PlainBillCongress, translated.Legislation. Context. Public interest.Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Congressional Research Service
Version 00 · Introduced in House · Feb 10, 2025
Rural Physician Workforce Production Act of 2025
This bill allows certain hospitals to receive additional payment under Medicare for full-time equivalent residents who receive training in rural areas.
Specifically, hospitals, critical access hospitals, sole community hospitals, and rural emergency hospitals may elect to receive payment for time spent by a resident in a rural training location if the resident trains for at least eight weeks in the location and the hospital pays the salary and benefits of the resident during this time. Additionally, hospitals may receive payment for all time spent by residents in a residency program in which 50% of all training is in rural locations, regardless of where the training occurs or specialty.
Payments are based on the difference between the total amount of eligible payments (as determined by the Centers for Medicare & Medicaid Services) and the amount of graduate medical education payments received (if applicable).
People & committees
Rep. Harshbarger, Diana [R-TN-1] · R–TN
Legislative record
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Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Introduced in House
Introduced in House
Primary sources
Text links open the official source. We also preserved the text version used in the PlainBill explanation below.
No related bills are listed in this snapshot. This does not establish whether the proposal has appeared in earlier Congresses.
Source last updated: Oct 2, 2026. Consult Congress.gov for the current record.
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PlainBill explanation
Based on the full Introduced in House · 2025-02-10 text. This explanation has not received human editorial review. This overview describes the proposal’s major provisions; it does not establish what its real-world effects would be.
This bill proposes an optional Medicare payment for hospitals supporting doctors’ residency training in qualifying rural locations. Payments would use a national training-cost benchmark, with different rules for some urban hospitals, and qualifying residents would be excluded from certain resident-count limits. Hospitals would generally have to pay residents’ salaries and benefits during rural training. The proposal would also limit total Medicare medical-education payments to what they would otherwise have been, allowing adjustments to existing payments. These are proposed changes, not established law in the supplied evidence.
an applicable hospital may elect to receive the elective rural sustainability per resident payment amount for each full-time-equivalent resident in an approved medical residency training program that receives training in a rural training location
Such amount shall be the amount that the Secretary determines is equal to the median national direct GME training costs per full-time-equivalent resident for 2015 described in table 9 on page 33 of the March 2018 GAO report on Physician Workforce (GAO–18–240), updated for each subsequent year through the first year beginning on or after the date of the enactment of this subsection, by the annual percentage increase in the consumer price index for all urban consumers (all items; United States city average).
in the case of an applicable hospital that is not located in a rural area— (aa) with respect to such residents that receive training in a rural track or an integrated rural track, the total elective rural sustainability amount per resident shall be equal to the amount established under subclause (I); and (bb) with respect to such residents that receive training in a rural training location and who are not participating in a rural track or an integrated rural track, the total elective rural sustainability amount per resident shall be equal to 50 percent of the amount established under subclause (I)
The hospital pays the salary and benefits of the resident for the time spent training in a rural training location.
shall not result in— (i) the establishment of a limitation on the number of residents in allopathic or osteopathic medicine for purposes of subsections (d)(5)(B) and (h) with respect to an approved medical residency training program of an applicable hospital (or be taken into account in determining such a limitation during the cap building period of an applicable hospital); or (ii) the counting of any resident with respect to which the applicable hospital receives an elective rural sustainability per resident payment amount under this subsection towards the application of the limitation described in clause (i)
The Secretary shall ensure that aggregate payments for direct medical education costs and indirect medical education costs under this title, including any payments under this subsection, for each year (effective beginning on or after the date that is 1 year after the date of enactment of this subsection) are not greater than the aggregate payments for such costs that would have been made under this title for the year without the application of this subsection.
For purposes of carrying out the budget neutrality requirement under the preceding sentence, the Secretary may make appropriate adjustments to the amount of such payments for direct graduate medical education costs and indirect medical education costs under subsections (h) and (d)(5)(B), respectively.
2025-02-10: Introduced in House
Section 1 names the proposal the Rural Physician Workforce Production Act of 2025.
This Act may be cited as the Rural Physician Workforce Production Act of 2025.
Hospitals could choose the new payment for cost reporting periods beginning at least one year after enactment, even if they otherwise could not receive the specified Medicare payments or adjustments for those residents.
