Us Congress 2025-2026 Regular Session

Us Congress House Bill HB1153 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	I
2	2	119THCONGRESS
3	3	1
4	4	STSESSION H. R. 1153
5	5	To amend title XVIII of the Social Security Act to support rural residency
6	6	training funding that is equitable for all States, and for other purposes.
7	7	IN THE HOUSE OF REPRESENTATIVES
8	8	FEBRUARY10, 2025
9	9	Mrs. H
10	10	ARSHBARGER(for herself, Ms. SCHRIER, and Mr. BACON) introduced
11	11	the following bill; which was referred to the Committee on Ways and
12	12	Means, and in addition to the Committee on Energy and Commerce, for
13	13	a period to be subsequently determined by the Speaker, in each case for
14	14	consideration of such provisions as fall within the jurisdiction of the com-
15	15	mittee concerned
16	16	A BILL
17	17	To amend title XVIII of the Social Security Act to support
18	18	rural residency training funding that is equitable for
19	19	all States, and for other purposes.
20	20	Be it enacted by the Senate and House of Representa-1
21	21	tives of the United States of America in Congress assembled, 2
22	22	SECTION 1. SHORT TITLE. 3
23	23	This Act may be cited as the ‘‘Rural Physician Work-4
24	24	force Production Act of 2025’’. 5
25	25	VerDate Sep 11 2014 22:38 Mar 07, 2025 Jkt 059200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1153.IH H1153
26	26	ssavage on LAPJG3WLY3PROD with BILLS 2
27	27	•HR 1153 IH
28	28	SEC. 2. ELECTIVE RURAL SUSTAINABILITY PER RESIDENT 1
29	29	PAYMENT FOR RESIDENTS TRAINING IN 2
30	30	RURAL TRAINING LOCATIONS. 3
31	31	(a) I
32	32	NGENERAL.—Section 1886 of the Social Secu-4
33	33	rity Act (42 U.S.C. 1395ww) is amended by adding at the 5
34	34	end the following new subsection: 6
35	35	‘‘(u) E
36	36	LECTIVERURALSUSTAINABILITYPERRESI-7
37	37	DENTPAYMENTAMOUNT FORRESIDENTSTRAINING IN 8
38	38	R
39	39	URALTRAININGLOCATIONS.— 9
40	40	‘‘(1) D
41	41	ETERMINATION OF ELECTIVE RURAL 10
42	42	SUSTAINABILITY PER RESIDENT PAYMENT 11
43	43	AMOUNT.— 12
44	44	‘‘(A) I
45	45	N GENERAL.—The elective rural sus-13
46	46	tainability per resident payment amount deter-14
47	47	mined under this subsection for an applicable 15
48	48	hospital (as defined in paragraph (7)(A)) that 16
49	49	makes an election under paragraph (2), with re-17
50	50	spect to each full-time-equivalent resident in an 18
51	51	approved medical residency training program 19
52	52	that receives training in a rural training loca-20
53	53	tion (as defined in paragraph (7)(C)), is an 21
54	54	amount equal to the difference between— 22
55	55	‘‘(i) the total elective rural sustain-23
56	56	ability amount determined under subpara-24
57	57	graph (B) (or, in the case of an applicable 25
58	58	hospital not located in a rural area, the 26
59	59	VerDate Sep 11 2014 22:38 Mar 07, 2025 Jkt 059200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1153.IH H1153
60	60	ssavage on LAPJG3WLY3PROD with BILLS 3
61	61	•HR 1153 IH
62	62	total elective rural sustainability amount or 1
63	63	urban total elective rural sustainability 2
64	64	amount, as applicable, determined under 3
65	65	such subparagraph); and 4
66	66	‘‘(ii) the amount (if any) the applica-5
67	67	ble hospital otherwise receives for direct 6
68	68	graduate medical education costs under 7
69	69	subsection (h) or section 1814(l), as appli-8
70	70	cable, with respect to each such resident. 9
71	71	‘‘(B) T
72	72	OTAL ELECTIVE RURAL SUSTAIN -10
73	73	ABILITY AMOUNT.— 11
74	74	‘‘(i) E
75	75	STABLISHMENT FOR INITIAL 12
76	76	COST REPORTING PERIODS .— 13
77	77	‘‘(I) I
78	78	N GENERAL.—Subject to 14
79	79	subclause (II), for cost reporting peri-15
80	80	ods beginning during the first year be-16
81	81	ginning on or after the date of the en-17
82	82	actment of this subsection, the Sec-18
83	83	retary shall establish a total elective 19
84	84	rural sustainability amount for time 20
85	85	spent by each full-time-equivalent resi-21
86	86	dent in an approved medical residency 22
87	87	training program that receives train-23
88	88	ing in a rural training location. Such 24
