,i  #aaf? ,,congress  #a/ ,session  ,h4 
,r4 #edcb  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,decemb] #ac1         
#bjai,ms4 ,muc>sel-,p[ell 7= h]self &   
,ms4 ,port]7 introduc$ ! foll[+ bill2   
:i* 0 ref]r$ to ! ,committee on ,ways & 
,means1 & 9 addition to ! ,committee on 
,en]gy & ,comm]ce1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
c\nt t[>d ! det]m9ation ( full "t       
equival5cy = graduate m$ical education  
"u ! ,m$ic>e program "t sp5t 9 an       
approv$ m$ical resid5cy tra9+ program = 
tra9+ 9 culturally & l+ui/ically        
appropriate c>e4  #a4 ,%ort title ,?is  
,act may be cit$ z ! ,m$ical ,education 
= a ,div]se ,am]ica ,act4  #b4 ,tra9+   
tomorr['s doctors = culturally &        
l+ui/ically appropriate c>e3 graduate   
m$ical education  7a7 ,direct ,,gme     
,section #ahhf7;h77#d7 ( ! ,social      

,security ,act 7#db ,u4,s4,c4 #bb       
#acieww7h77#d77 is am5d$ by add+ at !   
end ! foll[+ new subp>agraph 3  7,l7    
,treatm5t ( cultural compet5cy tra9+ ,9 
det]m9+ a hospital's numb] ( full-"t    
equival5t resid5ts = purposes ( ?is     
subsection1 all ! "t t is sp5t by an    
int]n or resid5t 9 an approv$ m$ical    
resid5cy tra9+ program = education &    
tra9+ 9 cultural compet5cy & l+ui/ically
 appropriate s]vice deliv]y %all be     
c\nt$ t[>d ! det]m9ation ( full "t      
equival5cy4  4  7b7 ,indirect m$ical    
education ,section #ahhf7;d77#e77;,b7 ( 
! ,social ,security ,act 7#db ,u4,s4,c4 
#acieww7d77#e77;,b77 is am5d$-- 7#a7 by 
r$esignat+ ! clause 7x7 add$ by section 
#eeje7;b7 ( ! ,pati5t ,protection &     
,af=dable ,c>e ,act z clause 7xi72 &    
7#b7 by add+ at ! end ! foll[+ new      
clause3  7xii7 ,! provisions (          
subp>agraph 7,l7 ( subsection 7h77#d7   
%all apply "u ?is subp>agraph 9 ! same  
mann] z !y apply "u su* subsection4  4  
7c7 ,effective date ,! am5dm5ts made by 

subsections 7a7 & 7b7 %all apply )      
respect to paym5ts made to hospitals on 
or aft] ! date t is "o ye> aft] ! date (
 ! enactm5t ( ?is ,act4