Title: Advancing Medical Resident Training in Community Hospitals Act of 2018
Policy area: Health

Summary:
Advancing Medical Resident Training in 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]
[H.R. 6056 Introduced in House (IH)]

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115th CONGRESS
  2d Session
                                H. R. 6056

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 8, 2018

Mr. Gottheimer (for himself, Mr. MacArthur, Mr. Pascrell, Mr. Norcross, 
  Mrs. Watson Coleman, and Mr. Lance) 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 
                               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 Representatives 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 2018''.

SEC. 2. 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 3.0 full-time-equivalent 
                                residents in a new medical residency 
                                training program in any cost reporting 
                                period beginning on or after October 1, 
                                1997, and before the date of the 
                                enactment of this clause, 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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