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Children's Hospitals Graduate Medical Education Payment Program CHGME PP ALERT - TIMELINE FOR RECONCILIATION PAYMENTS This notice requests comments on setting a final date for inclusion of hearing decisions by the Provider Reimbursement Review Board (PRRB) for Federal fiscal year (FFY) payment purposes. The proposal is to set July 15 for the 2004 FFY and June 30th for future FFYs. If the Board has not determined the actual number of full time equivalent residents (FTEs) in a particular case by such date, the decision of the CHGME fiscal intermediary (FI), which is overseen by the Department, will stand. A Board decision after such date would be taken into account for payment determinations in the next FFY as appropriate. The CHGME PP is required to distribute all appropriated funds within
the FFY. To comply with this requirement, the date 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 In order to distribute all appropriated funds to children’s hospitals participating in the CHGME PP within a FFY, assessments of FTE resident counts must be completed prior to the due date for submission of the reconciliation applications. For FFY 2004, the CHGME PP has received all reconciliation applications and will be completing program review by the first week in June. The reconciliation applications reflect the final decision of the CHGME FI. The program will make final determination of reconciliation payments by the third week in June, with reconciliation payments to participating children’s hospitals starting July 7. However, if one or more of the participating children’s hospitals dispute the CHGME FI’s final assessments of their FTE resident count, they may appeal this determination. Specifically, for CHGME PP FTE resident count disputes that would affect CHGME payments in excess of $10,000, a hospital may request a hearing by the PRRB as specified in §1878 of the Social Security Act (42 U.S.C. 1395oo), implemented by regulations at 42 C.F.R. Part 405, subpart R. As the official with the delegated authority to administer the CHGME PP, the HRSA Administrator may affirm, reverse, or modify decisions of the PRRB brought under this program. The Board has done a remarkable job of expediting hearings for this unique program. However, both the Board and the HRSA Administrator must have a reasonable period of time for the review process. Although the July 15th -and June 30th in future years- deadline may present a challenge for resolving any remaining disputes before the Board, the Department must fulfill its statutory mandate and duty to all participating hospitals. However, continuing PRRB cases may still be considered. A Board decision after such date would be taken into account for payment decisions in the next FFY. Submit all written comments on this proposal by June 17, 2004, to Ayah E. Johnson Ph.D., Chief, Graduate Medical Branch, Division of Medicine and Dentistry, Bureau of Health Professions, Health Resources and Services Administration, Room 9A-05, Parklawn Building, 5600 Fishers Lane, Rockville Maryland 20857; or by e-mail to ChildrensHospitalsGME@hrsa.gov. For further information contact Dr. Ayah Johnson at (301) 443-1058 or (301) 443-6190.
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