I 106thcongress H.R.1645 1stSession ToamendtitleX\^IIoftheSocialSecuritA'Acttopiwideforfiillpa^iiient ratesunder [Medicareto hospitalsforcosts ofdirect gi-ad\xatemedical education ofresidentsforresidencytrainingprograms in specialtiesoi- subspecialtieswhichthe SeeretaiyofHealth and Human Sendeesdes- ignatesascriticalneedspecialtyorsubspecialtytrainingprogi-ams. m THE HOUSE OF REPRESENTATIVES April29,1999 Mr. Stark (for himself, Mr. McDermott, Mr. Leams of Georgia, Mrs. Thtrjiax,Ms.Kaptur,Ms.Jackson-LeeofTexas,Mr.Filner,Mr. CUMMINGS,^Is.BRO^^'NofFlorida,Mr.Frost,andMr.Hillluid)in- troducedthefollo\\ingbill;whieliwasreferredtotheConunitteeonWays andMeans,andinadditiontotheConunitteeonCommeree,foraperiod tobe.subsequentlydetenninedbytheSpeaker,ineachcaseforconsider- ationofsuchpro\n.sionsasfallA\dthinthejurisdictionoftheconunittee concerned To amend title XVlll ofthe Social SecurityAct 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 sub- specialties which the Secretary of Health and Human Services designates as critical need specialty or sub- specialtytrainingprograms. 1 BeitenactedhytheSenateandHouseofRepresenta- 2 tivesoftheUnitedStatesofAmericainCongressassembled, — 1 SECTION1.SHORTTITLE. 2 ThisActmaybecitedasthe"MedicareCriticalNeed 3 GMEProtectionActof1999". 4 SEC.2.FULLPTEPAYMENTFORRESIDENTSINCRITICAL 5 NEED SPECIALTY ORSUBSPECIALTYTRAIN- 6 INGPROGRAMS. — 7 (a) Treatjient as Initl\l Residency Period. 8 (1) In GENERAL.—Section 1886(h)(5)(F) of 9 the Social Security Act (42 U.S.C. 10 1395w(h)(5)(F))isamended— 11 (A)inclause(i) 12 (i) by striking "clause (ii)" and in- 13 serting"clause(ii)or(iii)";and 14 (ii)bystriking"and"attheend; 15 (B) inclause (ii),bystrikingtheperiodat 16 theendandinserting",and";and 17 (C) by inserting after clause (ii), the fol- 18 lowingnewclause: 19 "(iii) subject to the requirement for 20 budget neutrality under paragraph (7), a ,21 period of years, determined by the Sec- 22 retaiyunder subparagraph (K)(iv), during 23 whichanindividualisinaresidencytrain- 24 ing program designated by the Secretary 25 as acriticalneed specialtyorsubspecialty, 26 as defined in subparagraph (K), shall be HR1645m 3 1 treated as part ofthe initial residencype- 2 riod, but shall notbe counted against any 3 limitationonthe initialresidencyperiod.". 4 (2) Determination of critical need spe- — 5 cialty or subspecialty. Section 1886(h)(5) of 6 such Act (42 U.S.C. 1395ww(h)(5)) is amended by 7 adding at the end the following new subparagraph: — 8 "(K)Criticalneedspeciality. — 9 "(i) Definition. The term 'critical 10 need specialty or subspecialty' means a 11 specialtyor subspecialtydesignatedbythe 12 Secretaryunder this subparagraph with a 13 current or imminent critical shortage of 14 physicians. — 15 "(ii) Criteria. ^Forpurposesofdes- 16 ignating a critical need specialty or sub- 17 specialtyunderthissubparagraph,theSec- 18 retary shall prescribe criteria for deter- 19 mining critical shortages of physicians or 20 residents in approved medical residency 21 training programs. The Secretary shall 22 pubhshintheFederalRegisterthecriteria 23 estabhshedunderthisclause andthe form 24 andmannerbywhichdataissubmittedfor HR1645IH 4 1 the Secretary's reviewunderthis subpara- 2 graph. — 3 "(iii)Periodofdesignation. — 4 "(I) In general. designa- 5 tionofacriticalneedspecialtyorsub- 6 specialty under this subparagraph 7 shall apply until the Secretary deter- 8 mines the specialty or subspecialty 9 doesnotmeetthecriteriafordesigna- 10 tion as a critical need specialty or 11 subspecialty. 12 "(U) Report.—Inthe event the 13 Secretary determines that a specialty 14 or subspecialty no longer meets the 15 criteria for being a critical need spe- 16 cialty or subspecialty, the Secretary 17 shall submit a reportto Congress de- 18 scribingthe reasons for discontinuing 19 thedesignation.". — 20 (b) Maintaining Budget Neutrality. Section 21 1886(h) ofsuchAct (42 U.S.C. 1395ww(h)) is amended 22 byaddingattheendthefollowingnewparagraph: 23 "(7)BudgetNeutralityAdjustmentforCrit- 24 iCAL Need Speclalty or Subspecialty Designa- — 25 TION. IftheSecretarydesignatesacriticalneedspecialty HR1645IH 1 orsubspecialtyforafiscalyear,the Secretaryshallmake 2 aproportionaladjustmenttopaymentamountsunderthis 3 subsection for such fiscal year so that the aggregate of 4 the payments under this subsection for such fiscal year 5 shallequalthe aggregatepaymentsthatwouldhavebeen 6 madeunderthissubsectionforsuchfiscalyeariftheSec- 7 retaiyhadnotdesignatedacriticalneedspecialtyorsub- 8 specialty.". — 9 (c) Effecthte Date. The amendments made by 10 thisAct shall applywith respectto paymentsunder sec- 11 tion 1886(h) of the Social Security Act (42 U.S.C. 12 1395ww(h)) made forresidents in, orbeginningtraining 13 in,acriticalneedspecialtyorsubspecialtyonorafterJuly 14 1,2000. O HR1645m ensLIBRHRV 3 amS 0DDLE4flD L