II 117th CONGRESS 2d Session S. 5041 IN THE SENATE OF THE UNITED STATES September 29, 2022 Ms. Stabenow (for herself, Mr. Daines , and Mr. Menendez ) 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 provide for the distribution of additional residency positions in psychiatry and subspecialties.

1. Short title This Act may be cited as the Training Psychiatrists for the Future Act . 2. Distribution of additional residency positions in psychiatry and psychiatry subspecialties (a) In general Section 1886(h) of the Social Security Act ( 42 U.S.C. 1395ww(h) ) is amended— (1) in paragraph (4)(F)(i), by striking and (9) and inserting (9), and (10) ; (2) in paragraph (4)(H)(i), by striking and (9) and inserting (9), and (10) ; and (3) by adding at the end the following new paragraph: (10) Distribution of additional residency positions in psychiatry and psychiatry subspecialties (A) Additional residency positions (i) In general For fiscal year 2025, and for each succeeding fiscal year until the aggregate number of full-time equivalent residency positions distributed under this paragraph is equal to the aggregate number of such positions made available (as specified in clause (ii)(I)), the Secretary shall, subject to the succeeding provisions of this paragraph, increase the otherwise applicable resident limit for each qualifying hospital (as defined in subparagraph (F)) that submits a timely application under this subparagraph by such number as the Secretary may approve effective beginning July 1 of the fiscal year of the increase. (ii) Number available for distribution (I) Total number available The aggregate number of such positions made available under this paragraph shall be equal to 400. (II) Annual limit The aggregate number of such positions so made available shall not exceed 200 for a fiscal year. (iii) Distribution for psychiatry or psychiatry subspecialty residencies Each of the positions made available under this paragraph shall be in a psychiatry or psychiatry subspecialty residency (as defined in subparagraph (F)). (iv) Process for distributing positions (I) Rounds of applications The Secretary shall initiate a separate round of applications for an increase under clause (i) for each fiscal year for which such an increase is to be provided. (II) Timing The Secretary shall notify hospitals of the number of positions distributed to the hospital under this paragraph as a result of an increase in the otherwise applicable resident limit by January 31 of the fiscal year of the increase. Such increase shall be effective beginning July 1 of such fiscal year. (B) Distribution For purposes of providing an increase in the otherwise applicable resident limit under subparagraph (A), the following shall apply: (i) Considerations in distribution In determining for which qualifying hospitals such an increase is provided under subparagraph (A), the Secretary shall take into account the demonstrated likelihood of the hospital filling the positions made available under this paragraph within the first 5 training years beginning after the date the increase would be effective, as determined by the Secretary. (ii) Distribution for certain categories of hospitals With respect to the aggregate number of such positions available for distribution under this paragraph, the Secretary shall distribute such aggregate number to the following categories of hospitals: (I) To hospitals that are located in a rural area (as defined in section 1886(d)(2)(D)) or are treated as being located in a rural area pursuant to section 1886(d)(8)(E). (II) To hospitals in which the reference resident level of the hospital (as specified in subparagraph (F)(iv)) is greater than the otherwise applicable resident limit. (III) To hospitals in States with— (aa) new medical schools that received Candidate School status from the Liaison Committee on Medical Education or that received Pre-Accreditation status from the American Osteopathic Association Commission on Osteopathic College Accreditation on or after January 1, 2000, and that have achieved or continue to progress toward Full Accreditation status (as such term is defined by the Liaison Committee on Medical Education) or toward Accreditation status (as such term is defined by the American Osteopathic Association Commission on Osteopathic College Accreditation); or (bb) additional locations and branch campuses established on or after January 1, 2000, by medical schools with Full Accreditation status (as such term is defined by the Liaison Committee on Medical Education) or Accreditation status (as such term is defined by the American Osteopathic Association Commission on Osteopathic College Accreditation). (IV) To hospitals that serve areas designated as health professional shortage areas under section 332(a)(1)(A) of the Public Health Service Act, as determined by the Secretary. (V) To hospitals located in States with less than 27 residents per 100,000 people. (C) Requirements (i) In general Subject to clause (ii), a hospital that receives an increase in the otherwise applicable resident limit under this paragraph shall ensure, during the 5-year period beginning on the date of such increase, that— (I) the number of full-time equivalent residents in a psychiatry or psychiatry subspecialty residency (as defined in subparagraph (F)), excluding any additional positions attributable to an increase under this paragraph, is not less than the average number of full-time equivalent residents in such a residency during the 3 most recent cost reporting periods ending prior to the date of enactment of this paragraph; and (II) all of the positions attributable to such increase are in a psychiatry or psychiatry subspecialty residency (as determined by the Secretary). The Secretary may determine whether a hospital has met the requirements under this clause during such 5-year period in such manner and at such time as the Secretary determines appropriate, including at the end of such 5-year period. (ii) Redistribution of positions if hospital no longer meets certain requirements In the case where the Secretary determines that a hospital described in clause (i) does not meet either of the requirements under subclause (I) or (II) of such clause, the Secretary shall— (I) reduce the otherwise applicable resident limit of the hospital by the amount by which such limit was increased under this paragraph; and (II) provide for the distribution of positions attributable to such reduction in accordance with the requirements of this paragraph. (iii) Limitation A hospital may not receive more than 10 additional full-time equivalent residency positions under this paragraph. (iv) Prohibition on distribution to hospitals without an increase agreement No increase in the otherwise applicable resident limit of a hospital may be made under this paragraph 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 this paragraph. (D) Application of per resident amounts for nonprimary care With respect to additional residency positions in a hospital attributable to the increase provided under this paragraph, the approved FTE per resident amounts are deemed to be equal to the hospital per resident amounts for nonprimary care computed under paragraph (2)(D) for that hospital. (E) Permitting facilities to apply aggregation rules The Secretary shall permit hospitals receiving additional residency 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 aggregated pursuant to paragraph (4)(H) among members of the same affiliated group. (F) Definitions In this paragraph: (i) Otherwise applicable resident limit The term otherwise applicable 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 paragraphs (7)(A), (7)(B), (8)(A), (8)(B), and (9)(A). (ii) Psychiatry or psychiatry subspecialty residency The term psychiatry or psychiatry subspecialty residency means a residency in psychiatry as accredited by the Accreditation Council for Graduate Medical Education for the purpose of preventing, diagnosing, and treating mental health disorders. (iii) Qualifying hospital The term qualifying hospital means a hospital described in any of subclauses (I) through (V) of subparagraph (B)(ii). (iv) Reference resident level The term reference resident level means, with respect to a hospital, the resident level for the most recent cost reporting period of the hospital ending on or before the date of enactment of this paragraph, for which a cost report has been settled (or, if not, submitted (subject to audit)), as determined by the Secretary. (v) Resident level The term resident level has the meaning given such term in paragraph (7)(C)(i). . (b) IME Section 1886(d)(5)(B) of the Social Security Act ( 42 U.S.C. 1395ww(d)(5)(B) ) is amended— (1) in clause (v), in the third sentence, by striking and (h)(9) and inserting (h)(9), and (h)(10) ; (2) by moving clause (xii) 4 ems to the left; and (3) by adding at the end the following new clause: (xiii) For discharges occurring on or after July 1, 2024, insofar as an additional payment amount under this subparagraph is attributable to resident positions distributed to a hospital under subsection (h)(10), the indirect teaching adjustment factor shall be computed in the same manner as provided under clause (ii) with respect to such resident positions. . (c) Prohibition on judicial review Section 1886(h)(7)(E) of the Social Security Act (42 U.S.C. 1395ww—4(h)(7)(E)) is amended by inserting paragraph (10), after paragraph (8), .