,i  #aad? ,,congress  #a/ ,session  ,h4 
,r4 #cbib  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,july #bi1 #bjae ,mr4 
,brady ( ,texas introduc$ ! foll[+ bill2
 :i* 0 ref]r$ to ! ,committee on ,ways &
 ,means  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
revise ,m$ic>e paym5t = indirect m$ical 
education 7,,ime7 co/s 9 tea*+          
hospitals4  #a4 ,%ort title ,?is ,act   
may be cit$ z ! ,m$ic>e ,,ime ,pool ,act
 ( #bjae4  #b4 ,revision ( ,m$ic>e      
paym5ts = indirect m$ical education     
7,,ime7 co/s 9 tea*+ hospitals  7a7 ,9  
g5]al ,section #ahhf ( ! ,social        
,security ,act 7#db ,u4,s4,c4 #acieww7  
is am5d$--  7#a7 9 subsection           
7d77#e77;,b7-- 7,a7 9 ! clause 7x7 add$ 
by section #eeje7;b7 ( ! ,pati5t        
,protection & ,af=dable ,c>e ,act--  7i7
 by mov+ ! ind5tation ( ea* provision 9 
su* clause #f ems to ! left2 &  7ii7 by 
r$esignat+ su* clause z clause 7xi72 &  
7,b7 by add+ at ! end ! foll[+ new      
clause3  7xii7 ,) respect to dis*>ges   

occurr+ 9 co/ report+ p]iods end+ dur+  
or aft] fiscal ye> #bjai1 in/ead ( !    
additional paym5t t w\ld h be5 paid "u  
?is subp>agraph to a subsection 7d7     
hospital or a subsection 7d7 ,pu]to     
,rico hospital ) indirect co/s ( m$ical 
education & not)/&+ ! previ\s provisions
 ( ?is subp>agraph1 !re %all be paid to 
! hospital ! paym5t det]m9$ "u          
subsection 7t7 = su* hospital & co/     
report+ p]iod4  2 &  7#b7 by add+ at !  
end ! foll[+ new subsection3  7t7       
,paym5t = indirect m$ical education     
7#a7 ,9 g5]al  7,a7 ,am\nt ( paym5t ,=  
purposes ( subsection 7d77#e77;,b77xii71
 ! paym5t "u ?is subsection = a         
subsection 7d7 hospital 7or a subsection
 7d7 ,pu]to ,rico hospital7 = a co/     
report+ p]iod end+ dur+ or aft] fiscal  
ye> #bjai is ! paym5t ( an am\nt equal  
to ! product (--  7i7 ! ,,ime pool am\nt
 comput$ "u p>agraph 7#b7 = ! fiscal    
ye>2 &  7ii7 ! allotm5t factor "u       
p>agraph 7#c7 = su* co/ report+ p]iod & 
fiscal ye>4  7,b7 ,=m ( paym5t ,paym5ts 

( am\nts "u ?is subsection %all be made 
f ! ,f$]al ,hospital ,insurance ,tru/   
,fund ) respect to a co/ report+ p]iod 9
 accordance ) su* tim+ z ! ,secret>y    
det]m9es is simil> to ! tim+ (          
additional paym5ts t are made "u        
subsection 7h74  7#b7 ,,ime pool am\nt  
7,a7 ,9 g5]al ,! ,,ime pool am\nt "u ?is
 p>agraph-- 7i7 = fiscal ye> #bjai is   
equal to ! base am\nt comput$ "u        
subp>agraph 7,b72 &  7ii7 = a subsequ5t 
fiscal ye> is equal to ! sum (-- 7,i7 ! 
,,ime pool am\nt "u ?is p>agraph = !    
previ\s fiscal ye> increas$ by ! m>ket  
basket p]c5tage increase 7z def9$ 9     
subsection 7b77#c77;,b77iii77 applicable
 to dis*>ges occurr+ 9 su* subsequ5t    
fiscal ye>2 &  7,,ii7 ! new tea*+       
program am\nt comput$ "u subp>agraph    
7,c7 = ! fiscal ye>4  7,b7 ,base am\nt  
,! base am\nt comput$ "u ?is subp>agraph
 is #i1ejj1jjj1jjj1 increas$ by ! sum1 =
 ea* ( fiscal ye>s #bjae ?r\gh #bjai1 ( 
! product (--  7i7 ! weight$ av]age     
numb] ( full-"t-equival5t resid5t       

positions 9 approv$ m$ical resid5cy     
tra9+ programs 7z det]m9$ "u subsection 
7h77#d77 = :i* paym5t is fir/ made "u   
subsection 7h7 9 ! fiscal ye>2 &  7ii7 !
 ,secret>y's e/imate ( ! national av]age
 exp5ditures p] resid5t position t are  
attributable to additional paym5ts "u   
subsection 7d77#e77;,b7 = dis*>ges 9 su*
 fiscal ye>4  7,c7 ,adju/m5t = new tea*+
 programs ,! new tea*+ program am\nt    
comput$ "u ?is subp>agraph = a fiscal   
ye> is equal to ! product (--  7i7 !    
weight$ av]age numb] ( full-"t-equival5t
 resid5t positions 9 approv$ m$ical     
resid5cy tra9+ programs 7z det]m9$ "u   
subsection 7h77#d77 = :i* paym5t is fir/
 made "u subsection 7h7 9 ! fiscal ye>2 
&  7ii7 ! ,,ime pool am\nt "u ?is       
p>agraph = ! fiscal ye> 7det]m9$ )\t    
reg>d to ?is subp>agraph71 divid$ by !  
av]age numb] ( all full-"t-equival5t    
resid5t positions 9 approv$ m$ical      
resid5cy tra9+ programs 7z det]m9$ "u   
subsection 7h77#d77 = :i* paym5t is made
 "u subsection 7h7 9 ! fiscal ye> 7z    

e/imat$ by ! ,secret>y74  7#c7 ,allotm5t
 bas$ on ,,fte resid5t c\nt ,! allotm5t 
factor "u ?is p>agraph = a hospital     
eligible to receive paym5t "u ?is       
subsection ) respect to a co/ report+   
p]iod end+ 9 a fiscal ye> is equal to ! 
ratio 7z e/imat$ by ! ,secret>y7 (--    
7,a7 ! weight$ av]age numb] (           
full-"t-equival5t resid5ts = ! hospital 
= ! co/ report+ p]iod 7z det]m9$ "u     
subsection 7h77#d772 to  7,b7 ! total ( 
! weight$ av]age numb]s (               
full-"t-equival5t resid5ts1 z det]m9$ "u
 subp>agraph 7,a71 = all su* hospitals =
 co/ report+ p]iods end+ 9 su* fiscal   
ye>4  ,! ,secret>y %all make su*        
adju/m5ts 9 su* allotm5t factor =       
subsequ5t co/ report+ p]iods z !        
,secret>y det]m9es necess>y to acc\nt = 
errors 9 ! ,secret>y's e/imation ( su*  
allotm5t factor "u ?is p>agraph =       
previ\s co/ report+ p]iods4  4