,,ii  #aah? ,,congress  #a/ ,session    
,s4 #ahfi  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,june #g1 #bjbc,mr4    
,braun 7= himself1 ,ms4 ,hassan1 & ,mr4 
,k5n$y7 introduc$ ! foll[+ bill2 :i* 0  
read twice & ref]r$ to ! ,committee on  
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act &    
title ,,xxvii ( ! ,public ,heal? ,s]vice
 ,act to ensure fair bill+ practice =   
items & s]vices furni%$ by (f-campus    
hospital locations1 to am5d su* title   
,,xviii to provide = paym5ts = graduate 
nurs+ education co/s1 & = o!r purposes4 
#a4 ,%ort title ,?is ,act may be cit$ z 
! ,site-bas$ ,invoic+ & ,transp>5cy     
,enhancem5t ,act or ! ,,site ,act4  #b4 
,ensur+ fair bill+ practice = items &   
s]vices furni%$ by (f-campus hospital   
locations  7a7 ,promot+ ,m$ic>e         
site-,neutral paym5ts ,section          
#ahcc7t77#ba7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciel7t77#ba77 is      
am5d$-- 7#a7 by r$esignat+ subp>agraph  
7,e7 z subp>agraph 7,g72 &  7#b7 by     

ins]t+ aft] subp>agraph 7,d7 ! foll[+   
new subp>agraphs3  7,e7 ,sunset ( c]ta9 
exceptions ,! provisions ( clauses 7ii7 
& 7iv7 ( subp>agraph 7,b7 %all n apply )
 respect to applicable items & s]vices  
furni%$ on or aft] ,janu>y #a1 #bjbe4   
7,f7 ,special paym5t rule =             
non-applicable items & s]vices furni%$  
at c]ta9 (f-campus d$icat$ em]g5cy      
dep>tm5ts  7i7 ,9 g5]al ,9 ! case (     
cov]$ ,,opd s]vices furni%$ by an       
applicable d$icat$ em]g5cy dep>tm5t dur+
 #bjbe or a subsequ5t ye>1 ! paym5t     
am\nt = su* s]vice t w\ld o!rwise be    
det]m9$ "u ?is subsection 7)\t reg>d to 
! application ( ?is subp>agraph7 = su*  
ye> %all be r$uc$ by #cj p]c5t4  7ii7   
,applicable d$icat$ em]g5cy dep>tm5t ,9 
clause 7i71 ! t]m applicable d$icat$    
em]g5cy dep>tm5t means a d$icat$ em]g5cy
 dep>tm5t 7z def9$ 9 section #dhi4bd7;b7
 ( title #db ( ! ,code ( ,f$]al         
,regulations7 t-- 7,i7 is an (f-campus  
outpati5t dep>tm5t ( a provid] 7z def9$ 
9 subp>agraph 7,b772 &  7,,ii7 is locat$

 #f or few] miles f ano!r hospital1     
critical access hospital1 or rural      
em]g5cy hospital1 includ+ ! p>5t        
hospital ( su* em]g5cy dep>tm5t4  4  7b7
 ,ensur+ sep>ate ,n,p,is = (f-,campus   
outpati5t dep>tm5ts ( a provid]  7#a7 ,9
 g5]al ,section #aagc7;b7 ( ! ,social   
,security ,act 7#db ,u4,s4,c4           
#acbj;d-#b7;b77 is am5d$ by add+ at !   
end ! foll[+ new p>agraph3  7#c7 ,ensur+
 sep>ate ,n,p,is = (f-campus outpati5t  
dep>tm5ts ( a provid] ,! /&>ds specifi$ 
"u p>agraph 7#a7 %all ensure t1 n lat]  
?an ,janu>y #a1 #bjbe1 ea* (f-campus    
outpati5t dep>tm5t ( a provid] 7z def9$ 
9 section #ahcc7t77#ba77;,b77 is assign$
 a sep>ate unique heal? id5tifi] f su*  
provid]4  4  7#b7 ,treatm5t ( c]ta9     
dep>tm5ts z subp>ts ( a hospital ,n lat]
 ?an ,janu>y #a1 #bjbe1 ! ,secret>y (   
,heal? & ,human ,s]vices %all revise    
sections #afb4djh & #afb4daj ( title    
#de1 ,code ( ,f$]al ,regulations1 to    
ensure t ea* (f-campus outpati5t        
dep>tm5t ( a provid] 7z def9$ 9 section 