89	89	amount shall be the amount that the 25
90	90	VerDate Sep 11 2014 22:38 Mar 07, 2025 Jkt 059200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1153.IH H1153
91	91	ssavage on LAPJG3WLY3PROD with BILLS 4
92	92	•HR 1153 IH
93	93	Secretary determines is equal to the 1
94	94	median national direct GME training 2
95	95	costs per full-time-equivalent resident 3
96	96	for 2015 described in table 9 on page 4
97	97	33 of the March 2018 GAO report on 5
98	98	Physician Workforce (GAO–18–240), 6
99	99	updated for each subsequent year 7
100	100	through the first year beginning on or 8
101	101	after the date of the enactment of this 9
102	102	subsection, by the annual percentage 10
103	103	increase in the consumer price index 11
104	104	for all urban consumers (all items; 12
105	105	United States city average). 13
106	106	‘‘(II) A
107	107	PPLICATION TO URBAN 14
108	108	HOSPITALS.—For cost reporting peri-15
109	109	ods beginning during the first year be-16
110	110	ginning on or after the date of the en-17
111	111	actment of this subsection, in the case 18
112	112	of an applicable hospital that is not 19
113	113	located in a rural area— 20
114	114	‘‘(aa) with respect to such 21
115	115	residents that receive training in 22
116	116	a rural track or an integrated 23
117	117	rural track, the total elective 24
118	118	rural sustainability amount per 25
119	119	VerDate Sep 11 2014 22:38 Mar 07, 2025 Jkt 059200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1153.IH H1153
120	120	ssavage on LAPJG3WLY3PROD with BILLS 5
121	121	•HR 1153 IH
122	122	resident shall be equal to the 1
123	123	amount established under sub-2
124	124	clause (I); and 3
125	125	‘‘(bb) with respect to such 4
126	126	residents that receive training in 5
127	127	a rural training location and who 6
128	128	are not participating in a rural 7
129	129	track or an integrated rural 8
130	130	track, the total elective rural sus-9
131	131	tainability amount per resident 10
132	132	shall be equal to 50 percent of 11
133	133	the amount established under 12
134	134	subclause (I) (referred to in this 13
135	135	subsection as the ‘urban total 14
136	136	elective rural sustainability 15
137	137	amount’). 16
138	138	‘‘(ii) U
139	139	PDATING FOR SUBSEQUENT 17
140	140	COST REPORTING PERIODS .—For each sub-18
141	141	sequent cost reporting period, the total 19
142	142	elective rural sustainability amount under 20
143	143	clause (i)(I) and clause (i)(II)(aa) and the 21
144	144	urban total elective rural sustainability 22
145	145	amount under clause (i)(II)(bb), respec-23
146	146	tively, are equal to such amounts deter-24
147	147	mined under such clause for the previous 25
148	148	VerDate Sep 11 2014 22:38 Mar 07, 2025 Jkt 059200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1153.IH H1153
149	149	ssavage on LAPJG3WLY3PROD with BILLS 6
150	150	•HR 1153 IH
151	151	cost reporting period updated, through the 1
152	152	midpoint of the period, by projecting the 2
153	153	estimated percentage change in the con-3
154	154	sumer price index for all urban consumers 4
155	155	(all items; United States city average) dur-5
156	156	ing the 12-month period ending at that 6
157	157	midpoint, with appropriate adjustments to 7
158	158	reflect previous under- or over-estimations 8
159	159	under this clause in the projected percent-9
160	160	age change in the consumer price index for 10
161	161	medical care services. 11
162	162	‘‘(C) C
163	163	LARIFICATION.—The total elective 12
164	164	rural sustainability amount, the urban total 13
165	165	elective rural sustainability amount, and the 14
166	166	elective rural sustainability per resident pay-15
167	167	ment amount determined under this paragraph 16
168	168	shall not be discounted or otherwise adjusted 17
169	169	based on the Medicare patient load (as defined 18
170	170	in subsection (h)(3)(C)) of an applicable hos-19
171	171	pital or discharges in a diagnosis-related group. 20
172	172	‘‘(2) E
173	173	LECTION.—For cost reporting periods 21
