article: SECTION 1. SHORT TITLE. This Act may be cited as the ``Frontline Medical Education Act''. SEC. 2. INCLUDING SERVICES OF INTERNS AND RESIDENTS AT ANY FEDERALLY- QUALIFIED HEALTH CENTER UNDER ANY PROGRAM PAID FOR BY A HOSPITAL IN DETERMINING MEDICARE PAYMENTS FOR GRADUATE MEDICAL EDUCATION. (a) Payment for Direct Costs of Graduate Medical Education.-- Section 1886(h)(4)(E) of the Social Security Act (42 U.S.C. 1395ww(h)(4)(E)) is amended by striking ``setting.'' and inserting the following: ``setting (or, in the case of activities performed at an Federally-qualified health center described in section 1861(aa)(4), if the hospital incurs any of the costs for the training program at such center and reimburses the center for any of the costs of the program that the center incurs).''. (b) Payment for Indirect Costs of Graduate Medical Education.-- Section 1886(d)(5)(B)(iv) of such Act (42 U.S.C. 1395ww(d)(5)(B)(iv)), as amended by section 13506 of the Omnibus Budget Reconciliation Act of 1993, is amended-- (1) by striking ``entity receiving a grant'' and all that follows through ``control of the hospital'' and inserting ``Federally-qualified health center described in section 1861(aa)(4)''; (2) by striking ``all, or substantially all, of the costs'' and inserting ``any of the costs''; and (3) by striking ``residents)'' and inserting ``residents and reimburses the center for any of the costs of the program that the center incurs)''. (c) Effective Date.--The amendments made by subsections (a) and (b) shall apply to services furnished during cost reporting periods beginning on or after October 1, 1994. SEC. 3. MEDICARE PAYMENT FOR DIRECT MEDICAL EDUCATION COSTS OF FEDERALLY-QUALIFIED HEALTH CENTERS. (a) In General.--Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is amended by inserting after section 1889 the following new section: ``graduate medical education payments for federally-qualified health centers ``Sec. 1890. (a) In General.--Notwithstanding any other provision of this title, in the case of any Federally-qualified health center that participates in an approved medical residency training program, in addition to any other payments that may be made to the center under this title, the Secretary shall provide for payment to the center for direct graduate medical education costs in accordance with subsection (b). ``(b) Determination of Amount of Payment.-- ``(1) In general.--Subject to paragraph (4), the amount of payment made to a Federally-qualified health center under this section for direct medical education for a fiscal year is equal to the product of-- ``(A) the aggregate approved amount (as defined in paragraph (2)) for the year; and ``(B) the center's medicare patient load (as defined in subsection (d)(2)) for the year. ``(2) Aggregate approved amount.--In paragraph (1), the term `aggregate approved amount' means, for a fiscal year, the product of-- ``(A) the approved FTE resident amount (determined under paragraph (3)) for the year; and ``(B) the weighted average number of full-time equivalent residents (as determined by the Secretary in a manner similar to the manner used to determine the number of such residents under section 1886(h)(4)) providing services for the center under the approved medical residency training program in which the center participates during the year. ``(3) Determination of approved fte resident amount.-- ``(A) In general.--For each approved medical residency training program, the Secretary shall determine an approved FTE resident amount for each fiscal year (beginning with fiscal year 1995) equal to 250 percent of the national average salary for the year (as defined in subparagraph (B)(ii)). ``(B) Determination of national average salary.-- ``(i) Determination of base amount.--The Secretary shall determine a base salary amount equal to the Secretary's estimate (using the most recent available audited cost reports) of the national average salary, including fringe benefits, for a full-time-equivalent resident in an approved medical residency training program during fiscal year 1990, increased (in a compounded manner) by the sum of the estimated percentage changes in the consumer price index during the 12-month periods between the midpoint of fiscal year 1990 and the midpoint of fiscal year 1994. ``(ii) National average salary defined.--In this paragraph, the `national average salary' for a fiscal year is equal to-- ``(I) for fiscal year 1995, the base amount determined under clause (i) updated through the midpoint of the year by projecting the estimated percentage change in the consumer price index during the 12-month period ending at that midpoint (with appropriate adjustments to reflect previous under- or over-estimations under this subparagraph in the projected percentage change in the consumer price index); and ``(II) for a subsequent fiscal year, the amount determined under this clause for the previous fiscal year updated through the midpoint of the year by projecting the estimated percentage change in the consumer price index during the 12-month period ending at that midpoint (with appropriate adjustments to reflect previous under- or over-estimations under this subparagraph in the projected percentage change in the consumer price index). ``(4) Offset for reimbursement received directly through hospitals.--The amount of payment made to a Federally-qualified health center under this subsection with respect to costs incurred by the center shall be reduced by the amount of any payment received by the center from a hospital under section 1886(d)(5)(B)(iv) or section 1886(h)(4)(E) as reimbursement for such costs. ``(c) Allocation of Payments Among Trust Funds.--In providing for payments under this section, the Secretary shall provide for an allocation of such payments between part A and part B (and the trust funds established under the respective parts) as reasonably reflects the proportion of direct graduate medical costs of Federally-qualified health centers associated with the provision of services under each respective part. ``(d) Definitions.--In this section: ``(1) The terms `approved medical residency training program', `consumer price index', `direct graduate medical education costs', and `resident' have the meaning given such terms under section 1886(h)(5). ``(2) The term `Federally-qualified health center' has the meaning given such term under section 1861(aa)(4). ``(3) The term `medicare patient load' means, with respect to a Federally-qualified health center for a year, the fraction of the center's services during the year which are attributable to individuals entitled to benefits under this title (based on such measure of services as the Secretary determines to be appropriate for purposes of this section).''. (b) Effective Date.--The amendment made by subsection (a) shall apply to services furnished during cost reporting periods beginning on or after October 1, 1994. SEC. 4. REPEAL OF APPLICATION OF PRODUCTIVITY SCREENS FOR CENTERS RECEIVING PAYMENTS FOR MEDICAL EDUCATION. Section 1861(aa) of the Social Security Act (42 U.S.C. 1395x(aa)) is amended by adding at the end the following new paragraph: ``(8)(A) In the case of a Federally-qualified health center receiving any medical education payment described in subparagraph (B) during a cost reporting period, the Secretary shall waive the application of any screening guideline used to determine the productivity of practitioners providing services at the center for purposes of paragraph (3) or (4). ``(B) A medical education payment described in this subparagraph is a payment made to a Federally-qualified health center-- ``(i) by a hospital as reimbursement to the center for medical education costs, as described in section 1886(d)(5)(B)(iv) or section 1886(h)(4)(E); or ``(ii) by the Secretary under section 1890.''.
summary: Frontline Medical Education Act - Amends title XVIII (Medicare) of the Social Security Act with respect to: (1) services of interns and residents at federally-qualified health centers and Medicare payments for graduate medical education; (2) Medicare payment for direct graduate medical education costs of such centers; and (3) waiver of the application of productivity screens for such centers receiving medical education payments.