#ahcc7t77#ba77;,b7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#aciel7t77#ba77;,b777 is treat$ z a     
subp>t 7z describ$ 9 su* sections7 ( su*
 provid] & assign$ a unique heal?       
id5tifi] pursuant to section            
#aagc7;b77#c7 ( su* ,act 7z add$ by     
p>agraph 7#a774  7c7 ,bill+ requirem5ts 
= (f-,campus outpati5t dep>tm5ts ( a    
provid]  7#a7 ,m$ic>e ,section          
#ahff7;a77#a7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acie;cc7a77#a77 is     
am5d$-- 7,a7 9 subp>agraph 7,x71 by     
/rik+ & at ! end2  7,b7 9 subp>agraph   
7,y77ii77,v71 by /rik+ ! p]iod & ins]t+ 
1 &2 &  7,c7 by ins]t+ aft] subp>agraph 
7,y7 ! foll[+ new subp>agraph3  7,z7 9 !
 case ( a hospital ) an (f-campus       
outpati5t dep>tm5t ( a provid] 7z def9$ 
9 section #ahcc7t77#ba77;,b771 ) respect
 to items & s]vices furni%$ at su*      
dep>tm5t ( a provid] on or aft] ,janu>y 
#a1 #bjbe1 to include 9 any claim =m    
submitt$ "u ?is title 7includ+ "u "p ,c 
( ?is title7 = su* items & s]vices !    

unique heal? id5tifi] e/abli%$ = su*    
dep>tm5t ( a provid] pursuant to section
 #aagc7;b77#c74  4  7#b7 ,o!r provid]s  
,"p ,e ( title ,,xxvii ( ! ,public      
,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#cjj;gg-#aca et seq47 is am5d$ by add+  
at ! end ! foll[+ new section3          
#bgii;,b-#aj4 ,bill+ requirem5ts =      
(f-campus dep>tm5ts ( a provid] or      
facility ,a heal? c>e provid] or        
facility may n1 ) respect to items &    
s]vices furni%$ to an individual at an  
(f-campus outpati5t dep>tm5t ( a provid]
 7z def9$ 9 section #ahcc7t77#ba77;,b7 (
 ! ,social ,security ,act7 on or aft]   
,janu>y #a1 #bjbe1 submit a claim = su* 
items & s]vices to a gr\p heal? plan or 
heal? insurance issu]1 & may n bill su* 
an individual or hold su* individual    
liable = su* items & s]vices1 unless su*
 items & s]vices are bill$-- 7#a7 us+ ! 
sep>ate unique heal? id5tifi] e/abli%$ =
 su* dep>tm5t pursuant to section       
#aagc7;b77#c7 ( su* ,act2 &  7#b7 on a  
,,hipaa ,x#ab #hcg,p transaction =m or  

,,cms #aejj =m 7or a successor          
transaction or =m74  4  7#c7 ,effective 
date ,! am5dm5t made by p>agraph 7#a7   
%all apply ) respect to claims submitt$ 
= items & s]vices furni%$ on or aft]    
,janu>y #a1 #bjbe4  #c4 ,paym5ts =      
graduate nurs+ education co/s  7a7 ,9   
g5]al ,title ,,xviii ( ! ,social        
,security ,act 7#db ,u4,s4,c4 #acie et  
seq47 is am5d$ by add+ at ! end ! foll[+
 new section3  #ahii;,c4 ,paym5ts =     
graduate nurs+ education co/s  7a7 ,9   
g5]al ,! ,secret>y %all provide =       
paym5ts = qualifi$ tra9+ co/s 9         
accordance ) ?is section4 ,su* paym5ts  
%all be made f ! ,f$]al ,supplem5t>y    
,m$ical ,insurance ,tru/ ,fund "u       
section #ahda4  7b7 ,e/abli%m5t ( ,hub  
/ructure  7#a7 ,application ,an eligible
 hospital seek+ to op]ate z a ,graduate 
,nurs+ ,education ,hub 79 ?is section   
ref]r$ to z a ,hub7 %all submit an      
application to ! ,secret>y at su* "t1 9 
su* mann]1 & conta9+ su* in=mation z !  
,secret>y may specify4  7#b7 ,selection 

