hospital tier. (4) Methodology for States with fewer than 15 disproportionate share hospitals (A) In general In the case of a State that has fewer than 15 disproportionate share hospitals, the State shall use the methodology for identifying and making payments to disproportionate share hospitals that is developed by the Secretary under subparagraph (B). (B) Development of methodology Not later than 18 months after the date of enactment of the SAFE Hospitals Act of 2018 , the Secretary shall develop a methodology for identifying and making payments to disproportionate share hospitals for States that have fewer than 15 disproportionate share hospitals that prioritizes DSH payments to hospitals with disproportionately high volumes of Medicaid patients and low-income patients. (5) No effect on waiver authority Nothing in this subsection shall be construed as preventing the Secretary from approving a waiver under section 1115 or other law with respect to requirements under this subsection related to the methodology used by States to identify and make payments to disproportionate share hospitals. . (b) Modification of cap on individual DSH payments Section 1923(g)(1)(A) of the Social Security Act ( 42 U.S.C. 1396r–4(g)(1)(A) ) is amended, in the first sentence, by inserting , including any costs incurred by the hospital during the year that are associated with subsidizing a physician or a clinic or other health center that is owned and operated by, controlled by, or in common control with the hospital for the purpose of providing care to indigent patients before the period. (c) Modification of DSH qualification requirements (1) In general Section 1923(d)(3) of the Social Security Act ( 42 U.S.C. 1396r–4(d)(3) ) is amended by striking unless the hospital and all that follows through the period and inserting the following: “unless the hospital— (A) has a Medicaid inpatient utilization rate (as defined in subsection (b)(2)) that is not more than 1 standard deviation below the mean Medicaid inpatient utilization rate for