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PUBLIC LAW 103-66—AUG. 10, 1993 107 STAT. 605 (A) the requirements of clauses (iv) and (v) of section 1877(hX4XA) of the Social Security Act, as amended by this section, shall not apply; and (B) the second sentence of subsection (aX2), and sub- sections (bX2XB), (c), (dX2), (eXD, and (hX4XB) of section 1877 of such Act, as in effect on the day before the date of the enactment of this Act, shall apply (instead of the corresponding provision in such section as so amended). SEC. 13568. DIRECT GRADUATE MEDICAL EDUCATION. (a) ELIMINATION OF COST-OF-LIVING UPDATE IN PER RESIDENT AMOUNTS FOR DIRECT MEDICAL EDUCATION.—Section 1886(h) (42 U.S.C. 1395ww(h)) is amended— (1) in paragraph (2XD)— (A) by striking 'Tor each" and inserting "(i) Except as provided in clause (ii), for each", and (B) by adding at the end the following new clause: "(ii) For cost reporting periods beginning during fiscal year 1994 or fiscal year 1995, the approved FTE resident amount for a hospital shall not be updated iinder clause (i) for a resident who is not a primary care resident (as defined in paragraph (5XH)) or a resident enrolled in an approved medical residency training program in obstetrics and gynecology."; and (2) in paragraph (5)— (A) by redesignating subparagraph (H) as subpara- graph (I); and (B) by inserting after subparagraph (G) the following new subparagraph: "(H) PRIMARY CARE RESIDENT.—The term 'primary care resident' means a resident enrolled in an approved medical residency training program in family medicine, general internal medicine, general pediatrics, preventive medicine, geriatric medicine, or osteopathic general practice.". (b) INITIAL RESIDENCY PERIOD.— (1) IN GENERAL.—Section 1886(hX5XF) (42 U.S.C. 1395ww(hX5XF)) is amended— (A) by striking "plus one year", and (B) in clause (li), b^ inserting "or a preventive medicine residency or fellowship program" after "fellowship pro- gram". (2) EFFECTIVE DATES.—The amendments made by para- 42USCi395ww graphs (IXA) and (IXB) shall take effect on July 1, 1995, ^o^ and the date of the enactment of this Act, respectively. (c) ADJUSTMENT FOR PUBUCLY-FUNDED FAMILY PRACTICE RESI- DENCY PROGRAMS.— (1) IN GENERAL.—Section 1886(hX5) (42 U.S.C. 1395ww(hX5)), as amended by subsection (a), is amended by adding at the end the following new subparagraph: "(J) ADJUSTMENTS FOR CERTAIN FAMILY PRACTICE RESI- DENCY PROGRAMS.— "(i) IN GENERAL.—^In the case of an approved medi- cal residency training pn^am (meeting the reouire- ments of clause (ii)) of a hospital which received funds from the United States, a State, or a political subdivi- sion of a State or an instrumentality of such a State or political subdivision (other than payments under