42 U.S.C. § 256h | Program of payments to teaching health centers that operate graduate medical education programs

(a)

Payments

(1)

In general

Subject to subsection (h)(2), the Secretary shall make payments under this section for direct expenses and indirect expenses to qualified teaching health centers that are listed as sponsoring institutions by the relevant accrediting body for, as appropriate—

(A)

maintenance of filled positions at existing approved graduate medical residency training programs;

(B)

expansion of existing approved graduate medical residency training programs; and

(C)

establishment of new approved graduate medical residency training programs.

(2)

Per resident amount

In making payments under paragraph (1), the Secretary shall consider the cost of training residents at teaching health centers and the implications of the per resident amount on approved graduate medical residency training programs at teaching health centers.

(3)

Priority

In making payments under paragraph (1)(C), the Secretary shall give priority to qualified teaching health centers that—

(A)

section 254e of this title section 295p of this title serve a health professional shortage area with a designation in effect under or a medically underserved community (as defined in ); or

(B)

section 1395ww(d)(2)(D) of this title are located in a rural area (as defined in ).

(b)

Amount of payments

(1)

In general

Subject to paragraph (2), the amounts payable under this section to qualified teaching health centers for an approved graduate medical residency training program for a fiscal year are each of the following amounts:

(A)

Direct expense amount

The amount determined under subsection (c) for direct expenses associated with sponsoring approved graduate medical residency training programs.

(B)

Indirect expense amount

The amount determined under subsection (d) for indirect expenses associated with the additional costs relating to teaching residents in such programs.

(2)

Capped amount

(A)

In general

The total of the payments made to qualified teaching health centers under paragraph (1)(A) or paragraph (1)(B) in a fiscal year shall not exceed the amount of funds appropriated under subsection (g) for such payments for that fiscal year.

(B)

Limitation

1 So in original. Probably should be “subsections”.

The Secretary shall limit the funding of full-time equivalent residents in order to ensure the direct and indirect payments as determined under subsection  (c) and (d) do not exceed the total amount of funds appropriated in a fiscal year under subsection (g).

(C)

Addition

October 1, 2023December 31, 2024Notwithstanding any provision of this section, for the period beginning on , and ending on , the Secretary may use any amounts made available in any fiscal year to carry out this section (including amounts recouped under subsection (f)) to make payments described in paragraphs (1)(A) and (1)(B), in addition to the total amount of funds appropriated under subsection (g).

(c)

Amount of payment for direct graduate medical education

(1)

In general

The amount determined under this subsection for payments to qualified teaching health centers for direct graduate expenses relating to approved graduate medical residency training programs for a fiscal year is equal to the product of—

(A)

the updated national per resident amount for direct graduate medical education, as determined under paragraph (2); and

(B)

section 1395ww(h)(4) of this title the average number of full-time equivalent residents in the teaching health center’s graduate approved medical residency training programs as determined under (without regard to the limitation under subparagraph (F) of such section) during the fiscal year.

(2)

Updated national per resident amount for direct graduate medical education

The updated per resident amount for direct graduate medical education for a qualified teaching health center for a fiscal year is an amount determined as follows:

(A)

Determination of qualified teaching health center per resident amount

The Secretary shall compute for each individual qualified teaching health center a per resident amount—

(i)

section 256e(c)(2)(D) of this title by dividing the national average per resident amount computed under into a wage-related portion and a non-wage related portion by applying the proportion determined under subparagraph (B);

(ii)

section 1395ww(d)(3)(E) of this title 42 U.S.C. 1395ww by multiplying the wage-related portion by the factor applied under (but without application of section 4410 of the Balanced Budget Act of 1997 ( note)) during the preceding fiscal year for the teaching health center’s area; and

(iii)

by adding the non-wage-related portion to the amount computed under clause (ii).

(B)

Updating rate

The Secretary shall update such per resident amount for each such qualified teaching health center as determined appropriate by the Secretary.

(d)

Amount of payment for indirect medical education

(1)

In general

The amount determined under this subsection for payments to qualified teaching health centers for indirect expenses associated with the additional costs of teaching residents for a fiscal year is equal to an amount determined appropriate by the Secretary.

(2)

Factors

In determining the amount under paragraph (1), the Secretary shall—

(A)

evaluate indirect training costs relative to supporting a primary care residency program in qualified teaching health centers; and

(B)

based on this evaluation, assure that the aggregate of the payments for indirect expenses under this section and the payments for direct graduate medical education as determined under subsection (c) in a fiscal year do not exceed the amount appropriated for such expenses as determined in subsection (g).

