I 
116TH CONGRESS 
1ST SESSION H. R. 3425 
To amend title XVIII of the Social Security Act to establish rules for payment 
for graduate medical education (GME) costs for hospitals that establish 
a new medical residency training program after hosting resident rotators 
for short durations. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 21, 2019 
Mr. KIND (for himself and Mr. HOLDING) 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 provi-
sions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to establish 
rules for payment for graduate medical education (GME) 
costs for hospitals that establish a new medical residency 
training program after hosting resident rotators for short 
durations. 
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 ‘‘Advancing Medical 
Resident Training in Community Hospitals Act of 2019’’. 
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SEC. 2. MEDICARE GME TREATMENT OF HOSPITALS ESTAB-
LISHING NEW MEDICAL RESIDENCY TRAIN-
ING PROGRAMS AFTER HOSTING MEDICAL 
RESIDENT ROTATORS FOR SHORT DURA-
TIONS. 
(a) REDETERMINATION OF APPROVED FTE RESI-
DENT AMOUNT.—Section 1886(h)(2)(F) of the Social Se-
curity Act (42 U.S.C. 1395ww(h)(2)(F)) is amended— 
(1) by inserting ‘‘(i)’’ before ‘‘In the case of’’; 
and 
(2) by adding at the end the following: 
‘‘(ii) In applying this subparagraph in the 
case of a hospital that, on or after the date of 
the enactment of this clause, begins to train 
residents and has not entered into a GME af-
filiation agreement (as defined by the Secretary 
for purposes of paragraph (4)(H)(ii)), the Sec-
retary shall not establish an FTE resident 
amount until such time as the Secretary deter-
mines that the hospital has trained at least 1.0 
full-time-equivalent resident in an approved 
medical residency training program in a cost re-
porting period. 
‘‘(iii) In applying this subparagraph for 
cost reporting periods beginning on or after the 
date of enactment of this clause, in the case of 
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a hospital that, as of such date of enactment, 
has an approved FTE resident amount based 
on the training in an approved medical resi-
dency program of— 
‘‘(I) less than 1.0 full-time-equivalent 
resident in any cost reporting period begin-
ning before October 1, 1997, as deter-
mined by the Secretary; or 
‘‘(II) no more than 3.0 full-time- 
equivalent residents in any cost reporting 
period beginning on or after October 1, 
1997, and before the date of the enactment 
of this clause, as determined by the Sec-
retary, 
in lieu of such FTE resident amount the Sec-
retary shall, in accordance with the method-
ology described in section 413.77(e) of title 42 
of the Code of Federal Regulations (or any suc-
cessor regulation), establish a new FTE resi-
dent amount if the hospital trains at least 1.0 
full-time-equivalent resident (in the case of a 
hospital described in subclause (I)) or more 
than 3.0 full-time-equivalent residents (in the 
case of a hospital described in subclause (II)) in 
a cost reporting period beginning on or after 
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such date of enactment and before the date that 
is 5 years after such date of enactment. 
‘‘(iv) For purposes of carrying out this 
subparagraph for cost reporting periods begin-
ning on or after the date of the enactment of 
this clause, a hospital shall report full-time- 
equivalent residents on its cost report for a cost 
reporting period if the hospital trains at least 
1.0 full-time-equivalent residents in an ap-
proved medical residency training program in 
such period. 
‘‘(v) As appropriate, the Secretary may 
consider information from any cost reporting 
period necessary to establish a new FTE resi-
dent amount as described in clause (iii).’’. 
(b) REDETERMINATION OF FTE RESIDENT LIMITA-
TION.—Section 1886(h)(4)(H)(i) of the Social Security 
Act (42 U.S.C. 1395ww(h)(4)(H)(i)) is amended— 
(1) by inserting ‘‘(I)’’ before ‘‘The Secretary’’; 
and 
(2) by adding at the end the following: 
‘‘(II) In applying this clause in the 
case of a hospital that, on or after the date 
of the enactment of this subclause, begins 
to train residents in a new approved med-
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ical residency training program (as defined 
by the Secretary), the Secretary shall not 
determine a limitation applicable to the 
hospital under subparagraph (F) until 
such time as the Secretary determines that 
the hospital has trained at least 1.0 full- 
time-equivalent resident in such new ap-
proved medical residency training program 
in a cost reporting period. 
‘‘(III) In applying this clause in the 
case of a hospital that, as of the date of 
the enactment of this subclause, has a lim-
itation under subparagraph (F), based on 
a cost reporting period beginning before 
October 1, 1997, of less than 1.0 full-time- 
equivalent resident, the Secretary shall ad-
just the limitation in the manner applica-
ble to a new approved medical residency 
training program if the Secretary deter-
mines the hospital trains at least 1.0 full- 
time-equivalent residents in a program 
year beginning on or after such date of en-
actment and before the date that is 5 years 
after such date of enactment. 
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‘‘(IV) In applying this clause in the 
case of a hospital that, as of the date of 
the enactment of this subclause, has a lim-
itation under subparagraph (F), based on 
a cost reporting period beginning on or 
after October 1, 1997, and before such 
date of enactment, of no more than 3.0 
full-time-equivalent residents, the Sec-
retary shall adjust the limitation in the 
manner applicable to a new approved med-
ical residency training program if the Sec-
retary determines the hospital begins train-
ing more than 3.0 full-time-equivalent resi-
dents in a program year beginning on or 
after such date of enactment and before 
the date that is 5 years after such date of 
enactment. 
‘‘(V) An adjustment to the limitation 
applicable to a hospital made pursuant to 
subclause (III) or (IV) shall be made in a 
manner consistent with the methodology, 
as appropriate, in section 413.79(e) of title 
42, Code of Federal Regulations (or any 
successor regulation). As appropriate, the 
Secretary may consider information from 
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any cost reporting periods necessary to 
make such an adjustment to the limita-
tion.’’. 
(c) TECHNICAL AND CONFORMING AMENDMENTS.— 
Section 1886 of the Social Security Act (42 U.S.C. 
1395ww) is amended— 
(1) in subsection (d)(5)(B)(viii), by striking 
‘‘subsection (h)(4)(H)’’ and inserting ‘‘paragraphs 
(2)(F)(iv) and (4)(H) of subsection (h)’’; and 
(2) in subsection (h)— 
(A) in paragraph (4)(H)(iv), by striking 
‘‘an rural area’’ and inserting ‘‘a rural area’’; 
and 
(B) in paragraph (7)(E), by striking 
‘‘under this’’ and all that follows through the 
period at the end and inserting the following: 
‘‘under this paragraph, paragraph (8), clause 
(i), (ii), (iii), or (v) of paragraph (2)(F), or 
clause (i) or (vi) of paragraph (4)(H).’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to payment under section 1886 of 
the Social Security Act (42 U.S.C. 1395ww) for cost re-
porting periods beginning on or after the date of the en-
actment of this Act. 
Æ 
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