,,ii  #aad? ,,congress  #b;d ,session   
,s4 #cebb  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,decemb] #h1 #bjaf,mr4 
,:iteh\se introduc$ ! foll[+ bill2 :i* 0
 read twice & ref]r$ to ! ,committee on 
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
modify ! paym5t am\nt = direct graduate 
m$ical education co/s = c]ta9 hospitals4
  #a4 ,%ort title ,?is ,act may be cit$ 
z ! ,graduate ,m$ical ,education ,equity
 ,act4  #b4 ,paym5t am\nt = direct      
graduate m$ical education co/s = c]ta9  
hospitals ,section #ahhf7;h77#c7 ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acieww7h77#c77 is am5d$-- 7#a7 9       
subp>agraph 7,a71 by /rik+ ,! paym5t &  
ins]t+ ,subject to subp>agraph 7,e71 !  
paym5t2 &  7#b7 by add+ at ! end !      
foll[+ new subp>agraph3  7,e7 ,paym5t   
am\nt = c]ta9 hospitals  7i7 ,9 g5]al   
,beg9n+ on or aft] ! date ( enactm5t (  
?is subp>agraph1 ! paym5t am\nt = a     
qualifi$ hospital 7z def9$ 9 clause     
7ii77 = ! hospital's co/ report+ p]iod  

beg9n+ dur+ ! fiscal ye> t imm$iately   
foll[s ! date on :i* ! qualifi$ hospital
 submits a lett] ( int5t describ$ 9     
clause 7iv7 is equal to ! product (--   
7,i7 ! aggregate approv$ am\nt 7z def9$ 
9 subp>agraph 7,b77 = t p]iod1 &  7,,ii7
 ! hospital's ,m$icaid inpati5t         
utilization rate 7z def9$ 9 section     
#aibc7;b77#b77 = t p]iod4  7ii7         
,qualifi$ hospital def9$ ,9 ?is         
subp>agraph1 ! t]m qualifi$ hospital    
means1 ) respect to a hospital co/      
report+ p]iod1 a hospital t-- 7,i7 is   
det]m9$ by ! ,secret>y to meet !        
requirem5ts describ$ 9 clause 7iii7 = ! 
prec$+ hospital co/ report+ p]iod2 &    
7,,ii7 submits to ! ,secret>y a lett] ( 
int5t describ$ 9 clause 7iv7 z "p ( its 
annual co/ report = su* prec$+ p]iod4   
7iii7 ,requirem5ts describ$ ,) respect  
to a qualifi$ hospital1 ! foll[+        
requirem5ts are describ$ 9 ?is clause3  
7,i7 ,! hospital has a p>ticipation     
agreem5t "u ?is title4  7,,ii7 ,!       
hospital has an approv$ m$ical resid5cy 

tra9+ program 7z def9$ 9 p>agraph       
7#e77;,a774  7,,iii7 ,) respect to !    
hospital co/ report+ p]iod involv$1 !   
aggregate ,m$ic>e fee-=-s]vice & manag$ 
c>e inpati5t load ( ! hospital does n   
exce$ #aj p]c5t ( ! total inpati5t days 
( ! hospital4  7,,iv7 ,) respect to su* 
p]iod1 ! hospital does n receive paym5ts
 = graduate m$ical education "u ei!r ( !
 foll[+3  7aa7 ,a ,/ate plan "u title   
,,xix4  7bb7 ,! ,*ildr5's ,hospitals    
,graduate ,m$ical ,education ,paym5t    
,program "u section #cdj;,e ( ! ,public 
,heal? ,s]vice ,act4  7iv7 ,lett] (     
int5t describ$ ,n lat] ?an #f mon?s aft]
 ! date ( enactm5t ( ?is subp>agraph1 ! 
,secret>y %all make available a model   
lett] ( int5t on ! ,int]net website ( ! 
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices4    
,su* lett] %all require ! foll[+        
in=mation ) respect to a hospital = !   
hospital co/ report+ p]iod involv$3     
7,i7 ,a /atem5t ( int5t = ! hospital to 
be a qualifi$ hospital "u ?is           
subp>agraph4  7,,ii7 ,an atte/ation t ! 

hospital does n receive paym5ts =       
graduate m$ical education "u a ,/ate    
plan "u title ,,xix4  7v7 ,failure to   
meet requirem5ts ,if a hospital does n  
meet "o or m ( ! requirem5ts describ$ 9 
clause 7iii71 ! ,secret>y %all notify ! 
hospital 9 writ+ n lat] ?an #fj days    
foll[+ ! receipt ( ! hospital's lett] ( 
int5t4  7vi7 ,ensur+ no duplicate       
paym5ts ,) respect to a qualifi$        
hospital1 ! paym5t am\nt "u ?is         
subp>agraph = a hospital co/ report+    
p]iod %all be 9 lieu ( any o!r paym5t   
am\nt t w\ld o!rwise be applicable =    
direct graduate m$ical education co/s = 
su* p]iod "u ?is subsection4  4