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  • Washington Highlights

    CMS Proposes Graduate Medical Education Changes in FY 2022 IPPS Proposed Rule


    Brad Cunningham, Sr. Regulatory Analyst, Graduate Medical Education

    The Centers for Medicare and Medicaid Services (CMS) released the Fiscal Year (FY) 2022 Inpatient Prospective Payment System (IPPS) proposed rule on April 27. In addition to hospital payment and quality changes [refer to related story], CMS introduced proposals specific to graduate medical education (GME).

    Based on three sections of the Consolidated Appropriations Act, 2021 (Sec. 126, 127, and 131, P.L. 116-260), CMS proposes the following rules to implement those provisions: 

    • Closing Gaps in Health Equity in GME. 1,000 new residency slots are available over a five-year period starting in FY 2023, with up to 200 slots to be distributed per year. No hospital would receive more than 1.0 full time equivalent (FTE) per year under either of the two alternative methodologies proposed for distribution of the slots. The first alternative would prioritize hospitals with the highest Health Professional Shortage Area (HPSA) scores. In this proposal, CMS estimates that all residency positions would be distributed through HPSA scoring. The second alternative would give CMS additional time to work with stakeholders to develop a “more refined approach for future years,” and the Agency would distribute 200 additional residency slots for FY 2023 among hospitals in four categories—rural hospitals, hospitals above their current cap, hospitals located in states with new medical schools or branch campuses, and hospitals that serve HPSAs—with higher priority given to hospitals that qualify in more categories. Applications for new slots are due January 31 of the preceding fiscal year (i.e. FY 2023 applications would be due Jan. 31, 2022).
    • Promoting Rural Hospital GME Funding Opportunity. Removes the “separately accredited” requirement for rural training tracks (RTTs), which would allow urban hospitals to partner with a rural hospital with any accredited training program. Also allows rural hospitals to increase their RTT cap similar to urban hospitals and allows urban hospitals to start multiple new RTTs. Beginning Oct. 1, 2022, hospitals that train residents in newly created RTTs will have a five-year cap building window.
    • Addressing Adjustment of Low Per Resident Amounts (PRA). CMS proposes to permit certain hospitals with less than 3.0 FTEs on their cost report (starting Oct. 1, 1997 to the date of enactment of the CAA, Dec. 27, 2020) to reset their PRA for direct graduate medical education (DGME) payments and establish a new cap for DGME and indirect medical education. CMS will consider resetting each during a 5-year window starting at enactment, Dec. 27, 2020, and ending Dec. 26, 2025.

    The AAMC will submit comments to CMS, which are due by June 28.