text: 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.''.
target: 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.
feat_title: Frontline Medical Education Act