Notice2022-22862
Agency Information Collection Activities: Proposed Collection: Public Comment Request; Information Collection Request Title: Initial and Reconciliation Application Forms To Report Graduate Medical Education Data and Full-Time Equivalent (FTE) Residents Trained by Hospitals Participating in the Children's Hospitals Graduate Medical Education Payment Program; and FTE Resident Assessment Forms To Report FTE Residents Trained by Organizations Participating in the Children's Hospitals and Teaching Health Center Graduate Medical Education Programs, OMB No. 0915-0247-Revision
Primary source
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Published
October 21, 2022
Issuing agencies
Health and Human Services DepartmentHealth Resources and Services Administration
Abstract
In compliance with the requirement for opportunity for public comment on proposed data collection projects of the Paperwork Reduction Act of 1995, HRSA announces plans to submit an Information Collection Request (ICR), described below, to the Office of Management and Budget (OMB). Prior to submitting the ICR to OMB, HRSA seeks comments from the public regarding the burden estimate, below, or any other aspect of the ICR.
Full Text
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<title>Federal Register, Volume 87 Issue 203 (Friday, October 21, 2022)</title>
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[Federal Register Volume 87, Number 203 (Friday, October 21, 2022)]
[Notices]
[Pages 64061-64065]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2022-22862]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration
Agency Information Collection Activities: Proposed Collection:
Public Comment Request; Information Collection Request Title: Initial
and Reconciliation Application Forms To Report Graduate Medical
Education Data and Full-Time Equivalent (FTE) Residents Trained by
Hospitals Participating in the Children's Hospitals Graduate Medical
Education Payment Program; and FTE Resident Assessment Forms To Report
FTE Residents Trained by Organizations Participating in the Children's
Hospitals and Teaching Health Center Graduate Medical Education
Programs, OMB No. 0915-0247--Revision
AGENCY: Health Resources and Services Administration (HRSA), Department
of Health and Human Services.
ACTION: Notice.
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SUMMARY: In compliance with the requirement for opportunity for public
comment on proposed data collection projects of the Paperwork Reduction
Act of 1995, HRSA announces plans to submit an Information Collection
Request (ICR), described below, to the Office of Management and Budget
(OMB). Prior to submitting the ICR to OMB, HRSA seeks comments from the
public regarding the burden estimate, below, or any other aspect of the
ICR.
DATES: Comments on this ICR should be received no later than November
21, 2022.
ADDRESSES: Written comments and recommendations for the proposed
information collection should be sent within 30 days of publication of
this notice to <a href="http://www.reginfo.gov/public/do/PRAMain">www.reginfo.gov/public/do/PRAMain</a>. Find this particular
information collection by selecting ``Currently under Review--Open for
Public Comments'' or by using the search function.
FOR FURTHER INFORMATION CONTACT: To request more information on the
proposed project or to obtain a copy of the data collection plans and
draft
[[Page 64062]]
instruments, email <a href="/cdn-cgi/l/email-protection#e99988998c9b9e869b82a9819b9a88c78e869f"><span class="__cf_email__" data-cfemail="730312031601041c0118331b0100125d141c05">[email protected]</span></a> or call Samantha Miller, the
acting HRSA Information Collection Clearance Officer, at (301) 443-
9094.
SUPPLEMENTARY INFORMATION: When submitting comments or requesting
information, please include the ICR title for reference.
Information Collection Request Title: Initial and Reconciliation
Application Forms to Report Graduate Medical Education Data and FTE
Residents Trained by Children's Hospitals Participating in the
Children's Hospitals Graduate Medical Education (CHGME) Payment
Program; and FTE Resident Assessment Forms to Report FTE Residents
Trained by Organizations Participating in the Children's Hospitals and
Teaching Health Center Graduate Medical Education (THCGME) Programs,
OMB No. 0915-0247--Revision.
Abstract: The Healthcare Research and Quality Act of 1999 (Pub. L.
