H.R. 8943

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8943 Introduced in House (IH)]

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119th CONGRESS
2d Session
H. R. 8943

To amend title XVIII of the Social Security Act to prohibit payments 
for graduate medical education costs attributable to individuals who 
are not citizens or nationals of the United States under the Medicare 
program.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

May 20, 2026

Mr. Steube introduced the following bill; which was 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 BILL

To amend title XVIII of the Social Security Act to prohibit payments 
for graduate medical education costs attributable to individuals who 
are not citizens or nationals of the United States under the Medicare 
program.

Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Our Doctors First Act of 2026''.

SEC. 2. PROHIBITING FEDERALLY-FUNDED GRADUATE MEDICAL EDUCATION FOR 
NON-CITIZENS UNDER MEDICARE.

(a) Hospital Payments for Direct Graduate Medical Education 
Costs.--Section 1886(h) of the Social Security Act (42 U.S.C. 
1395ww(h)) is amended--
(1) in paragraph (1), by inserting ``, subject to paragraph 
(11)'' after ``of this subsection'';
(2) in paragraph (4), by adding at the end the following 
new subparagraph:
``(L) Non-citizen residents.--Such rules shall 
provide that, effective for cost reporting periods 
beginning on or after the date that is 1 year after the 
date of the enactment of this subparagraph, an 
individual shall not be counted as a resident unless 
such individual is a citizen or national of the United 
States.''; and
(3) by adding at the end the following new paragraph:
``(11) Sanctions for counting non-citizen residents.--
``(A) In general.--Effective for cost reporting 
periods beginning on or after the date that is 1 year 
after the date of the enactment of this paragraph, a 
hospital that submits a cost report counting 1 or more 
individuals who such hospital knows or should know are 
not citizens or nationals of the United States as 
interns or residents for purposes of payment under this 
subsection in violation of paragraph (4)(L) or payment 
under paragraphs (5)(B) and (11) of subsection (d) in 
violation of subsection (d)(5)(B)(xiv) shall be subject 
to the following sanctions:
``(i) In the case of the first cost 
reporting period for which such hospital 
submits such a cost report, a civil monetary 
penalty equal to 25 percent of the payment 
amount that would be attributable to the 
individuals so counted pursuant to such cost 
report if such individuals were permitted to be 
so counted under this subsection and subsection 
(d)(5)(B).
``(ii) In the case of the second cost 
reporting period for which such hospital 
submits such a cost report, a civil monetary 
penalty equal to $1,000,000.
``(iii) In the case of the third cost 
reporting period for which such hospital 
submits such a cost report, such hospital shall 
be excluded from receiving payments under this 
subsection and paragraphs (5)(B) and (11) of 
subsection (d) for a period of 5 years.
``(iv) In the case of each subsequent cost 
reporting period for which such hospital 
submits such a cost report, such hospital shall 
be excluded from receiving payments under this 
subsection and paragraphs (5)(B) and (11) of 
subsection (d) for a period of 10 years.
``(B) Procedures.--
``(i) Civil monetary penalties.--The 
provisions of section 1128A (other than 
subsection (a) and (b) of such section) shall 
apply to civil monetary penalties under this 
paragraph in the same manner as such provisions 
apply to a penalty or proceeding under 
subsection (a) of such section.
``(ii) Exclusion from payments.--The 
provisions of subsections (c)(1) and (f) of 
section 1128 shall apply to an exclusion from 
receiving payments under this paragraph in the 
same manner as such provisions apply to 
exclusions from participation under such 
section.''.
(b) Hospital Payments for Indirect Costs of Medical Education.--
Section 1886(d) of the Social Security Act (42 U.S.C. 1395ww(d))--
(1) in paragraph (5)(B)--
(A) by striking ``The Secretary'' and inserting 
``Subject to subsection (h)(11), the Secretary''; and
(B) by adding at the end the following new clause:
``(xiv) For discharges occurring on or after the first July 
1 occurring on or after the date that is 1 year after the date 
of the enactment of this clause, an individual shall not be 
counted as an intern or a resident under this subparagraph 
unless such individual is a citizen or national of the United 
States.''; and
(2) in paragraph (11)(A), by inserting ``subject to 
subsection (h)(11),'' before ``the Secretary''.
(c) Nonhospital Provider Payments for Direct Costs of Medical 
Education.--Section 1886(k) of the Social Security Act (42 U.S.C. 
1395ww(k)) is amended by adding at the end the following new paragraph:
``(3) Non-citizen residents.--
``(A) In general.--Effective for cost reporting 
periods beginning on or after the date that is 1 year 
after the date of the enactment of this paragraph, 
payment may not be made under this subsection for 
direct costs of medical education incurred with respect 
to residents who are not citizens or nationals of the 
United States.
``(B) Penalties.--
``(i) In general.--Effective for cost 
reporting periods beginning on or after the 
date that is 1 year after the date of the 
enactment of this paragraph, a qualified 
nonhospital provider that submits a cost report 
requesting payment under this subsection for 
direct costs of medical education incurred with 
respect to 1 or more residents who such 
qualified nonhospital provider knows or should 
know are not citizens or nationals of the 
United States in violation of subparagraph (A) 
shall be subject to the following sanctions:
``(I) In the case of the first cost 
reporting period for which such 
qualified nonhospital provider submits 
such a cost report, a civil monetary 
penalty equal to 25 percent of the 
payment amount requested pursuant to 
such cost report for direct costs of 
medical education incurred with respect 
to such residents.
``(II) In the case of the second 
cost reporting period for which such 
qualified nonhospital provider submits 
such a cost report, a civil monetary 
penalty equal to $1,000,000.
``(III) In the case of the third 
cost reporting period for which such 
qualified nonhospital provider submits 
such a cost report, such qualified 
nonhospital provider shall be excluded 
from receiving payments under this 
subsection for a period of 5 years.
``(IV) In the case of each 
subsequent cost reporting period for 
which such qualified nonhospital 
provider submits such a cost report, 
such qualified nonhospital provider 
shall be excluded from receiving 
payments under this subsection for a 
period of 10 years.
``(ii) Procedures.--
``(I) Civil monetary penalties.--
The provisions of section 1128A (other 
than subsection (a) and (b) of such 
section) shall apply to civil monetary 
penalties under this subparagraph in 
the same manner as such provisions 
apply to a penalty or proceeding under 
subsection (a) of such section.
``(II) Exclusion from payments.--
The provisions of subsections (c)(1) 
and (f) of section 1128 shall apply to 
an exclusion from receiving payments 
under this subparagraph in the same 
manner as such provisions apply to 
exclusions from participation under 
such section.''.
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