ACA Now

Statutory Text

SEC. 5508. INCREASING TEACHING CAPACITY.
(a) TEACHING HEALTH CENTERS TRAINING AND ENHANCEMENT.—
Part C of title VII of the Public Health Service Act (42
U.S.C. 293k et. seq.), as amended by section 5303, is further
amended by inserting after section 749 the following:
‘‘SEC. 749A ø42 U.S.C. 293l–1¿. TEACHING HEALTH CENTERS DEVELOPMENT
GRANTS.
‘‘(a) PROGRAM AUTHORIZED.—The Secretary may award grants
under this section to teaching health centers for the purpose of establishing
new accredited or expanded primary care residency programs.
‘‘(b) AMOUNT AND DURATION.—Grants awarded under this section
shall be for a term of not more than 3 years and the maximum
award may not be more than $500,000.
‘‘(c) USE OF FUNDS.—Amounts provided under a grant under
this section shall be used to cover the costs of—
‘‘(1) establishing or expanding a primary care residency
training program described in subsection (a), including costs
associated with—
‘‘(A) curriculum development;
‘‘(B) recruitment, training and retention of residents
and faculty:
‘‘(C) accreditation by the Accreditation Council for
Graduate Medical Education (ACGME), the American Dental
Association (ADA), or the American Osteopathic Association
(AOA); and
‘‘(D) faculty salaries during the development phase;
and
‘‘(2) technical assistance provided by an eligible entity.
‘‘(d) APPLICATION.—A teaching health center seeking a grant
under this section shall submit an application to the Secretary at
such time, in such manner, and containing such information as the
Secretary may require.
‘‘(e) PREFERENCE FOR CERTAIN APPLICATIONS.—In selecting recipients
for grants under this section, the Secretary shall give preference
to any such application that documents an existing affiliation
agreement with an area health education center program as
defined in sections 751 and 799B.
‘‘(f) DEFINITIONS.—In this section:
‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible entity’ means an
organization capable of providing technical assistance including
an area health education center program as defined in sections
751 and 799B.
‘‘(2) PRIMARY CARE RESIDENCY PROGRAM.—The term ‘primary
care residency program’ means an approved graduate
medical residency training program (as defined in section
340H) in family medicine, internal medicine, pediatrics, internal
medicine-pediatrics, obstetrics and gynecology, psychiatry,
general dentistry, pediatric dentistry, and geriatrics.
‘‘(3) TEACHING HEALTH CENTER.—
‘‘(A) IN GENERAL.—The term ‘teaching health center’
means an entity that—
‘‘(i) is a community based, ambulatory patient care
center; and
‘‘(ii) operates a primary care residency program.
‘‘(B) INCLUSION OF CERTAIN ENTITIES.—Such term includes
the following:
‘‘(i) A Federally qualified health center (as defined
in section 1905(l)(2)(B), of the Social Security Act).
‘‘(ii) A community mental health center (as defined
in section 1861(ff)(3)(B) of the Social Security
Act).
‘‘(iii) A rural health clinic, as defined in section
1861(aa) of the Social Security Act.
‘‘(iv) A health center operated by the Indian
Health Service, an Indian tribe or tribal organization,
or an urban Indian organization (as defined in section
4 of the Indian Health Care Improvement Act).
‘‘(v) An entity receiving funds under title X of the
Public Health Service Act.
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There is authorized
to be appropriated, $25,000,000 for fiscal year 2010, $50,000,000
for fiscal year 2011, $50,000,000 for fiscal year 2012, and such
sums as may be necessary for each fiscal year thereafter to carry
out this section. Not to exceed $5,000,000 annually may be used for
technical assistance program grants.’’.
(b) NATIONAL HEALTH SERVICE CORPS TEACHING CAPACITY.—
Section 338C(a) of the Public Health Service Act (42 U.S.C.
254m(a)) is amended to read as follows:
‘‘(a) SERVICE IN FULL-TIME CLINICAL PRACTICE.—Except as provided
in section 338D, each individual who has entered into a written
contract with the Secretary under section 338A or 338B shall
provide service in the full-time clinical practice of such individual’s
profession as a member of the Corps for the period of obligated
service provided in such contract. The Secretary may treat teaching
as clinical practice for up to 20 percent of such period of obligated
service. Notwithstanding the preceding sentence, with respect to a
member of the Corps participating in the teaching health centers
graduate medical education program under section 340H, for the
purpose of calculating time spent in full-time clinical practice
under this section, up to 50 percent of time spent teaching by such
member may be counted toward his or her service obligation. øAs
revised by section 10501(n)(5)¿’’.
(c) PAYMENTS TO QUALIFIED TEACHING HEALTH CENTERS.—
Part D of title III of the Public Health Service Act (42 U.S.C. 254b
et seq.) is amended by adding at the end the following:
‘‘Subpart XI—Support of Graduate Medical
Education in Qualified Teaching Health Centers
‘‘SEC. 340H ø42 U.S.C. 256h¿. PROGRAM OF PAYMENTS TO TEACHING
HEALTH CENTERS THAT OPERATE GRADUATE MEDICAL
EDUCATION PROGRAMS.
