H. R. 3590—549 
‘‘(I) are different from such standards in the 
other participating States; and 
‘‘(II) are different from the core training com-
petencies described in paragraph (3)(A); 
‘‘(iv) that participating States do not reduce the 
number of hours of training required under applicable 
State law or regulation after being selected to partici-
pate in the project; and 
‘‘(v) that participating States recruit a minimum 
number of eligible health and long-term care providers 
to participate in the project. 
‘‘(D) TECHNICAL ASSISTANCE.—The Secretary shall pro-
vide technical assistance to States in developing written 
materials and protocols for such core training competencies. 
‘‘(5) EVALUATION AND REPORT.— 
‘‘(A) EVALUATION.—The Secretary shall develop an 
experimental or control group testing protocol in consulta-
tion with an independent evaluation contractor selected 
by the Secretary. Such contractor shall evaluate— 
‘‘(i) the impact of core training competencies 
described in paragraph (3)(A), including curricula 
developed to implement such core training com-
petencies, for personal or home care aides within each 
participating State on job satisfaction, mastery of job 
skills, beneficiary and family caregiver satisfaction 
with services, and additional measures determined by 
the Secretary in consultation with the expert panel; 
‘‘(ii) the impact of providing such core training 
competencies on the existing training infrastructure 
and resources of States; and 
‘‘(iii) whether a minimum number of hours of ini-
tial training should be required for personal or home 
care aides and, if so, what minimum number of hours 
should be required. 
‘‘(B) REPORTS.— 
‘‘(i) REPORT
ON
INITIAL
IMPLEMENTATION.—Not 
later than 2 years after the date of enactment of this 
section, the Secretary shall submit to Congress a report 
on the initial implementation of activities conducted 
under the demonstration project, including any avail-
able results of the evaluation conducted under subpara-
graph (A) with respect to such activities, together with 
such recommendations for legislation or administrative 
action as the Secretary determines appropriate. 
‘‘(ii) FINAL REPORT.—Not later than 1 year after 
the completion of the demonstration project, the Sec-
retary shall submit to Congress a report containing 
the results of the evaluation conducted under subpara-
graph (A), together with such recommendations for 
legislation or administrative action as the Secretary 
determines appropriate. 
‘‘(6) DEFINITIONS.—In this subsection: 
‘‘(A) ELIGIBLE
HEALTH
AND
LONG-TERM
CARE
PRO-
VIDER.—The term ‘eligible health and long-term care pro-
vider’ means a personal or home care agency (including 
personal or home care public authorities), a nursing home, 
a home health agency (as defined in section 1861(o)), or
H. R. 3590—550 
any other health care provider the Secretary determines 
appropriate which— 
‘‘(i) is licensed or authorized to provide services 
in a participating State; and 
‘‘(ii) receives payment for services under title XIX. 
‘‘(B) PERSONAL
CARE
SERVICES.—The term ‘personal 
care services’ has the meaning given such term for purposes 
of title XIX. 
‘‘(C) PERSONAL OR HOME CARE AIDE.—The term ‘per-
sonal or home care aide’ means an individual who helps 
individuals who are elderly, disabled, ill, or mentally dis-
abled (including an individual with Alzheimer’s disease 
or other dementia) to live in their own home or a residential 
care facility (such as a nursing home, assisted living 
facility, or any other facility the Secretary determines 
appropriate) by providing routine personal care services 
and other appropriate services to the individual. 
‘‘(D) STATE.—The term ‘State’ has the meaning given 
that term for purposes of title XIX. 
‘‘(c) FUNDING.— 
‘‘(1) IN
GENERAL.—Subject to paragraph (2), out of any 
funds in the Treasury not otherwise appropriated, there are 
appropriated to the Secretary to carry out subsections (a) and 
(b), $85,000,000 for each of fiscal years 2010 through 2014. 