For cost reporting periods beginning on or after the date that is 1 year after the date of the enactment of this subsection, an applicable hospital may elect to receive the elective rural sustainability per resident payment amount
An applicable hospital may make an election under the preceding sentence regardless of whether the applicable hospital is otherwise eligible for a payment or adjustment for indirect and direct graduate medical education costs under subsections (d)(5)(B) and (h) or section 1814(l), as applicable, with respect to such residents.
Eligible institutions would include hospitals and the categories called critical access hospitals, sole community hospitals, and rural emergency hospitals. The bill relies on existing law for several of these classifications and for the definitions of residents, approved training programs, and direct training costs.
The term applicable hospital means a hospital, critical access hospital, sole community hospital (as defined in subsection (d)(5)(D)(iii)), or rural emergency hospital (as defined in section 1861(kkk)(2)).
The terms approved medical residency training program, direct graduate medical education costs, and resident have the meanings given those terms in subsection (h)(5).
The new payment per full-time-equivalent resident would equal the applicable rural training benchmark minus direct residency-training payments the hospital otherwise receives for that resident under the specified Medicare provisions.
is an amount equal to the difference between— (i) the total elective rural sustainability amount determined under subparagraph (B) (or, in the case of an applicable hospital not located in a rural area, the total elective rural sustainability amount or urban total elective rural sustainability amount, as applicable, determined under such subparagraph); and (ii) the amount (if any) the applicable hospital otherwise receives for direct graduate medical education costs under subsection (h) or section 1814(l), as applicable, with respect to each such resident.
The Secretary would establish the initial benchmark using the national median direct residency-training cost per full-time-equivalent resident for 2015 in a specified Government Accountability Office report. That figure would be updated using annual increases in the all-items Consumer Price Index for urban consumers through the first year beginning on or after enactment.
Such amount shall be the amount that the Secretary determines is equal to the median national direct GME training costs per full-time-equivalent resident for 2015 described in table 9 on page 33 of the March 2018 GAO report on Physician Workforce (GAO–18–240), updated for each subsequent year through the first year beginning on or after the date of the enactment of this subsection, by the annual percentage increase in the consumer price index for all urban consumers (all items; United States city average).
Hospitals outside rural areas would use the full benchmark for residents in rural tracks or integrated rural tracks. For residents training in qualifying rural locations outside those tracks, these hospitals would use 50 percent of the benchmark.
in the case of an applicable hospital that is not located in a rural area— (aa) with respect to such residents that receive training in a rural track or an integrated rural track, the total elective rural sustainability amount per resident shall be equal to the amount established under subclause (I); and (bb) with respect to such residents that receive training in a rural training location and who are not participating in a rural track or an integrated rural track, the total elective rural sustainability amount per resident shall be equal to 50 percent of the amount established under subclause (I)
Later benchmarks would be updated through each cost reporting period’s midpoint using projected changes in the all-items Consumer Price Index for urban consumers. The same provision describes corrections for past projection errors using the index for medical care services; the text does not explain the difference between those references.
updated, through the midpoint of the period, by projecting the estimated percentage change in the consumer price index for all urban consumers (all items; United States city average) during the 12-month period ending at that midpoint, with appropriate adjustments to reflect previous under- or over-estimations under this clause in the projected percentage change in the consumer price index for medical care services.
The benchmarks and new payment could not be discounted or otherwise adjusted based on a hospital’s Medicare patient load or its discharges in a diagnosis-related group. The definition of Medicare patient load is incorporated from existing law that is not supplied.
The total elective rural sustainability amount, the urban total elective rural sustainability amount, and the elective rural sustainability per resident payment amount determined under this paragraph shall not be discounted or otherwise adjusted based on the Medicare patient load (as defined in subsection (h)(3)(C)) of an applicable hospital or discharges in a diagnosis-related group.
The general eligibility rule would require a resident to spend the equivalent of at least eight weeks over the course of training in a qualifying rural location. The hospital would have to pay the resident’s salary and benefits for the rural training time.
The resident spends the equivalent of at least 8 weeks over the course of their training in a rural training location. (ii) The hospital pays the salary and benefits of the resident for the time spent training in a rural training location.
A special rule would cover all training time for residents in approved programs or separately defined tracks that provide more than half of total residency training in qualifying rural locations. This would include training elsewhere and would apply regardless of medical specialty.
