Title 42 — The Public Health and WelfareRelease 119-83
§256h Program of payments to teaching health centers that operate graduate medical education programs
Title 42 › Chapter CHAPTER 6A— - PUBLIC HEALTH SERVICE › Subchapter SUBCHAPTER II— - GENERAL POWERS AND DUTIES › Part Part D— - Primary Health Care › Subpart subpart xi— - support of graduate medical education in qualified teaching health centers › § 256h
Summary
The Secretary must pay qualified teaching health centers money to help cover the costs of training medical residents. Payments can help keep filled slots, grow current residency programs, or start new residency programs. When starting new programs, priority goes to centers that serve health professional shortage areas or medically underserved communities, or that are in rural areas. The direct payment equals an updated national per-resident rate multiplied by the center’s average number of full‑time equivalent residents; that per‑resident rate is adjusted for local wages. The Secretary decides the amount for indirect costs of teaching residents and may give advance payments based on estimates. All payments are limited by the money Congress provides each year. The law specifically provides funding amounts: $230,000,000 for fiscal years 2011–2015; $60,000,000 for each of 2016 and 2017; $126,500,000 for each of 2018–2023; $168,915,878 for 2024; $181,563,574 for 2025; $225,000,000 for 2026; $250,000,000 for 2027; $275,000,000 for 2028; and $300,000,000 for 2029. No more than 5 percent of any year’s funds may be used for administration. For the period October 1, 2023 through December 31, 2024, the Secretary may also use any available amounts, including recovered overpayments, to make payments in addition to the listed appropriations. Centers must file a yearly report about their residency programs, positions, patients seen, and where graduates practice. The Secretary may audit reports. If a center does not submit a complete and accurate report, or misses the report, its payment for the year will be cut by at least 25 percent, but the center gets 30 days to fix missing or incomplete information. The Secretary will adjust payments if resident counts change and can recover overpayments. These payments are in addition to other Medicare education payments and do not count against resident caps when residents rotate to hospitals. The Secretary must write rules to carry out the program. Definitions: “approved graduate medical residency training program” — a residency that counts toward specialty certification and meets accreditation; “new approved graduate medical residency training program” — one that has not gotten a payment before; “primary care residency program” and “qualified teaching health center” — as defined elsewhere in law.
Full Legal Text
Title 42, §256h
The Public Health and Welfare — Source: USLM XML via OLRC
(a)(1)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)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)In making payments under paragraph (1)(C), the Secretary shall give priority to qualified teaching health centers that—
(A)serve a health professional shortage area with a designation in effect under section 254e of this title or a medically underserved community (as defined in section 295p of this title); or
(B)are located in a rural area (as defined in section 1395ww(d)(2)(D) of this title).
(b)(1)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)The amount determined under subsection (c) for direct expenses associated with sponsoring approved graduate medical residency training programs.
(B)The amount determined under subsection (d) for indirect expenses associated with the additional costs relating to teaching residents in such programs.
(2)(A)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)The Secretary shall limit the funding of full-time equivalent residents in order to ensure the direct and indirect payments as determined under subsection 11 So in original. Probably should be “subsections”. (c) and (d) do not exceed the total amount of funds appropriated in a fiscal year under subsection (g).
(C)Notwithstanding any provision of this section, for the period beginning on October 1, 2023, and ending on December 31, 2024, 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)(1)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)the average number of full-time equivalent residents in the teaching health center’s graduate approved medical residency training programs as determined under section 1395ww(h)(4) of this title (without regard to the limitation under subparagraph (F) of such section) during the fiscal year.
(2)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)The Secretary shall compute for each individual qualified teaching health center a per resident amount—
(i)by dividing the national average per resident amount computed under section 256e(c)(2)(D) of this title into a wage-related portion and a non-wage related portion by applying the proportion determined under subparagraph (B);
(ii)by multiplying the wage-related portion by the factor applied under section 1395ww(d)(3)(E) of this title (but without application of section 4410 of the Balanced Budget Act of 1997 (42 U.S.C. 1395ww 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)The Secretary shall update such per resident amount for each such qualified teaching health center as determined appropriate by the Secretary.
(d)(1)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)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)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)Payments under this section—
(1)shall be in addition to any payments—
(A)for the indirect costs of medical education under section 1395ww(d)(5)(B) of this title;
(B)for direct graduate medical education costs under section 1395ww(h) of this title; and
(C)for direct costs of medical education under section 1395ww(k) of this title;
(2)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 section 1395ww(h)(4) of this title and clauses (v), (vi)(I), and (vi)(II) of section 1395ww(d)(5)(B) of this title for the portion of time that a resident rotates to a hospital; and
(3)shall not include the time in which a resident is counted toward full-time equivalency by a hospital under paragraph (2) or under section 1395ww(d)(5)(B)(iv) of this title, section 1395ww(h)(4)(E) of this title, or section 256e of this title.
