CMS Interim Final Rule on Revisions to Hospitals' FTE Resident Caps for Graduate Medical Education Purposes
March 2011
Interim final rule from the Centers for Medicare and Medicaid Services that makes revisions to the reductions and increases to hospitals' full-time equivalent (FTE) resident caps for Graduate Medical Education (GME) payment purposes. According to the interim final rule, published in the Federal Register on Monday March 14, 2011, "as part of the CY 2011 Hospital Outpatient PPS final rule published in the November 24, 2010 Federal Register (75 FR 71800), we implemented section 5503 of the Affordable Care Act, which added a new section 1886(h)(8) to the Act. Section 5503 of the Affordable Care Act provides for reductions in the statutory FTE resident caps for direct GME under Medicare for certain hospitals, and authorizes a 'redistribution' to hospitals of the estimated number of FTE resident slots resulting from the reductions. Section 5503 of the Affordable Care Act also amended section 1886(d)(5)(B)(v) of the Act to require application of the provisions of 1886(h)(8) of the Act 'in the same manner' to the FTE resident caps for IME. Section 1886(h)(8) of the Act requires that any such reduction to the FTE resident caps will be equal to 65 percent of the difference between the hospital's 'otherwise applicable resident limit' and its 'reference resident level.' Section 5503 of the Affordable Care Act as initially enacted did not include language specific to Medicare GME affiliated groups and did not provide for FTE resident cap reduction determinations based on the aggregate experience of a Medicare GME affiliated group. Accordingly, section 203 of the MMEA further amended section 1886(h)(8) of the Act to specify that the provisions of section 1886(h)(8) of the Act shall be applied to hospitals which are members of the same Medicare GME affiliated group, and the 'reference resident level' for each such hospital is the FTE resident count from the cost reporting period that results in the smallest difference between the FTE resident count and the FTE resident cap. We are revising Sec. 413.79(m)(7) to reflect the changes made by section 203 of the MMEA."
CMS Interim Final Rule on Revisions to Hospitals' FTE Resident Caps for Graduate Medical Education Purposes