( eligible hospitals to op]ate z ,hub   
7,a7 ,e/abli%m5t ( regions ,! ,secret>y 
%all e/abli% regions = ,hubs bas$ on    
hospital ref]ral regions4  7,b7         
,selection ( eligible hospitals ,= ea*  
hospital ref]ral region1 ! ,secret>y    
%all select n m ?an "o eligible hospital
 to op]ate z a ,hub4  7,c7 ,limitation  
,an eligible hospital may n be select$  
to op]ate1 or p>ticipate z an eligible  
p>tn] (1 m ?an "o ,hub "u ?is section4  
7,d7 ,adjac5t regions ,an eligible      
hospital may be select$ to op]ate z a   
,hub = "o or m adjac5t hospital ref]ral 
regions if no o!r qualify+ eligible     
hospital submits an application = su*   
regions1 9 :i* case ! eligible hospital 
%all op]ate z a s+le ,hub = su* regions4
  7,e7 ,multiple applications ,if m ?an 
"o eligible hospital submits an         
application to op]ate z a ,hub = a      
hospital ref]ral region1 ! ,secret>y    
%all consid] ea* application submitt$1  
giv+ special consid]ation to ! foll[+3  
7i7 ,! application ( ! eligible hospital

 t includes ! greate/ numb] ( applicable
 s*ools ( nurs+ t h an advanc$ practice 
regi/]$ nurse education program 9 !     
region 7or 9 an adjac5t region if an    
eligible hospital has n be5 select$ to  
op]ate z a ,hub = su* region & !        
eligible hospital is submitt+ an        
application to op]ate z a s+le ,hub =   
bo? regions74  7ii7 ,! application ( !  
eligible hospital t includes ! greate/  
numb] ( advanc$ practice regi/]$ nurses 
t h graduat$ f p>ticipat+ applicable    
s*ools ( nurs+ ov] ! prec$+ #c ye>s4    
7c7 ,hub requirem5ts  7#a7 ,contracts   
,ea* ,hub select$ pursuant to subsection
 7b77#b7 mu/ ent] into a writt5 agreem5t
 ) ea* eligible p>tn] ( ! ,hub t meets  
cont5ts & t]ms1 z det]m9$ by !          
,secret>y1 & sets out1 at a m9imum1 !   
foll[+3 7,a7 ,p>tn] ,obligations ,!     
obligations ( ! eligible p>tn] ) respect
 to ! provision ( qualifi$ tra9+4  7,b7 
,reimbursem5t ,! obligation ( ! ,hub to 
reimburse ! eligible p>tn] 79 a timely  
mann] z ! ,secret>y may specify7 = !    

co/s ( qualifi$ tra9+ = :i* paym5t is   
made "u ?is section t are attributable  
to su* p>tn]4  7,c7 ,gov]nance ,/ructure
 ,a gov]nance /ructure t includes ! ,hub
 & "o or m applicable s*ools ( nurs+ 9 !
 lead]%ip & an ov]sight process t is    
develop$ & approv$ by ! ,hub1 p>ticipat+
 applicable s*ools ( nurs+1 & o!r ,hub  
p>tn]s1 9 accordance ) requirem5ts      
e/abli%$ by ! ,secret>y4  7,d7          
,coord9ation ,! ma9t5ance ( an adequate 
sy/em = coord9ation ( cl9ical education 
sites & preceptors4 ,! ,secret>y may    
specify /&>ds = su* sy/em4  7,e7        
,preceptor tra9+ ,a sy/em = ! ,hub to   
provide at lea/ #d h\rs ( preceptor     
tra9+ to ea* preceptor ea* ye>4  7,f7   
,public heal? ne$s ,a process = tak+    
into consid]ation local1 ,/ate1 &       
regional work=ce ne$s to ensure public  
heal?4  7d7 ,paym5ts  7#a7 ,am\nt (     
paym5t ,! am\nt ( paym5t to a ,hub "u   
?is section = qualifi$ tra9+ co/s dur+ a
 ye> %all be equal to ! product (-- 7,a7
 ! annual p] /ud5t paym5t am\nt det]m9$ 

