTO ACCOUNT MORE 
THAN ONCE.—A qualified teaching hospital resident shall 
be taken into account under subsection (a) for the taxable 
in which the period described in subsection (c) ends and 
shall not be so taken into account for any other taxable 
year.’’. 
(b) CREDIT ALLOWED AS PART OF GENERAL BUSI-
NESS CREDIT.—Section 38(b) of such Code (defining cur-
rent year business credit) is amended by striking ‘‘plus’’ 
at the end of paragraph (35), by striking the period at 
the end of paragraph (36) and inserting ‘‘, plus’’, and by 
adding at the end the following new paragraph: 
‘‘(37) the small physician practice residency 
credit determined under section 45S(a).’’. 
(c) CONFORMING AMENDMENT.—The table of sec-
tions for subpart D of part IV of subchapter A of chapter 
1 of such Code is amended by adding at the end the fol-
lowing new item: 
‘‘Sec. 45S. Small physician practice residency credit.’’. 
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(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
the date of the enactment of this Act. 
Æ 
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