(f)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 1395oo 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) 22 See References in Text note below. of this title is subject to review under such section.
(g)(1)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)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)(1)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)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 293l–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)primarily serving a health professional shortage area with a designation in effect under section 254e of this title or a medically underserved community (as defined in section 295p of this title); or
(ii)located in a rural area (as defined in section 1395ww(d)(2)(D) of this title).
(H)Other information as deemed appropriate by the Secretary.
(2)(A)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)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)(A)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)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)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)The Secretary shall promulgate regulations to carry out this section.
(j)In this section:
(1)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)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)The term “primary care residency program” has the meaning given that term in section 293l–1 of this title.
(4)The term “qualified teaching health center” has the meaning given the term “teaching health center” in section 293l–1 of this title.
Legislative History
Notes & Related Subsidiaries
Editorial Notes
References in Text
section 4410 of the Balanced Budget Act of 1997, referred to in subsec. (c)(2)(A)(ii), is section 4410 of Pub. L. 105–33, which is set out as a note under section 1395ww of this title. section 1395ww(d) of this title, referred to in subsec. (f), was in the original “section 1186(d) of such Act”, and was translated as meaning section 1886(d) of act Aug. 14, 1935, ch. 531, known as the Social Security Act, to reflect the probable intent of Congress. The Social Security Act does not contain a section 1186. Codification Another section 340H of act July 1, 1944, was renumbered section 340I and is classified to section 256i of this title.
Amendments
2026—Subsec. (g)(1)(D) to (I). Pub. L. 119–75 added subpars. (D) to (I) and struck out former subpars. (D) to (G) which read as follows: “(D) $16,635,616 for the period beginning on
October 1, 2023, and ending on
November 17, 2023, $21,834,247 for the period beginning on
November 18, 2023, and ending on
January 19, 2024, $16,982,192 for the period beginning on
January 20, 2024, and ending on
March 8, 2024, and $164,136,986 for the period beginning on
October 1, 2023, and ending on
December 31, 2024; “(E) $43,150,685 for the period beginning on
January 1, 2025, and ending on
March 31, 2025; “(F) $87,739,726 for the period beginning on
April 1, 2025, and ending on
September 30, 2025; and “(G) $58,493,151 for the period beginning on
October 1, 2025, and ending on
January 30, 2026.” 2025—Subsec. (g)(1)(F). Pub. L. 119–4 added subpar. (F). Subsec. (g)(1)(G). Pub. L. 119–37 added subpar. (G). 2024—Subsec. (b)(2)(C). Pub. L. 118–42, § 101(c)(2), added subpar. (C). Subsec. (g)(1). Pub. L. 118–158, § 3101(c)(2), substituted “, not to exceed—” and subpars. (A) to (E) for period at end. Pub. L. 118–158, § 3101(c)(1), 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
October 1, 2023, and ending on
November 17, 2023, $21,834,247 for the period beginning on
November 18, 2023, and ending on
January 19, 2024, $16,982,192 for the period beginning on
January 20, 2024, and ending on
March 8, 2024, and $164,136,986 for the period beginning on
October 1, 2023, and ending on
December 31, 2024,” after “as may be necessary,”. Pub. L. 118–42, § 101(c)(1), substituted “$16,982,192 for the period beginning on
January 20, 2024, and ending on
March 8, 2024, and $164,136,986 for the period beginning on
October 1, 2023, and ending on
December 31, 2024” for “and $16,982,192 for the period beginning on
January 20, 2024, and ending on
March 8, 2024”. Pub. L. 118–35 substituted “$21,834,247 for the period beginning on
November 18, 2023, and ending on
January 19, 2024, and $16,982,192 for the period beginning on
January 20, 2024, and ending on
March 8, 2024” for “and $21,834,247 for the period beginning on
November 18, 2023, and ending on
January 19, 2024”. 2023—Subsec. (g)(1). Pub. L. 118–22 substituted “$16,635,616 for the period beginning on
October 1, 2023, and ending on
November 17, 2023, and $21,834,247 for the period beginning on
