text: SECTION 1. SHORT TITLE.
  
      This Act may be cited as the ``Primary Care Workforce Access 
  Improvement Act of 2011''.
  
  SEC. 2. MEDICARE PRIMARY CARE GRADUATE MEDICAL EDUCATION PILOT PROJECT.
  
      (a) Establishment.--The Secretary of Health and Human Services (in 
  this section referred to as the ``Secretary'') shall conduct a pilot 
  project under the Medicare program under title XVIII of the Social 
  Security Act, in accordance with the provisions of this section, to 
  test models for providing payment under such title for direct graduate 
  medical education and indirect medical education to medical education 
  entities, which entities are not otherwise eligible to receive such 
  payments under the Medicare program, for the costs of training primary 
  care residents.
      (b) Duration.--The Secretary shall conduct the pilot project under 
  this section over a 5-year period, which shall begin not later than 180 
  days after the date of the enactment of this Act.
      (c) Models.--
              (1) Required models.--Under the pilot project, the 
          Secretary shall test two of each of the following models:
                      (A) A model in which the medical education entity 
                  receiving funds under the pilot project is a community-
                  based independent corporate entity collaborating with 
                  two or more hospitals to operate one or more primary 
                  care graduate medical residency training programs.
                      (B) A model in which--
                              (i) the medical education entity receiving 
                          funds under the pilot project is established by 
                          two or more hospitals to operate one or more 
                          primary care graduate medical residency 
                          training programs; and
                              (ii) such hospitals may be the sole 
                          corporate members of the entity but the 
                          governing board of the entity shall include at 
                          least one community representative.
                      (C) A model in which the medical education entity 
                  receiving funds under the pilot project is a hospital 
                  subsidiary or independent corporation that operates one 
                  or more primary care graduate medical residency 
                  training programs for a hospital with community 
                  participation in the governance of the subsidiary or 
                  corporation.
                      (D) A model in which--
                              (i) the medical education entity receiving 
                          funds under the pilot project is independent of 
                          any hospital but collaborates with a hospital 
                          in operating one or more primary care graduate 
                          medical residency training programs; and
                              (ii) the medical education entity may 
                          include a university or school of medicine.
              (2) Additional models.--Under the pilot project, the 
          Secretary may test models of medical education entities in 
          addition to those described in paragraph (1).
      (d) Prioritization.--Under the pilot project, the Secretary of 
  Health and Human Services may give priority to testing models that 
  demonstrate the capability of improving the quality, quantity, and 
  distribution of primary care physicians, including the ability to 
  enhance primary care delivery in rural and underserved areas.
      (e) Payments.--
              (1) Payments to medical education entities.--Under the 
          pilot project, the Secretary shall establish a process under 
          which payments are made to each medical education entity 
          participating under such project for direct graduate medical 
          education and indirect medical education costs with respect to 
          primary care residents enrolled under a primary care graduate 
          medical residency training program operated pursuant to a model 
          of such entity under subsection (c) instead of any payment or 
          adjustment that would otherwise be made to a participant 
          hospital (as defined in subsection (m)) of such entity for 
          indirect and direct graduate medical education costs under 
          subsections (d)(5)(B) and (h) of section 1886 of the Social 
          Security Act (42 U.S.C. 1395ww) during the period of 
          participation of such entity in such project.
              (2) Calculation of payments.--Payments to a medical 
          education entity under the pilot project, with respect to a 
          primary care graduate medical education residency program, for 
          a cost reporting period during which the entity is 
          participating in such pilot shall be, based on the most 
          recently available data with respect to a previous cost 
          reporting period, equal to the sum of the following:
                      (A) Direct gme.--The amount that, out of all of the 
                  payment amounts (determined on a per resident basis) 
                  received by hospitals under section 1886(h) of the 
                  Social Security Act (42 U.S.C. 1395ww(h)) for such 
                  previous cost reporting period, is equal to the 95th 
                  percentile of such payment amounts.
                      (B) Indirect gme.--The amount that, out of all of 
                  the additional payment amounts (determined on a per 
                  resident basis) received by hospitals under section 
                  1886(d)(5)(B) of the Social Security Act (42 U.S.C. 
