Community and Rural Medical Residency Preservation Act of 2009 - Amends title XVIII (Medicare) of the Social Security Act with respect to the counting of time spent in outpatient settings by full-time-equivalent residents in approved medical residency training programs, for purposes of indirect medical education (IME) and direct graduate medical education (D-GME) payments.
Defines all, or substantially all, of the costs for the training program in that nonhospital setting as the residents' stipends and benefits and other costs, if any, as determined by the training hospital and the entity (wholly owned or operated by the hospital) operating the nonhospital setting.
Declares that the hospital is not required to pay the entity any amounts other than those determined by the hospital and the entity in order for the hospital to be considered to have incurred all, or substantially all, of the costs for the training program in that setting.