Page:United States Statutes at Large Volume 124.djvu/697

124 STAT. 671 PUBLIC LAW 111–148—MAR. 23, 2010 the direct and indirect payments as determined under sub- section (c) and (d) do not exceed the total amount of funds appropriated in a fiscal year under subsection (g). ‘‘(c) AMOUNT OF PAYMENT FOR DIRECT GRADUATE MEDICAL EDU- CATION.— ‘‘(1) IN GENERAL.—The amount determined under this sub- section for payments to qualified teaching health centers for direct graduate expenses relating to approved graduate medical residency training programs for a fiscal year is equal to the product of— ‘‘(A) the updated national per resident amount for direct graduate medical education, as determined under paragraph (2); and ‘‘(B) the average number of full-time equivalent resi- dents in the teaching health center’s graduate approved medical residency training programs as determined under section 1886(h)(4) of the Social Security Act (without regard to the limitation under subparagraph (F) of such section) during the fiscal year. ‘‘(2) UPDATED NATIONAL PER RESIDENT AMOUNT FOR DIRECT GRADUATE MEDICAL EDUCATION.—The updated per resident amount for direct graduate medical education for a qualified teaching health center for a fiscal year is an amount determined as follows: ‘‘(A) DETERMINATION OF QUALIFIED TEACHING HEALTH CENTER PER RESIDENT AMOUNT.—The Secretary shall com- pute for each individual qualified teaching health center a per resident amount— ‘‘(i) by dividing the national average per resident amount computed under section 340E(c)(2)(D) into a wage-related portion and a non-wage related portion by applying the proportion determined under subpara- graph (B); ‘‘(ii) by multiplying the wage-related portion by the factor applied under section 1886(d)(3)(E) of the Social Security Act (but without application of section 4410 of the Balanced Budget Act of 1997 (42 U.S.C. 1395ww note)) during the preceding fiscal year for the teaching health center’s area; and ‘‘(iii) by adding the non-wage-related portion to the amount computed under clause (ii). ‘‘(B) UPDATING RATE.—The Secretary shall update such per resident amount for each such qualified teaching health center as determined appropriate by the Secretary. ‘‘(d) AMOUNT OF PAYMENT FOR INDIRECT MEDICAL EDUCATION.— ‘‘(1) IN GENERAL.—The amount determined under this sub- section for payments to qualified teaching health centers for indirect expenses associated with the additional costs of teaching residents for a fiscal year is equal to an amount determined appropriate by the Secretary. ‘‘(2) FACTORS.—In determining the amount under para- graph (1), the Secretary shall— ‘‘(A) evaluate indirect training costs relative to sup- porting a primary care residency program in qualified teaching health centers; and ‘‘(B) based on this evaluation, assure that the aggregate of the payments for indirect expenses under this section Determination.