Page:United States Statutes at Large Volume 124.djvu/683

124 STAT. 657 PUBLIC LAW 111–148—MAR. 23, 2010 The Secretary may determine whether a hospital has met the requirements under this clause during such 5-year period in such manner and at such time as the Secretary determines appropriate, including at the end of such 5-year period. ‘‘(iii) REDISTRIBUTION OF POSITIONS IF HOSPITAL NO LONGER MEETS CERTAIN REQUIREMENTS.—In the case where the Secretary determines that a hospital described in clause (ii) does not meet either of the requirements under subclause (I) or (II) of such clause, the Secretary shall— ‘‘(I) reduce the otherwise applicable resident limit of the hospital by the amount by which such limit was increased under this paragraph; and ‘‘(II) provide for the distribution of positions attributable to such reduction in accordance with the requirements of this paragraph. ‘‘(C) CONSIDERATIONS IN REDISTRIBUTION.—In deter- mining for which hospitals the increase in the otherwise applicable resident limit is provided under subparagraph (B), the Secretary shall take into account— ‘‘(i) the demonstration likelihood of the hospital filling the positions made available under this para- graph within the first 3 cost reporting periods begin- ning on or after July 1, 2011, as determined by the Secretary; and ‘‘(ii) whether the hospital has an accredited rural training track (as described in paragraph (4)(H)(iv)). ‘‘(D) PRIORITY FOR CERTAIN AREAS.—In determining for which hospitals the increase in the otherwise applicable resident limit is provided under subparagraph (B), subject to subparagraph (E), the Secretary shall distribute the increase to hospitals based on the following factors: ‘‘(i) Whether the hospital is located in a State with a resident-to-population ratio in the lowest quar- tile (as determined by the Secretary). ‘‘(ii) Whether the hospital is located in a State, a territory of the United States, or the District of Columbia that is among the top 10 States, territories, or Districts in terms of the ratio of— ‘‘(I) the total population of the State, territory, or District living in an area designated (under such section 332(a)(1)(A)) as a health professional shortage area (as of the date of enactment of this paragraph); to ‘‘(II) the total population of the State, territory, or District (as determined by the Secretary based on the most recent available population data pub- lished by the Bureau of the Census). ‘‘(iii) Whether the hospital is located in a rural area (as defined in subsection (d)(2)(D)(ii)). ‘‘(E) RESERVATION OF POSITIONS FOR CERTAIN HOS- PITALS.— ‘‘(i) IN GENERAL.—Subject to clause (ii), the Sec- retary shall reserve the positions available for distribu- tion under this paragraph as follows: Effective date.