‘‘(2) TRAINING AND CERTIFICATION PROGRAMS FOR PERSONAL 
AND
HOME
CARE
AIDES.—With respect to the demonstration 
projects under subsection (b), the Secretary shall use $5,000,000 
of the amount appropriated under paragraph (1) for each of 
fiscal years 2010 through 2012 to carry out such projects. 
No funds appropriated under paragraph (1) shall be used to 
carry out demonstration projects under subsection (b) after 
fiscal year 2012. 
‘‘(d) NONAPPLICATION.— 
‘‘(1) IN GENERAL.—Except as provided in paragraph (2), 
the preceding sections of this title shall not apply to grant 
awarded under this section. 
‘‘(2) LIMITATIONS
ON
USE
OF
GRANTS.—Section 2005(a) 
(other than paragraph (6)) shall apply to a grant awarded 
under this section to the same extent and in the same manner 
as such section applies to payments to States under this title.’’. 
(b) EXTENSION
OF FAMILY-TO-FAMILY HEALTH INFORMATION 
CENTERS.—Section 501(c)(1)(A)(iii) of the Social Security Act (42 
U.S.C. 701(c)(1)(A)(iii)) is amended by striking ‘‘fiscal year 2009’’ 
and inserting ‘‘each of fiscal years 2009 through 2012’’. 
SEC. 5508. INCREASING TEACHING CAPACITY. 
(a) TEACHING
HEALTH
CENTERS
TRAINING
AND
ENHANCE-
MENT.—Part C of title VII of the Public Health Service Act (42 
U.S.C. 293k et. seq.), as amended by section 5303, is further 
amended by inserting after section 749 the following: 
‘‘SEC. 749A. TEACHING HEALTH CENTERS DEVELOPMENT GRANTS. 
‘‘(a) PROGRAM AUTHORIZED.—The Secretary may award grants 
under this section to teaching health centers for the purpose of 
establishing new accredited or expanded primary care residency 
programs.
H. R. 3590—551 
‘‘(b) AMOUNT AND DURATION.—Grants awarded under this sec-
tion shall be for a term of not more than 3 years and the maximum 
award may not be more than $500,000. 
‘‘(c) USE OF FUNDS.—Amounts provided under a grant under 
this section shall be used to cover the costs of— 
‘‘(1) establishing or expanding a primary care residency 
training program described in subsection (a), including costs 
associated with— 
‘‘(A) curriculum development; 
‘‘(B) recruitment, training and retention of residents 
and faculty: 
‘‘(C) accreditation by the Accreditation Council for 
Graduate Medical Education (ACGME), the American 
Dental Association (ADA), or the American Osteopathic 
Association (AOA); and 
‘‘(D) faculty salaries during the development phase; 
and 
‘‘(2) technical assistance provided by an eligible entity. 
‘‘(d) APPLICATION.—A teaching health center seeking a grant 
under this section shall submit an application to the Secretary 
at such time, in such manner, and containing such information 
as the Secretary may require. 
‘‘(e) PREFERENCE
FOR CERTAIN APPLICATIONS.—In selecting 
recipients for grants under this section, the Secretary shall give 
preference to any such application that documents an existing affili-
ation agreement with an area health education center program 
as defined in sections 751 and 799B. 
‘‘(f) DEFINITIONS.—In this section: 
‘‘(1) ELIGIBLE ENTITY.—The term ‘eligible entity’ means an 
organization capable of providing technical assistance including 
an area health education center program as defined in sections 
751 and 799B. 
‘‘(2) PRIMARY CARE RESIDENCY PROGRAM.—The term ‘pri-
mary care residency program’ means an approved graduate 
medical residency training program (as defined in section 340H) 
in family medicine, internal medicine, pediatrics, internal medi-
cine-pediatrics, obstetrics and gynecology, psychiatry, general 
dentistry, pediatric dentistry, and geriatrics. 
