124 STAT. 658 PUBLIC LAW 111–148—MAR. 23, 2010 ‘‘(I) 70 percent of such positions for distribu- tion to hospitals described in clause (i) of subpara- graph (D). ‘‘(II) 30 percent of such positions for distribu- tion to hospitals described in clause (ii) and (iii) of such subparagraph. ‘‘(ii) EXCEPTION IF POSITIONS NOT REDISTRIBUTED BY JULY 1, 2011.—In the case where the Secretary does not distribute positions to hospitals in accordance with clause (i) by July 1, 2011, the Secretary shall distribute such positions to other hospitals in accordance with the considerations described in subparagraph (C) and the priority described in subparagraph (D). ‘‘(F) LIMITATION.—A hospital may not receive more than 75 full-time equivalent additional residency positions under this paragraph. ‘‘(G) APPLICATION OF PER RESIDENT AMOUNTS FOR PRI- MARY CARE AND NONPRIMARY CARE.—With respect to addi- tional residency positions in a hospital attributable to the increase provided under this paragraph, the approved FTE per resident amounts are deemed to be equal to the hospital per resident amounts for primary care and nonprimary care computed under paragraph (2)(D) for that hospital. ‘‘(H) DEFINITIONS.—In this paragraph: ‘‘(i) REFERENCE RESIDENT LEVEL.—The term ‘ref- erence resident level’ means, with respect to a hospital, the highest resident level for any of the 3 most recent cost reporting periods (ending before the date of the enactment of this paragraph) of the hospital for which a cost report has been settled (or, if not, submitted (subject to audit)), as determined by the Secretary. ‘‘(ii) RESIDENT LEVEL.—The term ‘resident level’ has the meaning given such term in paragraph (7)(C)(i). ‘‘(iii) OTHERWISE APPLICABLE RESIDENT LIMIT.—The term ‘otherwise applicable resident limit’ means, with respect to a hospital, the limit otherwise applicable under subparagraphs (F)(i) and (H) of paragraph (4) on the resident level for the hospital determined with- out regard to this paragraph but taking into account paragraph (7)(A).’’. (b) IME.— (1) IN GENERAL.—Section 1886(d)(5)(B)(v) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)(v)), in the second sen- tence, is amended— (A) by striking ‘‘subsection (h)(7)’’ and inserting ‘‘sub- sections (h)(7) and (h)(8)’’; and (B) by striking ‘‘it applies’’ and inserting ‘‘they apply’’. (2) CONFORMING AMENDMENT.—Section 1886(d)(5)(B) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) is amended by adding at the end the following clause: ‘‘(x) For discharges occurring on or after July 1, 2011, insofar as an additional payment amount under this subpara- graph is attributable to resident positions distributed to a hos- pital under subsection (h)(8)(B), the indirect teaching adjust- ment factor shall be computed in the same manner as provided under clause (ii) with respect to such resident positions.’’. Effective date. Deadline.
