SEC. 422. REDISTRIBUTION OF UNUSED RESIDENT POSITIONS.
(a) IN GENERAL- Section 1886(h) (42 U.S.C.
1395ww(h)(4)) is amended--
(1) in paragraph (4)(F)(i), by inserting
`subject to paragraph (7),' after `October 1, 1997,';
(2) in paragraph (4)(H)(i), by inserting
`and subject to paragraph (7)' after `subparagraphs (F) and (G)'; and
(3) by adding at the end the following
new paragraph:
`(7) REDISTRIBUTION OF UNUSED RESIDENT POSITIONS-
`(A) REDUCTION IN LIMIT BASED ON UNUSED POSITIONS-
`(i) PROGRAMS SUBJECT TO REDUCTION-
`(I) IN GENERAL- Except as provided in subclause (II), if a
hospital's reference resident level (specified in clause (ii)) is less
than the otherwise applicable resident limit (as defined in
subparagraph (C)(ii)), effective for portions of cost reporting
periods occurring on or after July 1, 2005, the otherwise applicable
resident limit shall be reduced by 75 percent of the difference
between such otherwise applicable resident limit and such reference
resident level.
`(II) EXCEPTION FOR SMALL RURAL HOSPITALS- This subparagraph shall
not apply to a hospital located in a rural area (as defined in
subsection (d)(2)(D)(ii)) with fewer than 250 acute care inpatient
beds.
`(ii) REFERENCE RESIDENT LEVEL-
`(I) IN GENERAL- Except as otherwise provided in subclauses (II)
and (III), the reference resident level specified in this clause for a
hospital is the resident level for the most recent cost reporting
period of the hospital ending on or before September 30, 2002, for
which a cost report has been settled (or, if not, submitted (subject
to audit)), as determined by the Secretary.
`(II) USE OF MOST RECENT ACCOUNTING PERIOD TO RECOGNIZE EXPANSION
OF EXISTING PROGRAMS- If a hospital submits a timely request to
increase its resident level due to an expansion of an existing
residency training program that is not reflected on the most recent
settled cost report, after audit and subject to the discretion of the
Secretary, the reference resident level for such hospital is the
resident level for the cost reporting period that includes July 1,
2003, as determined by the Secretary.
`(III) EXPANSIONS UNDER NEWLY APPROVED PROGRAMS- Upon the timely
request of a hospital, the Secretary shall adjust the reference
resident level specified under subclause (I) or (II) to include the
number of medical residents that were approved in an application for a
medical residency training program that was approved by an appropriate
accrediting organization (as determined by the Secretary) before
January 1, 2002, but which was not in operation during the cost
reporting period used under subclause (I) or (II), as the case may be,
as determined by the Secretary.
`(iii) AFFILIATION- The provisions of clause (i) shall be applied to
hospitals which are members of the same affiliated group (as defined by
the Secretary under paragraph (4)(H)(ii)) as of July 1,
2003.
`(B) REDISTRIBUTION-
`(i) IN GENERAL- The Secretary is authorized to 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 for portions of cost reporting periods
occurring on or after July 1, 2005. The aggregate number of increases in
the otherwise applicable resident limits under this subparagraph may not
exceed the Secretary's estimate of the aggregate reduction in such
limits attributable to subparagraph (A).
`(ii) CONSIDERATIONS IN REDISTRIBUTION- In determining for which
hospitals the increase in the otherwise applicable resident limit is
provided under clause (i), the Secretary shall take into account the
demonstrated likelihood of the hospital filling the positions within the
first 3 cost reporting periods beginning on or after July 1, 2005, made
available under this subparagraph, as determined by the
Secretary.
`(iii) PRIORITY FOR RURAL AND SMALL URBAN AREAS- In determining for
which hospitals and residency training programs an increase in the
otherwise applicable resident limit is provided under clause (i), the
Secretary shall distribute the increase to programs of hospitals located
in the following priority order:
`(I) First, to hospitals located in rural areas (as defined in
subsection (d)(2)(D)(ii)).
`(II) Second, to hospitals located in urban areas that are not
large urban areas (as defined for purposes of subsection
(d)).
`(III) Third, to other hospitals in a State if the residency
training program involved is in a specialty for which there are not
other residency training programs in the State.
Increases of residency limits within the same priority category
under this clause shall be determined by the Secretary.
`(iv) LIMITATION- In no case shall more than 25 full-time equivalent
additional residency positions be made available under this subparagraph
with respect to any hospital.
`(v) APPLICATION OF LOCALITY ADJUSTED NATIONAL AVERAGE PER RESIDENT
AMOUNT- With respect to additional residency positions in a hospital
attributable to the increase provided under this subparagraph,
notwithstanding any other provision of this subsection, the approved FTE
resident amount is deemed to be equal to the locality adjusted national
average per resident amount computed under paragraph (4)(E) for that
hospital.
`(vi) CONSTRUCTION- Nothing in this subparagraph shall be construed
as permitting the redistribution of reductions in residency positions
attributable to voluntary reduction programs under paragraph (6), under
a demonstration project approved as of October 31, 2003, under the
authority of section 402 of Public Law 90-248, or as affecting the
ability of a hospital to establish new medical residency training
programs under paragraph (4)(H).
`(C) RESIDENT LEVEL AND LIMIT DEFINED- In this paragraph:
`(i) RESIDENT LEVEL- The term `resident level' means, with respect
to a hospital, the total number of full-time equivalent residents,
before the application of weighting factors (as determined under
paragraph (4)), in the fields of allopathic and osteopathic medicine for
the hospital.
`(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.
`(D) JUDICIAL REVIEW- There shall be no administrative or judicial
review under section 1869, 1878, or otherwise, with respect to
determinations made under this paragraph.'.
(A) in the second sentence of
clause (ii), by striking `For discharges' and inserting `Subject to clause
(ix), for discharges';
(B) in clause (v), by adding
at the end the following: `The provisions of subsection (h)(7) shall apply
with respect to the first sentence of this clause in the same manner as it
applies with respect to subsection (h)(4)(F)(i).'; and
(C) by adding at the end the
following new clause:
`(ix) For discharges occurring on or after July 1, 2005, insofar as an
additional payment amount under this subparagraph is attributable to
resident positions redistributed to a hospital under subsection (h)(7)(B),
in computing the indirect teaching adjustment factor under clause (ii) the
adjustment shall be computed in a manner as if `c' were equal to 0.66 with
respect to such resident positions.'.
(2) Chapter 35 of title 44, United States
Code, shall not apply with respect to applications under section 1886(h)(7)
of the Social Security Act, as added by subsection (a)(3).
(c) REPORT ON EXTENSION OF APPLICATIONS UNDER
REDISTRIBUTION PROGRAM- Not later than July 1, 2005, the Secretary shall submit
to Congress a report containing recommendations regarding whether to extend
the deadline for applications for an increase in resident limits under section
1886(h)(4)(I)(ii)(II) of the Social Security Act (as added by subsection (a)).
