(carryover) The federal government funds many education programs for health care providers, but the vast majority of this funding—more than $10.3 billion in 2015—supports physician residency training through the Department of Health and Human Services's (HHS) Medicare graduate medical education (GME) program. The AMA is providing $15 million over 5 years to fund eight innovation projects aimed at promoting systemic change in residency training. N/A. Medicare Graduate Medical Education Payments: An Overview The federal government makes significant investments in graduate medical education (GME) funding through various programs that support medical residency training; it invested an estimated $16 billion in 2015. Principle 6: Support existing and expanded funding for family medicine residencies by refocusing existing Medicare GME funding to first-certificate residency programs. (2) This section does not address Medicare payments for the direct and indirect costs of graduate medical education (that is, approved residency programs in medicine, osteopathy, dentistry, and podiatry). Medicare and Medicaid GME Funding - Status Update and Advocacy for Change Residency Program Solutions March 2016 Louis Sanner, MD, MSPH Univ of Wisconsin-Madison Lou.sanner@fammed.wisc.edu Future residents can learn with the AMA about the funding and workforce issues residency programs will face in the coming years. Total expenditures in 2017 were $705.9 billion. 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. 3414, S. 2892) would provide Medicare support for an additional 1,000 GME positions over the next five years in hospitals that have, or are in the process of establishing, accredited residency programs in specialties needed to respond to the opioid epidemic. AHA does not claim ownership of any content, including content incorporated by permission into AHA produced materials, created by any third party and cannot grant permission to use, distribute or otherwise reproduce such third party content. In 2017, Medicare covered over 58 million people. For IME purposes, residents training in nonprovider settings must spend their time in patient care activities in order to be counted. Roughly 10,000 Americans turn 65 every day, a trend that will continue in the coming years. When a hospital decides to close one of its residency training programs, or the hospital itself closes, questions arise as to what will become of its GME-funded resident slots. As for funding provided by Medicaid, the federal government matches a portion of what state Medicaid programs pay for GME. Effective for portions of cost reporting periods occurring on or after July 1, 2011 for direct GME and IME, a hospital's FTE resident caps will be reduced by 65 percent of the “excess” resident slots if its “reference resident level” is less than its “otherwise applicable resident limit.” The Secretary is authorized to increase the otherwise applicable FTE resident cap for each qualifying hospital that submits a timely application by a number that the Secretary may approve, effective for portions of cost reporting periods occurring on or after July 1, 2011. The Affordable Care Act amended section 1886(h)(4)(E) of the Act for direct GME purposes (and section 1886(d)(5)(B)(iv) of the Act for IME purposes), effective July 1, 2010, to allow a hospital to count residents training in nonprovider settings if the residents are engaged in patient care activities and if the hospital incurs the costs of the stipends and fringe benefits of the resident during the time the residents spend in that setting. 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Adding these positions will help ensure patients have access to needed care. To see the list of awardees, see the link below called Section 5503 Cap Decreases and Increases - Posted 8/15/2011 . 1763) that would add up to 15,000 Medicare-funded residency positions over five years, similar to an AHA-supported bill (S. 348) introduced last month in the Senate. The projects are being led by organizations with oversight of GME. The amount of DGME payments varies for each hospital. Medical students: What you need to know about the GME landscape. Medicaid Services. Prior to the passage of the ACA, generally, if a teaching hospital closed, its direct GME and IME FTE resident cap slots would be “lost,” because those slots are associated with a specific hospital's Medicare provider agreement that has terminated. CMS announced its decision August 1 in the Federal Register after hospitals and national organizations pressured the agency to reconsider its proposal to eliminate funding for first-year pharmacy residencies. "America's teaching hospitals serve a unique and critical role in the nation's health care system," said AHA Executive Vice President Tom Nickels. Specific Medicare regulations permit the temporary transfer of funded positions to accommodate so-called 'displaced' residents, and other rules permit slot transfers on a permanent basis. 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). the hospital incurs all, or substantially all, of the costs for the training program in that setting." N/A. Section 5503 of the Affordable Care Act provides for reductions in the direct GME and IME FTE resident caps for certain hospitals, and authorizes a “redistribution” to certain hospitals of the estimated number of FTE resident slots resulting from the reductions. These funds can only be used for Medicare. Reps. Terri Sewell, D-Ala., and John Katko, R-N.Y., today introduced the Resident Physician Shortage Reduction Act of 2019 (H.R. . 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) of the Act, as added by section 9202 of the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 (Pub. 