; or (ii) located in a rural area (as defined in section 1886(d)(2)(D) of the Social Security Act). . (4) Report on training costs Not later than March 31, 2019, the Secretary of Health and Human Services shall submit to the Congress a report on the direct graduate expenses of approved graduate medical residency training programs, and the indirect expenses associated with the additional costs of teaching residents, of qualified teaching health centers (as such terms are used or defined in section 340H of the Public Health Service Act ( 42 U.S.C. 256h )). (5) Definition Subsection (j) of section 340H of the Public Health Service Act ( 42 U.S.C. 256h ) is amended— (A) by redesignating paragraphs (2) and (3) as paragraphs (3) and (4), respectively