November 18, 2023, and ending on
January 19, 2024” for “and $16,635,616 for the period beginning on
October 1, 2023, and ending on
November 17, 2023”. Pub. L. 118–15 struck out “and” before “$126,500,000” and inserted “and $16,635,616 for the period beginning on
October 1, 2023, and ending on
November 17, 2023,” before “to remain available”. 2020—Subsec. (g)(1). Pub. L. 116–260 inserted “and” after “2017,” and substituted “2023” for “fiscal year 2020, and $27,379,452 for the period beginning on
October 1, 2020, and ending on
December 18, 2020”. Pub. L. 116–215 substituted “$27,379,452” for “$24,953,425” and “
December 18, 2020” for “
December 11, 2020”. Pub. L. 116–159 substituted “$24,953,425” for “$21,141,096” and “
December 11, 2020” for “
November 30, 2020”. Pub. L. 116–136 substituted “through fiscal year 2020, and $21,141,096 for the period beginning on
October 1, 2020, and ending on
November 30, 2020” for “and 2019, and $81,445,205 for the period beginning on
October 1, 2019, and ending on
May 22, 2020”. 2019—Subsec. (g)(1). Pub. L. 116–94 substituted “$81,445,205” for “$28,072,603” and “
May 22, 2020” for “
December 20, 2019”. Pub. L. 116–69 substituted “$28,072,603” for “$18,021,918” and “
December 20, 2019” for “
November 21, 2019”. Pub. L. 116–59 struck out “and” before “$126,500,000” and inserted “and $18,021,918 for the period beginning on
October 1, 2019, and ending on
November 21, 2019,” before “to remain available”. 2018—Subsec. (a). Pub. L. 115–123, § 50901(d)(1), 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.” Subsec. (f). Pub. L. 115–123, § 50901(d)(6), substituted “teaching health center” for “hospital” wherever appearing. Subsec. (g)(1). Pub. L. 115–123, § 50901(d)(2), 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,”. Subsec. (h)(1)(D) to (H). Pub. L. 115–123, § 50901(d)(3), added subpars. (D) to (G) and redesignated former subpar. (D) as (H). Subsec. (j)(2) to (4). Pub. L. 115–123, § 50901(d)(5), added par. (2) and redesignated former pars. (2) and (3) as (3) and (4), respectively. 2017—Subsec. (g). Pub. L. 115–96 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. 2015—Subsec. (g). Pub. L. 114–10 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, § 2604, Mar. 11, 2021, 135 Stat. 44, provided that: “(a) In General.—In addition to amounts otherwise available, and notwithstanding the capped amount referenced in section 340H(b)(2) and 340H(d)(2) of the Public Health Service Act (42 U.S.C. 256h(b)(2) 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 September 30, 2023, for the program of payments to teaching health centers that operate graduate medical education under section 340H of the Public Health Service Act (42 U.S.C. 256h) and for teaching health center development grants authorized under section 749A of the Public Health Service Act (42 U.S.C. 293l–1). “(b) Use of Funds.—Amounts made available pursuant to subsection (a) shall be used for the following activities:“(1) 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 (42 U.S.C. 256h(a)(1)(C)). “(2) To provide an increase to the per resident amount described in section 340H(a)(2) of the Public Health Service Act (42 U.S.C. 256h(a)(2)) of $10,000. “(3) For making payments under section 340H(a)(1)(A) of the Public Health Service Act (42 U.S.C. 256h(a)(1)(A))) [sic] to qualified teaching health centers for maintenance of filled positions at existing approved graduate medical residency training programs. “(4) For making payments under section 340H(a)(1)(B) of the Public Health Service Act (42 U.S.C. 256h(a)(1)(B)) for the expansion of existing approved graduate medical residency training programs. “(5) For making awards under section 749A of the Public Health Service Act (42 U.S.C. 293l–1) to teaching health centers for the purpose of establishing new accredited or expanded primary care residency programs. “(6) To cover administrative costs and activities necessary for qualified teaching health centers receiving payments under section 340H of the Public Health Service Act (42 U.S.C. 256h) to carry out activities under such section.” Payments for Previous Fiscal Years Pub. L. 115–123, div. E, title IX, § 50901(d)(7), Feb. 9, 2018, 132 Stat. 289, provided that: “The provisions of section 340H of the Public Health Service Act (42 U.S.C. 256h), as in effect on the day before the date of enactment of Public Law 115–96 [Dec. 22, 2017], shall continue to apply with respect to payments under such section for fiscal years before fiscal year 2018.”
Reference
Citations & Metadata
Citation
42 U.S.C. § 256h
Title 42 — The Public Health and Welfare
Last Updated
Apr 18, 2026
Release point: 119-83