Page:United States Statutes at Large Volume 124.djvu/682

124 STAT. 656 PUBLIC LAW 111–148—MAR. 23, 2010 ‘‘(A) REDUCTIONS IN LIMIT BASED ON UNUSED POSI- TIONS.— ‘‘(i) IN GENERAL.—Except as provided in clause (ii), if a hospital’s reference resident level (as defined in subparagraph (H)(i)) is less than the otherwise applicable resident limit (as defined in subparagraph (H)(iii)), effective for portions of cost reporting periods occurring on or after July 1, 2011, the otherwise applicable resident limit shall be reduced by 65 percent of the difference between such otherwise applicable resident limit and such reference resident level. ‘‘(ii) EXCEPTIONS.—This subparagraph shall not apply to— ‘‘(I) a hospital located in a rural area (as defined in subsection (d)(2)(D)(ii)) with fewer than 250 acute care inpatient beds; ‘‘(II) a hospital that was part of a qualifying entity which had a voluntary residency reduction plan approved under paragraph (6)(B) or under the authority of section 402 of Public Law 90– 248, if the hospital demonstrates to the Secretary that it has a specified plan in place for filling the unused positions by not later than 2 years after the date of enactment of this paragraph; or ‘‘(III) a hospital described in paragraph (4)(H)(v). ‘‘(B) DISTRIBUTION.— ‘‘(i) IN GENERAL.—The Secretary shall increase the otherwise applicable resident limit for each qualifying hospital that submits an application under this subparagraph by such number as the Secretary may approve for portions of cost reporting periods occurring on or after July 1, 2011. The aggregate number of increases in the otherwise applicable resident limit under this subparagraph shall be equal to the aggre- gate reduction in such limits attributable to subpara- graph (A) (as estimated by the Secretary). ‘‘(ii) REQUIREMENTS.—Subject to clause (iii), a hos- pital that receives an increase in the otherwise applicable resident limit under this subparagraph shall ensure, during the 5-year period beginning on the date of such increase, that— ‘‘(I) the number of full-time equivalent primary care residents, as defined in paragraph (5)(H) (as determined by the Secretary), excluding any addi- tional positions under subclause (II), is not less than the average number of full-time equivalent primary care residents (as so determined) during the 3 most recent cost reporting periods ending prior to the date of enactment of this paragraph; and ‘‘(II) not less than 75 percent of the positions attributable to such increase are in a primary care or general surgery residency (as determined by the Secretary). Deadline. Effective date.