Notice2024-31240
Children's Hospitals Graduate Medical Education Payment Program: Updated Methodology To Determine Full-Time Equivalent Resident Count
Primary source
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Published
December 30, 2024
Issuing agencies
Health and Human Services DepartmentHealth Resources and Services Administration
Abstract
This notice seeks public comment on updating the Children's Hospitals Graduate Medical Education (CHGME) Payment Program's method of determining an eligible children's hospital (as defined within the Public Health Service Act) weighted allopathic and osteopathic full- time equivalent (FTE) resident count when a children's hospital's weighted allopathic and osteopathic FTE resident count exceeds its direct graduate medical education (GME) FTE resident cap in order to be consistent with the methodology used by the Centers for Medicare & Medicaid Services (CMS) beginning in the fiscal year (FY) 2026 application cycle.
Full Text
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<title>Federal Register, Volume 89 Issue 249 (Monday, December 30, 2024)</title>
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[Federal Register Volume 89, Number 249 (Monday, December 30, 2024)]
[Notices]
[Pages 106525-106526]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2024-31240]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration
Children's Hospitals Graduate Medical Education Payment Program:
Updated Methodology To Determine Full-Time Equivalent Resident Count
AGENCY: Health Resources and Services Administration (HRSA), Department
of Health and Human Services.
ACTION: Request for public comment.
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SUMMARY: This notice seeks public comment on updating the Children's
Hospitals Graduate Medical Education (CHGME) Payment Program's method
of determining an eligible children's hospital (as defined within the
Public Health Service Act) weighted allopathic and osteopathic full-
time equivalent (FTE) resident count when a children's hospital's
weighted allopathic and osteopathic FTE resident count exceeds its
direct graduate medical education (GME) FTE resident cap in order to be
consistent with the methodology used by the Centers for Medicare &
Medicaid Services (CMS) beginning in the fiscal year (FY) 2026
application cycle.
DATES: Comments on this notice should be received no later than January
29, 2025.
ADDRESSES: Written comments should be submitted to Robyn Duarte, Public
Health Analyst, by email <a href="/cdn-cgi/l/email-protection#4e1c0a3b2f3c3a2b7f0e263c3d2f60292138"><span class="__cf_email__" data-cfemail="beecfacbdfcccadb8ffed6cccddf90d9d1c8">[email protected]</span></a>.
FOR FURTHER INFORMATION CONTACT: Robyn Duarte, Public Health Analyst,
Bureau of Health Workforce, Division of Medicine and Dentistry, HRSA,
5600 Fishers Lane, Rockville, MD 20857, 301-443-3254.
SUPPLEMENTARY INFORMATION: The CHGME Payment Program is authorized by
section 340E of the Public Health Service Act. For direct GME payments,
section 340E(c)(1)(B) requires that the average number of FTE residents
in the hospital's approved residency programs be determined according
to section 1886(h)(4) of the Social Security Act. As noticed in the
March 1, 2001, Federal Register (66 FR 12940), section 1886(h)(4) has
been implemented by regulations at 42 CFR 413.78 through 413.83
(formerly 42 CFR 413.86(f)-(i)), which HRSA has used to determine the
total and weighted numbers of FTE residents. In the CMS FY 2023
inpatient prospective payment systems (IPPS) and long-term care
hospital prospective payment system (LTCH PPS) final rule published in
the Federal Register on August 10, 2022 (87 FR 48780, 49065-49072)
(referred to as the ``FY 2023 IPPS/LTCH PPS final rule''), CMS modified
the Medicare direct GME payment methodology and amended section 413.79
by revising paragraphs (c)(2)(iii) and (d)(3). Through this notice,
HRSA is seeking comment on its intent to adopt the same direct GME
payment methodology as CMS when HRSA calculates FTE residents for the
CHGME Payment Program beginning in the FY 2026 application cycle.
Background
To the extent feasible, HRSA has historically sought consistency
with CMS regulations to minimize burden for children's teaching
hospitals participating in the CHGME Payment Program that must also
comply with CMS regulations. Consistency reduces the potential
challenges in reporting FTE resident counts to Medicare and CHGME.
Currently, the CHGME Payment Program methodology for determining
the weighted allopathic and osteopathic FTE resident count applies the
direct GME FTE resident cap when a hospital's weighted allopathic and
osteopathic FTE resident count is greater than its direct GME FTE
resident cap. The current CHGME direct GME methodology reduces a
hospital's weighted direct GME resident count by a proportion equal to
the ratio of its GME FTE resident cap to its unweighted direct GME
resident count. The direct GME FTE resident cap is applied to reduce
the weighting factor of residents who are beyond their initial
residency
[[Page 106526]]
period to an amount less than 0.5. See 66 FR 12940.
CMS GME Final Regulation Change
In August 2022, CMS finalized a new methodology for applying the
direct GME FTE resident cap when a hospital's weighted allopathic and
osteopathic FTE resident count is greater than its direct GME FTE
resident cap, in a way that does not reduce the weighting factor of
residents that are beyond their initial residency period to an amount
less than 0.5. Under the new method, if a hospital's unweighted
allopathic and osteopathic FTE resident count exceeds its direct GME
FTE resident cap, then the weighted allopathic and osteopathic FTE
resident count is equal to the hospital's direct GME FTE resident cap
or its actual weighted allopathic and osteopathic FTE resident count,
whichever is lesser. The direct GME FTE resident cap reflects the
maximum number of allopathic and osteopathic residents that a hospital
may count for purposes of direct GME payment in a cost reporting
period.
Alignment of CHGME and Medicare GME Policy
For more than two decades, HRSA has followed CMS's approach to
calculating the FTE resident count. [See March 1, 2001, Federal
Register Notice (66 FRN 12940), ``The Department follows Medicare
rules regarding the use of the initial residency period. The Medicare
rules reduce counts for all hospitals that train residents beyond their
initial residency period (i.e., fellows) with regard to the [direct
medical education] DME and [indirect Medical Education] IME portions of
the GME reimbursement.''] Therefore, HRSA proposes to adopt CMS's
modified direct GME payment methodology with respect to determining the
weighted number of allopathic and osteopathic FTE residents (i.e.,
fellows) for all eligible children's hospitals participating in the
CHGME Payment Program beginning in FY 2026.
In this notice, we refer to the FTE adjusted cap (or 2013 CHGME
Reauthorization cap pursuant to Pub. L. 113-98) reported on Line 4.06,
5.06, and 6.06 of the HRSA 99-1 Form as the ``direct GME FTE resident
cap'' to correspond with CMS terminology.
HRSA proposes to modify its methodology to adopt the CMS
methodology described in the amended 42 CFR 413.79 in whole. HRSA
anticipates implementing the updated methodology for determining the
weighted allopathic and osteopathic FTE resident count starting in the
FY 2026 application cycle (project period October 1, 2025, through
September 30, 2026).
Direct GME Methodology in FY 2026--Proposal for Public Comment
Starting in FY 2026, where a CHGME participating hospital's
unweighted allopathic and osteopathic FTE resident count exceeds the
hospital's FTE resident cap, and the weighted allopathic and
osteopathic FTE resident count also exceeds that FTE resident cap, the
respective weighted allopathic and osteopathic FTE resident count is
adjusted to make the total weighted allopathic and osteopathic FTE
resident count equal the FTE resident cap. If the weighted allopathic
and osteopathic FTE resident count does not exceed that FTE resident
cap, then the allowable weighted allopathic and osteopathic FTE
resident count for direct GME payment is the actual weighted allopathic
and osteopathic FTE resident count.
This proposed update to the methodology for determining the
weighted allopathic and osteopathic FTE resident count for the CHGME
Program is intended to reconcile weighted FTE resident counts reported
in Lines 4.13 (both Hospital Data columns), 5.13, and 6.13 of the HRSA
Form 99-1 with Lines 9 and 22 of the CMS Form 2552-10, Worksheet E-4,
respectively. Entries in Lines 4.13 (both Hospital Data columns), 5.13,
and 6.13 report the weighted resident FTE count for allopathic and
osteopathic programs following application of the direct GME FTE
resident cap.
This updated methodology for determining weighted allopathic and
osteopathic FTE resident count may result in adjustments to the
weighted FTE resident 3-year rolling average used to determine direct
medical education (DME) payment amounts for the eligible children's
hospitals participating in the CHGME Payment Program.
The DME payment amounts for CHGME are impacted by many factors
including the number of residents the hospital trained during the year,
the hospital's wage index, as well as the overall appropriation. The
updated methodology for determining the weighted FTE resident count
will impact awardees that add more residents and fellows above their
hospital's direct GME FTE resident cap. The updated methodology may
also impact the DME payments for awardees overall as a hospital may
receive a different relative share of the CHGME appropriation due to
these shifts in the weighted FTE resident counts experienced by some
hospitals.
The CHGME Payment Program proposes to implement this updated
methodology beginning in FY 2026 to reduce burden on hospitals
participating in CHGME and Medicare GME and to reduce the risk of
potential audit discrepancies that may impact payments.
Diana Espinosa,
Principal Deputy Administrator.
[FR Doc. 2024-31240 Filed 12-27-24; 8:45 am]
BILLING CODE 4165-15-P
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