‘‘(3) TEACHING HEALTH CENTER.— 
‘‘(A) IN GENERAL.—The term ‘teaching health center’ 
means an entity that— 
‘‘(i) is a community based, ambulatory patient care 
center; and 
‘‘(ii) operates a primary care residency program. 
‘‘(B) INCLUSION
OF
CERTAIN
ENTITIES.—Such term 
includes the following: 
‘‘(i) A Federally qualified health center (as defined 
in section 1905(l)(2)(B), of the Social Security Act). 
‘‘(ii) A community mental health center (as defined 
in section 1861(ff)(3)(B) of the Social Security Act). 
‘‘(iii) A rural health clinic, as defined in section 
1861(aa) of the Social Security Act. 
‘‘(iv) A health center operated by the Indian Health 
Service, an Indian tribe or tribal organization, or an 
urban Indian organization (as defined in section 4 of 
the Indian Health Care Improvement Act).
H. R. 3590—552 
‘‘(v) An entity receiving funds under title X of 
the Public Health Service Act. 
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There is authorized 
to be appropriated, $25,000,000 for fiscal year 2010, $50,000,000 
for fiscal year 2011, $50,000,000 for fiscal year 2012, and such 
sums as may be necessary for each fiscal year thereafter to carry 
out this section. Not to exceed $5,000,000 annually may be used 
for technical assistance program grants.’’. 
(b) NATIONAL HEALTH SERVICE CORPS TEACHING CAPACITY.— 
Section 338C(a) of the Public Health Service Act (42 U.S.C. 254m(a)) 
is amended to read as follows: 
‘‘(a) SERVICE IN FULL-TIME CLINICAL PRACTICE.—Except as pro-
vided in section 338D, each individual who has entered into a 
written contract with the Secretary under section 338A or 338B 
shall provide service in the full-time clinical practice of such individ-
ual’s profession as a member of the Corps for the period of obligated 
service provided in such contract. For the purpose of calculating 
time spent in full-time clinical practice under this subsection, up 
to 50 percent of time spent teaching by a member of the Corps 
may be counted toward his or her service obligation.’’. 
(c) PAYMENTS TO QUALIFIED TEACHING HEALTH CENTERS.—Part 
D of title III of the Public Health Service Act (42 U.S.C. 254b 
et seq.) is amended by adding at the end the following: 
‘‘Subpart XI—Support of Graduate Medical 
Education in Qualified Teaching Health Centers 
‘‘SEC. 340H. PROGRAM OF PAYMENTS TO TEACHING HEALTH CENTERS 
THAT OPERATE GRADUATE MEDICAL EDUCATION PRO-
GRAMS. 
‘‘(a) PAYMENTS.—Subject to subsection (h)(2), the Secretary 
shall make payments under this section for direct expenses and 
for indirect expenses to qualified teaching health centers that are 
listed as sponsoring institutions by the relevant accrediting body 
for expansion of existing or establishment of new approved graduate 
medical residency training programs. 
‘‘(b) AMOUNT OF PAYMENTS.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), the amounts 
payable under this section to qualified teaching health centers 
for an approved graduate medical residency training program 
for a fiscal year are each of the following amounts: 
‘‘(A) DIRECT
EXPENSE
AMOUNT.—The amount deter-
mined under subsection (c) for direct expenses associated 
with sponsoring approved graduate medical residency 
training programs. 
‘‘(B) INDIRECT EXPENSE AMOUNT.—The amount deter-
mined under subsection (d) for indirect expenses associated 
with the additional costs relating to teaching residents 
in such programs. 
‘‘(2) CAPPED AMOUNT.— 
‘‘(A) IN GENERAL.—The total of the payments made 
to qualified teaching health centers under paragraph (1)(A) 
or paragraph (1)(B) in a fiscal year shall not exceed the 
amount of funds appropriated under subsection (g) for such 
payments for that fiscal year. 
