Distribution of additional Medicare GME residency positions

(a) Distribution (1) In general Section 1886(h) of the Social Security Act (42 U.S.C. 1395ww(h)) is amended— (A) in paragraph (4)(F)(i), by striking and (10) and inserting (10), and (11); (B) in paragraph (4)(H)(i), by striking and (10) and inserting (10), and (11); and (C) by adding at the end the following new paragraph: (11) Distribution of additional residency positions in psychiatry and psychiatry subspecialties and primary care (A) Additional residency positions (i) In general For each of fiscal years 2027 through 2036 and for each succeeding fiscal year until the aggregate number of full-time equivalent residency positions distributed under this paragraph is equal to the aggregate number of such positions made available (as specified in clause (ii)(I)), the Secretary shall, subject to the succeeding provisions of this paragraph, increase the otherwise applicable resident limit for each qualifying hospital that submits a timely application under this subparagraph by such number as the Secretary may approve effective beginning July 1 of the fiscal year of the increase. (ii) Number available for distribution (I) Total number available The aggregate number of such positions made available under this paragraph shall be equal to 50,220. (II) Annual limit The aggregate number of such positions so made available shall not exceed 5,022 for a fiscal year. (iii) Distribution for psychiatry or psychiatry subspecialty residencies; primary care residencies For each of fiscal years 2027 through 2036, of the positions made available under this paragraph— (I) at least 15 percent shall be distributed for a psychiatry or psychiatry subspecialty residency (as defined in subparagraph (F)); (II) at least 30 percent shall be distributed for a primary care residency (as defined in such subparagraph); and (iv) 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 31 of the fiscal year of the increase. Such increase shall be effective beginning July 1 of such fiscal year. (B) Considerations in distribution In determining for which qualifying hospitals an 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 training years beginning after the date the increase would be effective, as determined by the Secretary. (C) Requirements (i) 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. (ii) Requirement for hospitals to expand programs If a hospital that receives an increase in the otherwise applicable resident limit under this paragraph would be eligible for an adjustment to the otherwise applicable resident limit for participation in a new medical residency training program under section 413.79(e)(3) of title 42, Code of Federal Regulations (or any successor regulation), the hospital shall ensure that any positions made available under this paragraph are used to expand an existing program of the hospital and not for participation in a new medical residency training program. (D) Application of per resident amounts for 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 nonprimary care computed under paragraph (2)(D) for that hospital. (E) 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. (F) 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)(A), and (10)(A). (ii) Primary care residency The term primary care residency means a residency in a program described in paragraph (5)(H). (iii) Psychiatry or psychiatry subspecialty residency The term psychiatry or psychiatry subspecialty residency has the meaning given that term in paragraph (10)(F). (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).. (2) IME Section 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) is amended— (A) in clause (v), in the third sentence, by striking and (h)(10) and inserting (h)(10), and (h)(11); and (B) by adding at the end the following new clause: (xiii) 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.. (3) Prohibition on judicial review Section 1886(h)(7)(E) of the Social Security Act (42 U.S.C. 1395ww(h)(7)(E)) is amended by inserting paragraph (11), after paragraph (10),.