; and (bb) an intern and resident to bed ratio of at least 0.19 (or at least 150 residents and fellows); or (II) in the case of such a hospital not described in subclause (I)— (aa) a disproportionate patient bed count of at least 250; (bb) an average Medicare case mix index of at least 2.0; and (cc) an intern and resident to bed ratio of at least 0.2 (or at least 175 residents and fellows); and (iii) a nonprofit hospital with 1,000 or more 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 55 percent (or a disproportionate patient percentage for such fiscal year of at least 55 percent). (C) Specified hospital The term specified hospital means, with respect to a fiscal year, a hospital with an amount determined under subsection (g) for such year that is so determined under paragraph (2)(A)(ii) of such subsection. . (b) Conforming amendment Section 1923(g)(1) of the Social Security Act ( 42 U.S.C. 1396r–4(g)(1) ) is amended by striking A payment adjustment and inserting Subject to subsection (k), a payment adjustment . (c) Effective date The amendments made by this section shall apply with respect to fiscal year 2024 and each subsequent fiscal year.