‘‘(B) LIMITATION.—The Secretary shall limit the 
funding of full-time equivalent residents in order to ensure
H. R. 3590—553 
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
H. R. 3590—554 
and the payments for direct graduate medical education 
as determined under subsection (c) in a fiscal year do 
not exceed the amount appropriated for such expenses as 
determined in subsection (g). 
‘‘(3) INTERIM PAYMENT.—Before the Secretary makes a pay-
ment under this subsection pursuant to a determination of 
indirect expenses under paragraph (1), the Secretary may pro-
vide to qualified teaching health centers a payment, in addition 
to any payment made under subsection (c), for expected indirect 
expenses associated with the additional costs of teaching resi-
dents for a fiscal year, based on an estimate by the Secretary. 
‘‘(e) CLARIFICATION REGARDING RELATIONSHIP TO OTHER PAY-
MENTS FOR GRADUATE MEDICAL EDUCATION.—Payments under this 
section— 
‘‘(1) shall be in addition to any payments— 
‘‘(A) for the indirect costs of medical education under 
section 1886(d)(5)(B) of the Social Security Act; 
‘‘(B) for direct graduate medical education costs under 
section 1886(h) of such Act; and 
‘‘(C) for direct costs of medical education under section 
1886(k) of such Act; 
‘‘(2) shall not be taken into account in applying the limita-
tion on the number of total full-time equivalent residents under 
subparagraphs (F) and (G) of section 1886(h)(4) of such Act 
and clauses (v), (vi)(I), and (vi)(II) of section 1886(d)(5)(B) of 
such Act for the portion of time that a resident rotates to 
a hospital; and 
‘‘(3) shall not include the time in which a resident is 
counted toward full-time equivalency by a hospital under para-
graph (2) or under section 1886(d)(5)(B)(iv) of the Social Secu-
rity Act, section 1886(h)(4)(E) of such Act, or section 340E 
of this Act. 
‘‘(f) RECONCILIATION.—The Secretary shall determine any 
changes to the number of residents reported by a hospital in the 
application of the hospital for the current fiscal year to determine 
the final amount payable to the hospital for the current fiscal 
year for both direct expense and indirect expense amounts. Based 
on such determination, the Secretary shall recoup any overpayments 
made to pay any balance due to the extent possible. The final 
amount so determined shall be considered a final intermediary 
determination for the purposes of section 1878 of the Social Security 
Act and shall be subject to administrative and judicial review under 
that section in the same manner as the amount of payment under 
section 1186(d) of such Act is subject to review under such section. 
‘‘(g) FUNDING.—To carry out this section, there are appropriated 
such sums as may be necessary, not to exceed $230,000,000, for 
the period of fiscal years 2011 through 2015. 
‘‘(h) ANNUAL REPORTING REQUIRED.— 
‘‘(1) ANNUAL REPORT.—The report required under this para-
graph for a qualified teaching health center for a fiscal year 
is a report that includes (in a form and manner specified 
by the Secretary) the following information for the residency 
academic year completed immediately prior to such fiscal year: 
‘‘(A) The types of primary care resident approved 
training programs that the qualified teaching health center 
provided for residents.
H. R. 3590—555 
‘‘(B) The number of approved training positions for 
residents described in paragraph (4). 
‘‘(C) The number of residents described in paragraph 
(4) who completed their residency training at the end of 
such residency academic year and care for vulnerable popu-
lations living in underserved areas. 
‘‘(D) Other information as deemed appropriate by the 
Secretary. 
‘‘(2) AUDIT AUTHORITY; LIMITATION ON PAYMENT.— 
‘‘(A) AUDIT AUTHORITY.—The Secretary may audit a 
qualified teaching health center to ensure the accuracy 
and completeness of the information submitted in a report 
under paragraph (1). 
‘‘(B) LIMITATION
ON
PAYMENT.—A teaching health 
center may only receive payment in a cost reporting period 
for a number of such resident positions that is greater 
than the base level of primary care resident positions, 
as determined by the Secretary. For purposes of this 
subparagraph, the ‘base level of primary care residents’ 
for a teaching health center is the level of such residents 
as of a base period. 