                  1395ww(d)(5)(B)) for such previous cost reporting 
                  period, is equal to the 95th percentile of such payment 
                  amounts.
              (3) Additional payments for programs serving underserved 
          areas.--Payments in addition to the payments described in 
          paragraph (2) may be made under the pilot project for primary 
          care graduate medical residency training programs that--
                      (A) operate in sites and areas that are underserved 
                  by primary care physicians; or
                      (B) change their training sites to include those 
                  areas.
              (4) Payments from medicare trust funds.--In providing for 
          such payments under this subsection to medical education 
          entities, the Secretary shall provide for an allocation of such 
          payments between part A and part B (and the Federal Hospital 
          Insurance Trust Fund under section 1817 of the Social Security 
          Act (42 U.S.C. 1395i) and the Federal Supplementary Medical 
          Insurance Trust Fund under section 1841 of such Act (42 U.S.C. 
          1395t)) in the same manner as the Secretary provides for an 
          allocation of payments under subsections (d)(5)(B) and (h), 
          respectively, of section 1886 of such Act (42 U.S.C. 1395ww).
      (f) Uses of Payments.--
              (1) In general.--A medical education entity receiving 
          payments under the pilot project shall use such payments for 
          the training of primary care residents, including training 
          activities in appropriate inpatient and outpatient settings in 
          primary care graduate medical residency training programs 
          accredited by the Accreditation Council for Graduate Medical 
          Education or the American Osteopathic Association and for all 
          relevant topics including patient care, care management, 
          working in teams, supervision, and quality improvement.
              (2) Limitations.--Payments shall only be made for training 
          primary care residents up to the initial board certification of 
          such residents, except that with respect to training in 
          geriatric medicine, payments may also be made for a fellowship 
          after initial board certification.
      (g) Expansion During Pilot Project.--A medical education entity 
  receiving funds under the pilot project, with respect to a primary care 
  graduate medical residency training program, shall be allowed to 
  increase by up to 50 percent the number of full-time equivalent primary 
  care residents enrolled in the such program (determined in accordance 
  with the process under subsection (d)(2)(A)(ii)) during the duration of 
  the participation of such entity in such project.
      (h) Treatment After Project.--
              (1) In general.--Subject to paragraphs (2) and (3), after 
          the last day of the pilot project, which may be extended at the 
          discretion of the Secretary, any participant hospital of a 
          medical education entity under the pilot project, shall receive 
          payments under subsection (d)(5)(B) and (h) of section 1886 of 
          the Social Security Act (42 U.S.C. 1395ww) in the same manner 
          and to the same extent such hospital would receive such 
          payments without application of this Act and such payments 
          shall be calculated based on the number of full-time equivalent 
          residents enrolled in such program without regard to any 
          increase made pursuant to subsection (g).
              (2) Exception to ensure residents enrolled during pilot are 
          able to complete training.--Subject to paragraph (3), a medical 
          education entity receiving funds under the pilot project, with 
          respect to a primary care graduate medical residency training 
          program, shall continue to receive funding under this section 
          (even after the last day of the project), with respect to each 
          primary care resident who is enrolled under such program while 
          the entity is participating in such project, to the extent and 
          in such amounts necessary to allow for the full duration of 
          training, subject to subsection (f)(2), of such primary care 
          resident. Any such payments made pursuant to this subparagraph 
          shall be deemed to be a payment made under the pilot project.
              (3) Limitation.--In no case may the total duration of the 
          pilot project exceed seven years and in no case may payments be 
          made under this section to a medical education entity for a 
          period exceeding seven years.
      (i) Budget Neutrality.--For each year that the pilot project under 
  this section is being conducted (and for any subsequent year to the 
  extent subsection (h)(2) applies), the Secretary shall reduce payments 
  under subsections (d)(5)(B) and (h) of section 1886 of the Social 
  Security Act (42 U.S.C. 1395ww) by such amount as the Secretary 
  determines to be necessary to ensure that carrying out the pilot 
  project under this section during such year does not result in 
  expenditures under title XVIII of the Social Security Act for such year 
  that exceed the amount of such expenditures that would have been made 
  for such year without application of this section.
