Page:United States Statutes at Large Volume 117.djvu/2303

 117 STAT. 2284

PUBLIC LAW 108–173—DEC. 8, 2003 (1) shall not apply to episodes and visits ending after such period; and (2) shall not be taken into account in calculating the payment amounts applicable for episodes and visits occurring after such period.

SEC. 422. REDISTRIBUTION OF UNUSED RESIDENT POSITIONS.

(a) IN GENERAL.—Section 1886(h) (42 U.S.C. 1395ww(h)(4)) is amended— (1) in paragraph (4)(F)(i), by inserting ‘‘subject to paragraph (7),’’ after ‘‘October 1, 1997,’’; (2) in paragraph (4)(H)(i), by inserting ‘‘and subject to paragraph (7)’’ after ‘‘subparagraphs (F) and (G)’’; and (3) by adding at the end the following new paragraph: ‘‘(7) REDISTRIBUTION OF UNUSED RESIDENT POSITIONS.— ‘‘(A) REDUCTION IN LIMIT BASED ON UNUSED POSITIONS.— ‘‘(i) PROGRAMS SUBJECT TO REDUCTION.— ‘‘(I) IN GENERAL.—Except as provided in subclause (II), if a hospital’s reference resident level (specified in clause (ii)) is less than the otherwise applicable resident limit (as defined in subparagraph (C)(ii)), effective for portions of cost reporting periods occurring on or after July 1, 2005, the otherwise applicable resident limit shall be reduced by 75 percent of the difference between such otherwise applicable resident limit and such reference resident level. ‘‘(II) EXCEPTION FOR SMALL RURAL HOSPITALS.—This subparagraph shall not apply to a hospital located in a rural area (as defined in subsection (d)(2)(D)(ii)) with fewer than 250 acute care inpatient beds. ‘‘(ii) REFERENCE RESIDENT LEVEL.— ‘‘(I) IN GENERAL.—Except as otherwise provided in subclauses (II) and (III), the reference resident level specified in this clause for a hospital is the resident level for the most recent cost reporting period of the hospital ending on or before September 30, 2002, for which a cost report has been settled (or, if not, submitted (subject to audit)), as determined by the Secretary. ‘‘(II) USE OF MOST RECENT ACCOUNTING PERIOD TO RECOGNIZE EXPANSION OF EXISTING PROGRAMS.—If a hospital submits a timely request to increase its resident level due to an expansion of an existing residency training program that is not reflected on the most recent settled cost report, after audit and subject to the discretion of the Secretary, the reference resident level for such hospital is the resident level for the cost reporting period that includes July 1, 2003, as determined by the Secretary. ‘‘(III) EXPANSIONS UNDER NEWLY APPROVED PROGRAMS.—Upon the timely request of a hospital, the Secretary shall adjust the reference resident level specified under subclause (I) or (II) to include

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