106-129) established the CHGME Payment Program, Section 340E of the
Public Health Service Act, most recently amended by the Dr. Benjy
Frances Brooks Children's Hospital Graduate Medical Education (GME)
Support Reauthorization Act of 2018 (Pub. L. 115-241). In 2010, the
Patient Protection and Affordable Care Act (Pub. L. 111-148)
established the THCGME Program, Section 340H of the Public Health
Service Act, most recently amended by the Consolidated Appropriations
Act, 2021 (Pub. L. 116-260). The American Rescue Plan Act of 2021 (Pub.
L. 117-2) provided additional funding for the THCGME Program.
The CHGME Payment Program and the THCGME Program provide federal
funding to support GME programs that train medical and dental
residents. Specifically, the CHGME Payment Program supports residency
programs at freestanding children's hospitals that train residents in
pediatric, pediatric subspecialty, and non-pediatric care. The THCGME
Program supports training for primary care residents (including
residents in family medicine, internal medicine, pediatrics, internal
medicine-pediatrics, obstetrics and gynecology, psychiatry, general
dentistry, pediatric dentistry, and geriatrics) in community-based
ambulatory patient care settings.
Children's hospitals and teaching health centers funded by HRSA's
CHGME and THCGME programs, respectively, are required to report the
number of FTE residents trained during the federal fiscal year (FY).
Fiscal intermediaries are contracted by HRSA to carry out an assessment
of FTE resident counts reflected in participating children's hospitals
and teaching health centers applications to determine any changes to
the resident FTE counts initially reported. Fiscal intermediaries audit
the data reported by the children's hospitals and the teaching health
centers and report the verified FTE resident counts to HRSA. An
assessment of the children's hospital and teaching health center data
ensures that applicable Medicare regulations and HRSA program
requirements are followed when determining the number of full-time
equivalent residents eligible for funding.
HRSA plans to submit an Information Collection Request for several
reasons. First, the current OMB clearance for the CHGME Payment Program
application and FTE resident assessment forms and exhibits expires
January 31, 2023. Second, in addition to using the FTE resident
assessment forms and exhibits for the CHGME Payment Program audits,
HRSA plans to use CHGME FTE resident assessment forms and exhibits for
THCGME Program audits. HRSA combined the FTE resident assessments of
participating children's hospitals and teaching health centers into one
audit contract to reduce costs to the federal government and to
facilitate the fiscal intermediary's review of those residents training
in both children's hospitals and teaching health centers funded by
HRSA. As part of the FTE resident assessment process, the fiscal
intermediary must ensure resolution of overlaps identified in the FTE
residents reported between CHGME children's hospitals and the THCGME
teaching health centers. The overlap reports indicate when an FTE
resident is claimed for CHGME payment during the same period of
training time claimed for reimbursement from any other source of
federal GME funding, to include the THCGME Program. The use of the same
FTE resident assessment forms and exhibits during the audit of both the
children's hospitals and teaching health centers is more efficient for
fiscal intermediaries to complete that perform both CHGME and THCGME
audits, and for HRSA to review. Lastly, HRSA is proposing changes to
the current CHGME Payment Program application and the FTE assessment
forms and exhibits to be used for the CHGME Payment Program and THCGME
Program. The changes are only proposed to the HRSA 99-1 form (also
known as Exhibit O(2)), the HRSA 99-5 form, and the FTE resident
assessment exhibits. All other CHGME Payment Program application and
FTE resident assessment forms are the same as currently approved. The
changes described require OMB approval and are as follows:
1. CHGME Payment Program Application Instructions and Guidance:
Update initial and reconciliation application instructions and
guidance. Some of the examples provided in the instructions and
guidance reference the FY 2010 application cycle and related dates.
HRSA will update these dates to FY 2020 or more information that is
relevant to applicants.
2. CHGME Payment Program Application HRSA 99-1 form: Revise Lines
4.05a, 5.05a, and 6.05a of the HRSA 99-1 form to include language
referencing additional add-ons to the cap.
To the extent that it is reasonable and feasible, HRSA adheres to
Centers for Medicare & Medicaid Services (CMS) regulations to ease the
burden for children's teaching hospitals participating in the CHGME
Payment Program that must also comply with CMS regulations.
Specifically, per 66 FR 12940 (March 1, 2001) and 66 FR 37980 (July 20,
2001) the CHGME Payment Program follows the regulations provided at 42
CFR 413.86(f), (g), (h), and (i), which are now reflected in 42 CFR
413.79, regarding the application of the FTE resident caps as described
in Section 1886(h) of the Social Security Act.
