I 
117TH CONGRESS 
2D SESSION 
H. R. 8508 
To amend title XVIII of the Social Security Act to support rural residency 
training funding that is equitable for all States, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 26, 2022 
Mr. O’HALLERAN (for himself and Mrs. HARSHBARGER) introduced the fol-
lowing 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 consider-
ation of such provisions as fall within the jurisdiction of the committee 
concerned 
A BILL 
To amend title XVIII of the Social Security Act to support 
rural residency training funding that is equitable for 
all States, 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 ‘‘Rural Physician Work-
force Production Act of 2022’’. 
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SEC. 2. ELECTIVE RURAL SUSTAINABILITY PER RESIDENT 
PAYMENT 
FOR 
RESIDENTS 
TRAINING 
IN 
RURAL TRAINING LOCATIONS. 
(a) IN GENERAL.—Section 1886 of the Social Secu-
rity Act (42 U.S.C. 1395ww) is amended by adding at the 
end the following new subsection: 
‘‘(u) ELECTIVE RURAL SUSTAINABILITY PER RESI-
DENT PAYMENT AMOUNT FOR RESIDENTS TRAINING IN 
RURAL TRAINING LOCATIONS.— 
‘‘(1) DETERMINATION
OF
ELECTIVE
RURAL 
SUSTAINABILITY
PER
RESIDENT
PAYMENT 
AMOUNT.— 
‘‘(A) IN GENERAL.—The elective rural sus-
tainability per resident payment amount deter-
mined under this subsection for an applicable 
hospital (as defined in paragraph (7)(A)) that 
makes an election under paragraph (2), with re-
spect to each full-time-equivalent resident in an 
approved medical residency training program 
that receives training in a rural training loca-
tion (as defined in paragraph (7)(C)), is an 
amount equal to the difference between— 
‘‘(i) the total elective rural sustain-
ability amount determined under subpara-
graph (B) (or, in the case of an applicable 
hospital not located in a rural area, the 
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total elective rural sustainability amount or 
urban total elective rural sustainability 
amount, as applicable, determined under 
such subparagraph); and 
‘‘(ii) the amount (if any) the applica-
ble hospital otherwise receives for direct 
graduate medical education costs under 
subsection (h) or section 1814(l), as appli-
cable, with respect to each such resident. 
‘‘(B) TOTAL
ELECTIVE
RURAL
SUSTAIN-
ABILITY AMOUNT.— 
‘‘(i) ESTABLISHMENT
FOR
INITIAL 
COST REPORTING PERIODS.— 
‘‘(I) IN
GENERAL.—Subject to 
subclause (II), for cost reporting peri-
ods beginning during the first year be-
ginning on or after the date of the en-
actment of this subsection, the Sec-
retary shall establish a total elective 
rural sustainability amount for time 
spent by each full-time-equivalent resi-
dent in an approved medical residency 
training program that receives train-
ing in a rural training location. Such 
amount shall be the amount that the 
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Secretary determines is equal to the 
median national direct GME training 
costs per full-time equivalent resident 
for 2015 described in table 9 on page 
33 of the March 2018 GAO report on 
Physician Workforce (GAO–18–240), 
updated for each subsequent year 
through the first year beginning on or 
after the date of the enactment of this 
subsection, by the annual percentage 
increase in the consumer price index 
for all urban consumers (all items; 
United States city average). 
‘‘(II) APPLICATION
TO
URBAN 
HOSPITALS.—For cost reporting peri-
ods beginning during the first year be-
ginning on or after the date of the en-
actment of this subsection, in the case 
of an applicable hospital that is not 
located in a rural area— 
‘‘(aa) with respect to such 
residents that receive training in 
a rural track or an integrated 
rural track, the total elective 
rural sustainability amount per 
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resident shall be equal to the 
amount established under sub-
clause (I); and 
‘‘(bb) with respect to such 
residents that receive training in 
a rural training location and who 
are not participating in a rural 
track or an integrated rural 
track, the total elective rural sus-
tainability amount per resident 
shall be equal to 50 percent of 
the amount established under 
subclause (I) (referred to in this 
subsection as the ‘urban total 
elective 
rural 
sustainability 
amount’). 
‘‘(ii) UPDATING
FOR
SUBSEQUENT 
COST REPORTING PERIODS.—For each sub-
sequent cost reporting period, the total 
elective rural sustainability amount under 
clause (i)(I) and clause (i)(II)(aa) and the 
urban total elective rural sustainability 
amount under clause (i)(II)(bb), respec-
tively, are equal to such amounts deter-
mined under such clause for the previous 
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