119-s2439

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 2439 Introduced in Senate

    (IS) ]

<DOC>

119th CONGRESS
 1st Session
 S. 2439

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

_______________________________________________________________________

 IN THE SENATE OF THE UNITED STATES

 July 24, 2025

 Mr. Boozman (for himself, Mr. Warnock, Ms. Collins, Mr. Schumer, Mrs. 
Gillibrand, Ms. Rosen, Ms. Klobuchar, Mr. King, Mr. Gallego, Mr. Welch, 
 Ms. Slotkin, and Mr. Durbin) introduced the following bill; which was 
 read twice and referred to the Committee on Finance

_______________________________________________________________________

 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 ``and

    (10) '' and 
 inserting ``

    (10) , and

    (11) '';

    (2) in paragraph

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

    (10) '' and 
 inserting ``

    (10) , and

    (11) '';

    (3) in paragraph

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

    (11) ,'' 
 after ``paragraph

    (10) ,''; 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 
 2027 through 2033 (and succeeding fiscal years 
 if the Secretary determines that there are 
 additional residency positions available to 
 distribute under clause
            (iii) 
            (II) ), the 
 Secretary shall increase the otherwise 
 applicable resident limit for each qualifying 
 hospital (as defined in subparagraph
        (G) ) 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. Except as provided 
 in clause
            (iii) , the aggregate number of 
 increases in the otherwise applicable resident 
 limit under this subparagraph shall be equal to 
 2,000 in each of fiscal years 2027 through 
 2033.
 ``
            (ii) 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 2027 through 
 2033.
 ``
            (II) Number available.--In each 
 of such rounds, the aggregate number of 
 positions available for distribution in 
 the fiscal year as a result of an 
 increase in the otherwise applicable 
 resident limit (as described in clause
            (i) ) shall be distributed, plus any 
 additional positions available under 
 clause
            (iii) .
 ``
            (III) Timing.--The Secretary 
 shall notify hospitals of the number of 
 positions distributed to the hospital 
 under this paragraph as result of an 
 increase in the otherwise applicable 
 resident limit by January 31 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.
 ``
            (iii) 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
            (i) , 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 
 2033.--If the aggregate number of 
 positions distributed under this 
 paragraph during the 7-year period of 
 fiscal years 2027 through 2033 is less 
 than 14,000, the Secretary shall, in 
 accordance with the considerations 
 described in subparagraph
        (B)
            (i) and 
 the priority described in subparagraph
        (B)
            (ii) , 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) Distribution to certain hospitals.--
 ``
            (i) Consideration in distribution.--In 
 determining for which hospitals the increase in 
 the otherwise applicable resident limit 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 
 

section 1886
            (d) (2)
            (D) ), 
 excluding hospitals that are 
 treated as being located in a 
 rural area pursuant to 

section 1886
            (d) (8)
        (E) ;
 ``

    (bb) are located in an 
 area that has a rural-urban 
 commuting code equal to or 
 great than 4.0;
 ``
            (cc) are sole community 
 hospitals (as defined in 
 

section 1866
            (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
        (G)
            (iv) ) 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) Special rules.--
 ``
            (I) In general.--In distributing 
 positions under clause
            (ii) , the 
 Secretary shall not prioritize 
 hospitals in multiple categories over 
 hospitals in an individual category or 
 based on 

section 332 of the Public 
 Health Service Act.
 ``
            (II) 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--
 ``

    (aa) a historically Black 
 medical school (as defined in 
 subparagraph
        (G) ); or
 ``

    (bb) any other school 
 listed in 

section 326

    (e)

    (1) of 
 the Higher Education Act of 
 1965 that establishes a medical 
 college.
 ``
            (C) Prohibition on distribution to hospitals 
 without an increase agreement.--No increase in the 
 otherwise applicable resident limit of a hospital may 
 be made under this paragraph 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 this paragraph.
 ``
            (D) 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 and paragraphs

    (9) and

    (10) over the 
 period of fiscal years 2027 through 2033.
 ``
            (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.
 ``
        (E) 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.
 ``
        (F) 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.
 ``
        (G) === Definitions. ===
-In this paragraph:
 ``
            (i) 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.
 ``
            (ii) 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)
        (A) ,

    (9)
        (B) ,

    (10)
        (A) , and

    (10)
        (B) .
 ``
            (iii) Qualifying hospital.--The term 
 `qualifying hospital' means a hospital 
 described in any of subclauses
            (I) through
            (IV) of subparagraph
        (B)
            (ii) .
 ``
            (iv) Reference resident level.--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.
 ``
            (v) Resident level.--The term `resident 
 level' has the meaning given such term in 
 paragraph

    (7)
            (C) 
            (i) .''.

    (b) IME.--

    (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 third 
 sentence, is amended by striking ``and

    (h)

    (10) '' and inserting 
 ``

    (h)

    (10) , and

    (h)

    (11) ''.

    (2) Conforming provision.--

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 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 the 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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