On Dec. 17, the Centers for Medicare & Medicaid Services (CMS) issued a final rule with comment period. The rule implements legislative changes to Medicare payments to teaching hospitals contained in the Consolidated Appropriations Act (CAA) and addresses organ acquisition payment policies through changes, clarifications, and codifications relative to organ procurement organizations (OPOs), transplant hospitals, and donor community hospitals.
Related to Medicare Indirect Medical Education and Direct Graduate Medical Education payments, CMS is finalizing the following policies:
- Criteria to Distribute Additional Residency Slots Included in the CAA: Section 126 of the CAA included 1,000 additional residency slots for distribution, phased in at no more than 200 per year starting in federal fiscal year (FFY) 2023. As required by Congress, CMS is prioritizing applications from qualifying hospitals that serve geographic areas and underserved populations with the greatest need. CMS estimates that this additional funding will total approximately $1.8 billion from FFY 2023 through FFY 2031.
- Increase in Resident Cap for Rural Training Track (RTT) Hospitals: The rule also implements Section 127 of the CAA, which allows rural teaching hospitals participating in an accredited RTT to receive increases to their full-tie equivalent caps.
- Allow Hospitals that Establish a New Residency Program after Previously Hosting Residents for Short Durations a Cap Increase: Section 131 of the CAA allows hospitals that limited their ability to receive Medicare funding for residents in a new training program by accepting residents that rotated to the hospital from other training programs in past years to increase their cap if they are starting a new program. As required by Congress, the final rule allows qualifying hospitals that begin a new medical residency training program within the first five years after enactment to request a cap increase.
In the rule, CMS does not finalize the proposed changes to policies related to counting organs for purposes of determining Medicare payment for organ acquisition costs. CHA, along with the American Hospital Association and others, strongly opposed these changes. The final rule notes that CMS may consider changes to its polices related to counting organs in the future. However, CMS does finalize the proposed policy requiring donor community hospitals and transplant hospitals to bill OPOs the lesser of customary charges that are reduced to costs, or negotiated rates, in line with Medicare reasonable cost principles.
Additional information is available in a CMS fact sheet. CHA will make a detailed summary of the rule available shortly.