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. Reps. Terri Sewell, D-Ala., and John Katko, R-N.Y., today introduced the Resident Physician Shortage Reduction Act of 2019 (H.R. 6 Specialized PGY2 pharmacy residency programs are not eligible for reimbursement because the certification achieved is not recognized as a requirement to work in the specialty area by “industry … The bills, S. 2892 and H.R. 3414, have bipartisan support and would increase funding to Medicare to pay for residencies in addiction medicine, addiction psychiatry, and pain management. Effective for cost reporting periods beginning on or after July 1, 2007 and before July 1, 2010, “all or substantially all of the costs for the training program” in the nonprovider setting is defined as at least 90 percent of the total of the costs of the residents' salaries and fringe benefits (including travel and lodging where applicable) and the portion of the cost of teaching physician's salaries attributable to nonpatient care direct GME activities. This Insight on the Issues focuses on Medicare’s role in funding and shaping GME. To request permission to reproduce AHA content, please, Bill to add 15,000 Medicare-funded residency slots introduced in House, Updates and Resources on Novel Coronavirus (COVID-19), Institute for Diversity and Health Equity, Rural Health and Critical Access Hospitals, AHA Rural Health Care Leadership Conference, Individual Membership Organization Events, Virtual Conference: Navigating a New Reality, Advancing Best Practices for Hospitals and Health Systems, CMS approves Tennessee plan for Medicaid block grant, CMS issues guidance on using Medicaid to address social determinants, CMS updates Physician Fee Schedule to reflect legislative changes, CMS updates FAQs on maintaining Medicaid enrollment during COVID-19 emergency, Study looks at impact of Medicaid expansion on hospital finances, CMS releases Medicaid maternal health tools, American Organization for Nursing Leadership. Funding for GME programs comes from a number of different sources, but the dominant funder is the Medicare program. The IOM report stated that "health care organizations, the Health Resources and Services Administration (HRSA) and Centers for Medicare and Medicaid Service (CMS), and philanthropic organizations should fund the development and implementation of nurse residency programs across all practice settings" (p. S-10). Refer to the Downloads section below to find the Section 5506 cap increases awarded to hospitals under various rounds of Section 5506, as well as Guidelines for Submitting Applications Under Section 5506, and the Section 5506 CMS Application Form. Download the Opioid Workforce Act (PDF) Industries that have become “influential” sources of funding in the past 10 years include pharmaceuticals, medical device, and biotechnology companies. Teaching Health Centers GME Payment Program Funding to applicant teaching health centers that meet the program’s eligibility requirements. Every hospital that trains residents in an approved residency program is entitled to receive Medicare DGME funding. SUSTAINABLE FUNDING FOR NRPs. . In addition, effective July 1, 2009, for direct GME purposes only, the time residents spend in certain nonpatient care activities that occur in a nonprovider setting that is primarily engaged in furnishing patient care may also be counted. [graduate medical education] funding to expand rapidly,” the paper says. Announced earlier this month, the new AMA Reimagining Residency initiative aims to significantly improve residency training. CMS issued a listing of which hospitals would receive additional slots under section 5503 on August 15, 2011, with the effective date of the slots retroactive to July 1, 2011. "They not only train future health care professionals but also conduct medical research and serve a distinct and vital role in delivering patient care. 7500 Security Boulevard, Baltimore, MD 21244, Hospital-Acquired Condition Reduction Program (HACRP), New Medical Services and New Technologies, Hospital Readmissions Reduction Program (HRRP), Historical Impact Files for FY 1994 through Present, Section 5506 Cap Increases Round 16 – Applications Due 1/30/20 – Results Posted 12/22/20 (ZIP), Section 5506 Cap Increases Round 15 – Applications Due 10/31/19 – Results Posted 5/11/20 (ZIP), Section 5506 Cap Increases Round 14 – Applications Due 7/22/19 – Results Posted 1/22/20 (ZIP), Section 5506 Cap Increases Round 13 – Applications Due 10/31/18 – Results Posted 5/21/19 (ZIP), Fact Sheet on Displaced Residents Due To Program or Hospital Closure (PDF), Section 5506 Cap Increases Round 12 – Applications Due 7/23/18 – Results Posted 1/31/19 (ZIP), Section 5506 Cap Increases Round 11 – Applications Due 7/23/18 – Results Posted 1/31/19 (ZIP), Section 5506 Cap Increases Round 10 –Applications Due 10/31/16-- Results Posted 1/31/2017 (ZIP), Section 5506 Cap Increases Round 9 –Applications Due 10/31/16-- Results Posted 1/31/2017 (ZIP), Section 5506 Cap Increases Round 8 –Applications Due 10/31/16-- Results Posted 1/31/2017 (ZIP), Guidelines for Submitting Applications Under Section 5506 - Posted August 2, 2016 (PDF), Section 5506 Cap Increases Related to Applications Due April 1, 2011 - Posted 2/28/12 (ZIP), 2007 American Medical Group Association Compensation Survey Data (PDF), Section 5503 Cap Decreases and Increases - Posted 8/15/2011 (ZIP), 2008 American Medical Group Association Compensation Survey Data (PDF), 2009 American Medical Group Association Compensation Survey Data (PDF), Section 5506 Cap Increases Round 7  – Applications due September 2, 2014  – Results Posted 12/31/14 (ZIP), Section 5506 Cap Increases Round 6  – Applications due October 31, 2013  – Results Posted 10/31/2014 (ZIP), Section 5506 Cap Increases Round 5  – Applications due August 29, 2013 (ZIP), Section 5506 Application Form  – Posted August 2, 2016 (PDF), Section 5506 Cap Increases Round 4  – Applications due July 25, 2013 (ZIP), Section 5506 Cap Increases Round 3  – Applications due Oct 29, 2012  – Posted 01/30/13 (ZIP), Section 5506 Cap Increases Round 2  – Applications due Dec. 1, 2011  – Posted 11/30/12 (ZIP), CMS–1430–IFC:  Revisions to the Reductions and Increases to Hospitals' FTE Resident Caps for Graduate Medical Education Payment Purposes - Text Version, CMS-1504-FC: CY 2011 OPPS Final Rule including Payments to Hospitals for Graduate Medical Education Costs (Published Version - pages 72133 - 72240 and 72261 - 72264), CMS-1504-FC: CY 2011 OPPS Final Rule including Payments to Hospitals for Graduate Medical Education Costs (Published Version - pages 72133 - 72240 and 72261 - 72264) - Text Version, CMS–1430–IFC:  Revisions to the Reductions and Increases to Hospitals' FTE Resident Caps for Graduate Medical Education Payment Purposes (PDF Version). 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