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Section 1886(h) of the Act, as added by section 9202 of the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 (Pub. L. 99-272) and implemented in regulations at existing §§413.75 through 413.83, establish a methodology for determining payments to hospitals for the costs of approved graduate medical education (GME) programs. Section 1886(h)(2) of the Act, as added by COBRA, sets forth a payment methodology for the determination of a hospital-specific, base-period per resident amount (PRA) that is calculated by dividing a hospital's allowable costs of GME for a base period by its number of residents in the base period. The base period is, for most hospitals, the hospital's cost reporting period beginning in FY 1984 (that is, the period of beginning between October 1, 1983, through September 30, 1984). Medicare direct GME payments are calculated by multiplying the PRA times the weighted number of full-time equivalent (FTE) residents working in all areas of the hospital (and non-hospital sites, when applicable), and the hospital's Medicare share of total inpatient days. Section 1886(h)(4)(F) of the Act established limits on the number of allopathic and osteopathic residents that hospitals may count for purposes of calculating direct GME payments. For most hospitals, the limits were the number of allopathic and osteopathic FTE residents training in the hospital's most recent cost reporting period ending on or before December 31, 1996. Under section 1886(h)(4)(E) of the Act, a hospital may count residents training in non-hospital settings for direct GME purposes (and under section 1886(d)(5)(B)(iv) of the Act, for IME purposes), if the residents spend their time in patient care activities and if ". . . the hospital incurs all, or substantially all, of the costs for the training program in that setting." The implementing regulations, first at §413.86(f)(3), effective July 1, 1987, and later at §413.86(f)(4) (redesignated as §413.78(d)) , effective January 1, 1999, require that, in addition to incurring all or substantially all of the costs of the program at the non-hospital setting, there must be a written agreement between the hospital and the non-hospital site (in place prior to the time the hospital begins to count the residents training in the non-hospital site) stating that the hospital will incur all or substantially all of the costs of training in the non-hospital setting. The regulations further specify that the written agreement must indicate the amount of compensation provided by the hospital to the non-hospital site for supervisory teaching activities. Effective October 1, 2004, the hospital must either have a written agreement with the non-hospital setting, or, as described in the regulations at §413.78(e), pay for all or substantially all of the costs concurrently with the training in the non-hospital setting. The following additional information is available via the links in the Downloads section at the bottom of the page: - Statement of Mark B. McClellan, M.D., Ph.D., Administrator, Centers for Medicare & Medicaid Services - Medicare Policy Clarifications on Graduate Medical Education Payments for Residents Training in Non-Hospital Settings (Posted: 04/08/05)
- View Questions Related to Medicare GME Payments for Residents Training in Non-Hospital Settings - These FAQs clarify the regulations related to how hospitals may include residents who are training in non-hospital settings in their resident count for purposes of determining their Direct Graduate Medical Education (DGME) and Indirect Graduate Medical Education (IME) payments. These FAQs focus on the documentation requirements related to counting residents' time in non-hospital settings, particularly those concerning teaching physician compensation. (Posted: 04/08/05)
- Section 422 Cap Increases of the P.L. 108-173 under Section 1886 (h)(7)(B) of the Act
Page Last Modified: 11/05/2008 7:28:42 AM
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