; and (B) in the case the amount determined under such subsection for such hospital and such year is so determined under paragraph (2)(A)(ii) of such subsection, individuals described in paragraph (1)(A) of such subsection as in effect on January 1, 2020. (4) Purpose described For purposes of paragraph (1), the purpose described in this paragraph is to ensure that care and services are available under the State plan (or waiver of such plan) in a geographic area at least to the extent that such care and services are available to the general population in such area. (5) Definitions In this subsection: (A) Disproportionate patient bed count The term disproportionate patient bed count means, with respect to a hospital and a fiscal year, the product of— (i) such hospital’s disproportionate patient percentage for such fiscal year; and (ii) such hospital’s number of beds for such fiscal year. (B) Multimission hospital The term multimission hospital means, with respect to a fiscal year— (i) a public hospital with 100 or more beds that has— (I) an average Medicare case mix index of at least 1.3; (II) an intern and resident to bed ratio of at least 0.17 (or at least 125 residents and fellows); and (III) an average disproportionate patient percentage over the 3-year period ending on the last day of such fiscal year of at least 40 percent (or a disproportionate patient percentage for such fiscal year of at least 40 percent); (ii) a nonprofit hospital with more than 199 but fewer than 1,000 beds that has an average disproportionate patient percentage over the 3-year period ending on the last day of such fiscal year of at least 40 percent (or a disproportionate patient percentage for such fiscal year of at least 40 percent) and has— (I) in the case of such a hospital with an average disproportionate patient percentage over such period of at least 45 percent— (aa) an average Medicare case mix index of at least 1.5; and (bb) an intern and resident to bed ratio of at least 0.19 (or at least 150 residents and fellows)