      (j) Waiver Authority.--The Secretary may waive such requirements of 
  titles XI and XVIII of the Social Security Act as may be necessary to 
  carry out the purpose of the pilot project under this section.
      (k) Report to Congress.--The Secretary is authorized to enter into 
  an agreement with the Institute of Medicine to conduct a study on the 
  results of the pilot project. Such agreement shall provide for the 
  Institute of Medicine to submit, not later than 1 year after the 
  completion of the pilot project under this section (or, if sooner, 
  January 1, 2019), to Congress a report on the results of such study, 
  including--
              (1) a detailed analysis of the effects of the pilot, 
          including the quality, quantity, and distribution of primary 
          care physicians during and after the pilot project compared to 
          the quality, quantity, and distribution of such physicians 
          before the pilot project; and the governance, administration 
          and financial strength of the medical educational entities that 
          participated in the pilot project;
              (2) recommendations on the extent to which the pilot 
          project should be expanded to all primary care residents; and
              (3) recommendations for such legislation and administrative 
          actions as needed.
      (l) Expansion.--If the Secretary determines that any of the models 
  tested under the pilot project under this section enhance the quality, 
  quantity, and distribution of primary care physicians for Medicare 
  beneficiaries, the Secretary may initiate comparable primary care 
  training projects.
      (m) Definitions.--For purposes of this section:
              (1) Direct graduate medical education costs; indirect 
          graduate medical education costs.--The terms ``direct graduate 
          medical education costs'' and ``indirect graduate medical 
          education'' have the meanings given such terms for purposes of 
          subsections (h) and (d)(5)(B), respectively, of section 1886 of 
          the Social Security Act (42 U.S.C. 1395ww).
              (2) Medical education entity.--The term ``medical education 
          entity'' means a corporate, nonprofit, or academic entity that 
          has as its principal mission the education and training of 
          primary care residents.
              (3) Medicare beneficiary.--The term ``Medicare 
          beneficiary'' means an individual entitled to benefits under 
          part A of title XVIII of the Social Security Act or enrolled 
          under part B of such title.
              (4) Participant hospital.--The term ``participant 
          hospital'' means, with respect to a medical education entity, 
          any hospital that establishes, is collaborating with, a 
          component of, or otherwise associated with, such entity to 
          operate a primary care graduate medical residency training 
          program under a model described in subsection (c).
              (5) Primary care graduate medical residency training 
          program.--The term ``primary care graduate medical residency 
          training program'' means an approved medical residency training 
          program (as defined in section 1886(h)(5)(A) of the Social 
          Security Act (42 U.S.C. 1395ww(h)(5)(A))) for training primary 
          care residents.
              (6) Primary care resident.--The term ``primary care 
          resident'' means a resident enrolled in an approved medical 
          residency training program in family medicine, general internal 
          medicine, general pediatrics, or geriatric medicine.
target: Primary Care Workforce Access Improvement Act of 2011 - Directs the Secretary of Health and Human Services (HHS) to conduct a pilot project under title XVIII (Medicare) of the Social Security Act to test models for providing payment for direct graduate medical education (GME) and indirect medical education (IME) to medical education entities (MEEs), not otherwise eligible to receive such payments, for the costs of training primary care residents.
  
  Requires testing of two of the following model MEEs: (1) a community-based independent corporate entity collaborating with two or more hospitals to operate one or more primary care graduate medical residency training programs (training hospitals); (2) a MEE, with at least one community representative on its board, which is established by two or more training hospitals which may be the sole corporate members of the MEE; (3) a hospital subsidiary or independent corporation, with community participation in its governance, that operates one or more training programs for a hospital; or (4) a MEE (including a university or school of medicine) independent of any hospital but collaborating with one in operating one or more primary care graduate medical residency training programs.
feat_title: To provide for a Medicare primary care graduate medical education pilot project in order to improve access to the primary care workforce.