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US Laws | Affordable Health Care Act (HR3950F)
TITLE V--HEALTH CARE WORKFORCE
Subtitle F--Strengthening Primary Care and Other Workforce Improvements

"(F) LIMITATION- A hospital may not receive more than 75 full-time equivalent additional residency positions under this paragraph. (8393)

"(G) APPLICATION OF PER RESIDENT AMOUNTS FOR PRIMARY CARE AND NONPRIMARY CARE- With respect to additional residency positions in a hospital attributable to the increase provided under this paragraph, the approved FTE per resident amounts are deemed to be equal to the hospital per resident amounts for primary care and nonprimary care computed under paragraph (2)(D) for that hospital. (8394)

"(H) DEFINITIONS- In this paragraph: (8395)

"(i) REFERENCE RESIDENT LEVEL- The term "reference resident level" means, with respect to a hospital, the highest resident level for any of the 3 most recent cost reporting periods (ending before the date of the enactment of this paragraph) of the hospital for which a cost report has been settled (or, if not, submitted (subject to audit)), as determined by the Secretary. (8396)

"(ii) RESIDENT LEVEL- The term "resident level" has the meaning given such term in paragraph (7)(C)(i). (8397)

"(iii) OTHERWISE APPLICABLE RESIDENT LIMIT- The term "otherwise applicable resident limit" means, with respect to a hospital, the limit otherwise applicable under subparagraphs (F)(i) and (H) of paragraph (4) on the resident level for the hospital determined without regard to this paragraph but taking into account paragraph (7)(A).". (8398)

(b) IME- (8399)

(1) IN GENERAL- Section 1886(d)(5)(B)(v) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)(v)), in the second sentence, is amended-- (8400)

(A) by striking "subsection (h)(7)" and inserting "subsections (h)(7) and (h)(8)"; and (8401)

(B) by striking "it applies" and inserting "they apply". (8402)

(2) CONFORMING AMENDMENT- Section 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) is amended by adding at the end the following clause: (8403)

"(x) For discharges occurring on or after July 1, 2011, insofar as an additional payment amount under this subparagraph is attributable to resident positions distributed to a hospital under subsection (h)(8)(B), the indirect teaching adjustment factor shall be computed in the same manner as provided under clause (ii) with respect to such resident positions.". (8404)

(c) Conforming Amendment- Section 422(b)(2) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173) is amended by striking "section 1886(h)(7)" and all that follows and inserting "paragraphs (7) and (8) of subsection (h) of section 1886 of the Social Security Act". (8405)

SEC. 5504. COUNTING RESIDENT TIME IN NONPROVIDER SETTINGS. (8406)(Text)

(a) GME- Section 1886(h)(4)(E) of the Social Security Act (42 U.S.C. 1395ww(h)(4)(E)) is amended-- (8407)

(1) by striking "shall be counted and that all the time" and inserting "shall be counted and that-- (8408)

"(i) effective for cost reporting periods beginning before July 1, 2010, all the time;"; (8409)

(2) in clause (i), as inserted by paragraph (1), by striking the period at the end and inserting "; and"; (8410)

(3) by inserting after clause (i), as so inserted, the following new clause: (8411)

"(ii) effective for cost reporting periods beginning on or after July 1, 2010, all the time so spent by a resident shall be counted towards the determination of full-time equivalency, without regard to the setting in which the activities are performed, if a hospital incurs the costs of the stipends and fringe benefits of the resident during the time the resident spends in that setting. If more than one hospital incurs these costs, either directly or through a third party, such hospitals shall count a proportional share of the time, as determined by written agreement between the hospitals, that a resident spends training in that setting."; and (8412)

(4) by adding at the end the following flush sentence: (8413)

"Any hospital claiming under this subparagraph for time spent in a nonprovider setting shall maintain and make available to the Secretary records regarding the amount of such time and such amount in comparison with amounts of such time in such base year as the Secretary shall specify.". (8414)

(b) IME- Section 1886(d)(5)(B)(iv) of the Social Security Act (42 U.S.C. 1395ww(d)(5)) is amended-- (8415)

(1) by striking "(iv) Effective for discharges occurring on or after October 1, 1997" and inserting "(iv)(I) Effective for discharges occurring on or after October 1, 1997, and before July 1, 2010"; and (8416)

(2) by inserting after clause (I), as inserted by paragraph (1), the following new subparagraph: (8417)

"(II) Effective for discharges occurring on or after July 1, 2010, all the time spent by an intern or resident in patient care activities in a nonprovider setting shall be counted towards the determination of full-time equivalency if a hospital incurs the costs of the stipends and fringe benefits of the intern or resident during the time the intern or resident spends in that setting. If more than one hospital incurs these costs, either directly or through a third party, such hospitals shall count a proportional share of the time, as determined by written agreement between the hospitals, that a resident spends training in that setting.". (8418)

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