A bill to amend the Social Security Act to increase payments for direct graduate medical education costs of primary care residents in initial residing period, and for other purposes.

Amends title XVIII (Medicare) of the Social Security Act to increase payments for direct graduate medical education (DME) costs of primary care residents in the initial residency period.

Provides an overall cap on approved Full Time Equivalent resident amounts.

Requires hospitals to provide more compensation to primary care residents than to non-primary care residents in order to receive DME funding.

 
S 1149 IS
102d CONGRESS
1st Session
S. 1149
To amend the Social Security Act to increase payments for direct graduate
medical education costs of primary care residents in initial residing period,
and for other purposes.
IN THE SENATE OF THE UNITED STATES
MAY 23 (legislative day, APRIL 25), 1991
Mrs. KASSEBAUM introduced the following bill; which was read twice and
referred to the Committee on Finance
A BILL
To amend the Social Security Act to increase payments for direct graduate
medical education costs of primary care residents in initial residing period,
and for other purposes.
  Be it enacted by the Senate and House of Representatives of the United
  States of America in Congress assembled,
SECTION 1. PAYMENTS FOR DIRECT GRADUATE MEDICAL EDUCATION COSTS OF PRIMARY
CARE RESIDENTS INCREASED.
  (a) IN GENERAL- Subparagraph (C) of section 1886(h)(4) of the Social
  Security Act (42 U.S.C. 1395ww(h)(4)) is amended to read as follows:
  `(C) WEIGHTING FACTORS FOR CERTAIN RESIDENTS- Subject to subparagraph (D),
  such rules shall provide, in calculating the number of full-time-equivalent
  residents in an approved residency program--
  `(i) on or after October 1, 1991, for a primary care resident who is in
  the resident's initial residency period, the weighting factor is 1.20,
  `(ii) on or after October 1, 1991, for a resident (other than a primary
  care resident) who is in the resident's initial residency period, the
  weighting factor is the applicable factor, and
  `(iii) on or after October 1, 1991, for a resident who is not in the
  resident's initial residency period, the weighting factor is .50.'.
  (b) DEFINITION- Section 1886(h)(5) of such Act (42 U.S.C. 1395ww(h)(5))
  is amended--
  (1) by redesignating subparagraph (H) as subparagraph (I); and
  (2) by inserting after subparagraph (G) the following new subparagraph:
  `(H) PRIMARY CARE RESIDENT- The term `primary care resident' means (in
  accordance with criteria established by the Secretary) a resident being
  trained in a distinct program of family practice medicine, general internal
  medicine, or general pediatrics.'.
  (c) OVERALL CAP ON PAYMENTS FOR DIRECT GRADUATE MEDICAL EDUCATION COSTS-
  Section 1886(h)(2) of such Act (42 U.S.C. 1395ww(h)(2)) is amended by
  adding at the end thereof the following new subparagraph:
  `(F) OVERALL CAP ON APPROVED FTE RESIDENT AMOUNTS- With respect to each
  fiscal year beginning after September 30, 1991, and ending before October
  1, 1994, the Secretary shall make such adjustments as are necessary to
  approved FTE resident amounts for all hospitals to maintain the aggregate
  payment amount for all hospitals for such fiscal year under paragraph (3)
  at the same level as such amount would have been if the weighting factor
  for clause (i)(I) had been 1.00 for hospital cost reporting periods for
  such fiscal year.'.
  (d) EFFECTIVE DATE- The amendments made by this section shall apply to
  cost reporting periods beginning on or after October 1, 1991.
SEC. 2. INCENTIVES TO PURSUE PRIMARY CARE RESIDENCIES.
  (a) IN GENERAL- Paragraph (4) of section 1886(h) of the Social Security Act
  (42 U.S.C. 1395ww(h)), as amended by section 1, is further amended--
  (1) in subparagraph (C), by striking `subparagraph (D)' and inserting
  `subparagraphs (D) and (F)', and
  (2) by adding at the end thereof the following new subparagraph:
  `(F) RESIDENT COMPENSATION REQUIREMENT-
  `(i) GENERAL RULE- For any fiscal year during which a hospital does not
  meet the compensation requirement described in clause (ii), the weighting
  factor for residents described in subclauses (II) and (III) of subparagraph
  (C)(i) shall be zero.
  `(ii) COMPENSATION REQUIREMENT- For purposes of clause (i), a hospital
  shall meet the compensation requirement for any fiscal year if such hospital
  provides a rate of compensation to each primary care resident which equals
  or exceeds 120 percent of the average rate of compensation of residents
  of such hospital who are not primary care residents.
  `(iii) COMPENSATION- For purposes of this subparagraph, the term
  `compensation' means the value of any salary, employee benefits, debt
  forgiveness, or other monetary or material payment, whether actually
  received before, during, or after any residency period.'.
  (b) EFFECTIVE DATE-
  (1) IN GENERAL- The amendments made by this section shall apply with
  respect to any resident entering an approved medical residency training
  program (as defined in section 1886(h)(5)(A) of the Social Security Act)
  at a hospital after the date of the enactment of this Act.
  (2) ELECTION- Any hospital may elect to apply such amendments to any
  resident in an approved medical residency training program on the date of
  the enactment of this Act.