An applicable hospital shall be eligible for payment of the elective rural sustainability per resident payment amount under this subsection for all time spent by residents in an approved medical residency program (or separately defined track within a program) that provides more than 50 percent of the total residency training time in rural training locations, regardless of where the training occurs and regardless of specialty.
A training location could qualify through any of three routes, using the 2010 census or a subsequent census adjustment: the specified statutory rural-area definition, a rural-urban commuting area code of at least 4.0, or training in or within 10 miles of a sole community hospital. The first route excludes hospitals treated as rural under the cited provision; the underlying statutory definitions are not reproduced.
based on the 2010 census or any subsequent census adjustment, meets one or more of the following criteria: (i) The training occurs in a location that is a rural area (as defined in section 1886(d)(2)(D)), not including any hospital treated as being located in a rural area pursuant to section 1886(d)(8)(E). (ii) The training occurs in a location that has a rural-urban commuting area code equal to or greater than 4.0. (iii) The training occurs in a sole community hospital (as defined in subsection (d)(5)(D)(iii)) or in a location that is within 10 miles of a sole community hospital.
The new payment provisions would not establish the specified resident-count limits or be taken into account in determining those limits during a hospital’s cap-building period. Residents for whom a hospital receives the new payment would not count toward those limits for direct and indirect medical-education payments.
shall not result in— (i) the establishment of a limitation on the number of residents in allopathic or osteopathic medicine for purposes of subsections (d)(5)(B) and (h) with respect to an approved medical residency training program of an applicable hospital (or be taken into account in determining such a limitation during the cap building period of an applicable hospital); or (ii) the counting of any resident with respect to which the applicable hospital receives an elective rural sustainability per resident payment amount under this subsection towards the application of the limitation described in clause (i)
The application rule also says the new provisions would not affect the determination of the specified additional indirect medical-education payment or hospital-specific approved full-time-equivalent resident amounts. A separate budget-neutrality provision would nevertheless authorize adjustments to direct and indirect medical-education payment amounts. The supplied text does not fully explain how these provisions would interact.
shall not have any effect on the determination of— (i) the additional payment amount under subsection (d)(5)(B); or (ii) hospital-specific approved FTE resident amounts under subsection (h).
the Secretary may make appropriate adjustments to the amount of such payments for direct graduate medical education costs and indirect medical education costs under subsections (h) and (d)(5)(B), respectively.
Full-time-equivalent residents would be determined using the existing rules in section 1886(h)(4), but without that provision’s subparagraph (F) limitation. Those existing calculation rules are not reproduced in the supplied evidence.
The determination of full-time-equivalent residents for purposes of this subsection shall be made in the same manner as the determination of full-time-equivalent residents under subsection (h)(4), but not taking into account the limitation under subparagraph (F) of such subsection.
The Secretary would divide the new payments between Medicare Parts A and B and their trust funds in a way that reasonably reflects the costs associated with services under each part.
the Secretary shall provide for an allocation of such payments between parts A and part B (and the trust funds established under the respective parts) as reasonably reflects the proportion of such costs associated with the provision of services under each respective part.
Beginning one year after enactment, total annual Medicare direct and indirect medical-education payments, including the new payments, could not exceed what would have been paid without the new subsection. The Secretary could adjust existing direct and indirect training payments to meet that requirement. This aggregate ceiling does not guarantee that every hospital’s payments would remain unchanged.
The Secretary shall ensure that aggregate payments for direct medical education costs and indirect medical education costs under this title, including any payments under this subsection, for each year (effective beginning on or after the date that is 1 year after the date of enactment of this subsection) are not greater than the aggregate payments for such costs that would have been made under this title for the year without the application of this subsection.
For purposes of carrying out the budget neutrality requirement under the preceding sentence, the Secretary may make appropriate adjustments to the amount of such payments for direct graduate medical education costs and indirect medical education costs under subsections (h) and (d)(5)(B), respectively.
For cost reporting periods beginning at least one year after enactment, a critical access hospital could choose to be treated as a hospital or as a non-provider setting when resident time is counted for the specified indirect and direct medical-education costs.
For cost reporting periods beginning on or after the date that is 1 year after the date of enactment of this paragraph, the following shall apply: (A) A critical access hospital may elect to be treated as a hospital or as a non-provider setting for purposes of counting resident time for indirect medical education costs and direct graduate medical education costs for the time spent by the resident in that setting under subsections (d)(5)(B) and (h), respectively, of section 1886.
