years of age. (iii) The institution has an average length of stay of less than 21 days for hospital inpatients age 65 or older. (iv) The institution has an approved medical residency training program and receive payment due under the Medicare and Medicaid programs for the reasonable costs of graduate medical education. (v) The institution uses psychiatric residents to provide inpatient psychiatric hospital services to individuals under the Medicare and Medicaid programs. (vi) The institution has documented experience in providing services to active duty military personnel and veterans. (vii) The institution has standards to care for the whole person, including referral agreements or other arrangements to address a patient’s medical, surgical, or diagnostic needs if such treatment services are not available within the institution. (viii) The institution agrees to report on quality measures (in such form, manner, and frequency as specified by the Secretary) and report to the Secretary (in a form, manner, and frequency as specified by the Secretary) such data as the Secretary determines appropriate to monitor and evaluate the demonstration project. (ix) The institution agrees to plan and implement an annual performance improvement project, aimed at improving the effectiveness of care provided to high utilizers of inpatient psychiatric hospital services (as defined in subsection (h)(1)), with identifiable measures in coordination with the Secretary and the State. (c) Deadline for implementation The Secretary shall implement the demonstration project by January 1, 2019. (d) Length of demonstration project The demonstration project shall be conducted for a period of 7 consecutive years. (e) Budget neutrality With respect to the operation of the demonstration project in a State for the period described in subsection (d), the State must demonstrate to the Secretary that project will not result in a net increase in the aggregate expenditures under the Medicaid program for such period for the State above the level of such