(3)

Interim payment

Before the Secretary makes a payment under this subsection pursuant to a determination of indirect expenses under paragraph (1), the Secretary may provide to qualified teaching health centers a payment, in addition to any payment made under subsection (c), for expected indirect expenses associated with the additional costs of teaching residents for a fiscal year, based on an estimate by the Secretary.

(e)

Clarification regarding relationship to other payments for graduate medical education

Payments under this section—

(1)

shall be in addition to any payments—

(A)

section 1395ww(d)(5)(B) of this title for the indirect costs of medical education under ;

(B)

section 1395ww(h) of this title for direct graduate medical education costs under ; and

(C)

section 1395ww(k) of this title for direct costs of medical education under ;

(2)

section 1395ww(h)(4) of this title section 1395ww(d)(5)(B) of this title shall not be taken into account in applying the limitation on the number of total full-time equivalent residents under subparagraphs (F) and (G) of and clauses (v), (vi)(I), and (vi)(II) of for the portion of time that a resident rotates to a hospital; and

(3)

section 1395ww(d)(5)(B)(iv) of this title section 1395ww(h)(4)(E) of this title section 256e of this title shall not include the time in which a resident is counted toward full-time equivalency by a hospital under paragraph (2) or under , , or .

(f)

Reconciliation

oo2

2 See References in Text note below.

The Secretary shall determine any changes to the number of residents reported by a teaching health center in the application of the teaching health center for the current fiscal year to determine the final amount payable to the teaching health center for the current fiscal year for both direct expense and indirect expense amounts. Based on such determination, the Secretary shall recoup any overpayments made to pay any balance due to the extent possible. The final amount so determined shall be considered a final intermediary determination for the purposes of section 1395 of this title and shall be subject to administrative and judicial review under that section in the same manner as the amount of payment under section 1395ww(d)  of this title is subject to review under such section.

(g)

Funding

(1)

In general

To carry out this section, there are appropriated such sums as may be necessary, to remain available until expended, not to exceed—

(A)

$230,000,000, for the period of fiscal years 2011 through 2015;

(B)

$60,000,000 for each of fiscal years 2016 and 2017;

(C)

$126,500,000 for each of fiscal years 2018 through 2023;

(D)

$168,915,878 for fiscal year 2024;

(E)

$181,563,574 for fiscal year 2025;

(F)

$225,000,000 for fiscal year 2026;

(G)

$250,000,000 for fiscal year 2027;

(H)

$275,000,000 for fiscal year 2028; and

(I)

$300,000,000 for fiscal year 2029.

(2)

Administrative expenses

Of the amount made available to carry out this section for any fiscal year, the Secretary may not use more than 5 percent of such amount for the expenses of administering this section.

(h)

Annual reporting required

(1)

Annual report

The report required under this paragraph for a qualified teaching health center for a fiscal year is a report that includes (in a form and manner specified by the Secretary) the following information for the residency academic year completed immediately prior to such fiscal year:

(A)

The types of primary care resident approved training programs that the qualified teaching health center provided for residents.

(B)

The number of approved training positions for residents described in paragraph (4).

(C)

The number of residents described in paragraph (4) who completed their residency training at the end of such residency academic year and care for vulnerable populations living in underserved areas.

(D)

The number of patients treated by residents described in paragraph (4).

(E)

The number of visits by patients treated by residents described in paragraph (4).

(F)

l Of the number of residents described in paragraph (4) who completed their residency training at the end of such residency academic year, the number and percentage of such residents entering primary care practice (meaning any of the areas of practice listed in the definition of a primary care residency program in section 293–1 of this title).

(G)

Of the number of residents described in paragraph (4) who completed their residency training at the end of such residency academic year, the number and percentage of such residents who entered practice at a health care facility—

(i)

section 254e of this title section 295p of this title primarily serving a health professional shortage area with a designation in effect under or a medically underserved community (as defined in ); or

(ii)

section 1395ww(d)(2)(D) of this title located in a rural area (as defined in ).

(H)

Other information as deemed appropriate by the Secretary.

(2)

Audit authority; limitation on payment

(A)

Audit authority

The Secretary may audit a qualified teaching health center to ensure the accuracy and completeness of the information submitted in a report under paragraph (1).

(B)

Limitation on payment

A teaching health center may only receive payment in a cost reporting period for a number of such resident positions that is greater than the base level of primary care resident positions, as determined by the Secretary. For purposes of this subparagraph, the “base level of primary care residents” for a teaching health center is the level of such residents as of a base period.

