HR 1645 IH

To amend title XVIII of the Social Security Act to provide for full payment rates under Medicare to hospitals for costs of direct graduate medical education of residents for residency training programs in specialties or subspecialties which the Secretary of Health and Human Services designates as critical need specialty or subspecialty training programs.

April 29, 1999

Mr. STARK (for himself, Mr. MCDERMOTT, Mr. LEWIS of Georgia, Mrs. THURMAN, Ms. KAPTUR, Ms. JACKSON-LEE of Texas, Mr. FILNER, Mr. CUMMINGS, Ms. BROWN of Florida, Mr. FROST, and Mr. HILLIARD) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on 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

To amend title XVIII of the Social Security Act to provide for full payment rates under Medicare to hospitals for costs of direct graduate medical education of residents for residency training programs in specialties or subspecialties which the Secretary of Health and Human Services designates as critical need specialty or subspecialty training programs.

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 `Medicare Critical Need GME Protection Act of 1999'.

SEC. 2. FULL FTE PAYMENT FOR RESIDENTS IN CRITICAL NEED SPECIALTY OR SUBSPECIALTY TRAINING PROGRAMS.

(a) TREATMENT AS INITIAL RESIDENCY PERIOD-

(1) IN GENERAL- Section 1886(h)(5)(F) of the Social Security Act (42 U.S.C. 1395ww(h)(5)(F)) is amended--

(A) in clause (i)--

(i) by striking `clause (ii)' and inserting `clause (ii) or (iii)'; and

(ii) by striking `and' at the end;

(B) in clause (ii), by striking the period at the end and inserting `, and'; and

(C) by inserting after clause (ii), the following new clause:

`(iii) subject to the requirement for budget neutrality under paragraph (7), a period of years, determined by the Secretary under subparagraph (K)(iv), during which an individual is in a residency training program designated by the Secretary as a critical need specialty or subspecialty, as defined in subparagraph (K), shall be treated as part of the initial residency period, but shall not be counted against any limitation on the initial residency period.'.

(2) DETERMINATION OF CRITICAL NEED SPECIALTY OR SUBSPECIALTY- Section 1886(h)(5) of such Act (42 U.S.C. 1395ww(h)(5)) is amended by adding at the end the following new subparagraph:

`(K) CRITICAL NEED SPECIALITY-

`(i) DEFINITION- The term `critical need specialty or subspecialty' means a specialty or subspecialty designated by the Secretary under this subparagraph with a current or imminent critical shortage of physicians.

`(ii) CRITERIA- For purposes of designating a critical need specialty or subspecialty under this subparagraph, the Secretary shall prescribe criteria for determining critical shortages of physicians or residents in approved medical residency training programs. The Secretary shall publish in the Federal Register the criteria established under this clause and the form and manner by which data is submitted for the Secretary's review under this subparagraph.

`(iii) PERIOD OF DESIGNATION-

`(I) IN GENERAL- A designation of a critical need specialty or subspecialty under this subparagraph shall apply until the Secretary determines the specialty or subspecialty does not meet the criteria for designation as a critical need specialty or subspecialty.

`(II) REPORT- In the event the Secretary determines that a specialty or subspecialty no longer meets the criteria for being a critical need specialty or subspecialty, the Secretary shall submit a report to Congress describing the reasons for discontinuing the designation.'.

(b) MAINTAINING BUDGET NEUTRALITY- Section 1886(h) of such Act (42 U.S.C. 1395ww(h)) is amended by adding at the end the following new paragraph:

`(7) BUDGET NEUTRALITY ADJUSTMENT FOR CRITICAL NEED SPECIALTY OR SUBSPECIALTY DESIGNATION- If the Secretary designates a critical need specialty or subspecialty for a fiscal year, the Secretary shall make a proportional adjustment to payment amounts under this subsection for such fiscal year so that the aggregate of the payments under this subsection for such fiscal year shall equal the aggregate payments that would have been made under this subsection for such fiscal year if the Secretary had not designated a critical need specialty or subspecialty.'.

(c) EFFECTIVE DATE- The amendments made by this Act shall apply with respect to payments under section 1886(h) of the Social Security Act (42 U.S.C. 1395ww(h)) made for residents in, or beginning training in, a critical need specialty or subspecialty on or after July 1, 2000.

END