psychiatry or psychiatry subspecialty residency
(10) Distribution of additional residency positions in psychiatry and psychiatry subspecialties (A) Additional residency positions (i) In general For fiscal year 2026, the Secretary shall, subject to the succeeding provisions of this paragraph, increase the otherwise applicable resident limit for each qualifying hospital (as defined in subparagraph (F)) that submits a timely application under this subparagraph by such number as the Secretary may approve effective beginning July 1 of the fiscal year of the increase. (ii) Number available for distribution The aggregate number of such positions made available under this paragraph shall be equal to 200. (iii) Distribution for psychiatry or psychiatry subspecialty residencies At least 100 of the positions made available under this paragraph shall be distributed for a psychiatry or psychiatry subspecialty residency (as defined in subparagraph (F)). (iv) Timing The Secretary shall notify hospitals of the number of positions distributed to the hospital under this paragraph as a result of an increase in the otherwise applicable resident limit by January 31 of the fiscal year of the increase. Such increase shall be effective beginning July 1 of such fiscal year. (B) Distribution For purposes of providing an increase in the otherwise applicable resident limit under subparagraph (A), the following shall apply: (i) Considerations in distribution In determining for which qualifying hospitals such an increase is provided under subparagraph (A), the Secretary shall take into account the demonstrated likelihood of the hospital filling the positions made available under this paragraph within the first 5 training years beginning after the date the increase would be effective, as determined by the Secretary. (ii) Minimum distribution for certain categories of hospitals With respect to the aggregate number of such positions available for distribution under this paragraph, the Secretary shall distribute not less than 10 percent of such aggregate number to each of the following categories of hospitals: (I) Hospitals that are located in a rural area (as defined in section 1395ww(d)(2)(D) of this title ) or are treated as being located in a rural area pursuant to section 1395ww(d)(8)(E) of this title . (II) Hospitals in which the reference resident level of the hospital (as specified in subparagraph (F)(iii)) is greater than the otherwise applicable resident limit. (III) Hospitals in States with— (aa) new medical schools that received “Candidate School” status from the Liaison Committee on Medical Education or that received “Pre-Accreditation” status from the American Osteopathic Association Commission on Osteopathic College Accreditation on or after January 1, 2000 , and that have achieved or continue to progress toward “Full Accreditation” status (as such term is defined by the Liaison Committee on Medical Education) or toward “Accreditation” status (as such term is defined by the American Osteopathic Association Commission on Osteopathic College Accreditation); or (bb) additional locations and branch campuses established on or after January 1, 2000 , by medical schools with “Full Accreditation” status (as such term is defined by the Liaison Committee on Medical Education) or “Accreditation” status (as such term is defined by the American Osteopathic Association Commission on Osteopathic College Accreditation). (IV) Hospitals that serve areas designated as health professional shortage areas under section 254e(a)(1)(A) of this title , as determined by the Secretary. (iii) Pro rata application The Secretary shall ensure that each qualifying hospital that submits a timely application under subparagraph (A) receives at least 1 (or a fraction of 1) of the positions made available under this paragraph before any qualifying hospital receives more than 1 of such positions. (C) Requirements (i) Limitation A hospital may not receive more than 10 additional full-time equivalent residency positions under this paragraph. (ii) Prohibition on distribution to hospitals without an increase agreement No increase in the otherwise applicable resident limit of a hospital may be made under this paragraph unless such hospital agrees to increase the total number of full-time equivalent residency positions under the approved medical residency training program of such hospital by the number of such positions made available by such increase under this paragraph. (iii) Requirement for hospitals to expand programs If a hospital that receives an increase in the otherwise applicable resident limit under this paragraph would be eligible for an adjustment to the otherwise applicable resident limit for participation in a new medical residency training program under section 413.79 (e)(3) of title 42, Code of Federal Regulations (or any successor regulation), the hospital shall ensure that any positions made available under this paragraph are used to expand an existing program of the hospital, and not for participation in a new medical residency training program. (D) Application of per resident amounts for nonprimary care With respect to additional residency positions in a hospital attributable to the increase provided under this paragraph, the approved FTE per resident amounts are deemed to be equal to the hospital per resident amounts for nonprimary care computed under paragraph (2)(D) for that hospital. (E) Permitting facilities to apply aggregation rules The Secretary shall permit hospitals receiving additional residency positions attributable to the increase provided under this paragraph to, beginning in the fifth year after the effective date of such increase, apply such positions to the limitation amount under paragraph (4)(F) that may be aggregated pursuant to paragraph (4)(H) among members of the same affiliated group. (F) Definitions In this paragraph: (i) Otherwise applicable resident limit The term “otherwise applicable resident limit” means, with respect to a hospital, the limit otherwise applicable under subparagraphs (F)(i) and (H) of paragraph (4) on the resident level for the hospital determined without regard to this paragraph but taking into account paragraphs (7)(A), (7)(B), (8)(A), (8)(B), and (9)(A). (ii) Psychiatry or psychiatry subspecialty residency The term “psychiatry or psychiatry subspecialty residency” means a residency in psychiatry as accredited by the Accreditation Council for Graduate Medical Education for the purpose of preventing, diagnosing, and treating mental health disorders. (iii) Qualifying hospital The term “qualifying hospital” means a hospital described in any of subclauses (I) through (IV) of subparagraph (B)(ii). (iv) Reference resident level The term “reference resident level” means, with respect to a hospital, the resident level for the most recent cost reporting period of the hospital ending on or before December 29, 2022 , for which a cost report has been settled (or, if not, submitted (subject to audit)), as determined by the Secretary. (v) Resident level The term “resident level” has the meaning given such term in paragraph (7)(C)(i).