HR4731-119

What This Bill Does

The Resident Physician Shortage Reduction Act expands Medicare graduate medical education caps. For fiscal years 2026 through 2032, and later years if positions remain, HHS must run seven application rounds and distribute 2,000 additional residency positions each year, plus carryover positions, until up to 14,000 positions are distributed. One-third of each year's slots are reserved for hospitals whose reference resident level exceeds their otherwise applicable resident limit, but those hospitals must exceed the cap by at least 10 positions and train at least 25 percent of full-time-equivalent residents in primary care and general surgery for five years. For the remaining positions, HHS must consider whether hospitals are likely to fill the slots within five cost-reporting periods and must distribute at least 10 percent to each listed category: rural hospitals or hospitals in rural-adjacent categories, over-cap hospitals, hospitals in states with new medical schools or new branch campuses after January 1, 2000, and hospitals serving health professional shortage areas. HHS must give priority within HPSA distributions to hospitals affiliated with historically Black medical schools or certain other listed institutions that establish medical colleges. Hospitals must increase their total FTE residency positions by the number awarded, generally may not receive more than 75 added FTE positions under the specified paragraphs during 2026-2032 unless HHS estimates excess available positions, and can eventually aggregate affiliated-group cap amounts. The bill also updates indirect medical education payment rules for discharges on or after July 1, 2027. GAO must study strategies for increasing health workforce diversity, including rural, lower-income, and underrepresented minority communities, and report recommendations to Congress within two years.

Who Benefits and How

Teaching hospitals benefit from new Medicare-supported residency cap slots if they qualify and apply successfully. Medical residents benefit from up to 14,000 additional training positions over the distribution period. Rural hospitals and HPSA hospitals benefit from reserved distribution categories and priority rules. Historically Black medical schools benefit from priority for affiliated hospitals in shortage-area distributions. Patients in underserved areas benefit if additional residents expand physician workforce pipelines.

Who Bears the Burden and How

HHS Secretary must run annual application rounds, distribute positions, track carryovers, and enforce priority categories and hospital limits. Hospitals receiving slots must actually increase FTE residency positions and comply with five-year primary-care and general-surgery commitments where applicable. Medicare trust funds and federal taxpayers bear added graduate medical education and indirect medical education payment costs. Government Accountability Office must study and report on health workforce diversity strategies within two years.

Key Provisions

• Adds 2,000 Medicare-supported residency positions per fiscal year from 2026 through 2032, with carryover until 14,000 are distributed.
• Reserves one-third of annual slots for qualifying hospitals already training above their resident caps.
• Requires at least 10 percent distribution to rural, over-cap, new-medical-school, and health-professional-shortage-area hospital categories.
• Limits most hospitals to 75 additional positions across specified distribution programs during 2026 through 2032.
• Requires GAO to study and report on strategies for increasing health professional workforce diversity.