174	174	beginning on or after the date that is 1 year after 22
175	175	the date of the enactment of this subsection, an ap-23
176	176	plicable hospital may elect to receive the elective 24
177	177	rural sustainability per resident payment amount for 25
178	178	VerDate Sep 11 2014 22:38 Mar 07, 2025 Jkt 059200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H1153.IH H1153
179	179	ssavage on LAPJG3WLY3PROD with BILLS 7
180	180	•HR 1153 IH
181	181	each full-time-equivalent resident in an approved 1
182	182	medical residency training program that receives 2
183	183	training in a rural training location in accordance 3
184	184	with this subsection. An applicable hospital may 4
185	185	make an election under the preceding sentence re-5
186	186	gardless of whether the applicable hospital is other-6
187	187	wise eligible for a payment or adjustment for indi-7
188	188	rect and direct graduate medical education costs 8
189	189	under subsections (d)(5)(B) and (h) or section 9
190	190	1814(l), as applicable, with respect to such resi-10
191	191	dents. 11
192	192	‘‘(3) A
193	193	PPLICATION.—The provisions of this sub-12
194	194	section, or the application of such provisions to an 13
195	195	applicable hospital— 14
196	196	‘‘(A) shall not result in— 15
197	197	‘‘(i) the establishment of a limitation 16
198	198	on the number of residents in allopathic or 17
199	199	osteopathic medicine for purposes of sub-18
200	200	sections (d)(5)(B) and (h) with respect to 19
201	201	an approved medical residency training 20
202	202	program of an applicable hospital (or be 21
203	203	taken into account in determining such a 22
204	204	limitation during the cap building period of 23
205	205	an applicable hospital); or 24
206	206	VerDate Sep 11 2014 22:38 Mar 07, 2025 Jkt 059200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1153.IH H1153
207	207	ssavage on LAPJG3WLY3PROD with BILLS 8
208	208	•HR 1153 IH
209	209	‘‘(ii) the counting of any resident with 1
210	210	respect to which the applicable hospital re-2
211	211	ceives an elective rural sustainability per 3
212	212	resident payment amount under this sub-4
213	213	section towards the application of the limi-5
214	214	tation described in clause (i) for purposes 6
215	215	of subsections (d)(5)(B) and (h); and 7
216	216	‘‘(B) shall not have any effect on the de-8
217	217	termination of— 9
218	218	‘‘(i) the additional payment amount 10
219	219	under subsection (d)(5)(B); or 11
220	220	‘‘(ii) hospital-specific approved FTE 12
221	221	resident amounts under subsection (h). 13
222	222	‘‘(4) A
223	223	LLOCATION OF PAYMENTS .—In providing 14
224	224	for payments under this subsection, the Secretary 15
225	225	shall provide for an allocation of such payments be-16
226	226	tween parts A and part B (and the trust funds es-17
227	227	tablished under the respective parts) as reasonably 18
228	228	reflects the proportion of such costs associated with 19
229	229	the provision of services under each respective part. 20
230	230	‘‘(5) E
231	231	LIGIBILITY FOR PAYMENT.— 21
232	232	‘‘(A) I
233	233	N GENERAL.—An applicable hospital 22
234	234	shall be eligible for payment of the elective 23
235	235	rural sustainability per resident payment 24
236	236	amount under this subsection for time spent by 25
237	237	VerDate Sep 11 2014 22:38 Mar 07, 2025 Jkt 059200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H1153.IH H1153
238	238	ssavage on LAPJG3WLY3PROD with BILLS 9
239	239	•HR 1153 IH
240	240	a resident training in a rural training location 1
241	241	if the following requirements are met: 2
242	242	‘‘(i) The resident spends the equiva-3
243	243	lent of at least 8 weeks over the course of 4
244	244	their training in a rural training location. 5
245	245	‘‘(ii) The hospital pays the salary and 6
246	246	benefits of the resident for the time spent 7
247	247	training in a rural training location. 8
248	248	‘‘(B) T
249	249	REATMENT OF TIME SPENT IN 9
250	250	RURAL TRACKS OR INTEGRATED RURAL 10
251	251	TRACKS.—An applicable hospital shall be eligi-11
