provide the total amount of payments otherwise
due for such periods, the Secretary shall reduce
the amount payable under this section for such
period on a pro rata basis to the extent to as-
sure that the aggregate of such payments does
not exceed the amount of funds provided under
subsection (d) for such cost reporting periods.
(c) MAKING OF PAYMENTS.—
(1) INTERIM PAYMENTS.—The Secretary shall
estimate, before the beginning of each cost reporting
period for a hospital for which a payment may be
made under this section, the amount of payment to
be made under this section to the hospital for such
period and shall make payment, in 26 equal interim
installments during such period, of the amounts obli-
gated to be paid.
(2) FINAL PAYMENT.—At the end of each such
period, the hospital shall submit to the Secretary
such information as the Secretary determines to be
necessary to determine the final payment amount
due under this section for the hospital for the pe-
riod. Based on such determination, the Secretary
shall recoup any overpayments made, or payment
balances due. The final amount so determined shall
be considered a final intermediary determination for
purposes of applying section 1878 of the Social Se-
curity Act and shall be subject to review under that
section in the same manner as the amount of pay-
ment under section 1886(d) of such Act is subject
to review under such section.
(d) LIMITATION ON EXPENDITURES.—
(1) IN GENERAL.—Subject to paragraph (2),
there are hereby appropriated, out of any money in
the Treasury not otherwise appropriated, for pay-
ments under this section for cost reporting periods
ending in each of fiscal years 1999 and 2000
$285,000,000.
(2) CARRYOVER OF EXCESS.—If the amount of
payments under this section for cost reporting peri-
ods ending in fiscal year 1999 is less than the
amount provided under this subsection for such pay-
ments for such periods, then the amount available
under this subsection for cost reporting periods end-
ing in fiscal year 2000 shall be increased by the
amount of such difference.
(e) RELATION TO MEDICARE AND MEDICAID PAY-
MENTS.—Notwithstanding any other provision of law,
payments under this section to a hospital for a cost report-
ing period—
(1) are in lieu of any amounts otherwise pay-
able to the hospital under section 1886(h) or
1886(d)(5)(F) of the Social Security Act to the hos-
pital for such cost reporting period, but
(2) shall not affect the amounts otherwise pay-
able to such hospitals under a State medicaid plan
under title XIX of such Act.
(f) DEFINITIONS.—In this section:
(1) APPROVED MEDICAL RESIDENCY TRAINING
PROGRAM.—The term ‘‘approved medical residency
training program’’ has the meaning given such term
in section 1886(h)(5)(A) of the Social Security Act
(42 U.S.C. 1395ww(h)(5)(A)).
(2) CHILDREN’S
HOSPITAL.—The term ‘‘chil-
dren’s hospital’’ means a hospital described in sec-
tion 1886(d)(1)(B)(iii) of the Social Security Act
(42 U.S.C. 1395ww(d)(1)(B)(iii)).
(3) 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 (42
U.S.C. 1395ww(h)(5)(C)).
(4) SECRETARY.—The term ‘‘Secretary’’ means
the Secretary of Health and Human Services.
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