(1) in the subpart heading, by adding ‘‘and 
Women’s Hospitals’’ at the end; 
(2) in section 340E(a), by striking ‘‘subpart’’ 
and inserting ‘‘section’’; and 
(3) by adding at the end the following: 
‘‘SEC. 340E–1. SUPPORT OF GRADUATE MEDICAL EDU-
CATION PROGRAMS IN WOMEN’S HOSPITALS. 
‘‘(a) PAYMENTS.—The Secretary shall make two pay-
ments under this section to each women’s hospital for each 
of fiscal years 2010 through 2014, one for the direct ex-
penses and the other for indirect expenses associated with 
operating approved graduate medical residency training 
programs. The Secretary shall promulgate regulations 
pursuant to the rulemaking requirements of title 5, United 
States Code, which shall govern payments made under this 
section. 
‘‘(b) AMOUNT OF PAYMENTS.— 
‘‘(1) IN GENERAL.—Subject to paragraphs (2) 
and (3), the amounts payable under this section to 
a women’s hospital for an approved graduate med-
ical residency training program for a fiscal year 
shall be each of the following: 
‘‘(A) DIRECT
EXPENSE
AMOUNT.—The 
amount determined in accordance with sub-
section (c) for direct expenses associated with 
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operating approved graduate medical residency 
training programs for a fiscal year. 
‘‘(B) INDIRECT
EXPENSE
AMOUNT.—The 
amount determined in accordance with sub-
section (c) for indirect expenses associated with 
the treatment of more severely ill patients and 
the additional costs relating to teaching resi-
dents in such programs for a fiscal year. 
‘‘(2) CAPPED AMOUNT.— 
‘‘(A) IN GENERAL.—The total of the pay-
ments made to women’s hospitals under para-
graph (1) in a fiscal year shall not exceed the 
funds appropriated under subsection (f) for 
such payments for that fiscal year. 
‘‘(B) PRO
RATA
REDUCTIONS
OF
PAY-
MENTS.—If the Secretary determines that the 
amount of funds appropriated under subsection 
(f) for a fiscal year is insufficient to provide the 
total amount of payments otherwise due for 
such periods under paragraph (1), the Sec-
retary shall reduce the amounts so payable on 
a pro rata basis to reflect such shortfall. 
‘‘(c) APPLICATION
OF ANNUAL REPORTING
AND 
OTHER
PROVISIONS.—The provisions of subsections 
(b)(3), (c), and (d) of section 340E shall apply with re-
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spect to women’s hospitals funded under this section in 
the same manner as such provisions apply with respect 
to children’s hospitals funded under such section 340E. 
In applying such provisions, the Secretary may make such 
modifications as may be necessary to apply such provisions 
with respect to women’s hospitals. 
‘‘(d) MAKING OF PAYMENTS.— 
‘‘(1) INTERIM PAYMENTS.—The Secretary shall 
determine, before the beginning of each fiscal year 
involved for which payments may be made for a hos-
pital under this section, the amounts of the pay-
ments for direct graduate medical education and in-
direct medical education for such fiscal year and 
shall (subject to paragraph (2)) make the payments 
of such amounts in 12 equal interim installments 
during such period. Such interim payments to each 
individual hospital shall be based on the number of 
residents reported in the hospital’s most recently 
filed Medicare cost report prior to the application 
date for the Federal fiscal year for which the interim 
payment amounts are established. In the case of a 
hospital that does not report residents on a Medicare 
cost report, such interim payments shall be based on 
the number of residents trained during the hospital’s 
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most recently completed Medicare cost report filing 
period. 
‘‘(2) WITHHOLDING.—The Secretary shall with-
hold up to 25 percent from each interim installment 
for direct and indirect graduate medical education 
paid under paragraph (1) as necessary to ensure a 
hospital will not be overpaid on an interim basis. 
‘‘(3) RECONCILIATION.—Prior to the end of 
each fiscal year, 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 re-
coup any overpayments made and pay any balance 
due to the extent possible. The final amount so de-
termined shall be considered a final intermediary de-
termination for the purposes of section 1878 of the 
Social Security Act and shall be subject to adminis-
trative and judicial review under that section in the 
same manner as the amount of payment under sec-
tion 1886(d) of such Act is subject to review under 
such section. 
‘‘(e) DEFINITIONS.—In this section: 
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‘‘(1) APPROVED
GRADUATE
MEDICAL
RESI-
DENCY
TRAINING
PROGRAM.—The term ‘approved 
graduate medical residency training program’ has 
the meaning given the term ‘approved medical resi-
dency training program’ in section 1886(h)(5)(A) of 
the Social Security Act. 
‘‘(2) DIRECT GRADUATE MEDICAL EDUCATION 
COSTS.—The term ‘direct graduate medical edu-
cation costs’ has the meaning given such term in 
section 1886(h)(5)(C) of the Social Security Act. 
‘‘(3) WOMEN’S HOSPITAL.—The term ‘women’s 
hospital’ means a hospital— 
‘‘(A) that has a Medicare provider agree-
ment under title XVIII of the Social Security 
Act; 
‘‘(B) that has an approved graduate med-
ical residency training program; 
‘‘(C) that has not been excluded from the 
Medicare prospective payment system; 
‘‘(D) that had at least 3,000 births during 
2007, as determined by the Centers for Medi-
care & Medicaid Services; and 
‘‘(E) with respect to which and as deter-
mined by the Centers for Medicare & Medicaid 
Services, less than 4 percent of the total dis-
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charges from the hospital during 2007 were 
Medicare discharges of individuals who, as of 
the time of the discharge— 
‘‘(i) were enrolled in the original 
Medicare fee-for-service program under 
part A of title XVIII of the Social Security 
Act; and 
‘‘(ii) were not enrolled in— 
‘‘(I) a Medicare Advantage plan 
under part C of title XVIII of that 
Act; 
‘‘(II) an eligible organization 
under section 1876 of that Act; or 
‘‘(III) a PACE program under 
section 1894 of that Act. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section, 
$12,000,000 for fiscal year 2010, and such sums as may 
be necessary for each of fiscal years 2011 through 2014.’’. 
Æ 
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