Physician Shortage GME Cap Flex Act of 2021
Bill: H.R.4014 | Sponsor: Rep. Ruiz, Raul (D-CA)
Policy area: Health

Summary:
Physician Shortage GME Cap Flex Act of 2021
This bill excludes certain hospitals that establish shortage specialty programs from the cap on full-time equivalent residents that is otherwise applicable, and provides for a new building period, for purposes of graduate medical education payments under Medicare.

To provide for a new building period with respect to the cap on full-
time equivalent residents for purposes of payment for graduate medical 
 education costs under the Medicare program for certain hospitals that 
             have established a shortage specialty program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Physician Shortage GME Cap Flex Act 
of 2021''.

SEC. 2. PROVIDING FOR A NEW BUILDING PERIOD WITH RESPECT TO THE CAP ON 
              FULL-TIME EQUIVALENT RESIDENTS FOR CERTAIN HOSPITALS THAT 
              HAVE ESTABLISHED A SHORTAGE SPECIALTY PROGRAM.

    Section 1886(h)(4) of the Social Security Act (42 U.S.C. 
1395ww(h)(4)) is amended by adding at the end the following new 
subparagraph:
                    ``(L) Treatment of certain qualifying hospitals.--
                            ``(i) In general.--For purposes of applying 
                        this paragraph and section 413.79 of title 42, 
                        Code of Federal Regulations (or a successor 
                        regulation), the Secretary shall treat, subject 
                        to clause (ii), a qualifying hospital (as 
                        defined in clause (iii)) with an approved 
                        medical residency training program as if such 
                        hospital--
                                    ``(I) had no allopathic or 
                                osteopathic residents in its most 
                                recent cost reporting period ending on 
                                or before December 31, 1996; and
                                    ``(II) began training residents for 
                                the first time in a new medical 
                                residency training program (as defined 
                                in paragraph (l) of such section) 
                                beginning on the date on which such 
                                hospital became a qualifying hospital.
                            ``(ii) Special rule for qualifying 
                        hospitals in cap-building period.--In the case 
                        of a qualifying hospital with an approved 
                        medical residency training program that, 
                        excluding the treatment described in clause 
                        (i), is a hospital that had no allopathic or 
                        osteopathic residents in its most recent cost 
                        reporting period ending on or before December 
                        31, 1996, and began training residents for the 
                        first time in a new medical residency training 
                        program (as defined in paragraph (l) of such 
                        section) during the 5-year period ending on the 
                        date described in clause (i)(II) with respect 
                        to such hospital, in lieu of applying such 
                        clause, the Secretary shall provide that the 
                        provisions of subsection (e) of section 413.79 
                        of title 42, Code of Federal Regulations (or a 
                        successor regulation), shall apply with respect 
                        to such hospital for an additional 5 years 
                        beyond the period during which such provisions 
                        would otherwise have applied to such hospital.
                            ``(iii) Definition.--In this subparagraph:
                                    ``(I) Qualifying hospital.--The 
                                term `qualifying hospital' means a 
                                hospital that--
                                            ``(aa) establishes a 
                                        shortage specialty program (as 
                                        defined in subclause (II)) 
                                        during the 5-year period 
                                        beginning on the date of the 
                                        enactment of this subparagraph; 
                                        and
                                            ``(bb) submits an 
                                        application to the Secretary 
                                        during such period containing 
                                        such information as the 
                                        Secretary may specify.
                                    ``(II) Shortage specialty 
                                program.--The term `shortage specialty 
                                program' means, with respect to a 
                                hospital located in a geographic area 
                                (as defined by the Secretary), any 
                                approved residency training program in 
                                a specialty for which the Secretary 
                                determines that there is a shortage of 
                                physicians practicing such specialty in 
                                such area at the time such program is 
                                established. In making such a 
                                determination, the Secretary shall take 
                                into account whether such hospital is 
                                located in an area--
                                            ``(aa) without adequate 
                                        health care resources (such as 
                                        in a rural area or a medically 
                                        underserved area (as defined by 
                                        the Administrator of the Health 
                                        Resources and Services 
                                        Administration));
                                            ``(bb) experiencing primary 
                                        care or specialty physician 
                                        shortages (such as in a health 
                                        professional shortage area (as 
                                        defined in section 332(a) of 
                                        the Public Health Service Act 
                                        (42 U.S.C. 254e(a))));
                                            ``(cc) without an adequate 
                                        number of approved residency 
                                        training programs;
                                            ``(dd) struggling to expand 
                                        or keep approved residency 
                                        training programs operational;
                                            ``(ee) lacking existing 
                                        medical training infrastructure 
                                        or in the process of building 
                                        such infrastructure;
                                            ``(ff) with a low resident-
                                        to-population ratio;
                                            ``(gg) with few full-time 
                                        equivalent resident positions; 
                                        or
                                            ``(hh) with a low 
                                        physician-to-population ratio 
                                        for physicians practicing in 
                                        the same specialty as the 
                                        shortage specialty program 
                                        concerned.''.
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