252	252	ble for payment of the elective rural sustain-12
253	253	ability per resident payment amount under this 13
254	254	subsection for all time spent by residents in an 14
255	255	approved medical residency program (or sepa-15
256	256	rately defined track within a program) that pro-16
257	257	vides more than 50 percent of the total resi-17
258	258	dency training time in rural training locations, 18
259	259	regardless of where the training occurs and re-19
260	260	gardless of specialty. 20
261	261	‘‘(6) D
262	262	ETERMINATION OF FULL -TIME-EQUIVA-21
263	263	LENT RESIDENTS.—The determination of full-time- 22
264	264	equivalent residents for purposes of this subsection 23
265	265	shall be made in the same manner as the determina-24
266	266	tion of full-time-equivalent residents under sub-25
267	267	VerDate Sep 11 2014 22:38 Mar 07, 2025 Jkt 059200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H1153.IH H1153
268	268	ssavage on LAPJG3WLY3PROD with BILLS 10
269	269	•HR 1153 IH
270	270	section (h)(4), but not taking into account the limi-1
271	271	tation under subparagraph (F) of such subsection. 2
272	272	‘‘(7) D
273	273	EFINITIONS.—In this subsection: 3
274	274	‘‘(A) A
275	275	PPLICABLE HOSPITAL .—The term 4
276	276	‘applicable hospital’ means a hospital, critical 5
277	277	access hospital, sole community hospital (as de-6
278	278	fined in subsection (d)(5)(D)(iii)), or rural 7
279	279	emergency hospital (as defined in section 8
280	280	1861(kkk)(2)). 9
281	281	‘‘(B) A
282	282	PPROVED MEDICAL RESIDENCY 10
283	283	TRAINING PROGRAM ; DIRECT GRADUATE MED -11
284	284	ICAL EDUCATION COSTS ; RESIDENT.—The 12
285	285	terms ‘approved medical residency training pro-13
286	286	gram’, ‘direct graduate medical education 14
287	287	costs’, and ‘resident’ have the meanings given 15
288	288	those terms in subsection (h)(5). 16
289	289	‘‘(C) R
290	290	URAL TRAINING LOCATION .—The 17
291	291	term ‘rural training location’ means a location 18
292	292	in which training occurs that, based on the 19
293	293	2010 census or any subsequent census adjust-20
294	294	ment, meets one or more of the following cri-21
295	295	teria: 22
296	296	‘‘(i) The training occurs in a location 23
297	297	that is a rural area (as defined in section 24
298	298	1886(d)(2)(D)), not including any hospital 25
299	299	VerDate Sep 11 2014 22:38 Mar 07, 2025 Jkt 059200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H1153.IH H1153
300	300	ssavage on LAPJG3WLY3PROD with BILLS 11
301	301	•HR 1153 IH
302	302	treated as being located in a rural area 1
303	303	pursuant to section 1886(d)(8)(E) . 2
304	304	‘‘(ii) The training occurs in a location 3
305	305	that has a rural-urban commuting area 4
306	306	code equal to or greater than 4.0. 5
307	307	‘‘(iii) The training occurs in a sole 6
308	308	community hospital (as defined in sub-7
309	309	section (d)(5)(D)(iii)) or in a location that 8
310	310	is within 10 miles of a sole community hos-9
311	311	pital. 10
312	312	‘‘(8) B
313	313	UDGET NEUTRALITY REQUIREMENT .— 11
314	314	The Secretary shall ensure that aggregate payments 12
315	315	for direct medical education costs and indirect med-13
316	316	ical education costs under this title, including any 14
317	317	payments under this subsection, for each year (effec-15
318	318	tive beginning on or after the date that is 1 year 16
319	319	after the date of enactment of this subsection) are 17
320	320	not greater than the aggregate payments for such 18
321	321	costs that would have been made under this title for 19
322	322	the year without the application of this subsection. 20
323	323	For purposes of carrying out the budget neutrality 21
324	324	requirement under the preceding sentence, the Sec-22
325	325	retary may make appropriate adjustments to the 23
326	326	amount of such payments for direct graduate med-24
327	327	ical education costs and indirect medical education 25
328	328	VerDate Sep 11 2014 22:38 Mar 07, 2025 Jkt 059200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H1153.IH H1153
