PUBLIC LAW 105-33 —AUG. 5, 1997 111 STAT. 477 program at an entity in a nonhospital setting shall be counted towards the determination of full-time equivalency if the hospital incurs all, or substantially all, of the costs for the training program in that setting.". SEC. 4622. PAYMENT TO HOSPITALS OF INDIRECT MEDICAL EDU- CATION COSTS FOR MEDICARE+CHOICE ENROLLEES. Section 1886(d) (42 U.S.C. 1395ww(d)) is amended by adding at the end the following: "(11) ADDITIONAL, PAYMENTS FOR MANAGED CARE ENROLL- EES. — "(A) IN GENERAL. —For portions of cost reporting periods occurring on or after January 1, 1998, the Secretary shall provide for an additional payment amount for each applicable discharge of any subsection (d) hospital that has an approved medical residency training program. "(B) APPLICABLE DISCHARGE.— For purposes of this paragraph, the term 'applicable discharge' means the discharge of any individual who is enrolled under a risksharing contract with an eligible organization under section 1876 and who is entitled to benefits under part A or any individual who is enrolled with a Medicare+Choice organization under part C. "(C) DETERMINATION OF AMOUNT. —The amount of the payment under this paragraph with respect to any applicable discharge shall be equal to the applicable percentage (as defined in subsection (h)(3)(D)(ii)) of the estimated average per discharge amount that would otherwise have been paid under paragraph (5)(B) if the individuals had not been enrolled as described in subparagraph (B). "(D) SPECIAL RULE FOR HOSPITALS UNDER REIMBURSE- MENT SYSTEM.—The Secretary shall establish rules for the application of this paragraph to a hospital reimbursed under a reimbursement system authorized under section 1814(b)(3) in the same manner as it would apply to the hospital if it were not reimbursed under such section.". Subchapter B—Direct Graduate Medical Education SEC. 4623. LIMITATION ON NUMBER OF RESIDENTS AND ROLLING AVERAGE FTE COUNT. Section 1886(h)(4) (42 U.S.C. 1395ww(h)(4)) is amended by adding after subparagraph (E) the following: "(F) LIMITATION ON NUMBER OF RESIDENTS IN ALLOPATHIC AND OSTEOPATHIC MEDICINE. —Such rules shall provide that for purposes of a cost reporting period beginning on or after October 1, 1997, the total number of full-time equivalent residents before application of weighting factors (as determined under this paragraph) with respect to a hospital's approved medical residency training program in the fields of allopathic medicine and osteopathic medicine may not exceed the number of such full-time equivalent residents for the hospital's most recent cost reporting period ending on or before December 31, 1996.
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