The CHGME Payment Program application forms have been revised to
accommodate the final rule with comment period issued by CMS on
December 27, 2021 (86 FR 73416). CMS issued the final rule to implement
policies based on legislative changes relative to Medicare GME for
teaching hospitals provided by Sections 126, 127, and 131 of the
Consolidated Appropriations Act (CAA), 2021 (Pub. L. 116-260).
The final rule implements Sections 126, 127, and 131 of the CAA
affecting Medicare direct GME and indirect medical education (IME)
payments to teaching hospitals. Section 126(a) of the CAA amended
section 1886(h) of the Social Security Act by adding a new section
1886(h)(9) of the Social Security Act requiring the distribution of
additional residency positions to qualifying hospitals. Section 127 of
the CAA amended section 1886(h)(4)(H)(iv) of the Social Security Act to
specify that in the case of a hospital not located in a rural area that
established or establishes a medical residency training program (or
rural track) in a rural area, the hospital, and each such hospital
located in a rural area that participates in such a training, is
allowed to receive
[[Page 64063]]
an adjustment to its FTE resident limit. Section 131 of the CAA also
amended section 1886(h)(4)(H)(i) of the Social Security Act to provide
an opportunity for hospitals that meet certain criteria and that have
very small FTE resident caps to replace those caps if the Secretary
determines the hospital begins training residents in a new program
beginning on or after enactment (December 27, 2020) and before 5 years
after enactment (December 26, 2025).
HRSA proposes to revise lines 4.05a, 5.05a, and 6.05a of the HRSA
99-1 form, which currently provide: ``Addition (to the cap) for the
unweighted resident FTE count for allopathic and osteopathic programs
due to Sec. 5503 of ACA.'' The revised language in lines 4.05a, 5.05a,
and 6.05a of the HRSA 99-1 form would provide: ``Addition (to the cap)
for the unweighted FTE resident count for allopathic and osteopathic
programs due to Sec. 5503 of ACA, Sec. 126, Sec. 127, and/or Sec.
131 of the CAA.''
3. CHGME Payment Program Application HRSA 99-5 form: Remove items
on the initial/reconciliation application form HRSA 99-5 form
checklist.
HRSA proposes to remove ``(1) a computer disk containing completed
HRSA forms; and (2) a copy of the hospital's completed application
package''. A computer disk of the completed HRSA application forms and
a copy of the completed application package are no longer needed
following the CHGME Payment Program application's integration into
HRSA's Electronic Handbooks. The application forms and supporting
documentation are currently provided electronically via the Electronic
Handbooks Tasks and Reports functions.
4. Revisions to the existing FTE resident assessment exhibits for
use by both the CHGME Payment Program and THCGME Program:
<bullet> Exhibit F--CHGME Fiscal Intermediary Introductory Request
Letter to Hospital: This letter introduces the fiscal intermediary to
the hospital and teaching health center and is a formal request to the
hospital and teaching health center for documentation to support FTE
residents claimed on the hospital's and teaching health center's
application. HRSA proposes revising the title and content of the letter
to provide clarity, reduce errors, and add language inclusive of
teaching health centers. The revised title will be Fiscal Intermediary
Introductory Request Letter to Teaching Provider.
<bullet> Exhibit N--Points for Future CHGME Auditors: This form
facilitates continuity of communication from one fiscal intermediary to
the next and helps HRSA and fiscal intermediaries track and follow up
any issues with each hospital in a timely manner. HRSA proposes
revising the title and content to include an area for points from prior
years and to add language inclusive of teaching health centers. The
revised title will be Points for Future Audits.
<bullet> Exhibit S--Final Medicare Administrative Contractor (MAC)
Letter/``Top Memorandum'': This letter is sent from the fiscal
intermediary to the MAC of each children's hospital and any teaching
health center affiliated hospital following completion of the audit.
This letter is to notify the MAC of the completion of the resident FTE
assessment for each respective children's hospital or teaching health
center affiliated hospital and to provide a summary report of the audit
findings to be incorporated into the Medicare cost report, if
applicable. HRSA has proposed revising the title and content to include
the notification to the MAC of the identification of an overlap and the
release of FTE resident(s) by the children's hospital or a teaching
health center affiliated hospital to resolve an overlap, if applicable.
