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CMS Proposes Graduate Medical Education Updates in FY 2023 IPPS

April 22, 2022

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CONTACTS
Brad Cunningham, Sr. Regulatory Analyst, Graduate Medical Education
For Media Inquiries

The Centers for Medicare & Medicaid (CMS) introduced two proposals specific to Graduate Medical Education (GME) with the release of the fiscal year 2023 Inpatient Prospective Payment System proposed rule on April 18 [refer to related story]. The agency proposed a new calculation for hospitals with a weighted full-time equivalent (FTE) count higher than their Medicare cap in response to a federal court’s decision in Milton S. Hershey Medical Center v. Becerra (Hershey). The CMS also proposed to create affiliation agreements for hospitals that jointly participate in certain rural track programs. 

 Hospitals whose weighted FTE count is greater than the FTE cap. The U.S. District Court for the District of Columbia held in Hershey that the CMS calculation for direct GME payment impermissibly changed the statutory weighting factors when hospitals weighted FTE count is greater than their Medicare cap. Specifically, the CMS proposed a new calculation to adjust the total weighted FTE count equal to the FTE cap. The proposal, if finalized, will be effective for cost reports beginning on or after Oct. 1. The CMS proposed to establish this policy retroactively, which means that hospitals with open or reopenable cost reports may take advantage of the proposed adjustment. 

 Updates to 1-2 Rural Track Programs (RTPs). For hospitals that have established, or will establish rural track programs before Oct. 1, the CMS proposed to create, for the first time, Rural Track Medicare GME Affiliation Agreements. Only hospitals that jointly train residents in separately accredited family medicine residency programs in the 1-2 format qualify for the proposed affiliation agreements.  The proposed affiliation agreements will allow hospitals to aggregate their respective indirect medical education (IME) and direct GME rural track FTE limitations and share RTP cap slots.

The AAMC will provide comments to the CMS regarding the proposed rule, which are due by June 17.

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