329	329	ssavage on LAPJG3WLY3PROD with BILLS 12
330	330	•HR 1153 IH
331	331	costs under subsections (h) and (d)(5)(B), respec-1
332	332	tively.’’. 2
333	333	(b) T
334	334	REATMENT OF CRITICALACCESSHOSPITALS 3
335	335	ANDSOLECOMMUNITYHOSPITALS.— 4
336	336	(1) C
337	337	RITICAL ACCESS HOSPITALS .—Section 5
338	338	1814(l) of the Social Security Act (42 U.S.C. 6
339	339	1395f(l)) is amended by adding at the end the fol-7
340	340	lowing new paragraph: 8
341	341	‘‘(6) For cost reporting periods beginning on or after 9
342	342	the date that is 1 year after the date of enactment of this 10
343	343	paragraph, the following shall apply: 11
344	344	‘‘(A) A critical access hospital may elect to be 12
345	345	treated as a hospital or as a non-provider setting for 13
346	346	purposes of counting resident time for indirect med-14
347	347	ical education costs and direct graduate medical edu-15
348	348	cation costs for the time spent by the resident in 16
349	349	that setting under subsections (d)(5)(B) and (h), re-17
350	350	spectively, of section 1886. 18
351	351	‘‘(B) Direct medical education costs shall not be 19
352	352	considered reasonable costs of a critical access hos-20
353	353	pital for purposes of payment under paragraph (1), 21
354	354	to the extent that the critical access hospital is 22
355	355	treated as a non-provider setting of another hospital 23
356	356	or another hospital receives payment for such costs 24
357	357	for the time spent by the resident in that setting 25
358	358	VerDate Sep 11 2014 22:38 Mar 07, 2025 Jkt 059200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H1153.IH H1153
359	359	ssavage on LAPJG3WLY3PROD with BILLS 13
360	360	•HR 1153 IH
361	361	pursuant to subsection (d)(5)(B), subsection (h), or 1
362	362	subsection (u) of section 1886.’’. 2
363	363	(2) S
364	364	OLE COMMUNITY HOSPITALS .—Section 3
365	365	1886(d)(5)(D) of the Social Security Act (42 U.S.C. 4
366	366	1395ww(d)(5)(D)) is amended by adding at the end 5
367	367	the following new clause: 6
368	368	‘‘(vi) For cost reporting periods beginning on or after 7
369	369	the date that is 1 year after the date of enactment of this 8
370	370	paragraph, the hospital-specific payment amount deter-9
371	371	mined under clause (i)(I) with respect to a sole community 10
372	372	hospital shall not include direct medical education costs, 11
373	373	to the extent that the sole community hospital receives 12
374	374	payment for such costs for the time spent by the resident 13
375	375	in that setting pursuant to subsection (u).’’. 14
376	376	(c) C
377	377	ONFORMINGAMENDMENTS.— 15
378	378	(1) Section 1886 of the Social Security Act (42 16
379	379	U.S.C. 1395ww) is amended— 17
380	380	(A) in subsection (d)(5)(B), in the matter 18
381	381	preceding clause (i), by striking ‘‘The Sec-19
382	382	retary’’ and inserting ‘‘Subject to subsection 20
383	383	(u), the Secretary’’; and 21
384	384	(B) in subsection (h)— 22
385	385	(i) in paragraph (1), by inserting 23
386	386	‘‘subject to subsection (u)’’ after 24
387	387	‘‘1861(v),’’; and 25
388	388	VerDate Sep 11 2014 22:38 Mar 07, 2025 Jkt 059200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H1153.IH H1153
389	389	ssavage on LAPJG3WLY3PROD with BILLS 14
390	390	•HR 1153 IH
391	391	(ii) in paragraph (3), in the flush 1
392	392	matter following subparagraph (B), by 2
393	393	striking ‘‘subsection (k)’’ and inserting 3
394	394	‘‘subsection (k) or subsection (u)’’. 4
395	395	SEC. 3. SUPPORTING NEW, EXPANDING, AND EXISTING 5
396	396	RURAL TRAINING TRACKS. 6
397	397	(a) D
398	398	IRECTGRADUATEMEDICALEDUCATION.—Sec-7
399	399	tion 1886(h) of the Social Security Act (42 U.S.C. 8
400	400	1395ww(h)) is amended— 9
401	401	(1) in paragraph (4)— 10
402	402	(A) in subparagraph (F)(i)— 11
403	403	(i) by striking ‘‘130 percent’’ and in-12
404	404	serting ‘‘for cost reporting periods begin-13
405	405	ning on or after October 1, 1997, and be-14
406	406	fore the date that is 1 year after the date 15
407	407	of enactment of the Rural Physician Work-16