(3)

Reduction in payment for failure to report

(A)

In general

The amount payable under this section to a qualified teaching health center for a fiscal year shall be reduced by at least 25 percent if the Secretary determines that—

(i)

the qualified teaching health center has failed to provide the Secretary, as an addendum to the qualified teaching health center’s application under this section for such fiscal year, the report required under paragraph (1) for the previous fiscal year; or

(ii)

such report fails to provide complete and accurate information required under any subparagraph of such paragraph.

(B)

Notice and opportunity to provide accurate and missing information

Before imposing a reduction under subparagraph (A) on the basis of a qualified teaching health center’s failure to provide complete and accurate information described in subparagraph (A)(ii), the Secretary shall provide notice to the teaching health center of such failure and the Secretary’s intention to impose such reduction and shall provide the teaching health center with the opportunity to provide the required information within the period of 30 days beginning on the date of such notice. If the teaching health center provides such information within such period, no reduction shall be made under subparagraph (A) on the basis of the previous failure to provide such information.

(4)

Residents

The residents described in this paragraph are those who are in part-time or full-time equivalent resident training positions at a qualified teaching health center in any approved graduate medical residency training program.

(i)

Regulations

The Secretary shall promulgate regulations to carry out this section.

(j)

Definitions

In this section:

(1)

Approved graduate medical residency training program

The term “approved graduate medical residency training program” means a residency or other postgraduate medical training program—

(A)

participation in which may be counted toward certification in a specialty or subspecialty and includes formal postgraduate training programs in geriatric medicine approved by the Secretary; and

(B)

that meets criteria for accreditation (as established by the Accreditation Council for Graduate Medical Education, the American Osteopathic Association, or the American Dental Association).

(2)

New approved graduate medical residency training program

The term “new approved graduate medical residency training program” means an approved graduate medical residency training program for which the sponsoring qualified teaching health center has not received a payment under this section for a previous fiscal year (other than pursuant to subsection (a)(1)(C)).

(3)

Primary care residency program

lThe term “primary care residency program” has the meaning given that term in section 293–1 of this title.

(4)

Qualified teaching health center

lThe term “qualified teaching health center” has the meaning given the term “teaching health center” in section 293–1 of this title.

July 1, 1944, ch. 373 Pub. L. 111–148, title V, § 5508(c)Mar. 23, 2010124 Stat. 670 Pub. L. 114–10, title II, § 221(b)Apr. 16, 2015129 Stat. 154 Pub. L. 115–63, title III, § 301(a)Sept. 29, 2017131 Stat. 1171 Pub. L. 115–96, div. C, title I, § 3101(c)Dec. 22, 2017131 Stat. 2048 Pub. L. 115–123, div. E, title IX, § 50901(d)(1)Feb. 9, 2018132 Stat. 287–289 Pub. L. 116–59, div. B, title I, § 1101(c)Sept. 27, 2019133 Stat. 1102 Pub. L. 116–69, div. B, title I, § 1101(c)Nov. 21, 2019133 Stat. 1136 Pub. L. 116–94, div. N, title I, § 401(c)Dec. 20, 2019133 Stat. 3113 Pub. L. 116–136, div. A, title III, § 3831(c)Mar. 27, 2020134 Stat. 434 Pub. L. 116–159, div. C, title I, § 2101(c)Oct. 1, 2020134 Stat. 728 Pub. L. 116–215, div. B, title II, § 1201(c)Dec. 11, 2020134 Stat. 1044 Pub. L. 116–260, div. BB, title III, § 301(c)Dec. 27, 2020134 Stat. 2922 Pub. L. 118–15, div. B, title III, § 2321(a)Sept. 30, 2023137 Stat. 94 Pub. L. 118–22, div. B, title II, § 201(a)Nov. 17, 2023137 Stat. 119 Pub. L. 118–35, div. B, title I, § 101(a)Jan. 19, 2024138 Stat. 4 Pub. L. 118–42, div. G, title I, § 101(c)(1)Mar. 9, 2024138 Stat. 397 Pub. L. 118–158, div. C, title I, § 3101(c)Dec. 21, 2024138 Stat. 1762 Pub. L. 119–4, div. B, title I, § 2101(c)Mar. 15, 2025139 Stat. 40 Pub. L. 119–37, div. F, title I, § 6101(c)Nov. 12, 2025139 Stat. 629 Pub. L. 119–75, div. J, title IV, § 6401(c)Feb. 3, 2026140 Stat. 687 (, title III, § 340H, as added , , ; amended , , ; , , ; , , ; –(3), (5), (6), , ; , , ; , , ; , , ; , , ; , , ; , , ; , , ; , , ; , , ; , , ; , (2), , ; , , ; , , ; , , ; , , .)

