Primary Care Workforce Access Improvement Act of 2011 - Directs the Secretary of Health and Human Services (HHS) to conduct a pilot project under title XVIII (Medicare) of the Social Security Act to test models for providing payment for direct graduate medical education (GME) and indirect medical education (IME) to medical education entities (MEEs), not otherwise eligible to receive such payments, for the costs of training primary care residents.
Requires testing of two of the following model MEEs: (1) a community-based independent corporate entity collaborating with two or more hospitals to operate one or more primary care graduate medical residency training programs (training hospitals); (2) a MEE, with at least one community representative on its board, which is established by two or more training hospitals which may be the sole corporate members of the MEE; (3) a hospital subsidiary or independent corporation, with community participation in its governance, that operates one or more training programs for a hospital; or (4) a MEE (including a university or school of medicine) independent of any hospital but collaborating with one in operating one or more primary care graduate medical residency training programs.
[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3667 Introduced in House (IH)]
112th CONGRESS
1st Session
H. R. 3667
To provide for a Medicare primary care graduate medical education pilot
project in order to improve access to the primary care workforce.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
December 14, 2011
Mrs. McMorris Rodgers (for herself and Mr. Thompson of California)
introduced the following bill; which was referred to the Committee on
Ways and Means, and in addition to the Committee on Energy and
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
_______________________________________________________________________
A BILL
To provide for a Medicare primary care graduate medical education pilot
project in order to improve access to the primary care workforce.
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 ``Primary Care Workforce Access
Improvement Act of 2011''.
SEC. 2. MEDICARE PRIMARY CARE GRADUATE MEDICAL EDUCATION PILOT PROJECT.
(a) Establishment.--The Secretary of Health and Human Services (in
this section referred to as the ``Secretary'') shall conduct a pilot
project under the Medicare program under title XVIII of the Social
Security Act, in accordance with the provisions of this section, to
test models for providing payment under such title for direct graduate
medical education and indirect medical education to medical education
entities, which entities are not otherwise eligible to receive such
payments under the Medicare program, for the costs of training primary
care residents.
(b) Duration.--The Secretary shall conduct the pilot project under
this section over a 5-year period, which shall begin not later than 180
days after the date of the enactment of this Act.
(c) Models.--
(1) Required models.--Under the pilot project, the
Secretary shall test two of each of the following models:
(A) A model in which the medical education entity
receiving funds under the pilot project is a community-
based independent corporate entity collaborating with
two or more hospitals to operate one or more primary
care graduate medical residency training programs.
(B) A model in which--
(i) the medical education entity receiving
funds under the pilot project is established by
two or more hospitals to operate one or more
primary care graduate medical residency
training programs; and
(ii) such hospitals may be the sole
corporate members of the entity but the
governing board of the entity shall include at
least one community representative.
(C) A model in which the medical education entity
receiving funds under the pilot project is a hospital
subsidiary or independent corporation that operates one
or more primary care graduate medical residency
training programs for a hospital with community
participation in the governance of the subsidiary or
corporation.
(D) A model in which--
(i) the medical education entity receiving
funds under the pilot project is independent of
any hospital but collaborates with a hospital
in operating one or more primary care graduate
medical residency training programs; and
(ii) the medical education entity may
include a university or school of medicine.
(2) Additional models.--Under the pilot project, the
Secretary may test models of medical education entities in
addition to those described in paragraph (1).
(d) Prioritization.--Under the pilot project, the Secretary of
Health and Human Services may give priority to testing models that
demonstrate the capability of improving the quality, quantity, and
distribution of primary care physicians, including the ability to
enhance primary care delivery in rural and underserved areas.
(e) Payments.--
(1) Payments to medical education entities.--Under the
pilot project, the Secretary shall establish a process under
which payments are made to each medical education entity
participating under such project for direct graduate medical
education and indirect medical education costs with respect to
primary care residents enrolled under a primary care graduate
medical residency training program operated pursuant to a model
of such entity under subsection (c) instead of any payment or
adjustment that would otherwise be made to a participant
hospital (as defined in subsection (m)) of such entity for
indirect and direct graduate medical education costs under
subsections (d)(5)(B) and (h) of section 1886 of the Social
Security Act (42 U.S.C. 1395ww) during the period of
participation of such entity in such project.
(2) Calculation of payments.--Payments to a medical
education entity under the pilot project, with respect to a
primary care graduate medical education residency program, for
a cost reporting period during which the entity is
participating in such pilot shall be, based on the most
recently available data with respect to a previous cost
reporting period, equal to the sum of the following:
(A) Direct gme.--The amount that, out of all of the
payment amounts (determined on a per resident basis)
received by hospitals under section 1886(h) of the
Social Security Act (42 U.S.C. 1395ww(h)) for such
previous cost reporting period, is equal to the 95th
percentile of such payment amounts.
(B) Indirect gme.--The amount that, out of all of
the additional payment amounts (determined on a per
resident basis) received by hospitals under section
1886(d)(5)(B) of the Social Security Act (42 U.S.C.
1395ww(d)(5)(B)) for such previous cost reporting
period, is equal to the 95th percentile of such payment
amounts.
(3) Additional payments for programs serving underserved
areas.--Payments in addition to the payments described in
paragraph (2) may be made under the pilot project for primary
care graduate medical residency training programs that--
(A) operate in sites and areas that are underserved
by primary care physicians; or
(B) change their training sites to include those
areas.
(4) Payments from medicare trust funds.--In providing for
such payments under this subsection to medical education
entities, the Secretary shall provide for an allocation of such
payments between part A and part B (and the Federal Hospital
Insurance Trust Fund under section 1817 of the Social Security
Act (42 U.S.C. 1395i) and the Federal Supplementary Medical
Insurance Trust Fund under section 1841 of such Act (42 U.S.C.
