Title: Supporting Graduate Medical Education at Community Hospitals Act of 2018
Policy area: Health

Summary:
Supporting Graduate Medical Education at Community Hospitals Act of 2018
This bill revises payment rules under Medicare for graduate medical education (GME) costs with respect to a hospital that establishes a new medical residency training program.
If a hospital has not entered into a GME affiliation agreement, the Centers for Medicare & Medicaid Services (CMS) must establish the hospital's full-time equivalent (FTE) resident amount only after determining that the hospital's medical residency training program trains more than 1.0 FTE resident in a cost reporting period. If a hospital has an approved FTE resident amount that is based on other specified thresholds, the CMS must give the hospital the opportunity to have the amount reestablished when the hospital begins training FTE residents in excess of the applicable threshold.
The bill also establishes similar thresholds for new determinations of certain adjustments to hospital payment limitations regarding FTE residents in allopathic and osteopathic medicine; a hospital that has an adjustment has the opportunity to have it redetermined once the applicable threshold is exceeded.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 3305 Introduced in Senate (IS)]

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115th CONGRESS
  2d Session
                                S. 3305

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 SENATE OF THE UNITED STATES

                             July 31, 2018

  Mr. Menendez (for himself and Mr. Booker) introduced the following 
  bill; which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 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 Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Supporting Graduate Medical 
Education at Community Hospitals Act of 2018''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) Graduate Medical Education or ``GME'' training programs 
        are of critical importance in developing the physician 
        workforce.
            (2) Current caps on GME training programs under Medicare 
        have been in place since 1997.
            (3) Hospitals seeking to launch GME training programs face 
        barriers in establishing physician training programs in 
        community hospitals.

SEC. 3. MEDICARE GME TREATMENT OF HOSPITALS ESTABLISHING NEW MEDICAL 
              RESIDENCY TRAINING PROGRAMS AFTER HOSTING MEDICAL 
              RESIDENT ROTATORS FOR SHORT DURATIONS.

    (a) Redetermination of Approved FTE Resident Amount.--Section 
1886(h)(2)(F) of the Social Security 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 to a hospital 
                that has not entered into a GME affiliation agreement 
                (as defined by the Secretary for purposes of paragraph 
                (4)(H)(ii)), the Secretary shall not provide for the 
                establishment of an FTE resident amount until such time 
                as the Secretary determines that the hospital has a 
                medical residency training program that trains more 
                than 1.0 full-time-equivalent resident in a cost 
                reporting period.
                    ``(iii) In the case of a hospital with an approved 
                FTE resident amount--
                            ``(I) based on the training of less than 
                        1.0 full-time-equivalent resident before 
                        October 1, 1997, or
                            ``(II) based on the training of no more 
                        than--
                                    ``(aa) for any cost reporting 
                                period beginning on or after October 1, 
                                1996, and before October 1, 1997, 6.0 
                                full-time-equivalent residents in a 
                                medical residency training program, or
                                    ``(bb) for any cost reporting 
                                period beginning on or after October 1, 
                                1997, 3.0 full-time-equivalent 
                                residents in a medical residency 
                                training program, or
                            ``(III) based on the training of no full-
                        time-equivalent residents in a medical 
                        residency training program for any ten 
                        consecutive cost reporting periods beginning on 
                        or after October 1, 1997,
                the Secretary shall provide the hospital an opportunity 
                to have a new FTE resident amount established when the 
                hospital begins training at least 1.0 full-time-
                equivalent resident (in the case of a hospital 
                described in subclauses (I or III)) or more than 3.0 
                full-time-equivalent residents (in the case of a 
                hospital described in subclause (II)) for cost 
                reporting periods beginning on or after the date of the 
                enactment of this clause and in accordance with the 
                methodology under the rules in effect as of October 1, 
                2015.''.
    (b) Redetermination of FTE Resident Limitation.--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) Under this clause the Secretary 
                        shall not determine an adjustment in the 
                        limitation applicable to a hospital under 
                        subparagraph (F) until the hospital trains more 
                        than 1.0 full-time-equivalent resident in a new 
                        medical residency training program in a cost 
                        reporting period.
                            ``(III) In the case of a hospital that has 
                        a limitation under subparagraph (F) of less 
                        than 1.0 full-time-equivalent resident as of 
                        the date of the enactment of this subclause 
                        based on training before October 1, 1997, under 
                        this clause the Secretary shall provide the 
                        hospital an opportunity to have a new 
                        adjustment in such limitation determined when 
                        such hospital begins training at least 1.0 
                        full-time-equivalent resident in accordance 
                        with the methodology applicable to hospitals 
                        under the rules in effect as of October 1, 
                        2015, and applied for cost reporting periods 
                        beginning on or after the date of the enactment 
                        of this subclause.
                            ``(IV) In the case of a hospital that has 
                        not reported full-time-equivalent residents in 
                        ten consecutive cost reporting periods 
                        subsequent to October 1, 1997, under this 
                        clause the Secretary shall provide the hospital 
                        an opportunity to have a new adjustment in such 
                        limitation determined when such hospital begins 
                        training at least 1.0 full-time-equivalent 
                        resident in accordance with the methodology 
                        applicable to hospitals under the rules in 
                        effect as of October 1, 2015, and applied for 
                        cost reporting periods beginning on or after 
                        the date of the enactment of this subclause.
                            ``(V) In the case of a hospital for which 
                        an adjustment in the limitation applicable to a 
                        hospital under subparagraph (F) is based on the 
                        training of no more than 3.0 full-time-
                        equivalent residents in a new medical residency 
                        training program in a cost reporting period 
                        beginning on or after October 1, 1997, and 
                        before the date of the enactment of this 
                        subclause, the Secretary shall provide the 
                        hospital an opportunity to have a new 
                        adjustment in such limitation determined when 
                        the hospital begins training more than 3.0 
                        full-time-equivalent residents in accordance 
                        with the methodology applicable to hospitals 
                        under the rules in effect as of October 1, 
                        2015, and applied for cost reporting periods 
                        beginning on or after the date of the enactment 
                        of this subclause.''.
    (c) 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 reporting periods beginning on or after the 
date of the enactment of this Act.
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