"u p>agraph 7#b7 = ! ,hub = ! ye>2 &    
7,b7 ! total numb] ( positions di/ribut$
 to ! ,hub "u subsection 7f71 z det]m9$ 
by ! ,secret>y4  7#b7 ,det]m9ation (    
,hub-specific annual p] /ud5t paym5t    
am\nt ,! ,secret>y %all det]m9e1 = ea*  
,hub1 an annual p] /ud5t paym5t am\nt = 
ea* ye> 7beg9n+ ) #bjbf74 ,su* am\nt    
%all be equal to ! unadju/$ p] /ud5t    
am\nt det]m9$ "u p>agraph 7#c71 z adju/$
 = geographic v>iation 9 wages 9 a      
budget neutral mann]1 z det]m9$         
appropriate by ! ,secret>y4  7#c7       
,unadju/$ p] /ud5t am\nt ,! unadju/$ p] 
/ud5t am\nt det]m9$ "u ?is p>agraph = a 
ye> is equal to ! product (-- 7,a7 #gej 
h\rs2 &  7,b7 ! m$ian h\rly wage = a    
nurse practition] 9 ! ,unit$ ,/ates1    
accord+ to ! ,occupational ,employm5t & 
,wage ,/ati/ics ( ! ,bureau ( ,labor    
,/ati/ics = ! mo/ rec5t ye> = :i* su*   
data is available 7or an appropriate    
successor measure71 increas$ or decreas$
 by ! p]c5tage *ange 9 ! consum] price  
index = all urban consum]s 7all items2  

,unit$ ,/ates city av]age7 f ,june ( !  
mo/ rec5t ye> = :i* su* data is         
available to ! ,june prec$+ ! ye>       
involv$4  7#d7 ,p]missible uses ( paym5t
 ,a ,hub may use paym5ts provid$ "u ?is 
section only = paym5t ( ! co/s (        
qualifi$ tra9+4  7e7 ,numb] ( tra9+     
positions available ,! maximum numb] (  
positions = :i* paym5t made be made "u  
?is section = a ye> %all be equal to--  
7#a7 = ea* ( #bjbf & #bjbg1 #aj1jjj     
advanc$ practice regi/]$ nurse /ud5ts2  
7#b7 = ea* ( #bjbh & #bjbi1 #ae1jjj     
advanc$ practice regi/]$ nurse /ud5ts2  
7#c7 = ea* ( #bjcj & #bjca3 #bj1jjj     
advanc$ practice regi/]$ nurse /ud5ts2 &
  7#d7 = #bjcb & subsequ5t ye>s1 !      
great] (-- 7,a7 #bj1jjj advanc$ practice
 regi/]$ nurse /ud5ts2 or  7,b7 ! numb] 
( advanc$ practice regi/]$ nurse /ud5ts 
ne$$ to ensure ! ratio ( su* /ud5ts to !
 numb] ( b5efici>ies "u ! program "u ?is
 title1 ! ,m$icaid program "u title     
,,xix1 & ! ,,*ip program "u title ,,xxi 
dur+ ! ye> is ! same z su* ratio =      

#bjca4  7f7 ,di/ribution ( tra9+        
positions  7#a7 ,9 g5]al  7,a7          
,di/ribution ,! ,secret>y %all di/ribute
 ! applicable p]c5t 7z def9$ 9          
subp>agraph 7,b77 ( ! total numb] (     
positions available = di/ribution "u    
subsection 7e7 = a ye> z foll[s3 7i7    
,ea* ,hub %all receive a m9imum numb] ( 
positions1 z det]m9$ by ! ,secret>y4    
7ii7 ,any rema9+ positions available =  
di/ribution "u ?is subp>agraph %all be  
di/ribut$ to ,hubs bas$ on ! foll[+     
factors3 7,i7 ,! numb] ( advanc$        
practice regi/]$ nurses t h graduat$ f  
p>ticipat+ applicable s*ools ( nurs+ ov]
 ! prec$+ #c ye>s4  7,,ii7 ,! %>e ( !   
relevant hospital ref]ral region t is   
locat$ 9 an area designat$ z a heal?    
pr(essional %ortage area "u section     
#ccb7;a77#a77;,a7 ( ! ,public ,heal?    
,s]vice ,act1 z det]m9$ by ! ,secret>y4 
7,,iii7 ,! %>e ( ! relevant hospital    
ref]ral region t is locat$ 9 a fronti]  
,/ate 7z def9$ 9 section                
#ahhf7;d77#c77;,e77iii77,,ii774  7,,iv7 

