I 
111TH CONGRESS 
1ST SESSION H. R. 2033 
To apply an alternative payment amount under the Medicare Program for 
certain graduate medical education programs established to train resi-
dents displaced by natural disasters. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 22, 2009 
Mr. CASSIDY (for himself, Mr. ALEXANDER, Mr. BOUSTANY, Mr. CAO, Mr. 
FLEMING, Mr. MELANCON, and Mr. SCALISE) 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 apply an alternative payment amount under the Medicare 
Program for certain graduate medical education pro-
grams established to train residents displaced by natural 
disasters. 
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. ALTERNATIVE PAYMENT AMOUNTS FOR GRAD-
UATE MEDICAL EDUCATION PROGRAMS ES-
TABLISHED 
TO 
TRAIN 
RESIDENTS 
DIS-
PLACED BY NATURAL DISASTERS. 
(a) IN GENERAL.—Notwithstanding any other provi-
sion of law, in applying section 1886(h) of the Social Secu-
rity Act (42 U.S.C. 1395ww(h)), and any regulations im-
plementing such section, with respect to an eligible hos-
pital for a cost reporting period beginning on or after July 
1, 2005, the Secretary of Health and Human Services 
shall provide for payments for direct graduate education 
costs in accordance with subsection (c) for such hospital 
and cost reporting period. 
(b) ELIGIBLE HOSPITAL DEFINED.—In this section, 
the term ‘‘eligible hospital’’ means a hospital that— 
(1) did not have an approved medical residency 
training 
program 
as 
defined 
under 
section 
1886(h)(5)(A) of the Social Security Act (42 U.S.C. 
1395ww(h)(5)(A)) before the date of a presidential 
declaration of major disaster issued under section 
401 of the Robert T. Stafford Disaster Relief and 
Emergency Assistance Act; 
(2) first participated in such a program to edu-
cate residents displaced from a graduate medical 
education program impacted by such disaster; and 
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(3) is located in a wage area, as defined by the 
Secretary, that is in, or immediately adjacent to, an 
area for which such disaster was declared. 
(c) PAYMENT TO ELIGIBLE HOSPITALS.—The pay-
ment amount for an eligible hospital for a cost reporting 
period in which the hospital operates a graduate medical 
education program referred to in subsection (b)(2) shall 
be— 
(1) for the first such cost reporting period, the 
reasonable costs (as determined based on rules ap-
plied in determining reasonable costs under section 
1886(h)(2)(A) of the Social Security Act (42 U.S.C. 
1395ww(h)(2)(A))) incurred by the hospital for such 
program; 
(2) for the second such cost reporting period, 
computed based on an alternative FTE resident 
amount 
calculated 
as 
described 
in 
section 
1886(h)(2)(A) of the Social Security Act (42 U.S.C. 
1395ww(h)(2)(A)), but using the reasonable costs 
incurred by the hospital for such program during 
such second cost reporting period and the number of 
FTE 
residents 
(as 
described 
in 
paragraphs 
(3)(B)(ii) and (4)(E) of section 1886(h) of the So-
cial Security Act (42 U.S.C. 1395ww(h))) in the 
program for such second cost reporting period; and 
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(3) for the third such cost reporting period and 
each subsequent cost reporting period, computed 
based on the alternative FTE resident amount under 
this section for the previous cost reporting period, 
updated and adjusted as described in section 
1886(h)(2)(D) of the Social Security Act (42 U.S.C. 
1395ww(h)(2)(D)). 
Æ 
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