Under the same effective-date rule, a critical access hospital’s reimbursable reasonable costs would exclude direct medical-education costs to the extent it is treated as another hospital’s non-provider setting or another hospital receives the specified payments for that resident’s time there.
For cost reporting periods beginning on or after the date that is 1 year after the date of enactment of this paragraph, the following shall apply:
Direct medical education costs shall not be considered reasonable costs of a critical access hospital for purposes of payment under paragraph (1), to the extent that the critical access hospital is treated as a non-provider setting of another hospital or another hospital receives payment for such costs for the time spent by the resident in that setting pursuant to subsection (d)(5)(B), subsection (h), or subsection (u) of section 1886.
For cost reporting periods beginning at least one year after enactment, a sole community hospital’s specified hospital-specific payment would exclude direct training costs to the extent the hospital receives the new rural payment for those costs.
For cost reporting periods beginning on or after the date that is 1 year after the date of enactment of this paragraph, the hospital-specific payment amount determined under clause (i)(I) with respect to a sole community hospital shall not include direct medical education costs, to the extent that the sole community hospital receives payment for such costs for the time spent by the resident in that setting pursuant to subsection (u).
Section 2 would make the specified existing direct and indirect medical-education provisions subject to the new subsection (u). It would also replace a reference to subsection (k) with a reference to subsection (k) or subsection (u). The underlying provisions are not reproduced, so their complete operation cannot be determined from these textual amendments alone.
in subsection (d)(5)(B), in the matter preceding clause (i), by striking The Secretary and inserting Subject to subsection (u), the Secretary
in paragraph (1), by inserting subject to subsection (u) after 1861(v),; and (ii) in paragraph (3), in the flush matter following subparagraph (B), by striking subsection (k) and inserting subsection (k) or subsection (u).
Section 3(a) would date-limit the existing direct medical-education provision’s 130 percent language to cost reporting periods beginning on or after October 1, 1997, and before one year after enactment. For periods beginning on or after that one-year point, it would add an exclusion from the specified limit for residents in programs or tracks providing more than half of total training in rural locations, regardless of training site or specialty. It would also add cross-references in section 1886(h)(4)(H) and (h)(5). The underlying law is not supplied, so the full effect of the 130 percent amendment cannot be established. The exclusion cites a rural-location definition at proposed subsection (u)(6)(C), although the supplied definition is in (u)(7)(C); that apparent error leaves uncertainty about its application as written.
by striking 130 percent and inserting for cost reporting periods beginning on or after October 1, 1997, and before the date that is 1 year after the date of enactment of the Rural Physician Workforce Production Act of 2025, 130 percent
For cost reporting periods beginning on or after the date that is 1 year after the date of enactment of the Rural Physician Workforce Production Act of 2025, such rules shall provide that any full-time-equivalent resident in an approved medical residency program (or separately defined track within a program) that provides more than 50 percent of the total residency training time in rural training locations (as defined in subsection (u)(6)(C)), regardless of where the training occurs and regardless of specialty, shall not be taken into account for purposes of applying the limitation under this subparagraph.
in subparagraph (H)— (i) in clause (i), in the second sentence, by inserting the following before the period: , in accordance with the second sentence of clause (i) of such subparagraph; and (ii) in clause (iv), by inserting the following before the period: , in accordance with the second sentence of clause (i) of such subparagraph
in paragraph (5), by adding at the end the following new subparagraph: (L) Special rules regarding application of elective rural sustainability per resident payment amount For special rules regarding application of the elective rural sustainability per resident payment amount under subsection (u), see paragraph (3) of such subsection.
(6) Determination of full-time-equivalent residents The determination of full-time-equivalent residents for purposes of this subsection shall be made in the same manner as the determination of full-time-equivalent residents under subsection (h)(4), but not taking into account the limitation under subparagraph (F) of such subsection. (7) Definitions In this subsection:
(C) Rural training location The term rural training location means a location in which training occurs that, based on the 2010 census or any subsequent census adjustment, meets one or more of the following criteria:
Section 3(b) would make a parallel amendment to the indirect medical-education provision: it would date-limit the referenced 130 percent language and, for cost reporting periods beginning at least one year after enactment, exclude residents in programs or tracks with more than half their training in rural locations from the specified limit, regardless of training site or specialty. It would also add a reference to the new payment’s application rules. The underlying law is absent, limiting conclusions about the full effect of the percentage amendment. This exclusion repeats the apparent definition-reference error described in section 3(a).
