View all text of Subpartxi [§ 256h - § 256h]
§ 256h. Program of payments to teaching health centers that operate graduate medical education programs
(a) Payments
(1) In generalSubject to subsection (h)(2), the Secretary shall make payments under this section for direct expenses and indirect expenses to qualified teaching health centers that are listed as sponsoring institutions by the relevant accrediting body for, as appropriate—
(A) maintenance of filled positions at existing approved graduate medical residency training programs;
(B) expansion of existing approved graduate medical residency training programs; and
(C) establishment of new approved graduate medical residency training programs.
(2) Per resident amount
(3) PriorityIn making payments under paragraph (1)(C), the Secretary shall give priority to qualified teaching health centers that—
(A) serve a health professional shortage area with a designation in effect under section 254e of this title or a medically underserved community (as defined in section 295p of this title); or
(B) are located in a rural area (as defined in section 1395ww(d)(2)(D) of this title).
(b) Amount of payments
(1) In generalSubject to paragraph (2), the amounts payable under this section to qualified teaching health centers for an approved graduate medical residency training program for a fiscal year are each of the following amounts:
(A) Direct expense amount
(B) Indirect expense amount
(2) Capped amount
(A) In general
(B) Limitation
(C) Addition
(c) Amount of payment for direct graduate medical education
(1) In generalThe amount determined under this subsection for payments to qualified teaching health centers for direct graduate expenses relating to approved graduate medical residency training programs for a fiscal year is equal to the product of—
(A) the updated national per resident amount for direct graduate medical education, as determined under paragraph (2); and
(B) the average number of full-time equivalent residents in the teaching health center’s graduate approved medical residency training programs as determined under section 1395ww(h)(4) of this title (without regard to the limitation under subparagraph (F) of such section) during the fiscal year.
(2) Updated national per resident amount for direct graduate medical educationThe updated per resident amount for direct graduate medical education for a qualified teaching health center for a fiscal year is an amount determined as follows:
(A) Determination of qualified teaching health center per resident amountThe Secretary shall compute for each individual qualified teaching health center a per resident amount—
(i) by dividing the national average per resident amount computed under section 256e(c)(2)(D) of this title into a wage-related portion and a non-wage related portion by applying the proportion determined under subparagraph (B);
(ii) by multiplying the wage-related portion by the factor applied under section 1395ww(d)(3)(E) of this title (but without application of section 4410 of the Balanced Budget Act of 1997 (42 U.S.C. 1395ww note)) during the preceding fiscal year for the teaching health center’s area; and
(iii) by adding the non-wage-related portion to the amount computed under clause (ii).
(B) Updating rate
(d) Amount of payment for indirect medical education
(1) In general
(2) FactorsIn determining the amount under paragraph (1), the Secretary shall—
(A) evaluate indirect training costs relative to supporting a primary care residency program in qualified teaching health centers; and
(B) based on this evaluation, assure that the aggregate of the payments for indirect expenses under this section and the payments for direct graduate medical education as determined under subsection (c) in a fiscal year do not exceed the amount appropriated for such expenses as determined in subsection (g).
(3) Interim payment
(e) Clarification regarding relationship to other payments for graduate medical educationPayments under this section—
(1) shall be in addition to any payments—
(A) for the indirect costs of medical education under section 1395ww(d)(5)(B) of this title;
(B) for direct graduate medical education costs under section 1395ww(h) of this title; and
(C) for direct costs of medical education under section 1395ww(k) of this title;
(2) shall not be taken into account in applying the limitation on the number of total full-time equivalent residents under subparagraphs (F) and (G) of section 1395ww(h)(4) of this title and clauses (v), (vi)(I), and (vi)(II) of section 1395ww(d)(5)(B) of this title for the portion of time that a resident rotates to a hospital; and
(3) shall not include the time in which a resident is counted toward full-time equivalency by a hospital under paragraph (2) or under section 1395ww(d)(5)(B)(iv) of this title, section 1395ww(h)(4)(E) of this title, or section 256e of this title.
(f) Reconciliation
(g) Funding
(1) In general
(2) Administrative expenses
(h) Annual reporting required
(1) Annual reportThe report required under this paragraph for a qualified teaching health center for a fiscal year is a report that includes (in a form and manner specified by the Secretary) the following information for the residency academic year completed immediately prior to such fiscal year:
(A) The types of primary care resident approved training programs that the qualified teaching health center provided for residents.