408	408	force Production Act of 2025, 130 per-17
409	409	cent’’; and 18
410	410	(ii) by adding at the end the fol-19
411	411	lowing: ‘‘For cost reporting periods begin-20
412	412	ning on or after the date that is 1 year 21
413	413	after the date of enactment of the Rural 22
414	414	Physician Workforce Production Act of 23
415	415	2025, such rules shall provide that any 24
416	416	full-time-equivalent resident in an ap-25
417	417	VerDate Sep 11 2014 22:38 Mar 07, 2025 Jkt 059200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\H1153.IH H1153
418	418	ssavage on LAPJG3WLY3PROD with BILLS 15
419	419	•HR 1153 IH
420	420	proved medical residency program (or sep-1
421	421	arately defined track within a program) 2
422	422	that provides more than 50 percent of the 3
423	423	total residency training time in rural train-4
424	424	ing locations (as defined in subsection 5
425	425	(u)(6)(C)), regardless of where the training 6
426	426	occurs and regardless of specialty, shall 7
427	427	not be taken into account for purposes of 8
428	428	applying the limitation under this subpara-9
429	429	graph.’’; and 10
430	430	(B) in subparagraph (H)— 11
431	431	(i) in clause (i), in the second sen-12
432	432	tence, by inserting the following before the 13
433	433	period: ‘‘, in accordance with the second 14
434	434	sentence of clause (i) of such subpara-15
435	435	graph’’; and 16
436	436	(ii) in clause (iv), by inserting the fol-17
437	437	lowing before the period: ‘‘, in accordance 18
438	438	with the second sentence of clause (i) of 19
439	439	such subparagraph’’; and 20
440	440	(2) in paragraph (5), by adding at the end the 21
441	441	following new subparagraph: 22
442	442	‘‘(L) S
443	443	PECIAL RULES REGARDING APPLICA -23
444	444	TION OF ELECTIVE RURAL SUSTAINABILITY PER 24
445	445	RESIDENT PAYMENT AMOUNT .—For special 25
446	446	VerDate Sep 11 2014 22:38 Mar 07, 2025 Jkt 059200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\H1153.IH H1153
447	447	ssavage on LAPJG3WLY3PROD with BILLS 16
448	448	•HR 1153 IH
449	449	rules regarding application of the elective rural 1
450	450	sustainability per resident payment amount 2
451	451	under subsection (u), see paragraph (3) of such 3
452	452	subsection.’’. 4
453	453	(b) I
454	454	NDIRECT MEDICALEDUCATION.—Section 5
455	455	1886(d)(5)(B)(v) is amended— 6
456	456	(1) by striking ‘‘130 percent’’ and inserting 7
457	457	‘‘for cost reporting periods beginning on or after Oc-8
458	458	tober 1, 1997, and before the date that is 1 year 9
459	459	after the date of enactment of the Rural Physician 10
460	460	Workforce Production Act of 2025, 130 percent’’; 11
461	461	and 12
462	462	(2) by adding at the end the following: ‘‘For 13
463	463	cost reporting periods beginning on or after the date 14
464	464	that is 1 year after the date of enactment of the 15
465	465	Rural Physician Workforce Production Act of 2025, 16
466	466	such rules shall provide that any full-time-equivalent 17
467	467	resident in an approved medical residency program 18
468	468	(or separately defined track within a program) that 19
469	469	provides more than 50 percent of the total residency 20
470	470	training time in rural training locations (as defined 21
471	471	in subsection (u)(6)(C)), regardless of where the 22
472	472	training occurs and regardless of specialty, shall not 23
473	473	be taken into account for purposes of applying the 24
474	474	limitation under this subparagraph. For special rules 25
475	475	VerDate Sep 11 2014 22:38 Mar 07, 2025 Jkt 059200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H1153.IH H1153
476	476	ssavage on LAPJG3WLY3PROD with BILLS 17
477	477	•HR 1153 IH
478	478	regarding application of the elective rural sustain-1
479	479	ability per resident payment amount under sub-2
480	480	section (u), see paragraph (3) of such subsection.’’. 3
481	481	Æ
482	482	VerDate Sep 11 2014 22:38 Mar 07, 2025 Jkt 059200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6301 E:\BILLS\H1153.IH H1153
483	483	ssavage on LAPJG3WLY3PROD with BILLS