119-hr4731

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4731 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 4731

 To amend title XVIII of the Social Security Act to provide for the 
distribution of additional residency positions, and for other purposes.

_______________________________________________________________________

 IN THE HOUSE OF REPRESENTATIVES

 July 23, 2025

 Ms. Sewell (for herself and Mr. Fitzpatrick) 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 amend title XVIII of the Social Security Act to provide for the 
distribution of additional residency positions, 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. SHORT TITLE.

 This Act may be cited as the ``Resident Physician Shortage 
Reduction Act of 2025''.

SEC. 2. DISTRIBUTION OF ADDITIONAL RESIDENCY POSITIONS.

    (a) In General.--

Section 1886

    (h) of the Social Security Act (42 
U.S.C. 1395ww

    (h) ) is amended--

    (1) in paragraph

    (4)
        (F)
            (i) , by striking ``paragraphs

    (7) ,

    (8) ,

    (9) , and

    (10) '' and inserting ``paragraphs

    (7) ,

    (8) ,

    (9) ,

    (10) , and

    (11) '';

    (2) in paragraph

    (4)
        (H)
            (i) , by striking ``paragraphs

    (7) ,

    (8) ,

    (9) , and

    (10) '' and inserting ``paragraphs

    (7) ,

    (8) ,

    (9) ,

    (10) , and

    (11) '';

