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Statutory Text

SEC. 5505. RULES FOR COUNTING RESIDENT TIME FOR DIDACTIC AND SCHOLARLY ACTIVITIES AND OTHER ACTIVITIES.
(a) GME.—Section 1886(h) of the Social Security Act (42 U.S.C.
1395ww(h)), as amended by section 5504, is amended—
(1) in paragraph (4)—
(A) in subparagraph (E), by striking ‘‘Such rules’’ and
inserting ‘‘Subject to subparagraphs (J) and (K), such
rules’’; and
(B) by adding at the end the following new subparagraphs:
‘‘(J) TREATMENT OF CERTAIN NONPROVIDER AND DIDACTIC
ACTIVITIES.—Such rules shall provide that all time
spent by an intern or resident in an approved medical residency
training program in a nonprovider setting that is
primarily engaged in furnishing patient care (as defined in
paragraph (5)(K)) in non-patient care activities, such as didactic
conferences and seminars, but not including re-
search not associated with the treatment or diagnosis of a
particular patient, as such time and activities are defined
by the Secretary, shall be counted toward the determination
of full-time equivalency.
‘‘(K) TREATMENT OF CERTAIN OTHER ACTIVITIES.—In
determining the hospital’s number of full-time equivalent
residents for purposes of this subsection, all the time that
is spent by an intern or resident in an approved medical
residency training program on vacation, sick leave, or
other approved leave, as such time is defined by the Secretary,
and that does not prolong the total time the resident
is participating in the approved program beyond the
normal duration of the program shall be counted toward
the determination of full-time equivalency.’’; and
(2) in paragraph (5), by adding at the end the following
new subparagraph:
‘‘(K) NONPROVIDER SETTING THAT IS PRIMARILY ENGAGED
IN FURNISHING PATIENT CARE.—The term ‘nonprovider
setting that is primarily engaged in furnishing patient
care’ means a nonprovider setting in which the primary
activity is the care and treatment of patients, as defined
by the Secretary.’’.
(b) IME DETERMINATIONS.—Section 1886(d)(5)(B) of such Act
(42 U.S.C. 1395ww(d)(5)(B)) is amended by adding at the end the
following new clause:
‘‘(x)(I) The provisions of subparagraph (K) of subsection
(h)(4) shall apply under this subparagraph in
the same manner as they apply under such subsection.
‘‘(II) In determining the hospital’s number of fulltime
equivalent residents for purposes of this subparagraph,
all the time spent by an intern or resident in
an approved medical residency training program in
non-patient care activities, such as didactic conferences
and seminars, as such time and activities are
defined by the Secretary, that occurs in the hospital
shall be counted toward the determination of full-time
equivalency if the hospital—
‘‘(aa) is recognized as a subsection (d) hospital;
‘‘(bb) is recognized as a subsection (d) Puerto
Rico hospital;
‘‘(cc) is reimbursed under a reimbursement
system authorized under section 1814(b)(3); or
‘‘(dd) is a provider-based hospital outpatient
department.
‘‘(III) In determining the hospital’s number of fulltime
equivalent residents for purposes of this subparagraph,
all the time spent by an intern or resident in
an approved medical residency training program in research
activities that are not associated with the treatment
or diagnosis of a particular patient, as such time
and activities are defined by the Secretary, shall not
be counted toward the determination of full-time
equivalency.’’.
(c) EFFECTIVE DATES.—
(1) IN GENERAL.—Except as otherwise provided, the Secretary
of Health and Human Services shall implement the
amendments made by this section in a manner so as to apply
to cost reporting periods beginning on or after January 1, 1983.
(2) GME.—Section 1886(h)(4)(J) of the Social Security Act,
as added by subsection (a)(1)(B), shall apply to cost reporting
periods beginning on or after July 1, 2009.
(3) IME.—Section 1886(d)(5)(B)(x)(III) of the Social Security
Act, as added by subsection (b), shall apply to cost reporting
periods beginning on or after October 1, 2001. Such section,
as so added, shall not give rise to any inference as to how the
law in effect prior to such date should be interpreted.
(d) APPLICATION.—The amendments made by this section shall
not be applied in a manner that requires reopening of any settled
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)). As added by section
10501(j)