The revised title will be Final MAC Adjustment and Overlap Resolution
Letter.
5. Addition of one FTE resident assessment exhibit for use by both
the CHGME Payment Program and THCGME Program:
HRSA proposes to add Exhibit E--Fiscal Intermediary Introductory
Request Letter to MAC which would request hospital information prior to
the commencement of the audit. This is a document that the fiscal
intermediaries currently use internally and include in their own
working papers. HRSA proposes to have this document included as part of
the FTE resident assessment report submitted by the fiscal
intermediaries to HRSA.
<bullet> This letter introduces the fiscal intermediary to the MAC
and is a formal request to the MAC for documentation to support FTE
residents claimed on the children's hospital's application and the
teaching health center's affiliated hospital Medicare Cost Report.
6. Deletion of one FTE resident assessment exhibit previously used
by the CHGME Payment Program.
HRSA proposes to discontinue the use of the FTE Resident Assessment
Cover Letter, which is no longer needed to share information from the
fiscal intermediary. The Conversation Record exhibit currently provides
the same information.
<bullet> This letter includes a brief description of the audit that
was performed and for which years, as well as a list of the documents
included for review by the CHGME Payment Program.
A 60-day notice published in the Federal Register on August 8,
2022, vol. 87, No. 151, pp. 48182-48186. There was one public comment
requesting information on types of residents reported, and a request to
view the draft forms and documentation.
Need and Proposed Use of the Information: Information collected
will be used during the CHGME Payment Program initial application and
the reconciliation process for both the CHGME Payment Program and
THCGME Program to determine the amount of graduate medical education
payments to be distributed to participating children's hospitals and
teaching health centers. The CHGME Payment Program initial application
forms and the FTE resident assessment forms for both the CHGME Payment
Program and THCGME Program will also be used to determine CHGME Payment
Program and THCGME Program eligibility and compliance with the
programs' requirements.
Likely Respondents: The CHGME Payment Program applicants, CHGME
Payment Program participants, and fiscal intermediaries auditing data
submitted by the participating children's hospitals and teaching health
centers.
Burden Statement: Burden in this context means the time expended by
persons to generate, maintain, retain, disclose, or provide the
information requested. This includes the time needed to review
instructions; to develop, acquire, install, and utilize technology and
systems for the purpose of collecting, validating, and verifying
information, processing and maintaining information, and disclosing and
providing information; to train personnel and to be able to respond to
a collection of information; to search data sources; to complete and
review the collection of information; and to transmit or otherwise
disclose the information. The total annual burden hours estimated for
this ICR are summarized in the table below. The CHGME participating
children's hospitals report their FTE residents using forms and
exhibits approved by OMB (#0915-0247). The THCGME participating
teaching health centers report their FTE residents using forms, tools
and exhibits approved by OMB (#0915-0342 and #0915-0367). The FTE
resident assessment forms and exhibits currently approved for use by
the CHGME Payment Program under OMB clearance #0915-0247 will be
reviewed or completed by the fiscal intermediaries during the audit of
the
[[Page 64064]]
FTE residents reported by the teaching health centers participating in
the THCGME Program. The FTE resident assessment forms and exhibits are
submitted to HRSA for approval. The fiscal intermediaries currently
reviewing or completing the forms and exhibits to perform the audit of
the 60 children's hospitals will utilize the forms and exhibits during
the audit of 60 teaching health centers. The increased number of
responses from the fiscal intermediaries related to the additional 60
THCGME audits performed results in an increase of approximately 2,000
burden hours.
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Number of Average burden
Total estimated annualized Number of responses per Total responses per response Total burden
burden hours: Form name respondents respondent (in hours) hours
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Application Cover Letter 60.............. 2 120............ 0.33 39.6
(CHGME Initial and
Reconciliation).
HRSA 99 Form (CHGME Initial 60.............. 2 120............ 0.33 39.6
and Reconciliation).
HRSA 99-1 Form (CHGME 60.............. 1 60............. 26.50 1,590.0
Initial).
