PUBLIC LAW 105-33—AUG. 5, 1997 111 STAT. 479 1876 and who are entitled to part A or with a Medicare+Choice organization under part C. The amount of such a payment shall equal the applicable percentage of the product of— "(I) the aggregate approved amount (as defined in subparagraph (B)) for that period; and "(11) the fraction of the total number of inpatient-bed days (as established by the Secretary) during the period which are attributable to such enrolled individuals, " (ii) APPLICABLE PERCE^^^AGE. —For purposes of clause (i), the applicable percentage is— "(I) 20 percent in 1998, "(II) 40 percent in 1999, "(III) 60 percent in 2000, and "(IV) 80 percent in 2001, and "(V) 100 percent in 2002 and subsequent years, "(iii) SPECLVL RULE FOR HOSPITALS UNDER REIMBURSEMENT SYSTEM. —The Secretary shall establish rules for the application of this subparagraph 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.". SEC. 4625. PERMITTING PAYMENT TO NONHOSPITAL PROVIDERS. (a) IN GENERAL.—Section 1886 (42 U.S.C. 1395ww), as amended by section 4421(a), is amended by adding at the end the following: "(k) PAYMENT TO NONHOSPITAL PROVIDERS.— "(1) IN GENERAL. —For cost reporting periods beginning on or after October 1, 1997, the Secretary may establish rules for pa3anent to qualified nonhospital providers for their direct costs of medical education, if those costs are incurred in the operation of an approved medical residency training program described in subsection (h). Such rules shall specify the amounts, form, and manner in which such payments will be made and the portion of such payments that will be made from each of the trust funds under this title. "(2) QUALIFIED NONHOSPITAL PROVIDERS.—For purposes of this subsection, the term 'qualified nonhospital providers' means— "(A) a Federally qualified health center, as defined in section 1861(aa)(4); "(B) a rural health clinic, as defined in section 1861(aa)(2); " (C) Medicare+Choice organizations; and "(D) such other providers (other than hospitals) as the Secretary determines to be appropriate.". (b) PROHIBITION ON DOUBLE PAYMENTS. — Section 1886(h)(3)(B) (42 U.S.C. 1395ww(h)(3)(B)) is amended by adding at the end the following: 'The Secretary shall reduce the aggregate approved amount to the extent payment is made under subsection (k) for residents included in the hospital's count of full-time equivalent residents.".
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