(B) The number of approved training positions for residents described in paragraph (4).
(C) The number of residents described in paragraph (4) who completed their residency training at the end of such residency academic year and care for vulnerable populations living in underserved areas.
(D) The number of patients treated by residents described in paragraph (4).
(E) The number of visits by patients treated by residents described in paragraph (4).
(F) Of the number of residents described in paragraph (4) who completed their residency training at the end of such residency academic year, the number and percentage of such residents entering primary care practice (meaning any of the areas of practice listed in the definition of a primary care residency program in section 293l–1 of this title).
(G) Of the number of residents described in paragraph (4) who completed their residency training at the end of such residency academic year, the number and percentage of such residents who entered practice at a health care facility—
(i) primarily serving a health professional shortage area with a designation in effect under section 254e of this title or a medically underserved community (as defined in section 295p of this title); or
(ii) located in a rural area (as defined in section 1395ww(d)(2)(D) of this title).
(H) Other information as deemed appropriate by the Secretary.
(2) Audit authority; limitation on payment
(A) Audit authority
(B) Limitation on payment
(3) Reduction in payment for failure to report
(A) In generalThe amount payable under this section to a qualified teaching health center for a fiscal year shall be reduced by at least 25 percent if the Secretary determines that—
(i) the qualified teaching health center has failed to provide the Secretary, as an addendum to the qualified teaching health center’s application under this section for such fiscal year, the report required under paragraph (1) for the previous fiscal year; or
(ii) such report fails to provide complete and accurate information required under any subparagraph of such paragraph.
(B) Notice and opportunity to provide accurate and missing information
(4) Residents
(i) Regulations
(j) DefinitionsIn this section:
(1) Approved graduate medical residency training programThe term “approved graduate medical residency training program” means a residency or other postgraduate medical training program—
(A) participation in which may be counted toward certification in a specialty or subspecialty and includes formal postgraduate training programs in geriatric medicine approved by the Secretary; and
(B) that meets criteria for accreditation (as established by the Accreditation Council for Graduate Medical Education, the American Osteopathic Association, or the American Dental Association).
(2) New approved graduate medical residency training program
(3) Primary care residency program
(4) Qualified teaching health center
(July 1, 1944, ch. 373, title III, § 340H, as added Pub. L. 111–148, title V, § 5508(c), Mar. 23, 2010, 124 Stat. 670; amended Pub. L. 114–10, title II, § 221(b), Apr. 16, 2015, 129 Stat. 154; Pub. L. 115–63, title III, § 301(a), Sept. 29, 2017, 131 Stat. 1171; Pub. L. 115–96, div. C, title I, § 3101(c), Dec. 22, 2017, 131 Stat. 2048; Pub. L. 115–123, div. E, title IX, § 50901(d)(1)–(3), (5), (6), Feb. 9, 2018, 132 Stat. 287–289; Pub. L. 116–59, div. B, title I, § 1101(c), Sept. 27, 2019, 133 Stat. 1102; Pub. L. 116–69, div. B, title I, § 1101(c), Nov. 21, 2019, 133 Stat. 1136; Pub. L. 116–94, div. N, title I, § 401(c), Dec. 20, 2019, 133 Stat. 3113; Pub. L. 116–136, div. A, title III, § 3831(c), Mar. 27, 2020, 134 Stat. 434; Pub. L. 116–159, div. C, title I, § 2101(c), Oct. 1, 2020, 134 Stat. 728; Pub. L. 116–215, div. B, title II, § 1201(c), Dec. 11, 2020, 134 Stat. 1044; Pub. L. 116–260, div. BB, title III, § 301(c), Dec. 27, 2020, 134 Stat. 2922; Pub. L. 118–15, div. B, title III, § 2321(a), Sept. 30, 2023, 137 Stat. 94; Pub. L. 118–22, div. B, title II, § 201(a), Nov. 17, 2023, 137 Stat. 119; Pub. L. 118–35, div. B, title I, § 101(a), Jan. 19, 2024, 138 Stat. 4; Pub. L. 118–42, div. G, title I, § 101(c)(1), (2), Mar. 9, 2024, 138 Stat. 397.)