‘‘(a) PAYMENTS.—Subject to subsection (h)(2), the Secretary
shall make payments under this section for direct expenses and for
indirect expenses to qualified teaching health centers that are listed
as sponsoring institutions by the relevant accrediting body for
expansion of existing or establishment of new approved graduate
medical residency training programs.
‘‘(b) AMOUNT OF PAYMENTS.—
‘‘(1) IN GENERAL.—Subject to paragraph (2), the amounts
payable under this section to qualified teaching health centers
for an approved graduate medical residency training program
for a fiscal year are each of the following amounts:
‘‘(A) DIRECT EXPENSE AMOUNT.—The amount determined
under subsection (c) for direct expenses associated
with sponsoring approved graduate medical residency
training programs.
‘‘(B) INDIRECT EXPENSE AMOUNT.—The amount determined
under subsection (d) for indirect expenses associated
with the additional costs relating to teaching residents
in such programs.
‘‘(2) CAPPED AMOUNT.—
‘‘(A) IN GENERAL.—The total of the payments made to
qualified teaching health centers under paragraph (1)(A)
or paragraph (1)(B) in a fiscal year shall not exceed the
amount of funds appropriated under subsection (g) for
such payments for that fiscal year.
‘‘(B) LIMITATION.—The Secretary shall limit the funding
of full-time equivalent residents in order to ensure the
direct and indirect payments as determined under subsection
(c) and (d) do not exceed the total amount of funds
appropriated in a fiscal year under subsection (g).
‘‘(c) AMOUNT OF PAYMENT FOR DIRECT GRADUATE MEDICAL
EDUCATION.—
‘‘(1) IN GENERAL.—The amount determined under this subsection
for payments to qualified teaching health centers for direct
graduate expenses relating to approved graduate medical
residency training programs for a fiscal year is equal to the
product of—
‘‘(A) the updated national per resident amount for direct
graduate medical education, as determined under
paragraph (2); and
‘‘(B) the average number of full-time equivalent residents
in the teaching health center’s graduate approved
medical residency training programs as determined under
section 1886(h)(4) of the Social Security Act (without regard
to the limitation under subparagraph (F) of such section)
during the fiscal year.
‘‘(2) UPDATED NATIONAL PER RESIDENT AMOUNT FOR DIRECT
GRADUATE MEDICAL EDUCATION.—The updated per resident
amount for direct graduate medical education for a qualified
teaching health center for a fiscal year is an amount determined
as follows:
‘‘(A) DETERMINATION OF QUALIFIED TEACHING HEALTH
CENTER PER RESIDENT AMOUNT.—The Secretary shall compute
for each individual qualified teaching health center a
per resident amount—
‘‘(i) by dividing the national average per resident
amount computed under section 340E(c)(2)(D) into a
wage-related portion and a non-wage related portion
subparagraph
(B);
‘‘(ii) by multiplying the wage-related portion by
the factor applied under section 1886(d)(3)(E) of the
Social Security Act (but without application of section
4410 of the Balanced Budget Act of 1997 (42 U.S.C.
1395ww note)) during the preceding fiscal year for the
teaching health center’s area; and
‘‘(iii) by adding the non-wage-related portion to
the amount computed under clause (ii).
‘‘(B) UPDATING RATE.—The Secretary shall update
such per resident amount for each such qualified teaching
health center as determined appropriate by the Secretary.
‘‘(d) AMOUNT OF PAYMENT FOR INDIRECT MEDICAL EDUCATION.—
‘‘(1) IN GENERAL.—The amount determined under this subsection
for payments to qualified teaching health centers for indirect
expenses associated with the additional costs of teaching
residents for a fiscal year is equal to an amount determined
appropriate by the Secretary.
‘‘(2) FACTORS.—In determining the amount under paragraph
(1), the Secretary shall—
‘‘(A) evaluate indirect training costs relative to supporting
a primary care residency program in qualified
teaching health centers; and
‘‘(B) based on this evaluation, assure that the aggregate
of the payments for indirect expenses under this section
and the payments for direct graduate medical education
as determined under subsection (c) in a fiscal year
do not exceed the amount appropriated for such expenses
as determined in subsection (g).
‘‘(3) INTERIM PAYMENT.—Before the Secretary makes a payment
under this subsection pursuant to a determination of indirect
expenses under paragraph (1), the Secretary may provide
to qualified teaching health centers a payment, in addition
to any payment made under subsection (c), for expected
indirect expenses associated with the additional costs of teaching
residents for a fiscal year, based on an estimate by the Secretary.
