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Statutory Text

SEC. 5503. DISTRIBUTION OF ADDITIONAL RESIDENCY POSITIONS.
(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 ‘‘paragraph (7)’’ and
inserting ‘‘paragraphs (7) and (8)’’;
(2) in paragraph (4)(H)(i), by striking ‘‘paragraph (7)’’ and
inserting ‘‘paragraphs (7) and (8)’’;
(3) in paragraph (7)(E), by inserting ‘‘or paragraph (8)’’ before
the period at the end; and
(4) by adding at the end the following new paragraph:
‘‘(8) DISTRIBUTION OF ADDITIONAL RESIDENCY POSITIONS.—
‘‘(A) REDUCTIONS IN LIMIT BASED ON UNUSED POSITIONS.—
‘‘(i) IN GENERAL.—Except as provided in clause (ii),
if a hospital’s reference resident level (as defined in
subparagraph (H)(i)) is less than the otherwise applicable
resident limit (as defined in subparagraph
(H)(iii)), effective for portions of cost reporting periods
occurring on or after July 1, 2011, the otherwise applicable
resident limit shall be reduced by 65 percent of
the difference between such otherwise applicable resident
limit and such reference resident level.
‘‘(ii) EXCEPTIONS.—This subparagraph shall not
apply to—
‘‘(I) a hospital located in a rural area (as defined
in subsection (d)(2)(D)(ii)) with fewer than
250 acute care inpatient beds;
‘‘(II) a hospital that was part of a qualifying
entity which had a voluntary residency reduction
plan approved under paragraph (6)(B) or under
the authority of section 402 of Public Law 90–248,
if the hospital demonstrates to the Secretary that
it has a specified plan in place for filling the unused
positions by not later than 2 years after the
date of enactment of this paragraph; or
‘‘(III) a hospital described in paragraph
(4)(H)(v).
‘‘(B) DISTRIBUTION.—
‘‘(i) IN GENERAL.—The Secretary shall increase the
otherwise applicable resident limit for each qualifying
hospital that submits an application under this subparagraph
by such number as the Secretary may approve
for portions of cost reporting periods occurring
on or after July 1, 2011. The aggregate number of increases
in the otherwise applicable resident limit
under this subparagraph shall be equal to the aggregate
reduction in such limits attributable to subparagraph
(A) (as estimated by the Secretary).
‘‘(ii) REQUIREMENTS.—Subject to clause (iii), a hospital
that receives an increase in the otherwise applicable
resident limit under this subparagraph shall ensure,
during the 5-year period beginning on the date
of such increase, that—
‘‘(I) the number of full-time equivalent primary
care residents, as defined in paragraph
(5)(H) (as determined by the Secretary), excluding
any additional positions under subclause (II), is
not less than the average number of full-time
equivalent primary care residents (as so determined)
during the 3 most recent cost reporting periods
ending prior to the date of enactment of this
paragraph; and
‘‘(II) not less than 75 percent of the positions
attributable to such increase are in a primary care
or general surgery 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.
‘‘(iii) REDISTRIBUTION OF POSITIONS IF HOSPITAL NO
LONGER MEETS CERTAIN REQUIREMENTS.—In the case
where the Secretary determines that a hospital described
in clause (ii) 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.
‘‘(C) CONSIDERATIONS IN REDISTRIBUTION.—In determining
for which hospitals the increase in the otherwise
applicable resident limit is provided under subparagraph
(B), the Secretary shall take into account—
‘‘(i) the demonstration likelihood of the hospital
filling the positions made available under this paragraph
within the first 3 cost reporting periods beginning
on or after July 1, 2011, as determined by the
Secretary; and
‘‘(ii) whether the hospital has an accredited rural
training track (as described in paragraph (4)(H)(iv)).