,! %>e ( ! relevant hospital ref]ral    
region t is locat$ 9 a rural area 7z    
def9$ 9 section #ahhf7;d77#b77;,d774    
7,v7 ,o!r factors det]m9$ appropriate by
 ! ,secret>y4  7,b7 ,applicable p]c5t   
def9$ ,= purposes ( subp>agraph 7,a71 ! 
t]m applicable p]c5t means-- 7i7 = #bjbf
 & #bjbg1 #ajj p]c5t2  7ii7 = #bjbh &   
#bjbi1 #ie p]c5t2 &  7iii7 = #bjcj & ea*
 subsequ5t ye>1 #ij p]c5t4  7#b7 ,te/+  
new tra9+ models  7,a7 ,9 g5]al ,!      
,secret>y %all di/ribute ! applicable   
p]c5t 7z def9$ 9 subp>agraph 7,b77 ( !  
total numb] ( positions available =     
di/ribution "u ?is subsection = a ye> to
 te/ new models ( tra9+ advanc$ practice
 regi/]$ nurses & o!r heal? c>e work]s  
or acc\nt = diff]5t work=ce ne$s 7=     
example1 a %ortage ( c]tifi$            
nurse-midwives or community heal?       
work]s74  7,b7 ,applicable p]c5t def9$  
,= purposes ( subp>agraph 7,a71 ! t]m   
applicable p]c5t means-- 7i7 = #bjbf &  
#bjbg1 #j p]c5t2  7ii7 = #bjbh & #bjbi1 
#e p]c5t2 &  7iii7 = #bjcj & ea*        

subsequ5t ye>1 #aj p]c5t4  7#c7         
,r$i/ribution ,! ,secret>y %all develop 
a process = r$i/ribut+-- 7,a7 unus$     
positions2 &  7,b7 positions f t]m9at$  
or clos$ ,hubs4  7g7 ,miscellane\s  7#a7
 ,waiv] au?ority ,! ,secret>y may waive 
su* requirem5ts ( title ,,xi & ?is title
 z may be necess>y to c>ry out ?is      
section4  7#b7 ,adm9i/ration ,*apt] #ce 
( title #dd1 ,unit$ ,/ates ,code1 %all n
 apply to ! implem5tation ( ?is section4
  7#c7 ,judicial review ,!re %all be no 
adm9i/rative or judicial review "u      
section #ahfi1 #ahgh1 or o!rwise1 )     
respect to det]m9ations made "u         
subsection 7d7 or subsection 7f74  7#d7 
,no effect on o!r paym5ts = m$ical      
education co/s ,no?+ 9 ?is section %all 
affect paym5ts "u subsection            
7d77#e77;,b71 7h71 or 7l77#b77;,b7 (    
section #ahhf4  7#e7 ,implem5tation     
fund+ ,= purposes ( c>ry+ out ?is       
section1 !re are appropriat$1 out (     
am\nts 9 ! ,treasury n o!rwise          
appropriat$1 to ! ,c5t]s = ,m$ic>e      

,m$icaid ,s]vices ,program ,managem5t   
,acc\nt = fiscal ye> #bjbd1             
#ajj1jjj1jjj1 to rema9 available until  
exp5d$4  7#f7 ,supplem5t n supplant     
,paym5ts "u ?is section 9 any giv5 ye>  
%all supplem5t1 n supplant1 o!r ,f$]al  
funds t h be5 made available 9 ! ye> =  
advanc$ practice regi/]$ nurse cl9ical  
education or tra9+4  7h7 ,def9itions ,9 
?is section3 7#a7 ,advanc$ practice     
regi/]$ nurse ,! t]m advanc$ practice   
regi/]$ nurse includes ! foll[+3 7,a7 ,a
 cl9ical nurse speciali/ 7z def9$ 9     
subsection 7aa77#e7 ( section #ahfa74   
7,b7 ,a nurse practition] 7z def9$ 9 su*
 subsection74  7,c7 ,a c]tifi$ regi/]$  
nurse ane/heti/ 7z def9$ 9 subsection   
7bb77#b7 ( su* section74  7,d7 ,a       
c]tifi$ nurse-midwife 7z def9$ 9        
subsection 7gg77#b7 ( su* section74     
7#b7 ,ambulatory c>e sett+ ,! t]m       
ambulatory c>e sett+ includes a ,f$]ally
 qualifi$ heal? c5t] 7z def9$ 9 section 
#ahfa7;aa77#d771 a rural heal? cl9ic 7z 
def9$ 9 section #ahfa7;aa77#d771 a      