1395t)) in the same manner as the Secretary provides for an
allocation of payments under subsections (d)(5)(B) and (h),
respectively, of section 1886 of such Act (42 U.S.C. 1395ww).
(f) Uses of Payments.--
(1) In general.--A medical education entity receiving
payments under the pilot project shall use such payments for
the training of primary care residents, including training
activities in appropriate inpatient and outpatient settings in
primary care graduate medical residency training programs
accredited by the Accreditation Council for Graduate Medical
Education or the American Osteopathic Association and for all
relevant topics including patient care, care management,
working in teams, supervision, and quality improvement.
(2) Limitations.--Payments shall only be made for training
primary care residents up to the initial board certification of
such residents, except that with respect to training in
geriatric medicine, payments may also be made for a fellowship
after initial board certification.
(g) Expansion During Pilot Project.--A medical education entity
receiving funds under the pilot project, with respect to a primary care
graduate medical residency training program, shall be allowed to
increase by up to 50 percent the number of full-time equivalent primary
care residents enrolled in the such program (determined in accordance
with the process under subsection (d)(2)(A)(ii)) during the duration of
the participation of such entity in such project.
(h) Treatment After Project.--
(1) In general.--Subject to paragraphs (2) and (3), after
the last day of the pilot project, which may be extended at the
discretion of the Secretary, any participant hospital of a
medical education entity under the pilot project, shall receive
payments under subsection (d)(5)(B) and (h) of section 1886 of
the Social Security Act (42 U.S.C. 1395ww) in the same manner
and to the same extent such hospital would receive such
payments without application of this Act and such payments
shall be calculated based on the number of full-time equivalent
residents enrolled in such program without regard to any
increase made pursuant to subsection (g).
(2) Exception to ensure residents enrolled during pilot are
able to complete training.--Subject to paragraph (3), a medical
education entity receiving funds under the pilot project, with
respect to a primary care graduate medical residency training
program, shall continue to receive funding under this section
(even after the last day of the project), with respect to each
primary care resident who is enrolled under such program while
the entity is participating in such project, to the extent and
in such amounts necessary to allow for the full duration of
training, subject to subsection (f)(2), of such primary care
resident. Any such payments made pursuant to this subparagraph
shall be deemed to be a payment made under the pilot project.
(3) Limitation.--In no case may the total duration of the
pilot project exceed seven years and in no case may payments be
made under this section to a medical education entity for a
period exceeding seven years.
(i) Budget Neutrality.--For each year that the pilot project under
this section is being conducted (and for any subsequent year to the
extent subsection (h)(2) applies), the Secretary shall reduce payments
under subsections (d)(5)(B) and (h) of section 1886 of the Social
Security Act (42 U.S.C. 1395ww) by such amount as the Secretary
determines to be necessary to ensure that carrying out the pilot
project under this section during such year does not result in
expenditures under title XVIII of the Social Security Act for such year
that exceed the amount of such expenditures that would have been made
for such year without application of this section.
(j) Waiver Authority.--The Secretary may waive such requirements of
titles XI and XVIII of the Social Security Act as may be necessary to
carry out the purpose of the pilot project under this section.
(k) Report to Congress.--The Secretary is authorized to enter into
an agreement with the Institute of Medicine to conduct a study on the
results of the pilot project. Such agreement shall provide for the
Institute of Medicine to submit, not later than 1 year after the
completion of the pilot project under this section (or, if sooner,
January 1, 2019), to Congress a report on the results of such study,
including--
(1) a detailed analysis of the effects of the pilot,
including the quality, quantity, and distribution of primary
care physicians during and after the pilot project compared to
the quality, quantity, and distribution of such physicians
before the pilot project; and the governance, administration
and financial strength of the medical educational entities that
participated in the pilot project;
(2) recommendations on the extent to which the pilot
project should be expanded to all primary care residents; and
(3) recommendations for such legislation and administrative
actions as needed.
(l) Expansion.--If the Secretary determines that any of the models
tested under the pilot project under this section enhance the quality,
quantity, and distribution of primary care physicians for Medicare
beneficiaries, the Secretary may initiate comparable primary care
training projects.
(m) Definitions.--For purposes of this section:
(1) Direct graduate medical education costs; indirect
graduate medical education costs.--The terms ``direct graduate
medical education costs'' and ``indirect graduate medical
education'' have the meanings given such terms for purposes of
subsections (h) and (d)(5)(B), respectively, of section 1886 of
the Social Security Act (42 U.S.C. 1395ww).
(2) Medical education entity.--The term ``medical education
entity'' means a corporate, nonprofit, or academic entity that
has as its principal mission the education and training of
primary care residents.
(3) Medicare beneficiary.--The term ``Medicare
beneficiary'' means an individual entitled to benefits under
part A of title XVIII of the Social Security Act or enrolled
under part B of such title.
(4) Participant hospital.--The term ``participant
hospital'' means, with respect to a medical education entity,
any hospital that establishes, is collaborating with, a
component of, or otherwise associated with, such entity to
operate a primary care graduate medical residency training
program under a model described in subsection (c).
(5) Primary care graduate medical residency training
program.--The term ``primary care graduate medical residency
training program'' means an approved medical residency training
program (as defined in section 1886(h)(5)(A) of the Social
Security Act (42 U.S.C. 1395ww(h)(5)(A))) for training primary
care residents.
(6) Primary care resident.--The term ``primary care
resident'' means a resident enrolled in an approved medical
residency training program in family medicine, general internal
medicine, general pediatrics, or geriatric medicine.
<all>
Introduced in House
Introduced in House
Sponsor introductory remarks on measure. (CR H8914-8915)
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and 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.
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and 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.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
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