; resident The terms approved medical residency training program , direct graduate medical education costs , and resident have the meanings given those terms in subsection (h)(5). (C) Rural training location The term rural training location means a location in which training occurs that, based on the 2010 census or any subsequent census adjustment, meets one or more of the following criteria: (i) The training occurs in a location that is a rural area (as defined in section 1886(d)(2)(D)). (ii) The training occurs in a location that has a rural-urban commuting area code equal to or greater than 4.0. (iii) The training occurs in a location that is within 10 miles of a sole community hospital (as defined in subsection (d)(5)(D)(iii))). (7) Budget neutrality requirement The Secretary shall ensure that aggregate payments for direct medical education costs and indirect medical education costs under this title, including any payments under this subsection, for each year (effective beginning on or after the date that is 1 year after the date of enactment of this subsection) are not greater than the aggregate payments for such costs that would have been made under this title for the year without the application of this subsection. For purposes of carrying out the budget neutrality requirement under the preceding sentence, the Secretary may make appropriate adjustments to the amount of such payments for direct graduate medical education costs and indirect medical education costs under subsections (h) and (d)(5)(B), respectively. . (b) Treatment of critical access hospitals and sole community hospitals (1) Critical access hospitals Section 1814(l) of the Social Security Act ( 42 U.S.C. 1395f(l) ) is amended by adding at the end the following new paragraph: (6) For cost reporting periods beginning on or after the date that is 1 year after the date of enactment of this paragraph, the following shall apply: (A) A critical access hospital may elect to be treated as a hospital or as a non-provider setting for purposes of