‘‘(3) REDUCTION IN PAYMENT FOR FAILURE TO REPORT.— 
‘‘(A) IN GENERAL.—The amount payable under this sec-
tion to a qualified teaching health center for a fiscal year 
shall be reduced by at least 25 percent if the Secretary 
determines that— 
‘‘(i) the qualified teaching health center has failed 
to provide the Secretary, as an addendum to the quali-
fied teaching health center’s application under this 
section for such fiscal year, the report required under 
paragraph (1) for the previous fiscal year; or 
‘‘(ii) such report fails to provide complete and 
accurate information required under any subparagraph 
of such paragraph. 
‘‘(B) NOTICE AND OPPORTUNITY TO PROVIDE ACCURATE 
AND MISSING INFORMATION.—Before imposing a reduction 
under subparagraph (A) on the basis of a qualified teaching 
health center’s failure to provide complete and accurate 
information described in subparagraph (A)(ii), the Secretary 
shall provide notice to the teaching health center of such 
failure and the Secretary’s intention to impose such reduc-
tion and shall provide the teaching health center with 
the opportunity to provide the required information within 
the period of 30 days beginning on the date of such notice. 
If the teaching health center provides such information 
within such period, no reduction shall be made under 
subparagraph (A) on the basis of the previous failure to 
provide such information. 
‘‘(4) RESIDENTS.—The residents described in this paragraph 
are those who are in part-time or full-time equivalent resident 
training positions at a qualified teaching health center in any 
approved graduate medical residency training program. 
‘‘(i) REGULATIONS.—The Secretary shall promulgate regulations 
to carry out this section. 
‘‘(j) DEFINITIONS.—In this section: 
‘‘(1) APPROVED
GRADUATE
MEDICAL
RESIDENCY
TRAINING 
PROGRAM.—The term ‘approved graduate medical residency
H. R. 3590—556 
training program’ means a residency or other postgraduate 
medical training program— 
‘‘(A) participation in which may be counted toward 
certification in a specialty or subspecialty and includes 
formal postgraduate training programs in geriatric medi-
cine approved by the Secretary; and 
‘‘(B) that meets criteria for accreditation (as established 
by the Accreditation Council for Graduate Medical Edu-
cation, the American Osteopathic Association, or the Amer-
ican Dental Association). 
‘‘(2) PRIMARY CARE RESIDENCY PROGRAM.—The term ‘pri-
mary care residency program’ has the meaning given that term 
in section 749A. 
‘‘(3) QUALIFIED
TEACHING
HEALTH
CENTER.—The term 
‘qualified teaching health center’ has the meaning given the 
term ‘teaching health center’ in section 749A.’’. 
SEC. 5509. GRADUATE NURSE EDUCATION DEMONSTRATION. 
(a) IN GENERAL.— 
(1) ESTABLISHMENT.— 
(A) IN GENERAL.—The Secretary shall establish a grad-
uate nurse education demonstration under title XVIII of 
the Social Security Act (42 U.S.C. 1395 et seq.) under 
which an eligible hospital may receive payment for the 
hospital’s reasonable costs (described in paragraph (2)) for 
the provision of qualified clinical training to advance prac-
tice nurses. 
(B) NUMBER.—The demonstration shall include up to 
5 eligible hospitals. 
(C) WRITTEN AGREEMENTS.—Eligible hospitals selected 
to participate in the demonstration shall enter into written 
agreements pursuant to subsection (b) in order to reimburse 
the eligible partners of the hospital the share of the costs 
attributable to each partner. 
(2) COSTS DESCRIBED.— 
(A) IN GENERAL.—Subject to subparagraph (B) and sub-
section (d), the costs described in this paragraph are the 
reasonable costs (as described in section 1861(v) of the 
Social Security Act (42 U.S.C. 1395x(v))) of each eligible 
hospital for the clinical training costs (as determined by 
the Secretary) that are attributable to providing advanced 
practice registered nurses with qualified training. 
