Children’s Hospitals Graduate Medical Education (CHGME) Payment Program

The purpose of the CHGME Payment Program is to compensate for the disparity in the level of Federal GME funding for freestanding children’s teaching hospitals versus other types of teaching hospitals. Federal funding for graduate medical education (GME) is primarily provided by the Centers for Medicare & Medicaid Services (CMS) and goes to full service teaching hospitals that serve primarily adult patients. 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 is administered by the Bureau of Health Workforce (BHW), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (HHS).

There are two categories of children’s hospitals that may be eligible for CHGME payments in FY 2021, depending on the funding appropriated to the program – “Currently Eligible Hospitals” and “Newly Qualified Hospitals”. Hospitals that are applying for the first time for the CHGME Payment Program may be hospitals that are new to the CHGME Payment Program but qualify under the “Currently Eligible Hospitals” requirements or eligible as a “Newly Qualified Hospital”. a. Currently Eligible Hospitals: Includes freestanding children’s hospitals that meet the original eligibility requirements for CHGME payments that were established prior to 5 the Children’s Hospital GME Support Reauthorization Act of 2013. These freestanding children’s hospitals must meet the following criteria: 1) Have a Medicare payment agreement; 2) Are excluded from the Medicare Inpatient Prospective Payment System (IPPS) pursuant to section 1886(d)(1)(B)(iii)5 of the Social Security Act (SSA) and its accompanying regulations; and 3) Participate in an approved GME residency training program as defined in section 1886(h)(5)(A) of the SSA. b. Newly Qualified Hospitals: As per the Children’s Hospital GME Support Reauthorization Act of 2013, a freestanding hospital may be eligible for CHGME payments depending on the level of funding appropriated to the program if it meets the following criteria: 1) Has a Medicare payment agreement; 2) Is excluded from Medicare IPPS pursuant to section 1886(d)(1)(B) of the SSA and its accompanying regulations; 3) Its inpatients are predominantly individuals under 18 years of age; 4) Has an approved medical residency training program as defined in section 1886(h)(5)(A) of the SSA; and 5) Is not otherwise qualified to receive payments as a Currently Eligible Hospital as defined under this section or section 1886(h) of the SSA. For those freestanding children’s hospitals that met the above requirements for Newly Qualified Hospitals as of April 7, 2014, and the Secretary had not previously determined an average number of FTE residents under section 1886(h)(4) of the SSA, the Secretary may establish such number of FTE residents for the purposes of calculating CHGME Payment Program payments. Any public or private nonprofit and for-profit children's teaching hospital with an accredited residency training program (as defined below), that meets all of the above requirements for either category of eligibility may apply, though final eligibility for receiving fu

Lisa Flach-Fulcher

(301)443-0365