Page:United States Statutes at Large Volume 100 Part 1.djvu/209

 PUBLIC LAW 99-272—APR. 7, 1986

-5Sj* ^

100 STAT. 173

"(ii) the hospital's medicare patient load (as defined in subparagraph (O) for that period. "(B) AGGREGATE APPROVED AMOUNT.—As used in subparagraph (A), the term 'aggregate approved amount' means, for a hospital cost reporting period, the product of— "(i) the hospital's approved FTE resident amount (determined under paragraph (2)) for that period, and "(ii) the weighted average number of full-timeequivalent residents (as determined under paragraph (4)) in the hospital's approved medical residency training programs in that period. "(C) MEDICARE PATIENT LOAD.—As used in subparagraph (A), the term 'medicare patient load' means, with respect to a hospital's cost reporting period, the fraction of the total number of inpatient-bed-days (as established by the Secretary) during the period which are attributable to patients with respect to whom payment may be made under part A. '(4) DETERMINATION OF FULL-TIME-EQUIVALENT RESIDENTS.—

"(A) RULES.—The Secretary shall establish rules consistent with this paragraph for the computation of the number of full-time-equivalent residents in an approved medical residency training program. "(B)

ADJUSTMENT FOR PART-YEAR OR PART-TIME RESI-

DENTS.—Such rules shall take into account individuals who serve as residents for only a portion of a period with a hospital or simultaneously with more than one hospital. "(C) WEIGHTING FACTORS FOR CERTAIN RESIDENTS.—Sub-

ject to subparagraph (E), such rules shall provide, in calculating the number of full-time-equivalent residents in an approved residency program— "(i) before July 1, 1986, for each resident the weighting factor is 1.00, "(ii) on or after July 1, 1986, for a resident who is in the resident's initial residency period (as defined in paragraph (5)(F)), the weighting factor is 1.00, "(iii) on or after July 1, 1986, and before July 1, 1987, for a resident who is not in the resident's initial residency period (as defined in paragraph (5)(F)), the weighting factor is.75, and "(iv) on or after July 1, 1987, for a resident who is not in the resident's initial residency period (as defined in paragraph (5)(F)), the weighting factor is.50. "(E) FOREIGN MEDICAL GRADUATES REQUIRED TO PASS FMGEMS EXAMINATION. —

"(i) IN GENERAL.—Except as provided in clause (ii), such rules shall provide that, in the case of an individual who is a foreign medical graduate (as defined in paragraph (5)(D)), the individual shall not be counted as a resident on or after July 1, 1986, unless— "(I) the individual has passed the FMGEMS examination (as defined in paragraph (5)(E)), or "(II) the individual has previously received certification from, or has previously passed the examination of, the Educational Commission for Foreign Medical Graduates.

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