This notice
finalizes the closing date for incorporating hearing determinations
by the Provider Reimbursement Review Board (PRRB) for Federal fiscal
year (FFY) payment purposes in the Children’s Hospitals Graduate
Medical Education Payment Program (CHGME PP). Specifically, for
FFY 2004 the final date will be July 15. June 30 will be the final
date for subsequent years. If the PRRB has not reached a decision
by such date, determining the actual number of full-time equivalent
residents in a particular case, the departmentally overseen decision
of the CHGME fiscal intermediary (FI) will stand. A PRRB decision
after such date would be taken into account for payment determinations
in the next FFY.
On June 4, the
Department issued a notice seeking comments on the establishment
of a final deadline for PRRB decisions under the CHGME PP. In response
to the proposal, the Department received six sets of comments from
interested parties. Several respondents recognized the need to
establish deadlines for an annually funded program in which all
hospitals are statutorily tied together though differing on what
the exact date should be. As explained in the initial proposal,
July 15 for FFY 2004, and June 30 for subsequent years was chosen
to ensure that the CHGME PP has time to: (1) make payment adjustments
to all participating hospitals based on the reconciliation applications;
(2) issue recoupment notices for overpayment if needed; and,
(3) redistribute
any recouped funds within the FFY. These requirements are statutory.
The date also allows some time for the Health Resources and Services
Administration (HRSA) Administrator’s review if necessary.
The Department
also received comments underlining the tension between an annually
funded program and the statutory right of review. While these commenters
objected to deadlines of any form, they failed to outline any mechanism
through which the CHGME PP could complete its statutory –and indeed
constitutional— obligation to disburse all funds prior to the close
of the FFY. Therefore, the Department will adopt the proposed deadlines.
Finally, the
Department received comments on the best way to conduct the auditing
process during the FFY and what statutory changes would be needed
to minimize disruption both before the PRRB and to operate the CHGME
PP more efficiently. The CHGME PP has no authority to change statutory
provisions. Secondly, the CHGME PP’s established, yet evolving,
auditing process is designed to conciliate all interested parties,
including participating hospitals, CHGME FIs, the Department and
the PRRB. The statutorily compressed time for application, audit,
dispute resolution and reconciliation requires some adaptation on
the part of all participants.
As stated in
the proposal, the PRRB has done a remarkable job of expediting hearings
for this unique program. However, the reasoned decision making required
both at the PRRB and at the HRSA Administrator level will suffer
if forced through a hurried process. Although the July 15 and June
30 in future years-deadline may present a challenge for resolving
any remaining disputes before the PRRB, the Department must fulfill
its statutory mandate and duty to all participating hospitals.
Continuing PRRB cases may not necessarily be mooted. A Board decision
after such date would be taken into account for payment decisions
in the next FFY.
For further
information contact Ayah E. Johnson Ph.D., Chief, Graduate Medical
Branch, Division of Medicine and Dentistry, Bureau of Health Professions,
HRSA, Room 9A-05, Parklawn Building, 5600 Fishers Lane, Rockville
Maryland 20857; or by e-mail to ChildrensHospitalGME@hrsa.gov;
or by phone at (301) 443-1058 or (301) 443-6190.
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