H.R. 1153 — Rural Physician Workforce Production Act of 2025

This section provides the short title of the Act as the “Rural Physician Workforce Production Act of 2025.”

This section establishes an elective rural sustainability per resident payment under Medicare for hospitals that train residents in rural training locations. As background, Medicare pays teaching hospitals for direct graduate medical education (GME) costs and, in some cases, indirect medical education costs. The new payment equals, for each full-time-equivalent resident in an approved medical residency training program receiving training in a rural training location, the difference between: (1) a total elective rural sustainability amount set by the Secretary, and (2) any amount the hospital otherwise receives for direct GME costs under 42 U.S.C. § 1395ww(h) or section 1814(l), as applicable. For cost reporting periods beginning during the first year after enactment, the Secretary must set the total elective rural sustainability amount at the median national direct GME training costs per full-time-equivalent resident for 2015, as reported in table 9 of the March 2018 Government Accountability Office report on physician workforce (GAO-18-240), updated through the first year after enactment by the annual percentage increase in the Consumer Price Index for All Urban Consumers. For subsequent cost reporting periods, the amount is updated through the midpoint of the period by projected CPI growth, with adjustments for prior under- or over-estimates. For urban hospitals, residents in a rural track or integrated rural track receive the full amount, while residents training in a rural location outside such tracks receive 50 percent of that amount. The provision also specifies that these amounts may not be discounted or adjusted based on Medicare patient load or diagnosis-related group discharges. The section permits an applicable hospital to elect this payment for cost reporting periods beginning on or after the date that is 1 year after enactment, regardless of whether the hospital is otherwise eligible for indirect or direct GME payments for those residents. It further provides that electing hospitals do not create or increase resident caps for allopathic or osteopathic medicine under 42 U.S.C. § 1395ww(d)(5)(B) and (h), and residents counted for this payment are not counted toward those caps.

This section revises the Medicare graduate medical education and indirect medical education resident-counting rules under 42 U.S.C. § 1395ww to exclude, beginning 1 year after enactment of the Rural Physician Workforce Production Act of 2025, any full-time-equivalent resident in an approved medical residency program or separately defined track that provides more than 50 percent of total training time in rural training locations, regardless of specialty or where the training occurs, from the resident caps used to calculate payments. It also clarifies that the existing 130 percent limitation applies only to cost reporting periods beginning on or after October 1, 1997, and before that 1-year-after-enactment date, and adds cross-references directing hospitals to special rules for the elective rural sustainability per resident payment amount under subsection (u).