,,ii  #aadth ,,congress  #b;d ,session  
,s4 #cebb  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,december #h1  
#bjaf,mr4 ,whitehouse introduced the    
following bill2 which was read twice and
 referred to the ,committee on ,finance 
,a ,,bill  ,to amend title ,,xviii of   
the ,social ,security ,act to modify the
 payment amount for direct graduate     
medical education costs for certain     
hospitals4  #a4 ,short title ,this ,act 
may be cited as the ,graduate ,medical  
,education ,equity ,act4  #b4 ,payment  
amount for direct graduate medical      
education costs for certain hospitals   
,section #ahhf7;h77#c7 of the ,social   
,security ,act 7#db ,u4,s4,c4           
#acieww7h77#c77 is amended-- 7#a7 in    
subparagraph 7,a71 by striking ,the     
payment and inserting ,subject to       
subparagraph 7,e71 the payment2 and     
7#b7 by adding at the end the following 
new subparagraph3  7,e7 ,payment amount 
for certain hospitals  7i7 ,in general  
,beginning on or after the date of      

enactment of this subparagraph1 the     
payment amount for a qualified hospital 
7as defined in clause 7ii77 for the     
hospital's cost reporting period        
beginning during the fiscal year that   
immediately follows the date on which   
the qualified hospital submits a letter 
of intent described in clause 7iv7 is   
equal to the product of--  7,i7 the     
aggregate approved amount 7as defined in
 subparagraph 7,b77 for that period1 and
  7,,ii7 the hospital's ,medicaid       
inpatient utilization rate 7as defined  
in section #aibc7;b77#b77 for that      
period4  7ii7 ,qualified hospital       
defined ,in this subparagraph1 the term 
qualified hospital means1 with respect  
to a hospital cost reporting period1 a  
hospital that-- 7,i7 is determined by   
the ,secretary to meet the requirements 
described in clause 7iii7 for the       
preceding hospital cost reporting       
period2 and  7,,ii7 submits to the      
,secretary a letter of intent described 
in clause 7iv7 as part of its annual    

cost report for such preceding period4  
7iii7 ,requirements described ,with     
respect to a qualified hospital1 the    
following requirements are described in 
this clause3 7,i7 ,the hospital has a   
participation agreement under this      
title4  7,,ii7 ,the hospital has an     
approved medical residency training     
program 7as defined in paragraph        
7#e77;,a774  7,,iii7 ,with respect to   
the hospital cost reporting period      
involved1 the aggregate ,medicare       
fee-for-service and managed care        
inpatient load of the hospital does not 
exceed #aj percent of the total         
inpatient days of the hospital4  7,,iv7 
,with respect to such period1 the       
hospital does not receive payments for  
graduate medical education under either 
of the following3  7aa7 ,a ,state plan  
under title ,,xix4  7bb7 ,the           
,children's ,hospitals ,graduate        
,medical ,education ,payment ,program   
under section #cdj;,e of the ,public    
,health ,service ,act4  7iv7 ,letter of 

intent described ,not later than #f     
months after the date of enactment of   
this subparagraph1 the ,secretary shall 
make available a model letter of intent 
on the ,internet website of the ,centers
 for ,medicare  ,medicaid ,services4    
,such letter shall require the following
 information with respect to a hospital 
for the hospital cost reporting period  
involved3  7,i7 ,a statement of intent  
for the hospital to be a qualified      
hospital under this subparagraph4       
7,,ii7 ,an attestation that the hospital
 does not receive payments for graduate 
medical education under a ,state plan   
under title ,,xix4  7v7 ,failure to meet
 requirements ,if a hospital does not   
meet one or more of the requirements    
described in clause 7iii71 the          
,secretary shall notify the hospital in 
writing not later than #fj days         
following the receipt of the hospital's 
letter of intent4  7vi7 ,ensuring no    
duplicate payments ,with respect to a   
qualified hospital1 the payment amount  

under this subparagraph for a hospital  
cost reporting period shall be in lieu  
of any other payment amount that would  
otherwise be applicable for direct      
graduate medical education costs for    
such period under this subsection4  4