clause (ii)(IV), the Secretary shall give pri-
ority to hospitals that are affiliated with— 
‘‘(I) a historically Black medical 
school (as defined in subparagraph 
(H)); or 
‘‘(II) any other school listed in 
section 326(e)(1) of the Higher Edu-
cation Act of 1965 that establishes a 
medical college. 
‘‘(D) PROHIBITION ON DISTRIBUTION TO 
HOSPITALS
WITHOUT
AN
INCREASE
AGREE-
MENT.—No increase in the otherwise applicable 
resident limit of a hospital may be made under 
subparagraph (C) unless such hospital agrees to 
increase the total number of full-time equivalent 
residency positions under the approved medical 
residency training program of such hospital by 
the number of such positions made available by 
such increase under the subparagraph. 
‘‘(E) LIMITATION.— 
‘‘(i) IN
GENERAL.—Except as pro-
vided in clause (ii), a hospital may not re-
ceive more than 75 full-time equivalent ad-
ditional residency positions in the aggre-
gate under this paragraph, paragraph (9), 
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and paragraph (10) over the period of fis-
cal years 2025 through 2031. 
‘‘(ii) INCREASE IN NUMBER OF ADDI-
TIONAL POSITIONS A HOSPITAL MAY RE-
CEIVE.—The Secretary shall increase the 
aggregate number of full-time equivalent 
additional residency positions a hospital 
may receive under this paragraph over 
such period if the Secretary estimates that 
the number of positions available for dis-
tribution under subparagraph (A) exceeds 
the number of applications approved under 
such subparagraph over such period. 
‘‘(F) APPLICATION
OF
PER
RESIDENT 
AMOUNTS
FOR
PRIMARY
CARE
AND
NONPRI-
MARY CARE.—With respect to additional resi-
dency positions in a hospital attributable to the 
increase provided under this paragraph, the ap-
proved FTE per resident amounts are deemed 
to be equal to the hospital per resident amounts 
for primary care and nonprimary care com-
puted under paragraph (2)(D) for that hospital. 
‘‘(G) PERMITTING
FACILITIES
TO
APPLY 
AGGREGATION
RULES.—The Secretary shall 
permit hospitals receiving additional residency 
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positions attributable to the increase provided 
under this paragraph to, beginning in the fifth 
year after the effective date of such increase, 
apply such positions to the limitation amount 
under paragraph (4)(F) that may be aggre-
gated pursuant to paragraph (4)(H) among 
members of the same affiliated group. 
‘‘(H) DEFINITIONS.—In this paragraph: 
‘‘(i) OTHERWISE
APPLICABLE
RESI-
DENT LIMIT.—The term ‘otherwise appli-
cable resident limit’ means, with respect to 
a hospital, the limit otherwise applicable 
under subparagraphs (F)(i) and (H) of 
paragraph (4) on the resident level for the 
hospital determined without regard to this 
paragraph but taking into account para-
graphs (7)(A), (7)(B), (8)(A), (8)(B), (9), 
(10)(A). and (10)(B). 
‘‘(ii) REFERENCE RESIDENT LEVEL.— 
Except as otherwise provided in subclause 
(II), the term ‘reference resident level’ 
means, with respect to a hospital, the resi-
dent level for the most recent cost report-
ing period of the hospital ending on or be-
fore the date of enactment of this para-
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graph, for which a cost report has been 
settled (or, if not, submitted (subject to 
audit)), as determined by the Secretary. 
‘‘(iii) RESIDENT
LEVEL.—The term 
‘resident level’ has the meaning given such 
term in paragraph (7)(C)(i). 
‘‘(iv) QUALIFYING
HOSPITAL.—The 
term ‘qualifying hospital’ means a hospital 
described in subparagraph (B)(i) or any of 
subclauses (I) through (IV) of subpara-
graph (C)(ii). 
‘‘(v) HISTORICALLY BLACK MEDICAL 
SCHOOL.—The term ‘historically Black 
medical school’ means Howard University 
College of Medicine, Charles R. Drew Uni-
versity of Medicine and Science, Meharry 
Medical College, Morehouse School of Med-
icine, Xavier University Graduate School 
of Health Sciences and Medical School, 
and Maryland College of Osteopathic Medi-
cine at Morgan State University.’’. 
(b) IME.—Section 1886(d)(5)(B) of the Social Secu-
rity Act (42 U.S.C. 1395ww(d)(5)(B)) is amended— 
(1) in clause (v), in the third sentence, by strik-
ing ‘‘subsections (h)(7), (h)(8), (h)(9), and (h)(10)’’ 
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and inserting ‘‘subsections (h)(7), (h)(8), (h)(9), 
(h)(10), and (h)(11)’’; and 
(2) by adding after clause (xiii) the following 
new clause: 
‘‘(xiv) For discharges occurring on or 
after July 1, 2026, insofar as an additional 
payment amount under this subparagraph 
is attributable to resident positions distrib-
uted to a hospital under subsection 
(h)(11), the indirect teaching adjustment 
factor shall be computed in the same man-
ner as provided under clause (ii) with re-
spect to such resident positions.’’. 
SEC. 3. STUDY AND REPORT ON STRATEGIES FOR INCREAS-
ING DIVERSITY. 
(a) STUDY.—The Comptroller General of the United 
States (in this section referred to as the ‘‘Comptroller 
General’’) shall conduct a study on strategies for increas-
ing the diversity of the health professional workforce. Such 
study shall include an analysis of strategies for increasing 
the number of health professionals from rural, lower in-
come, and underrepresented minority communities, includ-
ing which strategies are most effective for achieving such 
goal. 
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