Rural Physician Workforce Production Act of 2025
Sponsored By: Representative Harshbarger
Introduced
Summary
Expand and fund rural residency training. This bill would create an elective Medicare per-resident payment called the Elective Rural Sustainability amount to encourage more residency training in rural locations and to broaden which hospitals qualify for enhanced graduate medical education payments.
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- Rural hospitals and training sites would be able to opt in to a per-resident payment for trainees who spend at least eight weeks in a rural training location. The payment can apply even when the host hospital would not otherwise qualify for direct or indirect GME payments.
- Residency programs and residents in tracks that provide more than 50 percent rural training time would get special counting rules for full-time-equivalent residents and protection from the usual 130 percent GME cap. Residents who train in rural locations but not in a rural track would get a per-resident amount equal to 50 percent of the urban-aligned amount.
- Medicare rules would be adjusted for Direct and Indirect Graduate Medical Education to support new and expanding rural tracks and to change how Critical Access Hospitals and Sole Community Hospitals count resident time and related costs. The bill requires budget neutrality so aggregate Medicare GME payments would not exceed what would have been paid otherwise.
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Bill Overview
Analyzed Economic Effects
4 provisions identified: 1 benefits, 0 costs, 3 mixed.
Medicare doctor training funds held flat
The bill would require total Medicare payments for doctor training (direct and indirect GME), including the new rural payments, to stay budget‑neutral each year. The Secretary could adjust other GME payments so overall totals do not exceed what would have been paid without the new subsection. This would begin 1 year after enactment.
New payments to train rural doctors
This bill would let hospitals choose a new per‑resident payment when residents train in rural locations. To qualify, a resident would need at least 8 weeks in a rural site and the hospital must pay salary and benefits for that time. Programs or tracks with more than 50% of training in rural areas would get payment for all time, no matter where the day is spent. The first‑year amount would be based on the 2015 national median GME cost per resident and then updated each year by CPI‑U and corrected for past estimate errors. For non‑rural hospitals, residents in a rural track would get the full amount; residents who rotate to a rural site but not in a track would get 50%. Payments would be split between Medicare Parts A and B and would not be reduced for Medicare patient load or DRG counts. It would also let hospitals expand rural‑track training by not counting those residents against GME/IME caps. Most rules would start for cost reporting periods beginning 1 year after enactment.
Critical access hospitals choose counting rules
Critical access hospitals could choose to be treated as a hospital or as a non‑provider setting when counting resident time for Medicare GME payments. If treated as a non‑provider setting, the hospital could not claim those direct education costs as its own when another hospital is paid for that time. This option would start for cost reporting periods 1 year after enactment.
Sole community hospitals avoid double payment
If a sole community hospital is paid for direct education costs under the new rural payment, those same costs would be removed from its hospital‑specific payment. This would prevent double payment for the same training costs. The change would apply starting 1 year after enactment.
Sponsors & CoSponsors
Sponsor
Harshbarger
TN • R
Cosponsors
Schrier
WA • D
Sponsored 2/10/2025
Bacon
NE • R
Sponsored 2/10/2025
Cuellar
TX • D
Sponsored 2/13/2025
Tokuda
HI • D
Sponsored 3/18/2025
Leger Fernandez
NM • D
Sponsored 3/21/2025
Kiggans (VA)
VA • R
Sponsored 5/5/2025
Vindman
VA • D
Sponsored 6/20/2025
Vasquez
NM • D
Sponsored 7/21/2025
Bresnahan
PA • R
Sponsored 9/30/2025
Del. Moylan, James C. [R-GU-At Large]
GU • R
Sponsored 10/21/2025
Roll Call Votes
No roll call votes available for this bill.
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