‘‘(e) CLARIFICATION REGARDING RELATIONSHIP TO OTHER PAYMENTS
FOR GRADUATE MEDICAL EDUCATION.—Payments under this
section—
‘‘(1) shall be in addition to any payments—
‘‘(A) for the indirect costs of medical education under
section 1886(d)(5)(B) of the Social Security Act;
‘‘(B) for direct graduate medical education costs under
section 1886(h) of such Act; and
‘‘(C) for direct costs of medical education under section
1886(k) of such Act;
‘‘(2) shall not be taken into account in applying the limitation
on the number of total full-time equivalent residents
under subparagraphs (F) and (G) of section 1886(h)(4) of such
Act and clauses (v), (vi)(I), and (vi)(II) of section 1886(d)(5)(B)
of such Act for the portion of time that a resident rotates to
a hospital; and
‘‘(3) shall not include the time in which a resident is counted
toward full-time equivalency by a hospital under paragraph
(2) or under section 1886(d)(5)(B)(iv) of the Social Security Act,
section 1886(h)(4)(E) of such Act, or section 340E of this Act.
‘‘(f) RECONCILIATION.—The Secretary shall determine any
changes to the number of residents reported by a hospital in the
application of the hospital for the current fiscal year to determine
the final amount payable to the hospital for the current fiscal year
for both direct expense and indirect expense amounts. Based on
such determination, the Secretary shall recoup any overpayments
made to pay any balance due to the extent possible. The final
amount so determined shall be considered a final intermediary determination
for the purposes of section 1878 of the Social Security
Act and shall be subject to administrative and judicial review
under that section in the same manner as the amount of payment
under section 1186(d) of such Act is subject to review under such
section.
‘‘(g) FUNDING.—To carry out this section, there are appropriated
such sums as may be necessary, not to exceed
$230,000,000, for the period of fiscal years 2011 through 2015.
‘‘(h) ANNUAL REPORTING REQUIRED.—
‘‘(1) ANNUAL REPORT.—The report required under this
paragraph for a qualified teaching health center for a fiscal
year is a report that includes (in a form and manner specified
by the Secretary) the following information for the residency
academic year completed immediately prior to such fiscal year:
‘‘(A) The types of primary care resident approved
training programs that the qualified teaching health center
provided for residents.
‘‘(B) The number of approved training positions for
residents described in paragraph (4).
‘‘(C) The number of residents described in paragraph
(4) who completed their residency training at the end of
such residency academic year and care for vulnerable populations
living in underserved areas.
‘‘(D) Other information as deemed appropriate by the
Secretary.
‘‘(2) AUDIT AUTHORITY; LIMITATION ON PAYMENT.—
‘‘(A) AUDIT AUTHORITY.—The Secretary may audit a
qualified teaching health center to ensure the accuracy
and completeness of the information submitted in a report
under paragraph (1).
‘‘(B) LIMITATION ON PAYMENT.—A teaching health center
may only receive payment in a cost reporting period for
a number of such resident positions that is greater than
the base level of primary care resident positions, as determined
by the Secretary. For purposes of this subparagraph,
the ‘base level of primary care residents’ for a
teaching health center is the level of such residents as of
a base period.
‘‘(3) REDUCTION IN PAYMENT FOR FAILURE TO REPORT.—
‘‘(A) IN GENERAL.—The amount payable under this section
to a qualified teaching health center for a fiscal year
shall be reduced by at least 25 percent if the Secretary determines
that—
‘‘(i) the qualified teaching health center has failed
to provide the Secretary, as an addendum to the qualified
teaching health center’s application under this
section for such fiscal year, the report required under
paragraph (1) for the previous fiscal year; or
‘‘(ii) such report fails to provide complete and accurate
information required under any subparagraph
of such paragraph.
‘‘(B) NOTICE AND OPPORTUNITY TO PROVIDE ACCURATE
AND MISSING INFORMATION.—Before imposing a reduction
under subparagraph (A) on the basis of a qualified teaching
health center’s failure to provide complete and accurate
information described in subparagraph (A)(ii), the
Secretary shall provide notice to the teaching health center
of such failure and the Secretary’s intention to impose
such reduction and shall provide the teaching health center
with the opportunity to provide the required information
within the period of 30 days beginning on the date of
such notice. If the teaching health center provides such information
within such period, no reduction shall be made
under subparagraph (A) on the basis of the previous failure
to provide such information.
‘‘(4) RESIDENTS.—The residents described in this paragraph
are those who are in part-time or full-time equivalent
resident training positions at a qualified teaching health center
in any approved graduate medical residency training program.
‘‘(i) REGULATIONS.—The Secretary shall promulgate regulations
to carry out this section.
‘‘(j) DEFINITIONS.—In this section:
‘‘(1) APPROVED GRADUATE MEDICAL RESIDENCY TRAINING
PROGRAM.—The term ‘approved graduate medical residency
training program’ means a residency or other postgraduate
medical training program—
‘‘(A) participation in which may be counted toward certification
in a specialty or subspecialty and includes formal
postgraduate training programs in geriatric medicine approved
by the Secretary; and
‘‘(B) that meets criteria for accreditation (as established
by the Accreditation Council for Graduate Medical
Education, the American Osteopathic Association, or the
American Dental Association).
‘‘(2) PRIMARY CARE RESIDENCY PROGRAM.—The term ‘primary
care residency program’ has the meaning given that term
in section 749A.
‘‘(3) QUALIFIED TEACHING HEALTH CENTER.—The term
‘qualified teaching health center’ has the meaning given the
term ‘teaching health center’ in section 749A.’’.