‘‘(D) PRIORITY FOR CERTAIN AREAS.—In determining for
which hospitals the increase in the otherwise applicable
resident limit is provided under subparagraph (B), subject
to subparagraph (E), the Secretary shall distribute the increase
to hospitals based on the following factors:
‘‘(i) Whether the hospital is located in a State with
a resident-to-population ratio in the lowest quartile (as
determined by the Secretary).
‘‘(ii) Whether the hospital is located in a State, a
territory of the United States, or the District of Columbia
that is among the top 10 States, territories, or
Districts in terms of the ratio of—
‘‘(I) the total population of the State, territory,
or District living in an area designated (under
such section 332(a)(1)(A)) as a health professional
shortage area (as of the date of enactment of this
paragraph); to
‘‘(II) the total population of the State, territory,
or District (as determined by the Secretary
based on the most recent available population
data published by the Bureau of the Census).
‘‘(iii) Whether the hospital is located in a rural
area (as defined in subsection (d)(2)(D)(ii)).
‘‘(E) RESERVATION OF POSITIONS FOR CERTAIN HOSPITALS.—
‘‘(i) IN GENERAL.—Subject to clause (ii), the Secretary
shall reserve the positions available for distribution
under this paragraph as follows:
‘‘(I) 70 percent of such positions for distribution
to hospitals described in clause (i) of subparagraph
(D).
‘‘(II) 30 percent of such positions for distribution
to hospitals described in clause (ii) and (iii) of
such subparagraph.
‘‘(ii) EXCEPTION IF POSITIONS NOT REDISTRIBUTED
BY JULY 1, 2011.—In the case where the Secretary does
not distribute positions to hospitals in accordance with
clause (i) by July 1, 2011, the Secretary shall distribute
such positions to other hospitals in accordance
with the considerations described in subparagraph (C)
and the priority described in subparagraph (D).
‘‘(F) LIMITATION.—A hospital may not receive more
than 75 full-time equivalent additional residency positions
under this paragraph.
‘‘(G) APPLICATION OF PER RESIDENT AMOUNTS FOR PRIMARY
CARE AND 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 primary care and nonprimary
care computed under paragraph (2)(D) for that hospital.
‘‘(H) DEFINITIONS.—In this paragraph:
‘‘(i) REFERENCE RESIDENT LEVEL.—The term ‘reference
resident level’ means, with respect to a hospital,
the highest resident level for any of the 3 most
recent cost reporting periods (ending before the date of
the enactment of this paragraph) of the hospital for
which a cost report has been settled (or, if not, sub-
mitted (subject to audit)), as determined by the Secretary.
‘‘(ii) RESIDENT LEVEL.—The term ‘resident level’
has the meaning given such term in paragraph
(7)(C)(i).
‘‘(iii) 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
paragraph (7)(A).’’.
(b) IME.—
(1) IN GENERAL.—Section 1886(d)(5)(B)(v) of the Social Security
Act (42 U.S.C. 1395ww(d)(5)(B)(v)), in the second sentence,
is amended—
(A) by striking ‘‘subsection (h)(7)’’ and inserting ‘‘subsections
(h)(7) and (h)(8)’’; and
(B) by striking ‘‘it applies’’ and inserting ‘‘they apply’’.
(2) CONFORMING AMENDMENT.—Section 1886(d)(5)(B) of the
Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) is amended by
adding at the end the following clause:
‘‘(x) For discharges occurring on or after July 1, 2011, insofar
as an additional payment amount under this subparagraph
is attributable to resident positions distributed to a hospital
under subsection (h)(8)(B), the indirect teaching adjustment
factor shall be computed in the same manner as provided
under clause (ii) with respect to such resident positions.’’.
(c) CONFORMING AMENDMENT.—Section 422(b)(2) of the Medicare
Prescription Drug, Improvement, and Modernization Act of
2003 (Public Law 108–173) is amended by striking ‘‘section
1886(h)(7)’’ and all that follows and inserting ‘‘paragraphs (7) and
(8) of subsection (h) of section 1886 of the Social Security Act’’.