nurse-manag$ cl9ic1 an ambulatory       
practice1 a behavioral heal? cl9ic      
7includ+ a cl9ic c]tifi$ z a c]tifi$    
community behavioral heal? cl9ic        
pursuant to section #bbc ( ! ,protect+  
,access to ,m$ic>e ,act ( #bjad7 or o!r 
behavioral heal? sett+ 7z det]m9$       
appropriate by ! ,secret>y71 a physician
 or practition] (fice1 a s*ool1 a skill$
 nurs+ facility or nurs+ facility 7z    
def9$ 9 section #aiai7;a771 a hospice   
program1 a long-t]m c>e facility1 & any 
o!r sett+ specifi$ by ! ,secret>y4  7#c7
 ,applicable s*ool ( nurs+ ,! t]m       
applicable s*ool ( nurs+ means an       
accr$it$ s*ool ( nurs+ 7z def9$ 9       
section #hja ( ! ,public ,heal? ,s]vice 
,act74  7#d7 ,eligible hospital ,! t]m  
eligible hospital means a hospital or a 
critical access hospital t has a writt5 
agreem5t describ$ 9 subsection 7c77#a7 9
 place )-- 7,a7 at lea/ two applicable  
s*ools ( nurs+ 7or at lea/ "o applicable
 s*ool ( nurs+ if !re is only "o        
applicable s*ool ( nurs+ )9 ! hospital  

ref]ral region72 &  7,b7 at lea/ "o     
ambulatory c>e sett+ t is n own$ or     
op]at$ by a ,hub op]at$ by ! hospital or
 critical access hospital4  7#e7        
,eligible p>tn]  7,a7 ,9 g5]al ,! t]m   
eligible p>tn] means-- 7i7 an applicable
 s*ool ( nurs+ t has an advanc$ practice
 regi/]$ nurse education program2  7ii7 
an entity or practition] t is a         
p>ticipat+ provid] "u ?is title or a    
,/ate plan "u title ,,xix 7or a waiv] ( 
su* plan72 &  7iii7 any o!r entity      
det]m9$ appropriate by ! ,secret>y4     
7,b7 ,limitation ,an applicable s*ool ( 
nurs+1 entity1 or practition] describ$ 9
 subp>agraph 7,a7 may n p>ticipate z an 
eligible p>tn] ( m ?an "o ,hub "u ?is   
section4  7#f7 ,qualifi$ tra9+  7,a7 ,9 
g5]al ,! t]m qualifi$ tra9+ means       
tra9+-- 7i7 t provides an advanc$       
practice regi/]$ nurse ) ! cl9ical      
skills necess>y to provide prim>y c>e1  
behavioral heal? c>e1 ob/etric c>e1     
prev5tive c>e1 transitional c>e1 *ronic 
c>e managem5t1 & o!r s]vices appropriate

 = individuals entitl$ to1 or enroll$ =1
 b5efits "u "p ,a1 or enroll$ "u "p ,b2 
&  7ii7 subject to subp>agraph 7,b71 at 
lea/ a ?ird ( :i* is provid$ 9 an       
ambulatory c>e sett+ t is n own$ or     
op]at$ by a ,hub4  7,b7 ,waiv] (        
requirem5t = eligible hospitals locat$ 9
 rural or m$ically undes]v$ areas ,!    
,secret>y may waive ! requirem5t "u     
subp>agraph 7,a77ii71 or r$uce ! ?re%old
 o!rwise applicable "u su* subp>agraph1 
) respect to an eligible hospital t is  
locat$ 9 a rural or m$ically und]s]v$   
area4  4  7b7 ,exclusion ( paym5ts f    
calculation ( fee-=-,s]vice co/s "u     
,m$ic>e ,advantage ,section             
#ahec7;c77#a77;,d77i7 ( ! ,social       
,security ,act 7#db ,u4,s4,c4           
#aciew-#bc7;c77#a77;,d77i77 is am5d$ by 
/rik+ & #ahhf7n7 & #ahhf7;h7 & ins]t+   
#ahhf7n71 #ahhf7;h71 & #ahii;,c4