The deadline for new or amended Medicare graduate medical education (GME) affiliation agreements has been extended to January 1, 2021.

Background

Medicare GME affiliation agreements provide teaching hospitals with flexibility around reimbursement for their Medicare-funded GME cap slots. Specifically, teaching hospitals’ full-time equivalent (FTE) resident caps dictate the maximum number of residents for which the hospital is eligible to receive GME reimbursement from the Medicare program. Medicare GME affiliation agreements allow teaching hospitals with GME programs to share a combined FTE resident cap, and to reapportion the FTE slots among themselves. This could, for example, support programs where residents rotate through experiences at more than one hospital. The basic requirements for Medicare affiliated group agreements are summarized in this prior GME@Dentons Insight. Traditionally, Medicare GME affiliation agreements must be submitted to CMS and to the hospital’s Medicare Administrative Contractor (MAC) by July 1 each year, that is, in advance of the academic year to which they apply. The agreements remain in place for one academic year. Existing agreements traditionally can be amended up until the end of the relevant academic year, i.e., until June 30.

Extension

On September 29, 2020, CMS announced that the deadlines both (1) for submitting new affiliation agreements for the academic year starting July 1, 2020, and (2) for submitting amendments to existing affiliation agreements for the prior academic year ending June 30, 2020 were extended to January 1, 2021. Previously, CMS had extended both of these deadlines to October 1, 2020, in response to the COVID-19 public health emergency.

Instructions

CMS announced the changes to the deadlines in the “COVID-19 Emergency Declaration Blanket Waivers” document, which describes official regulatory changes made under the authority of section 1135 of the Social Security Act. The relevant paragraph states: “CMS is allowing hospitals to submit new and/or amended Medicare GME affiliation agreements as applicable to CMS and the MACs by January 1, 2021.” It further notes that, as under existing procedures, hospitals “should email agreements to CMS at Medicare_GME_Affiliation_Agreement@cms.hhs.gov, and indicate in the subject line whether the affiliation agreement is a new one or an amended one.” Separately, hospitals should also reach out to their MACs.

The GME @ Dentons team can help you evaluate any plans for Medicare GME affiliation agreements and help you craft a compliant arrangement. We will update you on any further developments in the area.