Editorial Notes

References in Text

section 4410 of Pub. L. 105–33 section 1395ww of this titleSection 4410 of the Balanced Budget Act of 1997, referred to in subsec. (c)(2)(A)(ii), is , which is set out as a note under .

Section 1395ww(d) of this titleact Aug. 14, 1935, ch. 531 , referred to in subsec. (f), was in the original “section 1186(d) of such Act”, and was translated as meaning section 1886(d) of , known as the Social Security Act, to reflect the probable intent of Congress. The Social Security Act does not contain a section 1186.

Codification

July 1, 1944section 256i of this titleAnother section 340H of act , was renumbered section 340I and is classified to .

Amendments

Pub. L. 119–752026—Subsec. (g)(1)(D) to (I). added subpars. (D) to (I) and struck out former subpars. (D) to (G) which read as follows:

October 1, 2023November 17, 2023November 18, 2023January 19, 2024January 20, 2024March 8, 2024October 1, 2023December 31, 2024“(D) $16,635,616 for the period beginning on , and ending on , $21,834,247 for the period beginning on , and ending on , $16,982,192 for the period beginning on , and ending on , and $164,136,986 for the period beginning on , and ending on ;

January 1, 2025March 31, 2025“(E) $43,150,685 for the period beginning on , and ending on ;

April 1, 2025September 30, 2025“(F) $87,739,726 for the period beginning on , and ending on ; and

October 1, 2025January 30, 2026“(G) $58,493,151 for the period beginning on , and ending on .”

Pub. L. 119–42025—Subsec. (g)(1)(F). added subpar. (F).

Pub. L. 119–37Subsec. (g)(1)(G). added subpar. (G).

Pub. L. 118–42, § 101(c)(2)2024—Subsec. (b)(2)(C). , added subpar. (C).

Pub. L. 118–158, § 3101(c)(2)Subsec. (g)(1). , substituted “, not to exceed—” and subpars. (A) to (E) for period at end.

Pub. L. 118–158, § 3101(c)(1)October 1, 2023November 17, 2023November 18, 2023January 19, 2024January 20, 2024March 8, 2024October 1, 2023December 31, 2024, struck out “not to exceed $230,000,000, for the period of fiscal years 2011 through 2015, $60,000,000 for each of fiscal years 2016 and 2017, $126,500,000 for each of fiscal years 2018 through 2023, $16,635,616 for the period beginning on , and ending on , $21,834,247 for the period beginning on , and ending on , $16,982,192 for the period beginning on , and ending on , and $164,136,986 for the period beginning on , and ending on ,” after “as may be necessary,”.

Pub. L. 118–42, § 101(c)(1)January 20, 2024March 8, 2024October 1, 2023December 31, 2024January 20, 2024March 8, 2024, substituted “$16,982,192 for the period beginning on , and ending on , and $164,136,986 for the period beginning on , and ending on ” for “and $16,982,192 for the period beginning on , and ending on ”.

Pub. L. 118–35November 18, 2023January 19, 2024January 20, 2024March 8, 2024November 18, 2023January 19, 2024 substituted “$21,834,247 for the period beginning on , and ending on , and $16,982,192 for the period beginning on , and ending on ” for “and $21,834,247 for the period beginning on , and ending on ”.

Pub. L. 118–22October 1, 2023November 17, 2023November 18, 2023January 19, 2024October 1, 2023November 17, 20232023—Subsec. (g)(1). substituted “$16,635,616 for the period beginning on , and ending on , and $21,834,247 for the period beginning on , and ending on ” for “and $16,635,616 for the period beginning on , and ending on ”.

Pub. L. 118–15October 1, 2023November 17, 2023 struck out “and” before “$126,500,000” and inserted “and $16,635,616 for the period beginning on , and ending on ,” before “to remain available”.

Pub. L. 116–260October 1, 2020December 18, 20202020—Subsec. (g)(1). inserted “and” after “2017,” and substituted “2023” for “fiscal year 2020, and $27,379,452 for the period beginning on , and ending on ”.

Pub. L. 116–215December 18, 2020December 11, 2020 substituted “$27,379,452” for “$24,953,425” and “” for “”.

Pub. L. 116–159December 11, 2020November 30, 2020 substituted “$24,953,425” for “$21,141,096” and “” for “”.

Pub. L. 116–136October 1, 2020November 30, 2020October 1, 2019May 22, 2020 substituted “through fiscal year 2020, and $21,141,096 for the period beginning on , and ending on ” for “and 2019, and $81,445,205 for the period beginning on , and ending on ”.

Pub. L. 116–94May 22, 2020December 20, 20192019—Subsec. (g)(1). substituted “$81,445,205” for “$28,072,603” and “” for “”.