    (3) in paragraph

    (7)
        (E) , by inserting ``paragraph

    (10) ,'' 
 after ``paragraph

    (8) ,''; and

    (4) by adding at the end the following new paragraph:
 ``

    (11) Distribution of additional residency positions.--
 ``
        (A) Additional residency positions.--
 ``
            (i) In general.--For each of fiscal years 
 2026 through 2032 (and succeeding fiscal years 
 if the Secretary determines that there are 
 additional residency positions available to 
 distribute under clause
            (iv) 
            (II) ), the 
 Secretary shall, subject to clause
            (ii) and 
 subparagraph
            (D) , increase the otherwise 
 applicable resident limit for each qualifying 
 hospital (as defined in subparagraph
        (H) ) that 
 submits a timely application under this 
 subparagraph by such number as the Secretary 
 may approve for portions of cost reporting 
 periods occurring on or after July 1 of the 
 fiscal year of the increase.
 ``
            (ii) Number available for distribution.--
 For each such fiscal year, the Secretary shall 
 determine the total number of additional 
 residency positions available for distribution 
 under clause
            (i) in accordance with the 
 following:
 ``
            (I) Allocation to hospitals 
 already operating over resident 
 limit.--One-third of such number shall 
 be available for distribution only to 
 hospitals described in subparagraph
        (B) .
 ``
            (II) Aggregate limitation.--
 Except as provided in clause
            (iv) 
            (I) , 
 the aggregate number of increases in 
 the otherwise applicable resident limit 
 under this subparagraph shall be equal 
 to 2,000 in each such year.
 ``
            (iii) Process for distributing 
 positions.--
 ``
            (I) Rounds of applications.--The 
 Secretary shall initiate 7 separate 
 rounds of applications for an increase 
 under clause
            (i) , 1 round with respect 
 to each of fiscal years 2026 through 
 2032.
 ``
            (II) Number available.--In each 
 of such rounds, the aggregate number of 
 positions available for distribution in 
 the fiscal year under clause
            (ii) shall 
 be distributed, plus any additional 
 positions available under clause
            (iv) .
 ``
            (III) Timing.--The Secretary 
 shall notify hospitals of the number of 
 positions distributed to the hospital 
 under this paragraph as a result of an 
 increase in the otherwise applicable 
 resident limit by January 1 of the 
 fiscal year of the increase. Such 
 increase shall be effective for 
 portions of cost reporting periods 
 beginning on or after July 1 of that 
 fiscal year.
 ``
            (iv) Positions not distributed during the 
 fiscal year.--
 ``
            (I) In general.--If the number of 
 resident full-time equivalent positions 
 distributed under this paragraph in a 
 fiscal year is less than the aggregate 
 number of positions available for 
 distribution in the fiscal year (as 
 described in clause
            (ii) , including 
 after application of this subclause), 
 the difference between such number 
 distributed and such number available 
 for distribution shall be added to the 
 aggregate number of positions available 
 for distribution in the following 
 fiscal year.
 ``
            (II) Exception if positions not 
 distributed by end of fiscal year 
 2032.--If the aggregate number of 
 positions distributed under this 
 paragraph during the 7-year period of 
 fiscal years 2026 through 2032 is less 
 than 14,000, the Secretary shall, in 
 accordance with the provisions of 
 clause
            (ii) and subparagraph
        (E) and 
 the considerations and priority 
 described in subparagraph
            (C) , conduct 
 an application and distribution process 
 in each subsequent fiscal year until 
 such time as the aggregate amount of 
 positions distributed under this 
 paragraph is equal to 14,000.
 ``
        (B) Allocation of distribution for positions to 
 hospitals already operating over resident limit.--
 ``
            (i) In general.--Subject to clauses
            (ii) and
            (iii) , in the case of a hospital in which 
 the reference resident level of the hospital 
 (as specified in subparagraph
        (H)
            (ii) ) is 
 greater than the otherwise applicable resident 
 limit, the increase in the otherwise applicable 
 resident limit under subparagraph
        (A) for a 
 fiscal year described in such subparagraph 
 shall be an amount equal to the product of the 
 total number of additional residency positions 
 available for distribution under subparagraph
        (A)
            (ii) 
            (I) for such fiscal year and the 
 quotient of--
 ``
            (I) the number of resident 
 positions by which the reference 
 resident level of the hospital exceeds 
 the otherwise applicable resident limit 
 for the hospital; and
 ``
            (II) the number of resident 
 positions by which the reference 
 resident level of all such hospitals 
 with respect to which an application is 
 approved under this paragraph exceeds 
 the otherwise applicable resident limit 
 for such hospitals.
 ``
            (ii) Requirements.--A hospital described 
 in clause
            (i) --
 ``
            (I) is not eligible for an 
 increase in the otherwise applicable 
 resident limit under this subparagraph 
 unless the amount by which the 
 reference resident level of the 
 hospital exceeds the otherwise 
 applicable resident limit is not less 
 than 10 and the hospital trains at 
 least 25 percent of the full-time 
 equivalent residents of the hospital in 
 primary care and general surgery (as of 
 the date of enactment of this 
 paragraph); and
 ``
            (II) shall continue to train at 
 least 25 percent of the full-time 
 equivalent residents of the hospital in 
 primary care and general surgery for 
 the 5-year period beginning on such 
 date.
 In the case where the Secretary determines that 
 a hospital described in clause
            (i) no longer 
 meets the requirement of subclause
            (II) , the 
 Secretary may reduce the otherwise applicable 
 resident limit of the hospital by the amount by 
 which such limit was increased under this 
 subparagraph.
 ``
            (iii) Clarification regarding eligibility 
 for other additional residency positions.--
 Nothing in this subparagraph shall be construed 
 as preventing a hospital described in clause
            (i) from applying for and receiving additional 
 residency positions under this paragraph that 
 are not reserved for distribution under this 
 subparagraph.
 ``
            (C) Distribution of other positions.--For 
 purposes of determining an increase in the otherwise 
 applicable resident limit under subparagraph
        (A) (other 
 than such an increase described in subparagraph
        (B) ), 
 the following shall apply:
 ``
            (i) Considerations in distribution.--In 
 determining for which hospitals such an 
 increase is provided under subparagraph
        (A) , 
 the Secretary shall take into account the 
 demonstrated likelihood of the hospital filling 
 the positions made available under this 
 paragraph within the first 5 cost reporting 
 periods beginning after the date the increase 
 would be effective, as determined by the 
 Secretary.
 ``
            (ii) Minimum distribution for certain 
 categories of hospitals.--With respect to the 
 aggregate number of such positions available 
 for distribution under this paragraph, the 
 Secretary shall distribute not less than 10 
 percent of such aggregate number to each of the 
 following categories of hospitals:
 ``
            (I) Hospitals that--
 ``

    (aa) are located in a 
 rural area (as defined in 
 subsection
            (d) (2)
            (D) ), 
 excluding hospitals that are 
 treated as being located in a 
 rural area pursuant to 
 subsection
            (d) (8)
        (E) ;
 ``

    (bb) are located in an 
 area that has a rural-urban 
 commuting code equal to or 
 greater than 4.0;
 ``
            (cc) are sole community 
 hospitals (as defined in 
 subsection
            (d) (5)
            (D) 
            (iii) );
 ``
            (dd) are located within 
 10 miles of a sole community 
 hospital; or
 ``

    (ee) for fiscal years 
 after fiscal year 2031, have an 
 accredited rural training track 
 (as described in paragraph

    (4)
        (H)
            (iv) ).
 ``
            (II) Hospitals in which the 
 reference resident level of the 
 hospital (as specified in subparagraph
        (H)
            (ii) ) is greater than the otherwise 
 applicable resident limit.
 ``
            (III) Hospitals in States with--
 ``

    (aa) new medical schools 
 that received `Candidate 
 School' status from the Liaison 
 Committee on Medical Education 
 or that received `Pre-
 Accreditation' status from the 
 American Osteopathic 
 Association Commission on 
 Osteopathic College 
 Accreditation on or after 
 January 1, 2000, and that have 
 achieved or continue to 
 progress toward `Full 
 Accreditation' status (as such 
 term is defined by the Liaison 
 Committee on Medical Education) 
 or toward `Accreditation' 
 status (as such term is defined 
 by the American Osteopathic 
 Association Commission on 
 Osteopathic College 
 Accreditation); or
 ``

    (bb) additional locations 
 and branch campuses established 
 on or after January 1, 2000, by 
 medical schools with `Full 
 Accreditation' status (as such 
 term is defined by the Liaison 
 Committee on Medical Education) 
 or `Accreditation' status (as 
 such term is defined by the 
 American Osteopathic 
 Association Commission on 
 Osteopathic College 
 Accreditation).
 ``
            (IV) Hospitals that serve areas 
 designated as health professional 
 shortage areas under 

section 332

    (a)

    (1)
        (A) of the Public Health 
 Service Act, as determined by the 
 Secretary.
 ``
            (iii) Prioritization in distribution to 
 hpsa hospitals.--In distributing positions to a 
 hospital described in clause
            (ii) 
            (IV) , the 
 Secretary shall give priority to hospitals that 
 are affiliated with--
 ``
            (I) a historically Black medical 
 school (as defined in subparagraph
        (H) ); or
 ``
            (II) any other school listed in 
 

section 326

    (e)

    (1) of the Higher 
 Education Act of 1965 that establishes 
 a medical college.
 ``
            (D) Prohibition on distribution to hospitals 
 without an increase agreement.--No increase in the 
 otherwise applicable resident limit of a hospital may 
 be made under subparagraph
            (C) unless such hospital 
 agrees to increase the total number of full-time 
 equivalent residency positions under the approved 
 medical residency training program of such hospital by 
 the number of such positions made available by such 
 increase under the subparagraph.
 ``
        (E) Limitation.--
 ``
            (i) In general.--Except as provided in 
 clause
            (ii) , a hospital may not receive more 
 than 75 full-time equivalent additional 
 residency positions in the aggregate under this 
 paragraph, paragraph

    (9) , and paragraph

    (10) over the period of fiscal years 2026 through 
 2032.
 ``
            (ii) Increase in number of additional 
 positions a hospital may receive.--The 
 Secretary shall increase the aggregate number 
 of full-time equivalent additional residency 
 positions a hospital may receive under this 
 paragraph over such period if the Secretary 
 estimates that the number of positions 
 available for distribution under subparagraph
        (A) exceeds the number of applications approved 
 under such subparagraph over such period.
 ``
        (F) 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.
 ``
        (G) Permitting facilities to apply aggregation 
 rules.--The Secretary shall permit hospitals receiving 
 additional residency positions attributable to the 
 increase provided under this paragraph to, beginning in 
 the fifth year after the effective date of such 
 increase, apply such positions to the limitation amount 
 under paragraph

    (4)
        (F) that may be aggregated pursuant 
 to paragraph

    (4)
        (H) among members of the same 
 affiliated group.
 ``
        (H) === Definitions. ===
-In this paragraph:
 ``
            (i) 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 paragraphs

    (7)
        (A) ,

    (7)
        (B) ,

    (8)
        (A) ,

    (8)
        (B) ,

    (9) ,

    (10)
        (A) , and

    (10)
        (B) .
 ``
            (ii) Reference resident level.--Except as 
 otherwise provided in subclause
            (II) , the term 
 `reference resident level' means, with respect 
 to a hospital, the resident level for the most 
 recent cost reporting period of the hospital 
 ending on or before the date of enactment of 
 this paragraph, for which a cost report has 
 been settled (or, if not, submitted (subject to 
 audit)), as determined by the Secretary.
 ``
            (iii) Resident level.--The term `resident 
 level' has the meaning given such term in 
 paragraph

    (7)
            (C) 
            (i) .
 ``
            (iv) Qualifying hospital.--The term 
 `qualifying hospital' means a hospital 
 described in subparagraph
        (B)
            (i) or any of 
 subclauses
            (I) through
            (IV) of subparagraph
            (C) 
            (ii) .
 ``
            (v) Historically black medical school.--
 The term `historically Black medical school' 
 means Howard University College of Medicine, 
 Charles R. Drew University of Medicine and 
 Science, Meharry Medical College, Morehouse 
 School of Medicine, Xavier University Graduate 
 School of Health Sciences and Medical School, 
 and Maryland College of Osteopathic Medicine at 
 Morgan State University.''.

    (b) IME.--

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

    (1) in clause
            (v) , in the third sentence, by striking 
 ``subsections

    (h)

    (7) ,

    (h)

    (8) ,

    (h)

    (9) , and

    (h)

    (10) '' and 
 inserting ``subsections

    (h)

    (7) ,

    (h)

    (8) ,

    (h)

    (9) ,

    (h)

    (10) , and

    (h)

    (11) ''; and

    (2) by adding after clause
            (xiii) the following new clause:
 ``
            (xiv) For discharges occurring on or 
 after July 1, 2027, insofar as an additional 
 payment amount under this subparagraph is 
 attributable to resident positions distributed 
 to a hospital under subsection

    (h)

    (11) , the 
 indirect teaching adjustment factor shall be 
 computed in the same manner as provided under 
 clause
            (ii) with respect to such resident 
 positions.''.

SEC. 3. STUDY AND REPORT ON STRATEGIES FOR INCREASING DIVERSITY.

    (a) Study.--The Comptroller General of the United States (in this 
section referred to as the ``Comptroller General'') shall conduct a 
study on strategies for increasing the diversity of the health 
professional workforce. Such study shall include an analysis of 
strategies for increasing the number of health professionals from 
rural, lower income, and underrepresented minority communities, 
including which strategies are most effective for achieving such goal.

    (b) Report.--Not later than 2 years after the date of enactment of 
this Act, the Comptroller General shall submit to Congress a report on 
the study conducted under subsection

    (a) , together with recommendations 
for such legislation and administrative action as the Comptroller 
General determines appropriate.
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