Children's Hospitals Graduate Medical Education Payment Program

The purpose of the CHGME Payment Program is to compensate for the disparity in the level of Federal graduate medical education (GME) funding for freestanding children's teaching hospitals versus other types of teaching hospitals. Hospitals typically

The purpose of the CHGME Payment Program is to compensate for the disparity in the level of Federal graduate medical education (GME) funding for freestanding children's teaching hospitals versus other types of teaching hospitals. Hospitals typically receive GME support GME through Medicare, and those payments are provided to hospitals based on their Medicare patient volume. Freestanding children's hospitals receive little to no GME funding from Medicare because children's hospitals have a low Medicare caseload. The CHGME Payment Program supports freestanding children's teaching hospitals that: 1) educate and train future pediatricians, pediatric sub-specialists, and other non-pediatric residents, including residents in dentistry; 2) provide care for vulnerable and underserved children; and 3) conduct innovative and valuable pediatric research. The CHGME Support Reauthorization Act of 2013 contained a provision to establish a quality bonus system (QBS). The goal of the QBS is to recognize and incentivize those CHGME Payment Program awardees with high quality training to meet the pediatric workforce needs of the nation.

A children's hospital is eligible to apply for CHGME Payment Program funding if it participates in an approved GME program; has a Medicare Provider Agreement; is excluded from the Medicare Inpatient Prospective Payment System (IPPS); and operates as a freestanding children's teaching hospital. A freestanding children's teaching hospital does not operate under a Medicare hospital provider number assigned to a larger health care entity that receives Medicare GME payments. A hospital remains eligible for payments as long as it trains residents as a freestanding children's hospital during the federal fiscal year that HRSA makes CHGME Payment Program payments.

Any public or private nonprofit and profit freestanding children's teaching hospital with an accredited residency training program which meets all eligibility requirements may apply.

Funds are restricted to eligible children's hospitals for direct expenses and the other indirect expenses associated with operating approved graduate medical residency programs.

Funds are restricted to eligible children's hospitals for direct expenses and the other indirect expenses associated with operating approved graduate medical residency programs.

In accordance with the Healthcare Research and Quality Act, 1999, Public Law 106-129, the Secretary of DHHS shall determine the number of resident FTE counts before the beginning of each fiscal year that payments are made for a hospital. The amounts of the payments for direct and indirect medical education are made to each hospital in 12 equal interim installments during the Federal fiscal year.

This program is excluded from coverage under E.O. 12372.

Freestanding children's hospitals that meet requirements are deemed eligible to receive funding under the CHGME Payment Program. Two types of categories of children's hospitals are eligible for CHGME funding and are either "Currently Eligible Hospitals" or "Newly Qualified Hospitals." Currently Eligible Hospitals are freestanding children's hospitals that meet the original eligibility requirements established prior to the Children's Hospital GME Support Reauthorization Act of 2013. Newly Qualified Hospitals are freestanding children's hospitals that meet the eligibility requirements in the Children's Hospital GME Support Reauthorization Act of 2013. The CHGME Support Reauthorization Act of 2013 contained a provision to establish a quality bonus system (QBS) for CHGME hospitals using any remaining funds after payments to newly qualified hospitals.

Notification is made in writing (electronic) by a Notice of Award (NoA). Section 340E(a) requires the Secretary of DHHS to make payments for direct and indirect expenses associated with operating approved graduate medical residency training programs for each fiscal year. The two statutory formulas (direct medical education and indirect medical education) outline payments to eligible children's teaching hospitals.

Approximately 120 to 180 days after receipt of applications.

Other. Hospitals can appeal the determination of FTE resident counts by CHGME fiscal intermediaries to the Provider Reimbursement Review Board (PRRB) under section 1878 of the Social Security Act.