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Statutory Text

SEC. 5504. COUNTING RESIDENT TIME IN NONPROVIDER SETTINGS.
(a) GME.—Section 1886(h)(4)(E) of the Social Security Act (42
U.S.C. 1395ww(h)(4)(E)) is amended—
(1) by striking ‘‘shall be counted and that all the time’’ and
inserting ‘‘shall be counted and that—
‘‘(i) effective for cost reporting periods beginning
before July 1, 2010, all the time;’’
(2) in clause (i), as inserted by paragraph (1), by striking
the period at the end and inserting ‘‘; and’’;
(3) by inserting after clause (i), as so inserted, the following
new clause:
‘‘(ii) effective for cost reporting periods beginning
on or after July 1, 2010, all the time so spent by a
resident shall be counted towards the determination of
full-time equivalency, without regard to the setting in
which the activities are performed, if a hospital incurs
the costs of the stipends and fringe benefits of the
resident during the time the resident spends in that
setting. If more than one hospital incurs these costs,
either directly or through a third party, such hospitals
shall count a proportional share of the time, as determined
by written agreement between the hospitals,
that a resident spends training in that setting.’’; and
(4) by adding at the end the following flush sentence:
‘‘Any hospital claiming under this subparagraph for time
spent in a nonprovider setting shall maintain and make
available to the Secretary records regarding the amount of
such time and such amount in comparison with amounts
of such time in such base year as the Secretary shall specify.’’.
(b) IME.—Section 1886(d)(5)(B)(iv) of the Social Security Act
(42 U.S.C. 1395ww(d)(5)) is amended—
(1) by striking ‘‘(iv) Effective for discharges occurring on or
after October 1, 1997’’ and inserting ‘‘(iv)(I) Effective for discharges
occurring on or after October 1, 1997, and before July
1, 2010’’; and
(2) by inserting after clause (I), as inserted by paragraph
(1), the following new subparagraph:
‘‘(II) Effective for discharges occurring on or after July 1,
2010, all the time spent by an intern or resident in patient
care activities in a nonprovider setting shall be counted towards
the determination of full-time equivalency if a hospital
incurs the costs of the stipends and fringe benefits of the intern
or resident during the time the intern or resident spends
in that setting. If more than one hospital incurs these costs, either
directly or through a third party, such hospitals shall
count a proportional share of the time, as determined by written
agreement between the hospitals, that a resident spends
training in that setting.’’
(c) APPLICATION.—The amendments made by this section shall
not be applied in a manner that requires reopening of any settled
hospital cost reports as to which there is not a jurisdictionally
proper appeal pending as of the date of the enactment of this Act
on the issue of payment for indirect costs of medical education
under section 1886(d)(5)(B) of the Social Security Act (42 U.S.C.
1395ww(d)(5)(B)) or for direct graduate medical education costs
under section 1886(h) of such Act (42 U.S.C. 1395ww(h)).