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Hospitals may receive direct GME and IME payments for residents in approved medical residency training programs. Section 1886(h)(5)(A) of the Act defines an approved medical residency training program as a residency or other postgraduate medical training program participation in which may be counted toward certification in a specialty or subspecialty and includes formal postgraduate training programs in geriatric medicine approved by the Secretary. The regulations at 413.75(b) define an approved medical residency program for purposes of direct GME payment as a program that meets one of four criteria: (1) is approved by one of the national organizations specified in the regulations at 415.152