Pub. L. 116–69December 20, 2019November 21, 2019 substituted “$28,072,603” for “$18,021,918” and “” for “”.

Pub. L. 116–59October 1, 2019November 21, 2019 struck out “and” before “$126,500,000” and inserted “and $18,021,918 for the period beginning on , and ending on ,” before “to remain available”.

Pub. L. 115–123, § 50901(d)(1)2018—Subsec. (a). , amended subsec. (a) generally. Prior to amendment, text read as follows: “Subject to subsection (h)(2), the Secretary shall make payments under this section for direct expenses and for indirect expenses to qualified teaching health centers that are listed as sponsoring institutions by the relevant accrediting body for expansion of existing or establishment of new approved graduate medical residency training programs.”

Pub. L. 115–123, § 50901(d)(6)Subsec. (f). , substituted “teaching health center” for “hospital” wherever appearing.

Pub. L. 115–123, § 50901(d)(2)Subsec. (g)(1). , substituted “and $126,500,000 for each of fiscal years 2018 and 2019,” for “and $30,000,000 for the period of the first and second quarters of fiscal year 2018,”.

Pub. L. 115–123, § 50901(d)(3)Subsec. (h)(1)(D) to (H). , added subpars. (D) to (G) and redesignated former subpar. (D) as (H).

Pub. L. 115–123, § 50901(d)(5)Subsec. (j)(2) to (4). , added par. (2) and redesignated former pars. (2) and (3) as (3) and (4), respectively.

Pub. L. 115–962017—Subsec. (g). designated existing provisions as par. (1), inserted heading, substituted “and $30,000,000 for the period of the first and second quarters of fiscal year 2018, to remain available until expended” for “and $15,000,000 for the first quarter of fiscal year 2018”, and added par. (2).

Pub. L. 115–63 substituted “2015, $60,000,000” for “2015 and $60,000,000” and inserted “, and $15,000,000 for the first quarter of fiscal year 2018” before period at end.

Pub. L. 114–102015—Subsec. (g). inserted “and $60,000,000 for each of fiscal years 2016 and 2017” before period at end.

Statutory Notes and Related Subsidiaries

Funding for Teaching Health Centers That Operate Graduate Medical Education

Pub. L. 117–2, title II, § 2604Mar. 11, 2021135 Stat. 44

“(a)

In General .—

42 U.S.C. 256h(b)(2)September 30, 202342 U.S.C. 256h 42 U.S.C. 293lIn addition to amounts otherwise available, and notwithstanding the capped amount referenced in sections 340H(b)(2) and 340H(d)(2) of the Public Health Service Act ( and (d)(2)), there is appropriated to the Secretary [of Health and Human Services] for fiscal year 2021, out of any money in the Treasury not otherwise appropriated, $330,000,000, to remain available until , for the program of payments to teaching health centers that operate graduate medical education under section 340H of the Public Health Service Act () and for teaching health center development grants authorized under section 749A of the Public Health Service Act (–1).

“(b)

Use of Funds .—

Amounts made available pursuant to subsection (a) shall be used for the following activities:

“(1)

42 U.S.C. 256h(a)(1)(C) For making payments to establish new approved graduate medical residency training programs pursuant to section 340H(a)(1)(C) of the Public Health Service Act ().

“(2)

42 U.S.C. 256h(a)(2) To provide an increase to the per resident amount described in section 340H(a)(2) of the Public Health Service Act () of $10,000.

“(3)

42 U.S.C. 256h(a)(1)(A) For making payments under section 340H(a)(1)(A) of the Public Health Service Act ()) [sic] to qualified teaching health centers for maintenance of filled positions at existing approved graduate medical residency training programs.

“(4)

42 U.S.C. 256h(a)(1)(B) For making payments under section 340H(a)(1)(B) of the Public Health Service Act () for the expansion of existing approved graduate medical residency training programs.

“(5)

42 U.S.C. 293l For making awards under section 749A of the Public Health Service Act (–1) to teaching health centers for the purpose of establishing new accredited or expanded primary care residency programs.

“(6)

42 U.S.C. 256h To cover administrative costs and activities necessary for qualified teaching health centers receiving payments under section 340H of the Public Health Service Act () to carry out activities under such section.”

, , , provided that:

Payments for Previous Fiscal Years

Pub. L. 115–123, div. E, title IX, § 50901(d)(7)Feb. 9, 2018132 Stat. 289

42 U.S.C. 256h Public Law 115–96Dec. 22, 2017“The provisions of section 340H of the Public Health Service Act (), as in effect on the day before the date of enactment of [], shall continue to apply with respect to payments under such section for fiscal years before fiscal year 2018.”

, , , provided that: