Notice2025-09364
Children's Hospitals Graduate Medical Education Payment Program: Updated Methodology To Determine Full-Time Equivalent Resident Count
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Published
May 27, 2025
Issuing agencies
Health and Human Services DepartmentHealth Resources and Services Administration
Abstract
HRSA published a notice in the Federal Register on December 30, 2024, soliciting feedback for a proposed update to the Children's Hospitals Graduate Medical Education (CHGME) Payment Program's method of determining an eligible children's hospital's (as defined within the Public Health Service Act) weighted allopathic and osteopathic full- time equivalent (FTE) resident count when this count exceeds its direct graduate medical education (GME) FTE resident cap. This proposed change is being made to be consistent with the methodology used by the Centers for Medicare & Medicaid Services (CMS) consistent with CHGME Payment Program's long-standing practice of using the same methodology in calculating FTE counts as CMS does in Medicare GME and to minimize administrative burden on hospital who participate in both programs. This notice summarizes and responds to the comments received during the 30-day comment period.
Full Text
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<title>Federal Register, Volume 90 Issue 100 (Tuesday, May 27, 2025)</title>
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[Federal Register Volume 90, Number 100 (Tuesday, May 27, 2025)]
[Notices]
[Pages 22315-22316]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2025-09364]
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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: Final response.
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SUMMARY: HRSA published a notice in the Federal Register on December
30, 2024, soliciting feedback for a proposed update to the Children's
Hospitals Graduate Medical Education (CHGME) Payment Program's method
of determining an eligible children's hospital's (as defined within the
Public Health Service Act) weighted allopathic and osteopathic full-
time equivalent (FTE) resident count when this count exceeds its direct
graduate medical education (GME) FTE resident cap. This proposed change
is being made to be consistent with the methodology used by the Centers
for Medicare & Medicaid Services (CMS) consistent with CHGME Payment
Program's long-standing practice of using the same methodology in
calculating FTE counts as CMS does in Medicare GME and to minimize
administrative burden on hospital who participate in both programs.
This notice summarizes and responds to the comments received during the
30-day comment period.
DATES: The proposed update to the CHGME direct GME methodology will be
implemented beginning in the fiscal year (FY) 2026 application cycle.
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, <a href="/cdn-cgi/l/email-protection#c49680b1a5b6b0a1f584acb6b7a5eaa3abb2"><span class="__cf_email__" data-cfemail="b6e4f2c3d7c4c2d387f6dec4c5d798d1d9c0">[email protected]</span></a>.
SUPPLEMENTARY INFORMATION: On December 30, 2024, through a Federal
Register Notice, HRSA announced a 30-day public comment period to
solicit input on the proposed updated direct GME methodology. Starting
in FY 2026, where both a CHGME participating hospital's unweighted and
weighted allopathic and osteopathic FTE resident counts exceed the FTE
resident cap, the respective weighted allopathic and osteopathic FTE
resident count is adjusted to equal the FTE resident cap. Where the
weighted allopathic and osteopathic FTE resident count does not exceed
the FTE resident cap, then the adjusted weighted allopathic and
osteopathic FTE resident count is the actual weighted allopathic and
osteopathic FTE resident count.
This proposed update to the methodology 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 may result in adjustments to the weighted
FTE resident 3-year rolling average used to determine direct medical
education payment amounts for the eligible children's hospitals
participating in the CHGME Payment Program.
HRSA received seven comments in response to the Federal Register
notice. HRSA carefully reviewed and considered the comments it received
and has synthesized and summarized the comments below.
Alignment of CHGME and CMS Direct GME Policy
Summary of Comments
Commenters supported the adoption of CMS' finalized 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 because the proposed updated CHGME
methodology provides an opportunity for CHGME participating children's
hospitals to determine an increased number of weighted allopathic and
osteopathic FTE residents and mirrors CMS' newly finalized methodology.
Response
HRSA agrees the adoption of CMS' modified direct GME payment
methodology with respect to determining the number of weighted
allopathic and osteopathic FTE residents (i.e., fellows) for all
eligible children's hospitals participating in the CHGME Payment
Program beginning in
[[Page 22316]]
FY 2026 will ensure that a participating children's hospital that
trains more fellows than included in its direct GME FTE resident cap
does not have its GME FTE resident cap reduced and minimize burden for
children's hospitals participating in the CHGME Payment Program that
must also comply with CMS regulations.
Impact of Updated CHGME Direct GME Policy
Summary of Comments
Commenters acknowledged CHGME's adoption of the new methodology
will result in changes to weighted allopathic and osteopathic FTE
resident counts and subsequent CHGME payments. Commenters stated that
due to the CHGME payment structure, the updated methodology will affect
each CHGME participating children's hospital's payments differently,
and an increase for one hospital may result in changes to other
hospitals' payments, and therefore the actual impact on individual
children's hospital's payments is unclear.
Response
HRSA cannot estimate payments until all the participating
children's hospitals submit their application data and a final
appropriation is provided, but acknowledges final payment amounts may
be affected. The direct medical education and indirect medical
education payments allocated to eligible children's hospitals are a
function of the number of resident FTEs participating in approved
medical residency programs (including the 3-year rolling average of
weighted resident FTE counts), inpatient discharges, case mix index,
and the number of inpatient available beds, as reported by children's
hospitals in their applications for CHGME Payment Program funding, as
well as the total funding appropriated for the program. Each of the
payments is determined by a legislative payment formula, and a hospital
receives its proportion of the total CHGME funding based on the
calculation of the formula.
The new method of calculating weighted allopathic and osteopathic
FTE resident counts may result in adjustments to the weighted FTE
resident 3-year rolling average used to calculate CHGME direct medical
education payments for the 59 children's hospitals currently
participating in the program. These adjustments are due to an increase
in the number of FTE residents credited to those hospitals that had
previously reported weighted allopathic and osteopathic FTE residents
at less than a 0.50 weighting factor due to the prior direct GME method
of calculating weighted allopathic and osteopathic FTE residents. As
the payment amount calculated for each hospital is determined by
multiple variables including FTE counts, and each hospital receives a
share of the total funding available, it is not possible to determine
the effect the updated methodology will have on the payment received by
each children's hospital.
Conclusion
HRSA thanks the public for their comments. After consideration of
the public comments received, HRSA is implementing the modification to
its direct GME 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 residents starting in the FY 2026 application cycle
(project period October 1, 2025, through September 30, 2026).
Starting in FY 2026, where both a CHGME participating hospital's
unweighted and weighted allopathic and osteopathic FTE resident counts
exceeds the FTE resident cap, the respective weighted allopathic and
osteopathic FTE resident count is adjusted to equal the FTE resident
cap. Where the weighted allopathic and osteopathic FTE resident count
does not exceed the FTE resident cap, then the adjusted weighted
allopathic and osteopathic FTE resident count is the actual weighted
allopathic and osteopathic FTE resident count.
HRSA will ensure information about the updated methodology is
available to the public and provide additional information regarding
any future change in direct GME methodology on the CHGME Payment
Program website at <a href="https://bhw.hrsa.gov/funding/apply-grant/childrens-hospitals-graduate-medical-education">https://bhw.hrsa.gov/funding/apply-grant/childrens-hospitals-graduate-medical-education</a>. In addition, if any changes to
direct GME methodology are made, HRSA plans to address this methodology
in a future technical assistance webinar should timing allow. HRSA has
historically sought consistency with CMS regulations to minimize the
burden for children's hospitals participating in the CHGME Payment
Program, which must also comply with CMS regulations. Consistency
reduces the potential challenges for CHGME participating hospitals
reporting FTE resident counts to Medicare and CHGME.
Thomas J. Engels,
Administrator.
[FR Doc. 2025-09364 Filed 5-23-25; 8:45 am]
BILLING CODE 4165-15-P
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