(B) LIMITATION.—With respect to a year, the amount 
reimbursed under subparagraph (A) may not exceed the 
amount of costs described in subparagraph (A) that are 
attributable to an increase in the number of advanced 
practice registered nurses enrolled in a program that pro-
vides qualified training during the year and for which 
the hospital is being reimbursed under the demonstration, 
as compared to the average number of advanced practice 
registered nurses who graduated in each year during the 
period beginning on January 1, 2006, and ending on 
December 31, 2010 (as determined by the Secretary) from 
the graduate nursing education program operated by the 
applicable school of nursing that is an eligible partner 
of the hospital for purposes of the demonstration.
H. R. 3590—557 
(3) WAIVER AUTHORITY.—The Secretary may waive such 
requirements of titles XI and XVIII of the Social Security 
Act as may be necessary to carry out the demonstration. 
(4) ADMINISTRATION.—Chapter 35 of title 44, United States 
Code, shall not apply to the implementation of this section. 
(b) WRITTEN AGREEMENTS WITH ELIGIBLE PARTNERS.—No pay-
ment shall be made under this section to an eligible hospital unless 
such hospital has in effect a written agreement with the eligible 
partners of the hospital. Such written agreement shall describe, 
at a minimum— 
(1) the obligations of the eligible partners with respect 
to the provision of qualified training; and 
(2) the obligation of the eligible hospital to reimburse such 
eligible partners applicable (in a timely manner) for the costs 
of such qualified training attributable to partner. 
(c) EVALUATION.—Not later than October 17, 2017, the Sec-
retary shall submit to Congress a report on the demonstration. 
Such report shall include an analysis of the following: 
(1) The growth in the number of advanced practice reg-
istered nurses with respect to a specific base year as a result 
of the demonstration. 
(2) The growth for each of the specialties described in 
subparagraphs (A) through (D) of subsection (e)(1). 
(3) The costs to the Medicare program under title XVIII 
of the Social Security Act as a result of the demonstration. 
(4) Other items the Secretary determines appropriate and 
relevant. 
(d) FUNDING.— 
(1) IN GENERAL.—There is hereby appropriated to the Sec-
retary, out of any funds in the Treasury not otherwise appro-
priated, $50,000,000 for each of fiscal years 2012 through 2015 
to carry out this section, including the design, implementation, 
monitoring, and evaluation of the demonstration. 
(2) PRORATION.—If the aggregate payments to eligible hos-
pitals under the demonstration exceed $50,000,000 for a fiscal 
year described in paragraph (1), the Secretary shall prorate 
the payment amounts to each eligible hospital in order to 
ensure that the aggregate payments do not exceed such amount. 
(3) WITHOUT
FISCAL
YEAR
LIMITATION.—Amounts appro-
priated under this subsection shall remain available without 
fiscal year limitation. 
(e) DEFINITIONS.—In this section: 
(1) ADVANCED
PRACTICE
REGISTERED
NURSE.—The term 
‘‘advanced practice registered nurse’’ includes the following: 
(A) A clinical nurse specialist (as defined in subsection 
(aa)(5) of section 1861 of the Social Security Act (42 U.S.C. 
1395x)). 
(B) A nurse practitioner (as defined in such subsection). 
(C) A certified registered nurse anesthetist (as defined 
in subsection (bb)(2) of such section). 
(D) A certified nurse-midwife (as defined in subsection 
(gg)(2) of such section). 
(2) APPLICABLE NON-HOSPITAL COMMUNITY-BASED CARE SET-
TING.—The term ‘‘applicable non-hospital community-based care 
setting’’ means a non-hospital community-based care setting 
which has entered into a written agreement (as described in 
subsection (b)) with the eligible hospital participating in the