(b) Indirect medical education Section 1886(d)(5)(B)(v) is amended— (1) by striking 130 percent and inserting for cost reporting periods beginning on or after October 1, 1997, and before the date that is 1 year after the date of enactment of the Rural Physician Workforce Production Act of 2025, 130 percent
For cost reporting periods beginning on or after the date that is 1 year after the date of enactment of the Rural Physician Workforce Production Act of 2025, such rules shall provide that any full-time-equivalent resident in an approved medical residency program (or separately defined track within a program) that provides more than 50 percent of the total residency training time in rural training locations (as defined in subsection (u)(6)(C)), regardless of where the training occurs and regardless of specialty, shall not be taken into account for purposes of applying the limitation under this subparagraph.
For special rules regarding application of the elective rural sustainability per resident payment amount under subsection (u), see paragraph (3) of such subsection.
(6) Determination of full-time-equivalent residents The determination of full-time-equivalent residents for purposes of this subsection shall be made in the same manner as the determination of full-time-equivalent residents under subsection (h)(4), but not taking into account the limitation under subparagraph (F) of such subsection. (7) Definitions In this subsection:
(C) Rural training location The term rural training location means a location in which training occurs that, based on the 2010 census or any subsequent census adjustment, meets one or more of the following criteria:
The supplied official-actions snapshot, updated October 2, 2026, records introduction in the House and referral to the Ways and Means and Energy and Commerce committees on February 10, 2025. This snapshot does not establish subsequent legislative action or enactment.
Source snapshot updated 2026-10-02T08:06:21Z.
2025-02-10: Introduced in House
2025-02-10: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
A closer look
Reviewed version: Introduced in House · 2025-02-10. These findings describe provisions and who may benefit; they are not judgments of waste, corruption, or motive.
This review covers the supplied bill text. “None identified” does not rule out provisions in later versions or accompanying reports and disclosures.
Provisions outside the bill’s main subject, or policy changes attached to appropriations.
None identified in the reviewed text
No unrelated provision or policy change attached to appropriations was identified after reviewing the complete supplied introduced text. This conclusion is limited to that version and does not establish absence in other versions or accompanying materials, or an amendment’s attachment history.
Spending directed to particular recipients or places outside ordinary competitive or formula-based allocation.
None identified in the reviewed text
No congressionally directed spending for particular recipients or places outside competitive or formula allocation was identified after reviewing the complete supplied introduced text. This conclusion is limited to that version. Member requests, disclosures, and committee or conference materials are absent, so formal earmark status and the contents of other versions or accompanying materials cannot be established.
Narrow exceptions, exemptions, or preferential treatment that warrant a closer look.
Findings to examine
A narrow alternative eligibility pathway warrants scrutiny as targeted treatment within the main policy. This classification does not establish improper treatment or motive.
Sole community hospitals and training locations within 10 miles of them would have a separate route to qualify as rural training locations. Because only one listed criterion must be met, this route would not require meeting either the rural-area or commuting-code criterion. It would extend eligibility for the main rural-training payment policy to hospitals supporting otherwise qualifying training at those locations. The underlying definition of sole community hospital is not supplied, so the evidence does not establish which facilities would benefit.
The term rural training location means a location in which training occurs that, based on the 2010 census or any subsequent census adjustment, meets one or more of the following criteria:
(i) The training occurs in a location that is a rural area (as defined in section 1886(d)(2)(D)), not including any hospital treated as being located in a rural area pursuant to section 1886(d)(8)(E). (ii) The training occurs in a location that has a rural-urban commuting area code equal to or greater than 4.0. (iii) The training occurs in a sole community hospital (as defined in subsection (d)(5)(D)(iii)) or in a location that is within 10 miles of a sole community hospital.
An applicable hospital shall be eligible for payment of the elective rural sustainability per resident payment amount under this subsection for time spent by a resident training in a rural training location if the following requirements are met: (i) The resident spends the equivalent of at least 8 weeks over the course of their training in a rural training location. (ii) The hospital pays the salary and benefits of the resident for the time spent training in a rural training location.
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