HRSA 99-1 Form (CHGME 60.............. 1 60............. 6.50 390.0
Reconciliation).
HRSA 99-1 (Supplemental) 30.............. 2 60............. 3.67 220.2
(CHGME FTE Resident
Assessment Only).
HRSA 99-2 Form (CHGME 60.............. 1 60............. 11.33 679.8
Initial).
HRSA 99-2 Form (CHGME 60.............. 1 60............. 3.67 220.2
Reconciliation).
HRSA 99-4 Form (CHGME 60.............. 1 60............. 12.50 750.0
Reconciliation).
HRSA 99-5 Form (Initial and 60.............. 2 120............ 0.33 39.6
Reconciliation).
CFO Form Letter (CHGME 60.............. 2 120............ 0.33 39.6
Initial and Reconciliation).
Exhibit 2 (CHGME Initial and 60.............. 2 120............ 0.33 39.6
Reconciliation).
Exhibit 3 (CHGME Initial and 60.............. 2 120............ 0.33 39.6
Reconciliation).
Exhibit 4 (CHGME Initial and 60.............. 2 120............ 0.33 39.6
Reconciliation).
Conversation Record (CHGME 30.............. 2 60............. 3.67 220.2
FTE Resident Assessment
Only).
Exhibit C (CHGME and THCGME 30.............. 4 120............ 3.67 440.4
FTE Resident Assessment).
Exhibit E (CHGME and THCGME 30.............. 4 120............ 3.67 440.4
FTE Resident Assessment).
Exhibit F (CHGME and THCGME 30.............. 4 120............ 3.67 440.4
FTE Resident Assessment).
Exhibit N (CHGME and THCGME 30.............. 4 120............ 3.67 440.4
FTE Resident Assessment).
Exhibit O(1) (CHGME and 30.............. 4 120............ 3.67 440.4
THCGME FTE Resident
Assessment).
Exhibit O(2) (HRSA 99-1) 30.............. 2 60............. 26.5 1590.0
(CHGME FTE Resident
Assessment Only).
Exhibit P (Reconciliation 30.............. 4 120............ 3.67 440.4
Tool) (CHGME and THCGME FTE
Resident Assessment).
Exhibit P(2) (CHGME and 30.............. 4 120............ 3.67 440.4
THCGME FTE Resident
Assessment).
Exhibit S (CHGME and THCGME 30.............. 4 120............ 3.67 440.4
FTE Resident Assessment).
Exhibit T (CHGME FTE Resident 30.............. 2 60............. 3.67 220.2
Assessment Only).
Exhibit T(1) (CHGME FTE 30.............. 2 60............. 3.67 220.2
Resident Assessment Only).
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Exhibit 1 (CHGME FTE Resident 30.............. 2 60............. 0.33 19.8
Assessment Only).
Exhibit 2 (CHGME FTE Resident 30.............. 2 60............. 0.33 19.8
Assessment Only).
Exhibit 3 (CHGME FTE Resident 30.............. 2 60............. 0.33 19.8
Assessment Only).
Exhibit 4 (CHGME FTE Resident 30.............. 2 60............. 0.33 19.8
Assessment Only).
Total.................... 90 (60 .............. 180 (60 .............. *** 9,980.40
children's children's
hospitals and hospitals
30 fiscal applications,
intermediaries 60 CHGME
*. audits and 60
THCGME audits)
**.
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* The total respondents are 90 because children's hospitals (60) and fiscal intermediaries (30) are completing
the forms.
** The total responses are 180 because children's hospitals (60) and fiscal intermediaries for the CHGME audits
(60) and the THCGME audits (60) are completing the forms.
*** The increase of 2,000 burden hours is due to the additional 60 THCGME audits.
HRSA specifically requests comments on (1) the necessity and
utility of the proposed information collection for the proper
performance of the agency's functions, (2) the accuracy of the
estimated burden, (3) ways to enhance the quality, utility, and clarity
of the information to be collected, and (4) the use of automated
collection techniques or other forms of information technology to
minimize the information collection burden.
Maria G. Button,
Director, Executive Secretariat.
[FR Doc. 2022-22862 Filed 10-20-22; 8:45 am]
BILLING CODE 4165-15-P
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